Showing papers in "American Journal of Drug and Alcohol Abuse in 1988"
TL;DR: The literature on patients presenting for general psychiatric treatment who are also substance abusers is reviewed, finding new options tailored to this population still remain to be studied, however, as do the changes necessary in the treatment system to assure proper long-term management.
Abstract: This paper reviews the literature on patients presenting for general psychiatric treatment who are also substance abusers. Place of presentation, diagnosis, and treatment are considered. A considerable portion of patients seen in emergency rooms, as much as half in some settings, are substance abusers, and over a third of general psychiatry admissions have been found to have their presenting problems materially influenced or precipitated by substance abuse. Substance abuse is also frequently found among psychiatric inpatients. Diagnostically, the differentiation of general psychiatric and addictive syndromes can be difficult: primary and secondary affective disorder from consequences of long-term substance abuse; and self-medication patterns from primary general psychiatric syndromes. Treatment studies are often focused on concomitant psychotherapeutic management for patient being treated for addiction. Often, emphasis is placed on pharmacotherapy for enhancing outcome in the dually diagnosed. Qualitative...
138 citations
TL;DR: Quinze a trente pour cent sont atteints de depression majeure, parmi les utilisateurs d'opiaces, tandis que 30% des cocainomanes souffrent de depressions bipolaires ou de cyclothymie, et de troubles de l'attention.
Abstract: (1988). Psychopathology in Substance Abusers: Diagnosis and Treatment. The American Journal of Drug and Alcohol Abuse: Vol. 14, No. 2, pp. 139-157.
117 citations
TL;DR: The results indicate that Mexican-Americans drink more and have more problems and are more accepting of drinking than Puerto Ricans and Cuban-Americans.
Abstract: The objective of this paper is to describe drinking patterns, alcohol problems, attitudes toward drinking and drunkenness, and attitudes toward appropriate drinking among Mexican-Americans, Puerto Ricans, and Cuban-Americans. Subjects were selected through a multistage probability procedure from the United States Hispanic population 18 years of age and older living in households. Data were collected in face to face interviews conducted in the respondent's home. The response rate for the survey was 72%. The results indicate that Mexican-Americans drink more and have more problems. While 22% of Mexican-American men report at least one alcohol problem, only 8% of Puerto Ricans and 3% of Cuban-Americans do so. Mexican-Americans are also more accepting of drinking than Puerto Ricans and Cuban-Americans. This is especially so when drinking means drinking enough to feel the effects of alcohol. The generalizability of these findings is somewhat limited by the small number of Cuban-Americans and Puerto Ricans inte...
99 citations
TL;DR: Treatment implications are that dopamine antagonists, which are usually prescribed for cocaine overdose, may be contraindicated and instead, dopamine agonists may reverse this rapidly fatal syndrome.
Abstract: A mechanism for rapid death in cocaine abusers is proposed based on the neuroleptic malignant syndrome (NMS). The mechanism involves decreased postsynaptic availability of dopamine either through direct receptor blockade, as postulated in classical NMS, or through relative dopamine depletion, as postulated in cocaine withdrawal. The hallmark symptoms of NMS include hyperpyrexia and muscular rigidity, but the cocaine associated syndrome is atypical in having minimal rigidity. This lack of muscle rigidity, however, appears to be consistent with NMS-like syndromes accompanying other conditions involving dopamine depletion rather than blockade. Treatment implications are that dopamine antagonists, which are usually prescribed for cocaine overdose, may be contraindicated and instead, dopamine agonists may reverse this rapidly fatal syndrome.
91 citations
TL;DR: Results indicate that severity of psychopathology is not key in predicting attrition; it is more the nature of the disorder that influences client dropout, and treatment facilities should routinely employ attrition prevention procedures.
Abstract: This study examined the relationships among demographics, personality variables, drug use, and early attrition from substance abuse treatment. Attrition was considered at two time intervals; immediately (after one visit) and after 2 months. One hundred consecutive admissions to a community drug-abuse treatment center were given the MCMI and the SCL-90R following a standard intake interview. Subjects were classified according to their primary drug of abuse, yielding 16 opiate, 16 amphetamine, 34 cocaine, and 29 marijuana abusers. ANOVA's, ANCOVA's, and chi-squares were performed to compare characteristics of the different groups. Immediate Dropouts were less likely to be court mandated than Remainers, but were not different on any other demographic or drug use variable. Remainers had higher scores than Immediate Dropouts on 7 MCMI scales. A significant interaction between drug type, symptom severity, and early attrition was found for amphetamine abusers with high levels of subjective distress as me...
