Treatment Populations,Services, and Outcomes for Cocaine and Crack-Cocaine Dependence

This paper analyzes demographic and other pretreatment characteristics, measures of treatment services received, and treatment outcomes of participantsin the National Treatment Improvement Evaluation Study (NTIES), a large-scale longitudinal study of substance abuse treatment (D. R. Gerstein et al., 1997; R. A. Johnson & D. R. Gerstein, 2000). The focus here is those treated primarily for cocaine powder or crack-cocaine dependence, compared with those in treatment for other substances, particularly heroin. Crack-dependent users tend to be female and black, older than primary marijuana or alcohol users but younger than those in treatment for heroin. Primary cocaine powder or crack users are likely to have entered treatment under pressure from the criminal justice system. After treatment there are substantial reductions in use of cocaine powder and crack, especially among participants with fewer prior treatment episodes and lower pretreatment intensity of use. Longer duration and intensity of treatment result in greater reductions in cocaine and crack use.     

Transgressing the father figure: performing queer theology as an act of liberation

ABSTRACT

This chapter examines the intersection of power, ritual, and the sacred through the lens of performing drag as a tool to subvert dominant notions of theological discourse. Grounded in Cheng’s assertion that queer theology is transgressive (Radical Love) and Althaus-Reid’s Indecent Theology, the foundational text which introduces the concept of theology as destabilizing and grounded in subversion, particularly in the realm of sexuality, we critique the forces of power operating within Catholicism. We ask: Whose bodies are allowed to play a powerful role in Catholicism? How has ritual performance perpetuated the colonization of the mind/spirit and how can it be used to undo that same colonization? In discussing a public drag performance using George Michael’s “Father Figure,” we suggest the possibility of liberation that exists in bringing theology into queer spaces, extending theology beyond the realm of religious institutions or the academy.     

Creativity in Teaching Case Conceptualization Skills: Role-play to Show the Interconnectedness of Domains

Case conceptualization is an important skill for counselors to master in order to meet treatment needs of clients. Some students struggle while learning this skill, as it requires advanced cognitive complexity, reflection skills, and affective awareness. Further, it is difficult for developing counselors to understand the interconnectedness of clients’ presenting problems, history, and strengths to form a holistic case conceptualization. The authors of this article describe a role-play for teaching the complexity of case conceptualization, in which students role-play various perspectives of psychosocial information and process the experience to create a holistic conceptualization. Activity steps are outlined with examples, and process questions to facilitate classroom discussion are included. Suggestions for implementation are also provided.     

Social inequality,scientific inequality,and the future of mental illness

Background

Despite five decades of increasingly elegant studies aimed at advancing the pathophysiology and treatment of mental illness, the results have not met expectations. Diagnoses are still based on observation, the clinical history, and an outmoded diagnostic system that stresses the historic goal of disease specificity. Psychotropic drugs are still based on molecular targets developed decades ago, with no increase in efficacy. Numerous biomarkers have been proposed, but none have the requisite degree of sensitivity and specificity, and therefore have no usefulness in the clinic. The obvious lack of progress in psychiatry needs exploration.

Methods

The historical goals of psychiatry are reviewed, including parity with medicine, a focus on diagnostic reliability rather than validity, and an emphasis on reductionism at the expense of socioeconomic issues. Data are used from Thomas Picketty and others to argue that our failure to advance clinical care may rest in part on the rise in social and economic inequality that began in the 1970s, and in part on our inability to move beyond the medical model of specificity of disease and treatment.

Results

It is demonstrated herein that the historical goal of specificity of disease and treatment has not only impeded the advance of diagnosis and treatment of mental illness, but, in combination with a rapid increase in socioeconomic inequality, has led to poorer outcomes and rising mortality rates in a number of disorders, including schizophrenia, anxiety, and depression.

Conclusions

It is proposed that Psychiatry should recognize the fact of socioeconomic inequality and its effects on mental disorders. The medical model, with its emphasis on diagnostic and treatment specificity, may not be appropriate for investigation of the brain, given its complexity. The rise of scientific inequality, with billions allocated to connectomics and genetics, may shift attention away from the need for improvements in clinical care. Unfortunately, the future prospects of those suffering from mental illness appear dim.