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This study characterized drug dependent women based on current psychopathology (MCMI-III) and then examined the relationship between psychopathology and treatment retention. Participants included 97 pregnant (88%), African-American (78%), single (90%) 30-year old women enrolled in a 6-month residential drug treatment program for women and children. Clustering on personality test scores using Ward's technique identified three subgroups with mild (24%), moderate (59%) and severe (18%) psychopathology. Treatment completion rates varied by group (66%, 45% and 29%), with half of the high severity group leaving against medical advice (AMA) within 60 days. Although the majority of low severity women completed the program as scheduled, they may also have done well in a less intensive treatment modality. Conversely, it appears that women with severe psychopathology may require a more flexible, psychiatrically-oriented approach than is found in most residential settings including greater emphasis on psychiatric issues, individual psychotherapy, and pharmacotherapy. [ABSTRACT FROM AUTHOR]

This study explored suicidality among 190 (68% male) participants in an HIV mental health clinic. Twenty-six percent had suicidal thoughts within 30 days of admission, 49% had a plan, and 48% expressed intent stating there was moderate or high likelihood they would take action. The most prevalent diagnoses among those with suicidal ideation were major depression (64%), drug dependence (52%), and depressive personality disorder (50%). In regression analyses, individuals with major depression, dysthymia, substance abuse, thought disorder, posttraumatic stress disorder, and borderline and avoidant personality disorders were at increased risk for suicidality whereas those with narcissistic personality disorder were at decreased risk. In addition, six of seven quality-of-life variables were associated with suicidal ideation, with the strongest correlations found for leisure/social (r =.36) and family/friends (r =.33). At-risk individuals, especially those with 'dual disorders,' unstable interpersonal relations, and a restricted social environment, should be carefully screened for suicidality. [ABSTRACT FROM AUTHOR]

Objectives: Disorders of behavioral dysregulation often involve more than one dsyregulated behavior (e.g., drug abuse and aggression, alcohol abuse and gambling). The high co-occurrence suggests the need of a transdiagnostic treatment that can be customized to target multiple specific behaviors., Method: The current pilot study compared a 20-week, individual transdiagnostic therapy (mindfulness and modification therapy [MMT]) versus treatment as usual (TAU) in targeting alcohol problems, drug use, physical aggression, and verbal aggression in self-referred women. Assessments were administered at baseline, post-intervention, and 2-month follow-up., Results: Wilcoxon signed-ranked tests and multilevel modeling showed that MMT (n = 13) displayed (a) significant and large decreases in alcohol/drug use, physical aggression, and verbal aggression; (b) significantly greater decreases in alcohol/drug use and physical aggression than did TAU (n = 8); and (c) minimal-to-no deterioration of effects at follow-up. Both conditions showed significant decreases in verbal aggression, with no statistically significant difference between conditions. MMT also displayed greater improvements in mindfulness., Conclusions: Preliminary findings support the feasibility and efficacy of MMT in decreasing multiple dysregulated behaviors., (© 2015 Wiley Periodicals, Inc.)

