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Introduction and Aims.Aim of this study was to evaluate the relationship of relapse with impulsivity, novelty seeking (NS) and craving during 12 month follow up after inpatient treatment in male alcohol dependents. Design and Methods.Among 156 consecutively admitted male alcohol dependents, 102 were examined by face to face interview 12 months after discharge from hospital. Patients were investigated with the Barratt Impulsiveness Scale, version 11 (BIS-11), the NS dimension of the Temperament and Character Inventory, the Penn Alcohol Craving Scale (PACS) and Michigan Alcoholism Screening Test at the end of 12 months. Results.Among 102 alcohol-dependent inpatients 61.8% (n = 63) were considered as relapsed to alcohol use during 12 month follow up. Sociodemographic variables did not differ between relapsed and non-relapsed groups. Mean scores of BIS-11 and NS and subscales of these scales were higher in relapsed group than non-relapsed group. BIS-11 and NS and their subscales were positively correlated with each other. PACS was also positively correlated with these scales and their subscales. Only exception was ‘exploratory excitability’ (NS1) subscale of NS, which did not differ between groups and did not correlate with PACS or BIS-11. Extravagance (NS3) and BIS-11 non-planning impulsiveness (NPI) scores were associated with craving in Stepwise Linear Regression model. Only NS3 showed an association with relapse in the first Forward Wald logistic regression model. When severity of craving was included in the second model, as an independent variable, it was also associated with relapse additional to NS3. Discussion and Conclusions.Both impulsivity and NS seem to be related with craving and relapse. Particularly, NS3 may be related with relapse both directly and indirectly via craving, whereas NPI may be related with relapse only indirectly via craving. Thus severity of craving may be a final pathway to relapse in these relationships of NS3 and NPI with relapse. These findings suggest that impulsivity, NS and craving are important variables to predict outcome and also for the treatment plan.[Evren C, Durkaya M, Evren B, Dalbudak E, Cetin R. Relationship of relapse with impulsivity, novelty seeking and craving in male alcohol-dependent inpatients. Drug Alcohol Rev 2012;31:81–90]

The aim of this study was to investigate the impact of lifetime posttraumatic stress disorder (PTSD), dissociation and a history of childhood trauma on quality of life (QoL) among men with alcohol dependency. A consecutive series of alcohol-dependent men (N=156) admitted to an inpatient treatment unit were screened using the Michigan Alcoholism Screening Test, the Clinician Administered PTSD Scale, the Dissociative Experiences Scale, and the Childhood Trauma Questionnaire. QoL was assessed using the Medical Outcomes Study Short-Form 36-item health survey. Fifty (32.1%) patients had lifetime diagnosis of PTSD. Besides problems related to severity of alcohol use, the lifetime PTSD group was impaired on several physical and mental components of QoL. While the lifetime PTSD group and remaining patients did not differ on reports of childhood trauma and dissociation, in lifetime PTSD group, dissociative patients had higher scores of childhood emotional abuse than those of the non-dissociative patients. In multivariate covariance analysis, both dissociation and lifetime PTSD predicted impairment in physical functioning, general health, vitality, and mental health components of QoL. Among alcohol-dependent men with lifetime PTSD, a history of childhood emotional abuse contributes to impairment of QoL through its relationship with dissociation.

Detecting patterns of maternal drinking that place fetuses at risk for fetal alcohol spectrum disorders (FASDs) is critical to diagnosis, treatment, and prevention but is challenging because information on antenatal drinking collected during pregnancy is often insufficient or lacking. Although retrospective assessments have been considered less favored by many researchers due to presumed poor reliability, this perception may be inaccurate because of reduced maternal denial and/or distortion. The present study hypothesized that fetal alcohol exposure, as assessed retrospectively during child adolescence, would be related significantly to prior measures of maternal drinking and would predict alcohol-related behavioral problems in teens better than antenatal measures of maternal alcohol consumption. Drinking was assessed during pregnancy, and retrospectively about the same pregnancy, at a 14-year follow-up in 288 African-American women using well-validated semistructured interviews. Regression analysis examined the predictive validity of both drinking assessments on pregnancy outcomes and on teacher-reported teen behavior outcomes. Retrospective maternal self-reported drinking assessed 14 years postpartum was significantly higher than antenatal reports of consumption. Retrospective report identified 10.8 times more women as risk drinkers (≥ one drink per day) than the antenatal report. Antenatal and retrospective reports were moderately correlated and both were correlated with the Michigan Alcoholism Screening Test. Self-reported alcohol consumption during pregnancy based on retrospective report identified significantly more teens exposed prenatally to at-risk alcohol levels than antenatal, in-pregnancy reports. Retrospective report predicted more teen behavior problems (e.g., attention problems and externalizing behaviors) than the antenatal report. Antenatal report predicted younger gestational age at birth and retrospective report predicted smaller birth size; neither predicted teen IQ. These results suggest that if only antenatal, in-pregnancy maternal report is used, then a substantial proportion of children exposed prenatally to risk levels of alcohol might be misclassified. The validity of retrospective assessment of prior drinking during pregnancy as a more effective indicator of prenatal exposure was established by predicting more behavioral problems in teens than antenatal report. Retrospective report can provide valid information about drinking during a prior pregnancy and may facilitate diagnosis and subsequent interventions by educators, social service personnel, and health-care providers, thereby reducing the life-long impact of FASDs.

Factors related with relapse in male alcohol dependents: 12 months follow-up study Objective: Aim of this study was to evaluate clinical variables related with relapse to alcohol abuse during 12 months follow-up after inpatient treatment in male alcohol dependents. Method: Participants were 156 consecutively admitted male alcohol dependents. Among these patients, 102 were available at the evaluation that took place one year after the inpatient treatment. Patients were investigated with the Symptom Check List (SCL-90) and Michigan Alcoholism Screening Test (MAST) at baseline and with the PENN Alcohol Craving Scale (PACS) one year later, at follow-up. Results: Among 102 alcohol dependent inpatients, 61.8% (n=63) were considered as relapsed to alcohol abuse. Sociodemographic variables did not differ between groups. Mean scores of MAST and global severity index of SCL-90 did not differ significantly between groups, whereas craving score was higher in the relapsed group. Also the relapsed group had less polyclinic control, less attendance to the Outpatient Treatment Program (OTP), less changes in social environment for self protection and less use of anticraving medications during one year follow-up. Severity of craving and not attending OTP during follow-up period predicted relapse in alcohol dependents. Conclusions: Severity of craving and not attending OTP seems to be the main factors related with relapse. Together with using anti-craving medications, regular attendance to OTP may help patients to recognize and manage with alcohol craving.

This study investigated differences in alcohol use, family of origin, and social support between a sample of adult children of alcoholics (ACOAs, 25 males and 25 females), and a sample of adult children of non-alcoholics (non-ACOAs, 25 males and 25 females). Participants completed a battery of tests: a demographic questionnaire, the Children of Alcoholics Screening Test, the Michigan Alcoholism Screening Test, the Family of Origin Scale, and the Dimension of Social Support Scale. Analysis of variance revealed that the two groups differed on alcohol consumption and family of origin, with ACOAs reporting significantly less alcohol use, and non-ACOAs reporting healthier families of origin. The findings indicate that not all ACOAs abuse alcohol or struggle with social or behavioural problems.

Objective: Studies have shown a relationship between the development of alcohol use disorder (AUD) and the existence of childhood traumas (CT). In this study, in order to gain a better understanding of the association between CT and AUD, the relationship between CT and AUD was analyzed. Further, it was investigated whether Early Maladaptive Schemas (EMS) play a mediating role in the relationship between emotional abuse (EA) and AUD. Methods: The participants were consecutively admitted male alcohol-dependent inpatients (n=220) and healthy controls (n=108). The participants were investigated with the Childhood Trauma Questionnaire (CTQ-28), Young Schema Questionnaire-Short Form (YSQ-SF) and Michigan Alcoholism Screening Test (MAST). Mediation ana-lyses were conducted in order to evaluate the mediating effect of EMS between the relationship of AUD and CT. Results: The difference between CT total score and the EA score between the control group and the AUD group were statistically significant. An analysis of different types of traumas in the correlation with AUD revealed EA as the main predictor of AUD both directly and through its mediating effect with the EMS. In addition, it was determined that in the relationship between EA and AUD, EMS such as Enmeshment, Emotional Inhibition, Dependence and Insufficient Self-Control had mediating effect. Discussion: CT, especially EA are quite common in male inpatients with AUD and the negative effects of EA may play an important role in the development of AUD by causing EMS. Our findings imply that those with EA history in childhood may be particularly vulnerable to the development of AUD in adulthood. Therefore, in the prevention of the development and in the treatment of AUD, it may be useful to take into consideration EA experiences, to screen EMS that may mediate such relationship through scales and to conduct interventions in this regard.

