Nathan H. Azrin

ALCOHOLISM TREATMENT BY DISULFIRAM AND COMMUNITY REINFORCEMENT THERAPY

Traditional disulfiram treatment has often been ineffective because of a failure to maintain usage. The present study with 43 alcoholics compared: (1) a traditional disulfiram treatment, (2) a socially motivated Disulfiram Assurance program and (3) a Disulfiram Assurance program combined with reinforcement therapy. About five sessions were given for each program. At the 6-month follow-up, the traditional treatment clients were drinking on most days and no longer taking the medication. The Disulfiram Assurance treatment resulted in almost total sobriety for married or (cohabitating) clients but had little benefit for the single ones. The combined program produced near-total sobriety for the single and married clients. These results indicate a promising integration of chemical, psychological and social treatment of alcoholism.

Family-member involvement to initiate and promote treatment of problem drinkers

The present study evaluated a method of teaching distressed family members of problem drinkers how to minimize their own distress, reduce the drinking, increase the motivation of the alcoholic to obtain formal treatment and assist in the treatment program. Twelve concerned family members were given either community-reinforcement counseling or a traditional type of counseling (control group). The reinforcement counseling resulted in more alcoholic persons obtaining treatment than did the traditional type and a greater reduction in drinking before the formal treatment was obtained; drinking was reduced further during the joint treatment of the family members and problem drinkers. These results suggest that the drinking of unmotivated alcoholic persons can be reduced by counseling concerned family members in the use of appropriate reinforcement procedures and can lead to the initiation of formal treatment.

Behavioral and Cognitive Treatments of Geriatric Insomnia

Geriatric insomnia is a prevalent problem that has not received adequate controlled evaluation of psychological treatments. The present study evaluated behavioral and cognitive methods, relative to a wait-list control condition, for treating 27 elderly subjects (mean age = 67 years) with sleepmaintenance insomnia. Both treatment methods, stimulus control and imagery training, produced significant improvement on the main outcome measure of awakening duration. Stimulus control yielded higher improvement rates than either imagery training or the control condition on awakening duration and total sleep-time measures. Sleep improvements were maintained by the two treatment methods at 3- and 12-month follow-ups. The results were corroborated by collateral ratings obtained from significant others. Subjective estimates of awakening duration and sleep latency correlated highly with objective measures recorded on an electromechanical timer. The findings suggest that geriatric insomnia can be effectively treated with psychological interventions and that behavioral procedures are more beneficial than cognitive procedures for sleep maintenance problems. Insomnia is a widespread health problem among the elderly. More than 25% of people aged 60 years or older report difficulty initiating and/or maintaining sleep (Mellinger, Baiter, & Uhlenhuth, 1985). Insomnia complaints increase with age, and disorders of maintaining sleep are especially prevalent among the elderly (Dement, Miles, & Carskadon, 1982; Webb & Campbell, 1980). Sleep-maintenance insomnia is a more pervasive and debilitating condition than onset insomnia and has proved refractory to treatment (Bootzin, Engle-Friedman, & Hazelwood, 1983). Pharmacotherapy is the most widely used method for treating insomnia. Thirty-nine percent of prescriptions for hypnotics are written for persons over 60 years of age (Institute of Medicine, 1979) and, in nursing facilities, 94% of the elderly have been prescribed sedative hypnotics (U.S. Public Health Service, 1976). Most sleeping medications are effective only temporarily, impair cognitive and psychomotor functions, and alter the sleep architecture (Morin & Kwentus, 1988). They are especially hazardous to health in older people because of the reduced metabolic functioning that results with age and the higher incidence of sleep-related respiratory impairments (Mendelson, 1980). Although their short-term use may be indicated as an adjunct for acute insomnia, alternative nonpharma

Behavior therapy for drug abuse: a controlled treatment outcome study

82 Ss were studied in a comparative evaluation of a behavioral vs supportive treatment for illegal drug use. Behavioral treatment included stimulus control, urge, control, contracting/family support and competing response procedures for an average of 19 sessions. 37% of Ss in the behavioral condition were drug-free at 2 months, 54% at 6 months, and 65% at 12 months vs 20 +/- 6% for the alternative treatment during all 12 months. The behavioral treatment was more effective across sex, age, educational level, marital status and type of drug (hard-drugs, cocaine, and marijuana). Greater improvement for this condition was also noted on measures of employment/school attendance, family relationships, depression, institutionalization and alcohol use.