Background & Aims: Weight management is a cornerstone of treatment for overweight/obese persons with non-alcoholic fatty liver disease (NAFLD). This exploratory study sought to: (i) evaluate readiness to change weight-related behaviours; (ii) assess psychosocial characteristics that may interfere with weight loss; and (iii) evaluate how baseline psychosocial features associate with 6-month change in weight in persons with NAFLD receiving standard medical care. The purpose of this investigation was to develop hypotheses regarding relationships between psychosocial factors and weight for use in future fully powered studies and clinical interventions, Methods: Fifty-eight overweight/obese participants with NAFLD completed baseline measures of personality, psychiatric symptoms and readiness for behaviour change and were followed up for 6 months in standard care., Results: One-third of participants (31.0%) were not interested in making weight-related behaviour changes; 58.6% were considering making a change, and 10.4% of individuals were actively working on or preparing to change. Six-month change in weight was non-significant and was not associated with baseline readiness for change. Depression, low conscientiousness and high neuroticism were associated with higher weight at 6-month follow-up with small to large effect sizes., Conclusions: Although participants received nutritional education and guidance, very few individuals presented in the active stage of change. Although readiness for change did not predict subsequent change in weight, personality factors and psychiatric symptoms were associated with weight outcomes. Integrated multidisciplinary approaches that address psychiatric needs and provide behavioural support for weight loss may help patients with NAFLD implement sustained lifestyle changes., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Substance use among HIV+ individuals can be a barrier to HIV care, resulting in poor health outcomes. Motivational interviewing (MI) is an effective intervention to reduce substance abuse and increase HIV-related health. Healthcare workers from various backgrounds can be effectively trained in delivering MI interventions; however, there has been limited evidence that peers can effectively deliver MI interventions with fidelity. Peers have traditionally worked in HIV care settings and represent a valid context for a peer-delivered intervention focused on motivational issues. We trained four peers in MI. In this paper, we describe the intervention, explain the MI training methods, and investigate whether peers can be trained in MI with fidelity. The MI training included didactic instruction, group workshops, and individual feedback sessions. Two of four peers achieved MI treatment fidelity as measured by the Motivational Interviewing Treatment Integrity Code Version 3.0. Overall, peers had difficulty using open-ended questions and querying pros and cons, skills thought necessary to elicit change talk. They also tended to give too much direct advice where reflections would have been appropriate. A challenge was training peers to change familiar ways of communicating. Nonetheless, they did well at assessing and highlighting motivation to change. The total training hours (40 h) was long compared with other published MI studies. However, the intervention included several components with two targeted change behaviors. It is likely that peers can be trained in MI with fidelity in less time given a more streamlined intervention. When working with peers who have life stressors similar to the target group, it is important to be flexible in the training.

Purpose of Review: Conventional biomarkers are poor measures of ongoing abstinence. Due to short and variable windows of detection, the chances that an active substance user will be detected during the 6-month waiting period depend on the testing method and the drug. Herein we discuss hair testing as an alternative matrix for monitoring abstinence. Issues and obstacles related to adoption of a more uniform testing protocol are identified., Recent Findings: Hair testing is a powerful matrix with the capacity to detect drugs for up to 90 days. Seemingly a logical choice for use in situations in which continuous abstinence is required, it mostly has been employed in Europe with forensic populations such as alcoholics seeking drivers license reinstatement. Only two studies have been conducted in transplant patients. In both, hair testing detected more active users than other modalities., Summary: Use of conventional biomarkers results in variable rates of drug detection, raising questions about fairness of the selection process. Hair analysis significantly increases detection rates. Programs adopting hair analysis should be prepared for more patients to be disqualified during the 6-month waiting period, but those testing negative at baseline could, theoretically, proceed with transplantation sooner. Selection of more optimal candidates also could improve outcomes.

Some HIV+ patients continue to engage in high-risk behaviors post-diagnosis. To tailor risk reduction interventions for "positives," it is necessary to understand contributing factors. We recently showed that HIV+ patients with co-morbid Axis I psychiatric and substance use disorders had the highest rates of ongoing risk behavior and those without diagnoses the lowest; substance dependence was more impactful than psychiatric disorders. In this companion paper, we provide complementary information about Axis II pathology based on data obtained from the same sample of 179 patients receiving HIV primary care. Patients were categorized as sub-threshold or as having personality traits/disorders (BR ≥ 75) on any of the 14 personality scales of the Millon Multiaxial Personality Inventory (MCMI-III). HIV risk behaviors assessed included (1) the number of sexual partners; (2) any sex without a condom; (3) lifetime and recent injection drug use (IDU); and (4) sharing of injection equipment. After controlling for a diagnosis of alcohol or drug dependence, borderline patients were more likely to have multiple sexual partners and to use condoms irregularly. Trends for multiple sex partners also were observed among patients with antisocial and depressive personality traits/disorders. Antisocial patients also were more likely to be current IDUs. Positives with personalities characterized by risk-taking tendencies and/or decreased capacity to engage in good self-care may benefit from risk reduction interventions that take their feelings of power/invincibility or (conversely) powerlessness/helplessness into account. For patients with antisocial and/or borderline traits/disorders, a "one size fits all" intervention focusing primarily on skills training is likely to fail because the underlying factors driving behavior are not being adequately addressed.

