Psychological And Methodological Issues In Substance Abuse Treatment/research

National Institute On Drug Abuse

Investigators

Linked publications & trials

Abstract

Although improvement in psychosocial functioning is a common goal in substance-abuse treatment, the primary outcome measure in most cocaine trials is rate of urinalysis-verified cocaine use. However, the relationship between cocaine use and psychosocial outcomes is not well documented. To investigate this relationship and identify the optimal urine-screen method, we retrospectively analyzed data from two 25-week randomized controlled trials of abstinence reinforcement in 368 cocaine/heroin users maintained on methadone. Cocaine use was measured thrice weekly by qualitative urinalysis, benzoylecgonine concentration (BE), and an estimate of New Uses of cocaine by application of an algorithm to BE. Social adjustment (SAS-SR), current diagnosis of cocaine dependence (by DSM-IV criteria), and depression symptoms (Beck Depression Inventory) were determined at study exit. Cocaine use was significantly lower in the abstinence-reinforcement groups compared to controls. Across groups, in-treatment cocaine use was significantly associated with worse social adjustment, current cocaine-dependence diagnosis, and depression at exit. Significant differences were detected more frequently with New Uses than qualitative urinalysis or BE. Nevertheless, the amount of variance accounted for by the urine screens was typically <15%. Urine screens, especially with New Uses criteria, can predict psychosocial functioning, but cannot substitute for more direct measures of psychosocial functioning.[unreadable] [unreadable] Individuals recovering from addictions frequently cite spirituality as a helpful influence. However, little is known about whether or how spirituality could be incorporated into formal treatment in a manner that is sensitive to individual differences. In the present study, focus groups were conducted with 25 methadone-maintained outpatients to examine beliefs about the role of spirituality in recovery and its appropriateness in formal treatment. Groups also discussed the relationship between spirituality and behavior during active addiction. Thematic analyses suggested that spirituality and religious practices suffered in complex ways during active addiction, but went hand in hand with recovery. Nearly all participants agreed that integration of a voluntary spiritual discussion group into formal treatment would be preferable to currently available alternatives. One limitation was that all participants identified as strongly spiritual. Studies of more diverse samples will help guide the development and evaluation of spiritually based interventions in formal treatment settings.[unreadable] [unreadable] We are continuing our work with ecological momentary assessment (EMA) evaluating the utility of hand-held electronic diaries to collect outcome data in clinical trials evaluating treatments for substance abuse. In addition to validating assumptions underlying preclinical models of relapse, EMA may be a useful outcome measure in future clinical trials of relapse-prevention medications. Preclinical research has shown that medications effects may be specific to certain types of relapse; EMA may be the only data collection approach in humans to prospectively answer this important research question.