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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.01.002 Byline: Prabha S. Chandra (a), Michael P. Carey (b), Kate B. Carey (b), K.R. Jairam (a), N.S. Girish (a), H.P. Rudresh (a) Keywords: Tobacco use; Nicotine dependence; Smoking; Psychiatric patients; India Abstract: Tobacco use among psychiatric patients in developing countries has not been well-investigated. To address this issue, we screened consecutive admissions to a major psychiatric hospital in southern India, and assessed the prevalence and correlates of tobacco use and nicotine dependence. Patients (n=988) provided information about their use of tobacco products, and participated in an interview that included the Fagerstrom Test for Nicotine Dependence as well as measures of other substance use. Three hundred and fifty-one patients (36%) reported current tobacco use, with 227 (65% of all users) reporting moderate to severe nicotine dependence. Current tobacco use as well as nicotine dependence were associated with male gender, a diagnosis of bipolar disorder, and risk of other substance use problems. The cultural context of these findings, and the implications for tobacco control among psychiatric patients, are discussed. Author Affiliation: (a) Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India (b) Center for Health and Behavior, 430 Huntington Hall, Syracuse University, Syracuse, NY 13244-2340, USA

Objective: This study was a post hoc analysis of linguistic and motivation variables found in writing samples following the administration of two mailed brief interventions. Method: At-risk college drinkers (N = 100) received personalized normative feedback (PNF) or an alcohol education (AE) brochure via mail. Participants responded to open-ended questions describing their reactions to the information they received. The writing samples were then coded for linguistic characteristics using the Linguistic Inquiry and Word Count program and for proportions of self-motivational statements using a modified version of the Motivational Interviewing Skills Code. Results: Group comparisons indicated that the PNF group used a significantly higher percentage of first-person-singular and school-related words, whereas the AE group used a higher percentage of discrepancy, second-person and body-related words. Furthermore, the PNF group produced more language consistent with motivation to change than did the AE group. Hierarchical regressions testing mediation and moderation indicated that linguistic references to school and motivation moderated the group effect on changes in consumption during the heaviest drinking week. Further, although the group predicted reduction in heavy, episodic drinking, its effect was completely mediated by linguistic variables. Conclusions: Findings confirmed that PNF elicits distinct verbal responses that are associated with increased motivation and behavior change., MAILED BRIEF INTERVENTIONS have been shown to decrease alcohol use among at-risk college drinkers (Agostinelli et al., 1995; Collins et al., 2002; Walters et al., 2000). Establishing this causal relationship [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2004.08.027 Byline: Henri Chabrol (a), Emmanuelle Duconge (a), Carine Casas (a), Charlotte Roura (a), Kate B. Carey (b) Abstract: This study investigated the relations between anxious, depressive and borderline symptomatology, motivations for cannabis use, and cannabis use and dependence among 212 adolescents and young adults, 114 of whom were cannabis users. Motives for cannabis use were assessed using the Marijuana Motives Measure (Simons, J., Correia, C. J., Carey, K. B., & Borsari, B. E. (1998). Validating a Five-Factor Motives Measure: Relations with use, problems and alcohol motives. Journal of Counseling Psychology, 45, 265-273.). In three sets of regression analyses, motives, cannabis use frequency, and cannabis dependence served as criterion variables. First, when motives were regressed on psychopathological measures, borderline symptomatology predicted expansion motives in both boys and girls. Second, when frequency of use was regressed on motives and psychopathological measures, enhancement motives were the only significant predictor among boys and expansion motives were the only significant predictor among girls. Finally, when cannabis dependence was regressed on motives and psychopathological measures, borderline symptomatology was the only significant predictor in boys and expansion motives were the only significant predictor in girls. This study suggests the importance of motives and borderline symptomatology in the understanding of cannabis use and dependence among adolescents and young adults. Author Affiliation: (a) Universite de Toulouse-Le Mirail, France (b) Syracuse University, United States

