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Formal Treatment (formal + treatment)
Selected AbstractsCommunity reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatmentADDICTION, Issue 10 2010Hendrik G. Roozen ABSTRACT Aims Many individuals with substance use disorders are opposed to seeking formal treatment, often leading to disruptive relationships with concerned significant others (CSOs). This is disturbing, as untreated individuals are often associated with a variety of other addiction-related problems. Community Reinforcement and Family Training (CRAFT) provides an option to the more traditional treatment and intervention approaches. The objective of this systematic review was to compare CRAFT with the Alcoholics Anonymous/Narcotics Anonymous (Al-Anon/Nar-Anon) model and the Johnson Institute intervention in terms of its ability to engage patients in treatment and improve the functioning of CSOs. Methods The electronic databases PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Library were consulted. Four high-quality randomized controlled trials were identified, with a total sample of 264 CSOs. Data were synthesized to quantify the effect with 95% confidence intervals, using the random effects model. Results CRAFT produced three times more patient engagement than Al-Anon/Nar-Anon [relative risk (RR) 3.25, 95% confidence interval (CI) 2.11,5.02, P < 0.0001; numbers needed to treat (NNT) = 2] and twice the engagement of the Johnson Institute intervention (RR 2.15, 95% CI 1.28,3.62, P = 0.004; NNT = 3). Overall, CRAFT encouraged approximately two-thirds of treatment-resistant patients to attend treatment, typically for four to six CRAFT sessions. CSOs showed marked psychosocial and physical improvements whether they were assigned to CRAFT, Al-Anon/Nar-Anon or the Johnson Institute intervention within the 6-month treatment window. Conclusion CRAFT has been found to be superior in engaging treatment-resistant substance-abusing individuals compared with the traditional programmes. [source] Intensive referral to 12-Step self-help groups and 6-month substance use disorder outcomesADDICTION, Issue 5 2006Christine Timko ABSTRACT Aims This study implemented and evaluated procedures to help clinicians make effective referrals to 12-Step self-help groups. Design Randomized controlled trial. Setting Out-patient substance use disorder treatment. Participants Individuals with substance use disorders (SUDs) entering a new treatment episode (n = 345) who were assigned randomly to a standard referral- or an intensive referral-to-self-help condition. Measurements Self-reports of 12-Step group attendance and involvement and substance use at baseline and a 6-month follow-up. Intervention The intensive referral intervention focused on encouraging patients to attend 12-Step meetings by connecting them to 12-Step volunteers. Findings Among patients with relatively less previous 12-Step meeting attendance, intensive referral was associated with more meeting attendance during follow-up than was standard referral. Among all patients, compared with those who received standard referral, those who received intensive referral were more likely to be involved with 12-Step groups during the 6-month follow-up (i.e. had provided service, had a spiritual awakening and currently had a sponsor). Intensive referral patients also had better alcohol and drug use outcomes at 6 months. Twelve-Step involvement mediated part of the association between referral condition and alcohol outcomes. Conclusions The brief intensive referral intervention was associated with improved 12-Step group involvement and substance use outcomes even among patients with considerable previous 12-Step group exposure and formal treatment. Future 12-Step intensive referral procedures should focus on encouraging 12-Step group involvement in addition to attendance to benefit patients most effectively. [source] Fiscal Transfers and Distributive Conflict in a Simple Endogenous Growth Model with UnemploymentGERMAN ECONOMIC REVIEW, Issue 1 2007Luigi Bonatti Capital,labor conflict; endogenous growth; politico-economic models; tax burden; welfare reforms Abstract. In the simplified formal treatment proposed in this paper, a decrease in a policy parameter , the ratio of total tax revenues to GDP , can monotonically increase long-term growth rate and may lead to a higher employment level. This notwithstanding, the paper shows that the redistributive implications of such a decrease may induce the wage earners to oppose it. As a consequence, policy-makers reflecting social preferences may undertake redistributive transfers generating persistent unemployment and lowering growth even if commitment technologies allowing them to follow preannounced tax policies were feasible. [source] Large B-cell lymphoma of the legINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2001Elsa Vasquez-del-Mercado MD A 74-year-old Mexican man presented with an 18-month history of multiple, violaceous, coalescing, firm, tender nodules with an ulcer in the anterior aspect of the right leg (Fig. 1) and slightly infiltrated, ill-defined erythematous plaques affecting the left leg and both forearms. He had not received any treatment for his condition. Past medical history was relevant for noninsulin-dependent diabetes mellitus and hypertension without formal treatment and a history of heavy alcohol intake in his youth. A biopsy specimen of both plaque-type lesions of the forearm and tumorous lesions of the leg showed a diffuse, nonepidermotropic mononuclear infiltrate throughout the dermis and extending to the subcutis. The infiltrate was composed of pleomorphic, atypical, large mononuclear cells (Fig. 2). Immunostaining with CD20 was positive for the atypical cells while CD3 was positive for normal appearing lymphocytes, characterized as reactive T cells. Additional laboratory and image studies ruled out extracutaneous involvement. The diagnosis of primary cutaneous large B cell lymphoma of the leg (LBCLL) was made. The patient was initiated on radiotherapy localized to the right leg with a very good initial response, nevertheless resolution was not achieved and the plaques in the rest of the limbs remained unchanged. Thus, the patient started chemotherapy with CHOP (Cyclophosphamide, Vincristine, Doxorubicin, Prednisone). He has currently finished his fourth cycle with this chemotherapy regimen. The tumorous lesions involuted leaving only residual hyperpigmentation (Fig. 3) and the plaques in the rest of the limbs disappeared, the area of the ulcer diminished considerably. There is still no evidence of extracutaneous involvement. Figure 1. Nodules and ulcer in the anterior aspect of the right leg Figure 2. Atypical lymphocytes, with large, pleomorphic nuclei and multiple nucleoles. Positivity for CD20 antigen was demonstrated by immunohistochemical analysis (hematoxylin and eosin; X 600) Figure 3. Residual hyperpigmentation and granulation tissue after chemotherapy [source] Bayesian clustering and product partition modelsJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES B (STATISTICAL METHODOLOGY), Issue 2 2003Fernando A. Quintana Summary. We present a decision theoretic formulation of product partition models (PPMs) that allows a formal treatment of different decision problems such as estimation or hypothesis testing and clustering methods simultaneously. A key observation in our construction is the fact that PPMs can be formulated in the context of model selection. The underlying partition structure in these models is closely related to that arising in connection with Dirichlet processes. This allows a straightforward adaptation of some computational strategies,originally devised for nonparametric Bayesian problems,to our framework. The resulting algorithms are more flexible than other competing alternatives that are used for problems involving PPMs. We propose an algorithm that yields Bayes estimates of the quantities of interest and the groups of experimental units. We explore the application of our methods to the detection of outliers in normal and Student t regression models, with clustering structure equivalent to that induced by a Dirichlet process prior. We also discuss the sensitivity of the results considering different prior distributions for the partitions. [source] | ||||||||||