Context: No randomized trials have examined treatments for prescription opioid dependence, despite its increasing prevalence., Objective: To evaluate the efficacy of brief and extended buprenorphine hydrochloride-naloxone hydrochloride treatment, with different counseling intensities, for patients dependent on prescription opioids., Design: Multisite, randomized clinical trial using a 2-phase adaptive treatment research design. Brief treatment (phase 1) included 2-week buprenorphine-naloxone stabilization, 2-week taper, and 8-week postmedication follow-up. Patients with successful opioid use outcomes exited the study; unsuccessful patients entered phase 2: extended (12-week) buprenorphine-naloxone treatment, 4-week taper, and 8-week postmedication follow-up., Setting: Ten US sites. Patients A total of 653 treatment-seeking outpatients dependent on prescription opioids., Interventions: In both phases, patients were randomized to standard medical management (SMM) or SMM plus opioid dependence counseling; all received buprenorphine-naloxone., Main Outcome Measures: Predefined "successful outcome" in each phase: composite measures indicating minimal or no opioid use based on urine test-confirmed self-reports., Results: During phase 1, only 6.6% (43 of 653) of patients had successful outcomes, with no difference between SMM and SMM plus opioid dependence counseling. In contrast, 49.2% (177 of 360) attained successful outcomes in phase 2 during extended buprenorphine-naloxone treatment (week 12), with no difference between counseling conditions. Success rates 8 weeks after completing the buprenorphine-naloxone taper (phase 2, week 24) dropped to 8.6% (31 of 360), again with no counseling difference. In secondary analyses, successful phase 2 outcomes were more common while taking buprenorphine-naloxone than 8 weeks after taper (49.2% [177 of 360] vs 8.6% [31 of 360], P < .001). Chronic pain did not affect opioid use outcomes; a history of ever using heroin was associated with lower phase 2 success rates while taking buprenorphine-naloxone., Conclusions: Prescription opioid-dependent patients are most likely to reduce opioid use during buprenorphine-naloxone treatment; if tapered off buprenorphine-naloxone, even after 12 weeks of treatment, the likelihood of an unsuccessful outcome is high, even in patients receiving counseling in addition to SMM.

The role of psychiatric and substance use disorders in HIV transmission has not been fully elucidated, particularly among those living with the virus. We compared sex and drug risk behaviors for 228 HIV+ patients in four diagnostic groups: (1) no diagnosis; (2) psychiatric only; (3) substance dependence only; and (4) co-morbid psychiatric and substance dependence. Significant group differences were observed for having multiple sex partners, condom use, and injection drug use (IDU), but not for sharing of injection equipment. Patients with co-morbid psychiatric and substance disorders reported multiple sex partners most frequently, while substance dependence contributed to irregular condom use and IDU. Analysis by substance use subgroup (no dependence, alcohol dependence only, drug dependence only, co-morbid alcohol, and drug dependence) showed that alcohol dependence contributed to having multiple sex partners, while alcohol and drug dependence both contributed to irregular condom use. Meanwhile, only drug dependence contributed to drug risk. HIV+ patients should be screened for psychopathology, with risk reduction interventions tailored to diagnostic group to achieve maximum effect.

Background: "Nonmedical" (i.e., illicit) use of opioid analgesics has skyrocketed among the general population during the past decade, with similar increases observed among pain patients who take opioids by prescription., Objective: Because 1 in 3 opioid-maintained pain patients may be affected, it is essential that healthcare providers learn more about this subpopulation as a first step toward improved detection, brief intervention, referral, and general management., Method: The authors examined baseline data for 40 chronic-pain patients in a treatment trial targeting opioid analgesic abuse., Results: Abuse-disorder patients were dysfunctional and had high rates of psychiatric disorders and troublesome personality traits. Providers characterized patients as manipulative, drug-seeking, and noncompliant; patients complained that they were pharmacologically undertreated and were considered "addicts." Despite having severe pain and addiction, their average daily opioid dose was only 69% of that used to treat addiction in the same geographic region., Conclusion: Abuse-disorder patients had a similar physical but worse psychiatric/personality presentation than other chronic-pain patients, which suggests the need for increased psychiatric involvement.

As substance abusers need to demonstrate abstinence prior to transplant, valid/reliable drug tests are needed. Patients may deny use, fearing surgery will be delayed. Breath, blood and urine tests have brief detection windows that allow patients to evade detection. Routine laboratory tests do not include all substances of abuse. Hair analysis overcomes these barriers, increasing the likelihood that active users will be identified. This study compared results for alcohol, opioids and cocaine based on 445 self-report, breath, urine and hair samples from 42 patients who had been denied a transplant due to recent substance abuse. Compared to hair toxicology, sensitivity for conventional drug tests was moderate for cocaine and opioids, but poor for alcohol. Of positive hair tests, only half were corroborated through other tests. In contrast, specificity was high across tests and substances, with positive findings from conventional tests confirmed through hair toxicology. Based on a 90-day detection window for hair analysis, two negative tests suggest 6 months of continuous abstinence. Hair testing should be considered as an alternative approach for monitoring substance use in the transplant population, either as a routine procedure or when the veracity of findings from conventional tests is in doubt.

