Treatment for Stimulant Use Disorders

Appendix A -- Bibliography

Alberti, R.E., and Emmons, M.L.

Your Perfect Right: A Guide to Assertive Living. San Luis Obsipo, CA: Impact Press, 1982.

Allcott, J.V., III; Barnhart, R.A.; and Mooney, L.A.

Acute lead poisoning in two users of illicit methamphetamine. Journal of the American Medical Association 258:510-511, 1987.
View the Medline version of this and related citations using NLM's PubMed

Amass, L.

Financing voucher programs for pregnant substance abusers through community donations [abstract]. In: Harris, L.S., ed. Problems of Drug Dependence 1996: Proceedings of the 58th Annual Scientific Meeting of the College on Problems of Drug Dependence. NIDA Research Monograph Series, Number 174. DHHS Pub. No. (ADM) 97-4236. Rockville, MD: National Institute on Drug Abuse, 1997. p. 60.

American Medical Association.

International Classification of Diseases, 9th revision clinical modification (ICD-9-CM). Chicago: American Medical Association, 1997.

American Psychiatric Association.

Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994.

Anglin, D.; Spears, K.L.; and Hutson, H.R.

Flunitrazepam and its involvement in date or acquaintance rape. Academic Emergency Medicine 4(4):323-326, 1997.
View the Medline version of this and related citations using NLM's PubMed

Anglin, M.D.; Kalechstein, A.; Magline, M.; Annon, J.; and Fiorentine, R. (UCLA Drug Abuse Research Center).

Epidemiology and Treatment of Methamphetamine Abuse in California: A Regional Report. Rockville, MD: National Evaluation Data and Technical Assistance Center (NEDTAC), Center for Substance Abuse Treatment, April 1998.

Angrist, B.

Amphetamine psychosis: Clinical variations of the syndrome. In: Cho, A.K., and Segal, D.S., eds. Amphetamine and Its Analogs: Psychopharmacology, Toxicology, and Abuse. San Diego, CA: Academic Press, 1994.

Anker, A.L., and Crowley, T.J.

Use of contingency contracts in specialty clinics for cocaine abuse. In: Harris, L.S., ed. Problems of Drug Dependence, 1981: Proceedings of the 43rd Annual Scientific Meeting, the Committee on Problems of Drug Dependence. NIDA Research Monograph Series, Number 41. NTIS Pub. No. 82-190760. Rockville, MD: National Institute on Drug Abuse, 1982. pp. 452-459.

Anthony, J.C.; Vlahov, D.; Nelson, K.E.; Cohn, S.; Astemborski, J.; and Solomon, L.

New evidence on intravenous cocaine use and the risk of infection with human immunodeficiency virus type 1. American Journal of Epidemiology 134(10):1175-1189, 1991.
View the Medline version of this and related citations using NLM's PubMed

Azrin, N.H., and Besalel, V.A.

Job Club Counselor's Manual. Baltimore, MD: University Park Press, 1980.

Azrin, N.H.; Naster, B.J.; and Jones, R.

Reciprocity counseling: A rapid learning based procedure for marital counseling. Behavioral Research and Therapy 11:365-382, 1973.
View the Medline version of this and related citations using NLM's PubMed

Barry, C.T.

"Treatment for methamphetamine abuse disorders." Presented at the Methamphetamine Interagency Task Force Federal Advisory Committee Meeting, Washington, DC, May 4-5, 1998.

Bauer, L.O.

Psychomotor and electroencephalographic sequelae of cocaine dependence. In: Majewska, M.D., ed. Neurotoxicity and Neuropathology Associated With Cocaine Abuse. NIDA Research Monograph Series, Number 163. DHHS Pub. No. (ADM) 96-4019. Rockville, MD: National Institute on Drug Abuse, 1996. pp. 66-93.

Beebe, D.K., and Walley, E.J.

Smokable methamphetamine (ICE): An old drug in a different form. American Family Physician 51:449-453, 1995.
View the Medline version of this and related citations using NLM's PubMed

Bell, D.S.

The experimental reproduction of amphetamine psychosis. Archives of General Psychiatry 29(1):35-40, 1973.
View the Medline version of this and related citations using NLM's PubMed

Biederman, J.; Faraone, S.V.; Spencer, T.; Wilens, T.; Norman, D.; Lapey, K.A.; Mick, E.; Lehman, B.K.; and Doyle, A.

Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry 150(12):1792-1798, 1993.
View the Medline version of this and related citations using NLM's PubMed

Biederman, J.; Wilens, T.; Mick, E.; Milberger, S.; Spencer, T.J.; and Faraone, S.V.

Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD): Effects of ADHD and psychiatric comorbidity. American Journal of Psychiatry 152(11):1652-1658, 1995.
View the Medline version of this and related citations using NLM's PubMed

Bigelow, G.E.; Stitzer, M.L.; Griffiths, R.R.; and Liebson, I.A.

Contingency management approaches to drug self-administration and drug abuse: Efficacy and limitations. Addictive Behavior 6:241-252, 1981.
View the Medline version of this and related citations using NLM's PubMed

Brady, K.T.; Lydiard, R.B.; Malcolm, R.; and Ballenger, J.C.

Cocaine-induced psychosis. Journal of Clinical Psychiatry 52(12):509-512, 1991.
View the Medline version of this and related citations using NLM's PubMed

Brotman, A.; Witkie, S.M.; Gelenberg, A.J.; Falk, W.E.; Wojcik, J.; and Leahy, L.

An open trial of maprotiline for the treatment of cocaine abuse: A pilot study. Journal of Clinical Psychopharmacology 8:125-127, 1988.
View the Medline version of this and related citations using NLM's PubMed

Budney, A.J., and Higgins, S.T.

A Community Reinforcement Plus Vouchers Approach: Treating Cocaine Addiction. Therapy Manuals for Drug Addiction, Manual 2. DHHS Pub. No. (ADM) 98-4309. Rockville, MD: National Institute on Drug Abuse, 1998.

Burton, B.T.

Heavy metal and organic contaminants associated with illicit methamphetamine production. In: Miller, M.A., and Kozel, N.J., eds. Methamphetamine Abuse: Epidemiologic Issues and Implications. NIDA Research Monograph Series, Number 115. DHHS Pub. No. (ADM) 91-1836. Rockville, MD: National Institute on Drug Abuse, 1991. pp. 47-59.

Carroll, K.M.

"Combining psychotherapy and pharmacotherapy treatments to improve drug abuse outcomes." Paper presented at Addictions '96: Treatments Across the Addictions, International Symposium, Hilton Head, SC, September 27-29, 1996.

Carroll, K.M.; Chang, G.; Behr, H.; Clinton, B.; and Kosten, T.

Improving treatment outcome in pregnant, methadone-maintained women: Results from a randomized clinical trial. American Journal on Addiction 4:56-59, 1995a.

Carroll, K.M.; Nich, C.; and Rounsaville, B.J.

Differential symptom reduction in depressed cocaine abusers treated with psychotherapy and pharmacotherapy. Journal of Nervous and Mental Disease 183(4):251-259, 1995b.
View the Medline version of this and related citations using NLM's PubMed

Carroll, K.M.; Power, M.E.; Bryant, K.; and Rounsaville, B.J.

One year follow-up status of treatment seeking cocaine abusers. Psychopathology and dependence severity as predictors of outcome. Journal of Nervous and Mental Disease 181:71-79, 1993a.
View the Medline version of this and related citations using NLM's PubMed

Carroll, K.M.; Rounsaville, B.J.; and Gawin, F.H.

A comparative trial of psychotherapies for ambulatory cocaine abusers: Relapse prevention and interpersonal psychotherapy. American Journal of Drug and Alcohol Abuse 17:229-247, 1991a.
View the Medline version of this and related citations using NLM's PubMed

Carroll, K.M.; Rounsaville, B.J.; Gordon, L.T.; Nich, C.; Jatlow, P.; Bisighini, R.M.; and Gawin, F.H.

Psychotherapy and pharmacotherapy for ambulatory cocaine abusers. Archives of General Psychiatry 51:177-187, 1994a.
View the Medline version of this and related citations using NLM's PubMed

Carroll, K.M.; Rounsaville, B.J.; and Keller, D.S.

Relapse prevention strategies for the treatment of cocaine abusers. American Journal of Drug and Alcohol Abuse 17:249-265, 1991b.
View the Medline version of this and related citations using NLM's PubMed

Carroll, K.M.; Rounsaville, B.J.; Nich C.; Gordon, L.; and Gawin F.

Integrating psychotherapy and pharmacotherapy for cocaine dependence: Results from a randomized clinical trial. In: Onken, L.S.; Blaine, J.D.; and Boren, J.J., eds. Integrating Behavioral Therapies With Medications in the Treatment of Drug Dependence. NIDA Research Monograph Series, Number 150. DHHS Pub. No. (ADM) 95-3899. Rockville, MD: National Institute on Drug Abuse, 1995c. pp. 19-36.

Carroll, K.M.; Rounsaville, B.J.; Nich, C.; Gordon, L.T.; Wirtz, P.W.; and Gawin, F.

One-year followup of psychotherapy and pharmacotherapy for cocaine dependence. Archives of General Psychiatry 51: 989-997, 1994b.
View the Medline version of this and related citations using NLM's PubMed

Carroll, K.; Ziedonis, D.; O'Malley, S.; McCance-Katz, E.; Gordon, L.; and Rounsaville, B.

Pharmacologic interventions for alcohol- and cocaine-abusing individuals: A pilot study of disulfiram vs. naltrexone. American Journal on Addictions 2:77-79, 1993b.

Castro, F.G.; Barrington, E.H.; Sharp, E.V.; Dial, L.S.; Wang. B.; and Rawson, R.

Behavioral and psychological profiles of cocaine users upon treatment entry: Ethnic comparisons. Drugs and Society 6:231-251, 1992.

Center for Substance Abuse Research, University of Maryland.

Methamphetamine use in the western United States: An in-depth look. Cesar Fax 6(29), 1997.

Center for Substance Abuse Treatment.

State Methadone Treatment Guidelines. Treatment Improvement Protocol (TIP) Series, No. 1. DHHS Pub. No. (SMA) 93-1991. Washington, DC: U.S. Government Printing Office, 1991.

Center for Substance Abuse Treatment.

Improving Treatment for Drug-Exposed Infants. Treatment Improvement Protocol (TIP) Series, No. 5. DHHS Pub. No. (SMA) 95-3057 (reprint). Washington, DC: U.S. Government Printing Office, 1993.

Center for Substance Abuse Treatment.

Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug Abuse. Treatment Improvement Protocol (TIP) Series, No. 9. DHHS Pub. No. (SMA) 94-2078. Washington, DC: U.S. Government Printing Office, 1994a.

Center for Substance Abuse Treatment.

Assessment and Treatment of Cocaine-Abusing Methadone-Maintained Patients. Treatment Improvement Protocol (TIP) Series, No. 10. DHHS Pub. No. (SMA) 94-3003. Washington, DC: U.S. Government Printing Office, 1994b.

Center for Substance Abuse Treatment.

Combining Substance Abuse Treatment With Intermediate Sanctions for Adults in the Criminal Justice System. Treatment Improvement Protocol (TIP) Series, No. 12. DHHS Pub. No. (SMA) 94-3004. Washington, DC: U.S. Government Printing Office, 1994c.

Center for Substance Abuse Treatment.

Treatment for HIV-Infected Alcohol and Other Drug Abusers. Treatment Improvement Protocol (TIP) Series, No. 15. DHHS Pub. No. (SMA) 95-3038. Washington, DC: U.S. Government Printing Office, 1995a.

Center for Substance Abuse Treatment.

Alcohol and Other Drug Screening of Hospitalized Trauma Patients. Treatment Improvement Protocol (TIP) Series, No. 16. DHHS Pub. No. (SMA) 95-3041. Washington, DC: U.S. Government Printing Office, 1995b.

Center for Substance Abuse Treatment.

Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System. Treatment Improvement Protocol (TIP) Series, No. 17. DHHS Pub. No. (SMA) 95-3039. Washington, DC: U.S. Government Printing Office, 1995c.

Center for Substance Abuse Treatment.

Detoxification From Alcohol and Other Drugs. Treatment Improvement Protocol (TIP) Series, No. 19. DHHS Pub. No. (SMA) 95-3046. Washington, DC: U.S. Government Printing Office, 1995d.

Center for Substance Abuse Treatment.

Combining Alcohol and Other Drug Abuse Treatment With Diversion for Juveniles in the Justice System. Treatment Improvement Protocol (TIP) Series, No. 21. DHHS Pub. No. (SMA) 95-3051. Washington, DC: U.S. Government Printing Office, 1995e.

Center for Substance Abuse Treatment.

Treatment Drug Courts: Integrating Substance Abuse Treatment With Legal Case Processing. Treatment Improvement Protocol (TIP) Series, No. 23. DHHS Pub. No. (SMA) 96-3113. Washington, DC: U.S. Government Printing Office, 1996.

Center for Substance Abuse Treatment.

Proceedings of the National Consensus Meeting on the Use, Abuse, and Sequelae of Abuse of Methamphetamine With Implications for Prevention, Treatment and Research. DHHS Pub. No. (SMA) 96-8013. Rockville, MD: CSAT, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services, 1997.

Center for Substance Abuse Treatment.

Substance Use Disorder Treatment for People With Physical and Cognitive Disabilities. Treatment Improvement Protocol (TIP) Series, No. 29. DHHS Pub. No. (SMA) 98-3249. Washington, DC: U.S. Government Printing Office, 1998a.

Center for Substance Abuse Treatment.

Continuity of Offender Treatment for Substance Use Disorders From Institution to Community. Treatment Improvement Protocol (TIP) Series, No. 30. DHHS Pub. No. (SMA) 98-3245. Washington, DC: U.S. Government Printing Office, 1998b.

Center for Substance Abuse Treatment.

Screening and Assessing Adolescents for Substance Use Disorders. Treatment Improvement Protocol (TIP) Series, No. 31. DHHS Pub. No. 99-3282. Washington, DC: U.S. Government Printing Office, 1999a.

Center for Substance Abuse Treatment.

Treatment of Adolescents With Substance Use Disorders. Treatment Improvement Protocol (TIP) Series, No. 32. DHHS Pub. No. 99-3283. Washington, DC: U.S. Government Printing Office, 1999b.

Chafetz, M.E.; Blaine, H.T.; and Hill, M.J.

Frontiers of Alcoholism. New York: Science House, 1970.

Chaisson, R.E.; Bacchetti, P.; Osmond, D.; Brodie, B.; Sande, M.A.; and Moss, A.R.

Cocaine use and HIV infection in intravenous drug users in San Francisco. Journal of the American Medical Association 261(4):561-565, 1989.
View the Medline version of this and related citations using NLM's PubMed

Chaney, E.F.

Social skills training. In: Hester, R.K., and Miller, W.R., eds. Handbook of Alcoholism Treatment Approaches. Elmsford, NY: Pergamon Press, 1989. pp. 206-221.

Charness, M.E.

Alcohol and the brain. Alcohol Health and Research World 14(2):85-89, 1990.

Cherek, D.R.; Kelly, T.H.; and Steinberg, J.L.

Behavioral contingencies and d-amphetamine effects on human aggressive and non-aggressive responding. In: Harris, L.S., ed. Problems of Drug Dependence, 1986: Proceedings of the 47th Annual Scientific Meeting of the Committee on Problems of Drug Dependence. NIDA Research Monograph Series, Number 67. DHHS Pub. No. (ADM) 86-1448. Rockville, MD: National Institute on Drug Abuse, 1986. pp. 184-189.

Childress, A.R.

Cue reactivity and cue reactivity interventions in drug dependence. In: Proceedings of the Symposia on Cocaine Addiction: Trends, Laboratory Research, Clinical Issues, and Treatment. Monograph Series No. 1. The Chemical Dependency Research Working Group. New York State Office of Alcoholism and Substance Abuse Services, 1994. http://www.users.interport.net/~nama/mono1.htm#Helping Cocaine Patients [Accessed October 10, 1997]

Cho, A.K.

Ice: A new dosage form of an old drug. Science 249: 631-634, 1990.

Christensen, J.D.; Kaufman, M.J.; Levin, J.M.; Mendelson, J.H.; Holman, B.L.; Cohen, B.M.; and Renshaw, P.F.

Abnormal cerebral metabolism in polydrug abusers during early withdrawal using 31P MR spectroscopy. Magnetic Resonance in Medicine 35:658-663, 1996.
View the Medline version of this and related citations using NLM's PubMed

Coca-Cola Bottling of Shreveport, Inc., et al. vs. The Coca-Cola Company, a Delaware Corporation, 769 F. Supp. 671.

Cohen, S.

Causes of the cocaine outbreak. In: Washton, A.M., and Gold, M.S., eds. Cocaine: A Clinician's Handbook. New York: Guilford Press, 1987. pp. 3-9.

Community Epidemiology Work Group, National Institutes of Health, National Institute on Drug Abuse.

Epidemiologic Trends in Drug Abuse. Vol. 1. NIH Pub. No. 96-4126. Rockville, MD: National Institute on Drug Abuse, June 1996a.

Community Epidemiology Work Group, National Institutes of Health, National Institute on Drug Abuse.

Epidemiologic Trends in Drug Abuse. Vol. 2. NIH Pub. No. 96-4127. Rockville, MD: National Institute on Drug Abuse, June 1996b.

Community Epidemiology Work Group, National Institutes of Health, National Institute on Drug Abuse.

"Epidemiologic Trends in Drug Abuse: Advance Report." Presented at the annual meeting of the Community Epidemiology Work Group, Washington DC, June 24-27, 1997.

Condelli, W.S.; Fairbank, J.A.; Dennis, M.L.; and Rachal, J.V.

Cocaine use by clients in methadone programs: Significance, scope, and behavioral interventions. Journal of Substance Abuse Treatment 8:203-212, 1991.
View the Medline version of this and related citations using NLM's PubMed

Cook, C.E.

Pyrolytic characteristics, pharmacokinetics, and bioavailability of smoked heroin, cocaine, phencyclidine, and methamphetamine. In: Miller, M.A., and Kozel, N.J., eds. Methamphetamine Abuse: Epidemiologic Issues and Implications. NIDA Research Monograph Series, Number 115. DHHS Pub. No. (ADM) 91-1836. Rockville, MD: National Institute on Drug Abuse, 1991. pp. 6-23.

Cook, C.E.; Jeffcoat, A.R.; Hill, J.M.; Pugh, D.E.; Patetta, P.K.; Sadler, B.M.; White, W.R.; and Perez-Reyes, M.

Pharmacokinetics of methamphetamine self-administered to human subjects by smoking S-(+)-MA hydrochloride. Drug Metabolism and Disposition 21:717-23, 1993.
View the Medline version of this and related citations using NLM's PubMed

Cooper, J.; Bloom, F.; and Roth, R.

The Biochemical Basis of Neuropharmacology, 6th ed. New York: Oxford University Press, 1991.

Cornish, J.W., and O'Brien, C.P.

Crack cocaine abuse: An epidemic with many public health consequences. Annual Review of Public Health 17:259-273, 1996.
View the Medline version of this and related citations using NLM's PubMed

Corrigan, I.D.

Substance abuse as a mediating factor in outcome from traumatic brain injury. Archives of Physical Medicine and Rehabilitation 76:302-309, 1995.
View the Medline version of this and related citations using NLM's PubMed

Costello, R.M.

Alcoholism treatment and evaluation: In search of methods. II. Collation of two-year follow-up studies. International Journal of the Addictions 10:251-275, 1975.
View the Medline version of this and related citations using NLM's PubMed

Cregler, L.L., and Mark, H.

Medical complications of cocaine abuse. New England Journal of Medicine 315:1495-1500, 1986.
View the Medline version of this and related citations using NLM's PubMed

Cunningham, J.K., and Thielemeir, M.A.

Trends and Regional Variations in Amphetamine-Related Emergency Admissions: California, 1984-1993. Los Angeles, CA: Public Statistics Institute, 1995.

Cunningham, J.K., and Thielemeir, M.A.

Trends and Regional Variations in Amphetamine-Related Emergency Admissions: California, 1985-1994. Los Angeles, CA: Public Statistics Institute, 1996.

Czuchry, M.; Dansereau, D.F.; Dees, S.M.; and Simpson, D.D.

The use of node-link mapping in drug abuse counseling: The role of attentional factors. Journal of Psychoactive Drugs 27:161-166, 1995.
View the Medline version of this and related citations using NLM's PubMed

Dansereau, D.F.; Joe, G.W.; and Simpson, D.D.

Attentional difficulties and the effectiveness of a visual representation strategy for counseling drug-addicted clients. International Journal of the Addictions 30:371-386, 1995.
View the Medline version of this and related citations using NLM's PubMed

Daras, M.

Neurologic complications of cocaine. In: Majewska, M.D., ed. Neurotoxicity and Neuropathology Associated With Cocaine Abuse. NIDA Research Monograph Series, Number 163. DHHS Pub. No. (ADM) 96-4019. Rockville, MD: National Institute on Drug Abuse, 1996. pp. 43-65.

Des Jarlais, D.C., and Friedman, S.R.

HIV epidemiology and interventions among injecting drug users. International Journal of STDs and AIDS 7 (suppl) 2:57-61, 1996.
View the Medline version of this and related citations using NLM's PubMed

Di Chiara, G.

The role of dopamine in drug abuse viewed from the perspective of its role in motivation. Drug and Alcohol Dependence 38:95-137, 1995.
View the Medline version of this and related citations using NLM's PubMed

Di Chiara, G.

Alcohol and dopamine. Alcohol Health and Research World 21(2):108-114, 1997.

Drug Enforcement Administration.

The Cocaine Threat to the United States. Washington, DC: Department of Justice, Drug Enforcement Administration, 1995.

Drug Enforcement Administration.

Methamphetamine Situation in the United States: Drug Intelligence Report. Washington, DC: Department of Justice, Drug Enforcement Administration, 1996.

Drug Enforcement Agency.

