Brad Donohue

Behavior therapy for drug abuse: a controlled treatment outcome study

82 Ss were studied in a comparative evaluation of a behavioral vs supportive treatment for illegal drug use. Behavioral treatment included stimulus control, urge, control, contracting/family support and competing response procedures for an average of 19 sessions. 37% of Ss in the behavioral condition were drug-free at 2 months, 54% at 6 months, and 65% at 12 months vs 20 +/- 6% for the alternative treatment during all 12 months. The behavioral treatment was more effective across sex, age, educational level, marital status and type of drug (hard-drugs, cocaine, and marijuana). Greater improvement for this condition was also noted on measures of employment/school attendance, family relationships, depression, institutionalization and alcohol use.

Follow-up results of Supportive versus Behavioral Therapy for illicit drug use

Follow-up data (mean 9 months) were obtained for 74 subjects who had been treated for a mean of 8 months and 17 sessions in a controlled comparison of Behavioral vs Supportive Counselling for drug abuse. Based on urinalysis, self-report, and family report, all subjects (100%) were actively using drugs at pre-treatment. During the last month of treatment, 81% of the Supportive treatment subjects and 44% of the Behavioral treatment subjects were using drugs at least once. At the follow-up month, drugs were used at least once by 71% of the Supportive vs 42% of Behavioral subjects. When drug use was measured in terms of the number of days of use per month, Supportive counselled subjects did not decrease drug use either by the end of treatment or at follow-up; for Behavioral subjects, drug use decreased by 63% by the end of treatment and by 73% at follow-up. Alcohol use, and days worked/or in school showed a similar pattern of greater improvement for the Behavioral treatment being maintained at the follow-up. These results indicate a substantial treatment-specific reduction of drug usage that endures after treatment is discontinued. The present favorable results appear attributable to the inclusion of family/significant others in therapy and the use of reinforcement contingent on urinalysis results.

Examination of psychiatric symptoms in student athletes.

In the present study, the authors examined the severity of psychiatric symptoms in undergraduate recreational (noncompetitive) athletes (n = 64) and National Collegiate Athletic Association (NCAA; competitive) athletes (n = 72). The results indicated that the 2 groups were similar in the severity of psychiatric symptoms. The recreational and NCAA athletes combined (n = 136) showed less severe global psychiatric symptoms when they were compared with an undergraduate control group (n = 435). The implications of the study are discussed in the context of those findings.

A controlled evaluation of family behavior therapy in concurrent child neglect and drug abuse.

OBJECTIVEnApproximately 50% of child protective service (CPS) referrals abuse drugs; yet, existing treatment studies in this population have been limited to case examinations. Therefore, a family-based behavioral therapy was evaluated in mothers referred from CPS for child neglect and drug abuse utilizing a controlled experimental design.nnnMETHODnSeventy-two mothers evidencing drug abuse or dependence and child neglect were randomly assigned to family behavior therapy (FBT) or treatment as usual (TAU). Participants were assessed at baseline, 6 months, and 10 months postrandomization.nnnRESULTSnAs hypothesized, intent-to-treat repeated measures analyses revealed mothers referred for child neglect not due to their children being exposed to illicit drugs demonstrated better outcomes in child maltreatment potential from baseline to 6- and 10-month postrandomization assessments when assigned to FBT, as compared with TAU mothers and FBT mothers who were referred due to child drug exposure. Similar results occurred for hard drug use from baseline to 6 and 10 months postrandomization. However, TAU mothers referred due to child drug exposure were also found to decrease their hard drug use more than TAU mothers of non-drug-exposed children and FBT mothers of drug-exposed children at 6 and 10 months postrandomization. Although effect sizes for mothers assigned to FBT were slightly larger for marijuana use than TAU (medium vs. large), these differences were not statistically significant. Specific to secondary outcomes, mothers in FBT, relative to TAU, increased time employed from baseline to 6 and 10 months postrandomization. Mothers in FBT, compared to TAU, also decreased HIV risk from baseline to 6 months postrandomization. There were no differences in outcome between FBT and TAU for number of days children were in CPS custody and alcohol intoxication, although FBT mothers demonstrated marginal decreases (p = .058) in incarceration from baseline to 6 months postrandomization relative to TAU mothers.nnnCONCLUSIONnFamily-based behavioral treatment programs offer promise in mothers who have been reported to CPS for concurrent substance abuse and child neglect of their children. However, continued intervention development in this population is very much needed.

A standardized method of diplomatically and effectively reporting child abuse to state authorities. A controlled evaluation.

