Assessment of an urgent admission procedure to an in-patient drug dependence unit

A comparison of private and public methadone maintenance patients

A study was undertaken to examine claims that unsuitable individuals were being admitted into private methadone maintenance programs in New South Wales in late 1985, early 1986. A comparison was made of interview data collected by an independent team of researchers from 457 private and 91 public patients. Exhaustive attempts were made to identify individuals who failed current official admission criteria. While there were statistically and clinically significant differences between private and public methadone patients, there was no evidence that unsuitable individuals were being admitted into maintenance. The data and a review of the literature suggest that the rapid expansion of private sector methadone programs allowed suitable individuals more immediate and more equitable access to maintenance treatment.

Research and the help-seeking process

Recognition of changes in the nature and extent of problem drug taking in the early 1980s led to changes in service provision and to an increased interest in help-seeking. The advent of AIDS accelerated these changes. This paper introduces concepts from the wider field of help-seeking and compliance with preventive health measures. It reviews the major conclusions of studies of help-seeking by problem drug takers, and identifies areas for further research. These include the need to 'unpack' the concept of 'drug problems' and to differentiate dimensions of needs in different individuals and populations; to evaluate attempts to make services attractive and accessible and to contact out-of-treatment groups; to assess the role of 'significant others'; to understand the demands that changing service roles place on agency staff; and to give greater prominence to studies of the process of help-seeking in terms of drug users' perceptions of their drug use, of problems, of risks and of services within the wider context of their lifestyles.

Cue exposure as an assessment technique in the management of a heroin addict: case report

A recently-detoxified heroin addict was exposed to a battery of drug-related stimuli which he had previously assisted in identifying as personally relevant. Skin conductance was measured during exposure to both drug-related stimuli and neutral stimulus items. The amplitude of the first skin conductance response following stimulus presentation and the number of skin conductance responses during stimulus presentation were significantly different for the drug-related and neutral stimuli. Post-exposure subjective ranking of the drug-related items differed markedly from pre-exposure ranking; and the post-exposure subjective rankings were closer to the ranked order of the measured physiological responses than the pre-exposure subjective rankings. The use of cue exposure assessment in planning treatment for relapse prevention and the possible importance of idiosyncratic cues in the environment are discussed.

Drug abuse treatment process: a review of the literature

The literature on drug abuse treatment is reviewed in two sections. The first of these briefly describes the three major treatment modalities (outpatient methadone, residential, and outpatient drug-free). The objectives and approaches of each modality are outlined, and a number of issues surrounding each modality are sketched. The second section of the review covers general studies of drug abuse treatment. In particular, studies of retention, counselor characteristics, program policies and goals, the nature and extent of services received by clients, the context in which treatment is administered, methadone dosage levels, and other such variables are reviewed. Various typologies of treatment are presented and discussed. Conclusions and implications for future research are also discussed.

Drug dependence, who gets treated?

Despite the fact that decisions about whether or not to admit patients to inpatient facilities are often made on the basis of "clinical judgment," there is little evidence to support the validity of this process. The present study investigates the ability of the staff at a London drug clinic to predict how addicts would behave after admission to an inpatient treatment unit, and the bases upon which decisions were reached. The results indicate that predictions on almost all measures of future behavior showed very little interrater reliability, and there was no way of knowing in advance who would do well and who would do badly. The predictions were not random guesses; they reflected "implicit theories" held by each rater about the sort of factors that they believed to operate in such circumstances. Some implications of these findings for the treatment of addicts are discussed.