Martina Reynolds

A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder

A randomized trial was performed in which imaginal exposure (IE) and cognitive therapy (CT) were compared in the treatment of chronic posttraumatic stress disorder (PTSD). Patients who continued to meet PTSD caseness at the end of a 4-week symptom-monitoring baseline period (n = 72) were randomly allocated to either IE or CT. There was a significant improvement in all measures over treatment and at follow-up, although there were no significant differences between the 2 treatments at any assessment. A significantly greater number of patients who showed worsening over treatment received IE, although this effect was not found at follow-up. Patients who worsened showed a greater tendency to miss treatment sessions, rated therapy as less credible, and were rated as less motivated by the therapist. It was concluded that either exposure or a challenge to cognition can result in symptom reduction, although neither resulted in complete improvement.

Treating an opiate-dependent inpatient population: a one-year follow-up study of treatment completers and noncompleters.

INTRODUCTION The aim of this study was to compare the characteristics of patients who completed (completers) inpatient treatment of drug dependence with those who failed to complete this programme (noncompleters). METHOD Participants were assessed at admission using the Substance Abuse Assessment Questionnaire (SAAQ) to obtain information about the sociodemographic background, history of drug and alcohol use, physical health, mental health, offending behaviour, and interpersonal relationships. Follow-up interviews were carried out 3, 6, 9, and 12 months after discharge using the SAAQ-Follow-up. To form the three comparison groups, participants were divided on the basis of completion of detoxification and receipt of aftercare. RESULTS AND CONCLUSIONS Significantly better treatment outcome was observed amongst those who completed detoxification and went on to spend at least 6 weeks in a recovery and/or residential rehabilitation unit. In contrast, there were no significant differences between noncompleters and completers who had no aftercare on the majority of measures of drug use during follow-up.

Substance use in the general hospital.

INTRODUCTION People misusing substances are overrepresented in health settings. Substance misuse can also be an underlying factor complicating medical diagnosis and management. AIMS (i) To establish the prevalence of substance misuse in the general hospital inpatient population; and (ii) to examine the relationship between medical diagnosis and substance misuse problem as identified by screening tools. METHOD This study adopted a three-step screening approach including a prospective questionnaire survey, interview, and case note review. Subjects included all adult patients admitted to a London teaching hospital over a 1-week period. RESULTS Seventy percent completed the questionnaire. Twenty-three percent was currently smoking, 14% was rated positive for alcohol misuse, and 12% positive for drug misuse. Only 65% of patients was screened for smoking, 54% for alcohol, and 9% for other substances. CONCLUSIONS People misusing one substance were more likely to be misusing others, hence the importance of screening all patients for all substances. Doctors were screening a small percentage of patients and they identified and intervened with only the severe ones.

Drug misuse among patients admitted to a general hospital

Aims In this paper we report the prevalence of prescribed drugs of misuse and illicit drugs used by patients admitted to a general hospital and the level of detection of drug problems by general medical staff. Design This is a prospective questionnaire survey, interview and case note review. Setting This study is a snapshot of one weeks admission to a general hospital. Findings Of the 408 people approached, 285 (70%) participated in the study. One hundred and sixty‐six people (62%) reported misuse of drugs at some time in their lives. Of these, 46 (17%) reported use of illegal drugs at some time in their lives, 22 (8%) in the past year, and 7 (2.6%) in the previous month. The most frequently reported drug type used ever, in the past year, and in the previous month, was over‐the‐counter medication and sedatives. All nine dependent patients identified by the interview were polydrug users and were significantly younger. Two of these patients were assessed for substance misuse by the medical staff. Conclusion This study suggests that younger patients should be asked about their drug use, especially their use of more readily available drugs. At present, few questions are being asked by health professionals, leaving drug misuse to continue to drain both healthcare and societys resources.

An investigation of descriptive and experimental aspects of intrusive thoughts in a sample of substance-dependent inpatients

Aims: Thought processes have been hypothesised to play a role in addiction and relapse (Salkovskis and Reynolds (1994)). Thought suppression and smoking cessation showed that suppression was associated with an increase in smoking-related intrusive thoughts, whilst a distracting task (relaxation) reduced intrusion frequency. This is a report of a similar study with a substance-dependent sample undergoing detoxification. Design: Subjects were randomly allocated to one of three groups (mention control, relaxation and suppress) and respectively were asked to monitor, suppress and do relaxation exercises, and suppress substance-related intrusive thoughts in period 1. In period 2 they were told that they could think about anything. Subjects recorded all substance-related intrusions in both periods. Participants and Setting: Inpatient opiate or multisubstance-dependent sample undergoing detoxification. Findings: Deliberate suppression of substance-related intrusive thoughts did not result in an increase in the frequency of the same for the suppression group compared to the mention control group. Relaxation facilitated thought suppression in the first period, but this effect was not carried over to the second period. Conclusions: In the absence of the task which acted as an effective structured distracter, feeling relaxed may act as a trigger for drug-related thoughts. This may have some implications for the use of relaxation as a form of distraction in the treatment for substance misusers.