合理药物治疗的辩证观

介绍合理药物治疗的手段及其对临床治疗产生的影响.指出把治疗药物监测和药物基因组学方法相结合应是以后药物治疗的最佳模式.     

The behavioral treatment of insomnia an alternative to drug therapy.

The use of hypnotic drugs to treat insomnia is criticized because of (a) tolerance effects, (b) carry-over effects, (c) alterations in sleep patterns, (d) rebound effects, and (e) attributional effects. Behavioral treatments represent a more viable alternative and are reviewed under four headings: (a) systematic desensitization: (b) applied relaxation; (c) attribution-based therapies; and (d) classical conditioning therapies. The behavioral therapies are predicated upon three views of insomnia: first, that insomnia results from excessively high levels of arousal prior to and during sleep; second, that insomnia occurs when the sleep environment lacks sufficient stimulus control over sleeping; and finally, that insomnia is often enhanced and maintained by exacerbation cycles in which worries about not falling asleep interfere even further with one's sleep.     

Theory development in a family-based therapy for adolescent drug abuse

Family-based treatments for adolescent drug abuse and related behavior problems have been developed and evaluated with success. Empirical support exists for the efficacy of family-based treatments, and process studies have begun to identify mechanisms by which these treatments may achieve their effects. This article discusses theory and related clinical refinements in a contemporary family-based intervention, multidimensional family therapy. Expansions in the theoretical basis of the model are discussed. I highlight 2 aspects of the theory evolution process, resulting in a sharper clinical focus on intrapersonal development and on adolescents' and families' functioning vis-à-vis influential extrafamilial ecologies of development.     

Reflections during a study on family therapy with drug addicts

This article presents ideas and reflections emerging during a project on family therapy with drug abusers. Initially inspired by the writings of Stanton and Todd on the subject, the project developed into a recursive and self-reflective process, characterized by increasing doubts about the usefulness of categorization of families, of pre-planning therapy, and of the therapist as an "expert." The limitations of approaches that emphasize the importance of understanding the family structure as the basis for changing it are discussed, particularly with respect to how they decrease therapist flexibility and may block the family's finding their own solution. Alternative approaches to practice and research are also discussed, bearing on ideas particularly formulated by theoreticians and practitioners inspired by second-order cybernetics.     

Behavior therapy for drug abuse: A controlled treatment outcome study

82 Ss were studied in a comparative evaluation of a behavioral vs supportive treatment for illegal drug use. Behavioral treatment included stimulus control, urge control, contracting/family support and competing response procedures for an average of 19 sessions. 37% of Ss in the behavioral condition were drug-free at 2 months, 54% at 6 months, and 65% at 12 months vs 20 ± 6% for the alternative treatment during all 12 months. The behavioral treatment was more effective across sex, age, educational level, marital status and type of drug (hard-drugs, cocaine, and marijuana). Greater improvement for this condition was also noted on measures of employment/school attendance, family relationships, depression, institutionalization and alcohol use.     

Family therapy vs. parent groups: Effects on adolescent drug abusers

Abstract

The families of adolescent drug abuse clients who were admitted to six outpatient drug-free (OPDF) treatment programs were randomly assigned to either a family therapy method or a parent group method. It was later found that in 93% of the family therapy families, one or both parents participated (N=85); but that in only 67% of the families assigned to a parent group did one or both parents participate (N=50). This is considered to be an important practical advantage for family therapy. At follow-up evaluation 15 months later (after a 6-month course of treatment and a 9-month follow-up period), the clients and their mothers in both groups reported significant improvement on numerous outcome criteria, including reduction in substance use. There was no significant difference between the two groups in degree of improvement.     

Learning sobriety together: behavioural couples therapy for alcoholism and drug abuse

Among the various types of partner- and family-involved interventions used to treat adults with substance use disorders, Behavioural Couples Therapy (BCT) has garnered the strongest empirical support for its efficacy. During the past thirty years, multiple studies have consistently found married or cohabiting substance-abusing patients who engage in BCT, compared to traditional individual-based counselling or partner-involved attention control treatments, report significantly greater (1) reductions in substance use, (2) levels of relationship satisfaction, and (3) greater improvements in other areas of relationship and family adjustment (e.g. reductions in partner violence, improvements in custodial children's adjustment). In addition to discussing the theoretical rationale for BCT as a treatment of substance abuse, this article describes specific therapeutic techniques used as part of this intervention and summarizes the relevant evaluative empirical literature.     

The use of a double-blind drug trial in family therapy to demedicalize a problem

A family therapy approach to a problem that had led previous clinicians to diagnose and treat a child as 'hyperkinetic', is described. The resistance to change that the preceding diagnosis had inculcated, is described. A method of overcoming this resistance by active involvement of the family in a double-blind trial of the drug treatment, was devised and used concurrently with a structural form of family therapy.     

Behavioral tolerance of squirrel monkeys to hypoxia: A model for evaluating drug therapy

A behavioral tolerance-time procedure for measuring hypoxia-induced disruption of avoidance behavior was developed using squirrel monkeys (Saimiri sciureus) under a Sidman avoidance contingency. Hypoxic atmospheres were acutely and repeatedly presented to highly trained monkeys during avoidance sessions with 5 min of normoxia between presentations of hypoxia. Behavioral tolerance time was defined as the period from the initiation of hypoxia to the occurrence of the first shock during each hypoxic presentation. Parametric studies demonstrated that reliable behavioral tolerance times could be obtained using a 5-sec response-shock interval and a 7% O₂ atmosphere. Acetazolamide, a drug previously shown to be beneficial for several types of functioning under hypoxic conditions, markedly lengthened behavioral tolerance time, suggesting a valid model for evaluating drug therapies.     