In an ethnically diverse sample of 195 married couples, we conducted a latent factor growth analysis to investigate the longitudinal link (4 time points over 4½ years) between marital aggression (physical and verbal aggression self- and partner-reports) and individual internalizing symptoms (depression and anxiety) as they relate to trajectories of alcohol use among husbands and wives. Alcohol use was operationalized as a latent factor with self- and partner reports of problem drinking as measured by the Michigan Alcoholism Screening Test and the Alcohol Dependence Scale. Verbal aggression by husbands or wives, by itself, has no effect on their alcohol use over time. In conjunction with depression, however, verbally aggressive husbands do have elevated drinking levels. The effects of husbands’ and wives’ physical aggression on their own and their partners’ drinking behavior were also significant. This study is one of the first to examine the change over time in alcohol use for marital partners as related to marital aggression and internalizing symptoms. Our results shed light on areas of marital functioning (aggression, internalizing, alcohol use) that have not been investigated in conjunction with each other in a longitudinal design. Aggr.

PurposeThe quick and simple Depression Scale (DEPS) has been a popular self-rating depression scale in Finland for nearly 15 years. The purpose was to assess the validity of the DEPS in various subgroups of patients.Materials and methodsPrimary care patients, aged 18–64, completed a postal questionnaire including the DEPS. Of the 1643 patients all screen-positive subjects and every 10th screen-negative subject were invited for interview (the Present State Examination, PSE). Complete DEPS scores were available for 410 patients. They were grouped by gender, age, marital status, perceived physical health, basic education and the Michigan Alcoholism Screening Test (MAST) score. Separately for each subgroup, receiver operating characteristic (ROC) curve analyses were done, sensitivity, specificity, area under the curve (AUC), predictive values and likelihood ratios were calculated, and Cronbach's α was estimated.ResultsThe DEPS was valid in general, but best for patients with basic education longer than 9 years.DiscussionThe key statistical figures for the DEPS were comparable to the figures for other short self-rating scales.ConclusionThe DEPS is a valid case finder for primary care patients in the age group 18–64 years, and especially suitable for more highly educated patients. Future studies comparing the DEPS with other simple depression rating scales are needed.

Research regarding gender differences in alcohol use and alcohol-related problems finds that men drink more and suffer higher rates of alcohol-related problems compared with women. The purpose of the current study was to examine whether these differences also exist between lesbians and gay men. A sample of 335 lesbians and gay men were recruited through lesbian and gay events, Listservs, and friendship networks. Items from the National Household Survey on Drug Abuse (Substance Abuse and Mental Health Services Administration, 2000) measured alcohol consumption. The Michigan Alcoholism Screening Test (Selzer, 1971) and the Drinker Inventory of Consequences (Miller, Tonigan, & Longabaugh, 1995) measured alcohol-related problems. Gay men tended to drink more often than lesbians, but there were no significant gender differences regarding alcohol-related problems. Research, theoretical, and clinical implications are discussed.

This exploratory study examines the potential relationship between parenting stress, child maltreatment, and alcoholism in a pilot data set. Twenty-four participants (six African-American, six European-American, six Mexican-American, and six Native-American) completed four questionnaires (Parenting Stress Index, Conflict Tactics Scale Parent-Child, Michigan Alcoholism Screening Test, Chemical Dependency Assessment Profile [PSI, CTSPC, MAST, and CDAP]). Through principle component analyses and multiple regression analyses, it was suggested that self-perceived parenting strength or competence directly affect a parent's tactics to deal with parent-child conflicts. Results indicated that self-confidence as a competent parent was related to the frequency of using verbal degrading and physical punishment. Parents who reported that the child's temperament bothers them a lot were more likely to physically abuse the child. Though all the participants could be categorized as alcoholic by the MAST, parents'...

The aim of this study was to investigate the relationship of self-mutilative behavior with dissociative experiences among men who are alcohol dependent. Participants were 176 inpatients consecutively admitted to an alcohol dependency treatment center. Dissociative Experiences Scale, Beck Depression Inventory, State-Trait Anxiety Inventory, Symptom Checklist-Revised, and Michigan Alcoholism Screening Test were conducted to all participants. A sizable proportion of patients (29.0%) reported self-mutilation (SM). Childhood abuse, younger age, early onset of alcoholism, and dissociative taxon membership predicted SM. The overall severity of clinical condition and the frequency of suicide attempts among those who reported SM were higher than those of the remaining patients. The Dissociative Experiences Scale-Taxon item “auditory verbal hallucinations” and the Symptom Checklist-Revised dimension “hostility” were predictors of SM. There is a complex relationship between dissociation, alcohol use, and SM. Increased awareness among clinicians on this relationship may increase the effectiveness of treatment interventions.

Aim: The aim of the present study was to evaluate the relationship between alexithymia and dissociation among men with alcoholism. Methods: Participants were 176 patients consecutively admitted to the inpatient unit of a addiction treatment center. The Toronto Alexithymia Scale, the Symptom Checklist-Revised, the Dissociative Experiences Scale, the Beck Depression Inventory, the Spielberger State–Trait Anxiety Inventory, and the Michigan Alcoholism Screening Test were administered to all participants. Results: Fifty-three patients were considered as having alexithymia. The alexithymic group had a significantly higher rate of dissociative taxon members (patients with pathological dissociation; 62.3%) according to Bayesian probability. Trait anxiety, overall psychiatric symptom severity, and pathological dissociation predicted alexithymia on covariance analysis. A multivariate analysis of covariance demonstrated that these predictors were related only to difficulty of identifying feelings, whereas trait anxiety was a significant covariant for difficulty of expressing feelings as well. Conclusion: Alexithymic phenomena are interrelated with dissociation and chronic anxiety among men with alcoholism. The relevance of this triad for prevention and treatment of alcoholism deserves interest in further research.

This study found a statistically significant inverse relationship between defensiveness and female college students' Michigan Alcoholism Screening Test (M. L. Selzer, 1971) and CAGE (J. A. Ewing, 1984) scores. Female college students who produce negative screening scores were more defensive than those whose alcohol use screens were positive.

Disordered gambling and alcohol dependence are influenced by unique and shared genetic factors. Although the evidence is mixed, some research has linked catechol-O-methyltransferase (COMT) rs4680 (or COMT Val158Met) to the development of gambling or drinking problems; however, no molecular genetic study has jointly examined gambling and drinking problems. Furthermore, the majority of past studies examined gambling or drinking problems using a case–control design. The purpose of the current study was to examine associations of COMT rs4680 with dimensionally and categorically measured gambling and drinking problems in a nonclinical sample (139 Caucasian adults). The current study found that COMT rs4680 was related to both dimensionally and categorically measured gambling and drinking problems. It appears that the COMT Met/Met genotype may be a genetic risk factor that contributes to the development of both gambling and drinking problems.

A relatively common stop codon (Q20*) was identified in the serotonin 2B receptor gene (HTR2B) in a Finnish founder population in 2010 and it was associated with impulsivity. Here we examine the phenotype of HTR2B Q20* carriers in a setting comprising 14 heterozygous HTR2B Q20* carriers and 156 healthy controls without the HTR2B Q20*. The tridimensional personality questionnaire, Brown–Goodwin lifetime aggression scale, the Michigan alcoholism screening test and lifetime drinking history were used to measure personality traits, impulsive and aggressive behavior, both while sober and under the influence of alcohol, and alcohol consumption. Regression analyses showed that among the HTR2B Q20* carriers, temperamental traits resembled a passive-dependent personality profile, and the presence of the HTR2B Q20* predicted impulsive and aggressive behaviors particularly under the influence of alcohol. Results present examples of how one gene may contribute to personality structure and behaviors in a founder population and how personality may translate into behavior.

