51
|
Carroll KM, Ball SA, Nich C, Martino S, Frankforter TL, Farentinos C, Kunkel LE, Mikulich-Gilbertson SK, Morgenstern J, Obert JL, Polcin D, Snead N, Woody GE. Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug Alcohol Depend 2006; 81:301-12. [PMID: 16169159 PMCID: PMC2386852 DOI: 10.1016/j.drugalcdep.2005.08.002] [Citation(s) in RCA: 284] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 07/29/2005] [Accepted: 08/08/2005] [Indexed: 12/17/2022]
Abstract
Despite recent emphasis on integrating empirically validated treatment into clinical practice, there are little data on whether manual-guided behavioral therapies can be implemented in standard clinical practice and whether incorporation of such techniques is associated with improved outcomes. The effectiveness of integrating motivational interviewing (MI) techniques into the initial contact and evaluation session was evaluated in a multisite randomized clinical trial. Participants were 423 substance users entering outpatient treatment in five community-based treatment settings, who were randomized to receive either the standard intake/evaluation session at each site or the same session in which MI techniques and strategies were integrated. Clinicians were drawn from the staff of the participating programs and were randomized either to learn and implement MI or to deliver the standard intake/evaluation session. Independent analyses of 315 session audiotapes suggested the two forms of treatment were highly discriminable and that clinicians trained to implement MI tended to have higher skill ratings. Regarding outcomes, for the sample as a whole, participants assigned to MI had significantly better retention through the 28-day follow-up than those assigned to the standard intervention. There were no significant effects of MI on substance use outcomes at either the 28-day or 84-day follow-up. Results suggest that community-based clinicians can effectively implement MI when provided training and supervision, and that integrating MI techniques in the earliest phases of treatment may have positive effects on retention early in the course of treatment.
Collapse
|
52
|
Ball SA, Carroll KM, Canning-Ball M, Rounsaville BJ. Reasons for dropout from drug abuse treatment: symptoms, personality, and motivation. Addict Behav 2006; 31:320-30. [PMID: 15964152 DOI: 10.1016/j.addbeh.2005.05.013] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 05/13/2005] [Indexed: 11/22/2022]
Abstract
Previous research has identified risk factors for early attrition from substance abuse treatment, but has not assessed reasons for dropout from the client's perspective. Interview and self-report assessment data were collected from 24 clients who prematurely terminated outpatient treatment to evaluate their subjective reasons for dropping out and the association of these reasons with demographic and clinical variables. Items from scales indicating problems with client motivation or conflicts with program staff were the most commonly endorsed. The severity of participant's symptoms and logistical problems interfering with appointments were less commonly reported as reasons for dropping out. Demographic, substance abuse, and motivational stage indicators were infrequently associated with subjective reasons for dropout. In contrast, indicators of maladaptive personality functioning were strongly associated with many reasons for dropping out, especially concerns about privacy and boundary issues within the program. Results from this preliminary evaluation will guide the development of an instrument and intervention focused on dropout risk factors and treatment reengagement.
Collapse
|
53
|
Carroll KM, Nich C, Ball SA. Practice makes progress? Homework assignments and outcome in treatment of cocaine dependence. J Consult Clin Psychol 2005; 73:749-55. [PMID: 16173864 PMCID: PMC2365906 DOI: 10.1037/0022-006x.73.4.749] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The relationship between treatment outcome and the extent to which participants completed homework assignments was evaluated among 60 cocaine-dependent individuals assigned to cognitive-behavioral therapy (CBT). Homework was assigned in 72% of all sessions and initiated by participants in 48% of the sessions in which it was assigned. Completion of homework was unrelated to participants' baseline characteristics and several indicators of treatment compliance. Participants who completed more homework assignments demonstrated significantly greater increases in the quantity and quality of their coping skills and used significantly less cocaine during treatment and through a 1-year follow-up. These data suggest that the extent to which participants are willing to complete extrasession assignments may be an important mediator of response to CBT.
Collapse
|
54
|
Ball SA, Cobb-Richardson P, Connolly AJ, Bujosa CT, O'neall TW. Substance abuse and personality disorders in homeless drop-in center clients: symptom severity and psychotherapy retention in a randomized clinical trial. Compr Psychiatry 2005; 46:371-9. [PMID: 16122538 DOI: 10.1016/j.comppsych.2004.11.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2004] [Accepted: 11/05/2004] [Indexed: 11/21/2022] Open
Abstract
This study evaluated the psychiatric symptoms, psychosocial problems, and treatment response of personality-disordered substance abusers receiving services within a homeless drop-in center. Fifty-two homeless clients were assessed after program admission and randomly assigned to receive either individual psychotherapy focused on personality disorder and substance abuse relapse prevention (dual-focus schema therapy [DFST]) or standard group substance abuse counseling (SAC). Client functioning was assessed using measures of personality disorder, psychiatric symptoms, early maladaptive schemas, interpersonal problems, and addiction-related psychosocial impairment. Therapy retention (total weeks in treatment) and utilization (number of weeks in which sessions were attended) were the primary outcomes. Although rates of cluster B personality disorders were comparable to other substance dependent samples, clusters A and C disorders were disproportionately more common. Clients reported significant psychiatric symptoms, criminality, and psychosocial impairment, yet made limited lifetime use of mental health services. Overall, there was greater utilization of individual DFST than group SAC. However, clients with more severe personality disorder symptoms demonstrated better utilization of SAC than DFST.
