bluuebunny/crossref_metadata_2025 huggingface dataset:
Korsakoff's syndrome on the MMPI-2
Authors: Egger Jos I. M. , Wester Arie J. , De Mey Hubert R. A. , Derksen Jan J. L.
Published: March 2003

Background:

This article describes an exploratory study of MMPI-2 administration to 20 patients with Korsakoff's disease, all admitted to the Korsakoff unit of a major psychiatric hospital in the Netherlands.

Methods:

We compared their MMPI-2 basic profiles with those of an inpatient alcohol-dependent non-Korsakoff group. Attention was also given to content scales and some selected supplementary scales. Furthermore, we explored the differences between MMPI-2 profiles of Korsakoff patients with and without insight into oneself and one's disease.

Results:

Compared with both the Dutch norms and the scale means of the non-Korsakoff alcoholics, Korsakoff patients showed an extraordinary flat profile. Illness insight appeared to be related to the levels of the various scales.

Discussion:

The results show the potential usefulness of the MMPI-2 in the differential diagnosis of chronic alcoholism and Korsakoff's disease.
Risperidone in the treatment of childhood autistic disorder: an open pilot study
Authors: Casaer Paul , Croonenberghs J. A. N. , Lagae Lieven , Deboutte Dirk
Published: March 2003

Objective:

To evaluate the tolerability and efficacy of risperidone in childhood autistic disorder.

Methods:

A multicenter, open-label, dose-titration study involving seven autistic children (mean age 7.6 years) receiving risperidone for 4 weeks.

Results:

Mean dose was 0.01 mg/kg/day on day 1, 0.019 mg/kg/day on day 7 (range 0.01–0.041 mg/kg/day) and 0.035 mg/kg/day on day 28 (range 0.014–0.064 mg/kg/day). Over the 4-week period, the Ritvo–Freeman Real Life Rating Scale total score measuring autistic behavior was significantly decreased (P = 0.019), as was the affectual reactions subscale (P = 0.029). Aberrant Behavior Checklist total score was significantly improved (P < 0.001), as were all subscales except inappropriate speech. Visual Analog Scale for individual target symptoms was significantly decreased (P = 0.001), and Clinical Global Impression severity of illness score was significantly improved (P = 0.006). The incidence of adverse effects was low, and no extrapyramidal symptoms were observed. No significant changes or clinically relevant abnormalities occurred in laboratory tests, vital signs or electrocardiograms. Plasma concentrations of the drug were similar to those in adult patients.

Conclusions:

These favorable results suggest that larger controlled trials of risperidone should be performed in autistic or mentally retarded patients with behavioral disturbances.
Brain cytokines and disease
Authors: Plata-Salaman Carlos R
Published: March 2003

Cytokines (e.g. various interleukins and subfamily members, tumor necrosis factors, interferons, chemokines and growth factors) act in the brain as immunoregulators and neuromodulators. Over a decade ago, the integrative article ‘Immunoregulators in the Nervous System’ (Neurosci Biobehav Rev1991; 15: 185–215) provided a comprehensive framework of pivotal issues on cytokines and the nervous system that recently have been extensively studied. Cytokine profiles in the brain, including cytokine generation and action, have been studied in multiple models associated with neuropathophysiological conditions. These include: (1) acute conditions and disorders such as stroke (cerebral ischemia or infarction and intracranial hemorrhage), traumatic brain injury, spinal cord injury and acute neuropathies; (2) chronic neurodegenerative disorders and chronic conditions, including Alzheimer's disease, Parkinson's disease, neuropathic pain, epilepsy and chronic neuropathies; (3) brain infections, including bacterial meningitis and encephalitis; (4) brain tumors; (5) neuroimmunological disorders per se, such as multiple sclerosis; (5) psychiatric disorders, including schizophrenia and depression; (6) neurological and neuropsychiatric manifestations associated with non- central nervous system (CNS) disorders such as peripheral cancer, liver, kidney and metabolic compromise, and peripheral infectious and inflammatory conditions; and (7) cytokine immunotherapy, which can be accompanied by neuropsychiatric manifestations when administered either via peripheral or brain routes. Cytokine profiles have also been studied in multiple animal models challenged with inflammatory, infectious, chemical, malignant and stressor insults. Essentially data show that cytokines play a pivotal role in multiple neuropathophysiological processes associated with different types of disorders and insults. Cytokine expression and action in the brain shows a different profile across conditions, but some similarities exist. Under a defined temporal sequence, cytokine involvement in neuroprotection or the induction of a deleterious pathophysiological cascade and in resolution/healing is proposed depending on the type of cytokine. In the brain, functional interactions among cytokines, balance between pro-inflammatory and anti-inflammatory cytokines and functional interactions with neurotransmitters and neuropeptides play a pivotal role in the overall cytokine profile, pattern of neuropathophysiological cascades, and quality and magnitude of neuropsychiatric manifestations. In this brief review various selected cytokine-related issues with relevance to the brain are discussed.
Peripheral endotoxin causes long-lasting changes in locus coeruleus activity via IL-1 in the brain
Authors: Borsody Mark K. , Weiss Jay M.
Published: March 2003