85 citations
TL;DR: The sexual history of this common dually-addicted population and the influence of cocaine and alcohol on commonly studied neurotransmitters and hormones along with their influence on sexual function are examined.
Abstract: Sexual dysfunction is not uncommon in alcoholics and in cocaine addicts. Alcohol abuse frequently develops along with cocaine dependence and the reverse is also common. We examined the sexual history of this common dually-addicted population. Sexual dysfunction was found in 62% (N = 50) of male cocaine and alcohol abusers consecutively admitted to a substance disorder treatment unit. The influence of cocaine and alcohol on commonly studied neurotransmitters and hormones along with their influence on sexual function are discussed.
83 citations
TL;DR: This report focuses specifically on the nonmedical use, or abuse, of benzodiazepines for purposes, durations, or at dosage levels not intended by the prescribing physician or in ways outside medical guidelines.
Abstract: Benzodiazepines are medications used to treat many of the most frequent and disturbing symptoms seen in medical practice, including anxiety, insomnia, muscle spasms, some forms of epilepsy, and other illnesses. The World Health Organization (WHO) has determined benzodiazepines to be “essential drugs” that should be available in all countries for medical purposes. As benzodiazepines were recognized as generally safe and effective drugs, their medical use increased but so did problems of abuse outside medical practice.This report focuses specifically on the nonmedical use, or abuse, of benzodiazepines. Abuse includes purely illegal use as well as use of prescribed benzodiazepines for purposes, durations, or at dosage levels not intended by the prescribing physician or in ways outside medical guidelines.The principal contribution of this report to the resolution of the controversy about the use of benzodiazepines is to draw a sharp distinction between the medical use of these drugs and their nonmedical use, ...
73 citations
TL;DR: In this paper, the frequencies of 15 self-reported symptoms of cocaine withdrawal were compared in 75 subjects to the symptoms listed as criteria by DSM-III for either amphetamine or cocaine withdrawal.
Abstract: The frequencies of 15 self-reported symptoms of cocaine withdrawal were compared in 75 subjects to the symptoms listed as criteria by DSM-III and DSM-III-R for either amphetamine or cocaine withdrawal. Three of the four most frequently reported symptoms, depression (75%), sleep disturbance (71%), and fatigue (69%), corresponded to DSM-III and DSM-III-R criteria. The only other DSM-III symptom, increased dreaming (33%), was infrequently reported, lending support to its deletion by DSM-III-R. Physical withdrawal symptoms, which are generally unappreciated in cocaine withdrawal, were reported by 64% of the sample. Neither the DSM-III criteria nor the new DSM-III-R criteria include other frequent symptoms which might contribute to relapse and impaired functioning, such as craving (69%), apathy/amotivation (67%), and restlessness (64%). Thus, these criteria may be too narrowly defined for treatment purposes.
63 citations
TL;DR: It is found that the maritally violent men tended to drink to forget worries, pains, and stresses in their lives more so than the nonviolent groups and therapy should not focus exclusively on alcohol use, but on underlying causes of both alcohol use and spouse abuse.
Abstract: This study compared the contexts and reasons for drinking of a maritally violent group as compared to three nonviolent comparison groups. We found that the maritally violent group reported higher levels of alcohol consumption in all of the drinking context items with the most significant differences being on drinking at home after work, at home while playing with the kids, at recreational activities, at home by oneself, on the job, at workday lunch, and with people after work. While we did find significant differences, the mean level of consumption in all contexts was relatively low. We found that the maritally violent men tended to drink to forget worries, pains, and stresses in their lives more so than the nonviolent groups. At least half the maritally violent men reported that drinking accompanied abusive events at least occasionally, while about one-third reported it often or very often accompanied their abuse. We concluded that while our findings indicate that alcohol use may facilitate marital violence, they also suggest that alcohol use and mental abuse may be symptoms of other individual, structural, or cultural norm factors. Therapy should not focus exclusively on alcohol use, but on underlying causes of both alcohol use and spouse abuse.
