Suggests that sex differences in cardiovascular reactivity (CVR) in past research are a function of differences in cognitive appraisal of stressors as masculine or feminine tasks. In the present study, we examined the role of the gender relevance of the stressor as a mediator of sex differences in CVR. The CVR of male and female college students (n = 95) to the cold pressor test (CPT) was compared under masculine and gender-neutral instructions during an anticipation phase, a stressor phase, and a recovery phase. Men were expected to show greater CVR than women to the masculine CPT but not to the gender-neutral CPT. Results supported this prediction for systolic blood pressure reactivity and heart rate reactivity but not for diastolic blood pressure reactivity. The potential influence of sex differences in appraisal of situations on CVR and coronary heart disease is discussed.
Continuing care following initial substance use disorder treatment often is associated with improved treatment outcomes and evidence-based interventions (EBIs) have been developed in this area. However, rates of patient participation in continuing care treatment and mutual help groups (MHGs) are low and a large gap exists between the existing EBIs and actual clinical care. This paper uses the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) to review the literature on continuing care treatment and monitoring, and mutual help-group promotion. Although existing research provides implications for implementing EBIs in continuing care, few direct implementation trials have been conducted. This literature indicates that EBIs in continuing care have been successfully modified for different settings, that they can be delivered using different modalities (e.g., individual, group, and telephone-based care), and that low cost options are available. Additionally, much is known about the differential effectiveness of continuing care with different populations that may guide treatment programs and providers in selecting the most effective interventions for their clients. One significant barrier to successful implementation of EBIs for continuing care is the lack of information about incentives for providing continuing care across what in the CFIR terminology is a program's outer setting (i.e., external economic, political, and social setting), and its inner setting (i.e., internal political, structural, and cultural contexts). Implications for implementation of EBIs in substance use disorder continuing care are discussed.
Although continuing care is strongly related to positive treatment outcomes for substance use disorder (SUD), participation rates are low and few effective interventions are available. In a randomized clinical trial with 150 participants (97% men), 75 graduates of a residential Veterans Affairs Medical Center SUD program who received an aftercare contract, attendance prompts, and reinforcers (CPR) were compared to 75 graduates who received standard treatment (STX). Among CPR participants, 55% completed at least 3 months of aftercare, compared to 36% in STX. Similarly, CPR participants remained in treatment longer than those in STX (5.5 vs. 4.4 months). Additionally, CPR participants were more likely to be abstinent compared to STX (57% vs. 37%) after 1 year. The CPR intervention offers a practical means to improve adherence among individuals in SUD treatment.
Increasing the length of participation in alcohol and drug treatment is associated with improved outcomes (1). The present study was designed to increase substance abuse aftercare participation following completion of inpatient treatment. We compared the effect of a 20-minute aftercare orientation session to a minimal treatment condition on aftercare group therapy participation. The orientation session was conducted by an aftercare group therapist, who met with the participant to encourage him to attend aftercare, to explain why aftercare is helpful, and to have him sign an aftercare participation contract. Participants in the minimal treatment condition watched a videotape on motivation to reach goals. Participants were 40 males in an inpatient substance abuse treatment program at a Veterans Affairs Medical Center (VAMC). Ninety percent were alcohol dependent; 35% were cocaine dependent; 10% were marijuana dependent; and 10% were polysubstance dependent. Participants who received the aftercare orientation were more likely to attend aftercare (70%) than those who received the minimal treatment (40%). Additionally, the former group attended more sessions (x = 3.0) than those who were not oriented to aftercare (x = 1.4). The utility and limitations of a brief orientation session on aftercare adherence are discussed.
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