Objective: Heavy drinking is prevalent on college campuses, and collegiate sporting events may precipitate heavy drinking. Despite this, relatively few studies have examined student drinking on the days of sporting events. In 2003, Syracuse University won the men's National College Athletic Association basketball championship; ongoing data collection allowed an investigation of alcohol consumption at Syracuse University during the two Final Four game days, when the semifinals and championship games are played. The goals of the study were to examine the level of alcohol use on these days and to examine factors related to game-day consumption. Method: As a part of an ongoing study, 206 undergraduate students completed several questionnaires, then returned daily drinking diaries at 1-week intervals for 4 consecutive weeks. Results: Alcohol consumption levels on the two game days exceeded what is typical on campus. Further analyses conducted using zero-inflated negative binomial regression modeling demonstrated that heavier drinkers were more likely to drink alcohol, and drink alcohol heavily, on both game days. Furthermore, lack of impulse control was independently associated with an increased likelihood of drinking on both days. Conclusions: Although results from this study should be considered preliminary, these data document heavier drinking associated with high-profile athletic events. Sporting events may be a particularly opportune time and venue for collegiate risk-reduction programs., HEAVY DRINKING IS PREVALENT on college campuses nationwide (Douglas et al., 1997; Meilman et al., 1997; Wechsler et al., 1995), and college students report a wide range of negative consequences [...]

An experimental manipulation to investigate the relationship between substance use and substance-free behaviors in a nonclinical sample of 133 young adults is conducted. The results demonstrate that the decreases in substance use can be achieved by increasing engagement in substance free behaviors.

Objective: The purpose of this study is to determine the accuracy of retrospective estimated blood alcohol concentrations (eBACs) for re-creating intoxication resulting from a naturally occurring drinking event. This study identified five eBAC equations, applied them to self-report data and compared the results to actual blood alcohol concentration obtained by a breath test. Method: A convenience sample of 109 drinkers was recruited near drinking establishments and asked to provide breath alcohol concentration (BrAC) samples. Participants were contacted by telephone on the next waking day to gather data required for five algorithms that determine eBAC. BrAC and eBAC obtained from each equation were compared to determine the level of agreement between the two approaches. Results: eBACs correlated highly with each other (r ≥ 0.99); [R.sup.2] for all algorithms ranged from 0.54 to 0.55 with BrAC as the criterion. On average, eBAC equations overestimated BrAC. Regression analysis identified the amount of time spent drinking, number of standard drinks, weight and year in school as factors related to discrepancy. Conclusions: These data indicate that, although all equations produce eBACs that are highly related, their relationship to BrAC does vary across equations. Using the best fitting equation, eBAC is more strongly correlated with BrAC when intoxication is less than 0.08 g/210 L of breath, and the magnitude of the relationship decreases as intoxication rises. (J. Stud. Alcohol 66: 130-138, 2005), BLOOD ALCOHOL CONCENTRATION (BAC) is receiving attention as an event-level index of problematic drinking because it is a numerical representation of intoxication easily compared across individuals. Put simply, BAC is [...]

Objective: The purpose of this study was to evaluate the test-retest reliability of the Timeline Followback (TLFB) interview for assessing daily alcohol and drug use with adults living with a severe mental illness. Method: Participants were 132 psychiatric outpatients (64% men) with a confirmed schizophrenia-spectrum (52%) or major mood disorder (48%) and a lifetime history of substance use disorder. They completed a 90-day TLFB twice, separated by a mean of 5 days, and represented 55% of the participants who originally consented to be in the study. Results: Test-retest reliability coefficients ranged from 0.73 to 1.00 (rounded) for 30-day TLFB and from 0.77 to 1.00 (rounded) for the 90-day TLFB. Within-subicet comparisons of means across the three 30-day windows revealed no significant differences, and no degradation of the magnitude of the reliability coefficients was observed with increasingly distant assessment periods. Conclusions: The TLFB is a reliable method of assessing alcohol and drug use in outpatients diagnosed with severe mental illness. (J. Stud. Alcohol 65: 774-781, 2004), THE FREQUENT CO-OCCURRENCE of substance use and misuse with severe mental disorders requires that alcohol and drug use behavior be assessed in psychiatric treatment settings. Epidemiological data indicate that one [...]

