bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating Substance Abuse Content into an HIV Risk–Reduction Intervention: A Pilot Study with Middle School–Aged Hispanic Students
Authors: Lazebnik Rina , Grey Scott F. , Ferguson Chad
Published: December 2009

A pilot study of a school–based HIV/AIDS risk reduction program with integrated components on substance abuse was conducted to determine: 1) its effectiveness in Hispanic, middle school–aged children and 2) if differences in effectiveness are found in students who report risky behaviors. Activity–oriented training on decision–making, HIV/AIDS illness, risky behaviors, and abstinence was provided to 125 students. Participants were classified into risk groups, based on reported sexual and alcohol/drug (AOD) activity. Effectiveness was analyzed by comparing the risk group's knowledge, beliefs, and perceived–risk scores pre/post–program in sexual activity, AOD use, disease course, and casual contact categories. This program improved some knowledge, few beliefs, and few perceived risks. The perceived–risk scores of the high–risk group did not reflect their higher risk for HIV/AIDS– School–based programs should measure actual HIV/AIDS risks, including AOD, to identify participants who need focused interventions. Further research is needed to understand how AOD influences risky sexual behaviors, and what content and interventions are useful.
Violence among Comorbid and Noncomorbid Severely Mentally III Adults: A Pilot Study
Authors: Boles Sharon M. , Johnson Patrick B.
Published: December 2009

This pilot study examined the relationship between substance dependence and violence in a sample of severely mentally ill adults. Subjects were 42 psychiatric outpatients enrolled in a clinical case management program in San Francisco, California. Almost 40% of the participants reported perpetrating at least one violent act in the past 12 months. Comorbid participants were over 4% times more likely to commit a violent act in the past 12 months than noncomorbid participants. Substance dependence was also more frequently associated with perpetration of a violent act by female than by male participants and by Caucasian than by African American participants. Comorbid mentally ill participants appear more likely to perpetrate violent acts than those with mental illness alone. The dangers of substance dependence in terms of the perpetration of violence may not be in mental illness or substance dependence alone but in their co–occurrence. Further investigation is needed to assess risk factors for violence and victimization in multiple environmental and situational domains. It will be important to explore the moderating effects of gender and race on the co–occurrence of mental illness, substance dependence, and the perpetration of violent acts.
A Comparison of Clonidine and Buprenorphine in the Outpatient Treatment of Opiate Withdrawal
Authors: Fingerhood Michael I. , Thompson Michele R. , Jasinski Donald R.
Published: December 2009

The opiate withdrawal syndrome, although not life threatening, is a major obstacle in the treatment of opiate dependence. Over a 12 week period, 124 patients (63% female, 66% African American and mean age 32.6 years) underwent 5 day treatment for opiate withdrawal. Patients treated in the first 6 weeks (n = 69) received clonidine based treatment (0.1 mg every 6 h with one dose received on–site each day and the others taken home), while patients treated in the latter 6 weeks (n = 65) received buprenorphine 0.3 mg IM daily. Both groups received supportive medications for diarrhea, cramps, aches, and nausea, had clonidine patches placed on day 4, and were offered naltrexone upon completion. Based on age, gender, and race the two treatment groups were similar. The completion rate was 75.4% for buprenorphine group and 47.5% for the clonidine group, p = .001. In conclusion, buprenorphine was superior to clonidine in enabling opiate dependent patients to successfully complete an outpatient detoxification program.
Development of an Instrument to Assess Problem Behavior in First Grade Students Prenatally Exposed to Cocaine. Part II: Validation
Authors: Covington Chandice , Nordstrom–Klee Beth , Delaney–Black Virginia , Templin Thomas , Ager Joel , Sokol Robert J.
Published: December 2009

In Part I, the initial development of a preliminary tool, the PROBS–14, was reported. The tool was developed and initially tested through a consensus process that tapped the perceptions of early education teachers. Concurrent validity between the PROBS–14 and the Conners’ Teacher Rating Scale (CTRS) was established with factor analysis, yielding a hyperactivity–conduct factor, composed of PROBS items and all but two of the CTRS subscales, and a central processing factor, composed of PROBS items and the remaining CTRS scales. The purpose of Part II was to further establish concurrent validity of the PROBS–14 with known pediatrie behavior measures (TRF, CTRS) and to ascertain if the PROBS–14 better predicts a cocaine behavioral effect. A sample of 468 African American children with known cocaine exposure (n = 200) and control status (n = 268) were evaluated. Factor analyses produced results similar to those reported in Part I, with PROBS items accounting for problem behavior variance beyond that accounted for by the TRF, and more specific than that accounted for by the CTRS. Additionally, children prenatally exposed to cocaine, particularly those exposed late in pregnancy, differed significantly from controls on the PROBS total, central processing scale, and several PROBS items. The PROBS instrument offers a promising brief measure of child problem behaviors with adequate concurrent and predictive validity, and which outperforms the TRF and CTRS in discriminating prenatal cocaine exposure status.
Women's Treatment Utilization and its Relationship to Childhood Sexual Abuse History and Lifetime PTSD
Authors: Simpson Tracy L.
Published: December 2009

