Relapse prevention as an interventive model for HIV risk reduction in gay and bisexual men

Despite considerable self-initiated HIV risk reduction among men who have sex with men, little is known about how to design interventions that will effectively assist individuals from this population in maintaining safer sex behaviors over time. The present study evaluated the effectiveness of a 17-session group counseling intervention that incorporated components based on a cognitive-behavioral model of relapse. Differential behavioral outcomes following treatment included an increase in the percentage of sexual activities that were protected and a decrease in unprotected oral sex. However, considerable risk reduction (e.g., increased condom use, decreased unprotected sex, and decreases in the number of male partners and in the total number of sexual acts) occurred in both treated and untreated participants. Measures of mediating attitudinal variables drawn from relapse prevention theory largely predicted behavioral changes. Over time, several of the risk reduction behaviors achieved at posttreatment were not maintained, suggesting the importance of further developing effective strategies for supporting behavior change maintenance.

The ethics of managed care: Part 3--Toward a common vision

A common set of values is one of the primary unifying elements of any systematized group. The moral crisis in health care today has more to do with value dis-integration than economic dis-array. The use of resource allocation mechanisms like managed care expand the needs of conscience with those of man-willed choice. If health professionals are to meet the ethical challenges of "managed care," they must start by reminding themselves of what the scientific and ethical commitments both promise and imply.

25 years: a slightly irreverent retrospective

From 1970 when room rates soared to 50 dollars a day, to the reorganization occasioned by DRGs, and restructuring for healthcare reform in the 1990s; from the gleaming white supervisory nurse of yesteryear, through nursing's image crisis, to the vice presidents and case managers of today; from the rise of critical care units to the development of ethics committees, Nursing Management's editor chronicles and comments on the major (and sometimes minor) events of the last 25 years of nursing.

Testing the abstinence violation effect construct with marijuana cessation

It has been proposed that internal, stable, and global attributions for the cause of a lapse following a period of abstinence and concomitant feelings of guilt and loss of control increased the probability of a return to regular substance use. The Abstinence Violation Effect (AVE) hypotheses were tested in a sample of 75 adult marijuana users who reported a lapse into marijuana use following completion of either a relapse prevention (RP) or social support group treatment aimed at abstinence. Results showed that more internal, stable, and global attributions for the cause of the lapse and perceived loss of control were related significantly to concurrently reported relapse. Further, internal and global attributions predicted marijuana use during the subsequent 6 months. Results are discussed in terms of support for the AVE construct, treatment implications, and the failure of the RP treatment to modify reactions to a lapse.

Perception of male drinkers as a function of their alcoholic beverage preference

The present study examined perception of a man's likelihood of driving after drinking and his ability to do so as a function of his choice of beverage. Perceptions of his social characteristics were also examined. The sample was composed of 200 volunteer undergraduate psychology students. Equal numbers of male and female subjects read one of four vignettes which varied only in the male protagonist's choice of beverage: beer, wine, shots of distilled spirits, or cola. After reading the story, subjects answered multiple-choice questions about the character, tapping social judgments, situational judgments and drinking and driving judgments. Subject drinking habits were also assessed. The most notable result was the consistently positive perception of the protagonist portrayed as an abstainer. The lack of a consistent alcoholic beverage distinction implies that the beer-spirits double standard is far from a clear-cut discrimination. Possible explanations for results are discussed. This study questions the robustness of the alcoholic beverage type bias and reflects the need for future research.

Health reform: the shape of things to come

To understand the various legislative initiatives at state and national levels, one must know what questions to ask and what issues are raised by each question. The questions are: (1) How much shall we reform the system? (2) How quickly shall we reform the system? (3) How shall we fund the system? and (4) How shall we organize or reorganize the system? If the complex issues these questions raise are dealt with quickly, boldly and fairly, meaningful health reform will be passed in 1993 and phased in over the next five to seven years.

Complete recovery after massive ethylene glycol ingestion

We treated a 64-year-old man who recovered completely from a massive antifreeze ingestion with ethylene glycol levels well above those of previously described survivors. Rapid and aggressive treatment of the patient with recognized methods, including hemodialysis, resulted in the favorable outcome.

Person perception as a function of drinking behavior, gender and sex role stereotypes

Gender and the level of drinking of the protagonist in a vignette were systematically varied to examine the effects of these variables on the inferences 400 undergraduates drew about the personal attributes and future of the character. Results showed that gender of the target did not significantly affect judgments about the protagonist, but perceptions of the character were strongly influenced by the alcohol-related behaviors attributed to him or her in the vignette. Evaluations of the protagonist generally became less favorable as drinking level increased. Abstainers were also viewed more positively than at least some comparison groups of drinkers on most measures. Although heavier drinkers were often stigmatized, they were also seen as having more fun. Subject gender, sex role attributes and attitudes toward women failed to influence judgments about the protagonists, but raters' own drinking habits did have an impact. Heavier drinkers showed a tendency to rate heavier drinking protagonists more favorably than did lighter drinkers. Implications of these results for prevailing theories about norms and evaluations affecting drinkers are discussed.