M Gossop

..quot; The prevalence of both attempts and success suggests that, for some opiate users, self-detoxification may be a pathway to abstinence...

..Psychological and physical health problems were reduced on both groups at follow-up. These changes represent important clinical benefits to the individual clients, to their families, and to society...

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..In addition to direct effects, treatment factors may have important indirect effects upon subsequent outcomes through their influence upon short-term outcomes...

..It is recommended that alcohol treatment agencies should provide a full routine health screen of patients at admission to treatment with provision or referral to appropriate treatment...

..About 10% reported injecting crack. The reductions in crack use are encouraging, but the onset of crack use among many non-users at intake suggests the need to develop more effective treatment interventions...

..The study also specifically investigates the relationship between content, frequency and duration of counselling provided during the first month of treatment, and heroin, cocaine, and alcohol use outcomes at 6 months...

..It was predicted that post-treatment NA/AA attendance would be related to improved substance use outcomes...

..The procedures leading to the development of the scale are described and results are presented showing that the SAWS has high internal consistency, and good construct and concurrent validity...

..The study further investigates differences in the combined use of the two substances by users of cocaine powder and crack cocaine...

..Both outcomes confer benefits, though the benefits of abstinence are greater. Users who were injectors at intake but who had stopped injecting at follow-up consistently achieved superior outcomes across a range of problem behaviours...

..NTORS investigates outcomes for drug misusers treated in existing services in residential and community settings...

..The main hypothesis was that 'taking steps' should be predictive of less frequent use of illicit opiates (heroin and non-prescribed methadone) at follow-up...

..To investigate differences in alcohol and drug consumption behaviours and related problems among users of cocaine powder versus crack cocaine...

..Drinking problems have been given insufficient attention in the treatment of illicit substance misuse problems, and efforts should be made to develop and strengthen the assessment and treatment of drinking problems among drug misusers...

..This study investigates the relationship between attendance at Alcoholics Anonymous (AA) meetings prior to, during, and after leaving treatment, and changes in clinical outcome following inpatient alcohol treatment...

..quot;Reverse transitions" (from injecting to chasing) may represent a useful intermediate treatment goal for drug injectors who cannot achieve abstinence...

..Critical treatment thresholds were identified using multiple logistic regression analyses. Longer stays in treatment were predictive of better 1 year outcomes...

..The extent of heavy drinking among drug misusers both before and after treatment indicates a need to develop and strengthen programs and interventions to tackle alcohol-related problems in this patient group...

..Reduced criminality also provides substantial economic benefits to society...

..These problems, compounded by the larger doses being used and their greater involvement in prostitution, place crack cocaine users at higher risk from HIV infection and other sexually transmitted diseases as well as other physical risks...

..Treatment goals should be made explicit both to the patient and to the clinical staff at the start of treatment. We suggest the need for a reappraisal of the goals and procedures of methadone reduction treatment...

..The Maudsley Addiction Profile (MAP) is the first instrument to be developed in the United Kingdom for this purpose...

..Lofexidine provides no discernible benefit as an adjunctive medication (to chlordiazepoxide) in alcohol detoxification and, on the basis of our study, appears to be contra-indicated...

..Many people with substance use disorders are vulnerable to other psychiatric disorders and present to addiction treatment services with comorbid psychiatric symptoms...

..Many programmes reported extensive waiting lists. These findings are discussed in the context of the growing international evidence of the association between patient outcome and the manner in which programme services are delivered...

..A cohort study design was used with double-blind random allocation to lofexidine+naloxone versus lofexidine+placebo. Patients who did not consent to, or who were excluded from randomisation received methadone...

..Heroin chasers display distinctly different personal and drug-taking characteristics and will need to be the subject of separate research studies and clinical programs...

..To assess the feasibility of a randomized clinical trial of supervised injectable versus oral methadone maintenance and to assess medium-term treatment outcomes...

..As AA/NA remain popular and accessible forms of substance misuse support, it is critical that we develop a clearer understanding of their impact and of the scope for their integration with generic forms of substance misuse treatment...

..These may have a negative impact on engagement and response to treatment and compromise clinical outcomes, heightening the risk of relapse...

..The internal and test-retest reliabilities of the MAP and TPQ are satisfactory. Both instruments are suitable for treatment evaluation and other relevant research purposes in the European Union...