1996 National Narcotics Intelligence Consumers Committee Report: The Supply of Illicit Drugs to the United States. Washington, DC: Department of Justice, Drug Enforcement Administration, 1997.

Dunteman, G.H.; Condelli, W.S.; and Fairbank, J.A.

Predicting cocaine use among methadone patients: Analysis of findings from a national study. Hospital and Community Psychiatry 43:608-611, 1992.
View the Medline version of this and related citations using NLM's PubMed

Elk, R.

Pregnant women and TB-exposed drug abusers: Reducing drug use and increasing treatment compliance. In: Higgins, S.T., and Silverman, K., eds. Motivating Behavior Change Among Illicit-Drug Abusers: Research on Contingency Management Interventions. Washington, DC: American Psychological Association, in press.

Ellinwood, E.H., Jr.

The epidemiology of stimulant abuse. In: Josephson, E., and Carroll, E.E., eds. Drug Use: Epidemiological and Sociological Approaches. Washington, DC: Hemisphere, 1974.

Ellinwood, E.H., Jr.

Emergency treatment of adverse reactions to CNS stimulants. A Treatment Manual for Acute Drug Abuse Emergencies. DHEW Pub. No. (ADM) 76-230. Rockville, MD: Alcohol, Drug Abuse and Mental Health Administration, 1975.

Ellinwood, E.H., Jr., and Lee, T.H.

Dose- and time-dependent effects of stimulants. In: Asghar, K., and De Souza, E., eds. Pharmacology and Toxicology of Amphetamine and Related Designer Drugs. NIDA Research Monograph Series, Number 94. DHHS Pub. No. (ADM) 89-1640. Rockville, MD: National Institute on Drug Abuse, 1989. pp. 323-340.

Ellinwood, E.H., Jr.; Sudilovsky, A.; and Nelson, L.M.

Evolving behavior in the clinical and experimental amphetamine (model) psychosis. American Journal of Psychiatry 130:1088-1093, 1973.
View the Medline version of this and related citations using NLM's PubMed

Fals-Stewart, W.; Birchler, G.R.; and O'Farrell, T.J.

Behavioral couples therapy for male substance-abusing patients: Effects on relationship adjustment and drug-seeking behavior. Journal of Consulting and Clinical Psychology 64:959-972, 1996.
View the Medline version of this and related citations using NLM's PubMed

Festinger, D.S.; Lamb, R.J.; Kirby, K.C.; and Marlowe, D.B.

The accelerated intake: A method for increasing initial attendance to outpatient cocaine treatment. Journal of Applied Behavioral Analysis 29:387-389, 1996.
View the Medline version of this and related citations using NLM's PubMed

Festinger, D.S.; Lamb, R.J.; Kountz, M.; Kirby, K.C.; and Marlowe, D.B.

Pre-treatment dropout as a function of treatment delay and client variables. Addictive Behaviors 20:111-115, 1995.
View the Medline version of this and related citations using NLM's PubMed

Feucht, T.E., and Kyle, G.M.

Methamphetamine use among adult arrestees: Findings from the Drug Use Forecasting (DUF) program. National Institute of Justice Research in Brief NCJ 161842, Nov. 1996.

Friedman, L.M.; Furberg, C.D.; and DeMets, D.L.

Fundamentals of Clinical Trials. Boston: John Wright, PSG, 1983.

Frosch, D.; Shoptaw, S.; Huber, A.; Rawson, R.A.; and Ling, W.

Sexual HIV risk among gay and bisexual male methamphetamine abusers. Journal of Substance Abuse Treatment 13(6):483-486, 1996.
View the Medline version of this and related citations using NLM's PubMed

Gawin, F.H., and Ellinwood, E.H., Jr.

Cocaine and other stimulants--actions, abuse, and treatment. New England Journal of Medicine 318:1173-1182, 1988.
View the Medline version of this and related citations using NLM's PubMed

Gawin, F.H., and Khalsa-Denison, M.E.

Is craving mood-driven or self-propelled? Sensitization and "street" stimulant addiction. In: Majewska, M.D., ed. Neurotoxicity and Neuropathology Associated With Cocaine Abuse. NIDA Research Monograph Series, Number 163. DHHS Pub. No. (ADM) 96-4019. Rockville, MD: National Institute on Drug Abuse, 1996. pp. 224-250.

Gawin, F.H., and Kleber, H.D.

Cocaine abuse treatment. Open pilot trial with desipramine and lithium carbonate. Archives of General Psychiatry 41:903-909, 1984.
View the Medline version of this and related citations using NLM's PubMed

Gawin, F.H., and Kleber, H.D.

Abstinence symptomatology and psychiatric diagnosis in cocaine abusers. Archives of General Psychiatry 43:107-113, 1986.
View the Medline version of this and related citations using NLM's PubMed

Gawin, F.H.; Kleber, H.D.; Byck, R.; Rounsaville, B.J.; Kosten, T.R.; Jatlow, P.I.; and Morgan, C.

Desipramine facilitation of initial cocaine abstinence. Archives of General Psychiatry 46:117-121, 1989.
View the Medline version of this and related citations using NLM's PubMed

Gerstein, D.R.; Johnson, R.A.; Harwood, H.J.; Fountain, D.; Suter, N.; Malloy, K., eds.

Evaluating Recovery Services: The California Drug and Alcohol Treatment Assessment (CALDATA). Washington, DC: National Academy Press, 1994.

Gold, M.S.

Cocaine (and crack): Clinical aspects. In: Lowinson, J.H.; Ruiz, P.; Millman, R.B.; and Langrod, J.G., eds. Substance Abuse: A Comprehensive Textbook, 3rd ed. Baltimore: Williams & Wilkins, 1997.

Gold, M.S., and Miller, N.S.

Cocaine (and crack): Neurobiology. In: Lowinson, J.H.; Ruiz, P.; Millman, R.B.; and Langrod, J.G., eds. Substance Abuse: A Comprehensive Textbook, 3rd ed. Baltimore: Williams & Wilkins, 1997.

Goldfrank, L.R., and Hoffman, R. S.

The cardiovascular effects of cocaine--update 1992. In: Sorer, H., ed. Acute Cocaine Intoxication: Current Methods of Treatment. NIDA Research Monograph Series, Number 123. DHHS Pub. No. (ADM) 93-3498. Rockville, MD: National Institute on Drug Abuse, 1993. pp. 70-109.

Golub, A.L., and Johnson, B.D.

Crack's decline: Some surprises across U.S. cities. National Institute of Justice Research in Brief, July 1997.

Goode, E.

Drugs in American Society, 4th ed. New York: McGraw-Hill, 1993.

Gorelick, D.A.

Pharmacologic therapies for cocaine addiction. In: Miller, N.S., and Gold, M., eds. Pharmacological Therapies for Alcohol and Drug Addictions. New York: Marcel Dekker, 1994. pp. 143-157.

Gorski, T., and Miller, M.

Staying Sober: A Guide for Relapse Prevention. Independence, MO: Independence Press, 1986.

Gottleib, A.

The Pleasures of Cocaine. Berkeley, CA: And/or Press, 1976.

Grabowski, J.; Rhoades, H.; Elk, R.; Schmitz, J.; Davis, C.; Creston, D.; and Kirby, K.

Fluoxetine is ineffective for treatment of cocaine dependence and concurrent opiate dependence: Two placebo controlled double-blind trials. Journal of Clinical Psychopharmacology 15:163-174, 1995.
View the Medline version of this and related citations using NLM's PubMed

Grant, B.F., and Harford, T.C.

Concurrent and simultaneous use of alcohol with cocaine: Results of national survey. Drug and Alcohol Dependence 25:97-104, 1990.
View the Medline version of this and related citations using NLM's PubMed

Grant, S.; London, E.D.; Newlin, D.B.; Villemagne, V.L.; Liu, X.; Contoreggi, C.; Phillips, R.L.; Kimes, A.S.; and Margolin, A.

Activation of memory circuits during cue-elicited cocaine craving. Proceedings of the National Academy of Sciences 93:12040-12045, 1995.

Griffith, J.D.; Cavanaugh, J.; Held, J.; and Oates, J.A.

Dextroamphetamine: Evaluation of psychomimetic properties in man. Archives of General Psychiatry 26(2):97-100, 1972.
View the Medline version of this and related citations using NLM's PubMed

Hall, J.N.; Uchman, R.S.; and Dominguez, R.

Trends and Patterns of Methamphetamine Use in the United States. Report prepared for the Department of Epidemiology and Statistical Analysis. NIDA Order No. 88MO31054801D. Miami, FL: Up Front Drug Information Center, 1988.

Hall, S.M.; Tunis, S.; Triffleman, E.; Banys, P.; Clark, H.W.; Tusel, D.; Stewart, P.; and Presti, D.

Continuity of care and desipramine in primary cocaine abusers. Journal of Nervous and Mental Disease 182:570-575, 1994.
View the Medline version of this and related citations using NLM's PubMed

Hando, J., and Hall, W.

Patterns of amphetamine use in Australia. In: Klee, H. ed. Amphetamine Misuse: International Perspectives on Current Trends. Amsterdam: Harwood Academic Publishers, 1997.

Havassy, B.E.; Wasserman, D.A.; and Hall, S.M.

Relapse to cocaine use: Conceptual issues. In: Tims, F.M., and Leukefeld, C.G., eds. Cocaine Treatment: Research and Clinical Perspectives. NIDA Research Monograph Series, Number 135. DHHS Pub. No. (ADM) 93-3639. Rockville, MD: National Institute on Drug Abuse, 1993. pp. 203-217.

Hawks, R.L., and Chiang, C.N.

Examples of specific drug assays. In: Hawks, R.L., and Chiang, C.N., eds. Urine Testing for Drugs of Abuse. NIDA Research Monograph Series, Number 73. DHHS Pub. No. (ADM) 87-1481. Rockville, MD: National Institute on Drug Abuse, 1986. pp. 84-112.

Heischobar, B., and Miller, M.A.

Methamphetamine abuse in California. In: Miller, M.A., and Kozel, N.J., eds. Methamphetamine Abuse: Epidemiologic Issues and Implications. NIDA Research Monograph Series, Number 115. DHHS Pub. No. (ADM) 91-1836. Rockville, MD: National Institute on Drug Abuse, 1991. pp. 60-71.

Herning, R.I.; Guo, X.; Better, W.E.; Weinhold, L.L.; Lange, W.R.; Cadet, J.L.; and Gorelick, D.A.

Neurophysiological signs in cocaine dependence: Increased EEG beta during withdrawal. Biological Psychiatry 41:1087-1094, 1997.
View the Medline version of this and related citations using NLM's PubMed

Higgins, S.T., and Budney, A.J.

Treatment of cocaine dependence through the principles of behavior analysis and behavioral pharmacology. In: Onken, L.S.; Blaine, J.D.; and Boren, J.J., eds. Behavioral Treatments for Drug Abuse and Dependence. NIDA Research Monograph Series, Number 137. NTIS Pub. No. 94-169570. Rockville, MD: National Institute on Drug Abuse, 1993. pp. 97-121.

Higgins, S.T., and Budney, A.J.

From the initial clinic contact to aftercare: A brief review of effective strategies for retaining cocaine abusers in treatment. In: Onken, L.S.; Blaine, J.D.; and Boren, J.J., eds. Beyond the Therapeutic Alliance: Keeping the Drug-Dependent Individual in Treatment. NIDA Research Monograph Series, Number 165. DHHS Pub. No. (ADM) 97-4142. Rockville, MD: National Institute on Drug Abuse, 1997. pp. 25-43.

Higgins, S.T.; Budney, A.J.; Bickel, W.K.; Foerg, F.E.; and Badger, G.J.

Alcohol dependence and simultaneous cocaine and alcohol use in cocaine-dependent patients. Journal of Addictive Diseases 13:177-189, 1994a.
View the Medline version of this and related citations using NLM's PubMed

Higgins, S.T.; Budney, A.J.; Bickel, W.K.; Foerg, F.E.; Donham, R.; and Badger, G.J.

Incentives improve treatment retention and cocaine abstinence in ambulatory cocaine-dependent patients. outcome in outpatient behavioural treatment of cocaine dependence. Archives of General Psychiatry 51:568-576, 1994b
View the Medline version of this and related citations using NLM's PubMed

Higgins, S.T.; Budney, A.J.; Bickel, W.K.; Foerg, F.E.; Ogden, D.; and Badger, G.J.

Outpatient behavioral treatment for cocaine dependence: One-year outcome. Experimental and Clinical Psychopharmacology 3:205-212, 1995.

Higgins, S.T.; Budney, A.J.; Bickel, W.K.; Hughes, J.R.; and Foerg, F.

Disulfiram therapy in patients abusing cocaine and alcohol. American Journal of Psychiatry 150:675-676, 1993a.
View the Medline version of this and related citations using NLM's PubMed

Higgins, S.T.; Budney, A.J.; Bickel, W.K.; Hughes, J.R.; Foerg, F.; and Badger, G.

Achieving cocaine abstinence with a behavioral approach. American Journal of Psychiatry 150:736-769, 1993b.
View the Medline version of this and related citations using NLM's PubMed

Higgins, S.T.; Delaney, D.D.; Budney, A.J.; Bickel, W.K.; Hughes, J.R.; Foerg, F.; and Fenwick, J.W.

A behavioral approach to achieving initial cocaine abstinence. American Journal of Psychiatry 148:1218-1224, 1991.
View the Medline version of this and related citations using NLM's PubMed

Higgins, S.T.; Roll, J.M.; and Bickel, W.K.

Alcohol pretreatment increases preference for cocaine over monetary reinforcement. Psychopharmacology 123:1-8, 1996.
View the Medline version of this and related citations using NLM's PubMed

Higgins, S.T., and Wong, C.J.

Treating cocaine abuse: What does research tell us? In: Higgins, S.T., and Katz, J.L., eds. Cocaine Abuse Research: Pharmacology, Behavior, and Clinician Application. San Diego, CA: Academic Press, 1998.

Higgins, S.T.; Wong, C.J.; Budney, A.J.; English, K.T.; and Kennedy, M.H.

Efficacy of incentives during outpatient behavioral treatment for cocaine dependence [abstract]. In: Harris, L.S., ed. Problems of Drug Dependence 1996: Proceedings of the 58th Annual Scientific Meeting of the College on Problems of Drug Dependence. NIDA Research Monograph Series, Number 174. DHHS Pub. No. (ADM) 97-4236. Rockville, MD: National Institute on Drug Abuse, 1997. p. 75.

Hiller-Sturmhfel, S.

Signal transmission among nerve cells. Alcohol Health and Research World 19(2):128, 1995.

Hoff, A.L.; Riordan, H.; Morris, L.; Cestaro, V.; Wienke, M.; Alpert, R.; Wang, G.J.; and Volkow, N.

Effects of crack cocaine on neurocognitive function. Psychiatry Research 60:167-176, 1996.
View the Medline version of this and related citations using NLM's PubMed

Huber, A.; Ling, W.; Shoptaw, S.; Gulati, V.; Brethen, P.; and Rawson, R.

Integrating treatments for methamphetamine abuse: A psychosocial perspective. Journal of Addictive Diseases 16(4):41-50, 1997.
View the Medline version of this and related citations using NLM's PubMed

Hughes, P.H.; Coletti, S.D.; Neri, R.L.; Umann, C.F.; Stahl, S.; Sicilian, D.M.; and Anthony, J.C.

Retaining cocaine-abusing women in a therapeutic community: The effect of a child live-in program. American Journal of Public Health 85:1149-1152, 1995.
View the Medline version of this and related citations using NLM's PubMed

Hurley, S.F.; Jolley, D.J.; Kaldor, J.M.

Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet 349(9068):1797-1800, 1997.
View the Medline version of this and related citations using NLM's PubMed

Iguchi, M.Y.; Belding, M.A.; Morral, A.R.; Lamb, R.J.; and Husband, S.D.

Reinforcing operants other than abstinence in drug abuse treatment: An effective alternative for reducing drug use. Journal of Consulting and Clinical Psychology 65:421-428, 1997.
View the Medline version of this and related citations using NLM's PubMed

Inaba, D.; Cohen, W.E.; and Holstein, M.E.

Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs, 2nd ed. Ashland, OR: CNS Productions, 1993.

Institute of Medicine.

Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Normand, J.; Vlahov, D.; and Moses, L.E., eds. Washington, DC: National Academy Press, 1995.

Irvine, G.D., and Chin, L.

The environmental impact and adverse health effects of clandestine manufacture of methamphetamine. In: Miller, M.A., and Kozel, N.J., eds. Methamphetamine Abuse: Epidemiologic Issues and Implications. NIDA Research Monograph Series, Number 115. DHHS Pub. No. (ADM) 91-1836. Rockville, MD: National Institute on Drug Abuse, 1991. pp. 33-46.

Iyo, M.; Nishio, M.; Itoh, T.; Fukuda, H.; Suzuki, K.; Yamasaki, T.; Fukui, S.; and Tateno, Y.

Dopamine D2 and serotonin S2 receptors in susceptibility to methamphetamine psychosis detected by positron emission tomography. Psychiatry Research 50:217-228, 1993.
View the Medline version of this and related citations using NLM's PubMed

Jenkins, S.W.; Warfield, N.A.; Blaine, J.D.; Cornish, J.; Ling, W.; Rosen, M.I.; Urschel, H.; Wesson, D.; and Ziedonis, D.

A pilot trial of gepirone vs. placebo in the treatment of cocaine dependency. Psychopharmacology Bulletin 28:21-26, 1992.
View the Medline version of this and related citations using NLM's PubMed

Jeri, F.R.

Coca-paste smoking in some Latin American countries: A severe and unabated form of addiction. Bulletin on Narcotics 36(2):15-31, 1984.
View the Medline version of this and related citations using NLM's PubMed

Joe, G.W.; Dansereau, D.F.; and Simpson, D.D.

Node-link mapping for counseling cocaine users in methadone treatment. Journal of Substance Abuse 6:393-406, 1994.
View the Medline version of this and related citations using NLM's PubMed

Johanson, C.E., and Fischman, M.W.

The pharmacology of cocaine related to its abuse. Pharmacological Reviews 41:3-52, 1989.
View the Medline version of this and related citations using NLM's PubMed

Johnson, R.E.; Eisenberg, Eissenberg, T.; Stitzer, M.L.; Strain, E.C.; Liebson, I.A.; and Bigelow, G.E.

A placebo controlled clinical trial of buprenorphine as a treatment of opioid dependence. Drug and Alcohol Dependence 40:17-25, 1995.
View the Medline version of this and related citations using NLM's PubMed

Kang, S.Y.; Kleinman, P.H.; Woody, G.E.; Millman, R.B.; Todd, T.C.; Kemp, J.; and Lipton, D.S.

Outcomes for cocaine abusers after once-a-week psychosocial therapy. American Journal of Psychiatry 148(5):630-635, 1991.
View the Medline version of this and related citations using NLM's PubMed

Khalsa, H.K.; Kowalewski, M.R.; Anglin, M.D.; and Wang, J.

HIV-related risk behaviors among cocaine users. AIDS Education and Prevention 4(1):71-83, 1992.
View the Medline version of this and related citations using NLM's PubMed

Kidorf, M., and Stitzer, M.L.

Contingent access to methadone maintenance treatment: Effects on cocaine use of mixed cocaine-opiate abusers. Experimental and Clinical Psychopharmacology 1:200-206, 1993.

King, G.R., and Ellinwood, E.H.

Amphetamines and other stimulants. In: Lowinson, J.H.; Ruiz, P.; Millman, R.B.; and Langrod, J.G., eds. Substance Abuse: A Comprehensive Textbook, 3rd ed. Baltimore: Williams & Wilkins, 1997.

Kirn, W.

Crank. Time Magazine 151(24):June 22, 1998.

Kissin, B.; Platz, A.; and Su, W.H.

Selective factors in treatment choice and outcome in alcoholics. In: Mello, N.K., and Mendelson, J.H., eds. Recent Advances in Studies of Alcoholism. Washington, DC: U.S. Government Printing Office, 1971. pp. 781-802.

Kleber, H.D.

Pharmacotherapy, current and potential, for the treatment of cocaine dependence. Clinical Neuropharmacology 18(suppl. 1):S96-S109, 1995.

Koob, G.F.

Drugs of abuse: Anatomy, pharmacology and function of reward pathways. Trends in Pharmacological Sciences 13:177-184, 1992.
View the Medline version of this and related citations using NLM's PubMed

Koob, G.F., and Le Moal, M.

Drug abuse: Hedonic homeostatic dysregulation. Science 278:52-58, 1997.
View the Medline version of this and related citations using NLM's PubMed

Kosten, T.R.; Rosen, M.I.; Schottenfeld, R.; and Ziedonis, D.

Buprenorphine for cocaine and opiate dependence. Psychopharmacology Bulletin 28:15-19, 1992.
View the Medline version of this and related citations using NLM's PubMed

Kral, A.H.; Bluthenthal, R.N.; Booth, R.E.; and Watters, J.K.

HIV seroprevalence among street-recruited injection drug and crack cocaine users in 16 US municipalities. American Journal of Public Health 88(1):108-113, 1998.
View the Medline version of this and related citations using NLM's PubMed

Kramer, J.C.

Introduction to amphetamine abuse. Journal of Psychedelic Drugs 2:8-13, 1969.

Kranzler, H.R.; Bauer, L.O.; Hersh, D.; and Klinghoffer, V.

Carbamazepine treatment of cocaine dependence: A placebo-controlled trial. Drug and Alcohol Dependence 38:203-211, 1995.
View the Medline version of this and related citations using NLM's PubMed

Kreek, M.J.

Opiates, opioids and addiction. Molecular Psychiatry 1:232-254, 1996.
View the Medline version of this and related citations using NLM's PubMed

Lago, J.A., and Kosten, T.R.

Stimulant withdrawal. Addiction 89:1477-1481, 1994.
View the Medline version of this and related citations using NLM's PubMed

Landry, M.

