Faculty Bibliography

Mental health practitioners in the office setting are often seen as deficient in addiction treatment skills. Relevant training in often quite limited, and trainees are generally not introduced in an effective office-based modality. We studied the feasibility of teaching beginning therapists how to apply Network Therapy, a cognitive-behavioral approach to achieving abstinence and preventing relapse that augments individual therapy with support from family and friends. The therapists were 19 psychiatric residents without experience in substance abuse treatment or outpatient therapy, and the patients were 24 cocaine-dependent patients who received a 24-week course of Network treatment. The patients remained in treatment for an average of 15.4 weeks. Seventy-nine percent of their observed weekly urine toxicologies were negative for cocaine, and 42% of patients produced clean urines in the 3 weeks immediately before termination. The overall outcome compares favorably with that reported in studies on cocaine treatment where experienced therapists were employed. Our results suggest that naive mental health trainees can be taught to apply Network Therapy for effective substance abuse management. This is particularly relevant to technology transfer for general mental health trainees, who are often thought to be perceived to be refractory to learning about the outpatient management of addiction

Reviews substance abuse training in psychiatric residency education in an attempt to highlight the importance of training psychiatric residents in addiction. This paper is intended for faculty members responsible for teaching addiction psychiatry to residents. Education of psychiatrists in addiction is reviewed, and the relevant issues and societal pressures are identified. Topics and suggested educational strategies are presented for teaching psychiatric residents about the pathology and treatments associated with substance abuse. Sbstacles to addiction psychiatry training are addressed and conclusions are presented. Topics covered in this outline of a model curriculum include effective diagnosis, medical complications of substance abuse, the disease model, dual diagnosis, and treatment selection.

Substance abuse treatments are increasingly employing standardized formats. This is especially the case for approaches that utilize an individual psychotherapy format but less so for family-based approaches. Network therapy, an approach that involves family members and peers in the patient's relapse prevention efforts, is theoretically and clinically differentiated in this paper from family systems therapy for addiction. Based on these conceptual differences, a Network Therapy Rating Scale (NTRS) was developed to measure the integrity and differentiability of network therapy from other family-based approaches to addiction treatment. Seven addictions faculty and 10 third- and fourth-year psychiatry residents recently trained in the network approach used the NTRS to rate excerpts of network and family systems therapy sessions. Data revealed the NTRS had high internal consistency reliability when utilized by both groups of raters. In addition, network and nonnetwork subscales within the NTRS rated congruent therapy excerpts significantly higher than noncongruent therapy excerpts, indicating that the NTRS subscales measure what they are designed to measure. Implications for research and training are discussed

The authors measured perceived social support among patients and their families as a predictor of retention in an inpatient addiction rehabilitation program. After detoxification from all substances of abuse, 66 sequentially admitted inpatients gave demographic and diagnostic information and completed scales of perceived social support from the program and their own families. Scales were completed at 7, 14, and 21 days. A total of 46 subjects completed the 21-day program, and 20 did not. Homeless status, initial weak perceived social support from family, and a relatively shorter history of crack-cocaine use were correlated with completion of the program. Patients with stronger connections to shelter and family were less likely to complete an inpatient addiction rehabilitation program. Patients who reported more years of crack-cocaine use were also less likely to complete the program. The authors discuss implications for treatment

The authors reviewed the charts of all women and a randomly selected sample of men over a 6-month period on two addiction treatment units at Bellevue Hospital Center in New York. The men were more likely to be admitted with schizophrenia and to have used substances of abuse other than alcohol, and the women were more likely to be admitted with affective disorders. Also, the women on the dual-diagnosis ward were more likely to be domiciled (i.e., not homeless), and the women on both units were significantly more likely to report having been crime victims. These findings suggest that dually diagnosed women need a substantially different treatment paradigm from men

The efficacy of the drug-free therapeutic community (TC) in treating patients with chemical dependence and in rehabilitating persons with criminal histories has been extensively studied and is well established since the late 1960's. More recently, this format has been modified in order to treat individuals suffering from both addictive disorders and chronic, severe mental illness. In an indigent inner-city population, this latter group includes many patients who also have significant histories of criminal behavior. To date, there have been no systematic attempts to assess the impact of a history of criminality on the course of treatment of these patients, as they might be thought less adaptable to the milieu of a TC. In the current study, data from a sample of homeless male MICA patients were analyzed to determine if those patients with a history of criminal convictions were as likely as non-criminal patients to adjust effectively to the social milieu of a modified drug-free therapeutic community. Of 183 sequential admissions studied, 76 had never been convicted of a crime, 46 had 1 conviction, and 61 had 2 or more. No differences were observed between the groups with respect to length of stay, social adjustment on admission, and change in social adjustment during the first two months of treatment. These findings suggest that a history of criminal conduct does not compromise a dually diagnosed patient's likelihood of engaging in the social contract necessary for successful treatment in a TC.

When confronted by the threat of illness, general medical and psychiatric patients may turn to treatments that have a spiritual orientation but lack empirical validation. This article examines the nature of contemporary movements that offer these treatments and their impact on medical care. A typology of spiritually oriented recovery movements is presented, including those associated with established religions, holistic medicine, or programs for self-liberation. Possible mechanisms for their behavioral and physiologic impact on health status are discussed. The psychological appeal of these treatments is analyzed in light of the way sick people may attribute meaning to illness and may then become engaged into a spiritual recovery movement, achieve a sense of self-efficacy through affiliation, and finally comply with putative 'healing' practices. Although some spiritual recovery movements provide hope in the face of illness and even offer therapeutic benefits, they may also discourage patients from getting appropriate medical treatment and promote harmful regimens. Options are discussed for mental health professionals' response to the spiritual orientation of their patients and options for future research