Faculty Bibliography

This study compared the efficacy of 2 approaches for the treatment of cocaine dependence among methadone-maintained patients with and without antisocial personality disorder (ASPD). Patients were randomly assigned to 4 study conditions: cognitive-behavioral treatment (CBT), contingency management (CM), CBT with CM, or methadone maintenance. The Structural Clinical Interview for Mental Disorders-IV was administered to 108 patients to assess ASPD. A 2-way analysis of variance showed that patients with ASPD were more likely to abstain from cocaine use during treatment than patients without ASPD. The strong treatment effect for ASPD patients was primarily due to the CM condition. Regression analyses showed that ASPD remained significantly related to CM treatment responsivity while controlling for other factors.

This study of 97 cocaine-dependent subjects assessed differences in the effects of cognitive behavioral therapy (CBT) and non-CBT treatments, such as contingency management (CM) and methadone maintenance, on patients' adoption of drug avoidance activities (DAA) after treatment, and whether the adoption of these activities was associated with sustained reductions in cocaine use during the follow-up period. Subjects who had been exposed to CBT reported more frequent engagement in drug-use avoidance activities at treatment end and at the 1-year follow-up than did subjects assigned to either the CM or control conditions. The composite DAA scores were significantly related to cocaine abstinence at both follow-up contacts. This finding suggests the importance of adopting a range of avoidance activities and engaging in them frequently, rather than relying on any single activity. Further, a series of multivariate regression models revealed that a subject's total DAA score accounted for more variance than did treatment group assignment in predicting reduced cocaine use over the 1-year follow-up period.

BACKGROUND:This study compared 2 psychosocial approaches for the treatment of cocaine dependence: contingency management (CM) and cognitive-behavioral therapy (CBT). METHODS:Patients with cocaine dependence who were receiving methadone maintenance treatment (n = 120) were randomly assigned to 1 of 4 conditions: CM, CBT, combined CM and CBT (CBT + CM), or treatment as usual (ie, methadone maintenance treatment program only [MMTP only]) (n = 30 per cell). The CM procedures and CBT materials were comparable to those used in previously published research. The active study period was 16 weeks, requiring 3 clinic visits per week. Participants were evaluated during treatment and at 17, 26, and 52 weeks after admission. RESULTS:Urinalysis results during the 16-week treatment period show that participants assigned to the 2 groups featuring CM had significantly superior in-treatment urinalysis results, whereas urinalysis results from participants in the CBT group were not significantly different than those from the MMTP-only group. At week 17, self-reported days of cocaine use were significantly reduced from baseline levels for all 3 treatment groups but not for the MMTP-only group. At the 26-week and 52-week follow-up points, CBT participants showed substantial improvement, resulting in equivalent performance with the CM groups as indicated by both urinalysis and self-reported cocaine use data. CONCLUSIONS:Study findings provide solid evidence of efficacy for CM and CBT. Although the effect of CM is significantly greater during treatment, CBT appears to produce comparable long-term outcomes. There was no evidence of an additive effect for the 2 treatments in the CM + CBT group.

Recent epidemiological surveys of illicit substance use show a particularly high prevalence of methamphetamine use in the western and southwestern United States-most notably California. Moreover, in their analysis of 1995 Drug Use Forecasting data, Anglin and colleagues (1998) found that methamphetamine was a preferred substance among California arrestees. The present study uses data from 807 state prison inmates in California (32% of whom reported using methamphetamine prior to incarceration) to examine the associations between methamphetamine use and HIV risk behaviors. Methamphetamine users in this sample were significantly more likely than nonusers to have injected drugs during the six months prior to their current incarceration. Among injectors, however, injection-related risks (such as dirty needles and needle sharing, etc.) were not significantly associated with methamphetamine use. However, past six-month sex-related risks were dramatically higher for methamphetamine users. These patterns persisted even after controlling for background differences between the two groups. The results of this study underscore the importance of addressing the higher sex-related HIV/AIDS risk among methamphetamine users undergoing prison-based drug treatment.

This paper presents approaches used in one rural U.S. state to describe the level of injecting drug use and to estimate the number of injectors not receiving drug-user treatment. The focus is on two broad areas of estimation that were used to present the prevalence of injecting drug use in Kentucky. The first estimation approach uses available data from secondary data sources. The second approach involves three small community studies.

In 1974, Robert Martinson, an adjunct assistant professor at the City College of New York, published an article titled "What Works?"”Questions and Answers About Prison Reform" (Martinson, 1974). In it, he summarized the results of a 3-year project"”Effectiveness of Correctional Treatment (ECT)"”which reviewed the effectiveness of 231 offender rehabilitation programs that had been evaluated during the prior 30 years (see also Lipton, Martinson, & Wilks, 1975). Based on his analysis of what was the most extensive offender treatment database that existed at that time, he concluded that "with few and isolated exceptions, the rehabilitative efforts that have been reported so far have had no appreciable effect on recidivism" (p. 25). Martinson's article has since been cited, perhaps naively, as one of the precipitating factors that quashed the treatment-oriented zeitgeist of the 1970s. In truth, Martinson may have provided an invaluable service to the rehabilitation movement by inadvertently giving human form to the undercurrents of skepticism that already existed. Thanks to Martinson, a once fragmented cadre of researchers and clinicians found themselves working in concert to refute what Martinson himself later described as a mischaracterization of his argument. But in these fevered attempts to prove Martinson wrong and, in some cases, vilify him personally, we may have ignored the most important part of his message. © 2002, Sage Publications. All rights reserved.