Showing papers in "American Journal of Drug and Alcohol Abuse in 1987"

Two New Rating Scales for Opiate Withdrawal

Abstract: Two new rating scales for measuring the signs and symptoms of opiate withdrawal are presented. The Subjective Opiate Withdrawal Scale (SOWS) contains 16 symptoms whose intensity the patient rates on a scale of 0 (not at all) to 4 (extremely). The Objective Opiate Withdrawal Scale (OOWS) contains 13 physically observable signs, rated present or absent, based on a timed period of observation of the patient by a rater. Opiate abusers admitted to a detoxification ward had significantly higher scores on the SOWS and OOWS before receiving methadone as compared to after receiving methadone for 2 days. Opiate abusers seeking treatment were challenged either with placebo or with 0.4 mg naloxone. Postchallenge SOWS and OOWS scores were significantly higher than prechallenge scores in the naloxone but not the placebo group. We have demonstrated good interrater reliability for the OOWS and good intrasubject reliability over time for both scales in controls and in patients on a methadone maintenance program. These scales are demonstrated to be valid and reliable indicators of the severity of the opiate withdrawal syndrome over a wide range of common signs and symptoms.

Substance abuse and psychosocial risk factors among teenagers: associations with sex, age, ethnicity, and type of school

Abstract: The search for the one causal influence to account for youthful drug use has always failed. An alternate approach is advocated and tested that relates exposure to and impact of various types of psychosocial risk factors to understanding substance use. Data were obtained from 2,926 students in the 7th, 9th, and 11th grades. Twelve risk factors were selected and tested. These 12 variables were able to explain over 50% of the variance in a measure of general drug use. A unit-weighted, summed index of risk factors was linearly related to use and abuse (heavy use) of cigarettes, alcohol, cannabis, cocaine, hard drugs, and a composite substance use score. Differential exposure to and impact of risk factors on drug-taking behaviors were tested for differences by sex, age, ethnicity, and type of school attending. Patterns of exposure were somewhat different than patterns of vulnerability and impact, and can partially account for the status-group differences in drug use.

Sex differences in addict careers. 4. Treatment.

Abstract: Comparisons of behaviors during treatment were made between a sample of women and a sample of men methadone maintenance clients. Women in this study exhibited high motivation for treatment. Overall, however, small differences were found between the sexes with respect to treatment process and outcome measures. The observed differences that were significant included use of substances other than heroin, interpersonal relationships, drug dealing, employment, and criminal behaviors. The differences seemed to be in accordance with traditional sex role expectations. The distinctive behavior pattern of Chicanas demonstrated in this study demands special attention. It is suggested that treatment programs should incorporate more services to meet women-specific needs.

Sex differences in addict careers. 1. Initiation of use

Abstract: Five-hundred-sixty-seven heroin addicts admitted to methadone maintenance treatment programs in southern California were included in the present analysis Systematic comparisons were made between women and men for Anglo and Chicano subpopulations The behaviors compared focused on initial drug use and other antecedent behaviors during the year prior to initiation of heroin use including interpersonal relationships, other substance use, drug dealing, legal income, and various criminal behaviors Unlike men, the initial use of heroin by women was highly influenced by a man, especially by a sex partner who is often a daily heroin user On the other hand, many women (like men) reported self-initiation of heroin use, multiple drug use, and drug dealing, thus demonstrating that they took an active role in their drug involvement Other differences between men and women for antecedent behaviors prior to narcotics use appear to be related to traditional expectations about gender roles in American society

Sex differences in addict careers. 2. Becoming addicted.

Abstract: Sex differences are examined for the period during which addiction develops after initial narcotics use. About 25% of the 546 heroin addicts studied became addicted within 1 month after initial use. More women than men fell into this category, and, on the average, women took less time to become addicted. For the majority of those studied (whose addiction occurred 1 month or longer after initial use), patterns of narcotic use during this phase of the addiction career were not significantly different by sex within Anglo or Chicano groups. Differences between female and male addicts in interpersonal relationships, other substance use, drug dealing, legal employment, and criminal behaviors parallel traditional sex role expectations.