An overview of cocaethylene, an alcohol-derived psychoactive cocaine metabolite. Journal of Psychoactive Drugs 24:273-276, 1992.
View the Medline version of this and related citations using NLM's PubMed

Landry, M.

Understanding Drugs of Abuse: The Processes of Addiction, Treatment, and Recovery. Washington, DC: American Psychiatric Press, 1994.

Landry, M.

Overview of Addiction Treatment Effectiveness. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 1995.

Landry, M.

Alcoholics Anonymous: Review of the Research. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, in press.

Leshner, A.I.

Addiction is a brain disease, and it matters. Science 278:45-47, 1997.
View the Medline version of this and related citations using NLM's PubMed

Leshner, A.I.

Treatment: Effects on the brain and body. In: Office of National Drug Control Policy (ONDCP), Office of Justice Programs, Department of Justice. The National Methamphetamine Drug Conference: Conference Proceedings, May 28-30, 1997, Omaha, Nebraska. Sponsored by ONDCP. Washington, DC: ONDCP, 1998. http://www.whitehousedrugpolicy.gov/drugfact/methconf/plenary2.html [Accessed June 23, 1998]

Lieberman, M.A.; Yalom, I.D.; and Miles, M.B.

Encounter Groups: First Facts. New York: Basic Books, 1973.

Ling, W., and Shoptaw, S.

Integration of research in pharmacotherapy for addictive disease: Where are we? Where are we going? Journal of Addictive Diseases 16:83-102, 1997.
View the Medline version of this and related citations using NLM's PubMed

London, E.D.; Cascella, N.G.; Wong, D.F.; Phillips, R.L.; Dannals, R.F.; Links, J.M.; Herning, R.; Grayson, R.; Jaffe, J.H.; and Wagner, H.N., Jr.

Cocaine-induced reduction of glucose utilization in human brain. Archives of General Psychiatry 47(6):567-574, 1990.
View the Medline version of this and related citations using NLM's PubMed

Lukas, S.E.; Sholar, M.; Lundahl, L.H.; Lamas, X.; Kouri, E.; Wines, J.D.; Kragie, L.; and Mendelson, J.H.

Sex differences in plasma cocaine levels and subjective effects after acute cocaine administration in human volunteers. Psychopharmacology 125(4):346-354, 1996.
View the Medline version of this and related citations using NLM's PubMed

Lurie, P., and Drucker, E.

An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA. Lancet 349(9052):604-608, 1997.
View the Medline version of this and related citations using NLM's PubMed

Majewska, M.D.

Cocaine addiction as a neurological disorder: Implications for treatment. In: Majewska, M.D., ed. Neurotoxicity and Neuropathology Associated with Cocaine Abuse. NIDA Research Monograph Series, Number 163. DHHS Pub. No. (ADM) 96-4019. Rockville, MD: National Institute on Drug Abuse, 1996. pp. 1-26.

Marlatt, G.A., and Gordon, J.R.

Relapse Prevention. New York: Guilford Press, 1985.

McCrady, B.S.; Noel, N.E.; Abrams, D.B.; Stout, R.L.; Nelson, H.F.; and Hay, W.M.

Comparative effectiveness of three types of spouse involvement in outpatient behavioral alcoholism treatment. Journal of Studies on Alcohol 47(6):459-467, 1986.
View the Medline version of this and related citations using NLM's PubMed

McLellan, A.T.; Arndt, I.O.; Metzger, D.S.; Woody, G.E.; and O'Brien, C.P.

The effects of psychosocial services in substance abuse treatment. Journal of the American Medical Association 269:1953-1996, 1993.
View the Medline version of this and related citations using NLM's PubMed

Melega, W.P.; Raleigh, M.J.; Stout, D.B.; Huang, S.-C.; and Phelps, M.E.

Ethological and 6-[18F]fluor-l-DOPA-PET profiles of long-term vunerability to chronic amphetamine. Behavioural Brain Research 84:259-268, 1997a.
View the Medline version of this and related citations using NLM's PubMed

Melega, W.P.; Raleigh, M.J.; Stout, D.B.; Lacan, G.; Huang, S.C.; and Phelps, M.E.

Recovery of striatal dopamine function after acute amphetamine- and methamphetamine-induced neurotoxicity in the vervet monkey. Brain Research 766(1-2):113-120, 1997b.
View the Medline version of this and related citations using NLM's PubMed

Mendelson, J.; Jones, R.T.; Upton, R.; and Jacob, P. III.

Methamphetamine and ethanol interactions in humans. Clinical Pharmacology and Therapeutics 57(5):559-568, 1995.
View the Medline version of this and related citations using NLM's PubMed

Mendelson, J.H., and Mello, N.K.

Management of cocaine abuse and dependence. New England Journal of Medicine 334:965-972, 1996.
View the Medline version of this and related citations using NLM's PubMed

Metzger, D.S.; Woody, G.E.; McLellan, A.T.; O'Brien, C.P.; Druley, P.; Navaline, H.; DePhilippis, D.; Stolley, P.; and Abrutyn, E.

Human immunodeficiency virus seroconversion among intravenous drug users in- and out- of treatment: An 18-month prospective follow-up. Journal of Acquired Immune Deficiency Syndrome 6(9):1049-1056, 1993.
View the Medline version of this and related citations using NLM's PubMed

Meyers, R.J., and Smith, J.E.

Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach. New York: Guilford Press, 1995.

Miczek, K.A.

Psychopharmacology of aggression. In: Iversen, L.L.; Snyder, S.H.; Iversen, S.D., eds. Handbook of Psychopharmacology. Vol. 19. New York: Plenum Press, 1987. pp. 183-328.

Miczek, K.A., and Tidey, J.W.

Amphetamines: Aggressive and social behavior. In: Asghar, K., and De Souza, E., eds. Pharmacology and Toxicology of Amphetamine and Related Designer Drugs. NIDA Research Monograph Series, Number 94. DHHS Pub. No. (ADM) 89-1640. Rockville, MD: National Institute on Drug Abuse, 1989. pp. 68-100.

Milby, J.B.; Schumacher, J.E.; Raczynski, J.M.; Caldwell, E.; Engle, M.; Michael, M.; and Carr, J.

Sufficient conditions for effective treatment of substance abusing homeless persons. Drug and Alcohol Dependence 43:23-38, 1996.
View the Medline version of this and related citations using NLM's PubMed

Miller, B.L.; Chiang, F.; McGill, L.; Sadow, T.; Goldberg, M.A.; and Mena, I.

Cerebrovascular complications from cocaine: Possible long-term sequelae. In: Sorer, H., ed. Acute Cocaine Intoxication: Current Methods of Treatment. NIDA Research Monograph Series, Number 123. DHHS Pub. No. (ADM) 93-3498. Rockville, MD: National Institute on Drug Abuse, 1993. pp. 129-146.

Miller, M., and Kozel, N.J.

Introduction and overview. In: Miller, M.A., and Kozel, N.J., eds. Methamphetamine Abuse: Epidemiologic Issues and Implications. NIDA Research Monograph Series, Number 115. DHHS Pub. No. (ADM) 91-1836. Rockville, MD: National Institute on Drug Abuse, 1991. pp. 1-5.

Miller, W.R.

Motivation for treatment: A review with special emphasis on alcoholism. Psychological Bulletin 98:84-107, 1985.
View the Medline version of this and related citations using NLM's PubMed

Miller, W.R.

Increasing motivation for change. In: Hester, R.K., and Miller, W.R., eds. Handbook of Alcoholism Treatment Approaches: Effective Alternatives, 2nd ed. Boston: Allyn & Bacon, 1995. pp. 89-104.

Miller, W.R., and Munoz, R.F.

How to Control Your Drinking, rev. ed. Albuquerque, NM: University of New Mexico Press, 1982.

Miller, W.R., and Rollnick, S.

Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford Press, 1991.

Milmoe, S.; Rosenthal, R.; Blane, H.T.; Chafetz, M.E.; and Wolf, I.

The doctor's voice: Postdictor of successful referral of alcoholic patients. Journal of Abnormal Psychology 48:590-84, 1967.
View the Medline version of this and related citations using NLM's PubMed

Monti, P.M.; Rohsenow, D.J.; Colby, S.M.; and Abrams, D.B.

Coping and social skills training. In: Hester, R.K., and Miller, W.R., eds. Handbook of Alcoholism Treatment Approaches: Effective Alternatives, 2nd ed. Boston: Allyn & Bacon, 1995. pp. 221-241.

Mori, A.; Suzuki, H.; and Ishiyama, I.

Three cases of acute methamphetamine intoxication: Analysis of optically active methamphetamine. Nippon Hoigaku Zasshi 46(4): 266-270, 1992.
View the Medline version of this and related citations using NLM's PubMed

Mueller, M.D., and Wyman, J.R.

Study sheds new light on the state of drug abuse treatment nationwide. NIDA Notes 12(5):1-7, 1997.

Nash, J.M.

Addicted. Time 149(18):69-76, 1997.

National Institute of Justice (NIJ), Office of Justice Programs, Department of Justice.

Crack, Powder Cocaine, and Heroin: Drug Purchase and Use Patterns in Six U.S. Cities. ONDCP Research Report NCJ 167265. Washington, DC: National Institute of Justice, 1997a.

National Institute of Justice (NIJ), Office of Justice Programs, Department of Justice.

Drug Use Forecasting: 1996 Annual Report on Adult and Juvenile Arrestees. Washington, DC: National Institute of Justice, 1997b.

National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Eighth Special Report to the U.S. Congress on Alcohol and Health From the Secretary of Health and Human Services, September 1993. NIH Pub. No. 94-3699. Bethesda, MD: National Institutes of Health, 1994.

National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Neuroscience research and medications development. Alcohol Alert 33(PH 366), 1996.

National Institute on Drug Abuse (NIDA).

Methamphetamine Abuse. NIDA Capsule Series (C-89-06). Revised September 1997. Http://165.112.78.61/NIDA Capsules/NCMethamphetamine.html [Accessed May 4, 1998].

National Institute on Drug Abuse (NIDA).

Methamphetamine: Abuse and Addiction. NIDA Research Report Series. NIH Pub. No. 98-4210. Rockville, MD: National Institute on Drug Abuse, April 1998a.

National Institute on Drug Abuse.

Monitoring the Future Study, High School and Youth Trends. Rockville, MD: National Institute on Drug Abuse, 1998b. http://www.nida.nih.gov/NIDACapsules/NCMTFuture.html [Accessed May 5, 1998].

National Institute on Drug Abuse.

NIDA expands research to meet challenge of methamphetamine abuse. NIDA Notes, Volume 13, 1998c. http://165.112.78.61/NIDA_Notes/NNVol13N1/DirRepVol13N1.html [Accessed December 9, 1998]

Nestler, E.J., and Aghajanian, G.K.

Molecular and cellular basis of addiction. Science 278:58-63, 1997.
View the Medline version of this and related citations using NLM's PubMed

Nestor, T.A.; Tamamoto, W.I.; Kam, T.H.; and Schultz, T.

Acute pulmonary oedema caused by crystalline methamphetamine. Lancet 2(8674):1277-1278, 1989.
View the Medline version of this and related citations using NLM's PubMed

Nunes, E.V.; McGrath, P.J.; Quitkin, F.M.; Ocepek-Welikson, K.; Stewart, J.W.; Koenig, T.; Wager, S.; and Klein, D.F.

Imipramine treatment of cocaine abuse: Possible boundaries of efficacy. Drug and Alcohol Dependence 39:185-195, 1995.
View the Medline version of this and related citations using NLM's PubMed

Obert, J.L.; Rawson, R.A.; and Miotto, K.

Substance abuse treatment for "hazardous users": An early intervention. Journal of Psychoactive Drugs 29(3):291-298, 1997.
View the Medline version of this and related citations using NLM's PubMed

O'Brien, C.P.; Childress, A.R.; McLellan, A.T.; and Ehrman, R.

Developing treatments that address classical conditioning. In: Tims, F.M., and Leukefeld, C.G., eds. Cocaine Treatment: Research and Clinical Perspectives. NIDA Research Monograph Series, Number 135. DHHS Pub. No. (ADM) 93-3639. Rockville, MD: National Institute on Drug Abuse, 1993. pp. 71-91.

Office of National Drug Control Policy (ONDCP), Office of Justice Programs, Department of Justice.

Street Terms: Drugs and the Drug Trade. ONDCP Drugs and Crime Data, Drugs and Crime Clearinghouse. ONDCP Research Report NCJ 151622. Washington, DC: Office of National Drug Control Policy, 1995.

Office of National Drug Control Policy (ONDCP), Office of Justice Programs, Department of Justice.

National Methamphetamine Strategy. Washington, DC: Office of National Drug Control Policy, April 1996.

Office of National Drug Control Policy (ONDCP), Office of Justice Programs, Department of Justice.

Pulse Check: Methamphetamine Trends in Five Western States and Hawaii. Washington, DC: Office of National Drug Control Policy, January 1997a. http://www.whitehousedrugpolicy.gov/drugfact/pulsechk/pcappa.html [Accessed January 19, 1998].

Office of National Drug Control Policy (ONDCP), Office of Justice Programs, Department of Justice.

Pulse Check: National Trends in Drug Abuse. Washington, DC: Office of National Drug Control Policy, Winter 1997b. http://www.whitehousedrugpolicy.gov/drugfact/pulsechk/pcindex.html [Accessed January 19, 1998].

Office of National Drug Control Policy (ONDCP), Office of Justice Programs, Department of Justice.

Cocaine: Facts and Figures. ONDCP Drugs and Crime Data, Drugs and Crime Clearinghouse. Pub. No. PK 24. Rockville, MD: Office of National Drug Control Policy, 1998a.

Office of National Drug Control Policy (ONDCP), Office of Justice Programs, Department of Justice.

Methamphetamine: Facts and Figures. ONDCP Drug Policy Information Clearinghouse. Pub. No. PK 29. Rockville, MD: Office of National Drug Control Policy, 1998b.

Office of National Drug Control Policy (ONDCP), Office of Justice Programs, Department of Justice.

The National Methamphetamine Drug Conference: Conference Proceedings, May 28-30, 1997, Omaha, Nebraska. Washington, DC: Office of National Drug Control Policy, 1998c.

O'Malley, S.; Adamse, M.; Heaton, R.K.; and Gawin, F.H.

Neuropsychological impairment in chronic cocaine abusers. American Journal of Drug and Alcohol Abuse 18:131-144, 1992.
View the Medline version of this and related citations using NLM's PubMed

Oro, A.S., and Dixon, S.D.

Perinatal cocaine and methamphetamine exposure: Maternal and neonatal correlates. Journal of Pediatrics 111: 571-578, 1987.
View the Medline version of this and related citations using NLM's PubMed

Parker, M.W.; Winstead, D.K.; and Willi, F.J.

Patient autonomy in alcohol rehabilitation: I. Literature Review. International Journal of the Addictions 14:1015-1022, 1979.
View the Medline version of this and related citations using NLM's PubMed

Paul, J.P.; Stall, R.; and Bloomfield, K.A.

Gay and alcoholics. Alcohol Health and Research World 15(2):151-160, 1991.

Paul, J.P.; Stall, R.D.; Crosby, G.M.; Barrett, D.C.; and Midanik, L.T.

Correlates of sexual risk-taking among gay male substance abusers. Addiction 89(8):971-983, 1994.
View the Medline version of this and related citations using NLM's PubMed

Paul, J.P.; Stall, R.; and Davis, F.

Sexual risk for HIV transmission among gay/bisexual men in substance-abuse treatment. AIDS Education and Prevention 5(1):11-24, 1993.
View the Medline version of this and related citations using NLM's PubMed

Peat, M.A.; Warren, P.F.; and Gibb, J.W.

Effects of single dose of methamphetamine and iprindole on the serotonergic and dopaminergic system of the rat brain. Journal of Pharmacological and Experimental Therapy 225:126-131, 1983.
View the Medline version of this and related citations using NLM's PubMed

Petersen, R.C.

"Methamphetamine abuse research--a review." Unpublished manuscript. Rockville, MD: Center for Substance Abuse Treatment, 1996.

Pettinati, H.

Diagnosing personality disorders in substance abusers. In: Harris, L.S., ed. Problems of Drug Dependence, 1990: Proceedings of the 54th Annual Scientific Meeting of the Committee on Problems of Drug Dependence. NIDA Research Monograph Series, Number 105. DHHS Pub. No. (ADM) 91-1753. Rockville, MD: Institute on Drug Abuse, 1991. pp. 236-242.

Prochaska, J.O.; DiClemente, C.C.; and Norcross, J.C.

In search of how people change: Applications to addictive behaviors. American Psychologist 47:1102-1114, 1992.
View the Medline version of this and related citations using NLM's PubMed

Rabin, S.M., and Little, B.B.

Peripartum methamphetamine use in a large urban population. Journal of Maternal and Fetal Medicine 3:101-103, 1994.

Rawson, R.A.

Relapse prevention programming in the treatment of opioid users. Substance Abuse Bulletin 2:1-5, 1986.

Rawson, R.A.; Huber, A.; Brethen, P.; and Ling, W.

"Treatment response and treatment outcome of methamphetamine and cocaine users." Presented at American Society of Addiction Medicine, New Orleans, Louisiana, 1998a.

Rawson, R.A.; Huber, A.; Brethen, P.; Shoptaw, S.; and Ling, W.

"Methamphetamine and cocaine: Comparison of reported effects and response to treatment." Presented at CPDD Satellite Conference on Methamphetamine, San Juan, Puerto Rico, 1996.

Rawson, R.A.; Obert, J.L.; and McCann, M.J.

The Matrix Intensive Outpatient Program Therapist Manual. Los Angeles, CA: The Matrix Center, Inc., 1995.

Rawson, R.A.; Obert, J.L.; McCann, M.J.; Castro, F.G.; and Ling, W.

Cocaine abuse treatment: A review of current strategies. Journal of Substance Abuse 3(4): 457-491, 1991a.
View the Medline version of this and related citations using NLM's PubMed

Rawson, R.A.; Obert, J.L.; McCann, M.J.; and Ling, W.

The Matrix Model of Outpatient Treatment for Alcohol Use and Dependency. Beverly Hills, CA: The Matrix Center, Inc., 1991b.

Rawson, R.A.; Obert, J.L.; McCann, M.J.; and Ling, W.

Neurobehavioral treatment for cocaine dependency: A preliminary evaluation. In: Tims, F.M., and Leukefeld, C.G., eds. Cocaine Treatment: Research and Clinical Perspectives. NIDA Research Monograph Series, Number 135. DHHS Pub. No. (ADM) 93-3639. Rockville, MD: National Institute on Drug Abuse, 1993. pp. 92-115.

Rawson, R.A.; Obert, J.L.; McCann, M.J.; and Mann, A.J.

Cocaine treatment outcome: Cocaine use following inpatient, outpatient, and no treatment. In: Harris, L.S., ed. Problems of Drug Dependence, 1986: Proceedings of the 47th Annual Scientific Meeting, the Committee on Problems of Drug Dependence. NIDA Research Monograph Series, Number 67. DHHS Pub. No. (ADM) 86-1448. Rockville, MD: National Institute on Drug Abuse, 1986. pp. 271-277.

Rawson, R.A.; Obert, J.L.; McCann, M.J.; Smith, D.P., and Ling, W.

Neurobehavioral treatment for cocaine dependency. Journal of Psychoactive Drugs 22:159-171, 1990.
View the Medline version of this and related citations using NLM's PubMed

Rawson, R.A.; Obert, J.L.; McCann, M.J.; Smith, D.P.; and Scheffey, E.H.

The Neurobehavioral Treatment Manual. Beverly Hills, CA: The Matrix Center, Inc., 1989.

Rawson, R.A.; Shoptaw, S.J.; Obert, J.L.; McCann, M.J.; Hasson, A.L.; Marinelli-Casey, P.J.; Brethen, P.R.; and Ling, W.

An intensive outpatient approach for cocaine abuse treatment: The Matrix Model. Journal of Substance Abuse Treatment 12:117-127, 1995.
View the Medline version of this and related citations using NLM's PubMed

Rawson, R.A.; Washton, A.M.; and Shoptaw, S.

"Psychoactive substance use and sexual behavior: A study and analysis." Presented at the American Society of Addiction Medicine, New Orleans, Louisiana, 1998b.

Renton, A.; Whitaker, L.; Ison, C.; Wadsworth, J.; and Harris, J.R.

Estimating the sexual mixing patterns in the general population from those in people acquiring gonorrhea infection: Theoretical foundation and empirical findings. Journal of Epidemiology and Community Health 49:205-213, 1995.
View the Medline version of this and related citations using NLM's PubMed

Restak, R.R.

The Mind. New York: Bantam Books, 1988.

Ricuarte, Ricaurte, G.A.; Schuster, C.R.; and Seiden, L.S.

Long-term effects of repeated methylamphetamine administration on dopamine and serotonin neurons in the rat brain: A regional study. Brain Research 193:153-163, 1980.
View the Medline version of this and related citations using NLM's PubMed

Robbins, T.W.; Cador, M.; Taylor, J.R.; and Everitt, B.J.

Limbic striatal interactions in reward-related processes. Neuroscience and Biobehavioral Reviews 13:155-162, 1989.
View the Medline version of this and related citations using NLM's PubMed

Robinson, T.E., and Becker, J.B.

Enduring changes in brain and behavior produced by chronic amphetamine administration: A review and evaluation of animal models of amphetamine psychosis. Brain Research 396:157-198, 1986.
View the Medline version of this and related citations using NLM's PubMed

Roll, J.M.; Higgins, S.T.; Steingard, S.; and McGinley, M.

Use of monetary reinforcement to reduce the cigarette smoking of persons with schizophrenia: A feasibility study. Experimental and Clinical Psychopharmacology 6:157-161, 1998.
View the Medline version of this and related citations using NLM's PubMed

Rounsaville, B., and Caroll, K.