The Alcohol Use Disorders and Associated Disabilities Interview Schedules' (AUDADIS) DSM-IV related items are used to evaluate the convergent validity of the Severity of Alcohol Dependence Questionnaire (SAD-Q), the Michigan Alcoholism Screening Test (MAST), and the Alcohol Use Disorders Identification Test (AUDIT) with persons convicted for multiple offences of driving under the influence. A total of 187 participants underwent semi-structured interviewing; of these 84% were alcohol dependent. The instruments exhibit acceptable internal consistency (all alphas > .85) as well as test/re-test reliability (all r = s ≥ .85). The MAST converged most closely with a DSM-IV diagnosis. Implications for rapid assessment instrument research as well as practice in public agencies are discussed.

The aim of the present study was to evaluate the prevalence of lifetime posttraumatic stress disorder (PTSD) in Turkish male alcohol-dependent inpatients, and to investigate the relationship of lifetime PTSD diagnosis with anxiety, depression, hopelessness, erectile dysfunction and psychosocial problems related with alcohol dependency. Eighty-two male inpatients who met DSM-IV criteria for alcohol dependence and 48 subjects without substance use disorder as a control group were included in the study. Subjects were applied the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), the Michigan Alcoholism Screening Test (MAST), the Beck Hopelessness Scale (BHS) and the International Index of Erectile Function (IIEF). Rate of lifetime PTSD diagnosis was found to be 26.8% among alcohol-dependent inpatients. The mean age of patients with lifetime PTSD was lower than in patients without this diagnosis, while there were no significant differences between these two groups in terms of age of first alcohol use, lifetime major depression, current depression, presence and severity of erectile dysfunction. Mean scores of HAM-D, HAM-A, BHS and MAST in the group with lifetime PTSD were significantly higher than the group without this diagnosis. There was a positive relationship between lifetime PTSD diagnosis and depression, anxiety, hopelessness and severity of psychosocial problems related to alcohol dependency, while there was no relationship between lifetime PTSD comorbidity and erectile dysfunction in alcohol-dependent patients.

The complete form of fetal alcohol syndrome (FAS) reportedly occurs in only 4% to 10% of children whose mothers drink heavily during pregnancy. Fetal alcohol spectrum disorder includes cases with some alcohol-related problems but not the full syndrome and is thus more common. Vulnerability to alcohol-related neurodevelopmental disorders is influenced by genetic polymorphisms of the class I alcohol dehydrogenase ADH1B, which affects the rate of alcohol metabolism. Expression of one of the 3 possible alleles, ADH1B*3, is associated with relatively rapid alcohol metabolism. This study sought to learn the degree to which the maternal ADH1B*3 allele may moderate the effects of in utero alcohol exposure on fetal growth and a range of cognitive and behavioral outcomes. The study population included 263 black mother-child pairs in whom moderate and heavy drinking were overrepresented. Most study participants were socioeconomically disadvantaged. The Michigan Alcoholism Screening Test (MAST) was administered to all mothers during the first prenatal visit, and blood was obtained for ADH genotyping; the children were genotyped at the 7.5- or 14-year visits. Fetal exposure to alcohol was assessed by interviewing the mothers about preconception drinking at the first prenatal visit and then at each subsequent visit asking about the amount of alcohol ingested daily since the previous visit. The children were evaluated at 6 and 12 months and 7.5 and 14 years of age. Infants were assessed using the Mental Development Index from the Bayley Scales of Infant Development. They also were tested for processing speed, visual reaction time, and complexity of play. At age 7.5 years, the children were tested for working memory by the Digit Span and Arithmetic subtests from the Wechsler Intelligence Scale for Children. The Verbal Fluency subtest of the McCarthy Scales of Children's Abilities served to measure executive function and working memory. The Continuous Performance Test quantified sustained attention. In addition, teachers were asked to assess social competence and behavior problems. Women who continued to drink during pregnancy decreased the frequency from 1.9 to 0.9 days a week, but the number of drinks consumed per occasion decreased only 20%, from 4.5 to 3.6 drinks. One third of the women also used cocaine, one third used marijuana, and almost two thirds smoked cigarettes. The most prominent genotype was homozygosity for the ADH1B*1 allele (64.5%), and the rest were either heterozygous (31.4%) or homozygous (4.6%) for the ADH1B*3 allele. At the time of conception, women who carried at least one copy of the ADH1B*3 allele drank half as much absolute alcohol per day (0.57 vs 0.96 ounces) and drank on fewer days per week (1.82 vs 2.45 days) than those who did not carry the allele. During pregnancy, both women who did and did not carry the ADH1B*3 allele reduced their drinking such that there was no difference between the groups in the amount of alcohol ingested per occasion (0.18 and 0.26 ounces, respectively) or the number of drinking days per week (0.67 and 0.85 days). Children whose mothers lacked the ADH1B*3 allele exhibited adverse effects of alcohol during infancy, scoring poorly on all tests, whereas the adverse effects on children whose mothers carried the ADH1B*3 allele were limited to reduced birth weight and processing speed on the FTII. At age 7.5 years, when focused attention, working memory, and efficiency of information processing were assessed, prenatal drinking was associated with poorer Category Fluency (the ability to monitor information retrieved from long-term memory) only in children whose mothers lacked the ADH1B*3 allele. These children also had poorer teacher ratings for attention, aggressive behavior, and social problems. In contrast, no consistent pattern of increased vulnerability during infancy was evident in children who themselves lacked the ADH1B*3 allele. When assessed at 7.5 years, children who carried at least one ADH1B*3 allele had fewer cognitive problems.

Aim To investigate longitudinally for both genders the relation between the age of onset of drinking and several indicators of alcohol use. Design and setting In the Finnish Jyvaskyla Longitudinal Study of Personality and Social Development, data have been collected by interviews, inventories, and questionnaires. Data on alcohol consumption was gathered at ages 14, 20, 27, 36 and 42 years; behavioural data at age 8. Participants A total of 155 women and 176 men; 90.4% of the original sample consisting of 12 complete school classes in 1968. Measurements The age of onset of drinking was determined based on participants’ responses that were closest to the actual age of onset of drinking. Four indicators of the adult use of alcohol were used: frequency of drinking, binge drinking, Cut-down, Annoyed, Guilt, Eye-opener (CAGE) and Malmo modified Michigan Alcoholism Screening Test (Mm-MAST). Socio-emotional behaviour at age 8 was assessed using teacher ratings and peer nominations. Findings Early onset of drinking was related to the four indicators of the use of alcohol in adulthood both in men and women. The level of adult alcohol use and alcohol problems was significantly higher in men. The risk for heavy drinking was highest in men and women if drinking was started at less than age 16 years. Socio-emotional behaviour and school success at age 8 did not predict the age of onset of drinking. Conclusions Delaying the initiation of drinking from early adolescence to late adolescence is an important goal for prevention efforts. No clear risk group for early initiators of drinking could be identified on the basis of preceding behaviour among 8-year-olds.

Although the Substance Abuse Subtle Screening Inventory-3 (SASSI-3; F. G. Miller & L. E. Lazowski, 1999) is widely used with college students (L. Myerholtz & H. Rosenberg, 1998), it is unclear whether the SASSI-3 is appropriate for use with this population. The authors investigated the SASSI-3's psychometric capabilities in a college student sample (N = 230). They found that the SASSI-3's psychometric properties are equal to or exceed those of the Michigan Alcoholism Screening Test (M. L. Selzer, 1971), the CAGE (J. A. Ewing, 1984), and the MacAndrew Alcoholism Scale-Revised (C. MacAndrew, 1965).

