Search

Alcohol and drug abuse are major areas of concern for many American Indian/Alaska Native communities. Research on these problems has often been less than successful, in part because many researchers are not sensitive to the culture and traditions of the tribes and communities with which they are working. They also often fail to incorporate tribal customs, traditions, and values into the interventions developed to deal with substance abuse. The authors describe the use of community-based participatory research and tribal participatory research approaches to develop a culturally sensitive substance abuse prevention program for Native youth. This project, The Community Pulling Together: Healing of the Canoe, is a collaboration between the Suquamish Tribe and the Alcohol and Drug Abuse Institute at the University of Washington, Seattle, Washington. KEYWORDS Alaska Native, American Indian, community-based participatory research, health disparities, substance abuse, tribal participatory research, youth

A cost-benefit analysis of a substance abuse treatment program that combines inpatient and outpatient services as compared to a treatment program that provides only outpatient services is presented. Resultes indicate that both programs provide benefits to society and combines programs are more favorable than partial programs.

Byline: Sureyya S Dikmen, Joan E Machamer, Dennis M Donovan, H.Richard Winn, Nancy R Temkin Abstract: See related editorial, 'Alcohol and Injury in the Emergency Department: Opportunities for Intervention.' Study objective: To determine (1) the significance of blood alcohol level in the emergency department in history of alcohol abuse and (2) the significance of habitual alcohol use in head-injured patients before and after injury. Design: Inception cohort study with 1-year follow-up. Setting: Level I trauma center. Participants: One hundred ninety-seven hospitalized adult head-injury survivors with a broad spectrum of head-injury severity. Results: Alcohol use and behavioral problems associated with alcohol use were assayed before injury and in the month and year after injury. The patients' blood alcohol levels in the ED were also examined. Preinjury alcohol abuse was frequent; 42% of the subjects were legally intoxicated while in the ED. The amount of drinking and magnitude of reported preinjury alcohol problems decreased soon after the injury but was followed by an increase by 1 year, although the amount of drinking did not return to the preinjury level (P Article History: Received 14 March 1994; Revised 20 December 1994; Revised 6 February 1995; Accepted 15 February 1995 Article Note: (footnote) [star] From the Departments of Rehabilitation Medicine*, Neurological Surgerya , BiostatisticsAs. and Psychiatry and Behavioral Sciencesn-and the Alcohol and Drug Abuse InstituteA[paragraph], University of Washington, Seattle, Washington., [star][star] This study was supported by grants HS04146, HS05304, and HS06497 from the Agency for Health Care Policy and Research; by grant H133B80081 from the National Institute of Disability and Rehabilitation Research; and by grant NS 19643 from the National Institutes of Health., a Address for reprints: Sureyya Dikmen, PhD, Rehabilitation Medicine, Box 356490, University of Washington, Seattle, Washington 98195, 206-685-7529, Fax 206-685-3244, aa Reprint no. 47/1/66178

To assess the proportion of Vietnam veterans with posttraumatic stress disorder (PTSD) within a population of substance abusers, and to investigate ways in which different war-related factors contribute to the development of PTSD, 269 Vietnam Veterans (with an average age of 39) from a Veteran Administration (VA) addiction treatment center were studied. While 116 had been exposed to combat (theatre veterans), the other 153 had not (era veterans). The veterans were of mixed ethnicity: 68 percent white, 22 percent black and 5 percent American Indian. They took several scales to assess addiction severity, combat experience, combat-related PTSD, and PTSD symptoms. Theatre veterans had significantly higher PTSD symptom scores than era veterans. Forty-six percent of the theater veterans were diagnosed with PTSD. Theatre veterans with PTSD had been significantly younger during war duty and more likely to have been wounded or stationed longer in war zones than non-PTSD theatre veterans. Extent of combat exposure was the strongest determinant of the severity of PTSD symptoms. Non-PTSD theatre veterans had fewer psychiatric problems than era veterans, suggesting resiliency among some combat exposed men. When theatre veterans with PTSD were compared with non-PTSD theater veterans, those with PTSD were more likely to be nonwhite, unemployed, and to have had more psychiatric treatment for aggressive and suicidal behavior. The finding that almost half of the theatre veterans had combat-related PTSD suggests that VA substance abuse centers are serving many clients at high risk for PTSD who require diagnostic screening and PTSD-related interventions in addition to substance-abuse counseling. (Consumer Summary produced by Reliance Medical Information, Inc.)

