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Baker, D. B., Knight, K., & Simpson, D. D. (1995). Identifying probationers with ADHD-related behaviors in a drug abuse treatment setting. Criminal Justice and Behavior, 22(1), 33-43.

Abstract: Increasing recognition is being given to the manifestations of attention deficit hyperactivity disorder (ADHD) in adulthood. Prospective studies have indicated that many children diagnosed with ADHD continue to have symptoms of the disorder. These often are associated with antisocial behaviors, suggesting that ADHD may be an undetected and untreated root cause of these behaviors. In the present study, indicators of ADHD were examined in a population of probationers in a court-referred drug abuse treatment setting. The results showed that 31% had symptoms indicative of ADHD and that these symptoms were associated with self-reported measures of arrest history, aggressive behavior, drug use, family atmosphere, and family mental health.

Camacho, L. M., Williams, M. L., Vogtsberger, K. N., & Simpson, D. D. (1995). Cognitive readiness of drug injectors to reduce AIDS risks. American Journal on Addictions, 4(1), 49-55.

Abstract: The impact of motivational factors on AIDS high-risk behavior after participation in an AIDS intervention program was explored among 208 out-of-treatment injecting drug users (IDUs). It was hypothesized that lower risk behavior would be evident at follow-up among IDUs who indicated higher concern about their susceptibility to AIDS prior to intervention. Results showed that this motivational indicator predicted lower risks 6 months after the intervention. Overall, this study indicates that psychoeducational AIDS interventions will be most beneficial to individuals with sufficient cognitive readiness to address drug and AIDS-related issues at a personal level. Assessments of risk and motivation levels of program participants should be used to tailor intervention strategies to meet individual needs.
 

Chatham, L. R., Knight, K., Joe, G. W., & Simpson, D. D. (1995). Suicidality in a sample of methadone maintenance clients. American Journal of Drug and Alcohol Abuse, 21(3), 345-361.

Abstract: Previous work has shown that suicide is a significant cause of death among substance abusers, including methadone-maintained clients, and that the prediction of suicidal ideation and behavior is difficult. Preliminary review of data collected at admission on a population of 438 methadone-maintained clients found 55 expressing some level of suicidal behaviors during the course of treatment. These clients were compared with a randomly selected comparison group of 55 nonsuicide clients matched for gender and race/ethnicity on measures of psychological dysfunction, drug use, family dysfunction, and help-seeking behaviors. Results showed that at time of admission suicidal clients reported: 1) more psychological dysfunction as evidenced by higher levels of depression, social dysfunction, hostility, risk-taking, and previous thoughts of suicide: 2) less family support at the present time and during childhood; and 3) more help-seeking behavior as evidenced by self-referral, number of previous treatment episodes, attendance at self-help meetings, and higher scores on motivational measures of desire for help. Differences in preadmission drug-using behaviors were not found between the two groups.

Chatham, L. R., Rowan-Szal, G. A., Joe, G. W., Brown, B. S., & Simpson, D. D. (1995). Heavy drinking in a population of methadone-maintained clients. Journal of Studies on Alcohol, 56(4), 417-422.

Abstract: Objective: The purpose of the study was to clarify the relationship between heavy use of alcohol and response to methadone treatment. Method: A sample of clients showing three or more DSM-III-R symptoms (n = 79) were identified and compared with a sample of heavy-drinking clients (n = 108) with less than three alcohol dependency symptoms on admitting characteristics and on tenure in treatment. Results: As expected, clients meeting DSM-III-R dependency criteria were significantly more likely to show evidence of psychological problems and dysfunction of family and peer relations at admission. An unexpected finding was that they were also more likely to remain in treatment longer than drinking clients who did not report dependency. Alcohol dependent clients were significantly more likely to have prior experience with self-help groups, which may reflect less denial and therefore relatively better ability to focus on opiate dependency problems. Conclusions: Failure to differentiate between alcohol dependent and nondependent groups of drinkers enrolled in methadone treatment may help account for reported differences in treatment outcomes studies. Recognizing these different types of drinkers also may help clinicians plan more effective treatments.