Collapse
|
55
|
Sholomskas DE, Syracuse-Siewert G, Rounsaville BJ, Ball SA, Nuro KF, Carroll KM. We don't train in vain: a dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. J Consult Clin Psychol 2005; 73:106-15. [PMID: 15709837 PMCID: PMC2367057 DOI: 10.1037/0022-006x.73.1.106] [Citation(s) in RCA: 407] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
There has been little research on the effectiveness of different training strategies or the impact of exposure to treatment manuals alone on clinicians' ability to effectively implement empirically supported therapies. Seventy-eight community-based clinicians were assigned to 1 of 3 training conditions: review of a cognitive-behavioral therapy (CBT) manual only, review of the manual plus access to a CBT training Web site, or review of the manual plus a didactic seminar followed by supervised casework. The primary outcome measure was the clinicians' ability to demonstrate key CBT interventions, as assessed by independent ratings of structured role plays. Statistically significant differences favoring the seminar plus supervision over the manual only condition were found for adherence and skill ratings for 2 of the 3 role plays, with intermediate scores for the Web condition.
Collapse
|
56
|
Todd M, Armeli S, Tennen H, Carney MA, Ball SA, Kranzler HR, Affleck G. Drinking to cope: a comparison of questionnaire and electronic diary reports. ACTA ACUST UNITED AC 2005; 66:121-9. [PMID: 15830912 DOI: 10.15288/jsa.2005.66.121] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this article is to assess the correspondence between questionnaire reports of dispositional drinking to cope (DTC) and different indices of daily DTC in a sample of nondependent heavy drinkers. METHOD Data from electronic diary (ED) records of interpersonal problems, negative affect, coping and drinking were used to examine how questionnaire reports of dispositional DTC corresponded to ED reports of daily DTC and to within-person associations among ED reports of negative affect, interpersonal problems and drinking. In the current study, 98 community-residing heavy drinkers using EDs recorded moods, interpersonal problems, coping attempts, desire to drink and drinking for 21 consecutive days. RESULTS The findings demonstrate correspondence between questionnaire reports of dispositional DTC and (1) ED reports of daily DTC, (2) intensity of negative mood associated with daily drinking initiation and (3) some between-person differences in within-day prediction of drinking and desire to drink from mood and interpersonal problem ratings. Those reporting higher dispositional DTC were somewhat more likely to drink in response to some negative moods and less likely to drink in response to some positive moods than those reporting relatively lower dispositional DTC, but these findings were mixed. CONCLUSIONS Questionnaire reports of dispositional DTC are at best inconsistently linked to observed within-person associations among daily moods, interpersonal problems and drinking even among heavy drinkers.
Collapse
|
57
|
Ball SA. Splitting lumps: type B or not type B; that is the question: a comment on Windle & Scheidt. Addiction 2004; 99:1610-1. [PMID: 15585054 DOI: 10.1111/j.1360-0443.2004.00947.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
58
|
Ball SA, Nich C, Rounsaville BJ, Eagan D, Carroll KM. Millon Clinical Multiaxial Inventory-III subtypes of opioid dependence: validity and matching to behavioral therapies. J Consult Clin Psychol 2004; 72:698-711. [PMID: 15301655 PMCID: PMC3709250 DOI: 10.1037/0022-006x.72.4.698] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The concurrent and predictive validity of 2 different methods of Millon Clinical Multiaxial Inventory-III subtyping (protocol sorting, cluster analysis) was evaluated in 125 recently detoxified opioid-dependent outpatients in a 12-week randomized clinical trial. Participants received naltrexone and relapse prevention group counseling and were assigned to 1 of 3 intervention conditions: (a) no-incentive vouchers, (b) incentive vouchers alone, or (c) incentive vouchers plus relationship counseling. Affective disturbance was the most common Axis I protocol-sorted subtype (66%), antisocial-narcissistic was the most common Axis II subtype (46%), and cluster analysis suggested that a 2-cluster solution (high vs. low psychiatric severity) was optimal. Predictive validity analyses indicated less symptom improvement for the higher problem subtypes, and patient treatment matching analyses indicated that some subtypes had better outcomes in the no-incentive voucher conditions.
Collapse
|
59
|
Carroll KM, Fenton LR, Ball SA, Nich C, Frankforter TL, Shi J, Rounsaville BJ. Efficacy of disulfiram and cognitive behavior therapy in cocaine-dependent outpatients: a randomized placebo-controlled trial. ACTA ACUST UNITED AC 2004; 61:264-72. [PMID: 14993114 PMCID: PMC3675448 DOI: 10.1001/archpsyc.61.3.264] [Citation(s) in RCA: 276] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Disulfiram has emerged as a promising treatment for cocaine dependence, but it has not yet been evaluated in general populations of cocaine users. OBJECTIVES To compare the effectiveness of disulfiram therapy with that of a placebo condition in reducing cocaine use and to compare the effectiveness of 2 active behavioral therapies-cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT)-in reducing cocaine use. DESIGN Randomized, placebo-controlled, double-masked (for medication condition), factorial (2 x 2) trial with 4 treatment conditions: disulfiram plus CBT, disulfiram plus IPT, placebo plus CBT, and placebo plus IPT. SETTING A community-based outpatient substance abuse treatment program. PATIENTS A total of 121 individuals meeting the criteria for current cocaine dependence. INTERVENTIONS Patients received either disulfiram (250 mg/d) or placebo in identical capsules. Medication compliance was monitored using a riboflavin marker procedure. Both behavioral therapies (CBT and IPT) were manual guided and were delivered in individual sessions for 12 weeks. MAIN OUTCOME MEASURES Random regression analyses of self-reported frequency of cocaine use and results of urine toxicology screens. RESULTS Participants assigned to disulfiram reduced their cocaine use significantly more than those assigned to placebo, and those assigned to CBT reduced their cocaine use significantly more than those assigned to IPT (P<.01 for both). Findings were consistent across all study samples (eg, intention to treat, treatment initiators, and treatment completers). Benefits of disulfiram use and CBT were most pronounced for participants who were not alcohol dependent at baseline or who fully abstained from drinking alcohol during treatment. Adverse effects experienced by participants who received disulfiram were mild and were not considerably different from those experienced by participants who received placebo. CONCLUSIONS Disulfiram and CBT are effective therapies for general populations of cocaine-dependent individuals. Disulfiram seems to exert a direct effect on cocaine use rather than through reducing concurrent alcohol use.