Psychiatric disorders in treatment-entering cocaine abusers. In: Schober, S., and Schade, C., eds. Epidemiology of Cocaine Use and Abuse. NIDA Research Monograph Series, Number 110. DHHS Pub. No. (ADM) 91-1787. Rockville, MD: National Institute on Drug Abuse, 1991. pp. 227-251.

Rowan-Szal, G.; Joe, G.W.; Chatham, L.R.; and Simpson, D.D.

A simple reinforcement system for methadone clients in a community-based treatment program. Journal of Substance Abuse Treatment 11:217-223, 1994.
View the Medline version of this and related citations using NLM's PubMed

Rowbotham, M.C.

Cocaine levels and elimination in inpatients and outpatients: Implications for emergency treatment of cocaine complications. In: Sorer, H., ed. Acute Cocaine Intoxication: Current Methods of Treatment. NIDA Research Monograph Series, Number 123. DHHS Pub. No. (ADM) 93-3498. Rockville, MD: National Institute on Drug Abuse, 1993. pp. 147-155.

Samber, S.

Methamphetamine spread creates need for more comprehensive approaches. The NCADI Reporter June 30, 1997. http://www.health.org/pressrel/itn/rep/19.htm [Accessed February 5, 1998].

Satel, S.L.; Southwick, S.M.; and Gawin, F.H.

Clinical features of cocaine-induced paranoia. American Journal of Psychiatry 148(4):495-498, 1991.
View the Medline version of this and related citations using NLM's PubMed

Sato, M.; Chen, C.C.; Akiyama, K.; and Otsuki, S.

Acute exacerbation of paranoid psychotic state after long-term abstinence in patients with previous methamphetamine psychosis. Biological Psychiatry 18:429-440, 1983.
View the Medline version of this and related citations using NLM's PubMed

Scandling, J., and Spital, A.

Amphetamine-associated myoblobinuric myoglobinuric renal failure. Southern Medical Journal 75: 237-240, 1982.
View the Medline version of this and related citations using NLM's PubMed

Schottenfeld, R.S.; Pakes, J.; Ziedonis, D.; and Kosten, T.R.

Buprenorphine: Dose-related effects on cocaine and opioid use in cocaine-abusing opioid-dependent humans. Biological Psychiatry 34:66-74, 1993.
View the Medline version of this and related citations using NLM's PubMed

Schrank, K.S.

Cocaine-related emergency department presentations. In: Sorer, H., ed. Acute Cocaine Intoxication: Current Methods of Treatment. NIDA Research Monograph Series, Number 123. DHHS Pub. No. (ADM) 93-3498. Rockville, MD: National Institute on Drug Abuse, 1993. pp. 110-128.

Seiden, L.S.; Fischman, M.W.; and Schuster, C.R.

Long-term methamphetamine induced changes in brain catecholamines in tolerant rhesus monkeys. Drug and Alcohol Dependence 1:215-219, 1976.
View the Medline version of this and related citations using NLM's PubMed

Selden, L.S.

Neurotoxicity of methamphetamine: Mechanisms of action and issues related to aging. In: Miller, M.A., and Kozel, N.J., eds. Methamphetamine Abuse: Epidemiologic Issues and Implications. NIDA Research Monograph Series, Number 115. DHHS Pub. No. (ADM) 91-1836. Rockville, MD: National Institute on Drug Abuse, 1991. pp. 24-32.

Self, D., and Nestler, E.

Molecular mechanisms of drug reinforcement and addiction. Annual Review of Neuroscience 18:463-495, 1995.
View the Medline version of this and related citations using NLM's PubMed

Shaner, A.; Roberts, L.J.; Eckman, T.A.; Tucker, D.E.; Tsuang, J.W.; Wilkens, J.N.; and Mintz, J.

Monetary reinforcement of abstinence from cocaine among mentally ill patients with cocaine dependence. Psychiatric Services 48:807-810, 1997.
View the Medline version of this and related citations using NLM's PubMed

Shoptaw, S.; Frosch, D.; Rawson, R.A.; and Ling, W.

Cocaine abuse counseling as HIV prevention. AIDS Education and Prevention 9(6):511-20, 1997.
View the Medline version of this and related citations using NLM's PubMed

Shoptaw, S.; Rawson, R.A.; McCabb, M.J.; and Obert, J.L.

The matrix model of outpatient stimulant abuse treatment: Evidence of efficacy. Journal of Addictive Diseases 13(4): 129-141, 1994.
View the Medline version of this and related citations using NLM's PubMed

Siegel, R.K.

Cocaine smoking. Journal of Psychoactive Drugs 14(4):271-359, 1982.
View the Medline version of this and related citations using NLM's PubMed

Siegel, R.K.

Cocaine smoking: Nature and extent of coca paste and cocaine free-base abuse. In: Washton, A.M., and Gold, M.S., eds. Cocaine: A Clinician's Handbook. New York: Guilford Press, 1987. pp. 175-191.

Silverman, K.; Bigelow, G.E.; and Stitzer, M.L.

Treatment of cocaine abuse in methadone maintenance patients. In: Higgins, S.T., and Katz, J.L., eds. Cocaine Abuse: Behavior, Pharmacology, and Clinical Applications. San Diego, CA: Academic Press, 1998.

Silverman, K.; Higgins, S.T.; Brooner, R.K.; Monyoya, I.D.; Cone, E.J.; Schuster, C.R.; and Preston, K.L.

Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy. Archives of General Psychiatry 53:409-415, 1996.
View the Medline version of this and related citations using NLM's PubMed

Sisson, R., and Azrin, N.H.

The community reinforcement approach. In: Hester, R.K., and Miller, W.R., eds. Handbook of Alcoholism Treatment Approaches: Effective Alternatives. New York: Pergamon Press, 1989. pp. 242-258.

Snyder, S.

Drugs and the Brain. New York: Scientific American Library, 1986.

Sorensen, J.L.

Preventing HIV transmission in drug treatment programs: What works? Journal of Addictive Diseases 10(4):67-79, 1991.
View the Medline version of this and related citations using NLM's PubMed

Sowder, B., and Beschner, G., eds.

"Methamphetamine: An illicit drug with high abuse potential." Unpublished report from NIDA contract no. 271-90-0002. Rockville, MD: T. Head and Company, Inc., 1993.

Spotts, J.V., and Spotts, C.A.

Use and Abuse of Amphetamine and Its Substitutes. NIDA Research Issues, No. 25. Rockville, MD: National Institute on Drug Abuse, 1980.

Stanton, M.D., and Shadish, W.R.

Outcome, attrition, and family-couples treatment for substance abuse: A meta-analysis and review of the controlled comparative studies. Psychological Bulletin 122:170-191, 1997.
View the Medline version of this and related citations using NLM's PubMed

Stapleton, J.M.; Morgan, M.J.; Phillips, R.L.; Wong, D.F.; Yung, B.C.; Shaya, E.K.; Dannals, R.F.; Liu, X.; Grayson, R.L.; and London, E.D.

Cerebral glucose utilization in polysubstance abuse. Neuropsychopharmacology 13(1):21-31, 1995.
View the Medline version of this and related citations using NLM's PubMed

Stark, M.J.

Dropping out of substance abuse treatment: A clinically oriented review. Clinical Psychology Review 12:93-116, 1992.

Stark, M.J.; Campbell, B.K.; and Brinkerhoff, C.V.

"Hello, may we help you?" A study of attrition prevention at the time of the first phone contact with substance-abusing clients. American Journal of Drug and Alcohol Abuse 16:67-76, 1990.
View the Medline version of this and related citations using NLM's PubMed

Stitzer, M.L.; Bickel, W.K.; Bigelow, G.E.; and Liebson, I.A.

Effects of methadone dose contingencies on urinalysis test results of poly-abusing methadone-maintenance patients. Drug and Alcohol Dependence 18:341-348, 1986.
View the Medline version of this and related citations using NLM's PubMed

Stitzer, M.L.; Bigelow, G.E.; and Gross, J.

Behavioral treatment of drug abuse. In: Karsu, T.B., ed. American Psychiatric Association Treatment Manual. Washington, DC: American Psychiatric Association, 1989.

Stitzer, M.L., and Higgins, S.T.

Behavioral treatment of drug and alcohol abuse. In: Bloom, F.E., and Kupfer, D.J., eds. Psychopharmacology: The Fourth Generation of Progress. New York: Raven Press, 1995. pp. 1807-1819.

Stitzer, M.L.; Iguchi, M.Y.; and Felch, L.J.

Contingent take-home incentive: Effects on drug use of methadone maintenance patients. Journal of Consulting and Clinical Psychology 60:927-934, 1992.
View the Medline version of this and related citations using NLM's PubMed

Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies.

National Household Survey on Drug Abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1988.

Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies.

National Household Survey on Drug Abuse. DHHS Pub. No. (ADM) 89-1636. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1989.

Substance Abuse and Mental Health Services Administration (SAMHSA), National Clearinghouse for Alcohol and Drug Information.

1993 Monitoring the Future Survey: Data Tables and Figures. Washington, DC: U.S. Government Printing Office, 1993a.

Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies.

National Household Survey on Drug Abuse. DHHS Pub. No. (SMA) 93-2053. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1993b.

Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies.

National Household Survey on Drug Abuse. DHHS Pub. No. (SMA) 97-3149. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1996a.

Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies.

Preliminary Estimates From the Drug Abuse Warning Network. Advance Report No. 17, August, 1996b. http://www.health.org/pubs/dawn/index-htm [Accessed May 6, 1998].

Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies.

Preliminary Results From the 1997 National Household Survey on Drug Abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration, 1998. http://www.samhsa.gov/oas/nhsda/nhsda97/httoc.htm [Accessed December 7, 1998].

Tennant, F.S., and Rawson, R.A.

Cocaine and amphetamine dependence treated with desipramine. In: Harris, L.S., ed. Problems of Drug Dependence, 1982: Proceedings of the 44th Annual Scientific Meeting, the Committee on Problems of Drug Dependence. NIDA Research Monograph Series, Number 43. NTIS Pub. No. 83-252692. Rockville, MD: National Institute on Drug Abuse, 1983. pp. 351-355.

Tinklenberg, J.R.

The treatment of acute amphetamine psychosis. A Treatment Manual for Acute Drug Abuse Emergencies. DHEW Pub. No. (ADM) 76-230. Rockville, MD: Alcohol, Drug Abuse, and Mental Health Administration, 1975.

Trulson, M.E., and Trulson, V.M.

Effects of chronic methamphetamine administration on tryptophan hydroxylase activity, [3H]-serotonin synaptosomal uptake, and serotonin metabolism in rat brain following systemic tryptophan loading. Neuropharmacology 21:521-527, 1982a.
View the Medline version of this and related citations using NLM's PubMed

Trulson, M.E., and Trulson, V.M.

Reduction in brain serotonin synthesis rate following chronic methamphetamine administration in rats. European Journal of Pharmacology 83:97-100, 1982b.
View the Medline version of this and related citations using NLM's PubMed

Tusel, D.J.; Piotrowski, N.A.; Sees, K.; Reilly, P.M.; Banys, P.; Meek, P.; and Hall, S.M.

Contingency contracting for illicit drug use with opioid addicts in methadone treatment [abstract]. In: Harris, L.S., ed. Problems of Drug Dependence 1994: Proceedings of the 56th Annual Scientific Meeting of the College on Drug Dependence. NIDA Research Monograph Series, Number 153. DHHS Pub. No. (ADM) 95-3883. Rockville, MD: National Institute on Drug Abuse, 1995. p. 155.

Ulm, R.R.; Volpicelli, J.R.; and Volpicelli, L.A.

Opiates and alcohol self-administration in animals. Journal of Clinical Psychiatry 56(suppl. 7):5-14, 1995.
View the Medline version of this and related citations using NLM's PubMed

van Gorp, W.G.; Altshuler, L.; Theberge, D.C.; Wilkins, J.; Dixon, W.

Cognitive impairment in euthymic bipolar patients with and without prior alcohol dependence: A preliminary study. Archives of General Psychiatry 55(1):41-46, 1998.
View the Medline version of this and related citations using NLM's PubMed

Volkow, N.D.; Ding, Y.S.; Fowler, J.S.; and Wang, G.J.

Cocaine addiction: Hypothesis derived from imaging studies with PET. Journal of Addictive Diseases 15:55-71, 1996.
View the Medline version of this and related citations using NLM's PubMed

Volkow, N.D.; Wang, G.J.; Fischman, M.W.; Foltin, R.W.; Fowler, J.S.; Abumrad, N.N.; Vitkum, S.; Logan, J.; Gatley, S.J.; Pappas, N.; Hitzemann, R.; and Shea, C.E.

Relationship between subjective effects of cocaine and dopamine transporter occupancy. Nature 386:827-830, 1997a.
View the Medline version of this and related citations using NLM's PubMed

Volkow, N.D.; Wang, G.J.; Fowler, J.S.; Logan, J.; Gatley, S.J.; Hitzemann, R.; Chen, A.D.; Dewey, S.L.; and Pappas, N.

Decreased striatal dopaminergic responsiveness in detoxified cocaine-dependent subjects. Nature 386:830-833, 1997b.
View the Medline version of this and related citations using NLM's PubMed

Wada, K., and Fukui, S.

Relationship between years of methamphetamine use and symptoms of methamphetamine psychosis. Japanese Journal of Alcohol and Drug Dependence 25:143-158, 1990.
View the Medline version of this and related citations using NLM's PubMed

Wagner, G.C.; Seiden, L.S.; and Schuster, C.R.

Methamphetamine-induced changes in brain catecholamines in rats and guinea pigs. Drug and Alcohol Dependence 4:435-438, 1979.
View the Medline version of this and related citations using NLM's PubMed

Wallace, B.C.

Treating crack cocaine dependence: The critical role of relapse prevention. Journal of Psychoactive Drugs 42(2):213-221, 1992.
View the Medline version of this and related citations using NLM's PubMed

Ward, A.S.; Haney, M.; Fischman, M.W.; and Foltin, W.

Binge cocaine self-administration in humans: Intravenous cocaine. Psychopharmacology 132:375-381, 1997.
View the Medline version of this and related citations using NLM's PubMed

Washton, A.M.

Preventing relapse to cocaine. Journal of Clinical Psychiatry 49(suppl. 2):34-38, 1988.
View the Medline version of this and related citations using NLM's PubMed

Washton, A.M.

Cocaine Addiction: Treatment, Recovery, and Relapse Prevention. New York: Norton, 1989.

Washton, A.M.

Cocaine Recovery Workbooks: Preventing Relapse. Center City, MN: Hazelden Educational Materials, 1990a.

Washton, A.M.

Staying Off Cocaine: Cravings, Other Drugs, and Slips. Center City, MN: Hazelden Foundation, 1990b.

Washton, A.M.

Step Zero: Getting to Recovery. New York: HarperCollins, 1991.

Washton, A.M.

Outpatient groups at different stages of substance abuse treatment: Preparation, initial abstinence, and relapse prevention. In: Brook, D., and Spitz, H., eds. Group Psychotherapy of Substance Abuse. Washington, DC: American Psychiatric Press, in press.

Washton, A.M., and Stone-Washton, N.

Outpatient treatment of cocaine and crack addiction: A clinical perspective. In: Tims, F.M., and Leukefeld, C.G., eds. Cocaine Treatment: Research and Clinical Perspectives. NIDA Research Monograph Series, Number 135. DHHS Pub. No. (ADM) 93-3639. Rockville, MD: National Institute on Drug Abuse, 1993. pp. 15-30.

Weddington, W.W.; Brown, B.S.; Haertzen, C.A.; Hess, J.M.; Mahaffey, J.R.; Kolar, A.F.; and Jaffe, J.H.

Comparison of amantadine and desipramine combined with psychotherapy for treatment of cocaine dependence. American Journal of Drug and Alcohol Abuse 17:137-152, 1991.

Weinrieb, R., and O'Brien, C.

Persistent cognitive deficits attributed to substance abuse. Neurologic Complications of Drug and Alcohol Abuse (Neurologic Clinics) 11(3):670-675, 1993.
View the Medline version of this and related citations using NLM's PubMed

Weis, D.A.

"Stimulant use disorder (adult)." Unpublished report. Minneapolis, MN: Institute for Healthcare Quality/Health Risk Management, 1997.

Wells, E.A.; Peterson, P.L.; Gainey, R.R.; Hawkins, J.D.; and Catalano, R.F.

Outpatient treatment for cocaine abuse: A controlled comparison of relapse prevention and twelve-step approaches. American Journal of Drug and Alcohol Abuse 20:1-17, 1994.
View the Medline version of this and related citations using NLM's PubMed

Wesson, D.R., and Smith, D.E.

Cocaine: Its use for central nervous system stimulation including recreational and medical use. In: Petersen, R.C., and Stillman, R.C., eds. Cocaine: 1977. NIDA Research Monograph Series, Number 13. DHHS Pub. No. (ADM) 77-432. Rockville, MD: National Institute on Drug Abuse, 1977. pp. 137-152.

West, R., and Gossop, M.

Overview: A comparison of withdrawal symptoms from difference different drug classes. Addiction 89:1483-1489, 1994.
View the Medline version of this and related citations using NLM's PubMed

Wetli, C.V.

The pathology of cocaine: Perspectives from the autopsy table. In: Sorer, H., ed. Acute Cocaine Intoxication: Current Methods of Treatment. NIDA Research Monograph Series, Number 123. DHHS Pub. No. (ADM) 93-3498. Rockville, MD: National Institute on Drug Abuse, 1993. pp. 172-182.

Wise, R.A.

Neuroleptics and operant behavior: The anhedonia hypothesis. Behavioral and Brain Science 5:39-87, 1982.

Wise, R.A.

Neurobiology of addiction. Current Opinions in Neurobiology 6:243-251, 1996.
View the Medline version of this and related citations using NLM's PubMed

Woody, G.E.; McLellan, A.T.; Luborsky, L.; and O'Brien, C.P.

Psychotherapy in community methadone programs: A validation study. American Journal of Psychiatry 152:1302-1308, 1995.

Woolverton, W.L.; Ricuarte, Ricaurte, G.A.; Forno, L.S.; and Seiden, L.S.

Long-term effects of [chronic] methamphetamine administration in rhesus monkeys. Brain Research 486:73-78, 1989.
View the Medline version of this and related citations using NLM's PubMed

Yamamura, T.; Hishida, S.; Hatake, K.; Taniguchi, T.; and Ouchi, H.

Effects of methamphetamine and ethanol on learning and brain neurotransmitters in rats. Pharmacological and Biochemical Behaviors 42(3):389-400, 1992.
View the Medline version of this and related citations using NLM's PubMed

Appendix B -- Client Worksheets

This appendix includes the following client worksheets:

  1. Daily Schedule and Planner
  2. Identifying External Cues and Triggers
  3. Identifying Internal Triggers
  4. Action Plan for Cues and Triggers
  5. Action Plan for Avoidance Strategies
  6. Feelings, Thoughts, and Behaviors
  7. Permission To Relapse
  8. Delayed Stimulant Withdrawal
  9. What About Alcohol?
  10. Action Plan for the Holidays
  11. Evaluating Your Self-Efficacy Regarding Relapse
  12. Increasing Your Self-Efficacy
  13. Stress: Identifying Your Warning Signs
  14. Anger: Identifying Your Warning Signs
  15. Recovery-Related Stress Reducers
  16. Learning To Solve Problems
  17. Managing Your Anger
  18. Selective Memory About Stimulant Use
  19. Fantasies About Controlled Use
  20. Those Ugly Reminders
  21. Recreational and Leisure Activities
  22. Examples of Recreational and Leisure Activities
  23. Exercise and Recovery
  24. Types of Exercise Activities
  25. Nutritional Self-Assessment
  26. The Food Guide Pyramid
  27. My Nutrition Improvement Action Plan
  28. Sample Behavioral Contract for Stimulant Abstinence
  29. Components of a Functional Analysis
  30. Preparing To Conduct a Functional Analysis: Identifying Your Triggers
  31. The Functional Analysis Worksheet
  32. Conducting a Functional Analysis of Your Stimulant Use
  33. Functional Analysis: Important Points To Consider
  34. Self-Management Planning
  35. Self-Management Planning Worksheet
  36. Relationship Happiness Scale
  37. Daily Reminder To Be Nice
  38. The Perfect Relationship
  39. Positive Requests
  40. Reciprocal Contract for Behavior Change
  41. Improving Communications
  42. Disagreements and Fights
  43. Good and Poor Listening Skills
  44. Recovery Self-Evaluation

Client Worksheet 1


Daily Schedule and Planner

Date:

_______________

7:00

_______________

8:00

_______________

9:00

_______________

10:00

_______________

11:00

_______________

12:00

_______________

1:00

_______________

2:00

_______________

3:00

_______________

4:00

_______________

5:00

_______________

6:00

_______________

7:00

_______________

8:00

_______________

9:00

_______________

10:00

_______________

11:00

_______________

Client Worksheet 2


Identifying External Cues and Triggers

Stimulant cues are those things in your life that remind you of stimulant use and can trigger drug hunger. Below are lists of people, places, events, objects, and activities. Check those items around which or whom you have frequently used stimulants. Within each list, circle the item that you think is most strongly associated with your stimulant use.

People

  • Drug dealers
  • Employer
  • Dates
  • Friends
  • Family members
  • Neighbors
  • Coworkers
  • Spouse/lover
  • _____________

 

Places

  • Neighborhoods
  • Hotels
  • Certain freeway exit
  • School
  • Friend's home
  • Worksite
  • Bathrooms
  • Downtown
  • Bars and clubs
  • Concerts
  • Stash storage place
  • _______________

 

Events

  • Meeting new people
  • Payday
  • During work
  • Before sex
  • Anniversaries
  • Group meetings
  • Calls from creditors
  • After work
  • During sex
  • Holidays
  • Parties
  • Before work
  • Going out
  • After sex
  • _______________

 

Objects

  • Paraphernalia
  • Movies
  • Credit cards
  • Magazine
  • Television
  • ATM machines
  • Pornography
  • Cash
  • _____________

 

Behaviors and Activities

  • Listening to certain music
  • Going out to dance or eat
  • When hanging out with friends
  • When driving
  • After paying bills
  • Before or during a date
  • When home alone
  • When dancing
  • After an argument
  • _____________________

 

Client Worksheet 3


Identifying Internal Triggers

Stimulant cues can include certain feelings and emotions that can trigger drug hunger. Below are lists of emotions, feelings, and circumstances. Check those items that, in the past, have been associated with your stimulant use. Within each list, circle the item that you think may be the internal trigger with which you may struggle the most.