A central issue in the substance abuse literature is whether a history of childhood sexual abuse (CSA) is a risk factor for poorer treatment outcomes. Although there is a strong belief that CSA is associated with increased substance abuse treatment utilization and relapse among women clients, most empirical evidence does not support this position. This study addresses this conundrum by exploring several possible explanations among a sample of women in substance abuse treatment. Unexpectedly, the results indicate that women with more severe histories of CSA were likely to have received less lifetime substance abuse treatment, although they were likely to have received more mental health treatment. In addition, the expected interaction between posttraumatic stress disorder (PTSD) status and CSA status and increased rates of both types of treatment was not found. However, participants with both PTSD and CSA concentrated on mental health treatment while those with only PTSD focused on substance abuse treatment.
Risk for Delirium Tremens in Patients with Alcohol Withdrawal Syndrome
Authors: Fiellin David A. , O'Connor Patrick G. , Holmboe Eric S. , Horwitz Ralph I.
Published: December 2009

To determine the characteristics associated with an increased risk for delirium tremens (DT) we performed a case–control study at the detoxification units of two hospitals. Cases met DSM–IV criteria for DT. For each case ( n = 15), 3 controls ( n = 45) were chosen. Eligibility criteria were applied equally to cases and controls. Cases were more likely than controls to report a prior complicated withdrawal (DT or alcohol withdrawal seizure) (53 vs. 27%, OR 3.1, 95% CI 0.94–10.55), have a systolic blood pressure greater than 145 mm Hg on admission (60 vs. 27%, OR 4.1, 95% CI 1.21–14.06), and have comorbidity scores of at least 1 (60 vs. 18%, OR 6.9, 95% CI 1.92–25.08). Zero cases (0%) and 15 (33%) controls had no prior complicated withdrawals and no adverse clinical features (systolic blood pressure >145 or comorbidity score >1). Compared to this group, the odds of being a case and having both prior complicated withdrawal and at least 1 adverse clinical feature was 44.8 (95% CI4.36–460). Elevated blood pressure, prior complicated alcohol withdrawal and medical comorbidity, alone and in combination, are associated with an increased risk of delirium tremens.
Tobacco and Alcohol Use and Medical Symptoms among Cocaine Dependent Patients
Authors: Patkar Ashwin A. , Lundy Allan , Leone Frank T. , Weinstein Stephen P. , Gottheil Edward , Steinberg Michael
Published: December 2009

Despite the widespread use of tobacco and alcohol by illicit drug users, the medical effects of smoking and alcohol use remain understudied among such individuals. We investigated the relationship between smoking and alcohol use, and medical symptoms among 125 cocaine dependent patients. Subjects were assessed for smoking, alcohol use, and medical problems using a standardized self–report instrument (MILCOM). Medical symptoms were compared among nonsmokers, moderate smokers (less than 10 cigarettes per day), and heavy smokers (10 or more cigarettes per day) using partial chi–square statistics. Similar comparisons of medical symptoms were made between alcohol users (more than 2 drinks per day) and nonusers. Contrary to our expectations, there were no significant differences between nonsmokers, moderate smokers, and heavy smokers across most of the 14 major medical systems. However, regardless of the level of cocaine use, nonsmokers reported the fewest symptoms on the general subscale (p < 0.05) while moderate smokers reported the most nose/throat and respiratory symptoms (p < 0.01) among the three groups. As expected, significant relationships were observed between medical symptoms and alcohol use. Alcohol users reported more respiratory (p < 0.05), cardiovascular (p < 0.01), digestive (p < 0.05), head/neck (p < 0.001), eye (p < 0.01), and general (p < 0.05) symptoms than nonusers. While the findings generally support the link between alcohol and medical problems, it seems that the relationship between medical symptoms and smoking among cocaine patients may be more complex than that observed in the general population.
Gambling Behavior in Adolescent Substance Abuse
Authors: Kaminer Yifrah , Burleson Joseph A. , Jadamec Agnes
Published: December 2009

This study assessed the prevalence and correlates of gambling behavior (GB) in adolescent substance abusers (N = 97) consecutively admitted to an outpatient treatment program. Thirty–four percent of the cohort had never gambled; 57% were classified as social/nonpathological gamblers; 8% were labeled as in transition gamblers; and only 1% met criteria for pathological gambling. A significant finding was that males are more likely to gamble and to have a higher severity score than do females. A younger age of GB onset is seen for girls than boys and is correlated with a history of suicide attempts, diagnosis of depression, number of symptoms of oppositional behavior, cluster B personality disorders, and a higher need for psychiatric treatment. None of the gambling youths was ever referred for GB counseling. Increased awareness for and additional studies of adolescent gambling are required.
Article Commentary: Creating Meaning and Value in Substance Abuse Education
Authors: Barnes Henrietta N.
Published: December 2009