This study extends the Michigan Alcoholism Screening Test (MAST; M I, Selzer, 1971) literature base by examining 4 issues related to the validity of the MAST scores. Specifically, the authors ex a ...

Aims: To investigate the onset and outcome of alcohol dependence in subjects with childhood attention deficit/hyperactivity disorder (ADHD) in a Turkish sample. Methods: Among patients being treated for alcohol dependence, 15 had a history of childhood ADHD (ADHD (+)) and 45 did not (ADHD (-)). ADHD history was assessed according to DSM-IV criteria by a child and adolescent psychiatrist who interviewed the subjects and their close relatives. Severity of dependence was measured by the Michigan Alcoholism Screening Test. Subjects were followed up for 1 year for the assessment of relapse. Results: The age of onset for alcohol drinking, alcohol abuse and alcohol dependence were significantly lower in the ADHD (+) group than in the ADHD (-) group. Comorbid substance use was more prevalent in the ADHD (+) group. The study found no significant difference in the severity of alcohol dependence between ADHD (+) and ADHD (-) groups. During follow-up, 80% of the ADHD (+) subjects relapsed, compared with 55.6% in the ADHD (-) group. Relapse occurred on average 2.74 months earlier in the ADHD (+) group than in the ADHD (-) group. Conclusions: As found in other countries, alcohol dependence in Turkish subjects with childhood ADHD starts early and is relatively resistant to treatment. Early diagnosis and treatment of ADHD might help prevent alcohol- and substance-related disorders.

Two groups of driving-while-intoxicated (DWI) offenders with either one DWI offense or with repeat offenses were compared to a group of nonoffenders using the Minnesota Multiphasic Personality Inventory (MMPI-2) and the Michigan Alcoholism Screening Test (MAST). Demographic information was also collected regarding their prior legal history, family history, and blood alcohol level at the time of the DWI arrest. The results indicated both DWI groups had scored significantly higher than the comparison group on the K, Psychopathic Deviate (Pd) Scale, Over-Controlled Hostility (O-H) Scale, and MacAndrews Alcoholism Scale-Revised (MAC-R). The first offenders and multiple offenders did not differ significantly from one another. On the MAST, both DWI offender groups scored significantly higher than the nonoffenders. This time, however, the multiple offenders scored significantly higher than the first-offender group. Unexpectedly, the first offenders and multiple offenders did not differ with regards to blood alcohol level at the time of arrest. There were no significant differences noted with regard to prior legal history or family history of alcoholism for all three groups. These results are discussed with regard to assessment implications.

A case-control study on the relationship between alcohol dehydrogenase-2 (ADH2), aldehyde dehydrogenase-2 (ALDH2) and male probable alcohol use disorders (AUD) was performed in Khon Kaen, north-east Thailand. One hundred and fifty-three paired cases (probable AUD) and controls (non-probable AUD) were sampled from villagers aged 18-65 years using the modified Michigan Alcoholism Screening Test - Thai version, controls being matched for gender, age (+/- 4 years) and village. All of the cases and 86.9% of the controls were current drinkers. The percentage of ADH2*1/1 among cases was 47.1%, being significantly larger than the 29.4% among controls, and yielding a univariate odds ratio (OR) of 2.421* (95% confidence interval (CI) = 1.419-4.132) for developing probable AUD. The ALDH2*1/1 proportion among cases, 92.8%, was comparable to the 92.2% among controls, yielding a univariate OR of 1.100 (95%CI = 0.757-1.599). Multivariate analysis based on a conditional logistic regression model and a hierarchically well-formulated model strategy revealed that: (i) the OR of developing probable AUD due to 1 g increment of daily ethanol drinking was 1.110* among farmers (95%CI = 1.054-1.170); (ii) OR due to 1 g increment of daily ethanol drinking was 1.329* among non-farmers (95%CI = 1.109-1.593); (iii) OR due to either ADH2*1/1 or ALDH2*1/1 was insignificant; and (iv) the daily amount of smoking is independently associated with probable AUD. The present findings suggest that one of the genetic factors that may be related to probable AUD among Thai males living in the north-east is the ADH2 gene.

Although there are a wealth of clinically useful, brief, and low-cost assessment instruments available for use with drug-dependent populations, relatively few are broadly used in clinical practice. With an emphasis on: (1). the multidimensional nature of drug users' problems; and (2). assessments that can be integrated into empirically validated treatments, clinically useful assessments in four general categories (evaluation and diagnosis of drug dependence, identifying concurrent disorders and problems, treatment planning, and evaluation of treatment outcome) are briefly summarized. Progress in the field of drug abuse treatment has been significantly hampered by the failure to adopt, across research and clinical settings, a common set of assessments.

The present investigation was designed to study steroid hormones, alcohol and aggression interactions in men with a history of alcohol-related aggression (AGG+) and in a cross-sectional control population (AGG-).AGG+ (n = 40) and AGG- (n = 44) male volunteers completed the Buss-Perry Aggression Questionnaire and the revised Michigan Alcoholism Screening Test (MAST), after which plasma-free and total testosterone, 5alpha-dihydrotestosterone (DHT) and cortisol were determined.The AGG+ men displayed significantly (p.05) higher aggression and MAST measures compared with the AGG- men; however, no significant group differences were observed regarding the hormone values. Independently of the steroid hormones, MAST correlated positively with the hostility subscale in both AGG- and AGG+ groups. Free and total testosterone correlated positively with anger and DHT correlated positively with verbal aggression and anger, whereas cortisol correlated negatively with physical aggression and anger in the AGG- group. No significant correlations between steroid hormones and aggression parameters were observed in the AGG+ group. The age factor explained part of the MAST and steroid hormone correlations with aggression. A hormone and MAST independent moderation effect of age upon aggression was also found.The present study demonstrates an association between alcohol drinking and self-reported sober-state aggression, which implies that the etiology of alcohol misuse and aggressive behavior may involve common biological and/or social factors. These mechanisms, as well as age, androgens and cortisol, all represent factors that, in combination, regulate human aggression.

OBJECTIVES: To determine (1) the extent of agreement between the CAGE (acronym for cut down, annoyed by criticism, guilty about drinking, eye-opener drinks) and the Short Michigan Alcoholism Screening Test—Geriatric Version (SMAST-G) in identifying older persons who may have possible alcohol use disorders (AUDs) and (2) whether persons identified as having possible AUDs by each of these screening measures differ in their drinking, demographic, or health-related characteristics. DESIGN: Secondary analysis of a cross-sectional study using data from a self-administered mailed survey sample. SETTING: Three organizations were surveyed: (1) members of the American Association of Retired Persons and, in southern California, (2) managed care enrollees in a large medical group and (3) attendees of a community-based senior health center. PARTICIPANTS: One thousand eight hundred eighty-nine persons aged 55 and older completing a health risk appraisal for older persons (Health Risk Appraisal for the Elderly (HRA-E)). MEASUREMENTS: The HRA-E included items on drinking behaviors (including amount of alcohol use, the CAGE, and the SMAST-G) and health and demographic characteristics. RESULTS: Twenty-six percent of all persons screened positive on the CAGE or the SMAST-G. Fewer than half of all persons screening positive on either the CAGE or the SMAST-G, screened positive on both measures. Among current drinkers, persons screening positive on the SMAST-G alone drank less than persons screening positive on the CAGE alone, and these persons drank less than those screening positive on both the SMAST-G and the CAGE. More men screened positive on the CAGE alone than on the SMAST-G alone. CONCLUSION: Fewer than half of persons screening positive on either the CAGE or the SMAST-G screened positive on both measures, suggesting that these instruments may be capturing different aspects of unsafe drinking. A screening strategy employing both brief measures may identify more AUDs among older persons having differing demographic and health characteristics.

