Disability Income, Cocaine Use, and Repeated Hospitalization among Schizophrenic Cocaine Abusers — A Government-Sponsored Revolving Door?

Shaner, Andrew; Eckman, Thad A.; Roberts, Lisa J.; Wilkins, Jeffery N.; Tucker, Douglas; Tsuang, John; Mintz, Jim

doi:10.1056/nejm199509213331207

Cited by 190 publications

(105 citation statements)

References 28 publications

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“…Heretofore, these claims were accepted, even if reservedly, and the needs of such individuals were considered to be legitimate even when they were monitored closely (e.g., Satel 1995;Shaner et al 1995). The Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) programs and their recipients have been among the most visible and vulnerable targets of increased scrutiny and shrinking public beneficence.…”

Section: H a R S H S K E P T I C I S M P E R V A D E S C U R R E N T mentioning

confidence: 99%

Pathways to Disability Income among Persons with Severe, Persistent Psychiatric Disorders

et al. 1997

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Persons with psychiatric disorders comprise the largest diagnostic group of disabled recipients of Supplemental Security Income (SSI) and Social Security Disability Income (SSDI). A 32‐month prospective cohort study of pathways to application for and receipt of SSI and SSDI was conducted among 169 people with major psychiatric disorders who were at an early stage of their illness and who had never applied for or received disability income. Of the three pathways that formed the conceptual basis for the investigation—labeling, impairment, and needs/resources—the latter two emerged as significantly associated with receipt. Individuals with more severe symptoms who were African American, and who were psychologically dependent in a primary relationship and financially dependent on their families, were more likely to become recipients. Enabling and disabling aspects of disability income receipt suggest that it may be replacing prolonged hospitalization as the most enduring social role of persons with severe, persistent psychiatric disorders.

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Section: H a R S H S K E P T I C I S M P E R V A D E S C U R R E N T mentioning

confidence: 99%

Pathways to Disability Income among Persons with Severe, Persistent Psychiatric Disorders

et al. 1997

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“…However, a number of serious, yet untested, ethical objections have been raised against the practice of using high-magnitude incentives for research participation. Among these objections are that (1) large incentives, particularly if they are provided in the form of cash, could trigger a relapse to drug use (Fry and Dwyer, 2001;Koocher, 1991;Rosenheck, 1997;Shaner et al, 1995); and (2) large incentives may be coercive (Dickert and Grady, 1999;Macklin, 1981;McGee, 1997), meaning they could compromise participants' normal decisional processes and unduly entice them to participate even if they ordinarily would hold preferences against participation. As a result, researchers are often forced to use lower magnitude cash incentives or payments in the form of gift certificates or vouchers that must subsequently be exchanged for goods or services.…”

Section: Introductionmentioning

confidence: 99%

Higher magnitude cash payments improve research follow-up rates without increasing drug use or perceived coercion

Festinger

Marlowe

Dugosh

et al. 2008

Drug and Alcohol Dependence

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In a prior study (Festinger et al., 2005) we found that neither the mode (cash vs. gift card) nor magnitude ($10, $40, or $70) of research follow-up payments increased rates of new drug use or perceptions of coercion. However, higher payments and payments in cash were associated with better follow-up attendance, reduced tracking efforts, and improved participant satisfaction with the study. The present study extended those findings to higher payment magnitudes. Participants from an urban outpatient substance abuse treatment program were randomly assigned to receive $70, $100, $130, or $160 in either cash or a gift card for completing a follow-up assessment at 6 months post-admission (n ≅ 50 per cell). Apart from the payment incentives, all participants received a standardized, minimal platform of follow-up efforts. Findings revealed that neither the magnitude nor mode of payment had a significant effect on new drug use or perceived coercion. Consistent with our previous findings, higher payments and cash payments resulted in significantly higher follow-up rates and fewer tracking calls. In addition participants receiving cash vs. gift cards were more likely to use their payments for essential, non-luxury purchases. Follow-up rates for participants receiving cash payments of $100, $130, and $160 approached or exceeded the FDA required minimum of 70% for studies to be considered in evaluations of new medications. This suggests that the use of higher magnitude payments and cash payments may be effective strategies for obtaining more representative follow-up samples without increasing new drug use or perceptions of coercion.