Activity of locus coeruleus (LC) neurons, the major noradrenergic cell-body group in the brain whose axons give rise to approximately 70% of norepinephrine (NE) in the brain, is believed to play an important role in attention/vigilance, cognitive functions and behavioral disorders, particularly depression. Results described here show that in the rat, intraperitoneal (i.p.) injection of lipopolysaccharide (LPS, a bacterial endotoxin) causes long-lasting changes in electrophysiological activity of LC neurons that are mediated by interleukin-1 (IL-1) acting locally in the LC region. First, it was found that IL-1, when microinjected into the LC region or stimulated/expressed in that brain region, increased activity of LC neurons. The only exception to this was that a very low dose of microinjected IL-1 (5 pg) decreased LC activity, which could be blocked by an antagonist to corticotropin-releasing hormone (CRH), thus suggesting that the decrease was due to IL-1 stimulation of CRH release. All of these effects could be blocked by injection and/or infusion of IL-1 receptor antagonist (IL-1RA) specifically into the LC region. Next, intraperitoneal (i.p.) injection of a low dose of LPS(10 µg/kg or 100 ng/kg) was also found to increase LC activity. The excitation of LC produced by 10 µg/kg i.p. LPS increased progressively for at least 1 week, with LC neurons firing at more than twice their normal rate at 1 week after the i.p. LPS injection. Alteration of LC activity lasted for 3 weeks after a single i.p. injection of 10 µg/kg LPS. The effects of i.p. LPS on LC activity at any time after i.p. injection could be blocked by a brief microinfusion of IL-1RA into the LC region, thereby indicating that changes in LC activity seen after the i.p. LPS were caused by IL-1 acting in the LC region. Finally, i.p. injection of peptidoglycan, representing gram-positive bacteria, and polyinsinic-polycytidylic acid [poly(I):(C)], representing viral infection, also caused increases in LC activity, and the effects of peptidoglycan [but not those of poly(I):(C)] were blocked by microinfusion of IL-1RA into LC. These findings suggest that bacterial infections can give rise to prolonged changes in brain activity through cytokine action in brain.
The acute transient polymorphic psychosis: a biochemical subtype of the cycloid psychosis
Authors: Pepplinkhuizen L , van der Heijden F M M A , Tuinier S , Verhoeven W M A , Fekkes D
Published: March 2003

Background:

The pathogenesis of atypical psychoses, in particularly those characterized by polymorphic psychopathology, is hypothesized to be related to disturbances in amino acid metabolism.

Objective:

In the present study, the role of the amino acid serine was investigated in patients with acute transient polymorphic psychosis.

Methods:

Patients were loaded with serine and with the amino acids glycine and alanine as controls and subsequently evaluated for the development of psychopathological symptoms. In addition, plasma levels of amino acids were measured.

Results:

In a subgroup of patients suffering from atypical psychoses, this biochemical challenge resulted in the reappearance of psychedelic symptoms in particular. Furthermore, significantly lower plasma concentrations of serine were found.In vitroexperiments revealed a disturbance in the one-carbon metabolism. In another group of patients the loading provoked vegetative symptoms and fatigue.

Conclusions:

Disturbances in amino acid metabolism may be involved in the emergence of certain psychotic disorders.
The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users
Authors: GOSSOP MICHAEL , DARKE SHANE , GRIFFITHS PAUL , HANDO JULIE , POWIS BEVERLY , HALL WAYNE , STRANG JOHN
Published: March 2003

The Severity of Dependence Scale (SDS) was devised to provide a short, easily administered scale which can be used to measure the degree of dependence experienced by users of different types of drugs. The SDS contains five items, all of which are explicitly concerned with psychological components of dependence. These items are specifically concerned with impaired control over drug taking and with preoccupation and anxieties about drug use. The SDS was given to five samples of drug users in London and Sydney. The samples comprised users of heroin and users of cocaine in London, and users of amphetamines and methadone maintenance patients in Sydney. The SDS satisfies a number of criteria which indicate its suitability as a measure of dependence. All SDS items had significantly with a single factor, and the total SDS score was extremely highly correlated with the single factor score. The SDS score is related to behavioural patterns of drug taking that are, in themselves, indicators of dependence, such as dose, frequency of use, duration of use, daily use and degree of contact with other drug users; it also shows criterion validity in that drug users who have sought treatment at specialist and non‐specialist agencies for drug problems have higher SDS scores than non‐treatment samples. The psychometric properties of the scale were good in all five samples, despite being applied to primary users of different classes of drug, using different recruitment procedures in different cities in different countries.
Teenagers and alcohol misuse in the United States: by any definition, it's a big problem
Authors: ELLICKSON PHYLLIS L. , McGUIGAN KIMBERLY A. , ADAMS VIRGIL , BELL ROBERT M. , HAYS RON D.
Published: March 2003