Sex differences in addict careers. 3. Addiction.

Abstract: The process and correlates of addiction prior to treatment are examined for a sample of 546 women and men methadone maintenance clients. Narcotic addiction careers for women (defined both a...

Clonidine and naltrexone in the outpatient treatment of heroin withdrawal.

Abstract: Clonidine hydrochloride (an alpha-2 adrenergic agonist) and naltrexone hydrochloride (an opioid antagonist), given in combination, provided a safe and effective treatment of abrupt opioid withdrawal over 5 days in an outpatient/day setting. Before starting the clonidine, a naloxone challenge test was used to verify and quantify opioid dependence, and the naloxone challenge test score was then used to determine initial medication doses. Initial naloxone challenge test scores predicted subsequent patient discomfort during the 5-day clonidine-naltrexone protocol. Twelve of 14 (86%) heroin users successfully withdrew from opioids and simultaneously initiated naltrexone maintenance.

Correlation between drug use by teenagers and drug use by older family members.

Abstract: This study examines the relationship between drug use by teenagers and older family members living in the same household, using data from the National Survey on Drug Abuse. Drug use by teenagers was found to be correlated with drug use by fathers, mothers, and older siblings, in that teenagers were more likely to be drug users if the older adult was also a drug user. Correlations were significant across different drug types, but the most consistent relationship was between marijuana use by youth and marijuana use by the adult.

Suicide and alcoholism.

Abstract: (1987). Suicide and Alcoholism. The American Journal of Drug and Alcohol Abuse: Vol. 13, No. 3, pp. 327-341.

Retention of Court-Referred Adolescents and Young Adults in the Therapeutic Community

Abstract: Client retention for Abraxas, a therapeutic community (TC) whose clients are almost exclusively court referred, was compared with that for nine other TCs that primarily accept clients not referred by the courts. Retention was found to be dramatically higher for Abraxas than for all nine comparison TCs during the first month of treatment. After the first month of treatment, discharge rates for Abraxas were lower than those for an aggregate of seven of the TCs but were comparable to rates for two others. At the end of 10 months, more residents remained at Abraxas than at eight of the nine comparison programs. These differences between Abraxas and the nine comparison TCs are particularly notable in that Abraxas' population is primarily juvenile whereas the comparison program populations are primarily adult. Analysis of the Abraxas sample showed that client retention was significantly higher for court referrals, adults, and males, and did not significantly vary according to ethnicity. The authors conc...

The Use of the Diagnostic Interview Schedule in Drug-Dependent Patients

Abstract: In an attempt to diagnose other psychiatric disorders in substance abusers, some clinicians and investigators have utilized the NIMH Diagnostic Interview Schedule (DIS). This study assessed the validity of the DIS in a drug-dependent population by comparing DIS diagnoses with clinical diagnoses in 124 hospitalized drug abusers. Every attempt was made to establish the validity of the clinical diagnoses; these represented a consensus of two independent psychiatrists, based on repeated clinical interviews, observation of ward behavior, and information obtained from relatives regarding patient and family history. Concordance between clinical and DIS diagnoses (represented by the kappa statistic and percent agreement) was only moderate for DSM-III Axis I disorders other than substance abuse. In addition, the DIS diagnosed alcoholism less often and antisocial personality disorder more often than the clinicians. Factors contributing to the discrepancy between clinical and DIS diagnoses in this specific population include (a) drug abuse effects, whereby distinguishing between drug effects and primary psychiatric symptoms may be difficult; and (b) the effect of the treatment process itself, whereby patients are encouraged to rethink the role drugs have played in causing some of their difficulties. Patients' reports of the chronology of their symptoms may thus change according to what they have learned in treatment. The authors conclude that the DIS, like any single diagnostic interview, may have limited utility early in the treatment of drug-dependent patients, since their recollection of their previous symptoms may change dramatically as a result of treatment efforts.