EEG performance spectral mapping during drug therapy in a patient with schizophrenic psychosis

In a paranoid-hallucinatoric patient with chronic course and acute exacerbation a EEG mapping study during neuroleptic treatment was carried out. The typical changes of the alpha power spectra in schizophrenic psychoses as well the normalization after neuroleptic treatment could be found in the alpha map. The changes were in correlation to the clinical state.     

Family therapy with problem drinkers and drug takers: A pilot follow-up study

We report a retrospective outcome study of 36 problem drinkers and/or drug takers, treated with structural-strategic family therapy. The interval between treatment and follow-up varied from six months to two years. Follow-up data was available on 34 cases. Twenty had a pure alcohol problem and of these 18 had a good outcome at follow up. Five had a mixed drug/alcohol problem; of these all were free from problem drinking and four had become abstinent from drugs at follow-up. Of the nine patients with a pure drug problems, eight were abstinent from drugs at follow-up. Given the retrospective nature of this study and the lack of control data, these results must remain impressionistic but the implications of the findings are discussed.     

Sequential combinations of drug and cognitive behavioral therapy for chronic insomnia: an exploratory study

This study explores the efficacy of sequential treatments involving medication and cognitive behavioral treatment (CBT) for primary insomnia. Seventeen participants took part in a multiple baseline design and were assigned to: (a) medication for 5 weeks, followed by combined medication plus CBT for 5 weeks; (b) combined treatment for 5 weeks, followed by CBT alone; or (c) CBT alone. Each treatment sequence produced significant sleep improvements, but at different points in time. For the first sequence, most of the sleep improvement was obtained after the introduction of CBT, while for the other sequence and CBT alone, improvement appeared during the first weeks. These results suggest that sleep improvement seems affected by the way treatments are combined. Also, a sequence beginning with a combined treatment followed by CBT alone seems to produce the best outcome. Additional research should be conducted with larger samples to determine the most effective sequence.     

Group therapy with the multiply oppressed: Treating Latino,HIV-infected injecting drug users

The Latino community in New York City and across the country is disproportionally represented in the AIDS epidemic. This article explores the impact of multiply oppressed group membership on the psychotherapeutic group treatment of Latino, HIV-infected injecting drug users. The interaction of traditional Latino values with injecting drug user and seropositive identities is described. Clinical examples drawn from a bilingual group held in a methadone maintenance clinic in the South Bronx highlight how oppressed group memberships affect Yalom's curative factors.This article was written with the support of a Ryan White CARE Act Title I grant to Montefiore Medical Center through the City of New York, contract OHF-4165.     

A comparative study of family therapy in the treatment of opiate users in a London drug clinic

This study presents the results of a randomized treatment trial of family therapy and two control treatments for 119 outpatient opiate users. All treatments were combined with a methadone reduction programme. The control treatments were: (1) a 'standard' treatment (supportive psychotherapy) and (2) a 'low contact' intervention. Treatment outcome was evaluated six and twelve months after the initial assessment. Both the family therapy and minimal intervention groups had a significantly higher number of drug–free days at six and twelve months, compared to the standard treatment, despite receiving fewer treatment sessions. Across all treatments there was evidence for a gender difference in response to therapy in users who were in a couple relationship. In couples where both partners were using drugs women did significantly better than men. Men living with a non–drug–abusing partner fared better than men living with a drug–using partner. Across the treatment groups diminution in drug use was accompanied by improvements in psychosocial functioning. Unemployment, sharing needles and injecting drugs were predictive of poor outcome.     

Effects of moral reconation therapy upon moral reasoning, life purpose, and recidivism among drug and alcohol offenders

40 incarcerated DWI offenders and 62 drug offenders who were treated with Moral Reconation Therapy were assessed with respect to levels of moral reasoning, their perceived purpose in life, and subsequent recidivism. Analysis showed that, as clients progress in the program, levels of moral reasoning and purpose in life increase significantly. Level of moral reasoning appears to increase with clients' completion of therapeutic steps. Preliminary recidivism data on 103 male and female inmate-clients who have participated in an aftercare program using the therapy appear encouraging.     

Optimal drug use and rational drug policy

The Müller & Schumann (M&S) view of drug use is courageous and compelling, with radical implications for drug policy and research. It implies that most nations prohibit most drugs that could promote happiness, social capital, and economic growth; that most individuals underuse rather than overuse drugs; and that behavioral scientists could use drugs more effectively in generating hypotheses and collaborating empathically.     

Behavioral economics of drug self-administration and drug abuse policy.

The concepts of behavioral economics have proven useful for understanding the environmental control of overall levels of responding for a variety of commodities, including reinforcement by drug self-administration. These general concepts are summarized for application to the analysis of drug-reinforced behavior and proposed as the basis for future applications. This behavioral agenda includes the assessment of abuse liability, the assay of drug-reinforcer interactions, the design of drug abuse interventions, and the formulation of drug abuse public policy. These separate domains of investigation are described as part of an overall strategy for designing model projects to control drug use and testing public policy initiatives.