The study included 70 consecutive patients with fracture of the lower and upper limbs each and an equal number of age and sex matched normal control subjects. All the subjects were screened using the General Health Questionnaire (GHQ), the Michigan Alcoholism Screening Test (MAST), Carroll Rating Scale for Depression (CRSD), State-Trait Anxiety Inventory (STAI), Impact of Events Scale (IES), Fatigue Scale (FS) and the Perceived Stress Questionnaire (PSQ). Probable “Psychiatric cases” identified by the questionnaires underwent diagnostic psychiatric evaluation. As compared to normal controls, the limb fracture patients obtained significantly higher scores on the GHQ, MAST, CRSD, IES & FS but not on the STAI & PSQ. Psychiatric evaluation revealed significantly higher prevalence of psychiatric disorders in lower limb fracture patients (n=31) as compared to upper limb fracture patients (n=18) and control subjects (n=6). Limb fracture patients had a high prevalence of alcohol dependence/abuse (243%) and depressive disorders (6.4%). The results indicate that psychological intervention would greatly facilitate the management of these patients.

Despite a high prevalence of alcohol-related disabilities and the availability of cost-effective interventions, alcohol abuse and dependence commonly go undetected in hospital inpatients. In a university teaching hospital we compared three well validated screening methods for sensitivity and specificity—the Alcohol Use Disorders Identification Test (AUDIT, with various cut-off scores), CAGE (a four-question screening tool), and a 10-question version of the Michigan Alcoholism Screening Test (BMAST). A subset of patients also completed the DSM IV structured clinical interview for diagnosis. 1133 adult patients were randomly selected from all hospital admissions, with exclusion of day cases and patients too ill to be interviewed. Two-thirds of the patients were interviewed, most of the remainder being unavailable at the time. 30% of the men and 8% of the women met the DSM IV criteria for alcohol abuse or dependence. Sensitivities and specificities of the screening tools were as follows: AUDIT (with cut-off score > 8) 89% and 91%; CAGE 77% and 99%; BMAST 37% and 100%. 255 case records of patients scoring above the cut-off on one or more questionnaires were subsequently reviewed. The admitting team recognized an alcohol problem in only 46, of whom 17 were referred for appropriate follow up. As in previous hospital surveys, alcohol abuse and dependence was not receiving proper attention. The most efficient screening tool was the CAGE questionnaire.

The purpose of this paper is to review empirical data on currently used alcoholism screening instruments. It is the contention of this article that current established instruments have incorporated items significantly more characteristic of males' alcoholism or late stage problem drinking of women. They omit areas more germane to women's life course experiences, such as reproductive health issues and exposure to physical and sexual abuse. Indicators more appropriate for detecting problem drinking in women are proposed.

IntroductionSeveral studies show that attention-deficit/hyperactivity disorder (ADHD) may persist into adulthood, increasing the risk of antisocial behaviour, drug abuse, psychiatric comorbidities, aggressive behaviour, social impairment and suicide risk.ObjectivesAnalyze correlations among ADHD, substances abuse, alcoholism and suicide risk.AimThe aim of our study is to better understand the clinical features of ADHD during adulthood.MethodsWe analyzed the presence of ADHD symptoms, suicide risk and levels of hopelessness, alcoholism and substance abuse in a sample of 50 (40% males) in/outpatients of S. Andrea Hospital in Rome, between February and May 2016. We administered the following scales: Adult-Self Report Scale (ASRS), Columbia Suicide Severity Rating Scale (C-SSRS), Beck Hopelessness Scale (BHS), Michigan Alcoholism Screening Test (MAST), Drug Abuse Screening Test (DAST).ResultsIn our sample of 50 adult patients, 20% had ADHD symptoms (10 subjects). We found that those with ADHD showed more frequently death desires (85.7%; χ2 = 1.31; P = 0.25) and higher levels of hopelessness (66.7%; χ2 = 0.83; P = =0.36) if compared to subjects without ADHD symptoms (respectively 63% and 45.8%). In the overall group of ADHD patients, 10% showed severe alcoholism, 20% (χ2 = 1.39; P = 0.49) had a borderline behavior, whereas 40% presented a substance abuse (χ2 = 1.75; P = 0.18).ConclusionsADHD may represent a psychiatric disorder with an increased suicide risk. It would be important to screen for suicidality and comorbid symptoms routinely in ADHD in order to improve the treatment of the patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Objective: We aimed to examine the heavy metal bar patrons in Istanbul by means of self-reported questionnaires for psychiatric disorder symptoms. Material and Methods: Seventy-one volunteers from 4 popular heavy metal bars were included to the study. The Beck Depression Inventory, the Liebowitz Social Anxiety Scale (LSAS), the Adult Attention Deficit Disorder/Attention Deficit and Hyperactivity Disorder (ADD/ADHD) Scale and the Michigan Alcoholism Screening Test (MAST) were administered to the participants. Results: One fourth of the participants (25.4%) were under high risk for a depressive episode (BDI>17), 22 (32.3%) reported significant social anxiety (LSAS>30), and 41 (57.7%) showed moderate ADHD symptoms (Adult ADD/ADHD scale: 20-59). According to BDI score participants who were under the risk for depression showed higher scores in Adult ADD/ADHD scale scores than that of participants who were not under a risk for depression (p=0.001 for attention deficit; p=0.003 for hyperactivity; p=0.002 for impulsivity; p=0.001 for total score). In the study group, ADD/ADHD scale attention deficit score was positively correlated with the total fear, total avoidence and the total scores of LSAS (r=.359 p

Asian-Americans are a heterogeneous and rapidly growing population. The availability of and research on culturally specific assessment measures is an important consideration when working with Asian-American individuals. This chapter reviews substance use assessment instruments available for use in Asian populations and their psychometric properties. Both substance- and alcohol-specific abuse and dependence assessment measures have been translated and researched in different Asian populations. Specifically, the Addiction Severity Index, Drug Abuse Screening Test, Severity of Dependence Scale, CRAFFT, Alcohol Use Disorders Identification Test, Michigan Alcoholism Screening Test, and CAGE questionnaire have been evaluated. Notably, much of the research on psychometric properties of alcohol and substance assessment measures in Asian populations has been conducted in their respective countries and on limited samples. Further research into additional Asian subgroups, languages, females, and adolescents is necessary.

Alcoholism is a frequent and underdiagnosed mental health problem of later life. Its detection often relies on the use of screening instruments such as the Michigan Alcoholism Screening Test (MAST). The authors investigated the properties of the scale in a sample of 122 older adults recruited from a geriatric outpatient service in Sao Paulo, Brazil. Thirty-five subjects met criteria for the diagnosis of alcohol abuse or dependence according to DSM-III-R. The cutoff point 4/5 was associated with a sensitivity of 91.4%, specificity of 83.9%, and positive and negative predictive values of 69.6% and 96.0%, respectively. These results indicate that the MAST is a good screening test for the detection of alcohol abuse and dependence in an elderly male population and that the MAST should be used in combination with a questionnaire assessing the frequency/quantity of alcohol consumption to optimize the detection of cases and characterize their current drinking patterns.

The Michigan Alcoholism Screening Test (MAST), a commonly used instrument of alcohol-related problems, was examined to determine whether it assessed the same constructs in individuals from religions with different proscriptions regarding the use of alcohol.The MAST was completed by participants in the longitudinal Joint Child Health Project when they were approximately 23 years old. Subjects of this study (N= 747; 505 men) were 465 Hindus, 223 Catholics and 59 Muslims who reported drinking alcohol. Measurement invariance, the determination that the same constructs are being measured across groups, was tested by comparing factor invariance using multigroup structural equation modeling.The Hindu and Catholic groups had similar factor structures to those found in previous Australian, Canadian and U.S. samples. Metric invariance was obtained for the Hindu and Catholic groups, but not for the Muslim group.These findings suggest the measurement of MAST factors is invariant across a fairly broad segment of the population in which the MAST might be used. However, the lack of invariance in this sample of Muslims suggests that the MAST is not an appropriate instrument to use among all groups of drinkers. These findings highlight the importance of testing for invariance when using psychological measures to compare heterogeneous samples.