Among Latino day laborers at risk for unhealthy alcohol use, those who received a culturally adapted brief intervention did not reduce their alcohol use more than those not receiving the brief intervention.Latino immigrant men are at increased risk for unhealthy alcohol use. Vida PURA is a culturally adapted evidence-based intervention that consists of promotores providing screening and brief intervention to reduce unhealthy alcohol use among Latino immigrant men. The purpose was to assess the efficacy of Vida PURA in a pilot randomized control trial. Participants were screened for eligibility at a day labor worker center using the Alcohol Use Disorders Identification Test (AUDIT). Those with an AUDIT score ≥ 6 (N= 121) were randomized into an intervention (N= 77) or control group (N= 44). Participants in the intervention group received a brief intervention from a promotor including personalized feedback, motivational interviewing to assess their readiness to change, and referral to services. Participants in the control group received information about local substance use treatment services. We assessed changes in AUDIT scores, drinks per drinking day, drinking days, and frequency of heavy episodic drinking at 2 and 8 weeks following the baseline survey using a mixed-effects regression model. Many men had high AUDIT scores, indicating dependence. Both the intervention and control groups reduced their alcohol-related behaviors over time, but there were no significant differences between the groups. A culturally adapted brief intervention may not be enough to significantly reduce alcohol use among Latino day laborers, especially among those that are dependent. We discuss lessons learned from this trial, including the value of community-based approaches to reaching high-risk and underserved populations.

BackgroundOpioid overdose is a major and increasing cause of injury and death. There is an urgent need for interventions to reduce overdose events among high-risk persons.MethodsAdults at elevated risk for opioid overdose involving heroin or pharmaceutical opioids who had been cared for in an emergency department (ED) were randomised to overdose education combined with a brief behavioural intervention and take-home naloxone or usual care. Outcomes included: (1) time to first opioid overdose-related event resulting in medical attention or death using competing risks survival analysis; and (2) ED visit and hospitalisation rates, using negative binomial regression and adjusting for time at risk.ResultsDuring the follow-up period, 24% of the 241 participants had at least one overdose event, 85% had one or more ED visits and 55% had at least one hospitalisation, with no significant differences between intervention and comparison groups. The instantaneous risk of an overdose event was not significantly lower for the intervention group (sub-HR: 0.83; 95% CI 0.49 to 1.40).DiscussionThese null findings may be due in part to the severity of the population in terms of housing insecurity (70% impermanently housed), drug use, unemployment and acute healthcare issues. Given the high overdose and healthcare utilisation rates, more intensive interventions, such as direct referral and provision of housing and opioid agonist treatment medications, may be necessary to have a substantial impact on opioid overdoses for this high-acuity population in acute care settings.Trial registration numberNCT0178830; Results.

IMPORTANCE: Medical treatment settings such as emergency departments (EDs) present important opportunities to address problematic substance use. Currently, EDs do not typically intervene beyond acute medical stabilization. OBJECTIVE: To contrast the effects of a brief intervention with telephone boosters (BI-B) with those of screening, assessment, and referral to treatment (SAR) and minimal screening only (MSO) among drug-using ED patients. DESIGN, SETTING, AND PARTICIPANTS: Between October 2010 and February 2012, 1285 adult ED patients from 6 US academic hospitals, who scored 3 or greater on the 10-item Drug Abuse Screening Test (indicating moderate to severe problems related to drug use) and who were currently using drugs, were randomized to MSO (n = 431), SAR (n = 427), or BI-B (n = 427). Follow-up assessments were conducted at 3, 6, and 12 months by blinded interviewers. INTERVENTIONS: Following screening, MSO participants received only an informational pamphlet. The SAR participants received assessment plus referral to addiction treatment if indicated, and the BI-B participants received assessment and referral as in SAR, plus a manual-guided counseling session based on motivational interviewing principles and up to 2 “booster” sessions by telephone during the month following the ED visit. MAIN OUTCOMES AND MEASURES: Outcomes evaluated at follow-up visits included self-reported days using the patient-defined primary problem drug, days using any drug, days of heavy drinking, and drug use based on analysis of hair samples. The primary outcome was self-reported days of use of the patient-defined primary problem drug during the 30-day period preceding the 3-month follow-up. RESULTS: Follow-up rates were 89%, 86%, and 81% at 3, 6, and 12 months, respectively. For the primary outcome, estimated differences in number of days of use (95% CI) were as follows: MSO vs BI-B, 0.72 (−0.80 to 2.24), P (adjusted) = .57; SAR vs BI-B, 0.70 (−0.83 to 2.23), P (adjusted) = .57; SAR vs MSO, −0.02 (−1.53 to 1.50), P (adjusted) = .98. There were no significant differences between groups in self-reported days using the primary drug, days using any drug, or heavy drinking days at 3, 6, or 12 months. At the 3-month follow-up, participants in the SAR group had a higher rate of hair samples positive for their primary drug of abuse (265 of 280 [95%]) than did participants in the MSO group (253 of 287 [88%]) or the BI-B group (244 of 275 [89%]). Hair analysis differences between groups at other time points were not significant. CONCLUSIONS AND RELEVANCE: In this sample of drug users seeking emergency medical treatment, a relatively robust brief intervention did not improve substance use outcomes. More work is needed to determine how drug use disorders may be addressed effectively in the ED. TRIAL REGISTRATION: clinicaltrials.gov Identifier:NCT01207791

