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This chapter reviews the literature on employee voice. The authors examine various types of voice arrangements looking at the purpose of voice arrangements from both employee and management perspectives. It is suggested that employee-initiated voice is typically broader than the management schemes because the latter have as their core concern issues of efficiency and productivity, whereas employee-initiated voice sees employee interests as often compatible, but nevertheless separate from those of management. In examining voice arrangements across the globe, special attention is focused on the regulatory context, and the chapter draws on the varieties of capitalism literature to show how and why voice arrangements vary in different national settings.

A study was designed to develop a measure of both acute and chronic effects of THC administration on memory in the rat. Errors in an 8-arm radial maze, before and after two delay intervals (5 s and 1 h, introduced between the fourth and the fifth arm choice), constituted the principal dependent measures. The first experiment involved testing the animals shortly after administration of 1.25 mg/kg THC. The drug did not affect performance in the pre-delay tests, although a significant effect was observed after the 5-s delay but not after 1-h delay. In the second experiment, 5 mg/kg THC or saline were administered 6 days/week for 90 days. Testing was conducted 18 h after each drug administration. During chronic administration the pre-delay performance did not differ between groups but the post-delay performance of the THC group deteriorated in a gradual manner, relative to their controls, in both the 5-s and 1-h delay conditions. After discontinuation of drug administration, the differences between groups reversed only after 30 days. The results provided evidence that both acute and chronic administration of THC affected working-memory in the radial arm maze test, although it did not interfere with the general cues of the task (reference memory). Chronic drug effects on memory were reversible after prolonged abstinence. Thus, the 8-arm radial maze task proved to be a useful measure of THC effects on memory and could be further used to investigate more thoroughly the mechanisms involved in such drug effects.(ABSTRACT TRUNCATED AT 250 WORDS)

The clinical relevance of level of alcohol dependence is discussed. It is argued that level of dependence can be useful in making decisions about the nature and intensity of treatment. Practical issues about which there are no definitive answers are identified, namely: what constitutes adequate initial assessment?, should treatment be offered?, what treatment should be offered?, who should select the goal of treatment?, should written consent be obtained for certain procedures?, how should treatment be assessed? Guidelines are ofered for implementing brief treatments and for the selection of appropriate clients and therapists. Questions are raised about the relevance of variables other than dependence in predicting outcome, and about the possible reversibility of dependence.

Studies of treatment outcome for drug dependence are methodologically inferior to those for alcohol dependence, probably because scientific interest in drug use is more recent. Also, the behavior of drug dependence is very complex, since multiple drug use is normative for psychoactive drugs. Compared to clients in alcohol and tobacco studies, those in studies of drug dependence are more heterogeneous in their drug use. It is recommended that research priority be given to the identification of homogeneous subsets of the drug user population, including users of alcohol and tobacco. Several methods of measuring drug use have been advocated, but all have limitations, and little is known about their impact on the interpretation of treatment outcome. Recently the quality of designs in this area of research has improved, but avoidance of randomized trials continues to retard the acquisition of knowledge about the relative effectiveness of treatment procedures. Variability in the duration of follow-ups also impedes interpretation of findings; a minimum of six months post treatment is recommended. It is concluded that measures of drug use should be the principal outcome in evaluations of treatment effectiveness, that the role of therapist variables deserves research attention, and that criteria be developed for the interpretation of nonabstinent outcomes, which are the norm of clients treated for drug dependence.

The general objective of this review is to describe the chronic organic brain syndromes associated with alcoholism in their neuropsychological, neurological, and electrophysiological aspects. More specific objectives are to highlight five areas of current empirical or theoretical concern, as described below.

Summary An accurate evaluation of the effectiveness of substance abuse treatment depends largely upon the construction of measures which will capture the complexity of multiple substance use patterns. Of 256 subjects assessed for a drug abuse treatment programme, 90% had used drugs from four or more of eight classes (Alcohol, Cannabis, Hallucinogens, Narcotics, Sedative Hypnotics, Solvents, Stimulants, Tranquillizers) during the past year. A principal components analysis of frequency data from the drug classes indicated four orthogonal factors, explaining 72% of the variance. Cluster analysis (Ward's method) grouped subjects into five clusters, provisionally labelled A (predominantly alcohol), ADR (combining high use of alcohol,‘depressant’ and ‘recreational'drugs), D (predominantly ‘depressant’ drugs), R (mainly ‘recreational’ drugs) and S (very high use of solvents). Four of the clusters (A, D. R. S) combined drugs similar to the principal component factors, with a fifth cluster (ADR) indicating high use of all drug classes except solvents. The clusters also differed in several important ways, including age, social class, social stability, age at onset of drug problem, number of drug classes used, and present severity of drug and alcohol problems.