In order to better understand the components of effective treatment for the understudied population of opioid-dependent youth, separate focus groups were conducted in 2006 with clients, clinical staff, and clients' parents (total n = 22) at a novel methadone maintenance program for adolescents and young adults in suburban New York. Focus group sessions were audiotaped, transcribed, and analyzed for common themes. Clients, staff, and parents all reported that effective treatment for opioid addiction among young people is a long-term program, combines pharmacological and behavioral approaches, emphasizes a high degree of individual attention from staff, and incorporates clients' family members. The study's limitations were noted.

Development of working alliance was examined for 25 opioid-abusing pain patients and their therapists. Patients participated in an eight-session intervention based on adherence strategies and employment of a supportive, psychoeducational approach; methadone was prescribed for pain. Treatment goals included opioid analgesic adherence and decreasing pain, functional interference, and substance abuse. Patients and therapists completed the Helping Alliance Questionnaire-II following each treatment session. At baseline, scores of patients and therapists indicated good alliance. Patient alliance grew significantly over time regardless of addiction severity and independent of treatment outcomes. In contrast, therapist alliance grew only for patients without substance abuse comorbidity and/or who had good outcomes. Patients' and therapists' alliance scores were consistent during sessions focused on emotional bonds but diverged during sessions that demanded behavior change, suggesting that therapists may have reacted negatively to patients' lack of progress. Whether therapists' reactions to poor performers impacted subsequent patient outcomes is unknown but should be investigated.

Prochaska and DiClemente's Transtheoretical Model predicts dropout from substance-abuse treatment. However, it is not known whether readiness to quit smoking is associated with attrition from drug treatment programs with smoking restrictions. This study examined the relationship between smoking characteristics, smoking stage of change, and both length of stay (LOS) and discharge type among 75 perinatal substance abusers attending a smoke-free residential treatment program. URICA scores predicted LOS (P=.0004) and discharge type (P=.01). Women in action and maintenance remained in treatment longer and were more likely to complete treatment compared to those in precontemplation. Findings were not accounted for by addiction severity. Women with little interest in quitting smoking may have difficulty adhering to smoking restrictions during treatment for other drug problems, resulting in increased attrition. Alternatively, smoking stage of change may be a "proxy" for overall readiness to change in this population.

This study examined associations between childhood abuse and personality disturbances in 228 drug-dependent women. Thirty-six percent denied abuse, 50% reported emotional, 42% physical, and 42% sexual abuse. Million Clinical Multiarial Inventory (MCMI-III) scores > 74 provided evidence of personality disturbance and scores on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales measuring somatic complaints, depression, anxiety and postraumatic stress disorder (PTSD) served as covariates. Emotional and physical abuse survivors were at increased risk for borderline, masochistic, and avoidant disturbances and decreased risk for narcissistic disturbances. Emotional abuse survivors were also less likely to be sadistic whereas physical abuse survivors were more likely to be paranoid. Sexual abuse survivors were twice as likely be antisocial; however, no association was found with borderline personality. Finally, an increased prevalence of severe personality disturbances was observed among those experiencing multiple types of abuse. Childhood trauma predisposes drug-dependent women to develop troublesome personality characteristics that are independent of drug addiction and other psychological problems associated with childhood trauma.

This study examined associations between demographic, psychiatric, substance abuse, and childhood abuse variables and past 30-day victimization and perpetration among 77 perinatal substance abusers. Victimization rates were 70% emotional, 34% physical, 29% sexual, and 42% personal freedom violations. For perpetration, incidence was 71% emotional, 25% physical, 5% sexual, and 9% personal freedom violations. Through univariate regression, Addiction Severity Index (ASI) psychiatric and drug composite scores, childhood physical abuse, borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) were found to significantly predict victimization. In contrast, ASI psychiatric and drug composite scores, BPD, PTSD, and aggressive-sadistic and antisocial personality disorders were found to significantly predict perpetration. In multiple regression models, ASI drug and psychiatric composite scores accounted for the majority of the variance for both victimization and perpetration, suggesting that women with high ASI scores should be queried about their involvement in abusive acts at time of admission to drug treatment.

