Harold Lifshutz

HIV-1 among Inner City Dually Diagnosed Inpatients

The objectives of this study were to investigate HIV-1 seroprevalence and risk factors, disease progression, and awareness of HIV-1 serostatus in a population of inner city, substance using, psychiatric inpatients. To pursue these goals, we tested 118 (103 M, 15 F) dually diagnosed, acute care inpatients for HIV-1 antibodies and administered structured interviews. Twenty-seven (23%, including 24 M and 3 F) of the subjects were HIV-1 seropositive. Seropositivity was twice as great among intravenous drug users and men who had sex with other men as among patients not belonging to either of these two groups. Logistic regression analysis among male subjects revealed a significantly elevated HIV-1 risk associated with a primary diagnosis of depression (odds ratio adjusted for age, race, and presence of an AIDS risk behavior = 4.2, 95% confidence interval = 1.1, 16.5; p = 0.04). Less than half of the seropositives knew their HIV-1 status prior to this study, one had AIDS and four had two or more constitutional symptoms of AIDS. The high rate of seropositivity in this indigent, dually diagnosed population presents challenges to the health-care community. That few individuals had HIV-1 related symptoms may have implications for other treatment settings.

Treatment Compliance after Detoxification among Highly Disadvantaged Alcoholics

An outcome study was carried out on a series of 109 highly disadvantaged alcoholics discharged from the detoxification unit of a large municipal hospital in New York City. We examined the impact of a variety of clinical and demographic factors on retention in the initial phases of outpatient and inpatient treatment following discharge. Both high school completion and a history of at least 6 months of employment in the two years preceding admission correlated with frequency of registration for continued aftercare. Measurements of cognitive flexibility correlated with frequency of aftercare completion. An association strongly approaching significance was also found between length of hospital stay and aftercare completion. Some suggestions are made as to the assessment and aftercare planning for highly disadvantaged alcoholics.

Crack Cocaine Use and Sexual Behavior among Psychiatric Inpatients

Rises in both crack cocaine use and incidence of sexually transmitted diseases have been recently reported. In this study, we investigated the relationship between crack cocaine abuse and sexual behavior in 50 psychiatric inpatients. The relationship between crack use and sexual behavior is a very complicated one, influenced by many variables such as the dose of crack used, the users preexisting sexuality, gender, and psychiatric illness. Results indicated that while most of the subjects developed sexual disinterest and dysfunction with prolonged crack cocaine use, some of them became more sexually promiscuous and consequently contracted more sexually transmitted diseases. The implications of these findings regarding transmission of HIV among crack cocaine users are discussed.

Combined Substance Abuse and Psychiatric Disorders in Homeless and Domiciled Patients

Although homelessness in patients with combined addictive and psychiatric illness is a common problem, little has been reported about the epidemiology of homelessness in this patient population. The authors, in a study of 100 dually diagnosed patients admitted to a large metropolitan psychiatric hospital, found that a large portion of patients (N = 46) were homeless at the time of admission. Alcohol and crack/cocaine were the most frequently used drugs. Interestingly, there were no significant differences on most parameters between those who were homeless and those who were not. The authors observed that among the disadvantaged, inner-city dually diagnosed, many move in and out of the homeless state, seriously compromising their chances for recovery. Self-help treatment programs were more commonly used by homeless than domiciled patients. The homeless population may therefore be amenable to treatment in 12-step groups, as are domiciled patients.

Effect of Drugs of Abuse on Psychiatric Symptoms among Hospitalized Schizophrenics

In a group of 71 inpatient schizophrenics with no other concurrent psychiatric diagnosis except for dependence on one drug, we ascertained the subjective effect their drug of abuse had on their psychiatric symptoms 2 weeks prior to hospitalization. Psychiatric symptoms were assessed by means of the Hopkins Symptom Checklist (Revised) (SCL-90R). Cocaine addicts, but not alcoholics, reported aggravation more often than improvement of symptoms. Alcoholics reported alcohol-induced symptom improvement with a similar frequency as alcohol-induced symptom aggravation.

