Imbecility, pauperism, and crime: an appraisal of their relationship to substance use, abuse, and dependence.

Freud had stated that human judgments of value "follow directly ... wishes for happiness--that, accordingly, they are an attempt to support ... illusions with arguments." This paper argues that substance use/abuse/dependency treatment has been a failure because we understand little about eradicating the significant concerns associated with the use of chemicals that haunt mankind: ignorance, poverty, and crime. While technologies advance at dizzying speed, the human capacity to integrate new information and to achieve a quality life seems to evade many. The author presents her treatment regime which has helped some patients. But the psychologist is only one contributor to psychotherapy, habilitation and rehabilitation. It is advisable that each member of the professional and lay communities "tend to their own garden."

Domestic abuse by male alcohol and drug addicts.

Sixty-three male inpatient alcohol and drug addicts and 34 of their female partners participated in a study of variables associated with physical and nonphysical abuse of women. Results suggest that domestic abuse by male addicts is not directly related to experience of violence or addiction in the family of origin, external locus of control, or severity of alcohol abuse. Correlates of domestic abuse were an early onset of drug/alcohol-related problems; low income; a history of nonalcohol drug use, particularly cocaine; and a history of arrest and outpatient counseling.

The political process and its relationship to the psychotherapy of substance misusers: an historical perspective.

There are massive changes underway in the allocation of funds for health care in the United States which will impact upon services provided for users and misusers of intoxicating substances. Recent findings suggest that conditions in the marketplace and the development of professions have effected standards of care rather than a reasoned analysis of need and outcome. Psychologists question to what extent they will be involved in public policy issues including what is clinically and socially relevant. The goal of this paper was to determine if an historical perspective upon federal regulation of intoxicating substances (tobacco/alcohol/drugs) would enlighten the psychotherapy scientist in the pursuit of standards for service. The methodology included a review of the economic and social structure of colonial America which included tobacco plantations, breweries, and distilleries as well as a review of the formation of the federal government and political system in which men, women, and slaves were each assigned different performance standards/roles and economic rewards within the community. The implication is that potential for self-regulation and psychological development is based upon the legacy of our forefathers.

The Addiction Severity Index: predicting relationship to a hospital and a professional.

The Addiction Severity Index was developed to be a useful instrument in treatment planning for the substance abuser. Multivariate statistical tests were conducted on the questionnaire for a clinical sample of 190 males at a Veterans Administration hospital. When the desire for psychological treatment with a specific person was taken into consideration, the overall predictive validity of the instrument in designating discharge accounted for 69% of the variance rather than 24% of the variance. This finding could challenge the myth that substance abusers and patients from lower socioeconomic levels are not psychologically minded and not capable of being engaged in psychological process treatment. This finding is also relevant to governmental concerns for quality assurance and cost effectiveness, since it can be utilized to both improve treatment planning and delete irrelevant documentation and assessment procedures.

Attrition within a detoxification unit: patient response to policy and psychological intervention.

Professional psychological consultation with selected substance abusers was found in earlier work to stabilize patients as well as create organizational change. All patients subsequently were to undergo a psychological consultation. Three consecutive 10-month samples of male veterans (N = 254, 309, and 261) undergoing inpatient detoxification showed characteristic rectilinear decay curves while those refusing psychological consultation showed poisson-like negatively accelerating decay curves. Distributions clearly reflect (a) treatment contract, either 14- or 21-day length of stay; (b) presence or absence of a psychological consultation; and (c) an unknown factor. It is hypothesized that in addition to policy, the psychological focus upon self-experience rather than behavior had become internalized by the treatment team, thus creating a calmer interpersonal atmosphere, one more able to sustain the irritability, demandingness, and negativism of substance abusers, though with emotional cost to those involved. It is suggested that enlightened mental health policy be introduced on a wider scale.

Factor structure of the Addiction Severity Index in an inpatient detoxification sample.

This study examines the factor structure of the Addiction Severity Index for a clinical sample of 190 males in an inpatient detoxification unit at a Veterans Administration hospital. Factor analysis revealed a four-factor solution rather than the six-factor solution originally suggested. These four factors (accounting for 22% of the common variance) were labeled chemical addiction, criminality, psychological distress, and health-related problems. Overall results suggest that considerably more work must be expended in developing standards for an interview schedule applicable to the chemically dependent.

Psychological consultation with substance abusers.

Previous work has documented that compliance rates of substance abusers undergoing inpatient detoxification could be influenced by professional psychological consultation. The administrative structure has been previously described as well as a clinical/humanistic component within the administrative structure. This report describes the individualized psychological consultation. This consultative intervention is in accord with the tripartite model of mental health which views the assessment of pathology from the perspectives of the mental health practitioner, the patient, and the culture; and the recent advances within self-psychology. A self-psychological model is suggested to understand the detoxifying substance abuser, from a stage of loss of cohesiveness to one of personality stabilization. The hospital environment and persons within the environment provide both a framework and self-object functions (mirroring, idealizing, and alter ego) during detoxification. Research recommendations are made to collect empirical data on the psychology of the detoxifying addict.

An educational program for the assessment and development of psychological-mindedness in the chemically dependent.

Substance abusers can be conceptualized as alexithymic (Sifneos), psychically traumatized (Krystal), without internalized standards (Wurmser), and narcissistically defective (Kohut). Each of these theoretical systems conveys an important vantage point from which to view the rise of substance use and abuse and personality deterioration within the international community during this time of cultural fragmentation. Culture has been described as contributing to aspects of internalized psychic structure (Horney), to the maintenance of that structure (Bion), and to its members' performance of ongoing functions of mirroring and idealizing (Kohut). A detoxification program is described within which a psychological component has been found effective in stabilizing patients, in developing psychological-mindedness, in preparing some for psychic structural development, and in the creation of a facilitating, humanistic environment.

Professional psychotherapy and its relationship to compliance in treatment.

Compliance rates over a 21-month period for 57 drug-abusing patients receiving individual professional psychotherapy in addition to paraprofessional counseling were compared to compliance rates for patients not receiving individual professional psychotherapy. Compliance was defined as remaining in the treatment environment for an agreed upon time and neither leaving the hospital against medical advice nor being given a disciplinary discharge for illegal drug use, stealing, or fighting. Patients receiving professional psychotherapy had been assessed as having either higher levels of psychiatric symptoms or a history of a psychiatric diagnosis, or being potential management problems. Patients who received psychotherapy more likely remained stabilized in the treatment environment and in their role as patient. An additional finding was that clarity of the therapist's role in the ward environment affected the patient's stabilization. This study supports recent findings that professional psychotherapy can be effective for drug abusers. It suggests that individual psychotherapy/consultation with distressed and difficult patients experiencing disequilibrium in the hospital milieu can be an effective means of restoring that equilibrium.

Effect of the hypnotic flurazepam on the sleep of pentazocine and heroin addicts during withdrawal.

Fourteen male heroin addicts being detoxified on methadone and 14 male pentazocine addicts being detoxified drug-free were observed over a 24-hour period for 2 weeks in their sleeping patterns to assess the effects of flurazepam upon sleep during withdrawal. Results of objective and subjective measures find that flurazepam use is associated with more objective nighttime arousals and less total sleep for the heroin group compared to the pentazocine group. Heroin patients felt they had a poorer quality of sleep and took flurazepam more frequently than did the pentazocine patients. Heroin patients' assessments of their sleep and number of arousals correlated poorly with observations.