The construct validity of the Michigan Alcoholism Screening Test (MAST) and the Alcohol Use Disorders Identification Test (AUDIT) in screening for current DSM-IV alcohol dependence disorders with persons convicted of multiple offenses of Driving Under the Influence (DUI) is evaluated. These tests were administered to 126 DUI offenders presenting for court-ordered inpatient treatment at an agency. DSM-IV alcohol disorders are evaluated for a representative subset of clients in this program using National Longitudinal Alcohol Epidemiologic Surveys' DSM-IV Alcohol Dependence Diagnostic Criteria and Associated Questionnaire Items. Both instruments exhibit acceptable internal consistency. The MAST and The AUDIT correlate moderately well with each other (r=0.617). The MAST correlates more highly (r=0.602) than the AUDIT (r=0.432) with DSM-IV. Future research should examine if the results reported here apply to other multiple offender DUI programs. It is recommended that such programs employing test instruments evaluate their construct validity in a similar method.

Background Previous findings suggest that cognitive factors and expectancies related to drinking can mediate subjective sexual arousal as well as aggression in men. Our aim was to investigate the drinking habits and alcohol-related expectancies that might predispose men to sexually aggress in two groups of sexual offenders. Method Men convicted of rape (n = 10) were compared with men convicted of child molesting (n = 10) and with control subjects (n = 31). Current drinking habits (while not in prison) were assessed by self-report, and the extent of alcohol abuse was mapped by the Michigan Alcoholism Screening Test (MAST; Selzer, 1971). Cognitive expectancies related to alcohol use were explored by the standard Alcohol Expectancy Questionnaire (AEQ; Brown et al., 1980). Results The majority of the men who committed rape (70%) but only a third of the men convicted of child molesting were diagnosed with antisocial personality disorder. Alcohol abuse was common in men convicted of both rape and child molesting and the men convicted of rape expected significantly more positive effects from drinking than the control group. Both sex offender groups were the only groups to express significant alcohol-related cognitive expectancies linked to arousal and aggression. Expectancy patterns were directly linked to the antisocial personality characteristics. Conclusion Alcohol abuse is common in men who commit both rape and child molesting. Heavy drinking and the anticipation of alcohol effects such as sexual enhancement, arousal and aggression may facilitate sexual aggression in offenders with antisocial personality disorder. Copyright © 2001 Whurr Publishers Ltd.

Objective To measure a 1-day point prevalence of alcohol dependence among hospitalized patients and to assess practices of detection, evaluation, and diagnosis of alcohol problems. Patients and Methods On April 27, 1994, a total of 795 adult inpatients at 2 midwestern teaching hospitals were asked to complete a survey that included the Self-administered Alcoholism Screening Test (SAAST). The records of SAAST-positive patients were reviewed to determine the numbers of patients receiving laboratory screening for alcoholism, addiction consultative services, and a discharge diagnosis of alcoholism. Results The survey response rate was 84% (667/795). Of the 569 patients who provided SAAST information, 42 (7.4%) had a positive SAAST score and thus were identified as alcohol dependent. Thirteen (31%) of the 42 alcoholic patients received addiction or psychiatric consultative services during their hospitalization. Serum γ-glutamyltransferase was measured in 4 (11%) of the 38 actively drinking alcoholic patients. Three (7%) of 42 alcoholic patients received a discharge diagnosis of alcohol abuse or dependence. Conclusions The alcoholism prevalence rate was lower than those observed in several other US hospitals. Laboratory testing may be underutilized in identifying hospitalized patients who may be addicted to alcohol. Physician use of consultative services and diagnosis of alcohol dependence had not improved from similar observations more than 20 years earlier. These findings may indicate persistent problems in physician detection, assessment, and diagnosis of alcoholism.

The present study examined the relation between alcohol-related expectancies, body sensation fear and reactions to cues for alcohol following a hyperventilation task. Forty-two undergraduate students participated for course credit. Each student hyperventilated for 5 min, paced at a rate of 30 breaths per minute. Following hyperventilation, each student was exposed to containers with alcohol (beer and wine coolers), with subjective urge to consume and heart rate measures taken. Path analysis supported models associated with tension reduction and self-focused attention expectancies as significant contributors to increased urge to consume alcohol and lowered heart rate following hyperventilation. However, social-anxiety-related expectancies failed to demonstrate a relationship. These results suggest that additional work on the tension reduction model of alcohol use should examine physiological stressors in association with subject characteristics such as proneness to experience panic symptoms.

The present study was designed to test the hypothesis that preference for stronger sweet solutions may be associated with the genetic risk for alcoholism. Thirty-two male patients with alcohol dependence admitted for alcoholism in-patient treatment and 25 non-alcoholic control subjects were used in the study. Hedonic response to sweets was evaluated using the sweet preference t est. Family history of alcoholism was evaluated using a Russian version of the Michigan Alcoholism Screening Test modified for the assessment of the alcohol-related behaviour of the subject's biological father. Similar to our previous findings, alcoholics were far more likely to prefer the highest offered sucrose concentration (0.83 M), compared to non-alcoholic controls. Such preference was de termined by two factors: positive family history of alcoholism and alcoholic status. Statistically, these factors contributed to the lik elihood of preferring sweet solutions independently. Therefore, the effects of these factors may enhance each other. These findings suppor t the hypothesis that preference for a stronger sweet solution is associated with a paternal history of alcohol dependence and may re flect a genetic predisposition to alcoholism.

Introduction: Beginning early in childhood, patients with sickle cell disease (SCD) are at risk of life-threatening and debilitating health events. Despite the high morbidity and mortality of this disease, hematopoietic cell transplantation (HCT), the only curative therapy for SCD, remains underutilized. Between 2008 and 2012, an average of 76 HCTs per year were performed on patients with SCD in the United States (US), a remarkably low rate considering that nearly 100,000 people in the US are living with this disease and approximately 1,000 infants are born with SCD in the US each year. Multiple factors may contribute to the low rates of HCT in this population. However, there is a paucity of data concerning the level of awareness of HCT among parents and guardians of children with SCD, an important factor to consider in the assessment of HCT utilization rates. Objectives: To identify the proportion of parents and guardians of children with SCD who are aware of HCT as a treatment option, and to evaluate the relationship between patient demographics and parental/guardian awareness of this treatment option. Methods: A 25-item paper-based survey was developed to assess parent/guardian awareness of HCT, based upon feedback from leaders in SCD community health organizations and pediatric hematologists. The survey was administered to parents/guardians of pediatric patients with SCD during routine outpatient appointments with their child's hematologist and at SCD community events sponsored by participating clinical sites. The survey was anonymous, and a $5.00 gift card was provided to all participants who completed the survey. Participants were recruited from four clinical centers across three cities in the Midwestern United States. All parents/legal guardians of children ( Results: 229 respondents (95% biological parent, 1% adoptive parent, 4% legal guardian) have participated in the study to date. 95% of all eligible parents/guardians agreed to participate. 82% of study respondents indicated that they have heard of HCT as a treatment option for SCD (N=187). 53% indicated that their child's physician has talked to them about HCT at some point in the past (N=120). On average, patients were 2.84 years old when the parent/guardian first heard about HCT (N=178, 95% CI: 2.31-3.37); patients were 3.08 years old on average when the child's physician first mentioned HCT (N=113, 95% CI: 2.42-3.75). 76% of respondents indicated that they are aware that HCT can potentially cure SCD (N=172). Higher parent/guardian education level and SS genotype were associated with having heard about HCT as a treatment option. SS genotype was associated with having been informed about HCT by their child's physician. Having been informed about HCT by their child's physician was associated with parent/guardian awareness that HCT is a potentially curative treatment. Conclusions: The majority of parents/guardians of children with SCD enrolled in this study have heard of HCT and are aware that HCT is a potentially curative treatment. In this population, non-physician sources of information and parent/guardian education level play an important role in awareness of this treatment modality. Physician-family discussion about HCT plays an important role specifically in parent/guardian awareness of the curative potential of this treatment. These data underscore the importance of physicians discussing HCT with families, particularly those who have limited resources to research treatment options on their own. Disclosures Quinn: Amgen: Research Funding; Eli Lilly: Research Funding; Silver Lake Research Corporation: Consultancy. Hsu:Centers for Medicare and Medicaid Innovation: Research Funding; Mast Therapeutics: Research Funding; Pfizer: Consultancy, Research Funding; Purdue Pharma: Research Funding; Sancilio: Research Funding; Gerson Lehman Group: Consultancy; Eli Lilly: Research Funding; EMMI Solutions: Consultancy; Astra Zeneca: Consultancy, Research Funding; Hilton Publishing: Consultancy, Research Funding. Piccone:Novartis: Other: Speaker.