Background: The ultimate goal of alcohol treatment research is to develop interventions that help individuals reduce their alcohol use. To determine whether a treatment is effective, researchers must then evaluate whether a particular treatment affects changes in drinking behavior after treatment. Importantly, drinking following treatment tends to be highly variable between individuals and within individuals across time.

This article summarizes the proceedings of a symposium that was organized and chaired by Richard Longabaugh and presented at the 2004 Research Society on Alcoholism meeting in Vancouver, British Columbia, Canada. The aim of the presentation was to focus on evidence for the active ingredients of behavioral therapies for patients with alcohol use disorders. Dennis M. Donovan, PhD, reviewed evidence for the active ingredients of cognitive behavioral therapy. Barbara S. McCrady, PhD, presented a conceptual model for mechanisms of change in alcohol behavior couples therapy and reviewed evidence for this model. J. Scott Tonigan, PhD, presented data testing three hypothesized mechanisms of change in twelve‐step facilitation treatment. Mitchell P. Karno, PhD, presented therapy process data that tested whether matching therapist behaviors to client attribute across three therapies affected drinking outcomes. Jon Morgenstern served as discussant.

The present study investigated the effects of differing levels of depression and hypomania on alcoholics' expectancy for future success on chance and skill tasks. Subjects were classified into four groups based upon scores on the Beck Depression Inventory and the MMPI hypomania scale. The primary finding suggests that these two variables exert an interactive effect on such expectancies. The presence of hypomania among highly depressed alcoholics appears to counteract the typical depressive influence on expectancies, leading to a perception of response-outcome dependence similar to that found among nondepressed nonhypomanic subjects. The presence of hypomania in the absence of depression leads to patterns of dampened expectancies similar to those among depressed-nonhypomanic subjects. The relationship of these findings to propositions of the learned helplessness model of depression is discussed.

The present study investigated the influence of perceptual field orientation, as measured by the Group Embedded Figures Test (GEFT), on cognitive functioning among alcoholics and nonalcoholics. The subjects were classified as field dependent, intermediate, or field independent based upon their GEFT scores. Cognitive function was assessed by the Wechsler-Bellevue Intelligence Scale as well as the Category Test, Tactual Performance Test, and Trail Making Tests of the Halstead-Reitan Neuropsychological Test Battery, Three primary findings emerged. First, the alcoholics appeared to be significantly impaired on measures of abstraction, problem solving, and adaptive abilities relative to nonalcoholics. Second, a direct relationship was found between GEFT scores and level of cognitive function within both alcoholic and nonalcoholic samples, with field-dependent subjects evidencing the most impaired performance. Third, the level of perceptual field orientation accounted for a large portion of the variance between the alcoholic and nonalcoholic samples, with field-independent alcoholics performing at a level comparable to or greater than other nonalcoholic subgroups on a number of the cognitive variables. These results provide validational support for the GEFT and indicate that field orientation may be a relevant variable in the assessment of cognitive function in both alcoholics and nonalcoholics.