Many chronic alcoholics have demonstrable cognitive deficits and demonstrable brain damage (Parsons, 1977). It has, reasonably enough, been assumed that the brain damage causes the cognitive deficits, but the hypothesis has not been directly tested. The hypothesis would be supported if measures of tissue loss in alcoholic subjects were demonstrated to be good predictors of cognitive dysfunction and vice versa. The present report is of an attempt to conduct such a study, and contains some preliminary findings.

The past two decades have witnessed a dramatic increase in the use of a variety of psychoactive substances in the developed countries, and a predictable increase in the need for treatment services directed towards this problem. When presenting to treatment, most drug users report recent use of a wide variety of psychoactive substances (Farley, Santo, & Speck, 1979; Sadava, 1984; Wilkinson & Martin, 1983). Nonetheless, there is scant literature on the effectiveness of treatments for multiple substance abuse, also referred to as polydrug abuse (Sobell, Sobell, Ersner-Hirshfield, & Nirenberg, 1982).

Recent studies have indicated that impairment of memory is a common cognitive deficit related to long-term alcohol consumption. Such deficits range from subtle disturbance through a “subclinical” amnesic disorder to full-blown Korsakoff syndrome. This finding is congenial with the hypothesized continuum of alcohol-related impairment of memory. Among alcoholics, this memory impairment appears to be etiologically distinct from the commonly observed deficits in abstracting and problem-solving abilities.

About 1000 persons seeking treatment for alcohol or drug dependence were asked, relative to cigarettes, about the difficulty of quitting the use of the substance for which they were seeking treatment, the strength of their strongest urges to use, and the pleasure they derived from use. Fifty-seven percent said that cigarettes would be harder to quit using than their problem substance. These ratings were related to the level of cigarette dependence and the perceived difficulty of quitting the use of the problem substance. The alcohol-dependent persons were about four times more likely than the drug-dependent persons to say that their strongest urges for cigarettes were at least as great as their strongest urges for their problem substance. Cigarettes were generally rated as less pleasurable than alcohol or other drugs. Thus, experiential experts on dependence judge cigarette dependence as at least as "addictive" as other drug use, but not as pleasurable, indicating important similarities and differences between cigarette dependence and other forms of dependence on psychoactive substances. ( JAMA 1989;261:898-901)

Statutes are used to discourage the use, by children, of licit drugs like alcohol and tobacco. The psychological literature supports the view that children under the statutory ages could make a knowledgeable or intelligent decision about drug use, however it is unlikely that children under the statutory ages would make a voluntary decision to use drugs, in the sense that the term voluntary is used in law. Research on drug use suggests that the decision to use is heavily influenced by the example of other people, both adults and peers. It can therefore be argued that children should be discouraged from being influenced towards drug use. When the law is applied however it tends to be done in such a manner that the drug using child is culpable, rather than those who have encouraged the drug use. In law, minors seem to be considered incompetent to make the decision to use drugs, but culpable if they make such a decision.

Chronic heavy consumption of alcohol is associated with cognitive deficits, such as impaired ability to abstract, to solve problems and to learn new information. Since much treatment for alcoholism involves the learning of coping strategies of various levels of complexity, an assessment of the cognitive abilities of the clients would appear to be required both for differential assignment to treatment and for the prediction of duration of treatment. This argument is based upon the assumption that learning-in-treatment is an important determinant of outcome, and that alcohol-related cognitive deficits account for a significant proportion of the variance in learning ability. There is very little literature, of even a descriptive nature, on the relationship of neuropsychological status to treatment outcome, although research interest has accelerated in the last two years. Formidable methodological problems are inherent in such research. Problems in designing a study of the possible relationship of cognitive deficit to treatment outcome are discussed. An alternative procedure would be to continue descriptive studies, and to assess the impact of objective feedback about physiological and functional consequences of chronic drinking on subsequent decisions to drink. This approach is proposed. In a treatment study of problem drinkers recovery of function resulted from abstinence or very low levels of consumption, but moderate levels of consumption prevented this process. These data should inform the setting of target levels for consumption in the initial stages in programs teaching non-problematic drinking.

Neuroradiologic studies1,2 of alcoholics have been appearing in the scientific literature for almost 40 years. The earlier studies employed the technique of pneumoencephalography (PEG), but since the introduction in 1973 of computed tomographic (CT) scanning of the brain, it has been the preferred neuroradiologic technique.3,4 The findings from both types of study have been very consistent and show that alcoholics tend to have morphologic abnormalities of the brain. The type of abnormality observed is determined in part by the diagnostic technique used and is also affected by the criteria used in evaluating the neuroradiologic procedures5,6 Despite these variations in procedure and criteria, neuroradiologic studies consistently have shown that alcoholics tend to have abnormally wide cortical sulci and significant enlargement of the lateral and third ventricles. In addition, some investigators, using PEG and CT scan data, have reported evidence of cerebellar abnormalities in alcoholics, though this type of morphologic abnormality is less frequently reported than is enlargement of the ventricles and cortical sulci.