Alcohol

Issues Available Online

NAJAVITS, L.M., RUNKEL, R., NEUNER, C., FRANK, A.F., THASE, M.E., CRITS-CHRISTOPH, P. AND BLAINE, J. Rates and Symptoms of PTSD among Cocaine-Dependent Patients

ABSTRACT. Objective: This study evaluated lifetime traumatic events and current posttraumatic stress disorder (PTSD) symptoms in a substance abuse sample. Method: Participants in the study consisted of 558 (75.1% male) cocaine-dependent individuals who completed self-report measures of trauma and PTSD symptoms prior to entry into treatment. Results: Results showed a high number of lifetime traumatic events, even among those without PTSD. General disaster was the most prevalent. Current PTSD was found in 10.9% of the participants, with a significantly higher rate among women (21.6%) than among men (7.2%). For those with PTSD, the most prominent PTSD symptom cluster was arousal, and the most common symptoms were restricted affect, detachment and irritability. Participants with PTSD endorsed a large number of symptoms, almost double that needed to meet diagnostic criteria; however, neither number of traumas nor type of trauma was associated with their level of PTSD symptoms. Even among those not meeting PTSD criteria, subthreshold symptoms were found, with avoidance the most prominent cluster. Sociodemographic and recent cocaine use variables did not differentiate the PTSD from non-PTSD groups. Conclusions: PTSD is present in a sizeable percentage of cocaine-dependent treatment-seeking patients, particularly women. Clinicians might address arousal symptoms in particular, which were the most prominent symptom cluster, and which may be exacerbated by cocaine use. Even among those without PTSD, lifetime trauma is substantial and subthreshold PTSD symptoms are common. Vulnerability to PTSD needs further study, as sociodemographic and cocaine use variables did not distinguish between PTSD and non-PTSD groups. (J. Stud. Alcohol 64: 601-606, 2003)

KARNO, M.P. AND LONGABAUGH, R. Patient Depressive Symptoms and Therapist Focus on Emotional Material: A New Look at Project MATCH

ABSTRACT. Objective: Matching treatment modality to patient attribute generally did not improve outcomes in Project MATCH. Untested was whether actual therapist behaviors, irrespective of treatment -modality, interacted with patient attributes to improve outcomes. The present study examined whether patient depressive symptoms interacted with therapist focus on painful emotional material to predict the effectiveness of alcohol treatment. Two competing theoretical approaches to treatment effectiveness were considered in light of the results. Method: A self-report measure of pretreatment depressive symptoms was completed by 141 participants from the Providence Clinical Research Unit of Project MATCH. Therapist focus on emotional material was then judged by independent observer ratings of videotaped treatment sessions. The interaction between these patient and therapy variables was tested as a predictor of percentage of days abstinent (PDA) and percentage of heavy drinking days (PHDD) during treatment and over the first year following treatment. Results: The interaction between patient depressive symptoms and therapist emotion focus consistently predicted PDA and PHDD both during treatment and over the first year posttreatment. For patients with clinically elevated depressive symptoms, improved drinking outcomes occurred with a low therapist focus on painful emotional material. Conversely, depressed patients had worse drinking outcomes when the therapist had a high focus on emotional material. Therapist behavior did not affect drinking outcomes for patients with subclinical -depressive symptoms. Conclusions: The interaction between depressive symptoms and therapist focus on emotional material was an important predictor of alcohol treatment effectiveness. The results appear to support a theory in which the reduction of patient arousal is a potential mediator of treatment effectiveness. The consistency and robustness of these findings suggest that matching actual therapist behaviors to patient attributes may improve drinking outcomes more than matching based solely on treatment modality. (J. Stud. Alcohol 64: 607-615, 2003)

KELLY, T.M., DONOVAN, J.E., CORNELIUS, J.R., BUKSTEIN, O.G., DELBRIDGE, T.R. AND CLARK, D.B. Psychiatric Disorders among Older Adolescents Treated in Emergency Departments on Weekends: A Comparison with a Matched Community Sample

ABSTRACT. Objective: This study was undertaken to explore the characteristics of young patients treated in emergency departments (EDs) who follow through with an evaluation for psychiatric disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and to investigate differences in rates of psychiatric disorders between ED-treated adolescents and demographically similar adolescents recruited from the community. Method: Sixty three older adolescents (40 males) who were treated at two urban university hospital EDs were matched one-to-one on age, gender and race with 63 adolescents recruited from the community for participation in studies at an alcohol research center. Comprehensive psychiatric interviews were conducted with both groups. Results: ED-treated adolescents were diagnosed with higher rates of current alcohol use disorders (AUDs), current drug use disorders and current major depression than were community controls. The ED sample had a particularly high rate of the DSM-IV "hazardous use" of alcohol symptom. ED-treated adolescents also had a higher rate of lifetime comorbid alcohol use disorders and drug use disorders, as well as a higher rate of lifetime comorbid alcohol use disorders and major depression, compared with the community controls. Conclusions: Adolescents who are treated in EDs should be routinely assessed for the presence of AUD, drug involvement and depressive disorders. (J. Stud. Alcohol 64: 616-622, 2003)

CHESSON, H.W., HARRISON, P. AND STALL, R. Changes in Alcohol Consumption and in Sexually Transmitted Disease Incidence Rates in the United States: 1983-1998

ABSTRACT. Objective: A substantial research literature has documented an association between alcohol consumption and risky sexual behavior at the level of the individual. We explored the association between changes in alcohol consumption and sexually transmitted disease (STD) incidence rates at the level of the 50 U.S. states and the District of Columbia. Method: We used multivariate analyses to examine state-level changes in STD rates (gonorrhea and syphilis) and state-level changes in alcohol consumption, controlling for changes in state-level characteristics (e.g., poverty, age distribution of population) and for national trends in factors that affect STD rates. Results: From 1983 to 1998, changes in alcohol consumption were significantly associated with changes in gonorrhea and syphilis rates. Each 1% increase in per capita alcohol consumption was associated with increases of about 0.4% to 0.7% in reported gonorrhea incidence rates and 1.8% to 3.6% in reported syphilis incidence rates. Conclusions: The association between alcohol and risky sex, well documented at the level of the individual, might hold at the population level as well. (J. Stud. Alcohol 64: 623-630, 2003)

PAL, H.R., YADAV, S., JOY, P.S., MEHTA, S. AND RAY, R. Treatment Nonseeking in Alcohol Users: A Community-Based Study from North India

ABSTRACT. Objective: This study examined the reasons given for not seeking treatment by problem alcohol users who live close to a community outreach de-addiction center. Method: Consecutive households in the community were contacted, and inquiry identified 495 male family members who were using alcohol, 163 of whom reported use of alcohol in the previous year. Of these 163 subjects, the 79 who scored above the cut-off of =8 on the Alcohol Use Disorders Identification Test were further evaluated using a semistructured interview schedule to determine their reasons for not seeking treatment. Results: The majority (n = 40) considered alcohol use a "social" problem. Among the reasons for not seeking treatment, the two most commonly cited were "ashamed to admit problems" and "treatment does not help" in 26.5% (n = 21) and 22.8% (n = 18), respectively. Conclusions: The reasons for not seeking treatment for alcohol problems in this sample of Indian men resemble those cited in the literature. The data highlight the need for action to improve outreach to problem alcohol users. (J. Stud. Alcohol 64: 631-633, 2003)