Despite the fact that more adolescents use alcohol than any other drug, studies of teenage alcohol misuse are relatively rare. Those that exist frequently fail To include high school dropouts and often focus on only part of the problem, such as how much or how often the adolescent drinks. This study examines the prevalence and demographic predictors of teenage alcohol misuse in a diverse sample of 4390 high school seniors and dropouts. It focuses on three different dimensions of misuse—high‐risk drinking, alcohol‐related problems and high consumption—and provides prevalence estimates by gender and race/ethnicity that are weighted to represent the original seventh grade cohort of 30 California and Oregon schools. Results show that by grade 12, nearly 70% of these teenagers have exhibited some form of alcohol misuse within the past year. Two‐thirds have engaged in high‐risk drinking and over 50% have experienced one or more alcohol‐related problems. More stringent estimates that require variety or persistence of risky drinking and/or alcohol‐belated problems still capture between 40% and 54% of this population. However, focusing solely on high consumption fails to identify as many as half of these at‐risk misusers. Males and females both exhibit high rates of alcohol misuse, as do most racial ethnic groups. However, African Americans and Asians are less likely to misuse alcohol than whites and Hispanics. The results underscore the need for including different forms of alcohol misuse in prevention programs, for improving our understanding of its etiology, and for providing upper and lower bound estimates of alcohol misuse in future research.
Changing society, changing drinking: solitary drinking as a non‐pathological behaviour
Authors: DEMERS ANDRÉE , BOURGAULT CHANTAL
Published: March 2003

This study describes solitary drinking as it appears in a general population. The data are derived from a telephone survey carried out in April 1993 an a representative sample of 2015 adult drinkers from the Montreal metropolitan area. Thirty‐one percent of the respondents (n = 633) reported drinking without being in the company of other people. First, solitary drinking is described according to drinking contexts and drinking patterns. Secondly, a comparison of solitary drinkers with Those who did not report this behaviour is presented according to socio‐demographic characteristics, social representations of drinking and overall drinking patterns. Finally, a logistic regression analysis is performed to identify the main characteristics of the drinkers associated with solitary drinking. The results show that solitary drinking occurs mainly at home, at the end of the day, to accompany a meal, to mark a transition between work and leisure or to accompany a rest time. The quantity involved in solitary drinking is generally moderate. The results also show that solitary drinking is associated with gender, living alone, employment status, tension‐reduction and harmful representations of drinking. However, the main predictor of solitary drinking is overall drinking frequency, indicating the constituent place of alcohol in solitary drinkers' life‐style.
The optimal size of attributor for use with the University of Manchester Drug Misuse Database
Authors: CRABBE TIM , DONMALL MICHAEL
Published: March 2003

This paper describes the anonymous, attributable code which is applied to different individuals when they are reported to the regional drug misuse databases using the University of Manchester system. It then reports on the effect of removing selected data items included in the attributor on the system's abuity to distinguish between different drug users reported to the database. All of the attributable codes that did net use the full set of data items were found to reduce the system's ability to distinguish between the reporting of new drug users and new episodes of drug use for users previously reported to the database.
Temporal drinking patterns and variation in social consequences
Authors: DAWSON DEBORAH A.
Published: March 2003

Temporal drinking patterns and their associated social consequences are described for a sample of US adults aged IS years and over who drank at least 12 drinks in the preceding year and did not restrict their drinking to special occasions (n= 16 086). The earliest time of day when these current regular drinkers reported usually drinking was between 6 a.m. and II a.m. for 1.2%, between 11 a.m. and 3 p.m. for 7.3%, between 3 p.m. and 6 p.m. for 31.2%, and after 6 p.m. for 60.3%. Less than one‐tenth (7.7%) reported any drinking (not necessarily their earliest drinking) between midnight and 6 a.m. Characteristics associated with above‐average rates of both early (6 a.m.–3 p.m.) and late‐night (midnight–6 a.m.) drinking included male gender, black race, low education and income and heavy quantity of ethanol intake per drinking day. Early drinking was also characteristic of the elderly and daily drinkers. Prior to adjusting for background variables and quantity and frequency of intake, early drinking was associated with a two‐ to nine‐fold increase in the risk of alcohol‐related interpersonal problems, hazardous use, job/school problems and legal problems, and late‐night drinking was associated with a three‐ to eight‐fold increase in their prevalence. After adjusting for these factors in multiple logistic regression models, early drinking was associated with a 54% increase in the odds of interpersonal problems, a 39% increase in the odds of hazardous use and a 52% increase in the odds of legal problems. The association between early drinking and job/school problems fell just short of statistical significance. After adjusting for other factors, late‐night drinking retained a significant association with all of the outcomes except legal problems. The magnitude of its association was greater than that of early drinking but varied substantially (i.e. interacted) with quantity of intake, race, ethnicity and gender.
Fatal heroin ‘overdose’: a review
Authors: DARKE SHANE , ZADOR DEBORAH
Published: March 2003