"Negative" Feelings

 

  • Feeling afraid
  • Feeling anxious
  • Feeling guilty
  • Feeling irritated
  • Feeling overconfident
  • Feeling angry
  • Feeling criticized
  • Feeling hateful
  • Feeling jealous
  • Feeling overwhelmed
  • Feeling ashamed
  • Feeling depressed
  • Feeling inadequate
  • Feeling left out
  • _______________

 

"Normal" Feelings

 

  • Feeling bored
  • Feeling insecure
  • Feeling nervous
  • Feeling sad
  • Feeling embarrassed
  • Feeling lonely
  • Feeling pressured
  • Feeling tired
  • Feeling frustrated
  • Feeling neglected
  • Feeling relaxed
  • _______________

 

"Positive" Feelings

 

  • Feel like celebrating
  • Feeling excited
  • Feeling happy
  • Feeling passionate
  • Feeling strong
  • Feeling confident
  • Feeling exhausted
  • Feeling "normal"
  • Feeling sexually aroused
  • ________________

 

Client Worksheet 4


Action Plan for Cues and Triggers

Stimulant use becomes associated with certain people, places, activities, behaviors, and feelings. These act as reminders about your previous stimulant use. When you experience these reminders or cues and do nothing about them, they can develop into thoughts about using, feelings of craving, and possibly stimulant use. But the process can be interrupted.

Many external triggers can be avoided. All triggers can be defused. However, when you try to ignore the triggers, they can become overwhelming and lead to cravings. You should develop action plans so that you can avoid being exposed to cues and reminders, and if you are exposed, so that you can stop them from becoming triggers and cravings.

Client Worksheet 5


Action Plan for Avoidance Strategies

Stopping your stimulant use is more than simply having the desire and determination to stop. Rather, it requires action and behavior. More specifically, it requires specific plans of action that can decrease the likelihood of encountering reminders of your stimulant use.

Because there are numerous reminders of stimulant use in your environment, it is essential that you take specific steps to avoid them. Some of these steps may seem unnecessary to you at first glance. But experience shows that decreasing the reminders of your stimulant use will reduce the chances of experiencing drug thoughts, triggers, and cravings.

Getting rid of drugs and paraphernalia

Stopping contact with stimulant users

Avoiding high-risk areas

Being prepared for confrontations

Client Worksheet 6


Feelings, Thoughts, and Behaviors

When you use stimulants, things tend to get out of control. You spend more money than you mean to, you use more drugs than you intend, and you experience negative consequences because of your stimulant use. Because of this, you probably experienced embarrassment, shame, and guilt. These feelings are a normal part of the addiction process. To deal with these problems, you probably developed certain patterns that helped you cope and make it through another day.

Relapsive Feelings, Thoughts, and Behaviors

These types of feelings, thoughts, and behaviors are tools that you learned that helped you to survive while you were using stimulants. They need to be replaced by healthy tools that will help you to survive and grow when not using stimulants.

Client Worksheet 7


Permission To Relapse

Relapse is not an event. It is not simply using stimulants after a period of abstinence. Rather, like addiction and recovery, relapse is a process. Similarly, relapse does not suddenly appear out of nowhere. Like recovery, it generally begins with small steps that ultimately lead to full-blown relapse and a return to stimulant use.

One of these small steps that lead to relapse is making up reasons why starting to use stimulants again may be okay. For example, you might start daydreaming about certain circumstances and situations in which using stimulants would be permissible.

The problem is, fantasizing about situations can lead you to situations that are very high risk for relapse. All of a sudden, you "find yourself" in a dangerous situation and experience powerful cravings and urges. The good news is that by identifying examples in which you justify relapse, you can stop the chain of events and avoid relapse.

Self-medicating your feelings

When you feel depressed, angry, lonely, or scared, do you want to use stimulants? When you feel this way, how would you like to feel? Have you ever said something like:

It just happened

Do you ever believe the fantasy that you have no choice or that unexpected things just happen to you? Do you ever hear yourself say, "It just happened. I didn't choose to do it?" Have you ever said something like:

Blame it on something else

Have you ever heard yourself blame another person or a situation for your own behavior? Have you ever used stimulants to get back at someone else? Have you ever said something like:

Client Worksheet 8


Delayed Stimulant Withdrawal

Most people expect to experience several problems when they stop using stimulants. You may have been very sad or depressed, felt extremely tired and sleepy, had severe stimulant cravings, and found it very hard to concentrate. It is easy to recognize that these problems are directly related to abruptly stopping the use of stimulants. Most people call them withdrawal symptoms.

However, many people don't realize that some of these symptoms can reoccur a few months after last using stimulants. For example, after a few months, some people will feel sad or depressed, but generally not as depressed as during withdrawal. Some people will have a lack of energy and feel that they just don't care about things (apathy). Even though it may have been several months since you last used stimulants, you can experience a type of delayed stimulant withdrawal. These symptoms:

Delayed Withdrawal Checklist

The items listed below can be part of a delayed stimulant withdrawal. How many of them are you experiencing?

  • Sadness
  • No energy
  • Alcohol craving
  • Poor memory
  • Stopping exercise
  • Being alone
  • Feeling lonely
  • Anxiety
  • Mood swings
  • Alcohol use
  • Feeling hopeless
  • Feeling uneasy
  • Fuzzy thinking
  • Magnified feelings
  • Irritability
  • Cravings and urges
  • Not interested in treatment
  • Not participating in meetings
  • Canceling appointments
  • Relationship problems
  • Other negative thoughts/feelings/actions

Client Worksheet 9


What About Alcohol?

You came to treatment because you have a problem with stimulants. You made a commitment to stop using stimulants. But you may not have made a commitment to stop using alcohol, especially if you have never had any problems with it. At the same time, people in your recovery program and in your 12-Step group may be putting a lot of pressure on you for complete abstinence from all drugs, including alcohol. Why should you stop using alcohol?

Using alcohol masks your emotions and feelings and does not allow you to fully experience them

Using alcohol can arouse stimulant cravings

Using alcohol reduces your ability to resist stimulant cravings

Using alcohol can lead to irresponsible and inappropriate behavior

Using alcohol keeps you in contact with people, places, and situations that trigger stimulant cravings

Adapted with permission from Washton, 1990b.

Client Worksheet 10


Action Plan for the Holidays

Are you the kind of person who normally looks forward to and enjoys the holidays? Or do you typically hope that the holidays pass by quickly? Either way, the holidays and other special events can be high-risk situations.

Times of celebration

For many people, the holidays are a time of fun and family. Although they may be fun, the holidays often involve parties with alcohol, intense involvement with family members, and time off from work. The desire to spend time with family and friends can seem like a good excuse to skip treatment and recovery meetings. Time off from work can turn into periods of boredom and restlessness, or isolation. The parties can be fun but filled with reminders of substance use as well as actual use. Overall, it can be an intense time.

Times of sadness

For many people, the holidays are reminders of the problems in their lives. Christmas, Chanukah, and Kwanza, which are family-oriented holidays, may be emotionally difficult times for people who are single, divorced, or in broken families. The holidays can provoke intense memories from childhood. These holidays and New Year's Eve can prompt some people to focus on what they consider their failures over the past year. Overall, it can be an emotionally stressful time.

Client Worksheet 11


Evaluating Your Self-Efficacy Regarding Relapse

An important lesson to be learned during recovery is to avoid high-risk situations whenever possible. Thus, one of your most important goals during recovery is learning how to avoid situations that are high risks for triggers, cravings, and relapse. However, not all high-risk situations can be avoided. You may run into your old dealer or drug-using friends, or someone at work may offer you drugs.

Because you will not be able to avoid all high-risk situations, another important goal during recovery is learning to respond to high-risk situations and preparing yourself for these. A part of this goal is evaluating your ability to handle these emergencies. The feeling that you can handle certain high-risk situations and prevent relapse is called "self-efficacy."

On one hand, it is foolish to believe that you can handle all high-risk situations or that you can handle any high-risk situations without first developing skills and tools to avoid relapse. On the other hand, it is equally foolish to believe that you cannot develop skills and techniques to handle high-risk situations. The task is to evaluate how you think you can handle certain situations that you are likely to encounter.

Client Worksheet 12


Increasing Your Self-Efficacy

Self-efficacy regarding relapse is the belief that you have developed the skills to handle certain high-risk situations. This usually involves having specific action plans to (1) refuse going to an even higher risk situation, (2) refuse offers of alcohol or other drugs, (3) leave the high-risk situation, (4) defuse the trigger by engaging in some activity, (5) speak with a sponsor or recovering friend, and (6) process the situation in a 12-Step or recovery meeting.

You can increase your self-efficacy in dealing with high-risk situations through experiences in real life as well as through role-playing exercises. You may discover that you are over-confident and need to develop more tools. Or you may discover that you have more tools than you thought.

Role-playing exercises

In the following role-playing exercises, the counselor will play "the other person." In each of these exercises, think about the action plan steps above mentioned above and imagine yourself really being in the situation.

Self-evaluation

For each of these role-playing exercises, describe how you felt regarding

Client Worksheet 13


Stress: Identifying Your Warning Signs

Stress, anxiety, and anger are strongly connected to the ways in which you think and feel. They are also strongly connected to your physical well-being. That is, your experience of stress is related to the ways in which you think and perceive; they cause strong emotional responses, and they affect your physical well-being.

Above all, stress, anxiety, and anger are warning signs. They are ways that your body alerts you to the fact that something is wrong. They may not tell you exactly what is wrong, but they are warning signs that something needs to be changed.

When you are involved in stimulant use, it becomes easy to ignore these warning signs. An important task of recovery is to learn ways to decrease the levels of stress, anxiety, and anger in your life. But in order to do so, you must first learn to identify your warning signs. To help you accomplish this task, check off the following that have applied to you since being in treatment. Discuss what was going on in your life shortly before and while experiencing these warning signs of stress.

Client Worksheet 14


Anger: Identifying Your Warning Signs

Physical signs of anger

Because the physical signs of anger are caused by a part of your nervous system, they happen automatically. During an episode, you may have a few or all of these signs. They are temporary and will rapidly fade if you allow yourself an opportunity to cool down.

Emotional signs of anger

People have different emotional experiences when they are angry. Some people feel inadequate and insecure whereas others become aggressive and hostile. Others feel victimized.

Behavioral signs of anger

People have different behavioral reactions to anger. Some explode in fits of rage and yell at or hit other people. Some people become silent and go off to be alone.

Situations associated with anger

It is important to examine the situations that seem to be associated with your getting angry. You may be able to identify certain patterns and learn to avoid them.

Client Worksheet 15


Recovery-Related Stress Reducers

Life is full of stressors, or things in the world that put some type of pressure on us to do something, to act in a certain way, or to follow a rule. But stress is our internal response to stressors. For example, being caught in a traffic jam is a stressor. Getting angry, agitated, and anxious is a response to being caught in the traffic jam. That's stress. However, there are things that can stop the cycle of stressors becoming stressful experiences. These can be important aspects of your recovery.

Broadcast your recovery

If you are typical, a lot of people know that you use stimulants. Probably more than you realize. If you try to go through treatment without telling people, they will assume that you are still using. Your stimulant-using friends will call, drop by, and contact you to get together. That can cause a lot of stress. But if you broadcast your recovery, these people may stay away, and nonusing friends and family can help support your recovery. That can reduce your stress.

Let go of certain things

Being in recovery means starting many new activities, such as attending group therapy and 12-Step meetings, and exercising. Because there are only so many hours in a day, some activities will have to stop. The goal is to let go of unhealthy and unproductive routines and replace them with healthy ones. Therefore, you must make priorities about which activities you must let go. Prioritizing your daily activities can reduce your stress.

Don't recover alone

Many people feel alone during certain phases of recovery. It is easy to focus on past mistakes and problems and feel depressed and anxious. But the focus of recovery is being with others, talking to others about your struggles and successes, and listening to others regarding the ways that they are getting healthy. The alternative is being alone, whether physically or emotionally. That's stressful. Make recovery-related and recreational-related plans with others. That can reduce stress.

Client Worksheet 16


Learning To Solve Problems

During periods of active stimulant use, people are often overwhelmed by drug-related problems. They often hope that problems will disappear. When ignored, problems tend to worsen and become more numerous. The good news is that problems can be solved. But the solution involves an action plan.

Identify one problem at a time

Stimulant-related problems can seem overwhelming and prompt strong emotions. Focus on one problem at a time.

Understand the problem

Identify potential solutions

Write down all the potential solutions you can think of, especially those that you haven't tried before. Get advice from others.

Make an action plan

Identify one solution that you feel might work. Make a plan to put the solution into action. What should you do? When should you do it? Who can help you?

Don't give up

If the problem is not solved as you had hoped, do not give up. See if you can figure out why the solution did not work. Was there something that worked partially but not completely? Identify new potential solutions and make another action plan. Most important, don't procrastinate and ignore the problem.

Client Worksheet 17


Managing Your Anger

People get angry. It's a part of life. You will become angry at various times in your life. However, it is unhealthy to remain angry. Anger can make you impulsive, prompting you to say and do things that you don't mean to do. Anger can be a trigger for stimulant cravings.

You will become angry during your recovery. You will think about situations associated with deep-seated emotions. You will be expected to talk about feelings that you have never discussed with anyone before. As you become increasingly aware of the negative consequences of your stimulant use, you may experience strong emotions that are uncomfortable.

You probably learned unhealthy ways to deal with anger. You may tend to repress your anger and pretend that everything is okay. You may impulsively explode and express your anger through physical or emotional abuse of others. Or you may let it build up and let it eat away at you. However, you can learn to manage and express your anger in healthy ways.

Client Worksheet 18


Selective Memory About Stimulant Use

There is no question that stimulants can provide a dramatically euphoric experience that is outside of normal human experiences. That is one of the reasons why people use stimulants. You probably had several stimulant-induced experiences during which you felt intensely euphoric, extremely powerful, and invulnerable. However, these experiences are accompanied by equally strong but negative experiences.

You also had many experiences during which you felt extremely depressed, agitated, and irritable. Similarly, you also experienced many adverse consequences related to your stimulant use, such as financial and employment problems, problems with family and friends, health-related concerns, and legal problems.

It is natural to focus on the positive side of things and to want to downplay the negative side. In certain areas of life, that is a good rule to live by. But one of the tasks of recovery is to always remember the negative consequences caused by your stimulant use. One of the signs of relapse is when people selectively remember only the good times associated with stimulant use, especially the euphoric experiences. People who tell "war stories" and focus on their wild stimulant-related experiences can make themselves and the people listening to them experience triggers, cravings, and urges for stimulants.

Client Worksheet 19


Fantasies About Controlled Use

After being in recovery for several weeks or months, you generally start feeling better. Although the healing process is just beginning, your thinking begins to be somewhat more clear, you are learning to experience and express your feelings more effectively, and you are learning problem-solving skills. A few or many of the negative consequences of your stimulant use are becoming less severe and numerous.

It is during these early recovery phases that you may have fantasies about being able to return to stimulant use. You may believe that if you made some changes, you could once again use stimulants. You may tell yourself that if you are "careful" you could use stimulants without losing control. You may believe that you are ready to try using stimulants "one last time" to test whether you can use stimulants without losing control over its use. These are called "fantasies of controlled use." They are classic warning signs of impending relapse.

If you experience fantasies of controlled use, you should immediately develop an action plan. This plan should include: (1) recognizing these as fantasies and rejecting them as options; (2) recognizing these as warning signs of impending danger; (3) immediately seeking a 12-Step sponsor, a counselor, or a recovering friend to speak with; (4) attending a 12-Step and recovery group meeting as quickly as possible; and (5) talking about these warning signs at the meetings.

Client Worksheet 20


Those Ugly Reminders

If you find yourself thinking about those "great" times when you used stimulants or fantasizing about being able to control your stimulant use, you may benefit from what can be called "ugly reminders" about your stimulant use. These can help you to remember that your stimulant use included some fairly serious negative consequences and problems.

But don't go overboard. It is important to remember the kinds of problems that your stimulant use caused. You don't, however, want to beat up on yourself. Rather, when you experience the warning signs of selective memory and fantasies of control, remind yourself about the dark side of your stimulant use.

Client Worksheet 21


Recreational and Leisure Activities

When you were using stimulants, there were times when your life focused on obtaining, using, and recovering from the effects of the drugs. There were times when your life was probably chaotic, out of control, and without structure. Recovery is an opportunity for you to develop a structure to your life and fill it with healthy activities.

Recreational activities are experiences in which you actively participate in an organized activity, generally with others, to have fun and enjoy life. They include participation in sports, arts and crafts endeavors, and table games, as well as sober dances, bowling, touch football, and card games. Some involve physical exercise. Leisure activities are things that you do primarily for relaxation and pleasure, and which don't involve much work. These include taking walks, having friendly conversations, reading books, watching movies, or watching sports activities.

Action plan

Client Worksheet 22


Examples of Recreational and Leisure Activities

Recreational activities, leisure activities, and hobbies are all ways in which you can have fun, enjoy being with others, and add healthy activities to your life. They can also help you take your mind off drugs, add structure to your life, and maybe even learn something new. They can help you avoid being bored and restless. They can help you reduce stress and anxiety.

Recreational Activities

Leisure Activities

Hobbies

Backpacking

Attending auctions

Amateur radio

Baseball/softball

Attending auto races

Aquarium making

Basketball

Attending concerts

Arts and crafts

Billiards/playing pool

Attending plays

Astronomy

Bowling

Attending sports events

Auto repairing

Camping

Bicycling

Carpentry

Canoeing

Bird watching

Ceramics/pottery

Checkers

Coin collecting

Coaching Little League

Chess

Crossword puzzles

Computers

Dancing

Dining out

Cooking/baking

Golf

Driving

Electronics

Ice skating

Fishing

Flower arranging

Playing cards

Hiking

Gardening

Sailing/boating

Horseback riding

Genealogy

Shuffleboard

Listening to music

Home decorating

Skiing

Painting

Hunting

Skindiving

Picnics

Model building

Surfboarding

Playing video games

Photography

Swimming

Reading books

Playing music

Table tennis

Roller skating

Sewing

Touch football

Sightseeing

Singing

Volleyball

Sunbathing

Stained glass making

Weightlifting

Talking to friends

Volunteering

Other: _____________

Visiting museums

Woodworking

 

Walks in parks

Other: _____________

 

Watching movies and TV

 

 

Writing

 

 

Other: _____________

 

Client Worksheet 23


Exercise and Recovery

Some people find having a regular schedule of intense exercise workouts, such as aerobics and step-aerobics especially enjoyable. But exercise doesn't always have to be intense to be healthy and can be somewhat more gentle, such as vigorous walks, bike rides, and skating. Also, some people find it difficult to engage in exercise just for the sake of exercise. They may find greater satisfaction in exercise activities that are social and involve groups of people. This can include dancing, tennis, swimming, or having entire groups going for walks, taking bike rides, going for runs, and skating.

Some of the benefits of exercise include increasing your physical well-being, improving your emotional well-being, improving your mental alertness, improving your sleep, providing you with more energy, and reducing your stress and anxiety. Exercise also provides structure to your life and can help to prevent weight gain.

Client Worksheet 24


Types of Exercise Activities

You may not have noticed, but there are numerous opportunities for participating in exercise activities nearby. Unless you live in a very rural area (and maybe even if you do), you probably live near a county or city recreation department, a local YMCA gym, a Jewish Community Center, and private exercise clubs and gyms. Many of these, especially gyms that are sponsored by non-profit organizations, offer services that are low-cost or even free. You can get local information through the yellow pages under "gyms," "exercise," "recreation," and by contacting the local city or county recreation department.

Traditional activities

  • Jogging
  • Walking
  • Bicycling
  • Skating
  • Swimming
  • Weightlifting
  • Nautilus-type workouts

Exercise classes

  • Aerobics classes
  • Jazz-aerobics
  • Low-impact aerobics
  • High-impact aerobics
  • Step-aerobics classes
  • Water-aerobics

Martial arts

  • Judo
  • Jujitsu
  • Karate
  • Kung-Fu
  • Tai-Chi

Sports-type exercise

  • Baseball
  • Basketball
  • Racquetball
  • Roller hockey
  • Softball
  • Soccer
  • Tennis
  • Volleyball

Dance classes

  • Ballet dancing
  • Ballroom dancing
  • Country and western
  • Ethnic dancing
  • Jazz dancing
  • Latin dancing
  • Modern dancing
  • Swing dancing
  • Tap dancing

Client Worksheet 25


Nutritional Self-Assessment

If you are typical, your use of stimulants and other drugs, especially alcohol, has had a bad impact on your diet. Stimulants suppress your appetite by making you feel as if your hunger is satisfied, even though you have not eaten anything. When your appetite is artificially suppressed by stimulants, you eat less and therefore do not consume sufficient calories and nutrition. At the same time, stimulants speed up the metabolism of your body, creating an even greater need for calories. Also, if you typically use alcohol in combination with stimulants, you may have gotten most of your calories from alcohol, often called "empty calories."

In addition to not eating frequently enough, you may have learned poor ways of eating. For instance, you may have learned to eat impulsively. Also, you may have developed the habit of eating foods with little nutritional value when you did eat.

Nutritional self-assessment

Client Worksheet 26


The Food Guide Pyramid

You probably remember reading something about the Food Guide Pyramid, a guide to daily food choices, although you may not have thought about how it applies to you. Reviewing these five food groups and incorporating this information into your life can be important aspects of your recovery. Eating regularly, and eating meals that are balanced among these food groups, can help to decrease stimulant cravings, increase sleep, increase concentration, decrease withdrawal-related anxiety and depression, and provide sufficient energy required for recovery. The following provides a basic description of the five food groups and the recommended number of servings per day for each food group. Keep in mind that a "serving" is actually a fairly small amount.