Medical faculty committed to teaching about substance abuse face the challenges of teaching about a stigmatized disease. They often work with little support and few colleagues. These clinician educators must find tools to help sustain them in this work. Knowledge of emerging data on effective diagnosis and treatment of substance abuse in the primary care setting and excellent clinical skills in managing patients with substance abuse are key. More important is the ability to find sustenance and inspiration in working with the addicted patients who have been our teachers.
Missed Opportunities for Prevention: Failure to Identify Smoking in the Parents of Adolescent Patients
Authors: Key Janice D. , Marsh Linda D.
Published: December 2009

Smoking is an addiction that often begins in childhood or adolescence. Factors associated with early smoking initiation include parental smoking and socialization about smoking with their children. Previous studies evaluating the history obtained during routine pediatric appointments have not focused on parental smoking history and counseling. In this study, seventy–three (73) adolescents (mean age: 15.2 years; 77% female; 64% African–American) seen for medical care in a primary care clinic and their accompanying parent(s) (mean age: 43.5 years; 91% female) were surveyed about smoking followed by a review of each chart measuring documentation of adolescent and parent smoking history and counseling. Although the majority of adolescents were questioned about smoking (92%), parents were rarely questioned (1%) (p < 0.05). Adolescents were counseled about smoking (7%) and other risk–taking behaviors (44%); however, no parents were counseled about smoking or smoking socialization. Physicians frequently overlook an important factor in the prevention of smoking initiation at a young age, parental smoking history and counseling.
Gender Differences in Treatment–Seeking Brazilian Drug–Dependent Individuals
Authors: Zilberman Monica L. , Hochgraf Patricia B. , Andrade Arthur G.
Published: December 2009

The authors compared 66 women and 66 men entering an outpatient treatment for drug dependence, focussing on demographics, progression of dependence, and other associated clinical features. Most of the subjects were dependent on cocaine (75%). Women, as compared with men, had a higher level of education, were more likely to have migrated from other places to the city of Sao Paulo, to report past suicide attempts, and to have first–degree relatives with alcohol problems. There were no gender differences regarding the total time of drug use, baseline severity of dependence, and rates of concurrent psychiatric comorbidity. Clinicians working with drug–dependent women should note the high rates of suicidal behavior in this population, and should explore, besides psychiatric status, risk factors such as impulsive temperament traits. It should also be noted that higher rates of alcohol problems in women's family background pose challenges for the development of effective preventive and treatment strategies.
Book Review: Adolescents, Alcohol and Substance Abuse: Reaching Teens through Brief Interventions
Authors: McLaughlin Tara L.
Published: December 2009

The book reviewed in this article discusses the use of brief interventions in the treatment of adolescent substance abuse. Topics covered include the developmental context within which adolescent substance use occurs, the use of the harm reduction approach to reduce substance use, current assessment instruments, and the role of cognitive and genetic factors in the etiology of substance abuse. Examples of specific brief interventions with adolescents are described and possible avenues for future transdisciplinary research are explored. This expansive sourcebook will be of value to clinicians and academicians alike.
Sexual Identity and Substance use among Undergraduate Students
Authors: Esteban Sean , Boyd Carol , Hughes Tonda L. , d'Arcy Hannah
Published: December 2009

This study examined the association between sexual identity and use of alcohol and other drugs (AOD) among college undergraduate students. A survey regarding AOD use was administered to a random sample of 3607 undergraduate students. The sample included 65 self–identified lesbian or bisexual (LB) women and 54 self–identified gay or bisexual (GB) men. Multivariate logistic regression indicated that while alcohol use did not differ for LB and heterosexual women, LB women were significantly more likely to experience certain AOD–related consequences, smoke cigarettes, and use marijuana, ecstasy, and other drugs. GB men were significantly less likely than heterosexual men to drink heavily but were more likely to use some drugs. These findings provide evidence that sexual identity is an important predictor of AOD use among undergraduate students. These findings support the need for continued research and intervention efforts that target LGB collegians.
Smoking Cessation, Smoking Reduction, and Delayed Quitting among Smokers Given Nicotine Patches and a Self–Help Pamphlet
Authors: Jolicoeur Denise G. , Richter Kimber P. , Ahluwalia Jasjit S. , Mosier Michael C. , Resnicow Ken
Published: December 2009

Over–the–counter nicotine replacement raises questions regarding its “real world”; efficacy. This was an open–label, prospective study of 223 smokers who received 42 free nicotine patches and a self–help booklet via shopping mall distribution. The overall quit rate 6 months following distribution of the nicotine patches was 22% (50/223), almost the same quit rate found 6 weeks following patch distribution (21%, 47/223). Twelve percent (27/223) were abstinent at both 6 weeks and 6 months. Among the 83 participants who did not quit, cigarettes smoked per day dropped from 28 to 18. A substantial subgroup of quitters (14%) who, although still smoking at 6 weeks, were smoke free at 6 months, and it appears they had purposefully delayed a serious quit attempt. These results support the usefulness of nicotine patches in helping smokers quit, even with only minimal intervention such as a self–help manual.
Medical Specialization, Profession, and Mediating Beliefs that Predict Stated Likelihood of Alcohol Screening and Brief Intervention: Targeting Educational Interventions
Authors: Gassman Ruth A.
Published: December 2009