The current paper examines critically the literature on deaths attributed to heroin overdose, and examines the characteristics and circumstances of such deaths. In particular, the dominance of the widely held belief that heroin‐related fatalities are a consequence of overdose is challenged. Deaths attributed to overdose represented in the literature are typically older, heroin‐dependent males not in drug treatment at the time of death. Fatalities involving only heroin appear to form a minority of overdose occasions, the presence of other drugs (primarily central nervous system depressants such as alcohol and benzodiazepines) being commonly detected at autopsy. Furthermore, deaths attributed to overdose are likely to have morphine levels no higher than those who survive, or heroin users who die from other causes. It is concluded that the term overdose is, in many cases, a misleading term, since it implies the same mechanism of death in all cases, an implication that is neither clinically useful nor consistent with published data. Implications for the prevention of heroin‐related deaths are discussed.
The effectiveness of inpatient and outpatient treatment for alcohol abuse: the need to focus on mediators and moderators of setting effects
Authors: FINNEY JOHN W. , HAHN ANNETTE C. , MOOS RUDOLF H.
Published: March 2003

Previous reviews have concluded that there was no evidence for the superiority of inpatient over outpatient treatment of alcohol abuse, although particular types of patients might be more effectively treated in inpatient settings. In this review, we first consider the conceptual rationales that have been offered to support inpatient and outpatient treatment. Following that, the results of the relevant research on setting effects are presented. Five studies had significant setting effects favoring inpatient treatment, two studies found day hospital to be significantly more effective than inpatient treatment, and seven studies yielded no significant differences on drinking‐related outcome variables. In all but one instance in which a significant effect emerged, patients in the ‘superior’ setting received more intensive treatment and patients were not ‘preselected’ for their willingness to accept random assignment to treatment in either setting. Studies finding significant setting effects also conducted more treatment contrasts (18.6 vs. 4.9), on average, and had a mean statistical power level of 0.71 (median 0.79) to detect a medium‐sized effect, whereas studies with no significant findings had an average power level of 0.55 (median 0.57). When inpatient treatment teas found to be more effective, outpatients did not receive a respite in the form of inpatient detoxification and the studies were slightly less likely to have social stability inclusion criteria and to use random assignment to treatment settings. We consider the implications of our findings for future research, especially the need to examine the conceptual rationales put forward by proponents of inpatient and outpatient treatment, i.e. mediators and moderators of setting effects.
Heroin addiction in Bahrain: 15 years experience
Authors: ABDEL‐MAWGOUD MOHAMED , AL‐HADDAD MOHAMED K.
Published: March 2003

This study describes the development and outcome of a new treatment programme for the management of heroin addiction in Bahrain. The problem reached its peak in the early 1980s with several reported deaths and with the involvement of many disciplines in the overall response. In 1983, treatment of all addicts was restricted by law to the government psychiatric hospital. The newly established specialized drug unit was overwhelmed by the number of patients seeking treatment. The lack of sufficient resources and suitably trained staff forced the unit to adopt an outpatient maintenance therapy approach for most of its clients. In 1987, a new comprehensive treatment programme was introduced that relies on a clear philosophy, safe detoxification (using objective scales for withdrawal manifestations) rather than maintenance therapy, followed by psychological and social rehabilitation. A national committee for drug addiction leas formed and an intensive programme of education was started at ail levels. The results indicate an initial increase at inpatient level but a marked drop of outpatient attendance. The use of the Opioid Objective Withdrawal Manifestations Scale (OOWMS) revealed that only a small number of our patients developed moderate or severe signs of withdrawal that required detoxification, and the rate of dispensed controlled medication was reduced by 99%. The effect of this approach is discussed, with special reference to the need for a collaborative effort from all disciplines in planning, implementing, continuously evaluating and modifying the national programmes for handling the serious problem of addiction.
A comparison of positive and negative alcohol expectancy and value and their multiplicative composite as predictors of post‐treatment abstinence survivorship
Authors: JONES BARRY T. , McMAHON JOHN
Published: March 2003

