Faculty Bibliography

Network therapy was developed as a specialized type of combined individual and group therapy to ensure greater success in the office-based treatment of addicted patients by using both psychodynamic and cognitive-behavioral approaches to individual therapy while engaging the patient in a group support network composed of family members and peers. This article outlines the role of group cohesiveness as a vehicle for engaging patients in this treatment; the patient's family and peers are used as a therapeutic network, joining the patient and therapist at intervals in therapy sessions. This network is managed by the therapist to provide cohesiveness and support, to undermine denial, and to promote compliance with treatment. The author presents applications of the network technique designed to sustain abstinence and describes means of stabilizing the patient's involvement. Some specific techniques discussed include ambulatory detoxification, disulfiram and naltrexone administration, relapse prevention, and contingency contracting. Also discussed are recent research on the use of psychiatric residents and counselors for treatment, and use of the Internet in dissemination

At the conclusion of a 3-year demonstration project in a medical setting in which refusal to accept methadone was an inclusion criterion, 12 subjects were unable to detoxify from buprenorphine and remained adamant in their refusal to enroll in a MMTP. In order to study the feasibility of expanding opportunities for treatment previously unavailable to this under-served population of heroin addicts, these 12 subjects plus an additional 11 subjects (N = 23) were recruited for a 12 months trial of buprenorphine treatment conducted in an office-based setting on a fee-for-service basis. An additional cohort of 40 heroin dependent subjects were entered in a protocol for detoxification only. The findings demonstrate both feasibility and patient acceptance of office based fee-for-service buprenorphine treatment, supporting the need for (1) additional studies of this population and (2) changes in government regulations to reintroduce addiction treatment under physician auspices in private practice settings

According to the Therapeutic Community (TC) treatment approach, social affiliation with the drug-free peer community is the basis for patients initiating therapeutic change. A total of 322 TC residents were assessed with regard to social affiliation, acceptance of TC philosophy, perceived benefit of program components, level of depression, and length of time in treatment. Residents exhibited a higher level of affiliation with TC members than with untreated substance abusers they knew outside the program. Being female, and separated from a spouse, were each associated with a higher level of TC member affiliation. After controlling for sociodemographic characteristics, two variables emerged as unique significant correlates of affiliation: perceived benefit for recovery of TC treatment was associated with greater TC member affiliation, whereas level of depression was inversely correlated. These findings are interpreted in relation to the goals of the TC process and to implications for treatment

In response to the US Supreme Court case of Kumho Tire Com. Ltd. v. Carmichael (1999) the defendant/petitioner (Kumho) and amici for the defendant made assertions that juries have known tendencies to be improperly influenced by expert evidence. This brief addresses the issue of jury performance and jury responses to expert testimony. It reviews and summarizes a substantial body of research evidence about jury behavior that has been produced over the past quarter century. The body of empirical research findings conducted contradicts the petitioner's assumptions. Surveys of both federal and state judges show that the overwhelming majority believe that juries are competent and conscientious. Studies comparing judges' opinions of the evidence at trial show substantial agreement with verdicts rendered by juries. Evidence challenges the view that jurors abdicate their responsibilities as fact-finders when faced with expert evidence or that they are pro-plaintiff, anti-defendant, and anti-business. This brief sharply challenges the view expressed in the petitioners' and amici' briefs that juries are composed of persons who suspend critical reasoning skills whenever experts testify in a trial.

This report examines the impact of managed care (MC) and related developments on substance abuse treatment, and evaluates how it has been associated with a decline in the availability of proper treatment for many addicted patients. A trend toward carve-out and for-profit MC organizations is associated with lower financial incentives for intensive treatment than in earlier staff-model and not-for-profit MC organizations. The value of substance abuse insurance coverage has declined by 75% between 1988 and 1998 for employees of mid-to large-size companies, compared with only an 11.5% decline for general health insurance. The shift towards MC has also been associated with a drastic reduction in frequency and duration of inpatient hospitalization, and there is no clear evidence that this reduction has been offset by a corresponding increase in outpatient support. In a survey of physicians treating addiction, the majority felt that MC had a negative impact on detoxification and rehabilitation, and on their ethical practice of addiction medicine