Despite potentially devastating consequences to both mother and child, many pregnant substance abusers refuse treatment. To understand why, the present study compared women who enrolled in (N = 102) vs. declined (N = 23) day treatment. Participants were primarily African American, unemployed, high school graduates with a mean age of 27 years. Although demographic characteristics did not differ between groups, treatment enrollees had greater drug severity and were more likely to identify crack cocaine as their drug of choice. They also manifested more family and psychiatric problems, emotional distress, and Axis II psychopathology. In addition, treatment enrollees had greater legal severity and higher rates of criminal justice system involvement (46% vs. 13%). The women who declined perinatal addiction services may have perceived less need for intensive treatment due to lower problem severity and less distress. Development of alternative treatment approaches, such as limited perinatal addiction services provided in conjunction with prenatal care, is warranted.

Three subgroups of drug dependent women (N = 78) were identified through cluster analysis on MCMI-II scores. Group 1 (26%) presented a relatively benign clinical picture. In contrast, Group 2 (37%) evidenced severe addiction, psychiatric (Axis I), and personality (Axis II) problems. Group 3 (37%) was characterized by fewer Axis I problems, prominent addiction and externalizing (Cluster B) personality deficits. Group membership was significantly associated with retention in a gender-specific day treatment program. Group 2 experienced rapid attrition, with only 36% completing treatment, compared to 57% for Group 1 and 76% for Group 3. Results indicate that drug-dependent women with externalizing psychopathology can be retained in treatment when environmental barriers are removed and an adequate "holding environment" is maintained. However, women with severe psychiatric problems, unstable mood, and interpersonal deficits are less likely to complete treatment. Early identification of women at risk for drop-out affords an opportunity to intervene to prevent its occurrence.

The present study assessed 108 women enrolled in a residential treatment program for perinatal substance abusers in order to examine possible subtypes based on current alcohol, other drug and psychiatric problem severity. Most participants were African-American (81%), unmarried (91%), unemployed (97%), high school graduates (63%) with a mean age of 30 years. The primary substances of abuse were cocaine/crack (87%) and opiates (9%). The majority (79%) of subjects were also nicotine dependent. Drug severity did not distinguish between these groups; however, when cluster analysis was applied to ASI alcohol and psychiatric composite scores, three clusters emerged: (1) high alcohol, drug, and psychiatric problem severity (57%); (2) high drug and psychiatric problem severity (20%); and (3) high drug severity only (23%). Neither current nor childhood demographic characteristics differed among the three groups. However, significant differences were found among selected childhood risk factors, including perceived quality of relationships with family, age of onset of substance use, childhood abuse history, and family history of mental illness. These results emphasize the need for careful assessment and treatment planning that addresses the unique needs of these women.

This article outlines psychosocial and ethical issues to be considered when evaluating potential living organ donors. Six types of living donors are described: genetically related, emotionally related, "Good Samaritan" (both directed and nondirected), vendors, and organ exchangers. The primary domains to be assessed in the psychosocial evaluation are informed consent, motivation for donating and the decision-making process, adequacy of support (financial and social), behavioral and psychological health, and the donor-recipient relationship. Obstacles to the evaluation process include impression management, overt deception, minimization of behavioral risk factors, and cultural and language differences between the donor and the evaluator. Ethical concerns, such as the right to donate, donor autonomy, freedom from coercion, nonmaleficence and beneficence in donor selection, conflicts of interest, "reasonable" risks to donors, and recipient decision making are also explored. To fully evaluate living organ donation, studying psychosocial as well as medical outcomes is crucial.

This study investigated the association between two demographic and two psychological variables and treatment retention for 65 perinatal substance abusers. Subjects who lived in the community while attending day treatment were 6.125 times more likely to drp out than subjects who lived in a program-operated shelter (p < .0001). An interaction was found for pregnancy status and antisocial personality disorder (p < .0478). Subjects who were both pregnant and antisocial were 4.876 times more likely to remain in treatment than those who were neither pregnant nor antisocial. Degree of "treatment resistance," measured by the MMPI Negative Treatment Indicators (TRT) Scale, did not predict dropout. These findings indicate that supportive housing can play an important role in preventing dropout for perinatal substance abusers. Additionally, pregnancy may present a "window" of opportunity for treating a hard to reach population, drug abusing women with comorbid ASP.