Within social learning theory, positive alcohol expectancies represent motivation to drink and negative expectancies, motivation to restrain. It is also recognized that a subjective evaluation of expectancies ought to moderate their impact, although the evidence for this in social drinkers is problematic. This paper addresses the speculation that the moderating effect will be more evident in clinical populations. This study shows that (i) both expectancy and value reliably, independently and equally predict clients’abstinence survivorship following discharge from a treatment programme (and that this is almost entirely confined to the negative rather than positive terms). When (ii) expectancy evaluations are processed against expectancy through multiplicative composites (i.e. expectancy X value), their predictive power is only equivalent to either expectancy or value on its own. However (Hi) when the multiplicative composite is assessed following the statistical guidelines advocated by Evans (1991) (i.e. within the same model as its constituents, expectancy and value) the increase in outcome variance explained by its inclusion is negligible and casts doubt upon its use in alcohol research. This does not appear to apply to value, however, and its possible role in treatment is discussed.
The “WAM” score: sensitivity and specificity of a user friendly biological screening test for alcohol problems in trauma patients
Authors: NILSSEN ODD , RIES RICHARD , RIVARA FREDRICK P. , GURNEY JAMES G. , JURKOVICH GREGORY J.
Published: March 2003

Based on a weighted aggregation of three biological alcohol markers (gamma‐glutamyltransferase, blood alcohol and mean corpuscular volume), this study presents a screening instrument for alcohol problems in trauma patients. The sex‐specific performance of this instrument was explored on 1088 male and 352 female patients, 18years or older, admitted with blunt or penetrating trauma during a 30‐month period to a regional level one trauma center in Seattle, Washington (USA). The sum of the differentially weighted alcohol markers (“WAM”), determined from one blood sample, formed a “score continuum” ranging from 0 to 24, The WAM scores distributed themselves across the trauma population with higher WAM scores being correlated to higher screening instrument scores for alcohol problems. By using two of the best established screening tests for alcohol problems (CAGE and SMAST) to define cut‐off points for likely “alcohol abuse/dependence”, the WAM score of ≥ 7 in males showed 75% sensitivity and 83% specificity, whereas the WAM score of ≥ 6 for females displayed 85% sensitivity and 85% specificity. We conclude that a weighted combination of biological alcohol markers (WAM score) is a useful tool for identifying alcohol problems among trauma patients. Representing an alternative or addition to a more extensive interview, it could be used as a routine pan of the care of trauma patients.
WHO working group on population levels of alcohol consumption
Authors: ANDERSON PETER
Published: March 2003

Target 17 of the Health Policy for Europe calls for the health‐damaging consumption of dependence‐producing substances such as alcohol, tobacco and psychoactive substances to be significantly reduced in all Member States between the year 1980 and the year 2000. With regard to alcohol, if is suggested that alcohol consumption be reduced by 25%, with particular attention to reducing harmful use. A question posed by a number of Member Slates is what is the level of per capita alcohol consumption of lowest risk to physical, psychological and social harm. A working group was convened to consider population levels of alcohol consumption with particular reference to the Member States of the European Region of WHO. A basis for understanding population problem experience can be established through the interaction between individual risk and distribution of consumption levels within the population. The working group concluded that public health policy within the European Region should continue to advise decreases of per capita consumption. Even when taking into account coronary heart disease, it can be concluded at the population level, across all ranges of alcohol consumption found in almost all countries of Europe, that a reduction in consumption is linked to better health. However, public health policy concerning alcohol should not be based solely on mortality. All outcomes of drinking, that is mortality, morbidity, social and criminal consequences, as well as quality of life, should be considered. The existing data relating alcohol consumption to health originates from countries primarily with a cultural experience of consuming alcohol. In those countries, where there is a cultural or religious tradition of not consuming alcohol, there can be no public health grounds for recommending alcohol consumption.
Public health consequences of the J‐curve hypothesis of alcohol problems
Authors: SKOG OLE‐JØRGEN
Published: March 2003

This paper addresses some issues related to the hypothesis that the risk for premature death is a J‐shaped function of alcohol intake. The first part of the paper contains a discussion of the individual level epidemiological evidence. It is argued that the evidence is not yet good enough to allow precise statements about ‘safe limits’, nor does it allow a precise location of the ‘optimum’ consumption level. Measurement errors and confounding variables not yet controlled for remain substantial problems. In particular, future studies need to control for social integration, as this factor may affect both health status and alcohol consumption. The second part of the paper discusses the population level relationship. It is argued that, typically, what is optimum for an individual is too much for a population. Unintended side effects of major public health importance should be expected in this area. In the last section, a plea is made for aggregate level studies as a way of addressing the public health side of the issue.
Per capita alcohol consumption and total mortality: an analysis of historical data
Authors: NORSTRÖM THOR
Published: March 2003