56 citations
TL;DR: The findings suggest that patterns of cocaine use may be more dependent upon the number of years of use rather than on the age of the user.
Abstract: Developmental patterns of cocaine use were examined in a longitudinal sample of 1,308 male and female adolescents. The data indicate that substantial increases in use occurred between 15 and 18 and between 18 and 21 years old. Although there were developmental changes, there were no significant increases over time for same aged individuals. Gender differences within age groups were not statistically significant, although some differences were apparent. Examinations of intraindividual changes in cocaine use among continuous users indicate significant individual increases in all measures of cocaine use over a 3-year period. While continuous users increased their use of cocaine, they experienced decreases in their frequency of use of alcohol, marijuana, and other drugs. Analyses also suggest that those individuals who initiated cocaine use between T1 and T2 were already different from their age peers in terms of their cigarette, alcohol, and marijuana use at T1. Overall, the findings suggest that patterns of cocaine use may be more dependent upon the number of years of use rather than on the age of the user.
53 citations
TL;DR: Factors associated with overdoses included alcoholism, poor social adjustment, and legal problems, while depression, neuroticism, and family problems predicted suicidality during the subsequent 2.5 yr.
Abstract: During a 2.5-yr follow-up of 263 opioid addicts, suicidality was examined as a predictor of outcome and as an outcome to be predicted among initially nonsuicidal addicts. Suicidality predicted poor medical, psychosocial, and substance abuse outcomes, but fewer legal problems during follow-up. Among the 218 initially nonsuicidal opioid addicts, subsequent suicidality was not associated with a history of drug overdoses, and psychosocial factors predictive of future suicidality differed from factors associated with a history of overdoses. Factors associated with overdoses included alcoholism, poor social adjustment, and legal problems, while depression, neuroticism, and family problems predicted suicidality during the subsequent 2.5 yr.
TL;DR: It is suggested that the poor outcome evident among the infrequent attenders may be the result of "misaffiliation" or incomplete affiliation with the fellowship and/or the presence of a problem which supersedes the alcohol abuse.
Abstract: Pretreatment and posttreatment Alcoholics Anonymous (AA) affiliation was investigated in respect to treatment outcome, demographic variables, and psychometric variables for 173 consecutive admissions to a residential behaviorally oriented, multimodal treatment program Few variables were found to distinguish clients who chose to affiliate with AA following treatment from those who did not However, AA attenders tended to report a higher incidence of and more severe alcohol-related problems prior to treatment Pretreatment AA affiliation was not found to influence prognosis significantly However, an infrequent or irregular pattern of posttreatment AA attendance was associated with a much poorer prognosis than either regular attendance or nonattendance Success:failure ratios were statistically equivalent for the latter two groups It is suggested that the poor outcome evident among the infrequent attenders may be the result of "misaffiliation" or incomplete affiliation with the fellowship and/or the presence of a problem which supersedes the alcohol abuse
TL;DR: Factor and correlational analyses did not provide strong evidence of similar factor structure or convergent validity of the MMPI and MCMI with this population of former opiate addicts.
Abstract: The MMPI and MCMI were administered to 163 former opiate addicts who were being maintained in a methadone program affiliated with an urban hospital. Highest group mean MMPI scores were found for Psychopathic Deviate, Depression, Hypomania, and Hysteria. For the MCMI, highest group mean clinical syndrome scores were found for Drug Abuse, Alcohol Abuse, Anxiety, and Dysthymia; highest personality disorder scores were found for Antisocial, Narcissistic, Histrionic, and Paranoid. The MCMI Drug Abuse Scale identified only 49% of subjects as having a recurrent or recent history of drug abuse. Frequency and factor analyses documented the heterogeneity of the population with respect to clinical syndromes, as well as the prevalence of personality disorders (86% had elevations on MCMI Personality Scales). Factor and correlational analyses did not provide strong evidence of similar factor structure or convergent validity of the MMPI and MCMI with this population.
TL;DR: A social learning model which incorporates measures from both the sociological and psychological perspective of differential association is analyzed as an explanation of continued alcohol and marijuana use among youths, proving to be invariant across age and gender groups.
