Psychopathology as a Predictor of Treatment Outcome in Alcoholics

Rounsaville, Bruce J.; Dolinsky, Zelig S.; Babor, Thomas F.; Meyer, Roger E.

doi:10.1001/archpsyc.1987.01800180015002

Cited by 629 publications

(257 citation statements)

References 50 publications

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“…Some of these exclusion criteria are predictors of poor outcome and their use may lead to an overestimate of the efficacy of the intervention being studied. For instance, prior research has shown that the presence of co-occurring disorders including substance use disorders, major depressive disorder, and personality disorders (particularly antisocial personality disorder) in individuals with alcohol dependence is associated with poorer outcomes in alcohol trials and an increased risk of relapse Rounsaville et al, 1987;Tómasson and Vaglum, 1998;Hasin et al, 2002;Bradizza et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

Generalizability of clinical trials for alcohol dependence to community samples

Blanco

Olfson

Okuda

et al. 2008

Drug and Alcohol Dependence

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There is a growing concern that results of tightly controlled clinical trials of individuals with alcohol use disorders may not generalize to broader community samples. To assess the proportion of community-dwelling adults with alcohol dependence who would have been eligible for a typical alcohol dependence treatment study, we developed a new, simple method: we applied a standard set of eligibility criteria commonly used in alcohol outcome studies to a large (n = 43,093) representative US adult sample interviewed face-to-face, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We found that approximately one-half (50.5%) of all individuals with a DSM-IV diagnosis of alcohol dependence (n = 1484) and 79.4% of those who sought treatment (n = 185) were excluded by one or more study criteria. Individual study criteria excluded from 0.9% to 48.2% of the overall sample and 0.8% to 43.7% of the treatment-seeking sample. For the overall sample, the lack of motivation/compliance and financial situation criteria excluded the largest percentage of individuals. In the treatment-seeking subsample, comorbid medical conditions and legal problems excluded the largest proportions of individuals. Our study provides a new method to assess the generalizability of clinical trials, and gives further evidence that typical clinical trials for alcohol dependence likely exclude most adults with the disorder in the community and under care, and support the notion that clinical trials recruit "pure" rather than "typical" patients. Clinical trials should carefully evaluate the effects of the selected eligibility criteria on the generalizability of their results.

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Section: Discussionmentioning

confidence: 99%

Generalizability of clinical trials for alcohol dependence to community samples

Blanco

Olfson

Okuda

et al. 2008

Drug and Alcohol Dependence

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“…Early studies showed that APD was an indicator of poor treatment response, particularly in opioid-dependent samples (Alterman & Cacciola, 1991;Cacciola, Alterman, Rutherford, & Snider, 1995;Rounsaville, Dolinsky, Babor, & Meyer, 1987;Rounsaville, Kosten, Weissman, & Kleber, 1986;Woody et al, 1985). Later reports are mixed in their findings.…”

Section: Introductionmentioning

confidence: 99%

A behavioral treatment for opioid-dependent patients with antisocial personality

Neufeld¹,

Kidorf

Kolodner

et al. 2008

Journal of Substance Abuse Treatment

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Antisocial personality disorder (APD) is associated with increased problem severity in treatment seeking opioid dependent patients. Treatment studies have reported mixed results but generally show that APD patients make progress that is often comparable to drug dependent patients without the personality disorder. Much of this work is based on secondary analyses of studies evaluating responses to a variety of drug abuse treatment interventions. The present study reports on a randomized prospective trial evaluating a behavioral approach for managing opioid dependent patients with APD. Subjects (N=100) met DSM criteria for opioid dependence and APD using a structured clinical interview, and were randomly assigned to the experimental condition (n = 51) that used a highly structured contingency management intervention, or control condition (n = 49) that reflected standard methadone treatment. Subjects in the experimental group had significantly better counseling attendance and some indication of lower psychosocial impairment compared to the control group. The experimental intervention increased attendance in subjects with low, as well as high levels of psychopathy, and with and without other psychiatric comorbidity. These findings support the development of interventions more tailored to APD drug-dependent patients.

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“…Ainda que diferentes estudos não tenham conseguido chegar a conclusões consistentes e definitivas, características já associadas à adesão ao tratamento de alcoolistas incluem: o envolvimento de familiares ou pessoa próxima e significativa 4 ; ordenação judicial 5 ; gênero 6 ; idade 7 ; uso de outras substâncias psicoativas e psicopatologia comórbida 8,9 ; intensidade e duração do tratamento 10,11 . Aparentemente, descrença na gravidade clínica das conseqüências do uso de álcool pode resultar a falta de adesão ao tratamento 12 .…”

Section: Artigo Originalunclassified

“…Por outro lado, os sentimentos após terem bebido parecem separar os sujeitos em dois subgrupos distintos, relativos ao sentir-se bem ou sentir-se mal sob o efeito dos alcoó-licos: no primeiro caso, tenderiam ao abandono de tratamento e, no segundo, a melhores níveis de adesão. Ainda que seja necessário diferenciar entre comportamentos de consumo que antecedem ou se sucedem à instalação da síndrome de dependência, os resultados descritos podem ser compreendidos a partir da interação com características de personalidade -como busca do prazer e evitação do sofrimento 15,16 -ou com fenômenos psicopatológicos agravados ou aliviados pelo uso dos alcoólicos 8,17,18 .…”

Section: Tratamento Anterior Ou Atualunclassified

Fatores associados à adesão a um programa de tratamento de alcoolistas

Ribeiro

Garcia

et al. 2008

J. bras. psiquiatr.

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Palavras-chaveAlcoolismo, adesão, avaliação de alcoolistas, diagnóstico. resumo objetivo: A medida da adesão tem sido considerada alternativa objetiva e versátil para avaliação do resultado do tratamento de alcoolistas. Este estudo avaliou fatores associados à adesão de alcoolistas atendidos em um programa ambulatorial. método: Foram estudados 300 alcoolistas que concluíram a fase de avaliação do programa e avaliada a associação da adesão dos pacientes ao tratamento a todas as mais de mil variáveis do banco de dados do programa, utilizando o teste qui-quadrado de Pearson (p < 0,1). resultados: Entre as variáveis que se associaram positivamente à adesão foram identificadas: ter filhos; relação conjugal estável; afirmar problemas psicológicos; ter sofrido esquecimento ou fraqueza recentemente; sentir-se irritado quando alcoolizado; beber sozinho; apresentar comorbidade psiquiátrica; já ter procurado tratamento para alcoolismo, tratamento em psiquiatria; uso anterior de antidepressivos etc. Associaram-se negativamente: reduzir consumo por influência familiar; sentir-se auto-suficiente, expansivo, insatisfeito quando sóbrio; sentir-se auto-suficiente ou conformado quando alcoolizado; início do consumo com idade acima da média do grupo; ter-se envolvido em agressão física com amigos etc. conclusão: Os resultados sugerem a necessidade de desenvolvimento de estratégias diferenciadas para o cuidado de determinados grupos de pacientes e contribuem para a simplificação das rotinas de avaliação de alcoolistas.

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Psychopathology as a Predictor of Treatment Outcome in Alcoholics

Cited by 629 publications

References 50 publications

Generalizability of clinical trials for alcohol dependence to community samples

Generalizability of clinical trials for alcohol dependence to community samples

A behavioral treatment for opioid-dependent patients with antisocial personality

Fatores associados à adesão a um programa de tratamento de alcoolistas

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