Alcohol and opioid peptides: neuropharmacological rationale for physical craving of alcohol.

Abstract: Until recently alcoholism was regarded as an incurable psychological problem. During the last decade a chain of research has led to important hypotheses about the etiology of the physical craving of alcohol. Recent discoveries indicate that the brain has receptor sites for naturally occurring opiatelike substances (endorphins, enkephalins, and dynorphins) which are produced by the nervous system. Opiates such as morphine or heroin and some of the metabolic products of alcohol (tetrahydroisoquinolines) can also attach themselves to these receptors. It has been further discovered that the physiological craving for alcohol may be the result of a deficiency of the naturally occurring opiatelike substances as well as other neurochemical deficits (i.e., dopaminergic, GABAergic, and serotonergic). These neurochemical deficits can occur genetically or as a result of long-term heavy drinking.

The antecedents and benefits of achieving abstinence in opioid addicts: a 2.5-year follow-up study.

Abstract: This report examines long-term and short-term benefits of achieving abstinence from opioids in a sample of opioid addicts who were reevaluated 2.5 years following seeking treatment. Extensive assessment of drug use history and drug-associated problems had been obtained when the subjects applied for treatment. At follow-up evaluations, detailed information was obtained on intervening course of drug use, treatment, legal problems, psychological problems, social functioning, occupational functioning, and medical status. The results were as follows: (1) Achieving abstinence from illicit opioids was associated with concurrent improvement in other aspects of functioning including reduction of criminal activity, improved medical status, improved social functioning, and reduced abuse of other psychoactive substances. However, many of these improvements were reversed immediately if relapse to opioid use occurred. (2) Achieving abstinence was associated with being in drug treatment, especially treatment in a methadone maintenance program. (3) Achievement of abstinence was not successfully predicted by client characteristics measured at entrance into treatment. (4) Long-range benefits of abstinence were detectable in social functioning even for those who had relapsed at the time of follow-up reevaluation.

The response of primary care physicians to problem drinkers.

Abstract: This study examines the extent and characteristics of primary care physicians' response to their patients' drinking problems and several factors which might impede or facilitate their

Relationship of marital structure and interactions to opiate abuse relapse.

Abstract: Several aspects of marital functioning were associated with subsequent relapse to opiate abuse in 17 married addicts. The addicts and spouses were evaluated in a task-oriented interview and rated using the Beavers Timberlawn Family Assessment instrument. The global health-pathology ratings on this instrument indicated that most couples had rigid patterns of interacting, rather than a chaotic lack of structure or a flexible, negotiated partnership. Within this range of rigid functioning, higher ratings were associated with longer times drug-free (up to 18 months with a mean of 7 months). On the seven subscales of the Beavers', five were significantly correlated with the time drug-free: effective and clear leadership, closeness between the spouses, a nonhostile mood, empathy, and efficient negotiation and problem solving. The subscales associated with drug abstinence were quite different for a group of seven single ex-addicts participating in the same outpatient program, but living with their parents. For these single ex-addicts three subscales were correlated with the time drug-free: parental reaction to separation strivings, the open expression of thoughts and feelings, and empathy. This difference in the subscales associated with abstinence for married versus single addicts suggested some specificity in the characteristics of family structure and interaction that may be related to drug abstinence.

Depression in opioid users varies with substance use status

Abstract: The relation of substance use status to depressed mood during careers of 173 opioid users was estimated using the Zung Self-Rating Depression Scale. The data suggested a progression in severity of depression from those abstinent or using occasionally, who were least depressed, through intermediate substance use states, to those dependent on illicit opioids, who were most depressed. One hundred five subjects completed the Scale in two interviews separated by a mean of 4.5 years. Change in substance use status from not dependent at first interview to dependent at second interview was associated with increased depression.

