The Neuropsychology of Amphetamine and Opiate Dependence: Implications for Treatment

Chronic use of amphetamines and/or opiates has been associated with a wide range of cognitive deficits, involving domains of attention, inhibitory control, planning, decision-making, learning and memory. Although both amphetamine and opiate users show marked impairment in various aspects of cognitive function, the impairment profile is distinctly different according to the substance of abuse. In light of evidence showing that cognitive impairment in drug users has a negative impact on treatment engagement and efficacy, we review substance-specific deficits on executive and memory function, and discuss possibilities to address these during treatment intervention.     

The Implications of Brain Connectivity in the Neuropsychology of Autism

Autism is a neurodevelopmental disorder that has been associated with atypical brain functioning. Functional connectivity MRI (fcMRI) studies examining neural networks in autism have seen an exponential rise over the last decade. Such investigations have led to the characterization of autism as a distributed neural systems disorder. Studies have found widespread cortical underconnectivity, local overconnectivity, and mixed results suggesting disrupted brain connectivity as a potential neural signature of autism. In this review, we summarize the findings of previous fcMRI studies in autism with a detailed examination of their methodology, in order to better understand its potential and to delineate the pitfalls. We also address how a multimodal neuroimaging approach (incorporating different measures of brain connectivity) may help characterize the complex neurobiology of autism at a global level. Finally, we also address the potential of neuroimaging-based markers in assisting neuropsychological assessment of autism. The quest for a neural marker for autism is still ongoing, yet new findings suggest that aberrant brain connectivity may be a promising candidate.     

Spirituality in the Treatment of Alcoholism: A Worldview Approach

To consider alcoholism an addiction with a spiritual dimension has historically posed a problem for the logical positivism and egalitarian orientations of most Western-trained therapists and academics. Many of these professionals argue that to define alcoholism as including a spiritual component invites nonscientific if not mystical approaches to treatment. For this reason, it has been difficult to legitimize a definition of alcoholism that considers spiritual components to etiology or treatment. In this article, the author suggests that issues of spirituality are an important focus in the treatment of alcohol dependence. To consider spirituality as representative of how one views the world and his or her role in creation may well relieve some of a professional counselor's apprehension about inserting a “theology” into treatment.     

An Organizational Framework for Occupational Therapy in the Treatment of Alcoholism

Because occupational therapists are increasingly involved with alcoholism rehabilitation, an organizational treatment framework is presented that is based upon the psychodynamics of this diagnosis. Factors that contribute to the development of a unique defense structure characteristic of alcoholism are discussed as prerequisites for understanding the treatment needs of the adult. Treatment is organized into three hierarchical levels that correspond with progressive changes in the alcoholics' defense structure. Alcoholics at level one require directive treatment approaches that do not aggressively confront the preferred, but maladaptive defense mechanism in order to attain abstinence. Teaching coping strategies that provide alternatives to the preferred defense mechanisms are beneficial at level two. The third level involves stimulating the arrested emotional development of the alcoholic thus effectively challenging the continued utilization of these defense mechanisms. Specific occupational therapy methods and frames of reference are outlined that are appropriate for implementation at each treatment level.     

Motivation for Change: Implications forSubstance Abuse Treatment

Psychological science has made significant progress exploring the role of motivation in recovery from substance abuse and dependence over the past 20 years. Although recovery is complicated by physiological and psychological dependence, the intentions and motivation of the abuser are a critical part of this process. Motivation for change plays an important part in the process of recognizing the need for change, seeking treatment, and achieving successful sustained change. This article reviews how motivational readiness to change, as conceptualized within the transtheoretical model, contributes to the process of recovery. Important distinctions between intrinsic and extrinsic motivation, imposed and intentional change, and readiness for change versus readiness for treatment are highlighted.     