Collapse
|
60
|
Basu D, Ball SA, Feinn R, Gelernter J, Kranzler HR. Typologies of drug dependence: comparative validity of a multivariate and four univariate models. Drug Alcohol Depend 2004; 73:289-300. [PMID: 15036551 DOI: 10.1016/j.drugalcdep.2003.11.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2003] [Revised: 10/29/2003] [Accepted: 11/04/2003] [Indexed: 11/21/2022]
Abstract
Data from a longitudinal cohort study were used to directly compare the concurrent and predictive validity of four univariate typologic approaches with a multivariate approach in subtyping drug dependence. The four univariate typologies were based upon: (a) age-of-onset of drug abuse/dependence, (b) presence of drug abuse in first-degree relatives, (c) presence of antisocial personality disorder, and (d) sex. The multivariate typologic approach was based on indices of vulnerability, chronicity, consequences, and psychopathology, yielding the Type A/B dichotomy first demonstrated in alcohol dependence. Subtypes generated from the univariate typologies were then each compared with the multivariate typology on measures of concurrent and predictive validity, and the strength of association was compared statistically. There was evidence of significantly greater concurrent validity of the Type A/B typology compared with the univariate typologies across all the domains of validation (risk, substance use, psychopathology, personality, and overall functioning). The multivariate typology also fared better than the univariate ones in all three domains on which predictive validity was evaluated: substance use, psychopathology, and overall functioning, as well as the degree of change in several composite scores (drug, medical, legal, and psychiatric) and the global psychiatric symptom index. This direct method of comparison seemed to demonstrate the superior validity of the multivariate cluster-analytic approach over the univariate approaches to classifying subjects with drug dependence.
Collapse
|
61
|
Conway KP, Kane RJ, Ball SA, Poling JC, Rounsaville BJ. Personality, substance of choice, and polysubstance involvement among substance dependent patients. Drug Alcohol Depend 2003; 71:65-75. [PMID: 12821207 DOI: 10.1016/s0376-8716(03)00068-1] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors compared the association of several personality traits, drug of choice, and polysubstance involvement in 325 individuals (44% male) receiving treatment for substance dependence on heroin, cocaine, and/or alcohol. Measures included the Structured Clinical Interview for DSM-III-R, the MacAndrew Alcoholism Scale (MAC), the socialization scale of the California Psychological Inventory (CPI-Soc), the novelty seeking dimension of the Temperament and Character Inventory (TCI-NS), and the conscientiousness domain of the NEO Five-Factor Inventory (NEO-C). Analyses adjusted for demographic covariates, affective and antisocial personality disorder, and substance dependence severity. Although scant evidence supported the hypothesis that these personality traits were associated with substance choice, CPI-Soc and MAC were associated linearly with the extent of polysubstance involvement. Also, patients who were dependent on two or more substances displayed higher levels of TCI-NS, CPI-Soc, and MAC. Findings implicate an association between behavioral disinhibition and a continuum of addiction defined primarily in terms of polysubstance involvement.
Collapse
|
62
|
Carroll KM, Farentinos C, Ball SA, Crits-Christoph P, Libby B, Morgenstern J, Obert JL, Polcin D, Woody GE. MET meets the real world: design issues and clinical strategies in the Clinical Trials Network. J Subst Abuse Treat 2002; 23:73-80. [PMID: 12220604 PMCID: PMC3651591 DOI: 10.1016/s0740-5472(02)00255-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The Clinical Trials Network (CTN) represents a major initiative intended to bridge the gap between research and practice in substance abuse treatment by implementing a range of studies evaluating behavioral, pharmacologic, and combined treatments in community-based drug abuse treatment programs across the country. This article describes the development of CTN protocols evaluating the effectiveness of Motivational Enhancement Therapy and Motivational Interviewing. Design, training, and implementation challenges associated with conducting a clinical trial of brief behavioral treatments in community programs are discussed. Issues requiring attention included the diversity in treatments offered across sites, heterogeneity in the study sample, and training of clinicians drawn from the staff of community programs to deliver the study treatments.
Collapse
|
63
|
Carroll KM, Ball SA, Nich C, O'Connor PG, Eagan DA, Frankforter TL, Triffleman EG, Shi J, Rounsaville BJ. Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence: efficacy of contingency management and significant other involvement. ARCHIVES OF GENERAL PSYCHIATRY 2001; 58:755-61. [PMID: 11483141 PMCID: PMC3651594 DOI: 10.1001/archpsyc.58.8.755] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Contingency management (CM) and significant other involvement (SO) were evaluated as strategies to enhance treatment retention, medication compliance, and outcome for naltrexone treatment of opioid dependence. METHODS One hundred twenty-seven recently detoxified opioid-dependent individuals were randomly assigned to 1 of 3 conditions delivered for 12 weeks: (1) standard naltrexone treatment, given 3 times a week; (2) naltrexone treatment plus contingency management (CM), with delivery of vouchers contingent on naltrexone compliance and drug-free urine specimens; or (3) naltrexone treatment, CM, plus significant other involvement (SO), where a family member was invited to participate in up to 6 family counseling sessions. Principal outcomes were retention in treatment, compliance with naltrexone therapy, and number of drug-free urine specimens. RESULTS First, CM was associated with significant improvements in treatment retention (7.4 vs 5.6 weeks; P =.05) and in reduction in opioid use (19 vs 14 opioid-free urine specimens; P =.04) compared with standard naltrexone treatment. Second, assignment to SO did not significantly improve retention, compliance, or substance abuse outcomes compared with CM. Significant effects for the SO condition over CM on retention, compliance, and drug use outcomes were seen only for the subgroup who attended at least 1 family counseling session. The SO condition was associated with significant (P =.02) improvements in family functioning. CONCLUSION Behavioral therapies, such as CM, can be targeted to address weaknesses of specific pharmacotherapies, such as noncompliance, and thus can play a substantial role in broadening the utility of available pharmacotherapies.