..Better methods are required to provide interventions to tackle the problems and risk behaviors of these cocaine users...

..Finally, the possible future role of lofexidine in this field is considered...

..We suggest that risk reduction interventions are an important and effective component of treatment programmes...

..Just over half of admissions completed treatment. Multiple drug use was a poor prognostic indicator with fewer multiple drug users engaging with, or completing, treatment...

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..Results are discussed in terms of experiential factors and consistency theories of attitude formation and change...

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..This procedure may allow a larger proportion of opioid-dependent patients access to buprenorphine treatment...

..At a time when diamorphine may be coming under increased scrutiny, more detailed information is required of its uses and applications...

..Where the MMSE is used as a screening tool, it is recommended that scores are adjusted for the effects of age...

..Overall, the study showed that early onset, itself predicted by social networks, is linked to more frequent use of cannabis and that this appears to be sustained by less time spent with parents and more with drug-using peers...

..Understanding and responding to alcohol misuse among adolescents requires attention to psychological, social and developmental factors other than alcohol consumption alone...

..To investigate the persistence of use of heroin, cocaine and amphetamine drugs during imprisonment, and to identify factors associated with increased levels of persistence...

..This study investigates factors influencing the severity of opiate withdrawal symptoms, focusing on the relationship between methadone dose and withdrawal severity among opiate-dependent in-patients receiving methadone detoxification...

..Opiate/Benzodiazepine codependent patients reported less severe withdrawal symptoms during treatment with buprenorphine than with methadone and were also more likely to complete detoxification when treated with buprenorphine...

..Some of the psychiatric symptoms presented by drug-dependent patients at admission to treatment are associated with drug misuse and show rapid remission after substance misuse treatment...

..The study allows only tentative conclusions to be drawn, but these changes may be indicative of increased pressures placed on the programs and their staff...

..Concurrent benzodiazepine withdrawal exacerbates opiate specific withdrawal symptoms. Possible psychological and neurophysiological mechanisms for the observed sensitisation are discussed...

..The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities...

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..Social networks represent an important marker for integration in criminal networks in treatment-seeking drug users and a long-term barrier to rehabilitation...

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..To investigate factors associated with first entry to treatment and with treatment re-entry among cocaine users...

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..The study revealed inconsistencies in the recording of drug-related deaths on death certificates. The routine recording of all substances detected during toxicological examination would improve the accuracy of death certification...

..A comprehensive assessment of alcohol use among drug misusers should include separate assessments of alcohol consumption, alcohol-related problems and severity of alcohol dependence...

..The risk of non-fatal overdose at 1 year was associated with injecting and multiple drug use. These findings support the view that treatment an important role can play in reducing deaths among drug misusers...

..Implications for future research are discussed...

..After controlling for pretreatment differences, gender was not predictive of any of the outcome measures reported...

..Specific strategies need to be developed to address problematic cocaine use in these subgroups...

..Some economic costs and consequences of drug misuse and treatment were investigated among clients recruited to the National Treatment Outcome Research Study (NTORS)...

..Results show substantial reductions in a range of problems behaviours, among unselected samples of opiate dependent patients treated in GP and in clinic settings, which are sustained to 1-year and 2-year follow-up...

..The onus is on public decision-makers to decide whether the predicted reductions in crime are worth the opportunity costs of investing extra resources in a major expansion of treatment services...

..Preventive strategies should be developed to reduce the risk of adverse cocaine reactions. The findings are discussed in relation to the type of interventions that might be developed and lines of future research...

..Drug users' overdose risk may vary as a result of their prescribed and non-prescribed drug use. Interventions should be developed and tailored according to clients' needs and current use patterns...

..A dimensional scale that does not relate directly to the categorical definition would be counterproductive...

..62, P<.05). Our preliminary findings suggest that melatonin secretion may represent a neuroendocrine marker of NA neuronal hyperactivity during opiate withdrawal in opiate-dependent patients. Areas of future research are discussed...

..Such women face special difficulties in access to services and would benefit if treatment services were able to offer improved access and childcare support...

..Implications for the development of a process-driven theoretical understanding of TC and situational constraints are discussed, and applied recommendations for training intervention are presented...

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