Since total mortality is a classical proxy for the overall health status of the population, its degree of association with per capita alcohol consumption is of great interest. Existing evidence, based on historical data from the turn of the century, is mostly in graphical form. These data arc analysed using modern statistical tools. The results suggest a significant alcohol effect; a 1‐l increase in consumption is expected to increase mortality (middle‐aged men) by about 1 %. This effect might seem fairly modest but it is noted that it may well be locally substantial because of its concentration to specific categories of the population. The alcohol effect is also compared with the impact of a factor that is a surrogate for a large number of etiological agents, namely real wages. Although the latter factor seems to be the more important one the difference is not overwhelming. The shift in the cause of the death panorama during this century, with an increasing share of CHD‐mortality, may well have attenuated the aggregate relationship between alcohol and mortality.
Alcohol consumption in high school adolescents: frequency of use and dimensional structure of associated problems
Authors: LEWINSOHN PETER M. , ROHDE PAUL , SEELEY JOHN R.
Published: March 2003

The goal of this paper is in present data regarding the occurrence of alcohol consumption and the relative prevalences and the factorial structure of DSM‐IV symptoms of alcohol abuse/dependence in a sample of 1507 older (14–18 years) community adolescents. Participants were diagnostically assessed at two time points, approximately 1 year apart. Three‐quarters of the sample had tried alcohol. Boys in general had greater usual frequency and quantity of alcohol consumption than girls and began drinking at an earlier age; girls with a diagnosis of alcohol abuse/dependence had a significantly earlier mean age of alcohol disorder onset and were more likely to have a relapse of alcohol disorder. However, gender differences in symptom prevalence were non‐significant. Seventeen per cent of the sample had at least one alcohol abuse/dependence symptom. The most frequent symptoms included reduced activities because of alcohol use, consumed more than intended, and tolerance. Eight of the 11 symptoms made a unique contribution to the prediction of diagnosis in a multiple logistic regression analysis. Components analysis supported the general division of symptoms into the categories of abuse and dependence.
The latent dimensionality of DIS/DSM‐III‐R nicotine dependence: exploratory analyses
Authors: JOHNSON ERIC O. , BRESLAU NAOMI , ANTHONY JAMES C.
Published: March 2003

Decisions on DSM‐IV criteria for alcohol dependence were based in part on latent structure analyses of field survey data on alcohol problems. Analogously, to investigate the latent structure of nicotine dependence in an epidemiological sample, we carried out a dichotomous item factor analysis of DSM‐III‐R symptom data gathered from 394 young adults who reported a history of sustained daily smoking. Smokers and their dependence symptoms were identified by means of the NIMH Diagnostic Interview Schedule version III revised, administered to a random sample of 1007 21–30‐year‐olds who were members of a health maintenance organization in the Detroit area. Comparing different latent structure models using LISCOMP software with bootstrap re‐sampling, followed by multiple logistic regression, vie found that a two‐factor model indicating a ‘general dependence’ and a ‘failed cessation’ dimension best accounted for the observed data. Current smoking status (persistent vs. past smoking) was associated with the two factors independently. Replication and additional research on construct, discriminant and convergent validity are needed.
Determinants of suggestions for alcohol treatment
Authors: Room Robin , Bondy Susan , Ferris Jacqueline
Published: March 2003

Entry to treatment is often precipitated by suggestions or pressure from relatives or friends, but we know little of the circumstances in which suggestions to cut down on drinking include advice to seek professional help. In 1993, 1034 Ontario adults were asked in a random digit dialling telephone survey if they had said something to a friend or relative about their drinking, or suggested they cut down. About 35% had said something within the last year, and 15% had taken the further step of suggesting they seek professional help or helping them get assistance. Respondents were asked a series of questions about the circumstances of the most recent time they had said something to the person. Whether respondents who said something recommended seeking professional help is related to these circumstances, and to the respondent's demographics and relationship to the drinker.
Patterns in the institutional encounters of problem drinkers in a community human services network
Authors: Tam Tammy W. , Schmidt Laura , Weisner Constance
Published: March 2003

It is useful to view the social handling of alcohol problems in US communities from the perspective of a whole network of human service systems that share in the burden of identifying and responding to problem drinkers. This analysis examines the management of alcohol problems in different community service systems by mapping patterns in the institutional encounters of problem drinkers across alcohol treatment, drug treatment, mental health treatment, social welfare and criminal justice systems in a single US community. Findings highlight the prominence of large bureaucratic systems for social welfare and criminal justice as sources of referrals for smaller service systems offering treatment for alcohol problems. However, large proportions of problem‐drinking service recipients in the community remain exclusive clients of the welfare and criminal justice systems, making no contact with therapeutically orientated service settings. Compared with problem drinkers who obtain treatment services, problem drinkers on the case‐loads of criminal justice and welfare agencies tend to be younger, of higher socio‐economic status, are more likely to be male, and tend to drink less heavily and to experience fewer symptoms of alcohol dependence. Given the distinctive characteristics of problem drinkers found exclusively in criminal justice and welfare settings, it may be advisable for communities to introduce early intervention programs in these systems that target services to this particular subgroup of problem drinkers.
Substance abuse treatment for Ontario residents in the United States
Authors: Rush Brian , Tyas Suzanne , Martin Garth
Published: March 2003