Collapse
|
64
|
Ball SA, Rounsaville BJ, Tennen H, Kranzler HR. Reliability of personality disorder symptoms and personality traits in substance-dependent inpatients. JOURNAL OF ABNORMAL PSYCHOLOGY 2001. [PMID: 11358028 DOI: 10.1037//0021-843x.110.2.341] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors compared the internal consistency, 1-year temporal stability, and self-informant agreement of ratings of personality trait (NEO Five-Factor Inventory; NEO-FFI; P. T. Costa & R. R. McCrae, 1992) and personality disorder symptom severity (Structured Clinical Interview for DSM-III-R Personality Disorders Questionnaire; SCID-II-Q; R. L. Spitzer, J. B. W. Williams, M. Gibbon, & M. First, 1990) in 131 substance-dependent inpatients. Internal consistency coefficients were acceptable to very good for most NEO-FFI and SCID-II-Q scales, and temporal stability correlations were significant for all measures. Agreement between patient and informant ratings was more modest. Substance abuse and depression symptom severity moderated the temporal stability and self-informant agreement of several personality trait and disorder ratings. The authors did not find that the five factors were more reliable than the Axis II symptoms. Issues related to the reliability of personality assessment in multiply diagnosed patients are discussed.
Collapse
|
65
|
Ball SA. Reconceptualizing personality disorder categories using personality trait dimensions: introduction to special section. J Pers 2001; 69:147-53. [PMID: 11339793 DOI: 10.1111/1467-6494.00139] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The categorical model of personality disorders has been widely criticized, and many argue for it to be reconceptualized or replaced by a dimensional model rooted in personality trait research. Such criticisms have forged a much needed integration between the previously distinct research areas of normal and abnormal personality. The five articles in this special section provide compelling evidence for the usefulness of personality traits for describing and explaining the complexities of personality disorders among widely varying samples using very different assessment strategies.
Collapse
|
66
|
Abstract
We evaluated the association of Structure Clinical Interview for the DSM-IV Axis II (SCID-II) severity and personality traits, early maladaptive schemas, and presenting symptoms in 41 methadone-maintained patients meeting criteria for either antisocial, borderline, avoidant, or depressive personality disorder. Correlational analyses indicated that the severity of each personality disorder was associated with a unique profile of presenting problems and underlying traits and schemas. The evaluation of multiple psychological indicators appears to be a useful method for case conceptualization and planning interventions within a promising individual therapy model that focuses both on substance abuse and psychiatric symptoms and maladaptive schemas and coping styles.
Collapse
|
67
|
Ball SA, Rounsaville BJ, Tennen H, Kranzler HR. Reliability of personality disorder symptoms and personality traits in substance-dependent inpatients. JOURNAL OF ABNORMAL PSYCHOLOGY 2001; 110:341-52. [PMID: 11358028 DOI: 10.1037/0021-843x.110.2.341] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors compared the internal consistency, 1-year temporal stability, and self-informant agreement of ratings of personality trait (NEO Five-Factor Inventory; NEO-FFI; P. T. Costa & R. R. McCrae, 1992) and personality disorder symptom severity (Structured Clinical Interview for DSM-III-R Personality Disorders Questionnaire; SCID-II-Q; R. L. Spitzer, J. B. W. Williams, M. Gibbon, & M. First, 1990) in 131 substance-dependent inpatients. Internal consistency coefficients were acceptable to very good for most NEO-FFI and SCID-II-Q scales, and temporal stability correlations were significant for all measures. Agreement between patient and informant ratings was more modest. Substance abuse and depression symptom severity moderated the temporal stability and self-informant agreement of several personality trait and disorder ratings. The authors did not find that the five factors were more reliable than the Axis II symptoms. Issues related to the reliability of personality assessment in multiply diagnosed patients are discussed.
Collapse
|
68
|
Carroll KM, Nich C, Ball SA, McCance E, Frankforter TL, Rounsaville BJ. One-year follow-up of disulfiram and psychotherapy for cocaine-alcohol users: sustained effects of treatment. Addiction 2000; 95:1335-49. [PMID: 11048353 DOI: 10.1046/j.1360-0443.2000.95913355.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To evaluate outcomes 1 year after cessation of treatment for cocaine- and alcohol-dependent individuals. DESIGN Randomized controlled trial. SETTING Urban substance abuse treatment center. PARTICIPANTS Ninety-six of 122 subjects randomized to treatment. INTERVENTIONS One of five treatments delivered over 12 weeks. Cognitive-behavioral treatment (CBT) plus disulfiram; Twelve-Step facilitation (TSF) plus disulfiram; clinical management (CM) plus disulfiram; CBT without disulfiram; TSF without disulfiram. MEASUREMENTS Percentage of days of cocaine and alcohol use during follow-up, verified by urine toxicology screens and breathalyzer tests. RESULTS First, as a group, participants reported significant decreases in frequency of cocaine, but not alcohol, use after the end of treatment. Secondly, the main effects of disulfiram on cocaine and alcohol use were sustained during follow-up. Finally, initiation of abstinence for even brief periods of time within treatment was associated with significantly better outcome during follow-up. CONCLUSIONS These findings support the efficacy of disulfiram with this challenging population and suggest that comparatively brief treatments that facilitate the initiation of abstinence may have long-term benefits.