Abstract: A social learning model which incorporates measures from both the sociological perspective of differential association and the psychological perspective of behavior reinforcement is analyzed as an explanation of continued alcohol and marijuana use among youths. Data were gathered at two points in time from a sample of adolescents from New Jersey. The measurement and structural relationships among peer associations, attitudes, reinforcing and punishing consequences, and patterns of use were examined. It was found that, overall, the model fit the data for use of both substances, proving to be invariant across age and gender groups. The most pronounced difference between the alcohol and marijuana models was that differential associations exhibited the strongest relationship to maintenance of alcohol use while reinforcers were most salient to continued marijuana use.
TL;DR: In this study the demographic characteristics, family and childhood history, substance use patterns, and substance-related problems of 40 mild mentally retarded persons are compared with those of40 mild mentally retardation persons without substance abuse.
Abstract: Substance abuse among mentally retarded persons, first described 55 years ago, has received little or no attention by specialists in mental retardation. With deinstitutionalization, this problem has reappeared, often followed by victimization (i.e., assault, rape, robbery). In this study the demographic characteristics, family and childhood history, substance use patterns, and substance-related problems of 40 mild mentally retarded persons are compared with those of 40 mild mentally retarded persons without substance abuse. Similarities with substance abusers who are not mentally retarded are noted. Recommendations for alleviating this serious problem among mentally retarded persons are made.
TL;DR: Drug-using friends are by far the best predictor of drug use for both males and females in Arizona and Utah.
Abstract: We examined the correlates of self-reported lifetime use of alcohol, marijuana, amphetamines, and cocaine within a sample of almost 7,000 high school sophomores in Arizona and Utah. Correlates of drug use (including parental attachment, religious attachment, educational attachment, conventional values, and drug-using friends) showed very similar patterns by gender, with some interesting differences by location. Drug-using friends are by far the best predictor of drug use for both males and females in Arizona and Utah.
TL;DR: It is concluded that the prevalence of nitrite abuse among drug users has not changed as a result of the AIDS epidemic, but such use appears to have decreased within the homosexual community.
Abstract: Nitrite inhalants, as drugs of abuse, have received a new prominence in the literature since their use has been associated with Kaposi's Sarcoma and possibly other manifestations of acquired immuno...
TL;DR: The data indicate that teens with alcoholic parents were less likely to identify their parents as a source of support than teens from nonabusing families and alcohol-abusing teens appear to rely on friends more, and parents less, than demographically comparable nonabused teens.
Abstract: While there is considerable literature examining the relationship between the social functioning and alcohol abuse of adults, less is known about the social resources of adolescents in relation to their drinking or that of their parents. Various sources of social support were examined among 187 male and female adolescents from alcohol-abusing and nonabusing populations. Adolescent groups were divided into those whose family history was positive for alcohol abuse and those whose family history was negative for alcohol abuse. The data indicate that teens with alcoholic parents were less likely to identify their parents as a source of support than teens from nonabusing families. Alcohol-abusing teens appear to rely on friends more, and parents less, than demographically comparable nonabusing teens. Teens with abusing parents reported less parental support and more sibling support than teens from nonabusing families. The theoretical relevance of these findings as well as the implications for both abus...
TL;DR: C'est dans cette derniere phase seulement qu'on entreprendra une psychotherapie de fond, explorant les problemes sous-jacents abandonnant directivite et attitude de soutien.
Abstract: On definit trois stades dans la progression des psychotherapies de toxicomanes: 1) l'acquisition de la sobriete; 2) le debut de la guerison; 3) la guerison confirmee. C'est dans cette derniere phase seulement qu'on entreprendra une psychotherapie de fond, explorant les problemes sous-jacents abandonnant directivite et attitude de soutien
TL;DR: Methamphetamine has emerged since 1978 as the only street stimulant which is likely to contain what it purports to contain and appears to constitute a small but continuing portion of the illicit drug market.
Abstract: Methamphetamine has been marketed illicitly since the 1960s. Much of the street material was illicitly synthesized. Although methamphetamine quality was variable in the past decade, it has emerged since 1978 as the only street stimulant which is likely to contain what it purports to contain. Although there is a small volume of legitimate methamphetamine still made by the pharmaceutical industry, most material analyzed by street-drug laboratories appears to have been illegitimately synthesized and not diverted. For a decade, relatively little methamphetamine was submitted to street-drug analytical labs. In recent years, although the absolute volume of methamphetamine submissions changed little, this drug made up the bulk of alleged stimulant samples submitted to such facilities because of the paucity of amphetamine submissions. Methamphetamine synthesis and use appears to constitute a small but continuing portion of the illicit drug market.
