Final presentation for the Scaife Advanced Student Medical Seminar by Sonya Dave

1. Who makes it? Comparison
of those who do and those
who do not recover
Sonya Dave, PhD
Scaife Family Foundation Fellow
IRETA

2. Outline
1. Importance of question
2. Addicted population demographics
3. Recoverers vs. Relapsers:
a. Demographics
b. Treatments used
c. Attitudes
d. Cognitive predictors
4. Summary

3. Importance of understanding
features of those who relapse
Assist in allocating funds:
– Some programs focus on a demographic
– Give money to what works
– Change what does not work
Adjust therapy:
– Certain aspects of therapy work
– Instilling certain attitudes can be beneficial
– Extra emphasis for those predicted to relapse

4. Majority of illicit drug users are white
males 18-39 years; half finished 12th
White (Non- 10 – 11
Hispanic) Years
1-9 Years
Other
Hispanic
12 Years College/Graduate
Black
School
18-29 Years
Female
Less then 18 years
30-39 Years
Male 40 + Years

5. Population least likely to
abstain post treatment
Treatment is least effective for reducing drug use in:
– Men
– Younger population
– Crack users
– Less educated population
– Population not residing with spouse
– Repeat relapsers
Focus on improving abstinence for these groups.

6. Population least likely to improve
employment post treatment
Treatment associated with decreased employment in:
– Underrepresented minorities
– Elder
– Less educated
Focus on employment opportunities for these groups
Why decrease?
– Treatment starts upon employment problems
– Stigma in employment

7. Treatment that works has long
time periods and quality relation
Treatments associated with relapse prevention:
– Longer time period
– Motivated patients stay in treatment
– Quality therapist-client relations needed
– Presence of case manager
– Factors can compensate
Treatment pays off:
– DATOS study: costs of treatment vs. change in cost
of criminalization
– 3X cost to criminalize vs. treat

8. Attitudes associated with abstinence
Alcoholics belief that:
– I have a problem with alcohol
– Alcohol does not lead to positive effects
– I am confident of my ability to reduce my drinking
– I cannot control my urge to drink
Fostering these ideas in therapy client may aid
with recovery
Cannot “control urge to drink”
– AA Philosophy?
– Contradictory to “confident of reducing drinking”?

9. Cognitive predictors of abstinence:
DRCS and Gambling Test
Drug Related Cognitions Scale:
– Measures the attitudes described previously, e.g.
– Acceptance of problem and negative effects
– Confidence in ability to reduce drinking
– Lack of control of urge to drink
Iowa Gambling Test:
– Think: who wants to be a millionaire?
– Cognitive card-game test
– Shows people who abstain can put off immediate rewards for
chance of larger rewards
Use of these tests:
– Test patients before therapy start
– Use to personalize therapy
– Do NOT condemn patient to destiny

10. Summary
1. Relapse most common for young males
2. Employment outcomes are poor for hispanic, black,
less educated
3. Attitudes associated with abstinence: No denial,
confidence in quitting, lack of control, recognition of
negative effects
4. Good outcomes need: Quality relation, Long stays,
Case Manger
5. DRCS and Iowa Gambling test are predictors of
outcome and can be useful in personalizing therapy

11. Acknowledgements
IRETA & Scaife Family Foundation for
providing an useful, enjoyable and
educational internship
All speakers and sites for their time and
providing excellent talks and visits
My group of 8 other Scaife fellows