This study examined two aspects of affect dysregulation as risk factors for alcohol-related problems. From a sample of 592 undergraduates, 442 alcohol users were examined on measures of impulsivity, lability, alcohol use, and alcohol-related problems. As expected, affect lability and impulsivity significantly increased risk for alcohol problems even after controlling for gender and lifetime-use frequency. Impulsivity was further examined as a vulnerability factor, potentially enhancing the relations between use frequency and problems and affect lability and problems. Impulsivity did not moderate the use frequency--problems relationship. However. the relationship between affect lability and problems was greatest among participants with higher degrees of impulsivity. The results demonstrate that individual differences in affect dysregulation are associated with alcohol-related problems in young adults. Key Words: Affect dysregulation; Alcohol-related problems: Affect lability; Impulsivity., INTRODUCTION The majority of college students report drinking alcohol in the last month (1). Despite the prevalence of use, a considerably smaller proportion incurs problems (1). Understanding why some use [...]

This study investigated the efficacy of a 10-session, HIV-risk-reduction intervention with 221 women and 187 men receiving outpatient psychiatric care for a mental illness. Patients were randomly assigned to the HIV intervention, a structurally equivalent substance use reduction (SUR) intervention, or standard care; they were assessed pre- and postintervention and at 3- and 6-month follow-ups. Patients receiving the HIV-risk-reduction intervention reported less unprotected sex, fewer casual sex partners, fewer new sexually transmitted infections, more safer sex communications, improved HIV knowledge, more positive condom attitudes, stronger condom use intentions, and improved behavioral skills relative to patients in the SUR and control conditions. Patients receiving the SUR intervention reported fewer total and casual sex partners compared with control patients. Exploratory analyses suggested that female patients and patients diagnosed with a major depressive disorder were more likely to benefit from the HIV-risk-reduction intervention.

THIS STUDY used qualitative research methods to investigate the problem of sexual coercion among female psychiatric patients in India. Consecutive female admissions (n = 146) to the inpatient unit of a psychiatric hospital in southern India were screened regarding coercive sexual experiences. Women who reported coercion (n = 50; 34%) participated in a semi-structured interview to learn more about their experiences. Among these women, 24 (48%) reported that the perpetrator was their spouse, 13 (26%) identified a friend or acquaintance, and 10 (20%) identified a relative such as an uncle or cousin. Most experiences occurred in the women's homes. Thirty of the 50 coerced women (60%) reported that they had not disclosed their experience to anyone, and that they had not sought help. Women revealed a sense of helplessness, fear, and secrecy related to their experiences. The problem of sexual coercion is seldom addressed in mental health care in India; the prevalence and severity of such experiences warrant immediate clinical attention and continued research.

Objective: Many college students overestimate both the drinking behaviors (descriptive norms) and the approval of drinking (injunctive norms) of their peers. As a result, consistent self-other discrepancies (SODs) have been observed, in which self-perceptions of drinking behaviors and approval of drinking usually are lower than comparable judgments of others. These SODs form the foundation of the currently popular 'social norms approach' to alcohol abuse prevention, which conveys to students the actual campus norms regarding drinking behaviors and approval of alcohol use. However, little attention has been paid to the factors that can influence the magnitude of SODs. This research was conducted to address these issues. Method: This meta-analytic integration of 23 studies evaluated the influence of five predictors of SODs: norm type (injunctive or descriptive), gender, reference group, question specificity and campus size. These studies rendered 102 separate tests of SODs in descriptive and injunctive forms, representing the responses of 53,825 participants. Results: All five predictors were significantly related to self-other differences in the perception of norms. Greater SODs were evident for injunctive norms, estimates by women, distal reference groups and nonspecific questions, as well as on smaller campuses. Conclusions: More systematic attention should be given to how norms are assessed. In particular, SODs can be maximized or minimized, depending on the specificity of the behaviors/attitudes evaluated and the reference groups chosen for comparison. (J. Stud. Alcohol 64: 331-341, 2003), IN THE LAST DECADE, the 'social norms approach' to reducing excessive alcohol use on college campuses has enjoyed a swell of support (DeJong and Linkenbach, 1999; Keeling, 2000). This approach [...]