Practitioner–level educational approaches that promote screening and brief intervention (SBI) seldom consider providers’ profession and medical specialization. Strategies that consider these variables may be better equipped to affect change in beliefs and behavior. The aim of this study was to identify beliefs that predict stated likelihood of practicing SBI by specialty and health profession in order to guide the direction of educational strategies. Physicians and nurse practitioners were studied that specialized in family, internal, obstetric gynecology (ObGyn), and pediatric medicine. The results indicated that independent of amount of previous postgraduate alcohol education and knowledge, self–rated competence mediated between specialty and likelihood of practicing SBI. For instance, low self–rated competence for ObGyn was a barrier that suppressed likelihood of practicing SBI. Other findings were that role legitimacy mediated the association between profession and likelihood of SBI, so that lack of role legitimacy was a barrier for physicians but not for nurse practitioners. We suggest that targeted educational strategies for ObGyn and pediatric clinicians may prove more effective than the prevalent one–size–fits all approaches aimed at general adult populations.
Independent Clinical Correlates of Severe Alcohol Withdrawal
Authors: Kraemer Kevin L. , Mayo–Smith Michael F. , Calkins David R.
Published: December 2009

This retrospective cohort study sought to identify clinical variables that independently correlate with severe alcohol withdrawal and to quantify risk in a clinically useful manner. The records of 284 inpatients admitted to an acute detoxification unit at a Veterans Affairs teaching hospital were reviewed. Clinical data were recorded on standardized forms at the time of admission and abstracted by a physician reviewer. Alcohol withdrawal severity was prospectively measured with the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA–Ar) scale. Seventy–one patients (25% of cohort) had severe withdrawal. We identified six independent correlates of severe withdrawal: use of a morning eye–opener (adjusted odds ratio [OR], 5.6; 95% confidence interval [CI], 1.2–25.9), an initial CIWA–Ar score ≥ 10 (OR, 5.1; 95% CI, 2.4–10.6), a serum aspartate aminotransferase ≥ 80 U/L (OR, 4.2; 95% CI, 2.0–8.8), past benzo–diazepine use (OR, 3.6; 95% CI, 1.3–9.9), self–reported history of “delirium tremens”; (OR, 2.9; 95% CI, 1.3–6.2), and prior participation in two or more alcohol treatment programs (OR, 2.6; 95% CI, 1.3–5.6). Significantly higher risk was observed in subjects with three or more independent correlates. In conclusion, several readily available clinical variables correlate with the occurrence of severe alcohol withdrawal. Ascertainment of these variables early in the course of alcohol withdrawal has the potential to improve triage and treatment decisions.
Condom Use Behaviors in HIV–Infected African American Crack Cocaine Users
Authors: Timpson Sandra C. , Williams Mark L. , Bowen Anne M. , Keel K. Blair
Published: December 2009

The purpose of this study was to investigate sexual risk behaviors and factors associated with consistent condom use of HIV+ African Americans receiving HAART who smoke crack. Participants were African Americans in Houston, Texas and over 18, being treated for HIV, and reported currently using crack. Measures included demographic variables, sexual behaviors, drug use, and nine psychosocial scales and seven escape scales. One hundred thirty seven participated in the study. Condom use was low across all partner types. Regression analyses revealed two demographic variables, and two psychosocial and one escape scale were significantly associated with intention to use condoms. One of the more alarming findings of this study concerns the large number of individuals who know they are HIV positive yet continue to have unprotected sex. The inconsistent condom use by these HIV+ individuals threatens the progress that has been made to stem the epidemic.
A Modified Version of the CAGE as an Indicator of Alcohol Abuse and Its Consequences among Undergraduate Drinkers
Authors: Boyd Carol J. , McCabe Sean Esteban , d'Arcy Hannah
Published: December 2009

In March of 1999, we conducted a cross–sectional, web–based survey using a random sample of 2041 undergraduate students attending a large, public university in the Midwest. The sample was recruited via e–mail and students completed the Web survey from their computer terminals. Toward the goal of establishing the usefulness of the CAGE when screening undergraduates for alcohol misuse, we first examined the proportion of undergraduates with a positive score on a modified version of the CAGE and then determined the correlates of a positive CAGE score (e.g. alcohol consumption, fear of addiction, etc). We found preliminary evidence that the question “Have you been afraid you might be alcoholic” may be the best identifier, when compared to the modified CAGE, of at–risk students.
Physicians’ Attitudes regarding Reporting Alcohol–Impaired Drivers
Authors: Mello Michael J. , Nirenberg Ted D. , Lindquist David , Cullen H. Allethaire , Woolard Robert
Published: December 2009

