Delinda Mercer

Development of an adherence/competence rating scale for individual drug counseling

This paper reports on the development of a 43 item rating scale that assesses therapist adherence and competence in individual drug counseling (IDC) for the treatment of cocaine dependence. Three independent judges rated 41 audiotaped IDC sessions from the pilot/training phase of the NIDA collaborative cocaine study. Judges also rated 11 tapes of Cognitive sessions and ten tapes of Supportive Expressive psychodynamic sessions. Interjudge reliability for the total scale score and subscales ranged from 0.55 to 0.89 and internal consistency coefficients ranged from 0.43 to 0.95. Ratings indicated that IDC counselors used IDC techniques more frequently and competently than did therapists from other modalities.

Self-help activities in cocaine dependent patients entering treatment: results from the NIDA collaborative cocaine treatment study

Although little is known about self-help attendance among cocaine dependent patients, clinicians frequently recommend this treatment. Cocaine dependent patients (519) entering a psychotherapy study were therefore surveyed regarding their recent self-help group attendance and participation. During the previous week, 34% had attended a self-help group. Of self-help attenders who actively participated 55% initiated abstinence within the next month, compared with 40% of non-attenders and 38% of non-participating attenders (P < 0.01). These findings support the potential short-term positive prognostic significance of self-help attendance and participation in cocaine dependent patients.

Mediators of Outcome of Psychosocial Treatments for Cocaine Dependence

This study examined endorsement of 12-step philosophy and engagement in recommended 12-step activities as a mediator of the outcomes of individual plus group counseling for cocaine dependence. Assessments of drug use outcomes and the mediator were made at baseline and monthly for 6 months. Engagement in recommended 12-step activities was found to be a partial statistical mediator of drug use outcomes of individual (plus group) drug counseling, but no evidence for change in the mediator preceding change in drug use was found. In addition, a measure of beliefs about addiction developed to test mediation of outcome of cognitive therapy was found to correlate moderately with drug use outcomes in both cognitive therapy and individual drug counseling.

The Protocol Deviation Patient: Characterization and Implications for Clinical Trials Research

This paper addresses those patients who neither complete treatment nor drop out from clinical trials but who deviate from the protocol treatment by seeking or receiving additional treatment. Psychotherapy researchers may be missing important information by withdrawing these patients from analyses or combining them with dropouts from treatment. In a multisite psychotherapy outcome study for patients with cocaine dependence, patients who deviated from protocol could be distinguished from completers and dropouts on pretreatment patient characteristics. Patients who deviated from protocol were more likely to be African American, to have higher psychiatric severity, and to have had more previous drug treatment attempts. Data indicate that there is a value in obtaining follow-up assessment after the protocol deviation and including these patients in data analysis to avoid bias in findings. Differential outcome for protocol deviation patients compared to dropouts and completers is discussed. In diesem Beitrag we...

To use or to refuse cocaine— The deciding factors☆

Two types of narratives were obtained from 35 cocaine-addicted patients: narratives about using cocaine and narratives about not using cocaine. The most prevalent factors in using cocaine were (a) having enough money, (b) wish to end physical/emotional pain, and (c) wish/decision to use. The factors in narratives about not using cocaine were (a) patient arranged conditions to be nonstimulating for using cocaine, (b) recognition of bad consequences, and (c) wish/decision not to use. It is clear in both the cocaine-using episodes and not-using episodes that the patients wish/decision is important. The conditions for using cocaine tended to be more external, whereas those for not using tended to be more internal. Similar conditions were found by a questionnaire method. A major treatment implication of these findings is that the focus of therapy can be directed to planning strategies to minimize influence of the external factors and to rehearse strategies to prepare for situations involving cues that influence use of cocaine.