A randomized trial comparing levo-alpha acetylmethadol with methadone maintenance for patients in primary care settings in Australia.
Journal - Addiction (Abingdon, England) (England )
AIMS: The present study aimed to compare the efficacy of levo-alpha-acetylmethadol (LAAM) and methadone, as measured by retention in treatment and heroin use, in a randomized trial conducted under naturalistic conditions. SETTING: This study is the first randomized trial comparing LAAM with methadone in the primary care setting. Participants were recruited through 29 medical practitioners working in specialist and generalist settings in Australia. PARTICIPANTS: Existing methadone maintenance patients, aged 18 years and over and able to give informed consent, were randomized to receive either LAAM or methadone. A total of 93 patients participated. INTERVENTION: After being trained in the use of LAAM, existing methadone prescribers were then able to determine an individually tailored treatment regimen for each patient. The trial was an open-label study. Methadone and LAAM dosing was supervised through local community pharmacies. Participation in ancillary services (e.g. counselling) was optional for all patients. The treatment period for the trial was 12 months. MEASUREMENTS: Baseline, 3-, 6- and 12-month interviews were conducted. Outcome measures were retention in treatment, self-reported heroin use and serious adverse events. FINDINGS: There were no significant differences between LAAM and methadone on retention in treatment, nor heroin use. There was a trend for LAAM patients to have lower heroin use than methadone patients. Of the seven serious adverse events in the LAAM group, three were not drug-related. There were two dosing errors. CONCLUSIONS: This study demonstrates (a) the efficacy of LAAM as a treatment for heroin dependence, and (b) the capacity for LAAM to be effectively delivered in primary care settings by trained general practitioners and pharmacists. The next challenge is to resolve outstanding safety concerns with LAAM.
|ISSN : ||0965-2140|
|Mesh Heading : ||Adult Australia Family Practice Female Heroin Dependence Humans Male Methadone Methadyl Acetate Middle Aged Narcotics Outcome Assessment (Health Care) Treatment Outcome|
|Mesh Heading Relevant : ||rehabilitation therapeutic use therapeutic use therapeutic use|
The influence of the therapeutic relationship in treatment for alcohol dependency.
Journal - Drug and alcohol review (England )
The substance abuse field has been slow to embrace research into the impact of the therapeutic relationship on treatment outcome. Limited previous research has demonstrated that therapist factors such as unconditional regard and empathy are associated strongly with treatment outcome. This study examined the relationships between client perception of the therapist and client characteristics; client response to out-patient relapse prevention treatment; and client outcome 3 months following treatment for alcohol dependence. One hundred and sixty-one male clients of a 3-week relapse prevention programme participated in the research, completing questionnaires assessing their perception of therapist regard, empathy, congruence, attractiveness, expertness and trustworthiness.Treatment outcome was measured at the conclusion of treatment, and 3 months post-treatment. Clients who were more anxious and those with poorer cognitive functioning appeared to perceive therapists as showing less unconditional regard, empathy and congruence. Self-efficacy and coping skills acquisition measured at the end of treatment correlated significantly with clients' perceptions of the therapist as empathic, congruent and displaying high regard for them. Treatment outcome at 3 months was associated significantly with degree of perceived therapist expertness and empathy. These relationships held when cognitive functioning and skills acquisition were controlled for. Self-efficacy moderated the relationships between regard and empathy and outcome, but not perceived therapist expertness. A lower than desirable follow-up rate limits the generalizability of the findings. The quality of the therapeutic relationship as perceived by clients appears to be associated with client characteristics, response to treatment and treatment outcome.
|ISSN : ||0959-5236|
|Mesh Heading : ||Adult Alcoholism Directive Counseling Humans Male Middle Aged Neuropsychological Tests Statistics, Nonparametric Treatment Outcome methods statistics & numerical data|
|Mesh Heading Relevant : ||Psychotherapeutic Processes psychology therapy|