TL;DR: The American Journal of Drug and Alcohol Abuse: Vol. 14, No. 2, pp. 189-197 as discussed by the authors, was the first journal to report on adolescent alcohol and drug abuse.
Abstract: (1988). Adolescent Alcohol and Drug Abuse and Its Consequences— An Overview. The American Journal of Drug and Alcohol Abuse: Vol. 14, No. 2, pp. 189-197.
TL;DR: Systemic therapeutic interventions which have been constructed to achieve drug-free behavior are addressed and contextual goals (necessary to attain a therapeutic climate) and family goals are delineated.
Abstract: Adolescent drug use in the community is a widespread social problem. The abuse of alcohol and/or other illegal drugs ranges from random experimentation to a complex pattern of regular use of a combination of drugs. This paper addresses systemic therapeutic interventions which have been constructed to achieve drug-free behavior. The family is considered the unit of treatment. Contextual goals (necessary to attain a therapeutic climate) and family goals are delineated. These include unity and action within a parental coalition, therapeutic utilization of urinalyses, the bogeyman cometh, probation, home detoxification, and countering adolescent sabotage. Family structural and interactional features outside the explicit arena of drug-taking, such as marital conflict or adolescent autonomy/dependence issues, are not addressed but are discussed elsewhere. Clinical illustrations to document interventions discussed are provided.
TL;DR: The author advocates that a clinician play the role of a primary care therapist (PCT) for substance abusers to assure that appropriate treatment interventions are provided to meet patient needs.
Abstract: The author advocates that a clinician play the role of a primary care therapist (PCT) for substance abusers to assure that appropriate treatment interventions are provided to meet patient needs. In treating substance abusers, the PCT must be concerned about patients' needs for control, containment, contact, and comfort, especially initially, but also in an ongoing way. The PCT functions in direct, coordinating, and monitoring roles in order to optimally provide and combine psychotherapeutic and self-help elements.
TL;DR: La toxicomanie de la prehistoire a nos jours: la revolution agricole jusqu'en l'an 1500; l'ere post-colombienne; la revolution post-industrielle et l'epoque moderne.
Abstract: (1988). The Pursuit of Intoxication: Our 100 Century-Old Romance with Psychoactive Substances. The American Journal of Drug and Alcohol Abuse: Vol. 14, No. 2, pp. 175-187.
TL;DR: In the inner-city, a substantial number of young adult psychiatric inpatients are a high risk group for multiple substance abuse, and the coexistence of substance abuse and other psychiatric disorders has clinical and treatment implications, and calls for changes within the conventional psychiatric milieu.
Abstract: Multiple studies have reported about substance abuse in Blacks and Hispanics. However, little is known about substance-abusing psychiatric patients of these ethnic groups. This study reports the prevalence and patterns of substance abuse among 171 consecutive patients (90 Blacks and 81 Hispanics) admitted to the acute psychiatric unit of an inner-city general hospital. The lifetime prevalence was 63%. Within the month prior to admission, 48% had used the following substances: cannabis, 40%; alcohol, 37%; amphetamines, 20%; cocaine, 12%; phencyclidine (PCP), 12%; barbiturates and/or sedative-hypnotics, 10%; opioids, 9%; inhalants, 1%; hallucinogens, 1%. Those who abused alcohol were more likely to abuse barbiturates and/or sedative-hypnotics, and opioids. Logistic regression analysis showed that major depression, ethnicity, and schizophrenia each were significant predictors of particular types of abuse. Patients with major depression were less likely to use PCP, Blacks were more likely than Hispanics to us...
TL;DR: The analyses reveal that complex inter-relationships exist between the variables studied such that no easy generalizations are warranted as to the social desirability of one type of alcohol ordinance policy over another since various population and demographic variables strongly interact with the alcohol availability measures in determining their social impact.