The authors investigated the interactive contribution of patient characteristics and staff perceptions of the patient to decisions concerning the provision of continued alcoholism treatment following an initial 2-week evaluation period. Staff perceptions contributed significantly more to an individual’s acceptance or rejection than did patient characteristics. A high interpersonal attractiveness rating also led to a significantly more positive evaluation of the patients’ level of intelligence, knowledge of current events, morality, and adjustment. The present results and research findings with general psychiatric populations are compared.

Witkin's psychological differentiation construct and Rotter's locus of control construct were studied independently and in interaction to assess their ability to predict psychopathology and defensive style in a sample of 160 adult, male alcoholics. As predicted, locus of control was significantly correlated with both psychopathology and defensive style and field articulation was significantly correlated with defensive style. However, the congruent and incongruent construct was not significantly related to either psychopathology or defensive style.

Pilot data have provided tentative evidence that the degree of cognitive impairment may be a meaningful classificatory variable with respect to subsequent outcome. The purpose of the proposed study is to examine the differential effectiveness of short- and long-term intensive therapy for alcoholic subtypes defined by different levels of current problem-solving abilities. Subjects will be male alcoholic veterans participating in an inpatient treatment program at the Seattle Veterans Adminis tration Hospital. Patients volunteering to participate in thepresent study will initially be administered a neuropsychological test battery including the Wechsler Adult Intelligence Scale and tests from the Halstead battery. Scores from these tests will be used to determine the individuals' Brain-Age Quotient (BAQ), a measure of current adaptive abilities developed by Reitan. Measures of personality traits, psychosocial functioning, and drinking-related behavior will be collected on admission and at three-, six, and nine-month follow-up periods. Based on the antici pated findings of the present study, the length of the treatment program may be tailored to meet the specific needs, defined in terms of current adaptive abilities, of the individual client. Such a program would appear to maximize both the probabihty of a successful treatment outcome and mini mize unnecessary expenses.

The Locus of Control and Experienced Control scales were administered to 89 male alcoholics. Both correlational and difference data suggested an inverse relationship between alcoholics' perceived locus of control and the magnitude of control experienced in social situations. Alcoholics with an internal locus of control experienced a significantly greater magnitude of control over both interpersonal and intrapersonal sources of pressure or stress than did external alcoholics. The implications of these results with respect to psychosocial functioning and drinking behavior among alcoholic subgroups was discussed.

The present study was designed, first, to attempt to replicate the previously derived Goldstein and Linden Minnesota Multiphasic Personality Inventory alcoholic personality subtypes, and second, to relate these personality patterns to a multidimensional measure of alcohol usage. Two of the previously obtained profile types were replicated through two independent cluster analytic procedures. These subtypes were defined as psychopathic and neurotic-depressive, respectively. Higher levels of drinking-related impairment were associated with anxiety and depression, while lower levels of impairment were related to psychopathic features among patients hospitalized primarily for alcoholism. However, relatively heterogeneous, distinctive configurations of reported drinking benefits, styles, and consequences were found across the Goldstein- Linden subtypes. Methodological factors potentially contributing to the failure to replicate two of the previously derived subtypes were discussed. The potential therapeutic utility of a multivariate classification of personality functioning and the use of a multidimensional assessment of alcohol usage within alcoholic populations was also discussed.

The present study investigated the relationship of a multivariate classification of alcoholic patients based upon Minnesota Multiphasic Personality Inventory profiles taken at admission to psychopathology and drinking behavior at a 6- to 12-month follow-up interval. It was found that a subtype of patients characterized as psychoneurotic, with reactive anxiety and/or depression, evidenced significantly higher levels of psychopathology at follow-up than the remaining three subtypes. Furthermore, this subtype demonstrated higher levels of physical, social, and psychological impairment from post-treatment drinking episodes. No differences were found among the four subtypes with respect to outpatient therapists' ratings of personality change and adjustment. The findings indicate that such a multivariate classification of Minnesota Multiphasic Personality Inventory profiles has predictive utility. The results also suggest that the present subtypes would be useful in investigating the potential utility of differential therapeutic intervention strategies for different patients.

The present study investigated the relationship between Rotter's Locus of Control Scale (I-E) and 2 measures of cognitive style, the Group Embedded-figures Test and the Interpersonal Discrimination Test, for 50 alcoholics. The I-E scale did not correlate significantly with either the embedded-figures (r= .18) or the discrimination test (r= .13); the latter two scales correlated significantly (r= .30). It was concluded that perceived locus of control and cognitive style are independent constructs.