Our objective was to examine attitudes on reporting alcohol–impaired drivers by physicians of different specialties who are most likely to treat motor vehicle crash (MVC) patients. Specific objectives included examining 1) degree of comfort with reporting to police or Department of Motor Vehicles (DMV), 2) variability in attitudes across specialties surveyed, 3) perceived barriers to reporting, and 4) general attitudes on treating alcoholism. Physicians reported that they felt more comfortable with reporting to a medical review board of DMV than to police in all three of the case examples, which included treating a patient who is a clinically diagnosed alcohol–impaired MVC driver (66% DMV report, 36% police report), MVC driver at legal limit of blood alcohol concentration (63% DMV report, 32% police report), and an MVC driver with a very high blood alcohol concentration (81% DMV report, 53% police report). There was no difference between specialties in comfort with reporting, though emergency medicine physicians were less likely to screen and refer patients for counseling. The primary reasons given for not reporting an alcohol–impaired driver were physician–patient confidentiality and perceived threat of civil action by patients.
Measuring cognitive impairment in substance abusers with psychiatric comorbidity using the screening test for the Luria‐Nebraska neuropsychological battery: Comments regarding positive predictive power and diagnostic prevalence
Authors: Hittner James B. , Carpenter Kenneth M.
Published: December 2009

The present study examined the diagnostic accuracy of the Screening Test for the Luria‐Nebraska Neuropsychological Battery (ST‐LNNB). Specifically, the ability of the ST‐LNNB to detect cognitive impairment versus nonimpairment among psychiatrically involved substance abusers was assessed. In light of the fact that cognitive impairment is relatively common within this population and given the paucity of research on the ST‐LNNB, such data would be instrumental in clarifying the conditions under which the ST‐LNNB validly assesses cognitive impairment. Subjects consisted of 183 male and 89 female substance abusing inpatients with psychiatric comorbidity residing in a private psychiatric hospital. Level of cognitive functioning was assessed by the Shipley Institute of Living Scale (SILS), with Abstraction Quotients less than or equal to 90 denoting cognitive impairment. Results indicated that under conditions of low to moderate diagnostic prevalence (less than about .45), the ST‐LNNB evidenced low positive predictive power (PPP) when the recommended cutoff score of 8 was utilized. In order for the ST‐LNNB to demonstrate acceptable levels of PPP (i.e., .85 and .90), prevalences of impairment of .467 and .636 were necessary. Our data also suggested that the maximum PPP value for the ST‐LNNB may be limited. These results should be of interest to mental health professionals who currently use the ST‐LNNB and to clinicians who are considering incorporating brief cognitive screening instruments, such as the ST‐LNNB, into their assessment batteries.
Effects of gender on documentation of alcohol use in patients with psychiatric symptoms
Authors: Monroe Alicia D. , Levy Sheldon , McQuade William
Published: December 2009

Depression, anxiety, and insomnia are common symptoms evaluated in primary care practice that may be associated with substance use disorders or high‐risk substance use. Our objective was to examine the frequency of documentation of alcohol use as a component of the assessment of patients diagnosed with depression, anxiety, or insomnia and to examine the effect of patient gender on the rates of documentation of alcohol use. Records of 257 patients were reviewed; patients’ average age was 43; 79.8% were female; and 54% were smokers. Thirty‐six percent of patients had current alcohol use documented as a component of the assessment; women were half as likely as men to have their use documented. In a multivariate analysis, patient age (OR, 2.1; CI 1.2 to 3.5) and a history of substance abuse (OR, 2.5; CI, 1.4 to 4.9), not patient or physician gender, were associated with increased likelihood of documentation of alcohol use during the assessment of psychiatric symptoms.
Effectiveness of Brief Interventions in Reducing Substance use among At‐Risk Primary Care Patients in three Community‐Based Clinics
Authors: Oliansky Denise M. , Wildenhaus Kevin J. , Manlove Kris , Arnold Tommye , Schoener Eugene P.
Published: December 2009

This project identified patients “at risk”; for substance abuse and provided brief interventions (BI) to encourage behavior change. Substance use patterns of patients were determined using the Substance Use Screening Instrument (SUSI). The SUSI was administered to male and female adults, adolescents, and female adults at three community‐based clinics, respectively. “At‐risk”; patients were randomly assigned to intervention or control groups, and a BI was administered to the intervention groups. At each site, the SUSI was readministered to both groups at 1 and 3 months to determine the effectiveness of the BI reducing substance use across time. At two sites, the intervention groups, but not the controls, demonstrated significant reductions in substance use from baseline to 1‐month follow‐up. While there was no additional significant decrease from 1 to 3 months, it was encouraging that the decreased use seen at 1 month was maintained over time without a return to baseline use patterns. The results indicate that brief interventions have a positive impact on substance use behavior. Implications for these results and future directions are discussed.
High‐ and Low‐Dose Mazindol for Cocaine Dependence in Methadone‐Maintained Patients: A Preliminary Evaluation
Authors: Margolin Arthur , Avants S. Kelly , Malison Robert T. , Kosten Thomas R.
Published: December 2009

