RESUMEN
OBJECTIVE AND METHODS: We surveyed 293 individuals seeking methadone maintenance treatment (MMT) for opioid dependence about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in MMT. RESULTS: Among the 213 respondents reporting recent pain of at least moderate typical pain intensity, those with and those without a lifetime history of chronic pain endorsed similar rates of conventional (with the exception of past-week medical use of nonopiate medication), complementary, and alternative medicine utilization for pain reduction and a numerically smaller proportion endorsed last-week utilization of complementary and alternative medicine when compared with conventional medicine. The most frequently endorsed lifetime conventional pain treatments included opiate and over-the-counter medications, whereas the most frequently endorsed lifetime complementary and alternative medicine pain treatments included stretching, physical exercise, physical therapy, heat therapy, and prayer. Perceived efficacy of prior pain treatment but not interest in pain treatment was associated with chronic pain history status. CONCLUSION: These findings may have implications for resource and program planning in MMT programs.
RESUMEN
This preliminary study evaluated the relationship between therapy process variables (mechanistic processes and interpersonal processes), and treatment outcome (i.e., retention and cocaine abstinence) among 16 cocaine-dependent pregnant or postpartum women treated with the Community Reinforcement Approach (CRA). Two new rating scales were developed for this purpose. The Mechanisms of Action Rating Scale (MARS) assesses five CRA mechanistic domains (Big Picture goals, functional analyses of behavior, nondrug-related activities, skills training, and homework). The Interpersonal Variables Rating Scale (IVRS) measures three nonspecific or interpersonal dimensions of psychotherapy (i.e., empathy, response to resistance, and therapeutic alliance). These rating scales were used to rate one, early treatment, videotaped CRA session for each subject. Results indicated that: 1) sessions with patients who achieved three or more consecutive weeks of cocaine abstinence were rated significantly higher on therapist empathy and positive responses to resistance, and total IVRS scores (all of which indicate positive interpersonal processes); and 2) Big Picture goals, positive therapeutic alliance, and total IVRS scores were significantly and positively correlated with number of consecutive weeks of cocaine-negative urine toxicology tests. Only MARS homework scores were significantly and positively associated with number of study weeks completed. Finally, the pattern of interrelationships among the MARS subdomains suggests the coherence of the multifaceted CRA treatment. The findings of this preliminary study suggest the importance of monitoring both mechanistic and interpersonal processes during CRA treatment of cocaine dependence.
Asunto(s)
Trastornos Relacionados con Cocaína/terapia , Relaciones Interpersonales , Refuerzo en Psicología , Alcoholismo/epidemiología , Trastornos Relacionados con Cocaína/epidemiología , Servicios Comunitarios de Salud Mental , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Resultado del TratamientoRESUMEN
The effect of lifetime depression was examined in a randomized clinical trial in 164 opioid- and cocaine-dependent patients who were treated with desipramine in combination with either methadone or buprenorphine. We examined treatment retention, illicit opioid and cocaine use, and depressive symptoms, and found that opioid-free urines at baseline, but not later in treatment, were greater among the depressed than non-depressed patients. Among the depressed patients, depressive symptoms at baseline, but not later in treatment, were greater in patients treated with buprenorphine than methadone. Desipramine did not reduce depressive symptoms more than placebo. Finally, the depressed patients treated with desipramine and buprenorphine showed the least improvement in opioid-free urines, while the non-depressed patients treated with desipramine and methadone had more opioid-free urines than those patients treated with placebo desipramine. Cocaine-free urines showed no association with depression. This poor outcome with desipramine and buprenorphine suggests that this medication combination is not indicated in depressed opioid-dependent patients.