Stephen D. Husband

Reinforcing operants other than abstinence in drug abuse treatment: an effective alternative for reducing drug use.

This study examines the effectiveness of using vouchers to reinforce either the provision of urine samples testing negative for illicit drugs (UA group) or the completion of objective, individually defined, treatment-plan-related tasks (TP group). A third group was assigned to the clinics standard treatment (STD group). Participants were randomly assigned to groups after a 6-week baseline-stabilization period. Urine specimens were collected thrice weekly throughout the study. In the UA condition, participants earned

Impact of Comorbid Personality Disorders and Personality Disorder Symptoms on Outcomes of Behavioral Treatment for Cocaine Dependence

5 (U.S. dollars) in vouchers for each drug-free urine submitted. In the TP condition, participants earned up to

Decline in self-reported dysphoria after treatment entry in inner-city cocaine addicts.

15 in vouchers per week for demonstrating completion of treatment plan tasks assigned by their counselors. Contingencies were in effect for 12 weeks, after which all participants received the clinics standard treatment. Urinalysis results indicate that the TP intervention was significantly more effective in reducing illicit drug use than either the UA or STD interventions. These effects were maintained with a trend toward continuing improvement for the TP groups even after contingencies were discontinued.

A Cognitive Problem-Solving Employment Readiness Intervention for Methadone Clients

Studies have revealed a significant adverse impact of comorbid personality disorders on treatment tenure and outcome in a variety of psychiatric and substance abuse populations. We investigated whether this negative relationship also exists among 137 urban, poor, cocaine abusers in behaviorally oriented treatment. Axis II diagnoses were generated categorically using the SCID-II as well as dimensionally using numbers of SCID-II symptoms within diagnostic categories. Contrary to expectations, there were no significant differences between subjects with and without various categorical personality disorders on any outcome measures. Categorical Axis II diagnoses were also minimally correlated with drug use severity, depression, and anxiety at intake, indicating that these were not potential coveriates of outcome. However, dimensional analyses of personality symptoms generated from the SCID-II accounted for substantial proportions of variance in treatment outcomes. Implications of these data for Axis II assessment and drug treatment planning are discussed.

The Cognitive Skills Component in Substance Abuse Treatment in Correctional Settings: A Brief Review

This study examined self-reported dysphoria in 82 consecutive admissions to intensive outpatient treatment for cocaine abuse on whom data for the Beck scales for depression, anxiety, and hopelessness were available for intake and 4 subsequent weeks with no more than 1 missing data point. Mean scores on the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) decreased significantly between intake and Week 1, with no further significant changes from Weeks 1-4. Similar drops in the rate of clinically significant BDI and BAI scores also were observed. Scores on the Beck Hopelessness Scale (BHS) showed no significant changes. By Week 4, rates of clinically significant depression, anxiety, and hopelessness were similar (17%, 13%, and 16%, respectively). These findings suggest that assessing depression and anxiety using the BDI and BAI in this population should be postponed for at least 1 week after intake and that intake levels of self-reported mood may be inappropriate baseline measures for evaluating treatment effects.

Situations occasioning cocaine use and cocaine abstinence strategies

Employment has been identified as a major goal of drug abuse treatment yet few rigorous tests of employment-related interventions have been conducted. A10-session, manual-guided vocational cognitive problem-solving intervention was evaluated at five methadone treatment sites in an effort to reduce the high unemployment rate among methadone clients. The group intervention focused on helping participants explore the value they place on work, identifying social and psychological barriers to work, developing action strategies to overcome those barriers, setting realistic expectations of work, and taking action. At six months post-intervention, the experimental group (N = 67) demonstrated a significant increase in employment rate (13.4% to 26.9%); no significant change occurred for controls (N = 63). At 12 months post-intervention, however, overall employment gains declined in the experimental group, suggesting the need for additional intervention in order to maintain employment gains.

Quick Test and Wechsler Adult Intelligence Scale-Revised in a Prison's Clinical Setting:

Cognitive skills training programs of different types have been used with various populations, including substance abusers, to successfully teach skills so that individuals can function more adaptively. Yet, with a few notable exceptions, there is a paucity of reports in the literature describing the inclusion of a cognitive skills component in correctional substance abuse treatment. Moreover, there is a serious lack of substance abuse treatment programs in many of the nations jails; this is in spite of the fact that a substantial number of the nations prisoners have been identified as substance abusers or are incarcerated for drug-related crimes. This article provides a brief overview of cognitive skills interventions, and highlights two correctional treatment programs that incorporated a cognitive component and provided for a controlled outcome evaluation.

THE QUICK TEST COMPARED WITH THE WECHSLER ADULT INTELLIGENCE SCALE AS MEASURES OF INTELLECTUAL FUNCTIONING IN A PRISON CLINICAL SETTING

We interviewed 265 cocaine-experienced methadone patients about situations that occasioned their cocaine use and strategies they used to avoid cocaine use. Subjects identified an average of 15 situations that occasioned cocaine use. The three most frequently identified were having the drug present (86% of subjects), being offered the drug (85%) and having money available (83%). Subjects reporting fewer situations also reported longer periods of lifetime abstinence (p < 0.01). A principal components analysis extracted 10 groups of situations that were most frequently identified in combination. Subjects identified a median of seven strategies for avoiding cocaine use; however, there was large inter-subject variability. This variance was not accounted for by demographic variables, employment status or treatment experience. The three strategies identified most frequently were avoiding people and places (81%), thinking about what they could lose (76%) and leaving the situation (66%). The total number and type (reactive vs. proactive) of strategies identified by subjects had no relationship to cocaine abstinence, although four specific strategies (thinking about what could be lost, leaving the situation, moving to a new area and using a different drug) were positively correlated with cocaine abstinence. We discuss implications of these results for clinical practice.

Problem-solving types among high-risk IDUs: Potential treatment implications

The Quick Test and the WAIS-R were administered to 20 male patients (12 black, 8 white) in an urban prisons psychiatric hospital. The mean chronological age of the sample was 29 yr. Strong positive correlations ranged from .64 to .90 between the Quick Test IQs and the WAIS-R Verbal Scale IQs and Full Scale IQs, with a modest relationship to Performance IQs. These findings suggest that the Quick Test provides a reasonable estimate of conventional verbal intelligence for a population in an urban prisons clinical setting.

Assessment of coercive and noncoercive pressures to enter drug abuse treatment

The Quick Test and the WAIS were administered to 40 patients (39 males, one female) in an urban prison hospital. 34 patients were black. Chronological ages of the sample ranged from 16 to 39 yr., with a mean age of 27 yr. Analysis showed a strong positive correlation between the Quick Test IQs and the WAIS Verbal Scale IQs, Performance Scale IQs, and Full Scale IQs. These findings suggest that the Quick Test provides a reasonable estimate of conventional verbal intelligence in an urban minority prison population.