We conducted a preliminary investigation comparing high‐dose mazindol (8 mg/day), low dose mazindol (1 mg/day), and placebo for cocaine abstinence initiation in a 12‐week, double‐blind, randomized clinical trial enrolling 17 cocaine‐dependent, methadone‐maintained patients. Outcome data did not support a difference between the two dose levels on percentage positive urine screens positive for cocaine (1 mg mazindol=68%, 8 mg mazindol=75%, placebo=91%). Doses of mazindol greater than 8 mg may be needed for a cocaine blocking effect, although potential pressor effects may be a limiting factor.
Substance Abuse in Hawaii: Perspectives of Key Local Human Service Organizations
Authors: Waitzfelder Beth E. , Engel Charles C. , Gilbert Fred I.
Published: December 2009

Available evidence suggests that substance abuse in Hawaii is a substantial problem. The three major objectives of this study were to determine qualitatively Hawaii's human service organizations’ perspective regarding (1) the magnitude of the statewide substance abuse problem, (2) the unmet needs of the state's substance abuse treatment system, and (3) the features of the problem unique to Hawaii's many ethnic and other subgroups. The study targeted those human service organizations most burdened by the substance abuse problem. Respondents from 55 human service organizations were interviewed using a series of 21 open‐ended questions. Respondents perceived the magnitude of the Hawaii substance abuse problem to be at least comparable to that of the mainland United States. Although most respondents viewed the problem using a medical model, the problem was generally thought to be exacerbated by a community context in which substance abuse is accepted, excused, or denied. Increasing use of crystal methamphetamine and heroin were cited as the most worrisome trends. Systems issues identified were unstable funding, insufficient detoxification services, and limited availability of residential treatment and supportive services following treatment, such as housing and aftercare. Service delivery problems frequently associated with rural areas were identified, such as transportation, staff development, outreach, and difficulty providing a full range of services, particularly on neighbor islands. Cultural alienation, exacerbated by the state's prevailing multiculturalism, was thought to contribute to the substance abuse problem among all ethnic groups, but especially among Native Hawaiians. Cultural factors were thought to have a major impact on seeking care and subsequent acceptance of such care. Further study is needed to understand better the content of care, therapeutic elements, and efficacy of culturally specific treatment and prevention programs. To initiate change, concerted efforts are needed to inform Hawaii residents about the statewide substance abuse problem and local treatment system needs. Future studies should compare human service organization perceptions to those of individuals abusing substances and using these services.
Aftercare Compliance: Perceptions of People with Dual Diagnoses
Authors: Pollack Linda E. , Stuebben Gerald , Kouzekanani Kamiar , Krajewski Kenneth
Published: December 2009

This descriptive study was designed to leant, from the perspective of dually diagnosed inpatients, what factors affect their maintenance of an aftercare program. Ten audio‐recorded focus groups were conducted using a structured interview schedule‐additionally, patients participated in structured brief individual interviews, and their medical records were reviewed for demographic data and chief complaints on admission. Despite the numerous obstacles encountered by this population intrapersonalfy, interpersonalfy, environmentally, and socially, participants were able to provide (a) specific information to increase the understanding of compliance from their perspective and (b) recommendations for health care professionals to facilitate adherence to aftercare treatment plans.
Perinatal Substance Abuse Education: A Review of Existing Curricula
Authors: Redding Barbara A. , Selleck Cynthia S.
Published: December 2009

The magnitude of the substance abuse problem in this country requires that health care professionals be appropriately and adequately trained to recognize and care for substance abusing patients, yet didactic and clinical curricular content on the topic remains limited for most of them. Efforts have been made over the past 25 years to develop faculty who have expertise in alcohol, tobacco, and other drug abuse and who can provide leadership in curricular development. Through these efforts, pockets of faculty expertise developed in nursing, medicine, social work, and psychology programs around the country. In addition, a number of printed substance abuse curricula were developed. The purpose of this article is to address issues regarding the substance abuse information needed by health professionals and to review the available educationial curricula, especially as they relate to perinatal substance abuse. Discussion of methods to update information as substance abuse knowledge expands is also included.
A Pilot Project: Continuing Education for Pharmacists on Substance Abuse Prevention
Authors: Graham Antonnette , Pfeifer Judie , Trumble Jeanne , Nelson E. Don
Published: December 2009

The American Association of Colleges of Pharmacy advocates that pharmacists can have a significant impact on substance abuse prevention provided they receive adequate training. Continuing education programs are needed to enable practicing pharmacists to augment their limited education. This paper examines the process the Society of Teachers of Family Medicine (STFM) used to develop a pilot continuing education program for pharmacists. With limited literature and a small number of pharmacy teaching about substance abuse, input on topics and training methods was obtained from a convenience sample of practicing pharmacists to enhance the information from the pharmacist faculty regarded as content experts. Results of this pilot study revealed lack of agreement between faculty and practicing pharmacists regarding the prioritizing of content and educational methods. Consequently, input must be obtained from targeted audiences instead of relying solely on the advice of identified academic content experts when designing continuing educational programs. Other professions should consider this process when designing continuing education programs. Pharmacists are poised to play an important role in the prevention of substance abuse problems, but they need continuing education about substance abuse.
The Effects of Salty and Nonsalty Food on Peak Breath Alcohol Concentration and Divided Attention Task Performance in Women
Authors: Talbot Robin , La Grange Linda
Published: December 2009