A biracial comparison of adolescent alcohol use

Abstract: This study used a survey design to compare the drinking behaviors of Black and White students from two urban high schools in the city of Cleveland. Data are presented from 1,096 students who completed a 28-item self-report questionnaire measuring adolescent alcohol use and several factors which influence it. White males demonstrated the highest amount of alcohol use on all measures, while White females demonstrated drinking rates comparable to Black males. Blacks of both sexes exhibited the highest percentage of nondrinkers and the highest lifetime abstention rates. White respondents tended to have their initial drinking experiences almost a year earlier than their Black counterparts and perceived greater parental permissiveness regarding drinking. Relaxation was the most popular reason given for drinking by all groups of students. Higher percentages of White than Black students felt that conviviality and problem avoidance were benefits associated with drinking. Subcultural variations were also seen in th...

Alcohol use and depression in women with bulimia.

Abstract: In a preliminary study examining affective and addictive components of the bulimia syndrome, individual tendencies toward alcohol abuse and depression as well as family histories of alcoholism and affective disorder were examined. Twelve women meeting DSM-III criteria for bulimia and 12 matched controls participated in the investigation. Bulimic women were significantly more depressed than controls. Although there were no significant differences in global alcoholism scores, a subgroup of bulimics emerged for whom bulimia was one of multiple and debilitating addictions. In addition, bulimic women evidenced a significantly greater family history of alcoholism than controls. Bulimia is described as a disorder with salient disruptions in eating behavior yet strongly influenced by affective and addictive components.

The social context of drinking among high school drinking drivers.

Abstract: Over 2,000 high school students were surveyed with an anonymous questionnnaire to determine their frequency of drunk driving, social context of alcohol consumption, beliefs about drunk driving, and quantity and frequency of alcohol consumed. About 10% of the sample was identified as drunk drivers and they were compared with non-drunk driving drinkers according to a number of measures of where and why they drank. The results revealed highly significant differences in the social context of alcohol consumption for beer, wine, and liquor consumption. Across all three beverage categories, the most important discriminating social context factors were drinking at a dormitory and drinking to get along better on dates. Beer and liquor consumption were more important than wine consumption for discriminating drunk drivers from the non-problem drinking high school population. Quantity and frequency measures of alcohol consumption along with belief measures about drinking and driving did not substantially incr...

Severity of alcohol dependence and its relationship to additional psychiatric symptoms in male alcoholic inpatients.

Abstract: Many alcoholics suffer from distress associated with psychiatric symptoms in addition to alcoholism. Although there may be many such symptoms reported by the alcoholic, there may not be enough in any one category to meet DSM III criteria for an additional psychiatric diagnosis, and consequently these symptoms may not be considered in treatment planning. In addition, the prevalence and severity of psychiatric symptoms may be dependent on the progression of alcoholism. The purpose of this study was to examine whether a relationship exists between patterns of psychiatric symptomatology and the level of severity of alcohol dependence in an inpatient male alcoholic sample, and to describe how this information can be utilized to differentiate large groups of alcoholics into clinical meaningful categories. The study sample was comprised of 100 male alcoholic inpatients from the Alcoholism Treatment Unit at a metropolitan Veterans Administration Hospital. Subjects were administered The Michigan Alcoholism Screeni...

The use of vignette analysis of dangerous driving situations involving alcohol to differentiate adolescent DWI offenders and high school drivers.