Introduction: Patients with hemophilia A are at risk for acute bleeding which may affect muscles and other soft tissues but characteristically involves joints. Prophylaxis with factor VIII (FVIII) is the optimal treatment to prevent bleeding into joints and, when begun at a young age, may prevent arthropathy. BAX 8551, a polyethylene glycol (peg)ylated, full-length, recombinant FVIII built on ADVATE2, demonstrated extended half-life, efficacy, and safety for prophylaxis and treatment of bleeding in patients with severe hemophilia A. Methods: A phase 3, prospective, uncontrolled, multicenter study was performed in pediatric patients with severe hemophilia A without history of inhibitors. To be eligible, patients aged Results:Sixty-six patients were treated with a mean (SD) BAX 855 dose of 51.1 (5.5) IU/kg at a mean (SD) frequency of 1.8 (0.2) infusions/week. Fourteen of 66 patients (21.2%), 3/32 (9.4%) in the younger and 11/34 (32.4%) in the older cohort, had a total of 23 target joints at screening. The number of target joint bleeds decreased during a mean (SD) of 48.5 (7.7; median: 49.0) prophylactic EDs/patient. Five of 66 (7.6%) patients had at least 1 target joint bleed, 1/32 (3.1%) in the younger and 4/34 (11.8%) in the older cohort. The point estimate for the mean (95% CI) annualized rate of target joint bleeds was 0 (0 - infinity; median: 0) compared to an annualized rate of all joint bleeds of 1.1 (0.6 - 1.9; median: 0) and an annualized rate of all bleeds of 3.0 (2.2 - 4.2; median: 2.0) (Table 1). The point estimate for the mean (95% CI) annualized bleeding rate (ABR) in 52 patients without target joints was 2.9 (2.0 - 4.2; median: 2.0) and was similar in 14 patients with target joints at screening at 3.5 (1.9 - 6.6; median: 2.1). In the younger cohort, the ABR was lower in patients with than those without target joints. However, the number of patients During BAX 855 prophylaxis, no new target joints developed in any patient. Ten of 14 patients had at least 1 target joint revert to a non-target joint. In 8 of these 10 patients, 4 with 1 and 4 with 2 target joints, all target joints resolved. Conclusions:These results suggest that twice weekly infusion of BAX 855 is effective in the prevention of bleeding into target joints and may revert target to non-target joints in pediatric patients with severe hemophilia A. 1BAX 855 (Baxalta US Inc., now part of Shire) is licensed in the US and Japan under the trade name ADYNOVATE. 2ADVATE is a trade mark of Baxalta US Inc., now part of Shire. Disclosures Dunn: NovoNordisk: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Kedrion: Research Funding; Pfizer: Research Funding; CSL Behring: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Biogen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Baxalta (now part of Shire): Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bayer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Octapharma: Research Funding. Thompson:Eli Lily: Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Research Funding; bluebird bio: Consultancy, Research Funding; ApoPharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Mast: Research Funding; Amgen: Research Funding; Baxalta (now part of Shire): Research Funding. Engl:Shire: Employment, Equity Ownership. Sharkhawy:Baxalta (now part of Shire): Employment. Abbuehl:Baxalta (now part of Shire): Employment.

Introduction: Cognitive impairment is a serious complication of sickle cell disease (SCD) that affects both children and adults. While it is known to adversely affect school performance and overall development in children, its functional impact in adults is not known. Importantly, poor disease self-management and adherence to hydroxyurea are major problems in SCD and are likely to be impacted by cognitive impairment. In the study presented herein, we hypothesized that lower cognitive function in areas of memory and executive function would be associated with worse adherence to hydroxyurea therapy in adults with SCD. Methods: We designed a cross-sectional study of patients with SCD from the University of Pittsburgh Medical Center Adult Sickle Cell Clinic. Patients who underwent neurocognitive testing between 2011 and 2016 as part of an ongoing neurocognitive study and whose adherence to hydroxyurea therapy has been monitored by a dedicated clinical nurse were included. Performance on four neurocognitive tests of verbal learning, memory and executive function - the Hopkins Verbal Learning Test-Revised (HVLT-R) retention, HVLT-R total recall, Delis-Kaplan Executive Function System Trail Making Condition 4 vs. 5, and Color Word Condition 3 - were selected a priori as explanatory variables. We explored the association between the four test scores and the most recent adherence data at the time of the study. Adherence measures included the laboratory biomarkers red blood cell corpuscular volume (MCV) and percentage of fetal hemoglobin (HbF) - whose values are expected to rise with hydroxyurea therapy - and the patient's self-report of adherence categorized as "good" (≥ 80% adherence) or "less-than-good" (< 80% adherence). Differences between groups were compared by 2-sided t-test or chi-square tests where indicated. Results: Study participants (n=48) had a mean age of 35.2 years (range 22-60) and were predominantly female (58.3%). Fifty-two percent had higher than high-school level education, and 72.9% had a HbSS or HbS/β0 thalassemia phenotype. There were no statistically significant differences between the "good" adherence and "less-than-good" adherence groups with regard to these baseline characteristics. As expected, the mean MCV, an objective marker of hydroxyurea adherence, was significantly higher in the "good" adherence group (102.3 ± 15.0 vs. 89.1 ± 11.5 fL, p=0.005), corroborating the patients' self-report. We observed a statistically significant positive correlation between the HVLT-R retention score and MCV that remained significant after adjustment for demographic characteristics (Pearson r=0.309, p=0.033) and a similar correlation with HVLT-R total recall (Pearson r=0.269, p=0.065). A similar trend between HVLT-R retention and HbF percentage was observed (Pearson r=0.260, p=0.081). The mean HVLT-R retention and HVLT-R total recall scores were higher in the "good" adherence group (80.1% ± 27% vs. 64.9% ± 33%, and 41.9% ± 14% vs.34.1% ± 13%, respectively), although the difference between the two groups did not reach statistical significance. There was no significant difference in performance on the Trail Making Condition 4 vs. 5 or the Color Word Condition 3 tests. Discussion: Our study suggests that adherence to hydroxyurea therapy in adult patients with SCD might be affected by impairment in episodic memory, as measured in our study through HVLT-R retention, with qualitatively similar patterns by HVLT-R total recall. Although more extensive investigation is warranted, these results suggest that a brief, targeted neurocognitive assessment should be considered as a component of any strategy aimed at improving adherence to hydroxyurea and other therapeutic interventions in patients with SCD. Disclosures Jonassaint: Sicklesoft: Other: officer of Sicklesoft. Kato:Mast Therapeutics: Consultancy; Bayer: Research Funding.