Collapse
|
69
|
Gorelick DA, Hittner JB, Ball SA. Book review. Subst Abus 2000. [DOI: 10.1080/08897070009511433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
70
|
Wilfley DE, Friedman MA, Dounchis JZ, Stein RI, Welch RR, Ball SA. Comorbid psychopathology in binge eating disorder: relation to eating disorder severity at baseline and following treatment. J Consult Clin Psychol 2000; 68:641-9. [PMID: 10965639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Individuals with binge eating disorder (BED) have high rates of comorbid psychopathology, yet little is known about the relation of comorbidity to eating disorder features or response to treatment. These issues were examined among 162 BED patients participating in a psychotherapy trial. Axis I psychopathology was not significantly related to baseline eating disorder severity, as measured by the Structured Clinical Interview for DSM-III-R (SCID-I and SCID-II) and the Eating Disorder Examination. However, presence of Axis II psychopathology was significantly related to more severe binge eating and eating disorder psychopathology at baseline. Although overall presence of Axis II psychopathology did not predict treatment outcome, presence of Cluster B personality disorders predicted significantly higher levels of binge eating at 1 year following treatment. Results suggest the need to consider Cluster B disorders when designing treatments for BED.
Collapse
|
71
|
Ball SA, Young JE. Dual Focus Schema Therapy for personality disorders and substance dependence: Case study results. COGNITIVE AND BEHAVIORAL PRACTICE 2000. [DOI: 10.1016/s1077-7229(00)80083-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
72
|
Ball SA, Jaffe AJ, Crouse-Artus MS, Rounsaville BJ, O'Malley SS. Multidimensional subtypes and treatment outcome in first-time DWI offenders. Addict Behav 2000; 25:167-81. [PMID: 10795943 DOI: 10.1016/s0306-4603(99)00053-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The concurrent and predictive validity of Type A and B alcoholism subtypes was evaluated in 246 first-time driving-while-intoxicated (DWI) offenders. K-means analysis indicated that a two-cluster solution was optimal with Type Bs (28%) exhibiting greater premorbid risk factors, alcohol and psychosocial severity, drinking consequences, psychopathology, higher stage of change, and less coping confidence in comparison to less severe Type As (72%). After baseline assessment, participants were randomly assigned to one of three 10-week group treatments (DWI Education, Coping Skills, Interactional), and reassessed at termination, and at 6-month and 1-year follow-ups. Type B was associated with more severe symptoms after treatment, but there was no evidence for patient-treatment matching effects. Although Type A/B may be an important theoretical model for guiding alcoholism research, it usefulness and efficiency for treatment matching, planning, or placement purposes is questioned.
Collapse
|
73
|
Wilfley DE, Friedman MA, Dounchis JZ, Stein RI, Welch RR, Ball SA. Comorbid psychopathology in binge eating disorder: Relation to eating disorder severity at baseline and following treatment. J Consult Clin Psychol 2000. [DOI: 10.1037/0022-006x.68.4.641] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
74
|
Carroll KM, Nich C, Sifry RL, Nuro KF, Frankforter TL, Ball SA, Fenton L, Rounsaville BJ. A general system for evaluating therapist adherence and competence in psychotherapy research in the addictions. Drug Alcohol Depend 2000; 57:225-38. [PMID: 10661673 DOI: 10.1016/s0376-8716(99)00049-6] [Citation(s) in RCA: 286] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Yale Adherence and Competence Scale (YACS) is a general system for rating therapist adherence and competence in delivering behavioral treatments for substance use disorders. The system includes three scales measuring 'general' aspects of drug abuse treatment (assessment, general support, goals of treatment), as well as three scales measuring critical elements of three treatments that are frequently implemented as control or comparison treatments in clinical research in the addictions (clinical management (CM), twelve step facilitation (TSF), and cognitive behavioral therapy (CBT)). Validation of the YACS using data from a randomized clinical trial indicated that the scales have excellent reliability, factor structure, concurrent and discriminant validity. Correlations between adherence and competence scores within scales were in the moderate range, indicating independence (and thus nonredundancy) of these dimensions. Strategies for using the YACS in both psychotherapy and pharmacotherapy research in the addictions are described.
Collapse
|
75
|
Ball SA, Tennen H, Kranzler HR. Factor replicability and validity of the Temperament and Character Inventory in substance-dependent patients. Psychol Assess 1999. [DOI: 10.1037/1040-3590.11.4.514] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
76
|
Cecero JJ, Ball SA, Tennen H, Kranzler HR, Rounsaville BJ. Concurrent and predictive validity of antisocial personality disorder subtyping among substance abusers. J Nerv Ment Dis 1999; 187:478-86. [PMID: 10463065 DOI: 10.1097/00005053-199908000-00004] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Three hundred seventy inpatient and outpatient substance abusers were divided according to presence and subtype of antisocial personality disorder (APD) into groups comparing: a) adult antisocial behavior (AAB) versus full APD; b) APD with low versus high sociopathy; c) APD with versus without lifetime depression; and d) APD with versus without other axis II disorders. Multivariate regression was used to predict the unique contribution to the variance in baseline and 12-month follow-up measures of substance use, psychiatric severity, and personality. The presence of comorbid axis II pathology was the strongest predictor of baseline severity in all three domains. APD substance abusers with lifetime depression exhibited greater baseline to follow-up reductions in psychiatric severity than those APD substance abusers without a history of depression. All APD subtypes improved over time with treatment, suggesting that this diagnosis does not necessarily indicate poor prognosis.
Collapse
|
77
|
Ball SA. Book review. Subst Abus 1999. [DOI: 10.1080/08897079909511400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
78
|
Ball SA. Manualized treatment for substance abusers with personality disorders: dual focus schema therapy. Addict Behav 1998; 23:883-91. [PMID: 9801723 DOI: 10.1016/s0306-4603(98)00067-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The presence of an untreated personality disorder may be associated with worse compliance and outcome in substance abuse treatment. Therapeutic attention to the symptoms of personality disorder may reduce the severity of substance abuse and other Axis I symptoms which potentially contribute to relapse. A 24-week manual-guided individual cognitive-behavioral therapy approach has been developed that integrates relapse prevention with targeted intervention for early maladaptive schemas (enduring negative beliefs about oneself, others, and events) and coping styles. This Dual Focus Schema Therapy is being compared to 12-Step Drug Counseling for opioid-dependent individuals with personality disorders in an ongoing study funded by the National Institute on Drug Abuse. This article reviews Young's (1994) schema-focused theory and approach and summarizes the treatment manual, which integrates relapse prevention for substance abuse.