Women and Alcoholism: A Biopsychosocial Perspective and Treatment Approaches

Viewing alcoholism in women from a biopsychosocial perspective reveals a unique set of circumstances and challenges that women alcoholics face when compared with men. Biologically, women react differently to alcohol ingestion than do men. Women reach higher blood alcohol levels and sustain more somatic and cognitive damage than men when consuming equivalent amounts of alcohol. Psychosocially, women alcoholics face societal rebuke and chastisement of a greater magnitude than do men. Finally, barriers to treatment faced by women, such as the need for child care, cost of treatment, familial opposition, denial of alcoholism, and inadequate diagnostic training of physicians, must be overcome to create successful treatment approaches for the female alcoholic. Obstacles to and implications for treatment are also discussed.     

Neuropsychology Behind the Plate

Abstract

In baseball, plate umpires are asked to make difficult perceptual judgments on a consistent basis. This chapter addresses some neuro-psychological issues faced by umpires as they call balls and strikes, and whether it is ethical to ask fallible humans to referee sporting events when faced with technology that exposes “blown” calls.     

Implications of the Empirically Supported Treatment Movement for Psychoanalysis

In this article, I critique the empirically supported treatment (EST) movement and discuss the limitations of traditional psychotherapy research from a psychoanalytic perspective. The EST movement is based on a medical model that assumes that a psychotherapeutic treatment can be conceptualized independent of the human relationship in which it takes place. Psychotherapy and psychoanalysis are, however, treatments only in a metaphorical sense and are more akin to educational processes than medical treatments. Every therapeutic dyad is unique, and research that treats therapy as a standardized, disembodied entity will not contribute to our understanding. Nevertheless, there is a real need for psychoanalysts to become more actively involved in psychotherapy research both for political and scientific reasons. Although I do not believe that “empirical validation” in the form envisaged by the American Psychological Association task force is a realistic goal, I do believe in the value of microscopic studies of therapeutic process, particularly in the context of research-informed case histories.     

Neuropsychology of the aggressive psychopath: An integrative review

Neuropsychological studies of aggressive psychopaths have revealed characteristic deficits in skills that require verbal mediation, conceptual integration, and the abilities to anticipate consequences of actions and to use feedback from behavior to modify maladaptive response patterns. Formulations of this impairment pattern in terms of frontal lobe and left hemisphere dysfunction are reviewed. It is proposed that the aggressive psychopath suffers from an inability to form a self-referential conceptual classification system for behavioral control and that this predisposes to behavioral disinhibition in situations of stress and interpersonal ambiguity. Finally, implications of neuropsychological studies of aggressive psychopathy for the study of personality and psychopathology are discussed.     

Mental Health Values and Response to Alcoholism Treatment

Mental health values consist of the subset of values that refer to what constitutes good mental health. Torrey (1972) suggested that agreement between patient and therapist about such values may influence psychotherapy outcome. The authors found mixed support for this hypothesis using a sample of 100 chemical dependency inpatients. Positive treatment effects were associated with pretreatment agreement between counselor and patient about some mental health values, but with pretreatment disagreement about others. Because outcome measures assess general personality functioning, the authors suggest that attitudes about what constitutes good mental health may predict general psychotherapy effects as well as response to alcoholism treatment.     

Deviations from Prescribed Prompting Procedures: Implications for Treatment Integrity

The acquisition of new skills may be hindered when teaching procedures vary from previously validated approaches or contain errors. In the present study, we compared the acquisition and maintenance of response chains taught using a perfectly implemented system of least prompts and a multiple verbal prompts procedure (i.e., addition of multiple verbal prompts and failure to follow through with more intrusive prompts). Four children, aged 6–9, participated in the study. An adapted alternating treatments design was used to compare the effectiveness and efficiency of learning during the system of least prompts and the alternative system of least prompts. Results were consistent with those obtained in previous studies in that the perfectly implemented and alternative prompting procedures were effective in teaching new skills for all participants. However, the perfectly implemented treatment required fewer trials to mastery for 4 of the 5 evaluations. Response chains taught under the multiple verbal prompts condition had poorer maintenance for 2 of the 5 evaluations. The results of the current study suggest that deviations from empirically identified teaching procedures may reduce the speed with which new skills are acquired.