Fruit group and vegetable group

These are good sources of fiber and vitamins. Having sufficient fiber prevents constipation. Having sufficient vitamins ensures the healthy functioning of the brain, nerves, muscles, skin, and bones. Some vitamins help energy to be released from food. A healthy diet should include three to five servings of vegetables and between two and four servings of fruits each day. A serving can consist of 1/2 cup of fruit or vegetables, a small salad, one medium potato, or a wedge of lettuce.

Bread, rice, cereal, and pasta

These are good sources of protein, vitamins, and minerals. Proteins are the primary building blocks of muscle, skin, blood, and bones. The brain chemicals that become depleted by chronic stimulant use are made from proteins. A healthy diet should include between 6 and 11 servings from this group each day. A serving can consist of 1 slice of bread, 1/2 cup of pasta or rice, or 1 ounce of cereal.

Milk and cheese

These include milk, ice cream, yogurt, cheeses, and cottage cheese. These foods are a source of calcium, protein, and vitamins. Calcium is required for healthy bones and teeth. A healthy diet should include at least two to three servings each day. A serving can consist of 1 cup of skim milk, 1 1/2 cups of natural cheese, 1 1/2 cups of lowfat ice cream, or 1 1/4 ounces of hard cheese.

Meat, poultry, fish, dry beans, eggs, and nuts

These foods are rich in protein, minerals, and vitamins. A healthy diet should be limited to two to three servings per day from this food group. A serving can consist of 2 to 3 ounces of chicken, fish, or lean beef; 1 egg; 1/2 cup of cooked dry beans; 1/2 cup of nuts; or 2 tablespoons of peanut butter, which is equivalent to 1 ounce of lean meat.

Fats, oils, and sweets

No serving sizes are suggested because these foods should be eaten sparingly.

Client Worksheet 27


My Nutrition Improvement Action Plan

Stimulant-addicted people learn to act on impulse. It becomes commonplace to not eat regularly, to eat on the run, and to select foods based only on taste and not nutritional value. There is often no set schedule for meals, no meal planning, and an overreliance on high-calorie, high-fat fast foods, such as hamburgers and fries. However, with a little planning, eating can be transformed from an impulsive activity to an important and healthy component of recovery.

Make a schedule and a commitment

It is important to stop eating on the run. Making a schedule for meals can be a simple but very effective way to help add structure to your day. If you live with family members, mealtime can be a point during which all family members come together at least briefly. Take the time to list your daily and weekly priorities, such as 12-Step and recovery group meetings, and make a schedule that includes both meals and recovery priorities. Then make a commitment to continue and update this pattern.

Plan a few meals

It may seem foolish at first, but take the time to reflect on what meals you would like to have over the next several days or week. You don't have to plan out each meal. Rather, make a decision about some of the meals that you would like to have over the next several days, especially for dinner. In this way, you can plan ahead and purchase only those grocery items that you need to make the meals.

Make a grocery list

Once you have decided which meals you would like to have over the next several days, take the time to make a list of the grocery items that you need to prepare the meals. This helps you to avoid walking around the grocery store without a plan and buying groceries impulsively. Also, it will save money. You can divide your list into breakfast items, lunch items, dinner items, and snacks. Consider getting fruit as the primary type of snacks.

Plan meal preparation

Many people don't like to cook or clean up. If you live with others, it can be valuable to make a schedule about who does what. You can make agreements with others so that if one person cooks, another person cleans up.

Plan exceptions to the schedule

Most people enjoy eating out from time to time. You may have a favorite restaurant. However, eating out is often an impulsive behavior learned during periods of stimulant use. Thus, you can learn to incorporate eating out into your weekly schedule. In this way, eating out can be seen as a treat or a reward for keeping a healthy dining schedule.

Client Worksheet 28


Sample Behavioral Contract for Stimulant Abstinence

This is an agreement between _____________________ (the client) and ____________________ (the clinician) to help _____________________ (the client) maintain abstinence from stimulants.

I request my counselor to establish a schedule for collecting urine specimens from me for 24 weeks. I will provide urine samples three times per week on a Monday, Wednesday, and Friday schedule during the first 12 weeks of treatment. During the second 12 weeks (weeks 13 through 24), urine samples will be collected two times per week on a Monday-and-Thursday schedule. A clinical staff member of my sex will observe the urination. Half of each urine sample will be submitted for immediate analysis, and half will be saved at the clinic. Samples will be assayed for a variety of drugs of abuse, among which are cocaine, amphetamines, opioid drugs, marijuana, and sedatives. Each specimen for the collection request will consist of 3 ounces of urine. If the quantity is insufficient for analysis, that shall be considered a failure to provide a scheduled sample.

If I travel out of town due to an emergency, I will inform my therapist in advance of leaving. My therapist is authorized to verify such absences with __________________________ [significant other, etc.]. If I require hospitalization, my therapist will arrange to collect urine samples in the hospital. If I am sick and do not require hospitalization, I will still arrange to produce scheduled urine specimens. If I have difficulties with transportation, or inclement weather makes it difficult to travel, I will arrange (with the help of clinical staff) a way to get to the clinic for urine collection. On certain major holidays, the clinic will be closed. My therapist and I will mutually agree to modifications of the urine testing schedule during holiday weeks.

If for appropriate medical reasons, I am prescribed medication that is also a drug of abuse, I will provide to my therapist the name and phone number of my physician or dentist. I hereby give my therapist permission to contact my physician or dentist by phone and mail if I am given such a prescription. I agree to provide to my therapist a photocopy of the prescription or permit my therapist to see the prescription container. If the medication is appropriately prescribed, the appearance of the drug in urine tests will not be counted as relapse to drug use.

Stimulant-free urine samples

For each stimulant-negative urine sample collected during weeks 1 through 12 of treatment, _______________ points will be earned. A voucher stating the earned point value will be presented to me following the collection of a stimulant-free sample. This voucher will specify the number of points earned for that day, as well as the cumulative points earned to date and their monetary equivalent.

During the first 12 weeks of treatment, the first stimulant-free urine sample will be worth 10 points, with each consecutive stimulant-free sample collected thereafter earning an increment of 5 points above the previously earned amount. For example, if 10 points are earned on Wednesday for a stimulant-free sample, Friday's stimulant-free sample will earn 15 points, Monday's will earn 20 points, and so on. As an added incentive to remain abstinent from stimulants, a _____________ bonus will be earned for each week of three consecutive stimulant-negative urine samples collected. Assuming there are no stimulant-positive urine samples collected, the ______________ bonus can be earned during the first 12 weeks of treatment. During the second 12 weeks of treatment, the incentive program will be changed. Rather than earning points for stimulant-negative samples, _____________ will be earned.

For the entire 24 weeks of treatment, immediately after the urinalysis test results indicate that the urine sample is stimulant-negative, the following will happen. The _________________ [positive incentive] (weeks 1 through 12) or _____________ [positive incentive] (weeks 13 through 24) will be delivered.

Stimulant-positive urine samples

All urine samples will be screened for drug use. A record will be kept of all drugs that screened positive, although this contract will be in effect for stimulants only. For each stimulant-positive urine sample, I will not receive _______________ [positive contingency].

Failure to provide urine samples

The failure to provide a urine sample on the designated date without prior approval from my therapist will be treated as a stimulant-positive sample, and the procedure above will be in effect.

My signature below acknowledges that I have read, understand, and agree to the conditions of this urinalysis monitoring process. This process has been carefully explained to me, and I understand the consequences related to providing both stimulant-positive and stimulant-negative samples while I am a client at the program.

_____________________________

(Client)

_______________________________

(Date)

_____________________________

(Counselor)

_______________________________

(Date)

Client Worksheet 29


Components of a Functional Analysis

A functional analysis is a technique that can help you to understand your stimulant use so that you can engage in problem-solving solutions that will reduce the probability of future stimulant use. It allows you to identify the immediate causes of your stimulant use. A functional analysis is a method that helps you examine three aspects of your stimulant use:>

Triggers

In general, triggers are those circumstances, situations, people, locations, thoughts, and feelings that increase the likelihood that you will use stimulants. They do not force you to use stimulants, but they increase the likelihood that you will use them.

Feelings and thoughts

When you encounter a trigger, you typically respond with certain thoughts and feelings regarding the immediate consequences of using stimulants, such as feeling better, having fun, or forgetting about troubles. You may think about the steps that you need to take to obtain and use stimulants.

Behaviors

Once you are exposed to triggers, and after you start having thoughts and feelings about stimulants, you engage in certain behaviors. One of those behaviors is using stimulants. However, through treatment, your stimulant use can be replaced with alternate coping behaviors.

Positive consequences

Almost immediately after using stimulants, you experience positive, strongly reinforcing consequences. Some of the positive consequences include feeling euphoric, having more energy, feeling more sexual, forgetting negative events or feelings, not feeling sadness or depression, or not feeling emotional pain. These positive consequences are generally immediate and short-term.

Negative consequences

Some of the negative consequences are experienced during or shortly after stimulant use episodes, such as spending too much money, engaging in high-risk sexual behavior, irritating or injuring others, or missing work or school. Many of the negative consequences are delayed or take a while to develop, such as damage to family and social relations, financial health, emotional health, physical health, educational goals, vocational stability, and legal status.

Client Worksheet 30


Preparing To Conduct a Functional Analysis: Identifying Your Triggers

This worksheet should be completed before using Client Worksheet 32, Conducting a Functional Analysis of Your Stimulant Use, and Client Worksheet 31, The Functional Analysis Worksheet. This worksheet will help you to identify the circumstances, situations, people, locations, thoughts, and feelings that increase the likelihood that you will use stimulants.

Client Worksheet 31


The Functional Analysis Worksheet

Trigger

Feelings and Thoughts

Your Behavior

Positive Consequences

Negative Consequences

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Client Worksheet 32


Conducting a Functional Analysis of Your Stimulant Use

This worksheet is used in combination with Client Worksheet 31, The Functional Analysis Worksheet. It should be used only after completing Client Worksheet 30, Preparing to Conduct a Functional Analysis: Identifying Your Triggers.

Step 1

On the Functional Analysis Worksheet, in the column titled "Your behavior," briefly describe an example in which you recently used stimulants.

Step 2

Think about what you were doing immediately prior to this episode of stimulant use. Can you remember who you were with, what you were doing, or the time of day? Place these in the "Trigger" column.

Step 3

Immediately prior to using stimulants during this episode, what were you thinking about? Do you remember what you were feeling? Place whatever thoughts and feelings that you can remember in the "Feelings and thoughts" column.

Step 4

What happened immediately after you used the stimulants? How did your mood change? Did you feel euphoric or powerful? Did you feel that you had more energy or power than normal? Did you feel happy or not as depressed as before? Did you stop feeling bad about something?

Step 5

What have been the long-term consequences of this and other episodes of stimulant use? How has it affected your relationships with friends? How has it affected your family? How has it affected your work or school situation? How has it affected your financial situation? How has it affected your emotional health? How has it affected your physical health?

Return to Step 1

Describe another example of a relatively recent episode of stimulant use. Repeat all the steps as before. Repeat this until Client Worksheet 31, The Functional Analysis Worksheet, has been completely filled.

Client Worksheet 33


Functional Analysis: Important Points To Consider

You can quit

You can learn to stop using stimulants. Other people with stimulant problems have been able to learn how to stop using stimulants.

Stimulant abuse is a learned habit

It is important to begin thinking of your stimulant use as something you have learned to do. It is a learned habit. Learning how to stop using stimulants does not require that you understand exactly how your stimulant problem began. Blaming other persons, events, or circumstances does not help you learn how to stop. But what is effective is learning that your stimulant abuse is a problem that you can do something about.

The goal is to learn to stop using and start living

One goal of this treatment program is to help you learn how to stop using stimulants and other drugs. Another equally important goal is to help you learn how to live a drug-free lifestyle. You will obtain the most benefit from treatment if we can help you stop your stimulant use so that we can focus on helping you make other lifestyle changes that will promote long-term abstinence from stimulants.

Slips are not treatment failures

Mistakes are preventable and should be prevented. But mistakes happen. If you use stimulants during treatment, you should not view it as failure. Rather, such incidents can be used to help you learn more about your stimulant use so that you can more effectively learn to stop using completely. However, it does not give you permission to use stimulants.

Practice is important

You must learn to work on these new skills between treatment sessions. Learning and practicing new skills and behaviors is necessary. Talking about making changes is not sufficient to deal with high-risk situations. Rather, you learn by practice.

Client Worksheet 34


Self-Management Planning

By now, you have identified several of your triggers. You can organize them into categories, such as high-risk places, people, times of the day, activities, and feelings. This helps you to see that certain triggers are external and exist primarily in your environment (such as places) and some are internal, such as feelings and thoughts. Different triggers require different responses.

Avoiding triggers

Some triggers, such as certain high-risk places and people, can be avoided. This can involve taking alternate ways home so that you don't pass by your stimulant dealer's house, or not passing by bars and clubs that you frequently went to in the past.

Rearranging the environment

Although you don't have complete control over your entire environment, you have a lot of control over much of it, such as in your home. You can rid your home of stimulants, drug-using paraphernalia, and dealers' phone numbers. You can stop carrying cash, especially when you know that you will be passing by high-risk places.

Developing a new coping plan

You cannot avoid certain triggers. If cash or a certain family member is a trigger for you, it will not always be feasible to avoid these triggers. Thus, you must learn to prepare to encounter such triggers by developing new strategies or plans to help you to not use stimulants in such situations (such as calling your spouse after handling cash).

Make several copies of Client Worksheet 35, Self-Management Planning Worksheet. For each worksheet, you will address one trigger. Engage in the following steps.

Step 1

Select a specific trigger that you need to address. It should be a trigger that you are likely to encounter before the next session. Write this down in the "Trigger" column.

Step 2

Think about the different ways in which you can deal with this trigger. Can you avoid the trigger? Can you rearrange your environment so that you don't have to encounter the trigger? Is there some new coping strategy that you can engage in the event that you do encounter the trigger? Write these down in the "Plans" column. You may have several plans for each trigger.

Step 3

Working with your counselor, consider the overall effects or consequences of each plan. Write these down in the "Positive and Negative Consequences" column.

Step 4

How hard will it be to carry out each plan? With "1" being the least difficult, and "10" being the most difficult, write down the level of difficulty in the "Difficulty" column.

Step 5

Select a plan that seems to be reasonable. Working with your counselor, engage in role-playing exercises and practice engaging in this action plan.

Working with your counselor, you should repeat the above steps for at least three triggers in this session, and identify three additional triggers to work on before the next session.

Client Worksheet 35


Self-Management Planning Worksheet

Trigger

Plans

Positive and Negative Consequences

Difficulty (1-10)

 

Plan 1:

 

 

Plan 2:

 

 

Plan 3:

 

 

Plan 4:

 

 

Plan 5:

 

 

Plan 6:

 

 

Client Worksheet 36

Relationship Happiness Scale

This scale is intended to estimate your current happiness with your relationship in each of the ten areas listed below. Ask yourself the following question as you rate each area: How happy am I with my partner today in this area? Then circle the number that applies. Remember, you are indicating your current happiness. That is, it represents how you feel today. Also, do not let your feelings in one area influence the rating in another area.

 

Completely Unhappy

Completely Happy

Household responsibilities

1

2

3

4

5

6

7

8

9

10

 

Rearing of children

1

2

3

4

5

6

7

8

9

10

 

Social activities

1

2

3

4

5

6

7

8

9

10

 

Money

1

2

3

4

5

6

7

8

9

10

 

Communication

1

2

3

4

5

6

7

8

9

10

 

Sex & affection

1

2

3

4

5

6

7

8

9

10

 

Academic or occupational progress

1

2

3

4

5

6

7

8

9

10

 

Personal independence

1

2

3

4

5

6

7

8

9

10

 

Partner's independence

1

2

3

4

5

6

7

8

9

10

 

General happiness

1

2

3

4

5

6

7

8

9

10

 

Name ________________________________________

 

Date _____________________

 

Client Worksheet 37


Daily Reminder To Be Nice

It is easy for partners to take each other for granted, especially when stimulant use is part of the relationship. This worksheet is a way to help remind you that there are some simple and effective things that you can do to help reverse certain negative behaviors that may have become habitual in your relationship. This worksheet can help to remind you to do a few nice things for your partner and to record how often you actually engage in these behaviors.

Topic

Date

Date

Date

Date

Date

Did you express appreciation at least once to your partner today?

 

 

 

 

 

Did you compliment your partner at least once today?

 

 

 

 

 

Did you give your partner any pleasant surprises today?

 

 

 

 

 

Did you express visible affection to your partner at least once today?

 

 

 

 

 

Did you spend some time devoting your complete attention to pleasant conversation with your partner?

 

 

 

 

 

Did you initiate at least one of the pleasant conversations?

 

 

 

 

 

Did you make any offer to help before being asked?

 

 

 

 

 

with permission from Sisson and Azrin, 1989.

Client Worksheet 38


The Perfect Relationship

In each area listed below, write down the activities that would exist in what would be an ideal relationship for you. Be brief, specific, and positive about what you would like to occur.

Regarding "household responsibilities," I would like my partner to:





Regarding "child-rearing," I would like my partner to:





Regarding "social activities," I would like my partner to:





Regarding "independence," I would like my partner to:





Regarding "personal habits," I would like my partner to:





Regarding "managing money," I would like my partner to:





Adapted with permission from Sisson and Azrin, 1989.

Client Worksheet 39


Positive Requests

If you or your partner wants the other to make changes, the most effective way to accomplish this is by using positive communication. This is more effective and more pleasant than by negative communication, such as making demands, nagging the other person, or trying to order the other person to do something.

Engaging in positive communication is a skill, and it can be learned. It also takes practice. In the beginning, it may seem unnatural, but as you practice and incorporate it into your daily lives, it becomes natural.

The ways in which requests are made can be pleasant and will increase the likelihood that the requests will be fulfilled.

Be selfish

Don't be greedy, but don't be shy. Think about what would make you really happy. If it seems reasonable, ask for it.

Take the other person's point of view

Try to take the other person's point of view and understand how he or she feels. The other person may not recognize what you feel you need. The other person may not even realize that you are unhappy.

Take partial responsibility

When appropriate, accept partial responsibility regarding the current situation. You may never have expressed how important a specific situation is to you. Similarly, you may be equally responsible for the way a specific situation has evolved. For example, you may want your partner to become more involved in the children's homework. You may want to remind your partner that you have never expressed how important it is to you that both of you should help the kids with their homework. Also, you may want to state to your partner that you recognize that you haven't been spending sufficient time helping the kids with their homework, either.

Offer to help

Offer assistance to make it easier for your partner to fulfill your request.

Always try to say yes, if possible

Because you are going to be asking your partner to do things that will make you happy, you should be willing to do the same for your partner.

Compromise when necessary

Things will not always be black or white. There are times when it is best to compromise. Be willing to compromise so that both partners have something to gain.

Client Worksheet 40


Reciprocal Contract for Behavior Change

This contract is designed to assist you in achieving and maintaining positive changes in your relationship. During treatment, you will be asked to develop several of these contracts which will document reciprocal changes requested by you and your partner. By making a public commitment and placing it in writing, you are actively taking steps toward achieving and maintaining positive changes in your relationship.

I, ___________________________, agree to make every effort possible to make the following changes at my partner's request. I understand that this change is very important to him/her and therefore is also very important to me.

Behavior change

I, ___________________________, agree to make every effort possible to make the following changes at my partner's request. I understand that this change is very important to him/her and therefore is also very important to me.

Behavior change

This contract will continue throughout treatment unless a new contract is substituted or until one or both of the parties decides to terminate his or her participation.

Signatures

 

Client __________________________________

Date ____________________

Partner _________________________________

Date ____________________

Counselor ______________________________

Date ____________________

Client Worksheet 41


Improving Communications

Be polite to your partner

When talking to your partner, use the same courteous words and tone you would use with a stranger or a coworker.

Express positive feelings

Let your partner know what you like about the things that he or she has done. Focus on successes as much as on things that are not going well.

Do something nice

Without being asked or without a special reason, do something that your partner would like or find special. Also, do it without expecting something in return.

Determine the importance of an issue before complaining

Ask yourself whether or not something is worth complaining about. Express complaints only about things that matter.

Choose an appropriate time

Choose settings and times that are conducive to a positive discussion. Don't do it when either of you is angry or doesn't have time.

Have a goal in mind

What are you trying to achieve? What are you looking for? Why do you want these changes? Are they reasonable or achievable?

Be specific about your complaints

Focus on one thing at a time. Have a specific example of the problem. Be prepared to tell your partner precisely what you would like him or her to do differently. Stay focused, and don't bring up other problems.

Request changes in a positive manner

In a positive way, tell your partner what is bothering you and what you would like to see changed. Avoid criticisms, put-downs, and assumptions about motives.

Prepare to compromise

Be prepared to discuss solutions that work for both of you. Don't declare ultimatums or dismiss your partner's ideas.

Client Worksheet 42


Disagreements and Fights

Expect to have disagreements

Disagreements are normal aspects of relationships, even healthy ones. People in relationships will not always agree on everything.

Some disagreements are not disagreements

Very often, what people characterize as disagreements are in fact examples of miscommunication or poor communication.

Miscommunications involve unexpected responses

Miscommunications happen when the message that you are trying to send to your partner provokes a response that you did not expect or intend for him or her to have.

Miscommunications involve poor expression

Miscommunications often result from not expressing yourself clearly, specifically, or completely. Don't assume that you know what your partner does or does not know. Provide reasons why you are complaining or making a request.

The problem may be the message

You may have conveyed a message that you did not intend by not saying what you really meant, leaving out information, or by providing nonverbal messages inconsistent with the verbal message.

