Many patients with chronic opioid dependence are referred to drug-free outpatient treatment following inpatient detoxification even though successful outpatient treatment engagement and abstinence from opioids occur only in a minority of cases. This retrospective cohort analysis of medical records documents the post-discharge outcome in a treatment setting that maximizes the support during transition to abstinence-oriented outpatient care, with comprehensive social, medical and mental health services, including the availability of naltrexone. Participants were male veterans (N = 112) admitted at an urban VA medical center. Most patients (78%) successfully completed acute detoxification, 49% initiated naltrexone, and 76% accepted a VA aftercare plan. At 90-day follow-up, only 22% remained in aftercare, and < 3% had toxicology-verified abstinence from opioids. At one-year follow-up, 1 out of 5 had been readmitted for detoxification and 4.5% had died. Most patients successfully detoxified from opioids, but very few remained engaged and stabilized in abstinence-oriented outpatient treatment.

Research on Schill's Self-Defeating Personality Scale (SDPS; Schill, 1990) has focused primarily on interpersonal relationships and less on self-defeating behavior in other contexts. The SDPS was correlated with the Career Decision Scale (CDS; Osipow, Carney, Winer, Yanico, & Koschier, 1976), My Vocational Situation (MVS; Holland, Daiger, & Power, 1980), and the Career Factors Inventory (CFI; Chartrand, Robbins, Morrill, & Boggs, 1990). Participants with more self-defeating characteristics were more career indecisive, had less vocational identity, and were more indecisive in general. Women with higher scores on the Self-Defeating Personality Scale had significantly greater career choice anxiety and less need for self-knowledge, although men with higher scores did not. The effect of depression contributed substantially to the higher scores for career indecision and vocational identity among men with more self-defeating characteristics, and it accounted entirely for lack of desire for self-knowledge among women with more self-defeating characteristics. However, a general characteristic of indecisiveness in persons with more self-defeating characteristics was present and was independent of depressive affect. The differential effects among the CFI subscales support claims that the scale is factorally pure.

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