Abstract: Local alcohol ordinances were studied in the state of Tennessee where 28% of the population resides in jurisdictions that forbid the sale of alcohol to the public. Local alcohol ordinances range from “dry” (total prohibition) to “wet” (sale of alcohol permitted through both liquor stores and bars). Two alcohol-related variables (type of alcohol ordinance and number of alcohol outlets per 100,000 population) and four population variables (population size, percent change, percent residing in urban areas, percent non-White) were studied in relationship to four dependent variables (mortality rates resulting from motor vehicle crashes, liver disease and cirrhosis, suicide, and homicide). The results of the analysis suggest that these alcohol availability measures do play a role, directly and indirectly, in causing some socially deleterious behaviors and conditions. However, we would point out that the correlations between our alcohol availability measures and some of the socially injurious behaviors we...
TL;DR: Laos in the period 1965-1975 provided an opportunity to study sex differences in drug and alcohol use, as influenced by ethnicity, with much diversity occurred among the various ethnic groups with regard to male-female use of drugs and alcohol.
Abstract: Laos in the period 1965–1975 provided an opportunity to study sex differences in drug and alcohol use, as influenced by ethnicity. Several psychoactive substances were locally consumed, including opium, heroin, alcohol, tobacco, betel-areca, and cannabis, Much diversity occurred among the various ethnic groups with regard to male-female use of drugs and alcohol. Trends in these use patterns suggested the existence of certain principles which govern the male-female dimension of drug use. Social changes going on in the society were reflected in choice of substance forms by younger people as compared to their elders (e.g., cigarettes vs pipes or cigars, heroin vs opium, manufactured vs village-produced alcohol). Ecological factors, which contributed to drug availability, also were powerful in determining type of drugs and patterns of use.
TL;DR: In 1972, a drug incidence survey was conducted at a private southern university, and to evaluate the apparent change in trends of drug usage, a follow-up study was undertaken in 1986, which showed a decline in amphetamine and barbiturate use.
Abstract: In 1972, a drug incidence survey was conducted at a private southern university. Pooled results of this random survey of 1,032 students revealed that on at least one occasion, 90% of the students had tried alcohol, 70% had used tobacco, and 61% had experimented with marijuana. Use of amphetamines (38%), hallucinogens (28%), barbiturates (19%), and cocaine (10%) was much lower. To evaluate the apparent change in trends of drug usage, a follow-up study was undertaken in 1986 at the same school. The results showed a decline in amphetamine and barbiturate use. The greatest differences were seen in the nearly fourfold increase in one-time use of cocaine between 1972 and 1986 and the sixteenfold increase in students who used cocaine more than 10 times. It was noteworthy that one-third of the students who used marijuana had done so by the 9th grade. Similar early experimentation was noted with a majority of the other drugs.
TL;DR: Psychological need patterns among 116 drug addicts in treatment were measured with the Adjective Checklist and results suggest that a personality pattern at risk for premature termination before the person experiences the impulse to leave is identified.
Abstract: Psychological need patterns among 116 drug addicts in treatment were measured with the Adjective Checklist. Compared to program completers, program dropouts had higher needs for autonomy and aggression and lower needs for deference, nurturance, and affiliation. This personality style may form the basis of dropping out, among certain types of addicts in certain types of programs, when faced with situational, environmental, or interactional stress. Results also suggest that we may be able to identify a personality pattern at risk for premature termination before the person experiences the impulse to leave.
TL;DR: Even though the potential dangers of cigarette smoking and alcohol consumption during pregnancy have been well publicized, there is still a high percentage of women who participate in such behaviors and there may also exist an important role for the father in affecting these two behaviors and therefore indirectly affecting fetal development.
Abstract: The relationship between cigarette smoking and alcohol consumption behavior during pregnancy was examined in a select group of Danish women and their spouses. Five-hundred consecutive women who had uncomplicated pregnancies and delivered full-term babies were interviewed 3 + days postpartum. Information was collected about smoking and drinking behavior of all household members during pregnancy. Weg found (1) a high percentage of Danish women (70%) and their spouses (80%) consume alcohol during pregnancy, and (2) a significant correlation between maternal and paternal smoking (r =. 25, P*. 0001) and maternal and paternal drinking (r =. 35, P*. 0001). These data suggest that even though the potential dangers of cigarette smoking and alcohol consumption during pregnancy have been well publicized, there is still a high percentage of women who participate in such behaviors. There may also exist an important role for the father in affecting these two behaviors and therefore indirectly affecting fetal development.