Subgroups of addicted and nonaddicted borderline outpatients based on symptoms exhibited and comorbid disorders

This study examined gender differences in addiction, comorbid illnesses and symptoms in chemically dependent borderline outpatients. Subgroups were also identified empirically, using cluster analysis. Finally, the addicted group was compared to a matched, nonaddicted cohort to examine whether differences were borderline or addiction related. Forty-eight borderline outpatients (24 female, 24 male) seeking substance abuse treatment were diagnosed for axis I and II disorders. Subjects also received the Addiction Severity Index and several questions on abuse history were asked directly. All subjects displayed a high prevalence of mood disorders and used primarily alcohol and cocaine. Females exhibited more anxiety disorders, slightly higher psychiatric severity and more histories of sexual abuse. More males exhibited antisocial personality disorder and witnessed domestic violence. Cluster analysis identified two subgroups based on BPD criteria, distinguished by: (1) identity disturbance and frantic efforts to avoid abandonment and (2) affect disregulation and inappropriate expression of anger. These clusters did not differ on axis I disorders, personality disorders, addiction severity, or abuse history. When the complete (male and female) addicted group was compared with a nonaddicted cohort, numerous significant differences were found. Addicted patients exhibited more impulsivity and fewer comorbid personality disorders while nonaddicted patients displayed more inappropriate anger and frantic efforts to avoid abandonment. Gender differences seen in the addicted group were generally absent in the nonaddicted group. Cluster analysis of the combined (addicted and nonaddicted) group identified two groups defined by incidence of self-harming behaviors. Overall, there were fewer gender differences among addicted borderline patients than expected. Thus, there is no reason to suspect that women are more likely to be diagnosed as borderline because they look more typically borderline than men. Also, there is no evidence to suggest that gender specific treatment would be particularly useful. The gender differences present appeared to be addiction rather than borderline related. Male and female addicts displayed some differences in symptoms and comorbid illnesses and thus may have different needs in treatment. The most significant differences appear to be between addicted and nonaddicted borderline patients emphasizing the need for thorough assessment of drug abuse/addiction in borderline patients

Subgroups of addicted and nonaddicted borderline outpatients based on symptoms exhibited and comorbid disorders

This study examined gender differences in addiction, comorbid illnesses and symptoms in chemically dependent borderline outpatients. Subgroups were also identified empirically, using cluster analysis. Finally, the addicted group was compared to a matched, nonaddicted cohort to examine whether differences were borderline or addiction related. Forty-eight borderline outpatients (24 female, 24 male) seeking substance abuse treatment were diagnosed for axis I and II disorders. Subjects also received the Addiction Severity Index and several questions on abuse history were asked directly. All subjects displayed a high prevalence of mood disorders and used primarily alcohol and cocaine. Females exhibited more anxiety disorders, slightly higher psychiatric severity and more histories of sexual abuse. More males exhibited antisocial personality disorder and witnessed domestic violence. Cluster analysis identified two subgroups based on BPD criteria, distinguished by: (1) identity disturbance and frantic efforts to avoid abandonment and (2) affect disregulation and inappropriate expression of anger. These clusters did not differ on axis I disorders, personality disorders, addiction severity, or abuse history. When the complete (male and female) addicted group was compared with a nonaddicted cohort, numerous significant differences were found. Addicted patients exhibited more impulsivity and fewer comorbid personality disorders while nonaddicted patients displayed more inappropriate anger and frantic efforts to avoid abandonment. Gender differences seen in the addicted group were generally absent in the nonaddicted group. Cluster analysis of the combined (addicted and nonaddicted) group identified two groups defined by incidence of self-harming behaviors. Overall, there were fewer gender differences among addicted borderline patients than expected. Thus, there is no reason to suspect that women are more likely to be diagnosed as borderline because they look more typically borderline than men. Also, there is no evidence to suggest that gender specific treatment would be particularly useful. The gender differences present appeared to be addiction rather than borderline related. Male and female addicts displayed some differences in symptoms and comorbid illnesses and thus may have different needs in treatment. The most significant differences appear to be between addicted and nonaddicted borderline patients emphasizing the need for thorough assessment of drug abuse/addiction in borderline patients

Counseling for cocaine addiction: the collaborative cocaine treatment study model.