Abstract: Adolescent drivers are commonly involved in a variety of dangerous driving situations involving alcohol and drug use. Both situational and personality factors contribute to the adolescent DWI phenomenon. Little is known about young drivers' ability to analyze common potentially dangerous alcohol-involved driving situations, or in what respects differing patterns of analysis differentiate adolescent drivers at risk for DWI. Three groups of adolescent drivers (N = 153) completed an analysis of vignettes questionnaire to assess their decision-making skills and attitudes with respect to drinking and driving. The three comparison groups consisted of high school drivers, young DWI offenders, and juvenile offenders without DWI citations. Subjects were demographically similar except for academic performance, employment, family intactness, car ownership, and drug and alcohol use, with DWI offenders and non-DWI offenders showing significant differences in these measures (p less than .001). Situation analysis showed that adolescent DWI offenders more often than controls drink prior to driving (p less than .001), associate alcohol with many social events and dating (p less than .001), become angry when questioned about driving ability (p less than .001), play drinking games (p = .1), drive fast to resolve stress (p = .001), are less likely to recruit parents when faced with driving intoxicated (p less than .001), and a number of other situational characteristics indicating differential risk between groups for DWI. In many cases, other juvenile offenders matched responses of DWI offenders. Important aspects of these findings are discussed in the context of intervention strategies and the use of vignette analysis as one tool to identify high-risk adolescent drivers for DWI.

Alcohol and Alcoholism in Traffic and Other Accidental Deaths

Abstract: To assess the role of alcohol and alcoholism in motor vehicle and other accidental deaths, New Jersey State Medical Examiner cases from Essex County aged 16 or older during a 4-year period, October 1981 to September 1985, were analyzed. Cases were classified as alcoholics according to the following criteria: (1) autopsy findings of liver change or pancreatitis due to alcoholism or (2) any case record report of drinking problems. There were 467 age-eligible cases whose certified manner of death was an accident for which the decedent may have had some responsibility. The study sample consists of 300 cases with blood or brain alcohol levels (BALs) obtained within 6 h after injury, including 96 motor vehicle drivers, 78 pedestrians in motor vehicle accidents, 38 fire victims, and 33 fall victims. In the study sample, 23% were classified as alcoholics, 47% had positive BALs, and 36% had levels of 0.10% or more. Alcoholics much more often than nonalcoholics had positive BALs and levels of 0.20% or more. Acciden...

Predictors of 2.5-year outcome in opioid addicts: pretreatment source of income.

Abstract: A recent 6-month follow-up of methadone maintenance (MM) suggested that addicts supported by public assistance before seeking MM have a globally poor prognosis compared to addicts supported by employment or illegal activities. We therefore examined 2.5-year outcome among addicts prognostically stratified by three major sources of pretreatment income: employment (n = 48), welfare (n = 46), and criminal activities (n = 57). Significant improvements in substance abuse, family, legal, and psychological problems were reported by all three groups. Furthermore, the welfare group showed the most improvement in medical status and on the Social Adjustment, Maudsley neuroticism, and Beck Depression scales. Thus, the welfare patients did not appear to have a globally poorer prognosis, although they showed the least improvement in employment and legal problems. To examine whether welfare patients on MM had no more than "expected" improvement in legal and employment problems, patients treated with MM (n = 83) were compared to those getting only detoxification (DT) (n = 40). Welfare patients showed no more improvement in these two areas from MM treatment than from DT alone, while at follow-up the "employed" and "criminal" groups had substantially less illegal income and unemployment with MM than with DT alone. Thus, welfare patients may do relatively poorly in some areas when treated on MM.

Differences in Character Roles between Adolescents from Alcoholic and Nonalcoholic Homes

Abstract: The present study was an initial investigation to determine whether differences existed in role-prescribed behaviors between adolescents from alcoholic and nonalcoholic homes. Specifically, the study investigated Black's contention that children of alcoholics adopt one or more of the roles of responsible child, placater, adjuster, and acting-out chid. The Children of Alcoholics Screening Test (CAST) was used to identify responses to parental drinking behavior and the Children of Alcoholics Family Role Instrument (CAFRI) was developed to obtain a measure of subjects' perceptions of role behavior. The independent variable was group membership in either an alcoholic or nonalcoholic family and the dependent variables were the role scores on the CAFRI. Statistical comparisons of differences in individual roles between groups indicated that adolescents from alcoholic families rated themselves higher on the acting-out role with a prominent although nonsignificant tendency to exhibit behaviors characteris...