Arguing and fighting

People can argue and fight because communication skills used in this approach are not being followed. For example, when people don't remain focused on a topic, when they try to bring up issues when angry or at inappropriate times, or when they are overly critical, a discussion can easily get out of control and become a fight or an argument.

Recognize your pattern of fighting

The first step of gaining control of fighting and arguing behavior is to recognize your pattern of fighting. Fights can be thought of as bringing up issues without discussion or resolution. You can make lists of the types of situations that typically result in fights with your partner.

Avoidance

Some couples rarely argue but avoid conflict by never talking about important issues. In such situations, one partner typically gives in all of the time or both become adept at ignoring issues when they arise. This avoidant style of communication usually results in one or both partners feeling resentful, unloved, not cared for, or unimportant. It is important to develop communication skills that help you to recognize the issues that are important to both of you and to communicate requests and complaints at appropriate times.

Recognize avoidance problems

Some of the clues that avoidance may be a problem in your relationship are: (1) believing that there is no conflict in your relationship, (2) having dull and routine conversations that leave you feeling not connected, (3) avoiding certain topics because they will start fights, and (4) feeling resentful toward your partner so that you do not want to do special favors.

Client Worksheet 43


Good and Poor Listening Skills

Good listening promotes effective communication

It is important to engage in active listening to your partner. Active listening involves trying to completely understand what your partner is trying to communicate, specifically understanding what your partner wants and what your partner is feeling. When you think that you understand what your partner is trying to communicate, you can summarize what you think he or she is communicating and ask if you understand it correctly. You can ask your partner to explain it in more detail, or to provide examples, or ask him or her to explain it differently. You can ask what your partner is specifically feeling right now.

Validate your partner's feelings

It is important for you to let your partner feel that you can understand how and why he or she might feel the way that he or she is feeling. That is, you can communicate to your partner that his or her feelings make sense. You may not necessarily agree with your partner, but you can convey to your partner that you understand his or her point of view. This is an important way for you to communicate the message that you care about your partner and you care about the way that your partner feels. If you are angry and cannot validate your partner's feelings at the moment, you can request a short break, cool off for a few moments, and return when you can do so.

Poor listening sends poor messages

When you listen poorly, you can convey messages to your partner that will interfere with good communication. Poor listening conveys to your partner such messages as (1) I am not interested in your opinions or feelings; (2) Your feelings are silly; (3) You are foolish to have these feelings; (4) Your feelings don't deserve my attention; (5) My opinions and feelings are more important than yours; (6) My opinions and feelings are more reasonable than yours.

Types of poor listening behaviors

Self-summarizing involves the continual restatement of a position over and over during a discussion. Cross-complaining occurs when the complaint of one partner is met by a complaint by the other rather than trying to solve the original problem. Mind-reading occurs when issues are avoided by one partner feeling and acting as if he or she knows how the other partner feels or what the other would like to do. This results in the second partner feeling unimportant, left out of decisions, and resentful. Yes-butting involves one partner responding to the other with a series of "Yes, but...." statements. This sends the message that you don't want to change or meet your partner's needs or to understand your partner's point of view. Character assassination involves making requests or comments that attack your partner's whole self, rather than specific problem behaviors or areas for change. The complaining rut describes a pattern of communication characterized by continual complaints without suggestions for change or alternatives and without noting positive behavior changes.

Client Worksheet 44


Recovery Self-Evaluation

For each of the following topics, rate how satisfied you are at this time.

Recovery Self-Evaluation

 

 

Very Dissatisfied

Very Satisfied

Job/School

1

2

3

4

5

6

7

8

9

10

 

Friendships

1

2

3

4

5

6

7

8

9

10

 

Family Life

1

2

3

4

5

6

7

8

9

10

 

Leisure activities

1

2

3

4

5

6

7

8

9

10

 

Recreational activities

1

2

3

4

5

6

7

8

9

10

 

Stimulant use

1

2

3

4

5

6

7

8

9

10

 

Stimlant cravings

1

2

3

4

5

6

7

8

9

10

 

Alcohol/drug use

1

2

3

4

5

6

7

8

9

10

 

Alcohol/drug cravings

1

2

3

4

5

6

7

8

9

10

 

Self-esteem

1

2

3

4

5

6

7

8

9

10

 

Physical Health

1

2

3

4

5

6

7

8

9

10

 

Emotional health

1

2

3

4

5

6

7

8

9

10

 

Sexual fulfillment

1

2

3

4

5

6

7

8

9

10

 

Spiritual well-being

1

2

3

4

5

6

7

8

9

10

 

Adapted with permission from Rawson et al., 1995.

Appendix C --Screening Tests for Cognitive Impairments

The following list provides a number of tests that can be used to screen for cognitive impairments in stimulant users. The first two can generally be administered by counselors who are culturally competent for their client population. The other six tests should be administered and interpreted by a psychological testing specialist.

These tests can be administered quickly and easily and are used extensively in batteries created by neuro- and cognitive psychologists. Although the tests are very sensitive in revealing the existence of cognitive problems, particularly when several of the tests are administered in combination, they do not provide information on the exact nature or depth of the impairment. Positive screens should be referred to an appropriate collaborator (e.g., a neuropsychologist) for more extensive assessments.

Cognistat (Neurobehavioral Cognitive Status Examination)

This test is designed to assess intellectual functioning in five areas in adults 18 years of age and older. Administration of the test takes about 10 minutes for cognitively intact individuals and from 20 to 30 minutes for those who are cognitively impaired. Cognistat is available from:

Psychological Assessment Resources, Inc.
P.O. Box 998
Odessa, FL 33556
1-800-331-TEST

Brief Neuropsychological Cognitive Examination (BNCE)

This test is designed to evaluate the cognitive status of clients with psychiatric disorders or psychiatric manifestations of neurological disease. The reading level required for the test is minimal, and it is recommended for assessing mood disorders and substance use disorders. Both adolescents and adults can be tested in about 30 minutes. The BNCE is available from:

Western Psychological Services
12031 Wilshire Boulevard
Los Angeles, CA 90025-1251
1-800-648-8857

Backward Digital Span

This test is simply saying numbers at the rate of one per second and asking the client to repeat them backwards. For example, you might say "3, 8, 6" and would expect a response of "6, 8, 3." The examiner starts with three digits and goes up to nine digits. Three different number strings are presented at each level. If the client misses all three at a particular level, then the test is stopped. This test takes about 5 minutes to administer. It is a test of working memory capacity.

FAS Test of Verbal Fluency

The client is asked to say as many words (excluding proper names) that start with the letter F as she can in 1 minute. This is then repeated with the letter A, and again with the letter S.

Digit Symbol Subtest of the WAIS-R

This test taps the same thing as the Symbol Digit Modalities Test (i.e., the ability to manipulate simple information and pay attention). It is part of the revised Wechsler Adult Intelligence Scale (WAIS-R) and can be obtained from:

The Psychological Corporation
Harcourt Brace & Co.
15 East 26th Street
15th Floor
New York, NY 10010-1505
1-800-211-8378

Trail Making Test, Parts A and B

This test is very sensitive to brain function, is essentially connecting the dots, and takes about 5 minutes for both parts. The citation for the test is as follows:

Reitan, R.M. Validity of the trail making test as an indication of organic brain damage. Perceptual and Motor Skills 8:271-276, 1958.

Stroop Color Word Interference Test

Many versions of this test exist. It taps selective attention and the ability to ignore irrelevant information. A version can be obtained from either of the testing companies listed above.

Shipley-Hartford Tests of Vocabulary And Abstract Thinking

This is a short-form IQ test that takes a maximum of 20 minutes to administer. It is old but still widely used--particularly in the aging literature. The citation for the test is as follows:

Shipley, W.C. A self-administering scale for measuring intellectual impairment and deterioration. Journal of Psychology 9:371-377, 1940.

Repeated Memory Test (RMT)

The RMT, which was developed by Sara L. Simon, Ph.D., has five different versions, each equivalent in word frequency and length. Because the test is so simple, giving it multiple times does not seem to involve a learning curve. Each test consists of 25 words each printed 3/4 inches high on a 3-inch x 5-inch card.

The client is first told that she will be shown some words and that she will be asked to remember them. Then the words are presented to the subject, one at a time for 1 second each. When the client has seen all of the cards, there is an approximately 10-minute interval filled with distracter tasks. During this interval, other tests--such as the Digit Symbol, Trail Making A, and Trail Making B tests--may be administered.

The client is then given the recall test and told to write down any words that she remembers. The client is allowed as much time as she needs to complete the test. However, if 2 minutes have gone by without the client responding, suggest that she stop because no one remembers them all.

Next the client is given the recognition test and asked to circle the words that she remembers being shown.

A copy of the test follows, but for further information on the RMT, contact

Sara L. Simon, Ph.D.
Los Angeles Addiction Treatment Consortium
1001 W. Carson St., Suite U.
Torrance, CA 90502
310-224-4670
310-782-9140 (fax)

Scoring:

The recall test has two measures.

  1. Number correct
  2. Number of false positives (items remembered but not shown)

The recognition test has two measures.

  1. Number correct
  2. Number of false positives (items remembered but not shown)

A large number of false positives suggests that the patient was guessing and probably is having memory problems.

Test 1 Words

SAW

SALTSHAKER

OWL

ANCHOR

TIE

MONKEY

CAP

CANNON

KITE

SWEATER

NAIL

BICYCLE

PLUG

OSTRICH

DEER

THIMBLE

CHAIR

AIRPLANE

TRAIN

CIGARETTE

STOVE

WATERMELON

CIGAR

GARBAGE CAN

GLOVE

 

Recognition Test 1

Circle any items that were shown to you today during the testing session.

BASEBALL BAT

FOOTBALL

OSTRICH

CLOWN

MITTEN

SALTSHAKER

DESK

BICYCLE

RUG

BROOM

WATERMELON

CHICKEN

CHAIR

OWL

ROOSTER

BUS

DEER

GLOVE

TRAIN

PIPE

ANCHOR

WINDOW

SWEATER

GRAPES

SAW

BELT

STOVE

ENVELOPE

NAIL

IRON

KITE

CANNON

MONKEY

THIMBLE

GARBAGE CAN

CIGAR

TREE

GRASSHOPPER

AIRPLANE

MOON

KANGAROO

TIE

LEG

BREAD

CIGARETTE

PLUG

COAT

CAP

CLOCK

MUSHROOM

COW

Test 2 Words

RING

CHURCH

ANT

BEETLE

CAT

BLOUSE

POT

WRENCH

CARROT

PEPPER

CORN

GORILLA

STAR

PEACOCK

LION

UMBRELLA

LAMP

SUITCASE

BEAR

ACCORDION

PEACH

TENNIS RACKET

COUCH

CLOTHESPIN

CHAIN

 

Recognition Test 2

Circle any items that were shown to you today during the testing session.

ACCORDION

PEACH

TOOTHBRUSH

BEETLE

PEPPER

CARROT

JACKET

EAGLE

LETTUCE

HANGER

CAMEL

BEAR

RACCOON

WRENCH

PLIERS

ROLLING PIN

POT

RABBIT

TENNIS RACKET

FENCE

CHAIN

GORILLA

ARM

PEACOCK

UMBRELLA

SKIRT

SAILBOAT

MOTORCYCLE

CAR

LAMP

CUP

ANT

GIRAFFE

SWING

SUITCASE

TELEPHONE

FOOT

LION

FOX

CORN

CLOTHESPIN

BLOUSE

CAT

LEAF

CHURCH

STAR

SOCK

RING

DRESSER

CONCH

SHOE

Test 3 Words

TOP

WATCH

PIG

PENCIL

EAR

BARREL

LIPS

BASKET

REFRIGERATOR

DONKEY

FISH

TRUMPET

PAINTBRUSH

PENGUIN

SHOE

CHISEL

SWAN

SCISSORS

HORSE

SNOWMAN

RULER

ALLIGATOR

CROWN

ARTICHOKE

ONION

 

Recognition Test 3

Circle any items that were shown to you today during the testing session.

DOORKNOB

REFRIGERATOR

ALLIGATOR

TOMATO

BARN

ARTICHOKE

WATCH

CELERY

HELICOPTER

CHISEL

PANTS

PENGUIN

POTATO

TRUMPET

TABLE

KETTLE

SHEEP

SCISSORS

ASPARAGUS

PENCIL

SNOWMAN

FINGER

HORSE

WINDMILL

SLED

HAT

SHOE

CROWN

LOBSTER

BARREL

SWAN

WINEGLASS

DONKEY

POCKETBOOK

NUT

BASKET

BALL

RULER

DOG

KEY

FORK

PAINTBRUSH

DOLL

PEANUT

LIPS

PIG

EAR

ONION

TOP

FISH

BOAT

Test 4 Words

BED

PIANO

TOE

BOTTLE

COW

GUITAR

BOOK

SPIDER

GOAT

LEOPARD

WHEEL

PITCHER

BELL

BALLOON

FLAG

SEA HORSE

DRESS

RHINOCEROS

STOOL

BUTTERFLY

SNAIL

LIGHT SWITCH

MOUSE

TOASTER

THUMB

 

Recognition Test 4

Circle any items that were shown to you today during the testing session.

PITCHER

LIGHT SWITCH

TOE

BUTTERFLY

VIOLIN

GUITAR

LADDER

ASHTRAY

CAKE

PUMPKIN

SNAIL

BOWL

SCREWDRIVER

SEA HORSE

CANDLE

APPLE

BOOK

HAMMER

BOTTLE

IRONING BOARD

THUMB

TOASTER

DRESS

ROLLERSKATE

BANANA

FLAG

AXE

SPOON

LIGHTBULB

BALLOON

LEOPARD

KNIFE

PIANO

SPIDER

HEART

RHINOCEROS

HAIR

MOUSE

BIRD

WHEEL

BOW

TIGER

STOOL

SHIRT

BED

SUN

BELL

GOAT

Test 5 Words

EYE

WAGON

BEE

COMB

FLY

CHERRY

GUN

ORANGE

HARP

FLOWER

DUCK

WHISTLE

LOCK

FRYING PAN

LEMON

SANDWICH

BRUSH

NECKLACE

BUTTON

PINEAPPLE

ARROW

TELEVISION

SCREW

CATERPILLAR

GLASS

 

REcognition Test 5

Circle any items that were shown to you today during the testing session.

COMB

NAIL FILE

PINEAPPLE

ORANGE

EYE

TURTLE

SANDWICH

MOUNTAIN

WHISTLE

FROG

WAGON

SCREW

TELEVISION

HARP

BOOT

GLASS

PEN

TRAFFIC LIGHT

CHERRY

CATERPILLAR

GLASSES

FLOWER

NEEDLE

NOSE

ROCKING CHAIR

SNAKE

SQUIRREL

TRUCK

BUTTON

STRAWBERRY

LEMON

FRYING PAN

PEAR

BEE

VEST

FLUTE

SKUNK

GUN

BRUSH

SEAL

ELEPHANT

DUCK

CLOUD

FLY

BOX

NECKLACE

ARROW

LOCK

DOOR

VASE

SOFA

Name __________________________________________ Date ___________________

Recall Test for Words

Please write down all of the test words that you remember below:
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix D -- Glossary

Addiction:

A chronic, relapsing disease, characterized by compulsive drug-seeking and drug use, and by neurological adaptations in the brain.

Amygdala:

A discrete brain area that is part of the limbic system, has a large number of dopamine-containing neurons, and plays a role in the learning and performing of certain behaviors in response to incentive stimuli (i.e., motivation, reinforcement).

Analog:

A chemical compound that is similar to another drug in its effects, but differs slightly in its chemical structure.

Anergia:

Lack of energy.

Anhedonia:

Loss of interest in pleasurable activities; the inability to feel pleasure.

Anorexia:

Loss of appetite, accompanied by weight loss and thin, gaunt appearance.

Arrhythmia:

Irregular heartbeat.

Axon:

A long, thin fiber that conducts electrical impulses away from the neuron's cell body and on to other neurons.

Benzodiazepines:

Drugs that relieve anxiety or are prescribed as sedatives; they are among the most widely prescribed medications and include valium and librium.

Bradycardia:

Slowed heartbeat.

Bruxism:

The habitual, involuntary grinding of teeth, usually during sleep.

Cachexia:

Weight loss, wasting of muscle, and debility.

Central nervous system (CNS):

The brain and spinal cord.

Cerebellum:

A brain structure that controls coordination and regulation of complex voluntary muscular movements, posture, and balance.

Choreoathetoid:

Involuntary movement.

Convulsion:

An abnormal, uncontrollably violent involuntary contraction or series of contractions of the muscles; spasm or series of jerkings of the face, trunk, or limbs.

Craving:

A powerful, often uncontrollable desire for drugs.

Dendrites:

Thin, branched extensions of a neuron that extend from the cell in branched tendrils to receive information from adjacent neurons; they conduct electrical impulses inward toward the cell body.

Dermatitis:

Inflammation of the skin.

Designer drug:

A synthetic analog of a restricted drug that has psychoactive properties.

Detoxification:

A process of allowing the body to rid itself of a drug while managing the symptoms of withdrawal; often the first step in a drug treatment program.

Diaphoresis:

Profuse sweating, often with chills.

Diastolic blood pressure:

The pressure exerted by the blood on the cavities of the heart at the moment when they fill with blood.

Dopamine:

A neurotransmitter present in several brain regions involved in movement, emotion, motivation, reinforcement, and feelings of pleasure.

Dopaminergic:

Dopamine-mediated.

Dysphoria:

A mood of general dissatisfaction, restlessness, and anxiety.

Glucose utilization:

A general indicator of physiological activity; in the brain, an indicator of neurological activity presumed to be information processing.

Hypertension:

Elevated blood pressure.

Hyperthermia:

Elevated body temperature.

Limbic system:

A group of subcortical brain structures that are especially concerned with emotion and motivation.

Narcolepsy:

A disorder characterized by uncontrollable attacks of deep sleep.

Neuron:

The morphological and functional unit of the nervous system, consisting of the cell body, dendrites, and axon.

Neurotransmitters:

Chemical substances that transmit signals between neurons and that modulate neuronal activity.

Nucleus accumbens:

A discrete brain area that is part of the limbic system, has a large number of dopamine-containing neurons, and plays a role in the learning and performing of certain behaviors in response to incentive stimuli (i.e., motivation and reinforcement).

Paranoia:

A mental disorder characterized by the presence of systematized delusions, often of a persecutory character, involving being followed, poisoned, or harmed by other means, in an otherwise intact personality.

Physical dependence:

An adaptive physiological state that occurs with regular drug use and results in a withdrawal syndrome when drug use stops.

Psychosis:

A mental and behavioral disorder characterized by symptoms such as delusions or hallucinations that indicate an impaired conception of reality.

Psychosocial intervention:

An individual or group interaction that examines both psychological and social aspects of a person's life (e.g., age, education, marital, and related aspects of a person's life history).

Rhabdomyolysis:

An acute, potentially fatal disease of skeletal muscle characterized by muscle pain, weakness, and the production of red-brown urine.

Rush:

A surge of euphoric pleasure that rapidly follows administration of a drug.

Seizure:

Manifestation of a sudden onset of an abnormal mental or physical state, often characterized by complex behaviors, impaired consciousness, and convulsions.

Serotonin:

A neurotransmitter that has been implicated in states of consciousness, mood, depression, and anxiety.

Serotonergic:

Serotonin-mediated.

Stereotyped behaviors:

Frequent, almost mechanical repetition of the same posture, meaningless gestures or movement, or form of speech (as in schizophrenia).

Substantia nigra:

A discrete brain area that is part of the nigrostriatal system, interacts with the limbic system, has a large number of dopamine-containing cells, and is involved in learning to automatically execute complex movements triggered by a voluntary command; degenerative impairments in this area cause motor disturbances that occur in Parkinson's disease.

Synapse:

A microscopic gap, cleft, or junction between neurons across which chemical signals (neurotransmitters) are transmitted.

Systolic blood pressure.

The pressure exerted by the blood on the cavities of the heart at the moment when they contract.

Tachycardia:

Rapid heartbeat, with or without arrhythmia and chest pain.

Tolerance:

A condition in which higher doses of a drug are required to produce the same effect as experienced initially; often leads to physical dependence.

Toxic:

Temporary or permanent drug effects that are detrimental to the function or structure of a cell, organ, or organ system.

Urticaria:

An eruption of itching wheals, usually of systemic origin, which may be due to a state of hypersensitivity to food, drugs, or physical agents, such as heat or cold.

Ventral tegmental area:

A discrete brain area that is part of the mesocortical system, interacts with the limbic system, has a large number of dopamine-containing neurons, and is involved in attention span and short-term memory.

Withdrawal:

A psychological and/or physical syndrome caused by the abrupt cessation of the use of a drug in an habituated individual.

Appendix E --Resource Panel

Patrick Carpenter

Policy Analyst

Executive Office of the President

Office of National Drug Control Policy

Washington, D.C.

Johanna Clevenger, M.D.

Chief

Alcoholism and Substance Abuse Program Branch

Indian Health Service

Rockville, Maryland

Peter J. Cohen, M.D., J.D.

Special Expert

Medications Development Division

National Institute on Drug Abuse

National Institutes of Health

Bethesda, Maryland

Jerome Jaffe, M.D.

Director

Office of Evaluation, Scientific Analysis and Synthesis

Center for Substance Abuse Treatment

Rockville, Maryland

George Kanuck

Office of Policy Coordination and Planning

Center for Substance Abuse Treatment

Rockville, Maryland

Kate Malliarakis, C.N.P., M.S.M., N.C.A.D.C. II

Executive Office of the President

Office for Demand Reduction

Office of National Drug Control Policy

Washington, D.C.

Eleanor Sargent, C.A.C., N.C.A.C., M.A.

Director

Clinical Issues

National Association of Alcoholism and Drug Abuse Counselors

Arlington, Virginia

Appendix F --Field Reviewers

Patricia Bradford, L.I.S.W., L.M.F.T., C.T.S.

P.A. Bradford and Associates

Columbia, South Carolina

Peter J. Cohen, M.D., J.D.

