An Improved Diagnostic Evaluation Instrument for Substance Abuse Patients

McLellan, A. Thomas; Luborsky, Lester; Woody, George; O’Brien, Charles P.

doi:10.1097/00005053-198001000-00006

Cited by 3,078 publications

(1,571 citation statements)

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“…Psychological symptoms were assessed using the Addiction Severity Index Psychiatric Score (McLellan et al, 1980). The instrument assesses whether clients ever and currently experienced any of nine symptoms mainly from the depression and anxiety spectrum.…”

Section: Methodsmentioning

confidence: 99%

The role of the early therapeutic alliance in predicting drug treatment dropout

Meier

Donmall

McElduff

et al. 2006

Drug and Alcohol Dependence

124

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Background: To investigate the role of the therapeutic alliance in predicting length of retention in residential drug treatment. Methods:The study recruited 187 clients starting residential rehabilitation treatment for drug misuse in three UK services. Counsellor and client information was assessed at intake, and the average total scores of client and counsellor ratings on the WAI-S (obtained during weeks 1 to 3) were use as the alliance measure. Length of retention and treatment completion (stay beyond 90 days) were used as measures of retention.Results: Clients with weak counsellor rated alliances dropped out of treatment significantly sooner than clients with strong counsellor-rated therapeutic alliances, whether or not the model adjusted for individual counsellor effects and potential confounders including psychological wellbeing, treatment motivation and readiness, coping strategies, and attachment style. The client rated alliance did not predict length of retention. Apart from the alliance, pre-treatment crack use, secure attachment style and better coping strategies were associated with shorter retention, whereas greater confidence in treatment, older client age and better education predicted treatment completion. Counsellors with greater experience of delivering drug counselling retained clients longer. Conclusions:The findings of this study stress the importance of treatment professionals attending to the therapeutic alliance in drug treatment, as counsellors' alliance ratings were found to be amongst the strongest predictors of dropout. Using alliance measures as clinical tools may help treatment practitioners to become aware of the risk of disengagement early on. Prospective studies are needed to evaluate whether strategies of reallocating clients with poor alliances to different counsellors lead to improvements in retention.

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Section: Methodsmentioning

confidence: 99%

The role of the early therapeutic alliance in predicting drug treatment dropout

Meier

Donmall

McElduff

et al. 2006

Drug and Alcohol Dependence

124

View full text Add to dashboard Cite

show abstract

“…Adherence to the study medication regimen was monitored by self-report of medication use and by pill counts confirmed by weekly qualitative measurement of riboflavin (DelBoca et al, 1996). The Addiction Severity Index (ASI) was used to measure the severity of alcoholrelated problems during the pretreatment period (McLellan et al, 1980(McLellan et al, , 1992. The ASI is a 1 h, structured interview that measures the lifetime and recent (past 30 days) severity of problems in seven areas of biopsychosocial functioning (represented by component scores): medical status, employment and self-support, alcohol use, drug use, legal status, family and social relations, and psychiatric symptoms (McLellan et al, 1985).…”

Section: Assessment Instrumentsmentioning

confidence: 99%

A Functional Polymorphism of the μ-Opioid Receptor Gene is Associated with Naltrexone Response in Alcohol-Dependent Patients

Oslin

Berrettini

Kranzler

et al. 2003

Neuropsychopharmacol

550

399

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This study examined the association between two specific polymorphisms of the gene encoding the m-opioid receptor and treatment outcomes in alcohol-dependent patients who were prescribed naltrexone or placebo. A total of 82 patients (71 of European descent) who were randomized to naltrexone and 59 who were randomized to placebo (all of European descent) in one of three randomized, placebo-controlled clinical trials of naltrexone were genotyped at the A +118 G (Asn40Asp) and C +17 T (Ala6Val) SNPs in the gene encoding the m-opioid receptor (OPRM1). The association between genotype and drinking outcomes was measured over 12 weeks of treatment. In subjects of European descent, individuals with one or two copies of the Asp40 allele treated with naltrexone had significantly lower rates of relapse (p ¼ 0.044) and a longer time to return to heavy drinking (p ¼ 0.040) than those homozygous for the Asn40 allele. There were no differences in overall abstinence rates (p ¼ 0.611), nor were there differences in relapse rates or abstinence rates between the two genotype groups among those assigned to placebo. These preliminary results are consistent with prior literature demonstrating that the opioid system is involved in the reinforcing properties of alcohol and that allelic variation at OPRM1 is associated with differential response to a m-receptor antagonist. If replicated, these results would help to identify alcohol-dependent individuals who may be most likely to respond to treatment with naltrexone.

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“…Control subjects and cocaine abusers were recruited using newspaper advertisements. Participant selection was based on drug use history obtained using a structured interview, Drug Use Survey Questionnaire (DUSQ) (Smith, 1991), Addiction Severity Index (ASI) (McLellan et al, 1980), and the Psychiatric Diagnostic Interview Schedule (DIS) (Robins et al, 1981). Subjects received a full medical screening which included a complete physical, neurological examination, urine toxicology, and a pregnancy test for women.…”

Section: Participantsmentioning

confidence: 99%

Orbitofrontal cortex dysfunction in abstinent cocaine abusers performing a decision-making task

et al. 2003

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Cocaine abusers demonstrate faulty decision-making as manifested by their inability to discontinue self-destructive drug-seeking behaviors. The orbitofrontal cortex (OFC) plays an important role in decision-making. In this preliminary study we tested whether 25-day-abstinent cocaine abusers show alterations in normalized cerebral blood flow (rCBF) in the OFC using PET with 15 O during the Iowa Gambling Task (a decision-making task). This task measures the ability to weigh short-term rewards against long-term losses. A control task matched the sensorimotor aspects of the task but did not require decision-making. Cocaine abusers (N = 13) showed greater activation during performance of the Iowa Gambling Task in the right OFC and less activation in the right dorsolateral prefrontal cortex (DLPFC) and left medial prefrontal cortex (MPFC) compared to a control group (N = 13). Better Iowa Gambling Task performance was associated with greater activation in the right OFC in both groups. Also, the amount of cocaine used (grams/week) prior to the 25 days of enforced abstinence was negatively correlated with activation in the left OFC. Greater activation in the OFC in cocaine abusers compared to a control group may reflect differences in the anticipation of reward while less activation in the DLPFC and MPFC may reflect differences in planning and working memory. These findings suggest that cocaine abusers show persistent functional abnormalities in prefrontal neural networks involved in decision-making and these effects are related to cocaine abuse. Compromised decision-making could contribute to the development of addiction and undermine attempts at abstinence.

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An Improved Diagnostic Evaluation Instrument for Substance Abuse Patients

Cited by 3,078 publications

References 0 publications

The role of the early therapeutic alliance in predicting drug treatment dropout

The role of the early therapeutic alliance in predicting drug treatment dropout

A Functional Polymorphism of the μ-Opioid Receptor Gene is Associated with Naltrexone Response in Alcohol-Dependent Patients

Orbitofrontal cortex dysfunction in abstinent cocaine abusers performing a decision-making task

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