Collapse
|
79
|
Jantzen K, Ball SA, Leventhal JM, Schottenfeld RS. Types of abuse and cocaine use in pregnant women. J Subst Abuse Treat 1998; 15:319-23. [PMID: 9650140 DOI: 10.1016/s0740-5472(97)00198-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Previous research has found an association between childhood and adult physical and sexual abuse and substance abuse, but has not examined or compared specific dimensions of the abuse experience, such as its age of onset or the type, severity, or frequency. Women receiving perinatal care (N = 1189) at an inner-city hospital clinic were systematically questioned about their lifetime and current cocaine use and experiences of abuse. We found an association between a history of abuse in childhood and lifetime and current cocaine use, as well as physical and sexual abuse during childhood and pregnancy. There was no difference in the rates of cocaine use between women whose onset of abuse was in childhood versus adulthood. Childhood sexual abuse (alone or in combination with physical abuse) was more associated with lifetime cocaine use than was physical abuse alone. Cocaine use was related to the severity, but not the frequency of abuse.
Collapse
|
80
|
Ball SA, Kranzler HR, Tennen H, Poling JC, Rounsaville BJ. Personality disorder and dimension differences between type A and type B substance abusers. J Pers Disord 1998; 12:1-12. [PMID: 9573515 DOI: 10.1521/pedi.1998.12.1.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Substance abuse subtype differences in DSM-IV personality disorders and normal personality dimensions were evaluated in 370 inpatient and outpatient alcohol, cocaine, and opiate abusers. The Type A/Type B distinction was replicated, with Type B substance abusers exhibiting more premorbid risk factors, more severe substance abuse, and greater psychosocial impairment. As predicted, compared to Type A, Type B were more commonly diagnosed with, and had more severe symptoms of, all personality disorders except Schizoid. With regard to normal personality dimensions, Type B scored higher on neuroticism, novelty seeking, and harm avoidance; Type A scored higher on agreeableness, conscientiousness, cooperativeness, and self-directedness. These subtype differences remained after controlling for the effects of antisocial personality and psychiatric symptoms.
Collapse
|
81
|
Carroll KM, Nich C, Ball SA, McCance E, Rounsavile BJ. Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction 1998; 93:713-27. [PMID: 9692270 DOI: 10.1046/j.1360-0443.1998.9357137.x] [Citation(s) in RCA: 244] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To evaluate disulfiram and three forms of manual guided psychotherapy for individuals with cocaine dependence and concurrent alcohol abuse or dependence. DESIGN Randomized controlled trial. SETTING Urban substance abuse treatment center. PARTICIPANTS One hundred and twenty-two cocaine/alcohol abusers (27% female; 61% African-American or Hispanic). INTERVENTIONS One of five treatments delivered over 12 weeks: cognitive behavioral treatment (CBT) plus disulfiram; Twelve Step facilitation (TSF) plus disulfiram; clinical management (CM) plus disulfiram; CBT plus no medication; TSF plus no medication. MEASUREMENTS Duration of continuous abstinence from cocaine or alcohol; frequency and quantity of cocaine and alcohol use by week, verified by urine toxicology and breathalyzer screens. FINDINGS Disulfiram treatment was associated with significantly better retention in treatment, as well as longer duration of abstinence from alcohol and cocaine use. The two active psychotherapies (CBT and TSF) were associated with reduced cocaine use over time compared with supportive psychotherapy (CM). Cocaine and alcohol use were strongly related throughout treatment, particularly for subjects treated with disulfiram. CONCLUSIONS For the large proportion of cocaine-dependent individuals who also abuse alcohol, disulfiram combined with outpatient psychotherapy may be a promising treatment strategy. This study underlines (a) the significance of alcohol use among treatment-seeking cocaine abusers, (b) the promise of the strategy of treating co-morbid disorders among drug-dependent individuals, and (c) the importance of combining psychotherapy and pharmacotherapy in the treatment of drug use disorders.
Collapse
|
82
|
Ball SA, Tennen H, Poling JC, Kranzler HR, Rounsaville BJ. Personality, temperament, and character dimensions and the DSM-IV personality disorders in substance abusers. JOURNAL OF ABNORMAL PSYCHOLOGY 1998. [PMID: 9358685 DOI: 10.1037//0021-843x.106.4.545] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors evaluated the relationship between P. T. Costa and R. R. McCrae's (1992) NEO 5-factor model, C. R. Cloninger's (1993) 7-factor Temperament and Character Inventory (TCI), and the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed., personality disorders in 370 inpatient and outpatient alcohol, cocaine, and opiate abusers. NEO Neuroticism was associated with many disorders, and different patterns for Agreeableness, Conscientiousness, and Extraversion emerged for the different disorders. Several TCI scales were associated with different personality disorders, although not as strongly as the NEO dimensions. Results did not support most predictions made for the TCI. Normal personality dimensions contributed significantly to the prediction of personality disorder severity above and beyond substance abuse and depression symptoms.