A modified therapeutic community for the dually diagnosed Greenhouse program at bellevue hospital

Techniques used in therapeutic communities may be applicable to patients dually diagnosed with mental illness and a psychoactive substance use disorder (PSUD). This study was designed to evaluate the demographics, course, and outcome for 100 patients treated in one such residential program. One hundred indigent male patients admitted to a drug-free therapeutic community for the dually diagnosed were studied on admission and over the course of their treatment, and subjects were monitored throughout their stays on the basis of observed urine toxicology tests and a clinical assessment of drug or alcohol use. The mean age of the patients was 33.8 years, and the average length of stay was 121.0 days. Thirty-three of the patients completed the full 6-month program and moved on to another stable living environment. Only 12 patients had urine toxicologies positive for illicit drugs or alcohol while in the program. These findings support the possibility of applying the residential drug-free therapeutic community to dually diagnosed patients.

Concurrent Cocaine Withdrawal Is Associated With Reduced Severity of Alcohol Withdrawal

The purpose of this study was to implement an empirical assessment of the clinical response to standard alcohol detoxification during withdrawal from both alcohol and cocaine. One hundred forty-nine males consecutively admitted in acute alcohol withdrawal to a hospital-based detoxification unit were studied. All subjects completed a 4-day chlordiazepoxide detoxification. Patients who used drugs other than cocaine were excluded. Fifty-five subjects withdrawing only from alcohol and 94 subjects withdrawing from both alcohol and cocaine, as evidenced by positive urinalysis and history, were studied. Both groups reported similar amounts of daily alcohol intake and had a similar age of onset of alcohol dependence. Parental alcoholism was equally frequent in both groups. Statistically, several variables were directly related to severity of alcohol withdrawal, including associated cocaine abuse, age, abnormal laboratory values, and duration of homelessness. As measured by the Alcohol Withdrawal Scale (AWS), alcohol withdrawal was less severe among cocaine users, not only at intake but throughout the 4-day detoxification. Singly addicted alcoholics were older and had longer drinking histories, more prior detoxifications, and more abnormal laboratory values than cocaine users. A multiple regression analysis demonstrated a significant relationship between cocaine and severity of alcohol withdrawal. Cocaine users more frequently requested reductions in chlordiazepoxide dosages than singly addicted alcoholics, complaining of dysphoria, sedation, and weakness. The severity of alcohol withdrawal was associated with recent cocaine use, age, laboratory abnormalities, and duration of homelessness. Concurrent cocaine withdrawal in the sample was associated with reduced severity of alcohol withdrawal. Possible neurobiological mechanisms, as well as study limitations affecting interpretation of the findings, are discussed. Tailored detoxification as opposed to standard detoxification regimens may be more appropriate for the clinical management of combined alcohol-cocaine withdrawal.

Brief group psychotherapy for herpes patients: A preliminary study

Three time-limited group interventions for patients with genital herpes were compared: a cognitive-behavioral stress-management approach, a dynamically oriented psychotherapy approach, and a self-help approach. A posttherapy questionnaire was administered to all subjects to assess the relative impacts of the different treatment approaches and the therapeutic factors which subjects perceived as most salient in each form of treatment. Subjects in the cognitive-behavioral stress-management groups reported greater benefits than subjects in both other conditions. It is suggested that the high degree of structure and goal orientation which characterize this approach may produce superior results, at least when the group experience is time limited.

Developmental Risk Factors in Postpartum Women with Urine Tests Positive for Cocaine

The aim of the study was to ascertain whether there was a difference in developmental experiences between two groups of inner city postpartum patients, those who used cocaine during pregnancy and those who did not. A retrospective structured interview was administered to 80 postpartum women examining demographic characteristics, adaptive function, drug use patterns, and selected risk factors for adult substance abuse encountered before age 16. The sample was divided into two cohorts of women: 40 women identified by urine tests of their babies as using cocaine shortly before delivery and a comparison group of 40 women not identified by positive urines. Comparisons between the two cohorts revealed that the cocaine identified women had significantly higher overall past and present use of a broad range of drugs, particularly crack and other forms of cocaine, as well as lower levels of general adaptive functioning despite the fact that they were demographically comparable. When compared to the nonusers, they displayed markedly elevated scores on measures of developmental risk factors for adult substance use. This study highlights the importance of early developmental risk factors on later drug use during pregnancy and general adult adaptive functioning. Further study and intervention targeted at persons with these risk factors are warranted.