Czuchry, M., Dansereau, D. F., Dees, S. M., & Simpson, D. D. (1995). The use of node-link mapping in drug abuse counseling: The role of attentional factors. Journal of Psychoactive Drugs, 27(2), 161-166.

Abstract: This study extends previous research on the use of node-link mapping during counseling by addressing the effect that this visual representation technique has on clients with attentional problems. Participants were 13 counselors in a methadone treatment program and their 93 opioid-addicted clients who had been in treatment for more than three months. Both counselors and clients were randomly assigned to mapping-enhanced or standard counseling. Based on a self-report measure assessing attention-related problems of clients, they were categorized as having either adequate or poor levels of attentional stamina and attentional control. Consistent with previous findings, clients in mapping-enhanced counseling had lower percentages of urine samples that were positive for cocaine or heroin. In addition, results suggest that mapping has greater benefits in terms of session attendance and program perception for clients with poor attentional stamina. [Keywords: Attentional factors; counseling; drug abuse; node-link mapping; treatment]
 

Dansereau, D. F., Dees, S. M., Greener, J. M., & Simpson, D. D. (1995). Node-link mapping and the evaluation of drug abuse counseling sessions. Psychology of Addictive Behaviors, 9(3), 195-203.

Abstract: Node-link mapping is a visual representation system that can be used in group and individual counseling sessions to illustrate clients' problems, issues, and plans. One hundred sixty-nine methadone treatment clients and their 10 counselors evaluated each of their individual and group sessions during a 2.5-month period by using the Session Evaluation Questionnaire (W. B. Stiles, 1980) and map rating items. A series of multivariate analyses of variance and correlational analyses indicated that the use of mapping¾including the quantity and quality of mapping¾was positively related to higher ratings of session depth by both clients and counselors. In addition, mapped group sessions were rated higher on several evaluative dimensions than were mapped individual sessions.
 

Dansereau, D. F., Joe, G. W., & Simpson, D. D. (1995). Attentional difficulties and the effectiveness of a visual representation strategy for counseling drug-addicted clients. International Journal of the Addictions, 30(4), 371-386.

Abstract: Three hundred thirty-one opioid-addicted clients in methadone treatment were randomly assigned to counselors who used either mapping-enhanced or standard counseling. Those counseled with mapping had lower percentages of during-treatment urine specimens that were positive for either cocaine or opiates, and they were rated by their counselors as having higher rapport, motivation, and self-confidence. Clients were further classified into those exhibiting either good or poor attention during an intake interview. The results suggest that clients with poor attention are more likely to have positive urines, but that this tendency appears to be reduced under mapping-enhanced counseling. [Keywords: Counseling strategies; visual representation; attention difficulties; urinalysis results; node-link mapping]
 

Farabee, D., Simpson, D. D., Dansereau, D., & Knight, K. (1995). Cognitive inductions into treatment among drug users on probation. Journal of Drug Issues, 25(4), 669-682.

Abstract:  The present study evaluated the effectiveness of a cognitive tool designed to enhance drug treatment motivation among a sample of drug users on probation in a residential treatment facility (N = 33). The task involved listing the negative consequences of drug use as well as the positive consequences of abstinence as they relate to seven "divisions of the self" (e.g., social, mental, behavioral, physical, emotional, motivational, and spiritual/philosophical). Although performing this cognitive induction task within the first 10 days of treatment (immediate induction) did not appear to enhance motivational readiness for treatment, a comparison group receiving the induction strategy 1 month after entering treatment (delayed induction) scored significantly higher on motivational indices than did those in the immediate induction group. It is suggested that involuntary treatment recipients require a brief acclimation period before shifting their focus from external pressures (e.g., reacting against authority and newly imposed structure) to internal events (e.g., personal evaluation of the consequences of drug use).

