Gennaro Ottomanelli

Methadone Patients and Alcohol Abuse

A literature review was conducted on the excess use of alcohol by methadone patients. Although the rate of alcohol abuse among methadone patients was found to be high (compared to general population estimates), the rate was comparable to individuals who engaged in risk-taking behaviors and individuals under stress, such as college students and emergency room patients. Comparisons of rates for different samples was difficult because of the varying criteria used to define alcohol abuse and the absence of operational criteria applicable across different populations. Another source of difficulty was that some studies evaluated motivational variables (why the person drank) and found them to be more important predictors than sociodemographic variables (for example, history of drinking and social class). Contrary to the expectation that methadone patients who consumed excessive amounts of alcohol would require higher dosages of methadone, it was found that nonalcohol-abusing methadone patients requested the higher dosage levels. This finding, however, was subject to methodological confounds. The issue of whether the methadone patient who abused alcohol has a negative treatment outcome was a multifaceted question. The definition of treatment outcome for alcohol-abusing methadone patients determined whether the investigator concluded that there was a negative impact versus minimal impact.

The Earn-Your-Way Credit System: Use of a Token Economy in Narcotic Rehabilitation

The “Earn-Your-Way” credit system is an effort to assess the effectiveness of contingent reinforcement techniques in the treatment of heroin addicts. Rehabilitation efforts employing token economies have recently yielded encouraging results with groups of juvenile delinquents (Fineman, 1968; Tyler and Brown, 1968), with mentally retarded children (Lent, 1968) and with chronic psychiatric hospital patients (Atthow and Krasner, 1968; Montgomery and McBurney, 1970). Bernard and Eiesenman (1967) demonstrated the particular effectiveness of contingent reinforcement in conditioning the verbal behavior of a group of sociopaths. For the most part, token economy studies have concentrated on affecting limited areas of behavior. This study represents one of the first applications of the token economy behavioral modification technique to a civilly committed addict population in a milieu treatment program.

Patient Improvement, Measured by the MMPI and Pyp, Related to Paraprofessional and Professional Counselor Assignment

This study examined the treatment efficacy of professional and paraprofessional counselors with similar caseloads of narcotic addicts stabilizaed on methadone. The patients assigned to a professional counselor showed a statistically significant decrease on the D and Sc scales of the MMPI. The patients assigned to paraprofessional counselors did not demonstrate statistically significant decreases on the scales of the MMPI. On the basis of examined patient variables, the two groups of patients appeared comparable in terms of demographic characteristics prior to admission and there did not appear to be a bias in the assignment of patient to counselor.

Condom knowledge history of use and attitudes among chemically addicted populations.

The need for behavioral change of risky sexual practices has been of the highest priority since the onset of the AIDS epidemic. The major focus of education for safe sex has been emphasis on condom use. We surveyed 124 individuals applying to treatment for various chemical dependencies and 60 individuals applying for non-chemical-dependency medical treatment on various aspects of condom knowledge, history of use, and attitudes. Respondents reported that AIDS has motivated them to increase their use of condoms, however, only 13.9% always use them. Education is needed in the areas of increasing protection. Along with the use of a condom, the need for a reservoir tip and the risks associated with multiple sex partners should be stressed.

IV Versus Non-IV Drug Use and Selected Patient Variables Related to AIDS Risk Behaviors

A sample of 206 drug users volunteered for a survey questionnaire of AIDS-related risk behaviors. The Risk Behavior Inventory (RBI) was used to elicit self-report information on risk behaviors including drug use, needle use, and sexual practices. Non-IV cocaine users reported less risk behaviors than patients involved in IV drug use. Nevertheless, non-IV users remained substantially at risk for HIV exposure because of sexual practices and sexual interaction with IV drug users. Multiple regression analysis indicated that method of drug administration (IV vs non-IV) was the major contributor of accountable variance in risk behaviors, while other patient variables, such as age, gender, educational level, employment, and marital status, did not contribute significantly to the explained variance.

Risk Dimensions of HIV-Tested Substance Users

Methadone outpatients (n = 177) and outpatients enrolled in a nonchemotherapy (n = 65) counseling unit requested HIV testing. A HIV risk-related questionnaire elicited information on needle-sharing, drug injecting, sexual behaviors, and other risk activities. Although age and geographical seroprevalence were not significantly related to a positive HIV test result, a significant relationship was found between the patients self-report of AIDS deaths among personal acquaintances and serostatus. Dimensions of risk concerns were found to be significantly related to gender in the methadone sample but not in the nonchemotherapy sample. Serostatus in the nonchemotherapy sample was significantly related to drug injecting and the sum of a 12-item risk index constructed to predict HIV infection.

A Behavioral Measure of AIDS Information Seeking bY Drug and Alcohol Inpatients

A nonreactive, observational research method was used to measure AIDS information-seeking behavior of patients on four drug and alcohol inpatient units at a large public hospital in New York City. Results showed only 23 inquiries from 271 male and female patients over a six-week interval. Possible explanations and implications of these results are discussed.

RELIABILITY OF THE WEAK OPIATE WITHDRAWAL SCALE FOR INNER-CITY OPIATE USERS '

The reliability (Kuder-Richardson 20) of the 84-item Weak Opiate Withdrawal Scale was estimated for a sample of 70 inner-city men who used opiates and had passed through the acute withdrawal stage. Analysis suggested modification of the scale to exclude negatively worded as well as cognitively sophisticated items which elicit unreliable and paradoxical responses from this population.

DMI-Measured Defenses and HIV-Related Risk Behaviors in IV Compared to Non-IV Substance Abusers

The Defense Mechanism Inventory (DMI) and The Risk Behavior Inventory (RBI) were administered to substance abusers hospitalized on a drug detoxification service. The groups were categorized on the basis of self-reported IV versus non-IV substance abuse. Significant between-group differences were obtained on the DMI and RBI. The non-IV group responded less often than the IV group with the Turning Against Object (TAO) response option, resulting in higher scores when Turning Against Self (TAS), Reversal (REV), Principalization (PRN) and Projection (PRO) were summed into a single score. Significant within-group differences were obtained for DMI response levels and defenses. Both groups relied less on TAO at the thought level and more on PRN and REV as primary defenses. The IV group reported twice as many risk behaviors as the non-IV group and risked HIV exposure through needle use and sexual transmission modes. Consideration was given to the role of principalization and denial within the addicted individuals defense structure and the relationship of these defenses to HIV-related risk behavior.