Objective: The purpose of this study was to evaluate the relationship between blood alcohol concentration (BAC) derived from an in vivo breath test and retrospective estimates of BAC (eBAC) for the same drinking event. The relationship was expected to be lower at higher levels of BAC as a result of inaccuracies in the recall of self-report data, Method: The sample consisted of 44 persons (64% male) who were walking away from a bar district adjacent to a university campus. After giving informed consent, participants provided a breath sample and contact information. The next day a research assistant telephoned the participants and conducted a brief interview, using the equation prescribed by the National Highway Traffic Safety Administration, to obtain the self-report data necessary to calculate the eBAC for the previous evening. Results: The actual BACs and eBACs were not significantly different, and they were highly correlated (r = 0.84, n = 43). BAC did predict the magnitude of discrepancy between the two, and at BACs over 0.08, the relationship was nonsignificant. Conclusions: Although self-report data can be used to approximate the BAC obtained during a naturally occurring drinking event, the relationship is moderated by measured level of intoxication. Retrospective calculations are less accurate when estimating higher BACs. (J. Stud. Alcohol 63: 762-766, 2002), THE DEBATE ABOUT the utility of heavy episodic drinking as a marker of risky drinking on college campuses (e.g., DeJong, 2001; Wechsler and Nelson, 2001) has led some researchers to [...]

Objective: The current study examined the efficacy of mailed personalized normative feedback (PNF) as a brief alcohol intervention for at-risk college drinkers, and investigated discrepancy as a possible mediator of the intervention effect. Method: Participants consisted of 100 at-risk college drinkers who completed an alcohol-use assessment at baseline, 6-week posttest and 6-month follow-up. Measures included number of drinks consumed per heaviest drinking week, frequency of heavy-drinking episodes, peak blood alcohol concentration and number of alcohol-related problems, all for the last month. Participants were randomly assigned to either a mailed brief intervention (MBI; n = 49) or attention-control (C; n = 51) group. The MBI group received mailed PNF that was based on baseline responses to the drinking measures; the C group received a psychoeducational brochure about alcohol. Results: Mixed-model, repeated measures ANOVAs were used to examine the effects of time, group and gender on discrepancy and the drinking variables. Following the intervention, the MBI group reported significantly higher perceived discrepancy between self and others' drinking than the C group. The MBI group reported consuming significantly fewer drinks per heaviest drinking week and engaging in heavy episodic drinking less frequently than the C group at the 6-week posttest; however, these differences were no longer evident at the 6-month follow-up. Hierarchical regression analyses did not provide evidence for the hypothesized mediating effect of discrepancy. Conclusions: Mailed PNF may be a cost- and time-efficient means of developing discrepancy and temporarily reducing heavy alcohol consumption among at-risk college drinkers., FOR MANY YOUNG ADULTS, college is a time of experimentation with adult behaviors such as alcohol use. As many as 80% to 90% of college undergraduates drink alcohol (Haines and [...]

Objective: This study was undertaken to test the hypotheses that acute alcohol intoxication and alcohol-rated sex expectancies are negatively related to both risk perception (a motivational factor) and ability to negotiate safer sex (a behavioral skills factor) with a partner. Motivation and behavioral skills are determinants of safer sex according to the Information-Motivation-Behavioral Skills (IMB) model. Method: A total of 102 heterosexual females ages 21-30 years participated in two sessions. The first session involved the administration of various measures to confirm eligibility status, and random assignment to one of three beverage conditions: 'water control,' 'alcohol' (0.65 g alcohol/kg body weight) or 'placebo.' The second session involved administration of the beverage and then completion of a risk perception measure and an audiovisual role-play measure of behavioral skills. Results: Regression analyses showed that alcohol expectancies and the perception of intoxication contributed independent variance to both risk perception and behavioral skills. Actual alcohol intoxication had little influence on these dependent variables. Conclusions: Alcohol expectancies and related factors can be related to variables that theoretically precede the occurrence of risky sex. Research is needed on the processes through which expectancies might be related to the occurrence of safer sex, as well as on person and situation variables that moderate the effects of alcohol and alcohol expectancies on safer sex., ALTHOUGH HUMAN IMMUNODEFICIENCY VIRUS (HIV) transmission rates in men who have sex with men and in intravenous drug users declined during the 1990s, HIV transmission through heterosexual contact among young [...]