A Controlled Evaluation and Description of Individual-Cognitive Problem Solving and Family-Behavior Therapies in Dually-Diagnosed Conduct-Disordered and Substance-Dependent Youth

ABSTRACT There is a strong comorbid relationship between conduct and substance disorders in youth. However, there is an absence of controlled studies that have explicitly examined treatment efficacy in this dually-diagnosed population. In the present study, 56 such youth were randomly assigned to receive either individual-cognitive therapy or family-behavioral therapy. Subjects in both intervention groups demonstrated significant improvements in their conduct and reductions in their use of illicit drugs from pretreatment to post-treatment, and these results were maintained at follow-up. Measures of youth satisfaction with parents, parent satisfaction with youth, and overall mood of these youth demonstrated similar improvements and closely corresponded with improvements in standardized measures of conduct and drug use. No significant differences were found in conduct or reductions of illicit drug use between subjects in the two intervention conditions at post-treatment, or at 6-month follow-up. Study implications are discussed in light of these results.

Treatment of tourette syndrome by habit reversal: A waiting-list control group comparison *

The present investigation employed a waiting-list control group design to evaluate the effectiveness of the habit reversal treatment procedure in eliminating the multiple motor and vocal tics in 10 subjects with Tourette Syndrome. The mean percent reduction in tics for all 10 subjects at the last month of treatment was 93.0% at home and 93.5% in the clinic. Reductions occurred for vocal tics as well as each type of motor tic, for the children as well as the adults, for those subjects receiving TS medications as well as those not doing so, and for tic severity as well as tic frequency; there was no evidence of symptom substitution. These results suggest that Tourette Syndrome can be treated effectively with this type of behavior therapy.

An evaluation of behavioral treatments for tourette syndrome

The present study evaluated the effectiveness of self-monitoring, relaxation training and habit reversal in the treatment of 6 Tourette Syndrome (TS) subjects with multiple motor and vocal tics. A counterbalanced design was employed and tic frequencies were measured in the clinic setting using videotapes taken through a one-way mirror. Tics were reduced by an average of 55% with habit reversal, 44% with self-monitoring, and 32% with relaxation training and each behavioral procedure was the most effective treatment for at least one subject. All three treatment approaches may have some utility in the behavioral treatment of TS.

Follow-up results of Supportive versus Behavioral Therapy for illicit drug use

Follow-up data (mean 9 months) were obtained for 74 subjects who had been treated for a mean of 8 months and 17 sessions in a controlled comparison of Behavioral vs Supportive Counselling for drug abuse. Based on urinalysis, self-report, and family report, all subjects (100%) were actively using drugs at pre-treatment. During the last month of treatment, 81% of the Supportive treatment subjects and 44% of the Behavioral treatment subjects were using drugs at least once. At the follow-up month, drugs were used at least once by 71% of the Supportive vs 42% of Behavioral subjects. When drug use was measured in terms of the number of days of use per month, Supportive counselled subjects did not decrease drug use either by the end of treatment or at follow-up; for Behavioral subjects, drug use decreased by 63% by the end of treatment and by 73% at follow-up. Alcohol use, and days worked/or in school showed a similar pattern of greater improvement for the Behavioral treatment being maintained at the follow-up. These results indicate a substantial treatment-specific reduction of drug usage that endures after treatment is discontinued. The present favorable results appear attributable to the inclusion of family/significant others in therapy and the use of reinforcement contingent on urinalysis results.

Habit reversal for the treatment of Tourette syndrome

Abstract Habit reversal has been found effective for the treatment of individual tics. The present study used habit reversal to treat three subjects with the multiple tics of Tourette Syndrome. Tic frequency was reduced over a 6–8-month period by 93–95% in the clinic setting and by 64–99% in the home setting with a concurrent decrease in severity. The procedure holds promise as a treatment for Tourette Syndrome.

Behavioral and pharmacological treatments for tic and habit disorders: a review.

ABSTRACT. Children with tic and habit disorders are often seen by pediatricians, psychologists, or psychiatrists for evaluation and treatment. Current knowledge of the treatment-outcome research in these areas can serve as an important guide in the evaluation and treatment planning process. This article reviews the behavior therapy and pharmacological treatment of motor and vocal tic disorders, self-destructive oral habits, trichotillomania (hair pulling), onychophagia (nail biting), and thumb sucking. The research evidence indicates that all of these disorders can be effectively treated with behavioral or pharmacological approaches. J Dev Behav Pediatr 15:430–441, 1994. Index terms: tics, bruxism, trichotillomania, onychophagia, thumb sucking.