Janelle M. Koppenhaver

The effectiveness of telephone-based continuing care in the clinical management of alcohol and cocaine use disorders: 12-month outcomes.

This study of continuing care for substance dependent patients compared a telephone-based monitoring and brief counseling intervention (TEL) with 2 face-to-face interventions, relapse prevention (RP) and standard 12-step group counseling (STND). The participants were graduates of intensive outpatient programs who had current dependence on alcohol and/or cocaine. Self-report, collateral, and biological measures of alcohol and cocaine use were obtained over a 12-month follow-up. The treatment groups did not differ on abstinence-related outcomes in the complete sample (N = 359) or on cocaine use outcomes in participants with cocaine dependence (n = 268). However, in participants with alcohol dependence only (n = 91), TEL produced better alcohol use outcomes than STND on all measures examined and better outcomes than RP on some of the measures.

Pilot trial of effectiveness of mindfulness meditation for substance abuse patients

Aims, setting and intervention: This pilot study compared outcomes of 18 randomized substance‐abuse recovery house patients who received 8 weeks of mindfulness meditation plus standard treatment with that of 13 patients receiving just standard treatment. Design, measurement and findings: Addiction Severity Index composite scores indicated relatively greater improvement in medical problems over a 5‐month follow‐up period (baseline, 8 weeks and 5 months) for the meditation group, but no other group differences on this multi‐dimensional measure of various life problems. The groups did not differ in urine toxicology results during the study or at 8 weeks and 5 months. No differential group change was found on measures of psychological health. Conclusion: This initial small pilot evaluation yielded relatively little indication that meditation enhanced treatment outcomes for the substance abuse patients studied.

Predicting proximal factors in cocaine relapse and near miss episodes: clinical and theoretical implications

This study examined the degree of correspondence between relapse vulnerability factors assessed at intake to aftercare in 100 cocaine dependent patients and proximal factors in their first cocaine relapse and near miss episodes during a 1-year follow-up. Proximal factors in relapse and near miss episodes were also compared. Correspondence between experiences associated with prior use and experiences in the week prior to relapse and near miss episodes was generally poor. Psychiatric and family/social problem severity and coping factors at intake to aftercare predicted experiences in the week prior to near misses, and to a lesser degree, experiences in the week prior to relapse episodes. However, relapse vulnerability factors were also associated with psychiatric and family/social problem severity and mood during abstinent periods. Therefore, there was little evidence of specificity in relationships between relapse vulnerability factors and experiences prior to relapse. Proximal measures of coping, sensation seeking, positive experiences, and unpleasant affect differentiated relapses from near misses in a within-subjects analysis.

Factors in sustained recovery from cocaine dependence

The goal was to identify factors that predicted sustained cocaine abstinence and transitions from cocaine use to abstinence over 24 months. Data from baseline assessments and multiple follow-ups were obtained from three studies of continuing care for patients in intensive outpatient programs (IOPs). In the combined sample, remaining cocaine abstinent and transitioning into abstinence at the next follow-up were predicted by older age, less education, and less cocaine and alcohol use at baseline, and by higher self-efficacy, commitment to abstinence, better social support, lower depression, and lower scores on other problem severity measures assessed during the follow-up. In addition, higher self-help participation, self-help beliefs, readiness to change, and coping assessed during the follow-up predicted transitions from cocaine use to abstinence. These results were stable over 24 months. Commitment to abstinence, self-help behaviors and beliefs, and self-efficacy contributed independently to the prediction of cocaine use transitions. Implications for treatment are discussed.

Posttraumatic stress disorder and other psychopathology in substance abusing patients

Studies demonstrating greater problem severity in substance abuse patients with posttraumatic stress disorder (PTSD) versus those without have rarely considered other co-occurring psychiatric disorders. This study of 466 male veterans recently admitted to outpatient substance abuse treatment attempts to identify problems associated with PTSD versus those associated with other nonsubstance use Axis I disorders. Problem severity, particularly psychiatric, was examined across four groups of patients with substance use disorders (SUDs). Those with: 1, SUDs only (SU-Only); 2, PTSD, but no other Axis I disorders (SU+PTSD); 3, PTSD and other Axis I disorders (SU+PTSD+Axis I); and 4, no PTSD, but other Axis I disorders (SU+other Axis I). Results suggested a hierarchy of psychiatric, and to a lesser extent, other life problem severities associated with these diagnostic groupings. The most severe group was SU+PTSD+Axis I, followed in decreasing severity by the SU+other Axis I, SU+PTSD, and SU-Only groups. Additional analyses comparing the SU+PTSD+Axis I patients with a subgroup of Axis I patients with more than one Axis I disorder (SU+multiple Axis I) revealed few group differences except for more lifetime suicide attempts and psychiatric hospitalizations in the SU+PTSD+Axis I group. The findings suggest that it is not PTSD per se, but the frequent co-occurrence of PTSD and other psychopathology that largely accounts for previously reported greater problem severity of SUD patients with PTSD.

Continuous, categorical, and time to event cocaine use outcome variables: degree of intercorrelation and sensitivity to treatment group differences

Although a number of cocaine use variables are available for use in treatment outcome studies, there is little information on how strongly these variables are related or their relative sensitivity for detecting treatment group differences. Eight continuous and categorical variables of cocaine use obtained at 6-, 12-, 18-, and 24-month follow-ups, four event history variables, and one summary measure of cocaine use over the 24-month follow-up period were examined. The variables were generally correlated 0.30--0.50 or greater. An exploratory factor analysis in which the repeated measures were averaged across follow-up points yielded two factors, one made up of incidence of use variables (e.g. percent days cocaine use, monetary value of cocaine, abstinence status, time to relapse, urine toxicology) and a second consisting of perceived severity of use variables (e.g. drug and cocaine composites, craving). This factor solution was supported by confirmatory factor analyses conducted at each follow-up point. None of the variables yielded significant differences between the two treatment conditions in the study, standard group and individualized relapse prevention continuing care. However, monetary value of cocaine used and urine toxicology variables yielded the largest effect sizes (eta(2)=0.020 and 0.010, respectively).

Addiction Severity Index composite scores: Contribution of objective vs. subjective items to post‐treatment change

Aims: This study evaluated the generalizability of findings by Wertz, Cleaveland, and Stephens (Journal of Substance Abuse, 1995, 7, 175–188) that reductions in the Addiction Severity Indexs (ASI) alcohol and drug composite scores (CSs) following treatment were largely associated with reductions in subjective ratings of “being bothered/troubled” or “need for treatment” rather than more objective frequency of behaviors/problems. Design and participants: The data from three independent studies/groups of substance dependent patients—alcohol dependent (n=165), cocaine dependent (n=155), and opioid dependent (n=288)—were evaluated to determine whether positive changes in the ASIs CSs following treatment were driven by “objective” or “subjective” items, or both. Findings: An analysis of the drug and alcohol sections revealed that CSs in these two problem areas were significantly lower at 6 months post‐treatment entry and that both types of items showed significant reductions. Both types of items also generally contributed to significant reductions of CSs in the medical, legal, family‐social and psychiatric areas of the ASI. Conclusions: It was concluded that Wertz et al.s (1995) failure to find reductions in the objective items of the ASIs alcohol and drug sections was likely study specific.