Background: Pain is the leading cause of hospitalization and pediatric emergency department (PED) visits for children with sickle cell disease (SCD). The National Heart, Lung and Blood Institute (NHLBI) recommends rapid evaluation and treatment of moderate-severe vaso-occlusive pain episodes (VOEs) in the acute care setting, with timely pain assessments and repeat analgesia delivery to control pain. Quality-of-care indicators for children with SCD include the receipt of parenteral analgesia within 30 minutes of triage or 60 minutes of registration, with frequent pain reassessments and re-dosing of opioids within 30 minutes. Objective: To assess adherence to the 2014 NHLBI guideline for VOE management with respect to time to 1st and 2ndparenteral opioid delivery and time to pain assessment and its reassessment frequency in PEDs across the United States and Canada. Methods: A retrospective chart review evaluated 20 consecutive charts per site from 20 high-volume PEDs (n=400 charts total) including 14 Pediatric Emergency Care Applied Research Network (PECARN) sites, assessing children age 3-21 years with SCD/VOE receiving parenteral opioids. Time from arrival and triage/room placement (whichever came first) to 1st and 2ndparenteral opioid administration, and time to pain assessment and reassessment were assessed. Adoption of bedside registration after triage/room placement at many sites decreased the relevance of a 60-minute window from registration; we therefore focused on triage time/room placement and arrival time to determine our quality outcome measures. Results: Annual SCD/VOE volume based on ICD-9 code discharge diagnosis for the 20 PED sites combined was 6082 visits, with an admission rate of 66%. Overall admission rate for the 400 patient chart review was 67%. Mean age of the chart review cohort was 14±5 years, 54% were female, and the majority (92%) had HbSS. Median (IQR) time from arrival to room placement was 4 (0, 10) minutes, while median time from triage/rooming to intravenous (IV) catheter placement was 46 (28, 76) minutes. Median time from triage/room placement to 1st parenteral opioid was 56 (32, 94) minutes; 24% within 30 min, 28% 31-60 min, and 48% >60 min. A total of 46% of patients received parenteral opioids within 60 minutes of ED arrival time. Analysis of children who received two or more opioid doses revealed that only 17% received a 2nd parenteral opioid dose within 30 minutes of their 1st dose. Only 17% of the cohort received both their 1st dose within 30 minutes of triage and 2nd parenteral opioid within 30 minutes of the first. Mean total number of parenteral opioid doses given while in the PED (min-max) was 2.4 (1-13), over a median (IQR) of 5 hours (4, 7) spent in the PED prior to disposition home or to the inpatient ward. Of admitted patients (n=268), 18% received only a single dose of parenteral opioids while in the PED, 30% received 2 doses and 52% received 3 or more doses. Pain assessment scores were documented in 99% of charts, within a median of 3 minutes (0, 12) of triage/rooming, and 89% had documentation of pain reassessment, occurring within a median of 27 minutes (10.0, 52.0) of 1stparenteral opioid delivery. The mean number of pain assessments documented during the PED stay was 5±2. Conclusions:Delays in pain management for children with SCD commonly occur across PEDs, despite NHLBI recommendations for rapid evaluation and treatment of VOEs in the acute care setting. Only a minority of children received rapid parenteral opioid administration defined by the 2014 NIH guidelines, although pain assessment is often performed immediately and with frequent reassessments. Although the majority of patients are rapidly triaged and placed in rooms, children commonly wait 45 minutes or longer for IV placement, which could contribute to delays in delivery of parenteral opioids. This data help identify areas for quality improvement that can be targeted to improve patient care in the future. Disclosures Morris: Nourish Life: Patents & Royalties: I am inventor of IP owned by UCSF Benioff Children's Hospital, Licenced to Nourish Life; Nestle: Honoraria; Calithera: Consultancy; Endeavor: Consultancy; Pfizer: Consultancy; MAST: Research Funding. Dampier:Eli Lilly and Company: Consultancy, Research Funding. Hsu:Pfizer: Consultancy, Research Funding; Hilton Publishing: Consultancy, Research Funding; EMMI Solutions: Consultancy; Purdue Pharma: Research Funding; Gerson Lehman Group: Consultancy; Mast Therapeutics: Research Funding; Centers for Medicare and Medicaid Innovation: Research Funding; Astra Zeneca: Consultancy, Research Funding; Sancilio: Research Funding; Eli Lilly: Research Funding.

Eighty-two hospitalized alcoholics receiving pharmacological aversion therapy (PAT) over a 10-day treatment interval completed cognitive, behavioral, and psychophysiological measures evaluating conditioned aversion to alcohol. Pre-post assessments provided convergent support for the efficacy of PAT vis-à-vis production of conditioned aversion to alcohol. Positive alcohol-related outcome expectancies were significantly reduced, whereas confidence that drinking could be avoided in various high-risk situations for consumption was increased following PAT. Behavioral and cardiac rate assessments revealed significant changes following PAT that were specific to alcoholic beverages and potentially reflective of conditioned alcohol aversion. Patients with more extensive pretreatment experiences with alcohol-associated nausea and greater involvement in antisocial conduct appeared to be less susceptible to the PAT conditioning protocol.

Although only a handful of studies have examined alcoholism among lesbians, high rates of alcoholism among lesbians are often reported. This study investigated the prevalence of alcoholism and its ...

Alcohol consumption is a primary or secondary factor in many work-related accidents, suicides, homicides, violent crimes, and motor vehicle accidents. The absentee rate in alcoholics is 3.8 to 8.3 times greater than that for nonalcoholic workers. The purpose of this research was to evaluate the effectiveness of two interview questionnaires—the Brief Michigan Alcoholism Screening Test (BMAST) and the CAGE (cut down, annoyed by criticism, guilty about drinking, and eye-opener drinks). The validity of the BMAST and the CAGE as screening tools for alcohol problems has been verified in a number of nonworkplace settings. If they prove to be as effective for screening workers in an occupational medical setting, follow-up definitive diagnoses could result in earlier detection of alcohol problems and allow prompt intervention. Positive outcomes could include a safer workplace, less absenteeism, improved worker productivity, and a reduction in personal and family problems caused by drinking.

Alcoholism is one of the most common psychosocial disorders, affecting approximately 10% of the general population. The impact of alcoholism on the care of patients with other medical illnesses has not been addressed in many of these populations, including patients with end-stage renal disease (ESRD) undergoing hemodialysis. We set out to determine the prevalence of alcoholism in an urban hemodialysis population and ascertain whether alcoholism had an effect on compliance in this population. One hundred sixty-three urban hemodialysis patients were screened using the Michigan Alcoholism Screening Test (MAST), a 25-item questionnaire that has been validated in multiple trials. Forty-five patients (27.6%) scored 5 or greater on the MAST. The MAST-positive subjects were younger (age, 55 +/- 15 years versus 64 +/- 13 years) and tended to be men (58% versus 43%). There was no significant difference in the incidence of diabetic kidney disease; however, there were significantly more human immunodeficiency virus (HIV)-positive patients in the MAST-positive group. The dietary compliance measures of predialysis potassium or phosphorus levels did not differ between the two groups. A trend toward lower serum albumin level was evident in the men in the MAST-positive group (3.75 +/- 0.57 versus 3.91 +/- 0.30 g/dL; P = 0.0212). In conclusion, there is a high prevalence of alcoholism in the urban dialysis population. Alcoholic patients with ESRD are younger and tend to be men. HIV-positive patients with ESRD have a high prevalence of concomitant alcoholism. Compliance indicators of predialysis potassium and phosphorus levels are not affected. However, nutritional status, measured by serum albumin level, tends to be poorer in the alcoholic group.

The performance of alcohol use disorder screening instruments (CAGE, BMAST, AUDIT, TWEAK) at various cut points were compared between a Mexican American emergency room (ER) sample (n = 586) and a sample of ER patients in Mexico (n = 1,417) using ICD-10 and DSM-IV criteria for alcohol dependence and harmful drinking/abuse by gender and injury status. Lowering cut points improved instrument performance substantially for females in both samples. Further research is needed to explore instrument performance by gender and level of acculturation.

Assessment of alcohol-related problems is essential in psychiatric settings. The Michigan Alcoholism Screening Test (MAST) has been the most commonly evaluated self-report alcohol assessment tool in psychiatric settings. However, due to a large variation in reports of findings and conclusions, a clear understanding of the utility of the MAST in psychiatric settings continues to be elusive. Therefore, the major goals of this investigation were (1) to integrate the available information pertaining to the validity of the MAST when used in psychiatric settings, and (2) to investigate factors that may moderate the performance of the MAST.Using clinically determined alcohol-related diagnosis as a criterion, a meta-analytic integration of nine published studies investigating the criterion validity of the MAST in psychiatric settings is presented.Findings revealed that the MAST is significantly valid when used in psychiatric settings. However, sensitivity estimates were found to be of greater magnitude than specificity estimates. Further, validity estimates of the MAST were found to be higher in psychiatric samples that had a greater proportion of women and in samples that exhibited higher base rates of alcohol-use disorder.Results of this integration support the continued use of the MAST in psychiatric settings as a screening instrument and suggest that those who administer the MAST must be attentive to particular characteristics of respondents.