Can a 12-step program work in methadone maintenance treatment?

Three consecutive, professionally led (as opposed to self-help) groups following the 12-step program (TSP) were integrated into a methadone maintenance treatment (MMT) program that included 32 heroin-addicted individuals in recovery. This report describes our experience in meeting the challenges that arose and our conclusions regarding the therapeutic potential of this integration. A professional therapeutic staff guided the groups. In-depth interviews of 10 participants and the reflections of the group leaders provided data for learning about the groups' experience. Initially the participants rejected the concepts of Step 1, powerlessness and unmanageability of life. The assimilation of Step 4 (defining character defect) also aroused some resistance. The participants eventually adopted the pragmatic aspects of TSP, including its terminology. The establishment of a common language of recovery helped to create group coherence and a sense of belonging, and helped to meet the needs of those who felt stigmatized by both the nonaddicted and addicted population undergoing nonmethadone recovery. TSP could be adapted to various aspects of daily life, produced a sense of self-efficacy, and stimulated motivation for change. Therapeutic implications are discussed.     

Super-national treatment: A misconception or a creation with Chinese characteristics?

The term “super-national treatment” is used as a popular legal term in China. However, its definition and relationship with national treatment obligations have been highly debated. After tracking its history, comparing with the general meaning of national treatment in the context of international law, especially of the law of WTO (World Trade Organization), it shows that super-national treatment is a misconception of national treatment. With the gradual repeal of the preferential treatment of foreign-funded enterprises in China, super-national treatment, as a misleading legal term, should come to the end.     

For whom does prison-based drug treatment work? Results from a randomized experiment

Objectives

Prison-based therapeutic community (TC) drug treatment followed by community aftercare is widely recognized as the most effective treatment paradigm for drug-dependent offenders. However, few randomized experiments have addressed this question and fewer studies have examined how interactions between treatment modality and individual characteristics may explain variations in outcomes.

Methods

Using a randomized experimental design, this study examined the effects of treatment modality [TC vs. Outpatient (OP) group counseling], individual psychosocial characteristics (e.g., risk, negative affect), and interactions on reincarceration over a 3-year follow-up period. Survival analysis using Cox regression with covariates was used to analyze data obtained from 604 subjects at a specialized drug treatment prison.

Results

The expected advantage of TC failed to emerge. Critical and heretofore unexamined interactions between treatment modality (TC vs. OP), inmate levels of risk, and negative effect help explain these unexpected findings.

Conclusion

The superiority of prison TC to less intensive OP counseling was not supported. The effects of TC appear to be conditioned by critical responsivity factors that have received little empirical attention.     

Diffusion of treatment interventions: exploration of ‘secondary’ treatment diffusion

Abstract

The present report presents outcome results from a randomized controlled effect study on extended Aggression Replacement Training (ART). In a pre–post design, a 30-hour ART intervention was found to significantly reduce behavioral problems and increase social skills. The control group did not demonstrate comparable changes, but still indicated improvement. Such control-group improvement may be caused by improper treatment and control group implementation (diffusion of treatment) and/or ‘secondary’ diffusion caused by participants in the treatment group affecting control group subjects by demonstrating changed behavior. Both mechanisms were explored, and it is concluded that the improvement observed in the control group was due to such ‘secondary diffusion’. Implications of these findings are discussed.     

Why do sexual offenders refuse treatment?

Abstract

Theories of offender motivation for treatment have proposed that external factors may be as important as internal factors in creating a state of readiness for treatment. This paper reports an exploratory study of the barriers to treatment for incarcerated sexual offenders. Qualitative and quantitative analysis of interview and questionnaire data from treatment refusers and accepters suggested that refusers were less aware of the effectiveness of treatment, reported seeing negative side effects of treatment in others and felt they had a higher social status in prison which could be damaged by attending treatment. While this study does not demonstrate a causal link between these experiences and the decision to refuse treatment, it seems reasonable to suggest that take-up of treatment could be increased by more sustained efforts to build relationships with treatment refusers and by the provision of accessible information about treatment and its potential benefits.     

Inconceivable? Deducting the costs of fertility treatment

This Article considers whether infertile taxpayers can deduct their fertility treatment costs as medical expenses under Internal Revenue Code section 213 and whether they should be able to deduct them. Internal Revenue Code section 213 defines medical expenses as "amounts paid-for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." This definition is interpreted by reference to a baseline of normal biological functioning, which includes reproductive functioning. Most people conceive and bear children without having to incur expenses for fertility treatment. Expenses incurred to approximate the baseline of normal reproductive health are deductible, even if the taxpayer winds up better off, with a child, after the fertility treatment. The medical profession recognizes that infertility is a disease or condition. Infertility is a loss, just as a broken leg is a loss. Fertility treatment costs are thus medical expenses under section 213. In addition, given the existence of the medical expense deduction, taxpayers should be able to deduct the cost of fertility treatments, including IVF, egg donor, and surrogate procedures, under either an "ability-to-pay" or consequentialist normative approach. Reproduction is extremely important to most people. In addition, allowing taxpayers to deduct the costs of fertility treatment will encourage infertile taxpayers to elect the most effective treatment option and reduce the rate of risky multifetal pregnancies. This Article concludes that fertility treatment costs are deductible as medical expenses under current law and should be deductible as medical expenses.