Success and failure in rehabilitation: the case of methadone maintenance

A psychoeducational approach to methadone maintenance treatment: a survey of client reactions

STAR, a methadone clinic in Portland, Oregon employs a psychoeducational approach in an attempt to provide coherent, comprehensive treatment in meeting diverse client needs. Two hundred and thirty-eight STAR clients completed a 133 item survey as part of an evaluative review of the efficacy of the psychoeducational model. Clients were asked about their perceived treatment needs and expectations, drug use, criminality, mental and physical health, social and economic stability, and their sense of self-worth and life satisfaction. Respondents reported that receiving methadone was the most useful and best liked aspect of treatment, followed by individual counseling, and education and skill classes. Clients indicated low rates of criminal behavior and drug use, but acknowledged high rates of psychological symptoms including depression, anxiety, and irritability, and rated as very important the need to reduce drug use and to improve health, to achieve a sense of life satisfaction, to enhance feelings about self and relationships, especially those with their children. A majority of the respondents had less than adequate income, and a substantial minority had less than a high school education. Longer time in treatment at STAR was associated with reduced heroin and cocaine use and improvements in social, economic and legal realms. The discussion focuses on implications for methadone treatment in general and possible modifications of the STAR program.

The working capacity of the alcohol abuser. Prognostic multiple regression analyses

Thirty-four alcohol abusers treated at various rehabilitational locations in Sweden were the subjects of an extensive and interdisciplinary study. Thereafter, the working capacity of each subject was followed over a two-year period. Twelve individuals regained capacity for work, either partially or completely. Thirteen subjects were sick-listed or remained unemployed. The remaining 9 abusers were quickly and unexpectedly pensioned. In order to predict the rehabilitational outcome from the interdisciplinary findings at the onset of the time period, stepwise multiple regression analyses were performed. Those who felt less lonely and had no drinking buddies appeared most likely to be rehabilitated vocationally. This core combination of characteristics accounted for about one third of the variability in the outcome criterion, either trichotomized or dichotomized. Rehabilitational success could be even more strongly predicted by the appearance of such features as less prolonged abuse, social introversion (not cohabiting, reserved attitudes and having only a few friends), orientation to the future and a history of psychiatric care. An elevated level of plasma albumin and a decreased plasma-IgA value raised additionally the multiple correlation coefficient.

Loneliness correlates in advanced alcohol abusers. I. Social factors and needs

A previous report on 34 alcohol abusers undergoing rehabilitation revealed that, among 86 medical, social and psychological variables, "feelings of loneliness" were most important for the prognosis. The current analysis was performed in order to illuminate the less satisfactory prerequisites regarding external social factors and needs of the lonely alcohol abuser. Ninety-five abusers, the previously mentioned sample included, were examined twice with an approximate interval of two years. The results indicated that there were no simple or obvious correlations to the external social situation (the amount of contacts, social network, etc). Feelings of loneliness were more closely associated with dissatisfaction with the quality of existing relationships, independent of quantity. Furthermore, even in relation to work and activities, the lonely abusers showed a general dissatisfaction with the existing situation, independent of its nature. In addition, the lonely abusers felt dissatisfied in a number of need domains, although they were only inclined to stress the priority of some social needs. To sum up, the lonely abuser showed a recurrent pattern characterized by discontentment and dissatisfaction, in combination with some traces of passivity in essential life-spheres.