Ronald D. Serota

Gender differences and similarities in African-American crack cocaine abusers

Recent interest in womens health and patient-treatment matching has focused attention on gender differences among substance abusers. This article seeks to extend research in this area to African-American crack cocaine abusers. It describes gender differences and similarities in a large sample (652 males and 595 females) of this important group of patients at a publicly funded, inner-city intensive outpatient clinic. As in previous studies on white working-class inpatients, few significant gender differences were found on demographic characteristics or drug use or treatment histories. Moreover, there were few differences in psychiatric symptomatology, and none in treatment participation or retention. In contrast to some reports, we did not find that women entered treatment with higher levels of depression than men. Most statistically significant differences we found were either too small to be of practical importance, or reflected conventional gender differences ( e. g., women were more likely to care for dependents). —J Nerv Ment Dis 183:260-266, 1995

Underreporting of Cocaine Use at Posttreatment Follow-up and the Measurement of Treatment Effectiveness

Substance abusers, especially cocaine abusers, may underreport their substance use in outcome interviews. Follow-up interviews were conducted and urine specimens were obtained on 633 persons 9 months after admission to a 3-month cocaine treatment program. Although 422 (67%) reported no use of cocaine in the past 30 days, 134 of these (32%) had cocaine-positive urines. This group did not differ on most characteristics at intake or follow-up from the 288 with cocaine-negative urines. The amount of treatment received did affect willingness to admit drug use. Of 132 treatment completers who reported no cocaine use at follow-up, 21 (16%) had positive urines. Of 91 early dropouts who also reported no cocaine use, 36 (40%) had positive urines. This differential rate of underreporting had the effect of seriously underrepresenting the effectiveness of treatment completion as compared with little or no treatment.

Patient Treatment Choice and Compliance: Data from a Substance Abuse Treatment Program

The authors tested the hypothesis that patients (treatment-seeking cocaine-dependent persons) given the opportunity to choose between treatment approaches would do better than patients randomly assigned to the same approaches in treatment retention and 9-month outcome. Subjects were 34 patients who voluntarily chose to enter individual therapy 1 hour per week (IND) and 33 who chose intensive group therapy for 3 hours, 3 times weekly (INT). There were no significant differences between these two groups on demographic, personality, or addiction severity variables or in treatment retention or 9-month outcome. Comparison with samples of 30 patients who had been randomly assigned to IND and 30 to INT did not confirm the hypothesis that patients who chose their treatment would either remain in treatment for longer periods of time or manifest improved 9-month outcomes. The authors raise several motivational issues.

Correlates of employment : A cohort study

Employment is often viewed as a potent indicator of substanceabuse treatment outcome. This study was conducted to determine if personalityand/or demographic characteristics of a cohort of unemployed substance dependentpersons presenting for addiction treatment might predict employment 9 monthspostadmission. By using stepwise discriminant function analysis, seven variablespredictive of employment were identified. The positive value of employmentwas clearly documented. Those who gained employment were functioning betterwith regard to social and drug-use parameters than those who did not.

Characteristics of cocaine-addicted individuals who abuse their partners.

The purpose of this study was to determine what proportion of individuals entering treatment for cocaine dependence admitted to battering an intimate partner and to compare the characteristics of those who were not identified as batterers. Of the 77 men in the sample, 38% were characterized as cocaine-dependent batterers. The batterers and nonbatterers were found to differ on a variety of background and assessment variables. Cocaine-dependent batterers more often reported a history of serious conflict with their sexual partner, trouble controlling violent behavior, greater psychiatric disturbance, difficulty relaxing, and being easily annoyed. A summary of the findings as well as implications for future research are discussed.

Prediction of length of stay in an inpatient dual diagnosis unit

The institution of prospective payment systems, in which flat fees are paid per discharge, raised the concern that hospitals might preferentially admit patients expected to have a short length of stay (LOS). This concern presupposes that intake workers could accurately predict psychiatric hospitalization LOS, but this does not appear to have been empirically demonstrated. Accordingly, we examined the ability of two psychiatrists heading separate treatment teams on an inpatient, dual-diagnosis unit and a program coordinator who worked with both teams to predict LOS for 94 patients consecutively admitted to one or the other of these teams. Predictions were highly consistent across the raters and were significantly correlated with actual LOS (r = 0.25, 0.35, and 0.45 for the three raters). However, we found that the psychiatrists were accurate predictors only for patients for whom they were the attending psychiatrist. The program coordinator, who was involved in the treatment of all patients, was an accurate predictor for the patients of either psychiatrist. We concluded that the relationships found between predicted and actual LOS held true only when the rater also influenced treatment management and discharge. Our results do not support the proposition that specialized intake workers independent of those providing care would be able to predict LOS accurately.