Although many studies have examined issues relevant to reporting child maltreatment to state authorities, empirical evaluation of intervention programs to assist professionals in reporting child abuse is lacking. In the present study, a medical student was taught to perform a standardized behavioral method of reporting child abuse that incorporates nonperpetrating caregivers of child abuse victims in the reporting process. A controlled multiple baseline across behaviors (i.e., initiating child abuse report, responding to upset) experimental design was utilized to evaluate skills acquisition. Improvements in interpersonal skills related to reporting child abuse were demonstrated consequent to intervention. Future directions are discussed in light of these results.

Social Skills Training for Depressed, Visually Impaired Older Adults: A Treatment Manual

Late-onset visual impairment due to cataracts, glaucoma, macular degeneration, or diabetic retinopathy afflicts approximately 10% of people older than 65, and often results in depression and social dysfunction. Whereas the majority of sighted older adults are active participants in their community, individuals suffering from progressively worsening vision experience heightened levels of isolation and reduced social support, and participate in fewer reinforcing recreational activities. This article describes our social skills training package for the treatment of depressed, visually impaired, older adults. Our treatment focuses on increasing the frequency and level of assertiveness with which visually impaired older adults interact with each other. In addition to specified treatment methods, our empirically derived program employs standardized assessment measures to evaluate therapeutic progress. Sessions are implemented to reinforce efforts to apply social skills in the environment and reestablish skills that have begun to fade.

Relationship of depression with measures of social functioning in adult drug abusers

The present study describes the relationship between depression and several measures of social functioning--including employment, criminal activity, incarceration, marital functioning, and alcohol and drug use--in a population of adult drug abusers. Our investigation extends past work in this area by specifically investigating the effects of depression (as opposed to simple substance use) on social and interpersonal functioning. Predictably, elevated levels of depression were associated with increased use of hard drugs and alcohol, greater levels of institutionalization, reduced attendance at work or school, and lower overall rates of marital satisfaction. Consistent with previous reports, level of marijuana use was not related to severity of depression. It appears that depressed substance abusers experience significantly more social, vocational, and interpersonal dysfunction than their nondepressed counterparts. It is proposed that the efficacy of existing treatment programs for adult drug abusers will be enhanced through the addition of strategies to assess and ameliorate depression.

Social skills training in a depressed, visually impaired older adult

A multiple baseline design was used to assess the effects of social skills training (SST) in a 65-year-old woman suffering from major depression and severe macular degeneration. Responses to role-played scenarios requiring assertiveness, in vivo request for assistance and social involvement, self-reported assertiveness, depression, and happiness were repeatedly recorded during baseline, treatment, and follow-up phases. Results showed progressive improvement in targeted social skills with SST in both clinic and home settings. Concurrent with enhanced levels of social skill were dramatic decreases of depression to a nonclinical level. Improved skill levels and diminished Geriatric Depression Scale scores were maintained during the 7-month follow-up period, except at the 6 month assessment after which booster treatment was applied to reinstate maximum improvement.

Coexisting Child Neglect and Drug Abuse in Young Mothers: Specific Recommendations for Treatment Based on a Review of the Outcome Literature.

Although perpetrators of child neglect often abuse illicit substances, treatment outcome evaluations in drug-abusing young mothers who have been found to neglect their children are conspicuously absent. Problem-solving interventions and family-based therapies that include skill acquisition components have demonstrated effectiveness in substance-abusing adolescents and child-neglecting mothers. The purpose of this article is (a) to review studies that have examined the relationship of drug abuse and child neglect, (b) to review clinical treatments that appear to be effective in both perpetrators of child neglect and drug-abusing adolescents, and (c) to integrate empirically validated drug abuse and child neglect interventions for use in adolescent mothers who have been found to abuse drugs and neglect their children.

Behavioral Assessment and Treatment of Social Phobia: An Evaluative Review

This article provides an empirically derived description of social phobia, including onset, prevalence, comorbidity, and issues of differential diagnosis. Assessment and behavioral treatment strategies for social phobia are reviewed. It was not until the past few years that structured clinical interviews and self-report inventories have been developed with adequate reliability and validity to specifically assess social phobia. Thus much of the treatment outcome research is confounded with heterogeneous samples that make generalization of results difficult to interpret. Heterogeneity of samples, lack of controlled comparisons with adequate statistical power to detect treatment differences, and inconsistent findings do not permit the drawing of any definitive conclusions concerning the efficacy of behavioral treatment procedures at this time. More treatment comparison studies for social phobia need to be perfonmed using structured clinical interviews and standardized assessment devices specific for use with social phobia. Pre hoc power analyses should be performed to determine the number of subjects deemed adequate to detect differences when performing comparison studies. Assessment and treatment of social phobia with children is conspicuously nonexistent. Assessment and treatment procedures for social phobia need to be developed and standardized with children.