To ensure that treatment providers apply the most current scientifically supported approaches to their patients, NIDA has supported the development of the “Therapy Manuals for Drug Addiction” series. This series reflects NIDA’s commitment to rapidly applying basic findings in real life settings. The manuals are derived from those used efficaciously in NIDA-supported drug abuse treatment studies. They are intended for use by drug abuse treatment practitioners, mental health professionals, and all others concerned with the treatment of drug addiction. The manuals present clear, helpful information to aid drug treatment practitioners in providing the best possible care that science has to offer. They describe scientifically supported therapies for addiction and give guidance on session content and how to implement specific techniques. Of course, there is no substitute for training and supervision, and these manuals may not be applicable to all types of patients nor compatible with all clinical programs or treatment approaches. These manuals should be viewed as a supplement to, but not a replacement for, careful assessment of each patient, appropriate case formulation, ongoing monitoring of clinical status, and clinical judgment

Active Drug-Using Women Use Female-Initiated Barrier Methods to Reduce HIV/STI Risk: Results from a Randomized Trial

Background. We tested an original, woman-focused intervention, based on body empowerment, and female-initiated barrier methods, including the female condom (FC) and cervical barriers. Methods. Eligible women were \u3e= 18 years of age, HIV seronegative, and active drug users, reporting 30% or greater unprotected sex acts. Both controls (C) and intervention (I) participants received enhanced HIV/STI harm reduction counseling. I participants underwent 5 additional weekly group sessions. We compared change in frequency of unprotected vaginal intercourse across arms at 12 months. Results. Among 198 enrolled women, over 95% completed followup. Two-thirds were African-American; most of them used crack, had a primary partner, and reported sex exchange. In paired t-tests from baseline to followup, the frequency of unprotected vaginal sex dropped significantly for I (primary P \u3c 0.00, nonprimary P \u3c 0.002) and C (primary P \u3c 0.008, nonprimary P \u3c 0.000) arms with all partners. The difference in change across arms was of borderline significance for primary partner (P = 0.075); no difference was seen for nonprimary partner (P = 0.8). Use of male condom and FC increased with both partner types over time, but more consistently among I women. Conclusion: The ?value-added? impact of the intervention was observed mainly with primary partners. Body knowledge with routine FC counseling should be incorporated into interventions for drug-using women

Therapy manuals for drug addiction.

"Contract number N-01DA-4-2205"--Manuals 1-2."Printed September 1999"--Manual 3, t.p. verso."Printed April 1998"--Manuals 1-2, t.p. verso.Shipping list no.: 98-0202-P (manuals 1-2).Includes bibliographical references.manual 1. A cognitive-behavioral approach : treating cocaine addiction / Kathleen M. Carroll -- manual 2. A community reinforcement plus voucher approach : treating cocaine addiction / Alan J. Budney, Stephen T. Higgins -- manual 3. An individual drug counseling approach to treat cocaine addiction : the collaborative cocaine treatment study model / Delinda E. Mercer, George E. Woody. -- manual 4. Drug conunseling for cocaine addiction: The collaborative cocaine treatment study modelMode of access: Internet

Psychosocial Treatments for Cocaine Dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study

BACKGROUND This was a multicenter investigation examining the efficacy of 4 psychosocial treatments for cocaine-dependent patients. METHODS Four hundred eighty-seven patients were randomly assigned to 1 of 4 manual-guided treatments: individual drug counseling plus group drug counseling (GDC), cognitive therapy plus GDC, supportive-expressive therapy plus GDC, or GDC alone. Treatment was intensive, including 36 possible individual sessions and 24 group sessions for 6 months. Patients were assessed monthly during active treatment and at 9 and 12 months after baseline. Primary outcome measures were the Addiction Severity Index–Drug Use Composite score and the number of days of cocaine use in the past month. RESULTS Compared with the 2 psychotherapies and with GDC alone, individual drug counseling plus GDC showed the greatest improvement on the Addiction Severity Index–Drug Use Composite score. Individual group counseling plus GDC was also superior to the 2 psychotherapies on the number of days of cocaine use in the past month. Hypotheses regarding the superiority of psychotherapy to GDC for patients with greater psychiatric severity and the superiority of cognitive therapy plus GDC compared with supportive-expressive therapy plus GDC for patients with antisocial personality traits or external coping style were not confirmed. CONCLUSION Compared with professional psychotherapy, a manual-guided combination of intensive individual drug counseling and GDC has promise for the treatment of cocaine dependence.Arch Gen Psychiatry. 1999;56():493-502--