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“…Symptom exacerbation and psychiatric admissions have both been linked to acute drug use in outpatients with a severe and persistent mental illness (SPMI), such as schizophrenia (Haywood et al, 1995;Shaner et al, 1995). Individuals enrolled in outpatient treatment and "dually diagnosed" with psychiatric and substance use disorders exhibit poor (Keck, McElroy, Strakowski, Bourne, & West, 1997;Owen, Fischer, Booth, & Cuffel, 1996;Pristach & Smith, 1990), report more severe psychiatric symptoms (Carey, Carey, & Meisler, 1991), and involve themselves minimally in structured treatment programs Lehman, Herron, Schwartz, & Myers, 1993;Richardson, Craig, & Haugland, 1985).…”

Section: Introductionmentioning

confidence: 99%

Measuring readiness-to-change substance misuse among psychiatric outpatients: I. Reliability and validity of self-report measures.

et al. 2001

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Objective-The high rates of comorbid substance use disorders among persons living with severe and persistent mental illness (SPMI) have increased interest in assessing and enhancing motivation to change substance misuse in this population. This study provides evidence for the psychometric adequacy of three self-report measures of readiness-to-change.Method-The sample consisted of 84 persons (65% men) with co-occurring substance abuse or dependence and an SPMI. After a psychiatric assessment, participants completed three measures of readiness-to-change, which yielded seven subscales: (1) the Stages of Change Readiness and Treatment Eagerness Scale (ambivalence about change, recognition of substance-related problems, taking steps), (2) Decisional Balance Scale (pros of using, cons of using) and (3) the Alcohol and Drug Consequences Questionnaire (costs of quitting, benefits of quitting).Results-All of the subscales were stable over time, and 6 of the 7 subscales demonstrated excellent internal consistency. Reliability indices were comparable when analyses were repeated on subsets of participants defined by diagnosis, cognitive function, positive symptoms and negative symptoms. A pattern of theoretically meaningful intercorrelations provided convergent evidence of validity, and a general lack of relationships with demographic variables and indices of psychiatric status provided discriminant evidence of validity. These findings support efforts to quantify readiness-to-change substance misuse among persons with an SPMI.Substance use disorders are highly prevalent among persons with schizophrenia and other major mental illnesses. Persons with major (Axis I) mental disorders have three times the risk of drug or alcohol diagnoses compared to the rest of the population (Regier et al., 1990). Persons with schizophrenia represent a particularly high risk group for problems related to substance use. Among all persons with a diagnosis of schizophrenia, 47% meet lifetime criteria for a substance use disorder (Regier et al., 1990). This prevalence rate is often higher in samples of schizophrenic patients in treatment (Mueser et al., 1990;Test, Wallisch, Allness, & Ripp, 1989).A diagnosis of substance abuse or dependence impairs both the process and outcome of mental health treatment. Symptom exacerbation and psychiatric admissions have both been linked to acute drug use in outpatients with a severe and persistent mental illness (SPMI), such as schizophrenia (Haywood et al., 1995;Shaner et al., 1995). Individuals enrolled in outpatient treatment and "dually diagnosed" with psychiatric and substance use disorders exhibit poor (Keck, McElroy, Strakowski, Bourne, & West, 1997;Owen, Fischer, Booth, & Cuffel, 1996;Pristach & Smith, 1990), report more severe psychiatric symptoms (Carey, Carey, & Meisler, 1991), and involve themselves minimally in structured treatment programs Lehman, Herron, Schwartz, & Myers, 1993;Richardson, Craig, & Haugland, 1985). This pattern of poor treatment compliance and exacerbated symptoms leads ...

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Disability Income, Cocaine Use, and Repeated Hospitalization among Schizophrenic Cocaine Abusers — A Government-Sponsored Revolving Door?

Cited by 190 publications

References 28 publications

Pathways to Disability Income among Persons with Severe, Persistent Psychiatric Disorders

Pathways to Disability Income among Persons with Severe, Persistent Psychiatric Disorders

Higher magnitude cash payments improve research follow-up rates without increasing drug use or perceived coercion

Measuring readiness-to-change substance misuse among psychiatric outpatients: I. Reliability and validity of self-report measures.

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