Serologic, immunologic, and clinical features of parenteral drug users from contrasting populations.

Abstract: We screened inpatient and outpatient parenteral drug users with no clinical evidence of AIDS for immunodeficiency and antibodies to HTLV-III by ELISA. Among 20 outpatient drug users, 5 (25%) were seropositive. Three of these (and 2 who were seronegative) had low T-cell ratios. Over 6 months, 1 seropositive patient with a low ratio developed oral thrush and weight loss. We also studied 13 parenteral drug users hospitalized for conditions other than AIDS. Eight had low T-cell ratios, and at least 6 of these developed AIDS or ARC within 4 months. Serum from 8 of 13 inpatients was available for HTLV-III testing: 6/8 were seropositive and 3 of these 6 were among those developing AIDS or ARC. Abnormal T-cell ratios among all patients were associated with abnormal HTLV-III serology (p =. 02). Of the 7 patients who developed AIDS or ARC, 4 were tested for both antibodies and T-cell ratios: all 4 were seropositive and had low ratios. A low ratio (p =. 0004), a positive ELISA (p =. 014), and abnormalities of both t...

Life event and treatment attributions in drug abuse and rehabilitation.

Abstract: How positive and negative life events are perceived by drug abusers in nearly unexplored, yet attribution theory specifies ways in which such perceptions might differentiate drug abusers from nonabusers; it also suggests how attributions might relate to treatment effects and to rehabilitation. This study tested attributions about life events by drug abusers and matched controls as the drug abusers first entered residential treatment, and again later during treatment. Attributions about success and failure in treatment were also assessed. Results showed that attribution processes significantly differentiated drug abusers from controls and that those processes were related to ultimate rehabilitation outcome. Ways in which treatment might be made more effective by focusing on attribution processes are suggested.

PCP abuse in New Orleans: a six-year study.

Abstract: Methods for determination of PCP in body fluids are presented and a rapid screening method is suggested. The demographics, psychiatric profiles, forensic aspects, and diagnostic problems of PCP abuse are discussed.

Heroin availability and aggregate levels of use: secular trends in an urban black cohort.

Abstract: The influence of heroin availability on the aggregate level of use of this drug was investigated for a normal Black cohort (born between 1952 and 1957) who grew up in Harlem (New York City). Data obtained on the second and third waves of a panel study were used to estimate annual rates of heroin initiation and cessation from the mid-1960s through 1983. The aggregated time-series variables indicated that initiation into heroin use was largely confined to adolescence and that cessation rates exhibited substantial year-to-year fluctuations with no apparent relationship to either chronological age or calendar year. Respondents born before 1955, however, had much higher rates of heroin use than those born in later years. Temporal trends in initiation and cessation were uncorrelated with changes in the purity of heroin sold in New York City between 1973 and 1983, suggesting that aggregate levels of heroin use in this sample were little affected by changes in supply. More speculatively, cohort differences in lifetime prevalence may reflect varying availability at the times younger and older cohorts entered adolescence. This possibility could not be directly tested because of the absence of reliable purity data going back sufficiently far in time.

Chronobiological susceptibility to alcoholism: a hypothesis.

Abstract: The search for carriers of a specific biologic risk for alcoholism is ongoing. In addition to seeking “the needle in the haystack,” the need to monitor a broader phenotypic indicator such as Chronobiological interaction is hypothesized. Certain potential mediators of genetic predisposition to alcoholism are subject to periodic rhythmicity in both animal and human investigations. These mediators include prolactin, cortisol, and MOPEG levels along with possible sleep characteristics. Suggestions for future animal and human investigations are outlined using adequate sampling criteria, appropriate rating and recording instruments, and controls predisposed to other psychiatric diagnoses.