Special Expert

Medications Development Division

National Institute on Drug Abuse

National Institutes of Health

Bethesda, Maryland

Carol L. DeRosa, R.N.

Registered Nurse Consultant

Child Advocacy Unit

Anne Arundel County Department of Social Services

Severna Park, Maryland

Karen Kelly-Woodall, M.S., M.A.C., N.C.A.C. II

Criminal Justice Coordinator

Cork Institute

Georgia Addiction Technology Transfer Center

Morehouse School of Medicine

Atlanta, Georgia

Mitchell Markinem, M.A., N.C.A.C. II

Drug Court Program Coordinator

Fifth Circuit Solictor's Office

Columbia, South Carolina

Bonnie I. Pipe, B.S., C.C.D.C.

Clinical Director

Northern Cheyenne Recovery Center

Northern Cheyenne Board of Health

Lame Deer, Montana

Lynda A. Price, Ph.D., I.C.A.D.C.

Treatment Coordinator

Global House

National Drug Commission

Hamilton, Bermuda

Margaret M. Salinger, M.S.N., R.N., C.A.R.N.

National Nurses Society on Addiction

Department of Veterans Affairs Medical Center

Coatesville, Pennsylvania

Richard E. Steinberg, M.S.

President

WestCare

Las Vegas, Nevada

Christopher J. Stock, Pharm.D.

Clinical Pharmacist

Substance Abuse Program

Veterans Medical Center

Salt Lake City, Utah

Richard T. Suchinsky, M.D.

Associate Director for Addictive Disorders and Psychiatric Rehabiliation

Department of Veterans Affairs

Mental Health and Behavioral Sciences Services

Washington, DC

Sushma Taylor, Ph.D.

Executive Director

Administrative Office

Center Point, Inc.

San Rafael, California

Elizabeth Wells, Ph.D.

Research Associate Professor

Department of Psychiatry and Behavioral Sciences

University of Washington

Seattle, Washington

[Figures]

Figure 1-1: MA-Related Deaths for Los Angeles, Phoenix, San Diego, and San Francisco

Figure 1-1
MA-Related Deaths for Los Angeles, Phoenix, San Diego, and San Francisco

City

1992

1993

1994

Percentage Change 1992 to 1994

Los Angeles

68

198

219

+222

Phoenix

20

63

122

+510

San Diego

97

110

172

+77

San Francisco

48

62

69

+44

Source: DEA, 1996.

Figure 1-2: Some Street Names for Methamphetamine

Figure 1-2
Some Street Names for Methamphetamine

  • Crank
  • Crypto
  • Crystal
  • Crystal meth
  • Meth
  • Quill
  • Speed
  • Tweak (an MA-like substance)
  • White cross
  • Yellow bam

For Smokable Forms

  • Cristy
  • Hanyak
  • Ice
  • L.A. glass
  • Quartz

Source: ONDCP, 1995.

Figure 1-3: 1997 Monitoring the Future Study: Drug Use Among High School Seniors

Figure 1-2
1997 Monitoring the Future Study: Drug Use Among High School Seniors

Drug

Percentage ever used

Percentage used in the past year

Percentage used in the past month

Cocaine

8.7

5.5

2.3

Stimulants

16.5

10.2

4.8

Source: NIDA, 1998b.

Figure 2-1: The Typical Neuron

Figure 2-2: Typical Synaptic Junction

Figure 2-3: The Limbic Reward System

Figure 2-4: Dopamine's Normal Action

Figure 2-5: Comparison of Plasma Levels of Methamphetamine After Oral Administration and Smoking

Figure 2-6: Comparison of Plasma Levels of Methamphetamine And Cocaine After Smoking

Figure 2-7: Cocaine Blockade of the Dopamine Reuptake Transporter

Figure 2-8: The Course of Cocaine Addiction

Figure 2-8
The Course of Cocaine Addiction

Early Stage

  • Brain chemistry altered
  • Addictive thinking begins
  • Obsessive thoughts
  • Compulsive urges
  • Conditioned cravings
  • Lifestyle changes
  • Withdrawal from normal activities
  • Subtle physical and psychological consequences (e.g., jitters, irritability, mood swings)

Middle Stage

  • Loss of control
  • Cravings
  • Inability to stop despite consequences
  • Denial
  • Increasing isolation
  • Increasing physical and psychological consequences (e.g., paranoia, panic seizures)
  • Impaired work/school performance

Late Stage

  • Failure of efforts to stop
  • Severe financial problems
  • Severe work/school dysfunction
  • Plummeting self-esteem
  • Severe relationship problems
  • Chronic severe depression
  • Cocaine psychosis
  • Death

Source: Washton, 1989. Copyright 1989 by Arnold Washton. Used with permission from the author.

Figure 2-9: Methamphetamine's Effects on Synaptic and Intraneuronal Dopamine Leakage

Figure 3-1: Evaluating the Matrix Model

Figure 3-1
Evaluating the Matrix Model

The Center for Substance Abuse Treatment has recently solicited applications to replicate and evaluate the Matrix 8- and 16-week protocols for the treatment of MA use disorders. This project will represent the first multisite evaluation of a specific psychosocial approach for the treatment of MA disorders. The goal of the project is to collect data on the clinical efficacy of the treatment approach, as well as cost effectiveness information on the two treatment protocols. This project is scheduled to be completed by September 2001.

Figure 4-1: Schedule Appointments Quickly

Figure 4-1
Schedule Appointments Quickly

Making an appointment within 24 hours of initial phone contact significantly increases the likelihood of showing up for an initial appointment (Festinger et al., 1995, 1996; Stark, 1992; Stark et al., 1990). Such research suggests that an accelerated intake is a low-cost and effective method of reducing the high attrition rates commonly observed between the initial clinical contact and intake interview.

Figure 4-2: Treatment Duration, Frequency, and Format

Figure 4-2
Treatment Duration, Frequency, and Format

  • Research has not yet demonstrated the optimal duration, frequency, and format of treatment for stimulant addiction (Higgins and Wong, 1998). Some research suggests that longer treatment durations of 6 or 12 months are associated with better outcomes for cocaine-dependent individuals (Carroll et al., 1993a; Higgins et al., 1993a; Wells et al., 1994), but the research is not consistent and has not evaluated MA treatment.
  • Experience suggests that the duration of the initiating treatment is a minimum of several weeks. Most stimulant-dependent clients require 2 to 4 weeks to establish an initial period of abstinence and to overcome certain cognitive impairments. It is common for programs to encourage frequent visits during the first 2 to 4 weeks of treatment followed by less frequent visits.
  • For clients with stimulant use disorders during this phase, the frequency of visits or sessions seems to be more important than their length. For example, three or four weekly visits of approximately 30 minutes appear to be more beneficial than fewer weekly visits that last longer. There is no evidence that clinic visits lasting more than 90 minutes are more effective than shorter visits. The greater frequency of clinic visits can help to establish behavioral accountability, contain impulses, and create daily structure.
  • In practice, the most common format for stimulant use disorder treatment is group rather than individual therapies. Experience suggests that stimulant-dependent clients are capable of full participation in group-oriented therapies, although their low tolerance for frustration may make lengthy group sessions onerous. However, clients who are still paranoid and distrustful of others may not be willing to participate in group therapy, but may be willing to participate in individual counseling as an initial strategy and bridge into group treatment.

Figure 4-3: Basic Conditioning Factors in Stimulant Use

Figure 4-3
Basic Conditioning Factors in Stimulant Use

  • Stimulant cravings are the predictable results of chronic stimulant use and typically continue long after the stimulant use is stopped.
  • Stimulant cravings can be triggered by people, places, situations, things, and feelings that were previously associated with stimulant use. Anything that reminds clients of stimulant use can be a trigger for stimulant cravings.
  • Stimulant cravings are typically strong during the early abstinence period and become less frequent and severe over time. They lose their power only when not reinforced by stimulant use.
  • The strength of cravings does not diminish merely through the passage of time but because clients do not give into to the cravings when they occur.
  • Complete abstinence from all psychoactive drugs is the best way to ensure the most rapid and complete extinction of stimulant cravings.
  • Determination and willpower are poor defenses against cravings. Rather, specific actions must be taken to counteract cravings and urges whenever they occur.
  • Cravings and urges are always temporary. They are usually fleeting sensations lasting no more than a few minutes and tend to disappear quickly when immediate action is taken to remove oneself from the situation that has prompted the craving.

Source: Adapted with permission from Washton, 1989, p. 107.

Figure 4-4: Related Research: Behavioral Relationship Therapy

Figure 4-4
Related Research: Behavioral Relationship Therapy

A review of research evidence regarding behavioral relationship therapy and substance use disorder treatment outcomes (Landry, 1995) noted that

  • Behavioral relationship therapy can improve the quality of interpersonal relationships, promote rapid reductions in substance use, enhance maintenance of sobriety, enhance treatment outcomes, and decrease the probability of treatment dropout. Relationship therapy both during and following treatment improves treatment outcomes.
  • Spouse involvement in treatment yields better results than treatment without spouse involvement. Unilateral treatment of the spouse with the person with the substance use disorder has been found to increase the client's motivation for treatment.

Similarly, a meta-analysis of controlled studies that compared family therapy with other therapy approaches to substance use disorder treatment (Stanton and Shadish, 1997) noted that

  • Family therapy was more effective and had higher retention rates than individual counseling or therapy, peer group therapy, and family psychoeducation.

Figure 4-5: Responding to Slips in Group Sessions

Figure 4-5
Responding to Slips in Group Sessions

  • Ask the person to provide a detailed account of the sequence of feelings, events, and circumstances that led to the slip.
  • Encourage group members to ask the person for further details, and to help him identify early warning signs and self-sabotaging behaviors.
  • Encourage group members to state their concerns for the individual.
  • Encourage group members to offer advice and recommendations about preventing further slips.
  • Ask the person to discuss his thoughts and feelings about what has been said in the group and what he intends to do differently.

Source: Washton, 1990a.

Figure 4-6: Addressing Relapse

Figure 4-6
Addressing Relapse

An integral aspect of relapse prevention involves eliminating and correcting dangerous myths and misconceptions regarding the process of relapse and the appropriate treatment response to it. The Consensus Panel recommends that the following concepts be incorporated into educational efforts for clients, counselors, and nonclinical staff members.

  • Relapse is not necessarily a sign of poor motivation. Although relapse can be a sign of extreme ambivalence or poor motivation to quit using stimulants, even the most highly motivated and sincere clients can relapse. Relapse is a sign that something is wrong with the client's recovery plan, not with the client.
  • Relapse is not a sign of treatment failure. It is a temporary interruption in the client's abstinence. It means that the client's recovery plan is incomplete and is a signal that the client is doing something that he shouldn't do, or that the client should be doing something that he isn't.
  • Relapse is predictable and avoidable; rarely is it unpredictable. It is preceded by warning signs that the counselor and client should be trained to identify. It is the endpoint of a progression of attitudes and behaviors. It is interruptible and preventable.
  • Relapse is not a single event invariably involving drug use. Rather, relapse is a process, as is addiction, treatment, and recovery. It has a beginning, a midpoint, and an end. Returning to drug use is the endpoint, not the beginning of the process.
  • Relapse does not erase positive recovery changes. Clients need not "start over" but should avoid further drug use, remain in treatment, resume the recovery process where last left off, and enhance the treatment plan to avoid future relapses. A temporary setback can provide invaluable information about weaknesses in the treatment plan and suggest ways to prevent it from recurring in the future.
  • The absence of relapse does not guarantee successful recovery. Abstinence is an opportunity to recover but is not a guarantee of recovery. Many clients who experience relapse make tremendous strides in personal growth and maturity, although some clients with uninterrupted abstinence never experience substantial changes or achieve lasting growth. Abstinence is an important first step in the recovery process but is not the final goal.

Source: Adapted with permission from Washton, 1989.

Figure 4-7: Recommendations for Running a Relapse Prevention Group

Figure 4-7
Recommendations for Running a Relapse Prevention Group

  • A relapse prevention group is a forum for clients to create a program of recovery and relapse prevention. The group provides a setting for sharing information about relapse and relapse prevention and spotting signs of impending relapse. Clients heading toward relapse can be redirected, whereas those who are on a good course can be encouraged. The group setting allows for mutual client assistance within the guiding constraints of the group leader.
  • A group can be led by a therapist group leader and a recovering coleader. Ideally, the group leader also sees group members for individual sessions. The group leader must be clearly, actively, and unquestionably in control of the group and is responsible for setting the time limits and ensuring that all group members have opportunities to speak. The coleader can answer questions about and be an example of long-term sobriety.
  • The group meeting begins with an introduction of new members, who are asked to give a brief history of their drug use.
  • Following introductions, the group leader gives a casual and didactic presentation on a specific topic for approximately 15 minutes and/or presents an equally brief video.
  • Next, relapse and recovery are discussed among the group members for approximately 45 minutes.
  • For the next 30 minutes, the group leader elicits from the group members any recent problems that they want to discuss. Quiet and uncommunicative members are encouraged to talk about how they are feeling.
  • At the end of the group session, the group leader ties up loose ends and summarizes the discussion. Unresolved issues may be acknowledged, and discussions can be carried over to the next scheduled meeting. Clients who appear troubled, angry, or depressed, and those who mentioned cravings can be asked to remain. The group leader and coleader can encourage such individuals to speak with their therapist as soon as possible. All sessions should end with a confidentiality pledge and a commitment to attending the next group session.

Adapted, with permission. The Matrix Center, Inc. The Matrix Intensive Outpatient Program Therapist Manual. Los Angeles: Matrix Center, Inc., 1995.

Figure 4-8: Related Research: Disulfiram Therapy

Figure 4-8
Related Research: Disulfiram Therapy

An uncontrolled study by Higgins et al. (1993a) noted that supervised disulfiram therapy was associated with significant decreases in alcohol and cocaine use among outpatients with cocaine-related disorders. A subsequent controlled trial by Carroll et al. (1993b) provided support that disulfiram therapy can reduce cocaine and alcohol use in outpatients who use both substances.

Figure 4-9: Related Research: Alcoholics Anonymous (AA)

Figure 4-9
Related Research: Alcoholics Anonymous (AA)

A comprehensive review of the research on AA reveals several important findings:

  • Research demonstrates a strong association between AA participation that occurs during or following professional treatment and improvements in drinking behaviors and abstinence.
  • Research suggests a strong association between increased frequency in attending AA meetings and improvements in drinking behavior measures, such as abstinence and decreases in alcohol consumption.
  • Research suggests a modest association between increased participation in and affiliation with AA (such as obtaining or becoming a sponsor) and improvements in drinking behavior measures, such as abstinence, decreased drinking, and decreased relapse.
  • Research suggests modest associations between AA participation and improvements in several areas of psychosocial functioning.

Source: Landry, in press.

Figure 5-1: Effects of Route of Administration for Cocaine and MA

Figure 5-1
Effects of Route of Administration for Cocaine and MA

Route of Administration

Form of Drug

Onset of Action for Cocaine and MA

Duration of "High"

Oral

Powder/pill

10 to 30 minutes

45 to 90 minutes for cocaine
3 to 5 hours for MA

Intranasal

Powder

3 to 5 minutes

10 to 20 minutes for cocaine

Intravenous

Solution

5 to 10 seconds

10 to 20 minutes for cocaine
4 to 6 hours for MA

Inhalation

Crack cocaine/Ice (MA)

5 to 10 seconds

5 to 20 minutes for crack
8 to 24 hours for ice

Sources: Cook, 1991; Gold, 1997; Gold and Miller, 1997; Sowder and Beschner, 1993.

Figure 5-2: Dose Frequency Escalation Patterns, Cocaine and Amphetamine

Figure 5-3: Differences Between Cocaine and MA

Figure 5-3
Differences Between Cocaine and MA

Cocaine

MA

  • Plant-derived
  • Smoking produces a high that lasts 20 to 30 minutes
  • Is eliminated from the body in 1 hour
  • Used as a local anesthetic in some surgical procedures
  • Man-made
  • Smoking produces a high that lasts 8 to 24 hours
  • Is eliminated from the body in 12 hours
  • Limited medical use

Source: NIDA, 1998a.

Figure 5-4: Common Signs and Symptoms of Acute Stimulant Intoxication

Figure 5-4
Common Signs and Symptoms of Acute Stimulant Intoxication

Physiological

Psychological/Behavioral

  • Dilated pupils
  • Diaphoresis (profuse sweating)--often with chills
  • Hypertension (elevated blood pressure)
  • Tachycardia (increased heartbeat), with or without arrhythmia and chest pain
  • Bradycardia (slowed heart action)
  • Hyperthermia (elevated temperature)
  • Suppressed appetite, weight loss
  • Bruxism (teeth grinding)
  • Insomnia or decreased need for sleep
  • Tremors
  • Seizures--mostly for cocaine users
  • Headache--occasionally
  • Euphoria, heightened sense of well being
  • Increased vigor, giddiness, and sense of enhanced mental acuity and performance
  • Agitation, restlessness, irritability
  • Garrulousness, with pressure of speech, flight of ideas, and rapid shifts in thinking
  • Poor concentration
  • Grandiosity, exaggerated self-esteem, egocentricity
  • Hypervigilance, with increased curiosity about the environment
  • Enhanced sensory awareness
  • Fearlessness, suspiciousness
  • Impaired judgment, poor impulse control
  • Clear sensorium, not usually disoriented
  • Aggression and emotional lability, with potential for violence

Figure 5-5: Common Signs and Symptoms of Stimulant Withdrawal/Abstinence Syndrome

Figure 5-5
Common Signs and Symptoms of Stimulant Withdrawal/Abstinence Syndrome

Physiological

Psychological/Behavioral

  • Thin, gaunt appearance with reported weight loss or anorexia
  • Dehydration
  • Fatigue and lassitude, with lack of mental or physical energy
  • Dulled sensorium
  • Psychomotor lethargy and retardation--may be preceded by agitation
  • Hunger
  • Chills
  • Insomnia followed by hypersomnia
  • Dysphoric mood--that may deepen into clinical depression and suicidal ideation
  • Persistent and intense drug craving
  • Anxiety and irritability
  • Impaired memory
  • Anhedonia--loss of interest in pleasurable activities
  • Interpersonal withdrawal
  • Intense and vivid drug-related dreams

Figure 5-6: Common Symptoms of Chronic Stimulant Abuse/Dependence

Figure 5-6
Common Symptoms of Chronic Stimulant Abuse/Dependence

Physiological

Psychological/Behavioral

  • Extreme fatigue--with physical and mental exhaustion and disrupted sleep patterns
  • Nutritional disorders--extreme weight loss, anemia, anorexia, cachexia (body wasting)
  • Poor hygiene and self-care
  • Skin disorders and secondary skin infections--itching, lesions, hives, urticaria
  • Hair loss
  • Muscle pain/tenderness--may indicate rhabdomyolysis
  • Cardiovascular damage--from toxicity and contaminants in MA production, with concomitant renal and hepatic problems
  • Hypertensive crises with renal damage from sustained hypertension
  • Difficulty breathing--may reflect pulmonary edema, pneumonitis, obstructive airway disease, barotrauma, and other complications
  • Myocarditis, infarcts
  • Headaches, strokes, seizures, vision loss
  • Choreoathetoid (involuntary movement) disorders
  • Impaired sexual performance and reproductive functioning
  • Cerebrovascular changes, including evidence of cerebral hemorrhages and atrophy with associated cognitive deficits
  • Ischemic bowel, gastrointestinal complaints
  • Paranoia with misinterpretation of environmental cues; psychosis with delusions, and hallucinations
  • Apprehension--with hopelessness and a fear of impending doom that resembles panic disorder
  • Depression--with suicidal thinking and behavior
  • Acute anxiety
  • Eating disorders

Figure 5-7: Distinctive Indicators of Chronic Abuse of Cocaine Versus MA

Figure 5-7
Distinctive Indicators of Chronic Abuse of Cocaine Versus MA

Cocaine

MA

  • Nasal perforations and nose bleeds among snorters
  • Serious constipation due to dehydration and insufficient dietary fiber
  • Dental problems, including missing teeth, bleeding and infected gums, dental caries
  • Muscle cramping related to dehydration, with low magnesium and potassium levels
  • Dermatitis around the mouth from smoking hydrochloride salt
  • Stale urine smell due to ammonia constituents used in manufacturing MA
  • Various dermatologic conditions, including excoriated skin lesions

Figure 5-8: Recommended Approaches for Reducing the Risk of Violence

Figure 5-8
Recommended Approaches for Reducing the Risk of Violence

  • Keep the client in touch with reality by identifying yourself, using the client's name, and anticipating concerns.
  • Place the client in a quiet, subdued environment with only moderate stimuli. Ensure sufficient space so that the client does not feel confined. Have the door readily accessible to both the client and the interviewer, but do not let the client get between the interviewer and the door.
  • Acknowledge agitation and potential for escalation into violence by reassuring the client that you are aware of his distress. Ask clear simple questions, tolerate repetitive replies, and remain nonconfrontational.
  • Foster confidence by listening carefully, remaining nonjudgmental, and reinforcing any progress made.
  • Reduce risk by removing objects from the room that could be used as weapons and discreetly ensuring that the client has no weapons.
  • Be prepared to show force if necessary by having a backup plan for help and having chemical and physical restraints immediately available.
  • Train all medical or emergency staff to work as a team in managing an aggressive, paranoid, and potentially violent client.

Figure 5-9: Client Consent Form: Required Items

Figure 5-9
Client Consent Form: Required Items

  • Name or general description of the program(s) making the disclosure
  • Name or title of the individual or organization that will receive the disclosure
  • Name of the client who is the subject of the disclosure
  • Purpose of or need for the disclosure
  • How much and what kind of information will be disclosed
  • A statement that the client may revoke the consent at any time, except to the extent that the program has already acted in reliance on it
  • Date, event, or condition on which the consent form expires, if not previously revoked
  • Signature of the client (and, for minors in some States, her parent or legal guardian)
  • Date on which the consent is signed


-------------------------- End of Download Section --------------------------