In Canada, individuals experiencing problems related to their alcohol and drug use receive treatment and rehabilitative care through services provided primarily through the publicly funded health and social service system. During the past decade, however, an increasing number of Canadians have received treatment for substance abuse at facilities located in the United States, with most of the cost for this treatment borne by the various provincial health insurance plans. This paper provides a comprehensive analysis of the Ontario experience of treatment for substance abuse in the United States. First, the policy and planning context for the use of American treatment programs by Ontario residents and the rationale for recent changes to the reimbursement guidelines for such out‐of‐country treatment is reviewed. Secondly, the major trends in utilization of American programs over the past decade will be described and comparisons drawn to trends in the development of Ontario's own treatment system. This information has been used to help guide the development of treatment services in Ontario. In addition, the data serve as a baseline to measure the impact of various policy and program initiatives recently introduced in Ontario to reduce the utilization of treatment resources based in the United States.
Establishing and using a community inter‐agency client monitoring system to develop addictions treatment programs
Authors: Devillaer Michael
Published: March 2003

The Substance Abuse Monitor is a comprehensive community‐based addictions information system that forms the basis for an innovative approach to community needs assessment. This paper describes: (1) the conditions that created the need and support for the monitoring system; (2) the community development strategy that was employed to secure the commitment of agencies to the project; (3) the specifics of the needs assessment procedures; (4) some of the theoretical, clinical and methodological issues on which the procedures are based; (5) the practical applications of the system; and (6) the limitations of the system. The establishment of the database was based upon the idea that there would be benefits at several levels: the community, the participating agencies, the individual counsellors and the clients. The realization of these benefits requires that the information collected and the results generated must be capable of addressing specific service delivery problems with practical and tangible solutions. It is argued that the project has been successful in generating such solutions, and has considerable potential as an ongoing needs assessment tool.
Combining methods to identify new measures of women's drinking problems Part I: the ethnographic stage
Authors: AMES GENEVIEVE , SCHMIDT CATHERINE , KLEE LINNEA , SALTZ ROBERT
Published: March 2003

In recent years, some researchers in the alcohol survey field have raised concerns about the shortcomings in severity/frequency scales for drinking and drinking problems used for both clinical and household survey purposes, especially with regard to women. This article reports on Part I of a two‐part study that used ethnographic and survey methods to assess indicators of drinking problems among women across various US subcultures. Methodology for the ethnographic component consisted of three steps: analysis of findings in literature on indicators of women's drinking problems, and analysis of indicators addressed in the most commonly used standard instruments for alcohol assessment; semi‐structured interviews with 12 specialists in treatment and/or research who focused on alcohol problems of women; and semi‐structured interviews with 65 women from four ethnic populations who were clients in alcohol treatment centers. Analysis of these data from the ethnographic component produced a taxonomy of indicators of women' s drinking problems and fourteen novel indicators that are not included or are inadequately examined in the most commonly used alcohol assessment instruments. The novel indicators were then incorporated into a questionnaire used for a county‐wide survey of men and women that assessed indicators of drinking problems. Report of findings from the survey are presented in the second paper of this series.
Black identity and drinking in the US: a national study
Authors: HERD DENISE , GRUBE JOEL
Published: March 2003

The relationship between ethnic identity and drinking patterns was explored in 1947 black adults from a nation‐wide study of drinking behavior. Factor analysis revealed that a multi‐dimensional construct which included four factors‐media preferences, socio‐political awareness, endogamy and social networks‐was necessary to operationalize and measure the concept of ethnic identity. Using structural equation modeling, a model was tested which analyzed the impact of ethnic identification on religiosity and drinking norms, which in turn were predictors of drinking and heavier drinking latent variables. The results showed that ethnic identity influenced drinking behavior indirectly through its effects on drinking norms and religiosity as well as directly. Most aspects of ethnic identity decreased drinking levels. Respondents who scored higher on involvement with black social networks and black social and political awareness drank at lower levels than other respondents. These results were attributed to the prevalence of norms for abstinence and high levels of social control regarding drinking in black communities. However, high scores on using black media increased drinking rates. It was suggested that the promotion of alcohol use in black orientated media as well as the social settings attended by those who prefer black media might increase alcohol consumption.
Validity of the SCID in substance abuse patients
Authors: KRANZLER HENRY R. , KADDEN RONALD M. , BABOR THOMAS F. , TENNEN HOWARD , ROUNSAVILLE BRUCE J.
Published: March 2003