Joe, G. W., Brown, B. S., & Simpson, D. D. (1995). Psychological problems and client engagement in methadone treatment. Journal of Nervous and Mental Disease, 183(11), 704-710.

Abstract:  Client attendance at individual counseling sessions in community-based methadone treatment programs was more frequent among clients with self-reported psychological problems at intake. These problems included anxiety, depression, suicidal ideation, and other symptoms suggesting psychopathology (hallucinations, difficulty controlling violence, etc.). The sample consisted of 462 clients in treatment at least 90 days, divided into two groups of no psychological problems reported at intake (no problems group, N = 341) and two or more problems reported (high problems group, N = 121). The high problems group was twice as likely to attend the treatment program's recommended minimum number of individual counseling sessions (two per month) than was the no problems group, and was more likely to discuss psychological issues in their individual counseling sessions. The high problems group showed significant decreases in drug use and illegal activity in the first 3 months after admission and did not differ significantly from the no problems group on drug-positive urines or illicit activity at month 3. Within the high problems group, clients who attended at least two individual sessions per month reported less cocaine and speedball use during treatment than those who attended fewer sessions.
 

Joe, G. W., & Simpson D. D. (1995). HIV risks, gender, and cocaine use among opiate users. Drug and Alcohol Dependence 37, 23-28.

Abstract: HIV risks involving injection and sex behaviors were analyzed in relation to cocaine use and gender among 487 opiate-dependent clients in methadone treatment. Those who also used cocaine were at greater risk than non-cocaine users on HIV risky injection variables. Females were at more risk than males on the HIV risky sex behaviors involving unprotected sex in exchange for money or drugs and with injection users. There were interactions between cocaine use and gender, however, in relation to frequency of injecting with dirty works and sharing dirty works with strangers, as well as having unprotected sex for money or drugs, with injection users, and while intoxicated. HIV risks increased as a direct function of cocaine usage level among males, but not among females; instead, low-to-intermediate levels of cocaine use by females was associated with high-risk behaviors. Implications for HIV risk reduction interventions in drug treatment programs are discussed. [Keywords: HIV risks; gender; cocaine and opiate use]
 

Knight, D. K., Cross, D. R., Giles-Sims, J., & Simpson, D. D. (1995). Psychosocial functioning among adult drug users: The role of parental absence, support, and conflict. International Journal of the Addictions, 30(10), 1271-1288.

Abstract: The relationship between perceptions of parental absence, support, and conflict during childhood and psychosocial functioning in adulthood was examined for 411 drug user clients in methadone treatment. History of parental support was related to adult psychosocial functioning and parent-child conflict was related to psychosocial functioning only when parental support was low. Findings indicate parental absence is related to the quality of parental support, which in turn predicts psychosocial functioning in adulthood. Implications for treatment intervention are discussed. [Keywords: Heroin addicts; parental absence; parental support; parent-child conflict; psychosocial functioning]

Knight, K., Rowan-Szal, G., Hiller, M. L., Chatham, L. R., & Simpson, D. D. (1995). Hair analysis: A tool to identifying probationers in need of drug treatment. Federal Probation, 59(3), 58-62.

Abstract: Based on the advantages of hair analysis in detecting drug use and drug use severity, particularly within the criminal justice system, this study considered hair analysis as one of several "tools" to identify probationers in need of drug treatment. The sample included 51 cocaine-using probationers admitted to a publicly funded outpatient drug abuse treatment program. Results revealed that when used as a supplement to urinalysis and self-report information, hair analysis can be useful in identifying cocaine-using probationers when making treatment referral decisions. Specifically, hair analysis increased by about two-thirds the number of individuals who qualified for treatment. The study also found that the use of hair analysis was helpful in making a qualitative assessment concerning how much cocaine a probationer had consumed during the 3 months before treatment.

Lehman, W. E. K., Farabee, D. J., Holcom, M. L., & Simpson, D. D. (1995). Prediction of substance use in the workplace: Unique contributions of personal background and work environment variables. Journal of Drug Issues, 25(2), 253-274.