Collapse
|
83
|
Ball SA, Tennen H, Poling JC, Kranzler HR, Rounsaville BJ. Personality, temperament, and character dimensions and the DSM-IV personality disorders in substance abusers. JOURNAL OF ABNORMAL PSYCHOLOGY 1997; 106:545-53. [PMID: 9358685 DOI: 10.1037/0021-843x.106.4.545] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors evaluated the relationship between P. T. Costa and R. R. McCrae's (1992) NEO 5-factor model, C. R. Cloninger's (1993) 7-factor Temperament and Character Inventory (TCI), and the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed., personality disorders in 370 inpatient and outpatient alcohol, cocaine, and opiate abusers. NEO Neuroticism was associated with many disorders, and different patterns for Agreeableness, Conscientiousness, and Extraversion emerged for the different disorders. Several TCI scales were associated with different personality disorders, although not as strongly as the NEO dimensions. Results did not support most predictions made for the TCI. Normal personality dimensions contributed significantly to the prediction of personality disorder severity above and beyond substance abuse and depression symptoms.
Collapse
|
84
|
Ball SA, Mayes LC, DeTeso JA, Schottenfeld RS. Maternal Attentiveness of Cocaine Abusers During Child-Based Assessments. Am J Addict 1997. [DOI: 10.1111/j.1521-0391.1997.tb00562.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
85
|
Ball SA, Maves LC, DeTeso JA, Schottenfeld RS. Maternal attentiveness of cocaine abusers during child-based assessments. Am J Addict 1997; 6:135-43. [PMID: 9134075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Cocaine-abusing mothers were compared with non-cocaine-using mothers on videotaped ratings of attentiveness to their children during developmental assessments done at age 3 months (n = 64), 6 months (n = 80), 12 months (n = 90), and 18 months (n = 53). At the 3-month assessment only, cocaine-abusing women spent a lower percentage of time being attentive and made more shifts in attentiveness than did control-group mothers. These differences were not found at 6-, 12-, or 18-month assessments. Maternal attentiveness appears to be more strongly related to current depression symptoms than addiction severity in the cocaine-abusing group.
Collapse
|
86
|
O'Connor PG, Pearsall HR, Ball SA, Forsyth BWC, Faraclas WG, Schottenfeld RS. The impact of the Yale faculty development program: Clinical alcohol and drug research and education (cadre) on medical student teaching about substance abuse1. Subst Abus 1997. [DOI: 10.1080/08897079709511344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
87
|
Ball SA, Carroll KM, Robinson JE, O'Malley SS. Addiction Severity and MMPI-Derived Typologies in Cocaine Abusers. Am J Addict 1997. [DOI: 10.3109/10550499708993166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
88
|
Ball SA, Carroll KM, Robinson JE, O'Malley SS. Addiction severity and MMPI-derived typologies in cocaine abusers. Am J Addict 1997; 6:83-6. [PMID: 9097875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This study replicated the two Minnesota Multiphasic Personality Inventory subtypes (psychopathic and severe psychiatric) found in inpatient male cocaine abusers in an outpatient sample of 132 men and women. The Addiction Severity Index validated these subtype differences on the basis of psychiatric severity.
Collapse
|
89
|
Ball SA, Mayes LC, DeTeso JA, Schottenfeld RS. Maternal Attentiveness of Cocaine Abusers During Child-Based Assessments. Am J Addict 1997. [DOI: 10.3109/10550499709137024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
90
|
Ball SA, Carroll KM, Robinson JE, O'Malley SS. Addiction Severity and MMPI-Derived Typologies in Cocaine Abusers. Am J Addict 1997. [DOI: 10.1111/j.1521-0391.1997.tb00395.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
91
|
Ball SA, Schottenfeld RS. A five-factor model of personality and addiction, psychiatric, and AIDS risk severity in pregnant and postpartum cocaine misusers. Subst Use Misuse 1997; 32:25-41. [PMID: 9044535 DOI: 10.3109/10826089709027295] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The relationship between addiction severity, psychiatric symptoms, AIDS risk behaviors, and an alternative five-factor measure of personality, the Zuckerman-Kuhlman Personality Questionnaire, was assessed in 92 cocaine-misusing pregnant and postpartum women in an inner city outpatient treatment program. Three of the personality traits (Neuroticism-Anxiety, Impulsive Sensation Seeking, Aggression-Hostility) were significantly related to different subscales of the Addiction Severity Index, Beck Depression Inventory, various psychiatric symptoms, and high HIV risk sexual activity. Of these traits, Neuroticism-Anxiety seemed to be the most powerful predictor of symptom severity for this sample of women. Scores on the personality dimensions were not related to recency, frequency, amount, or duration of drug use or to treatment outcomes.
Collapse
|
92
|
Ball SA, Legow NE. Attachment theory as a working model for the therapist transitioning from early to later recovery substance abuse treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 1996; 22:533-47. [PMID: 8911591 DOI: 10.3109/00952999609001679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Psychotherapy with addicted individuals often involves a shift in therapeutic techniques during the transition from early to later recovery treatment. A conceptual model based in attachment theory can provide a rationale and framework for this shift in the treatment of some addicted persons. Techniques and case material are presented to illustrate how a therapist first "establishes a secure base" and then transitions to "facilitating exploration." An active, directive, supportive, and educative therapeutic approach that deemphasizes exploratory work in early recovery helps the patient achieve abstinence and develop a sense of security and attachment with the therapist. This sense of therapeutic security combined with ongoing abstinence permits a shift to a more nondirective, expressive therapeutic stance that facilitates the exploratory work of later recovery. Working through these issues in the therapeutic transition provides an excellent opportunity to examine the interpersonal and emotional difficulties of addicted patients. Two cases are presented to illustrate a successful and unsuccessful attempt to establish a secure base and facilitate exploration in substance abuse psychotherapy.