Structured or semi‐structured interviews, including the Structured Clinical Interview far DSM‐III‐R (SCID), are used widely to maximize the reliability and validity of psychiatric diagnoses. Although the reliability of such interviews appears adequate, there has been little effort to evaluate their validity. In a sample of 100 substance abuse patients, we evaluated the concurrent, discriminant and predictive validity of SCID substance use diagnoses, as well as co‐morbid disorders that occur commonly among these patients. The validity of current and life‐time substance use diagnoses obtained by a research technician using the SCID was good; it was moderate for antisocial personality disorder and major depression and poor for anxiety disorders. Although accurate diagnosis of substance use disorders in substance abuse patients can be accomplished by a research technician, the diagnosis of co‐morbid psychiatric disorders requires either additional expertise or the use of a diagnostic instrument specially designed for that purpose.
Cannabis use correlates with schizotypy in healthy people
Authors: WILLIAMS J. H. , WELLMAN N. A. , RAWLINS J. N. P.
Published: March 2003

Cannabis use or high scores on self‐report schizotypy questionnaires predict an increased risk of developing clinical psychosis. We tested whether cannabis use correlated with schizotypal and other personality traits in 211 healthy adults. Subjects who had used cannabis showed higher scores on schizotypy, borderline and psychoticism scales than never‐users. Multivariate analysis, covarying lie scale scores, age and educational level indicated that high schizotypal traits best discriminated subjects who had used cannabis from never‐users, whether or not they reported having used other recreational drugs. These results indicate that cannabis use is related to a personality dimension of psychosis‐proneness in healthy people.
Expectancies relate to symptoms of alcohol dependence in young adults
Authors: WILLIAMS R. J. , RICCIARDELLI L. A.
Published: March 2003

A significant relationship between the Alcohol Dependence Scale (ADS, Skinner & Allen, 1982) and positive expectancies for alcohol use (AEQ, Brown et al., 1987) is reported that has implications for educational programmes designed to promote sensible drinking. Expectancies predicted current drinking and dependence scores among a sample of young adults that contained 14.6% of subjects scoring above the cut‐off point on the ADS. AEQ scores were found to predict ADS scores over and above current drinking and the AEQ subscales successfully differentiated between heavy drinking and dependent drinking. Canonical correlations revealed that for males higher scores on Increased social assertiveness, Sexual enhancement and Arousal and power were related to higher symptoms of loss of control over drinking. The picture was more complex for females in that three canonical variates were found. First, personal expectancies elevated across all the subscales of the AEQ were related to Loss of control. Secondly, females with high scores on Global positive changes and Sexual enhancement showed more symptoms of obsessive drinking and finally, females with higher Arousal and power expectancies but lower Sexual enhancement also had higher scores on the Perceptual withdrawal subscale from the ADS.
Combining methods to identify new measures of women's drinking problems. Part II: The survey stage
Authors: SALTZ ROBERT , AMES GENEVIEVE
Published: March 2003

This is the second of a two‐part report on a study aimed at investigating novel indicators of drinking problems among women drinkers. The study was motivated by the suspicion that most measures of drinking problems grew out of studies of ‘male populations with the likelihood that such measures would be less relevant for female drinkers. The first pan of this report describes the background for the study and the steps that were taken to generate a short list of “novel” indicators which were then incorporated into an instrument for a general population survey. Using several measures of alcohol consumption as criteria for evaluating the indicators, this paper reports on which indicators may uncover dimensions of alcohol problems not already subsumed by a standard population screen, the CAGE. In particular, results suggest that indicators of “high capacity for alcohol”, “seeking out a ‘wet’ environment”, and “planning opportunities to drink” are promising for both women and men, with more qualified support for less “frequent illness” (for women) and “excessive behavior” (for men). These results must be viewed within the context of an exploratory study and indicate avenues for further research.
Addictive drugs as reinforcers: multiple partial actions on memory systems
Authors: WHITE NORMAN M.
Published: March 2003

This review applies some new experimental findings and theoretical ideas about how reinforcers act on the neural mechanisms of learning and memory to the problem of how addictive drugs affect behaviour. A basic assumption of this analysis is that all changes in behaviour, including those involved in drug addiction and the initiation of drug self‐administration, require the storage of new information in the nervous system. Animal studies suggest that such information is processed in several (this review deals with three) more or less independent learning and memory systems in the mammalian brain. Reinforcers can interact with these systems in three ways: they activate neural substrates of observable approach or escape responses, they produce unobservable internal states that can be perceived as rewarding or aversive, and they modulate or enhance the information stored in each of the memory systems. It is suggested that each addictive drug maintains its own self‐administration by mimicking some subset of these actions. Evidence supporting the notion of multiple memory systems and data on the actions of several drugs (amphetamine, cocaine, nicotine, alcohol and morphine) on these systems are briefly reviewed. The utility of the concept of “reward” for understanding the effects of drugs on behaviour is discussed. Evidence demonstrating actions of drugs on multiple neural substrates of reinforcement suggests that no single factor is likely to explain either addictive behaviour in general or self‐administration in particular. Some of the findings on the development and maintenance of self‐administration by animals of the five exemplar drugs are discussed in the context of these ideas.