There is recent evidence that gender‐based patterns of alcohol consumption are becoming less dissimilar and that, per capita, women are consuming more alcohol than ever before. Therefore, a better understanding of the acute effects of moderate alcohol consumption in women is essential to establishing reliable health and safety educational information. To address one component of health and safety information, we sought to determine if peak breath alcohol concentrations (BAC) could be manipulated by varying the amount of sodium our women participants ingested in a test meal. We also measured the association between BAC and the participant's performance on a divided attention (DA) task. The 12 participants were trained to use a computer‐generated DA task and subsequently participated in all of four experimental conditions. During each experimental session the participant consumed a placebo drink or a drink containing 0.6 g/kg ethanol and a 220‐kcal portion of salted or unsalted pretzels. She then performed four 15‐min trials of the DA task, after which the BAC Was measured and recorded. Reaction times and mean tracking error were recorded for each DA trial. Experimental sessions took place at the same time on days 7, 8, 9, and 10 of the participant's menstrual cycle. The BAC was significantly higher in the ethanol plus sodium condition than in the ethanol with no sodium condition. Reaction times and tracking tasks were impaired in all ethanol conditions. Scores on the DA tasks obtained from the high‐sodium group did not differ significantly from those of the low‐sodium group. When health care personnel provide drug education for women clients, the possible BAC‐elevating effects of consuming high‐sodium foods while drinking alcoholic beverages should be discussed.
Changes over One Semester in Drinking Game Playing and Alcohol use and Problems in a College Student Sample
Authors: Adams Celeste E. , Nagoshi Craig T.
Published: December 2009

One‐hundred ninety‐five alcohol‐using college students completed a questionnaire in early September, at the beginning of the fall semester, then completed a follow‐up questionnaire in mid‐November, near the end of the semester. The questionnaires included items on levels of alcohol use, the Eysenck I.7 measure of impulsiveness and venturesomeness, alcohol expectancies, perceived norms for alcohol use, reasons for drinking, and aspects of drinking game playing. As predicted, those students who were 18 years of age and younger, nearly all of them 1st‐year students, significantly increased their levels of alcohol use during their first semester in college. While increases in reasons for drinking were significantly predictive of increased alcohol use and problems in first‐year and older students, increases in expectancies of alcohol effects and in frequencies of drinking game playing were significantly predictive of increases in alcohol use and problems only for first‐year students. The present results provide further evidence of the importance of drinking games in the socialization of college students into problematic alcohol use.
Current Status of Professional Training in the Addictions
Authors: Keller Daniel S. , Dermatis Helen
Published: December 2009

Addictions training curricula within traditional graduate and postgraduate programs of professional disciplines lag behind those devoted to other disorders. After presenting a brief historical overview of addictions training in the United States, this paper focuses on current addictions training practices for each of the major health care professions, highlighting both recent advancements as well as shortcomings, particularly with respect to the ability to disseminate recent empirically tested addiction treatments. New psychosocial and pharmacotherapies for addictive disorders are then discussed which would be better disseminated within training programs with enhanced addictions training components. The paper concludes with a discussion of and recommendations for enhancing substance abuse training and knowledge dissemination.
A Comparison of Medical Symptoms Reported by Cocaine‐, Opiate‐, and Alcohol‐Dependent Patients
Authors: Patkar Ashwin A. , Sterling Robert C. , Gottheil Edward , Weinstein Stephen P.
Published: December 2009

Substance abuse is frequently associated with adverse medical consequences. The differences in medical symptoms reported by 101 alcohol‐, 113 cocaine‐, and 107 opiate‐dependent individuals receiving outpatient treatment were studied using a 134‐item questionnaire (MILCOM). Data analysis revealed interesting and unexpected findings, with cocaine patients reporting the fewest total symptoms among the three groups. Moreover, cocaine patients reported significantly fewer CNS and musculo‐skeletal symptoms compared to both alcohol and opiate patients and significantly fewer GI and urinary symptoms than the alcohol but not the opiate patients. In addition, there were sex‐ and race‐related differences in the pattern of symptoms reported. Women reported significantly more CVS, mood, nose/throat, CNS, skin, and GI symptoms than men. Similarly, Caucasians reported significantly more mood, CNS, nose/throat, head/neck, musculoskeletal, and GI symptoms than African‐Americans. The study highlights the influence of drug of choice, gender, and race on medical needs of substance‐abusing persons.
Alcide De Gasperi: the apprenticeship of a political leader
Authors: Bigaran Mariapia
Published: December 2009

This article deals with Alcide De Gasperi's political development, from his militancy in the Trentino Catholic movement under the Austro-Hungarian Empire until the advent of the Fascist regime. The analysis of his political writings and speeches (1909–1926) allows us to identify some fundamental issues in the development of someone whom we can call a ‘professional politician’. He was a municipal councillor and Member of Parliament in the Austro-Hungarian Empire; after the annexation of Trentino to Italy he was elected to the national Parliament (1921), appointed President of the parliamentary group and then Secretary (leader) of the Italian Popular Party. There he dealt with issues relating to local government, the battle for the autonomy of the new provinces inside the Italian State, the analysis of international relations in the context of the post-First World War period, and relations between the parties during the crisis of the liberal State. The wealth of his journalistic output and his political activity offer a valuable standpoint for reflecting on the continuity and the disruptions of a historical period of which he was a protagonist, an interpreter and a witness.
Alcide De Gasperi and the problem of reconstruction
Authors: Capperucci Vera
Published: December 2009