Participant selection biases can reduce the generalizability of research findings and lead to misestimates of intervention effectiveness. The authors examined factors associated with study participation and attrition among psychiatric outpatients recruited for the initial phase of a health promotion trial. Medical records were reviewed to obtain HIV-risk and substance abuse data, as well as psychiatric and demographic characteristics of potential participants. Of 895 eligible outpatients, 67% (n = 601) consented to participate, among whom 69% (n = 415) completed all baseline appointments. Compared with nonconsenters, consenters were more likely to be at risk for drug problems and to receive care from clinics serving more impaired patients. Study completion was associated with older age, a psychiatric diagnosis other than adjustment disorder, and a recent sexually transmitted disease diagnosis. These findings suggest that patients who could most benefit from risk reduction interventions are more likely to participate.

Patients with comorbid substance use and major mental disorders are treated frequently in the mental health system. Treatment models relevant for this subset of patients have emerged in recent years, however, few have been validated empirically and so relatively few sites benefit from this treatment development activity. Important additional sources of information about good treatment practices are the clinicians who have adopted the treatment of patients with dual disorders as a specialty. We conducted four focus groups (N = 12) with clinicians who were nominated by their peers as experienced and/or expert in treating persons with comorbid substance use and psychiatric disorders. Discussions followed a four-part outline that included (a) general questions about training and experience with the population, (b) preferred treatment methods, (c) motivational issues, and (d) recommendations to the field. Participants were trained in a variety of mental health disciplines and pursued substance abuse treatment credentials or other educational experiences outside of their primary training programs. Their treatment approaches emphasized psychoeducation, a good therapeutic relationship, and the need to be flexible regarding methods and goals. Abstinence was the preferred goal among most clinicians; even so, they expressed a pragmatic flexibility and other views consistent with the principles of harm reduction. Clinicians tended to respond to patients' ambivalent motivational states by addressing the consequences of behaviors in a nonconfrontive style; they also made use of positive incentives and external support. A number of recommendations were made to improve treatment, including greater institutional and programmatic support for the unique needs of this population. Keywords: Dual diagnosis; Substance abuse; Treatment; Clinician perspective

Drug and alcohol related problems are common among State Psychiatric Hospital outpatients. The importance of screening for drug and alcohol related problems among outpatients with persistent and severe mental illnesses is discussed.

The link between attitudes toward marijuana use and behaviour varies as a function of attitude toward drug-free experience. Less favourable attitudes toward drug-free experience are connected with higher reported use of marijuana.

The similarities and differences in a common set of motives for alcohol and marijuana were examined among experienced users of both drugs. Social motives were more highly endorsed for alcohol than marijuana, but expansion motives were more highly endorsed for marijuana. Experienced users of marijuana and alcohol were found to discriminate between their reasons for using the drugs.

Individuals with a severe mental illness and substance use disorder tend to have medical and social problems and to make slower progress in treatment than those who have either disorder alone. Nevertheless, little attention has been paid to the discovery of effective methods of modifying substance use in the severely mentally ill (SMI). The purpose of this study was to collect qualitative data as a way to help identify techniques that might help to change patterns of substance use in the SMI. The participants were 21 men and women who were psychiatric clinic outpatients and who had a current schizophrenia spectrum diagnosis. A total of 18 participants had a lifetime diagnosis of alcohol abuse or dependence, and 21 lifetime other drug diagnoses were recorded for the sample. These individuals participated in focus group discussions about topics related to substance use and people's experiences with trying to quit. The results showed that participants identified several therapeutic and extratherapeutic factors that helped them to initiate and maintain changes in their substance use, as well as factors that hindered change. The findings are related to knowledge about the effectiveness of substance use disorder treatment techniques in general, and implications of the data are discussed for the conduct of integrated treatment of individuals with severe mental illness and a substance use disorder.