Methods for enhancing transition of substance dependent patients from inpatient to outpatient treatment

This study examined methods for increasing transition of substance dependent patients from inpatient detoxification to outpatient aftercare. One hundred and ninety-six patients were randomly assigned to, (1) standard referral (standard); (2) standard referral with an incentive (incentive); or (3) staff escort from detoxification to aftercare with an incentive (escort+incentive). Incentives (worth US$13.00) were dispensed for completing aftercare intake procedures on the day of discharge from detoxification. More escort+incentive participants (76%) than those in the incentive (44%) or standard conditions (24%) completed intake. The escort+incentive procedure may be useful for improving transition from detoxification to aftercare.

Reinforcement-based outpatient treatment for opiate and cocaine abusers

A reinforcement-based intensive outpatient treatment was delivered to 37 recently detoxified, inner city, heroin and/or cocaine abusers who did not want methadone treatment. Attendance was scheduled and urine collected daily for the first 2 weeks, four times weekly for the next 2 weeks, and then thrice weekly for the final 8 weeks. As attendance incentives, patients received transportation assistance (bus tokens), and $28-$30 per week in vouchers to be spent on activities/items chosen and agreed upon with their counselor. As abstinence incentives, patients received weekend supported recreational activities, lunches, $42-$45 per week in vouchers, and rent or utilities payment ($150 over 4 weeks). Total potential earnings was $1,435 per patient; actual mean earnings was $583. Forty-three percent (n=16) completed 10 or more weeks of treatment. These 16 long-stay patients submitted 92% (SD=19) opiate- and cocaine-negative urines during their enrollment compared with 56% (SD=42) drug-negative urines submitted by 21 drop-outs, F(1,35)=9.99, p=0.003. Overall, 32% of clients became employed during their treatment episode; 94% of long-stay patients were employed at the end of their treatment episode. Patients who were drug-positive at intake were highly likely to drop out. Treatment outcomes compare favorably with those reported in the literature for outpatient nonmethadone treatment of opiate and cocaine abusers. Continued evaluation of this new treatment appears warranted.

Intoxicated sexual risk taking: an expectancy or cognitive impairment explanation?

OBJECTIVE

Two experimental studies tested expectancy and impairment explanations for the association between alcohol consumption and unsafe sexual behaviors.

METHOD

Young adults, who were administered alcohol (blood alcohol concentration mean = .08 mg%), placebo or water, rated the likelihood that potential consequences would result from risky sexual practices (Study 1, N = 161) and listed potential consequences that could result from having sex without a condom (Study 2, N = 135).

RESULTS

Intoxicated participants reported lower perceptions of risk (mean [+/-SD] = 4.5+/-2.1) than those who received placebo (mean = 5.8+/-1.3) or water (mean = 5.5+/-1.7). Intoxicated participants also listed fewer negative consequences (mean = 1.3+/-1.2) than those who received placebo (mean = 1.5+/-1.2) or water (mean = 2.1+/-1.5). In addition, participants who expected alcohol to disinhibit their sexual behavior reported stronger postdrinking perceptions of benefit (mean = 2.6+/-1.8) and indicated that they were more likely to engage in risky sexual practices (mean = 2.4+/-1.7) than those who did not expect sexual disinhibition (mean = 2.0+/-1.7, benefit; mean = 1.8+/-1.1, involvement).

CONCLUSIONS

Results support the hypotheses that (1) alcohol-related impairment reduces the drinker's perception of personal risk, and (2) positive outcome expectancies motivate drinkers to engage in risky sexual practices.