Collapse
|
93
|
Feingold A, Ball SA, Kranzler HR, Rounsaville BJ. Generalizability of the type A/type B distinction across different psychoactive substances. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 1996; 22:449-62. [PMID: 8841691 DOI: 10.3109/00952999609001671] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Previous research using cluster analysis has found that abusers of both alcohol and cocaine can be categorized into more severe (Type B) and less severe (Type A) subgroups. This article sought to replicate and extend these findings in a sample of 521 inpatients, outpatients, and nontreatment-seeking abusers of alcohol, cocaine, marijuana, and opiates. Cluster analyses of subsamples that met the DSM-IV criteria for dependence or abuse for alcohol, cocaine, marijuana, and opiates found that the Type A/Type B distinction was largely generalizable across drugs. Type As--who consistently accounted for about 60% of all substance abuse and about half of abusers in treatment-scored lower than Type Bs on a variety of substance abuse and psychiatric measures that were administered both at intake and at a 6-month follow-up.
Collapse
|
94
|
Ball SA. Type A and Type B Alcoholism: Applicability Across Subpopulations and Treatment Settings. Alcohol Health Res World 1996; 20:30-35. [PMID: 31798176 PMCID: PMC6876529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Babor's classification of alcoholism uses multiple characteristics to assign subjects to two categories, called type A and type B. Type B alcoholism appears to be consistently more severe than type A. Research findings are reviewed that support the usefulness of Babor's typology for different drugs of abuse, clinical settings, gender, and race.
Collapse
|
95
|
Ball SA, Carroll KM, Babor TF, Rounsaville BJ. Subtypes of cocaine abusers: support for a type A-type B distinction. J Consult Clin Psychol 1995. [PMID: 7896976 DOI: 10.1037//0022-006x.63.1.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The replicability and generalizability of a multidimensional alcoholism typological system was systematically assessed in 399 inpatient, outpatient, and non-treatment-seeking cocaine abusers. Two different cluster-analytic procedures supported the construct, concurrent, and predictive validity of the Type A-Type B distinction in cocaine abusers. Participants classified as Type B (33%) cocaine abusers exhibited higher rates of premorbid risk factors (family history, childhood behavior problems, personality, age of onset), more severe drug and alcohol abuse, more addiction-related psychosocial impairment, more antisocial behavior, and more comorbid psychiatric problems than Type A participants (67%). Multidimensional typological systems have had a major impact on the alcoholism field and may be equally important for the assessment, prevention, treatment, and theoretical understanding of other substance use disorders.
Collapse
|
96
|
Ball SA, Carroll KM, Babor TF, Rounsaville BJ. Subtypes of cocaine abusers: support for a type A-type B distinction. J Consult Clin Psychol 1995; 63:115-24. [PMID: 7896976 DOI: 10.1037/0022-006x.63.1.115] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The replicability and generalizability of a multidimensional alcoholism typological system was systematically assessed in 399 inpatient, outpatient, and non-treatment-seeking cocaine abusers. Two different cluster-analytic procedures supported the construct, concurrent, and predictive validity of the Type A-Type B distinction in cocaine abusers. Participants classified as Type B (33%) cocaine abusers exhibited higher rates of premorbid risk factors (family history, childhood behavior problems, personality, age of onset), more severe drug and alcohol abuse, more addiction-related psychosocial impairment, more antisocial behavior, and more comorbid psychiatric problems than Type A participants (67%). Multidimensional typological systems have had a major impact on the alcoholism field and may be equally important for the assessment, prevention, treatment, and theoretical understanding of other substance use disorders.
Collapse
|
97
|
Ball SA, Carroll KM, Rounsaville BJ. Sensation seeking, substance abuse, and psychopathology in treatment-seeking and community cocaine abusers. J Consult Clin Psychol 1995. [PMID: 7806714 DOI: 10.1037//0022-006x.62.5.1053] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sensation seeking, substance abuse severity, and psychiatric disorders were systematically assessed in a clinical and a community sample of 335 cocaine abusers. In contrast to low-sensation-seeking cocaine abusers, high-sensation seekers exhibited more severe symptoms of substance abuse, exhibited more severe psychosocial impairment, were more likely to be polysubstance abusers, and had an earlier age of onset for substance use and abuse. High-sensation seekers were more likely to report both a lifetime history and family history of antisocial personality, attention deficit disorder, and conduct disorder. Sensation seeking was related to several dimensions that are important for defining subtypes of substance abusers and was consistent with other features of a Type II classification.
Collapse
|
98
|
Ball SA. The validity of an alternative five-factor measure of personality in cocaine abusers. Psychol Assess 1995. [DOI: 10.1037/1040-3590.7.2.148] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
99
|
Ball SA, Carroll KM, Rounsaville BJ. Sensation seeking, substance abuse, and psychopathology in treatment-seeking and community cocaine abusers. J Consult Clin Psychol 1994; 62:1053-7. [PMID: 7806714 DOI: 10.1037/0022-006x.62.5.1053] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Sensation seeking, substance abuse severity, and psychiatric disorders were systematically assessed in a clinical and a community sample of 335 cocaine abusers. In contrast to low-sensation-seeking cocaine abusers, high-sensation seekers exhibited more severe symptoms of substance abuse, exhibited more severe psychosocial impairment, were more likely to be polysubstance abusers, and had an earlier age of onset for substance use and abuse. High-sensation seekers were more likely to report both a lifetime history and family history of antisocial personality, attention deficit disorder, and conduct disorder. Sensation seeking was related to several dimensions that are important for defining subtypes of substance abusers and was consistent with other features of a Type II classification.
Collapse
|
100
|
Abstract
Substance abuse and its correlative personality traits may have familial associations. We assessed the relationship between sensation seeking and drug use in 201 opiate addicts and 133 of their siblings in a cross-sectional family study. Probands and their drug-abusing siblings showed greater sensation seeking than their non-drug-abusing siblings and this diagnosis accounted for the most variance in regression models. Degree of sensation seeking correlated among drug-abusing siblings and with age of first drug use. The results are discussed in terms of substance abuse typologies and for using sensation-seeking assessments for prevention and treatment of substance abuse.
Collapse
|