Douglas K. Roszell

Relapse in opiate addicts: A behavioral analysis

Behavioral interviewing was used to study the relapse antecedents and concomitants of 38 opiate addicts on methadone maintenance. Relapse situations were categorized with regard to intra- or interpersonal determinants and implications for behavioral treatment interventions were discussed. Situations were also analyzed within an opponent process theory of motivation framework. Practical and theoretical difficulties with the study of relapse situations in substance abusing populations were highlighted.

Outcome of contingency contracting for illicit drug use in a methadone maintenance program

This study evaluates the outcome of a mandatory, clinic wide, structured contingency contracting system in a methadone maintenance program. The system involved weekly urine screening and placement on written individualized contracts for any of 106 male patients who displayed illicit drug use. Methadone dose decreases were the penultimate and detoxification and discharge the ultimate contingencies for unremitting drug use. Sixty subjects (56.6%) received contracts and 36 (35%) eventually left treatment. The contracts did not decrease the overall number of positive urines for the contract subjects, but opiate use did decrease significantly for subjects on more stringent contracts.

Heroin vs alcohol addiction--quantifiable psychosocial similarities and differences.

Abstract A pilot study of 50 heroin addicts and 66 alcohol addicts utilizing the recently developed quantitative methods for measuring life change and seriousness of illness. Alcohol addicts were found to have significant attenuation of perception of life change and seriousness of illness as compared to heroin addicts and current “normative” data. The heroin addicts were found to have a mild but significant augmentation of perception of life change and seriousness of illness as compared to the “normative” data. In addition both the heroin addicts and alcohol addicts were found to maintain very high levels of life change. The documented differences in perception and the maintenance of high levels of life change were felt to have potential significance in the treatment and evaluation of both groups of addicts.

Psychophysiologic and neuroendocrine findings in posttraumatic stress disorder: A review of theory and research

Abstract Psychophysiologic and neuroendocrine investigations of posttraumatic stress disorder (PTSD) are reviewed. Patients with PTSD have higher resting heart rate and blood pressure than asymptomatic controls, and urinary catecholamines are more elevated in PTSD subjects than in psychiatric patients without PTSD. Combat veterans with PTSD, when exposed to combat-related laboratory stressors, exhibit greater autonomic arousal than do various groups of control subjects. Diagnostic sensitivity in discriminating PTSD from non-PTSD subjects using biological variables is moderate, although specificity is substantially greater. The evidence supports models of conditioned autonomic nervous system arousal in PTSD.

Methadone Dosage: Patient Characteristics and Clinical Correlates

This paper summarizes data for 106 male opioid addicts which give evidence that there are demographic and clinical differences between groups of patients maintained in three ranges of methadone dosage (less than 35 mg, 36-59 mg, greater than 60 mg). At time of admission the Addiction Severity Index was administered. During the first month of treatment a routine battery of psychological tests--including the MMPI-168, 16PF, Shipley Institute of Living Scale, and Trail Making Test--was also administered. High-dose subjects were under greater emotional distress and experienced more anxiety (p less than .05), had more medical hospitalizations (p less than .05), and had been treated more frequently with psychoactive medications (p less than .05). They also had histories of greater use of barbiturates (p less than .001) and amphetamines (p less than .01). While in treatment they more frequently had urinalyses positive for illicit drugs during the first 6 months (p less than .05). Low-dose subjects had fewer friends (p less than .05). The 1-year program retention rates were found to be lower for the medium-dose group (p less than .05).

Frequency and Magnitude Distribution of Life Change in Heroin and Alcohol Addicts

A study of the frequency and magnitude of life change in two Veterans Administration Hospital addiction groups was made. Both heroin and alcohol addicts were characterized by a high frequency and magnitude of life change. The life change was highly correlated between the two addictions and there were no significant differences. This kind of evaluation is seen as important in identifying areas in which social disruption is concentrated and as an aid to organizing treatment in a way that is acceptable and nonthreatening to the patient.

Perception of Treatment Needs: Differences between Patients and Staff of a Drug Abuse Treatment Program

Patients and staff of the Seattle Veterans Administration Drug Dependency Treatment Program were surveyed to elicit their perception of treatment priorities in establishing a series of educationally oriented short-term groups. Comparisons of priorities were made between patients and staff, methadone and polydrug patients, and patients with alcohol problems and those without alcohol problems. After the survey a series of short-term groups was established and attendance was kept. It was found in general that the groups which patients thought had higher priority in their treatment--including drug and medical information, stress management, and money management--were better attended.

Autogenic Training in a Drug Abuse Program

The development of a program utilizing autogenic training with opiate-and polydrug-dependent individuals is described. A small cadre of staff were first trained in the procedure, and it was then used in the treatment of 23 patients with stress-related problems. Eleven patients completed the nine training sessions and rated their symptoms as being on the average 52% improved. Several case histories with varying outcome are described. The authors think that although autogenic training is no panacea, it is a useful modality in the drug abuse treatment armamentarium. Implications for further research and treatment are suggested.

Exploration of the relationship between frequency of illness, attrition from alcohol treatment, neuropsychological status and field dependence

One hundred thirty-nine male veterans receiving treatment for alcoholism were administered the Cornell Medical Index (CMI), neuropsychological tests comprising the Brain Age Quotient (BAQ) and the Group Embedded Figures Test (GEFT). Patients endorsing items on scale J (frequency of illness) of the CMI comprised a frequently ill group (27%) with the remaining patients comprising an infrequently ill group (73%). The frequently ill group patients were more likely to drop out of treatment, obtain lower BAQ scores and appear more field-dependent on the GEFT. Treatment attrition of frequently ill patients might be less if their individualized treatment plan involved greater structure consistent with their field dependent orientation and impaired neuropsychological status.