This paper explores the utility of relapse prevention therapy (RPT) for transplant candidates with substance use disorders. Similarities and differences between this population and the general substance abuse patient population are discussed and suggestions are made for modifying the RPT treatment protocol. Major issues include the source and intensity of motivation for treatment, the nature of the therapeutic relationship, the type and severity of psychosocial consequences that may have been experienced as a result of substance use, and the patient's perception of the problem (addiction versus liver disease). Recommendations are made to provide empathy and support around medical concerns, motivate them for sobriety, and work to build collaborative relationships between team members and patients. Patients need to see the RP therapists as working to help them maintain sobriety and obtain a transplant, not as policing their drug use.

This prospective study investigated in-treatment relapse in a sample of perinatal substance abusers in intensive outpatient treatment. Sixty-four female first-time admissions to a perinatal treatment program completed comprehensive psychological and psychosocial assessment before beginning treatment. Relapse was detected by urine toxicology screening and self-report. A regression analysis resulted in variable reduction, then survival analysis identified the impact of in-treatment relapse and other predictors on treatment length. Fifty-five percent of the subjects were classified as relapsers. Two risk factors for and six protective factors from in-treatment relapse were identified. The survival curves for relapsers and nonrelapsers did not differ until covariates were considered. Subjects with more severe consequences of drug use and less social exposure to drug use during treatment tended not to relapse during treatment, perhaps in order to prevent deterioration such as loss of children or incarceration. Relapse alone did not result in fewer treatment days. Few addiction characteristics were related to either in-treatment relapse or length of treatment. Rather, personality and demographic variables were more salient in both the regression and survival models. Treatment staff may need to reconsider their views of the meaning of relapse and should develop enhanced engagement and retention strategies for women at greater risk of relapse.

Forty perinatal substance abusers were administered multiple psychosocial, addiction, and psychological measures before beginning treatment. Results indicate that these patients are limited intellectually, educationally, financially, and emotionally. Psychiatric comorbidity was high, with 45% having non-substance abuse axis I diagnoses and 75% having confirmed (by two or more tests) axis II pathology. The most frequently identified axis I disorders were depression and anxiety. The most frequently detected personality disorders were antisocial, borderline, paranoid, and dependent. The average IQ was 87 (low average range) and nearly one third of the sample were found to be somewhat impaired intellectually. These data suggest that treatment programs must take psychological characteristics into account if they are going to succeed in helping these women achieve and maintain abstinence.

We review cellular and molecular processes involved in injury and repair of skeletal muscle with regard to the amount and location of damage produced. Discussion is based on advances made by use of newer techniques, including immunochemistry, in situ hybridization, molecular biology, ultrastructural analysis, and cell culture. Damage and repair processes after eccentric work, stretch, overload, chronic stimulation, cold injury, and other models are discussed for cellular and molecular components. Hypertrophy or hyperplasia can occur under certain conditions. After injury, satellite cells are activated by growth factors. These cells can also be activated during fiber-type transformation, probably to provide necessary DNA content rather than to supply cells of a new lineage. Emphasis is given to myosin mRNA studied by in situ hybridization to localize subcellular distribution. Increases in mRNA concentration are found near nuclei in damaged regions and at the subcellular sites being repaired in the middle of skeletal muscle fibers or near the myotendon junction. The activation of genes for muscle regulatory factors during development is compared with their activation in regeneration and response to injury.

From a nationwide study of 830 white, emotionally disturbed adolescents, ages 12 to 18, three samples were selected for study. One consisted of all boys (N = 31) and girls (N = 67) referred for treatment after suicide attempts. The second included those boys (N = 7) and girls (N = 22) referred for suicidal thoughts and threats, as well as suicide attempts. The third was comprised of those boys (N = 13) and girls (N = 12) referred for suicidal thoughts and threats, but who had made no known suicide attempts. Both self- and psychotherapist ratings on 1,250 variables were examined by comparing the endorsement rates for boys and girls in each criterion group separately with those of the remaining sample of distrubed adolescents who had not been referred for suicidal behavior. Our results confirm some past findings and introduce a large number of new correlates of adolescent suicidal behavior. They indicate that there is little difference between teenagers who attempt suicide and those who think about it or threaten it. The findings also highlight the necessity of studying the sexes separately.