Abstract: Relationships of personal and job factors with employee substance use in a sample of municipal workers were assessed. Logistic regression results showed that personal and job domains each significantly predicted substance use at and away from work, although the best fit was provided by a model including both domains. The profile of the employee most likely to be a substance abuser was a young male with low self-esteem and an arrest history, who came from a family with substance abuse problems, and associated with substance-using peers. The drug-using employee was also likely to be estranged from work and to work under risky job conditions.

Simpson, D. D. (1995). Drug Abuse Reporting Program (DARP). In J. H. Jaffe (Ed.), Encyclopedia of Drugs and Alcohol, Vol. 1 (pp. 393-394). New York: Simon & Schuster.

Summary:  The Drug Abuse Reporting Program began in 1969 as a comprehensive data system that included intake and during-treatment information on individuals entering drug treatment programs funded by the United States government.  Over time, it was the basis for carrying out the first national evaluation study of community-based treatment programs.  It was conducted at Texas Christian University over a period of twenty years and included four distinct phases of research:  (1) describing major treatment modalities and the characteristics of drug abusers entering them in the early 1970s; (2) describing during-treatment performance measures and how they related to differences in treatments and clients; (3) describing posttreatment outcomes and how they related to differences in treatments and clients; and (4) describing important elements of long-term addiction careers.  The DARP data system contained records on almost 44,000 admissions to 52 federally supported treatment agencies from 1969 to 1973.

Simpson, D. D. (1995). Toward the year 2000: Issues in treatment process and services research. International Journal of the Addictions, 30(7), 875-879.

Abstract:  Treatment-assisted recovery from drug dependency and addiction is a complex process involving cognitive readiness for change, restructing of psychological functioning and social support systems, establishing cognitive awareness and acquisition of better problem-solving skills, and making behavioral applications.  But we do not know much about this process and how to improve selective aspects of it.  This is because there has been too little systematic treatment process research in field settings for examining community outreach strategies, personal needs and satisfaction, delivery of services, interactions between patients and counselors, and environmental influences that promote therapeutic engagement and retention.  It is a highly dynamic process which is influenced by program and patient interactions within the treatment environment as well as many other contextual and environmental factors.  Progress in measuring and understanding these areas is essential to making significant advancements in the drug use or treatment field, and these needs have become even more evident in recent efforts to develop treatment policy recommendations as part of health care reform discussions in the United States.

Simpson, D. D., Chatham, L. R., & Brown, B. S. (1995). The role of evaluation research in drug abuse policy. Current Directions in Psychological Science: A Journal of the American Psychological Society, 4(4), 123-126.

Abstract:  Evaluation research has been crucial in establishing credibility of a national network of drug abuse treatment programs and obtaining public funds for their support.  It has led to new avenues of study involving modification and improvement of drug abuse intervention strategies, and—in the case of AIDS outreach initiatives—helped the field move beyond traditional treatment approaches to establish additional behavior change initiatives in the community.  The findings of evaluation studies have been translated into public policy, and thereby into program development, in accord with the visibility given to those findings and their urgency.

Simpson, D. D., Joe, G. W., Rowan-Szal, G. A., & Greener, J. (1995). Client engagement and change during drug abuse treatment. Journal of Substance Abuse, 7(1), 117-134.

Abstract:  Previous work has shown length of time in drug abuse treatment is associated with better outcomes, but the role of therapeutic engagement and process needs further examination. In this study, the total number of counseling sessions attended by 557 clients in their first 90 days of community-based outpatient treatment was examined in relation to indicators of treatment delivery and progress. Significant client improvements were found on behavioral criteria and psychosocial functioning during the first 3 months of treatment, and session attendance was positively related to favorable behavioral changes as well as to positive perceptions by clients and counselors of their therapeutic interactions. Client background, treatment motivation, and therapeutic focus of counseling in Month 1 were significant predictors of session attendance in the first 3 months following admission to methadone treatment.

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