Starting with a quick overview of the historiography of Italy from Fascism to the Republic, this article looks at Alcide De Gasperi's establishment as a leader within both the Italian political system and within his Party–the Christian Democrats–casting new light on three aspects of his political activity: (1) his relationship with the Church and the Catholics’ new modes of participation in political life; (2) the reasons inspiring the definition of the Republican State's institutional architecture; and (3) alliance strategy in government formation and in relationships with the other parties. The originality of De Gasperi's political activity can be defined in terms of these issues, together with the development of a distinctive political leadership, for too long overlooked, that would play a critical role in carrying Italy through its postwar reconstruction.
For Italy in a changing world: the political apogee of Alcide De Gasperi, 1948–1954
Authors: Taverni Barbara
Published: December 2009

Following the political stabilisation achieved with the victory at the election in 1948 of the Christian Democrat Party, De Gasperi's leadership had to deal with new domestic and international dynamics. The government dialogue with the ‘laical’ parties did not end with the reconstruction of the identity of a nation divided by the Fascist phenomenon, nor did it solidify along the lines of an ideologically driven anti-Communist design. De Gasperi's leadership was interwoven with profound changes in the role of the Church, the economic system and political organisation, founded upon new party and government systems. The national and European dimensions influenced one another in this conjuncture, resulting in a new set of equilibria: in the stability of the executive, within the limits set by the primacy of the parliamentary institutions and the organisational role of the party as a focus for political support; in economics, with a revision of classical economic liberalism; and in a unique synthesis of the secular tradition with social Catholicism, with a new interpretation of the 1948 Constitutional model.
Pupillometry reveals processing load during spoken language comprehension
Authors: Engelhardt Paul E. , Ferreira Fernanda , Patsenko Elena G.
Published: December 2009

This study investigated processing effort by measuring peoples’ pupil diameter as they listened to sentences containing a temporary syntactic ambiguity. In the first experiment, we manipulated prosody. The results showed that when prosodic structure conflicted with syntactic structure, pupil diameter reliably increased. In the second experiment, we manipulated both prosody and visual context. The results showed that when visual context was consistent with the correct interpretation, prosody had very little effect on processing effort. However, when visual context was inconsistent with the correct interpretation, prosody had a large effect on processing effort. The interaction between visual context and prosody shows that visual context has an effect on online processing and that it can modulate the influence of linguistic sources of information, such as prosody. Pupillometry is a sensitive measure of processing effort during spoken language comprehension.
Decay rates of strong planar rarefaction waves to scalar conservation laws with degenerate viscosity in several space dimensions
Authors: Chen Jing , Zhu Changjiang
Published: December 2009

This paper is concerned with the decay rates of the solution to the strong planar rarefaction waves for scalar conservation laws with degenerate viscosity in several space dimensions. The analysis is based on the

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2

L^2

-energy method and the decay property of rarefaction waves.
Existence and non-existence results for a logistic-type equation on manifolds
Authors: Pigola Stefano , Rigoli Marco , Setti Alberto
Published: December 2009

We study the steady state solutions of a generalized logistic-type equation on a complete Riemannian manifold. We provide sufficient conditions for existence, respectively non-existence of positive solutions, which depend on the relative size of the coefficients and their mutual interaction with the geometry of the manifold, which is mostly taken into account by means of conditions on the volume growth of geodesic balls.
Double Vogan diagrams and semisimple symmetric spaces
Authors: Chuah Meng-Kiat , Huang Jing-Song
Published: December 2009

A Vogan diagram is a set of involution and painting on a Dynkin diagram. It selects a real form, or equivalently an involution, from a complex simple Lie algebra. We introduce the double Vogan diagram, which is two sets of Vogan diagrams superimposed on an affine Dynkin diagram. They correspond to pairs of commuting involutions on complex simple Lie algebras, and therefore provide an independent classification of the simple locally symmetric pairs.
A reduction method for noncommutative 𝐿_{𝑝}-spaces and applications
Authors: Haagerup Uffe , Junge Marius , Xu Quanhua
Published: December 2009

We consider the reduction of problems on general noncommutative

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p

L_p

-spaces to the corresponding ones on those associated with finite von Neumann algebras. The main tool is an unpublished result of the first-named author which approximates any noncommutative

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p

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-space by tracial ones. We show that under some natural conditions a map between two von Neumann algebras extends to their crossed products by a locally compact abelian group or to their noncommutative

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p

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-spaces. We present applications of these results to the theory of noncommutative martingale inequalities by reducing most recent general noncommutative martingale/ergodic inequalities to those in the tracial case.