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Research is presented concerning the relationship existing between the present use of tobacco and a history of alcohol abuse in the health status of 589 male and female hospitalized individuals.

Recent studies have revealed differences between men and women alcoholics in symptoms, consequences, and help-seeking behavior related to alcohol usage. based on these findings, it was hypothesized that gender differences also would appear on alcohol screening instruments. The Self-Administered Alcoholism Screening Test (Colligan, Davis, 8 Morse, 1988; SAAST: Swenson 8 Morse, 1975) of 1,920 men and 1,775 women was subjected to a within-gender, principle-components, factor analysis with a varimax rotation. Gender differences at the component level were revealed. Men endorsed the 'help-seeking for alcohol-related problems' component while women endorsed the 'help-seeking for emotional problems' component. In addition, men expressed concern about receiving a psychiatric label while women expressed concern about receiving a drinker label. The results suggest that different items need to be used in screening women for alcohol-related problems.

We discuss recent measurements of the wavelength-dependent absorption coefficients in deep South Pole ice. The method uses transit-time distributions of pulses from a variable-frequency laser sent between emitters and receivers embedded in the ice. At depths of 800-1000 m scattering is dominated by residual air bubbles, whereas absorption occurs both in ice itself and in insoluble impurities. The absorption coefficient increases approximately exponentially with wavelength in the measured interval 410-610 nm. At the shortest wavelength our value is approximately a factor 20 below previous values obtained for laboratory ice and lake ice; with increasing wavelength the discrepancy with previous measurements decreases. At [approximately]415 to [approximately]500 nm the experimental uncertainties are small enough for us to resolve an extrinsic contribution to absorption in ice: submicrometer dust particles contribute by an amount that increases with depth and corresponds well with the expected increase seen near the Last Glacial Maximum in Vostok and Dome C ice cores. The laser pulse method allows remote mapping of gross structure in dust concentration as a function of depth in glacial ice.

Tobacco use may be associated with the high death rate in people with alcohol or non-nicotine drug addiction. Researchers followed 845 people admitted to the Inpatient Addiction Program of the Mayo Clinic between 1972 and 1983. Seventy-eight percent had a diagnosis of alcoholism and 75% of the total group were smokers. A total of 222 people died during a follow-up ranging from 0.1 to 21.8 years. Fifty-one percent of the deaths were tobacco-related, a frequency twice that of the general population. Coronary artery disease accounted for 46% of all deaths and chronic obstructive lung disease accounted for 17.8% of all deaths. Sixteen people died from lung cancer. Thirty-four percent of the deaths were related to alcohol abuse. After 20 years, the cumulative mortality rate in the group was 48%, compared to the expected rate of 18.5%. These findings underscore the need to treat drug addicts for their nicotine habit., Objective.--To determine the impact of tobacco- and alcohol-related deaths on overall mortality following inpatient treatment for alcoholism and other nonnicotine drugs of dependence. Design.--Population-based retrospective cohort study. Setting.--Olmsted County, Minnesota (the Rochester Epidemiology Project), and the Inpatient Addiction Program (IAP) at Mayo Clinic, Rochester. Patients.--All 845 Olmsted County residents admitted to an inpatient addiction program for treatment of alcoholism and other nonnicotine drugs of dependence during the period 1972 through 1983. Methods.--Patients were followed up through the medical record linkage system of the Rochester Epidemiology Project through December 1994 to obtain vital status, and death certificates were obtained for those who died. The underlying cause of death was classified as alcohol related, tobacco related, both, or neither based on the classification from the Centers for Disease Control and Prevention. The observed number of deaths by underlying cause was compared with the expected number using cause-specific 1987 death rates for the white population of the United States. All-cause mortality was also compared with that expected for persons in the West North Central Region of the United States of like age, sex, and year of birth. Univariate and multivariate assessments were made to identify predictors of all-cause mortality from baseline demographic information. Results.--At admission, the mean (SD) age of the 845 patients was 41.4 (14.5) years, and 35% were women. Altogether, 78% had alcohol as their only nonnicotine drug of dependence and 18% had alcohol and other nonnicotine drugs of dependence, while 4% were classified as having a nonalcohol, nonnicotine drug dependence alone. At admission, 75% were current and 8% former cigarette smokers, 3% were current cigar or pipe smokers, and 2% were current users of smokeless tobacco. Follow-up after the index IAP admission totaled 8913 person-years (mean [SD] of 10.5 [5.6] years per patient). Death certificates were obtained for 96% (214) of the 222 patients who died. Of these 214 deaths, 50.9% (109) had a tobacco-related and 34.1 % (73) had an alcohol-related underlying cause (P

As a part of a prospective study to assess the effect of nicotine dependence treatment among smokers undergoing inpatient treatment for other addictions, we surveyed the treatment staff about their attitudes toward smoking. The study was carried out in the Alcoholism and Drug Dependence Unit (ADDU), an inpatient addictions' treatment unit at Mayo Clinic. The subjects for this report were the ADDU staff. The attitude survey used was modified from that of Bobo and Gilchrist, and the survey was conducted for all staff before and after the prospective intervention study. Compared with the pre-study survey, the post-study survey indicated more staff thought nicotine dependence treatment should be provided to all smokers (p = 0.025). The percentage who thought that nicotine dependence treatment should be encouraged at the time of admission to the unit also increased (p = 0.005). Overall, staff attitudes toward nicotine dependence treatment changed toward more acceptance. While the intervention trial likely had an effect, other factors could also have played a role in this apparent change in staff attitude. Keywords - nicotine dependence; smoking cessation.

A questionnaire called the Self-Administered Nicotine-Dependence Scale is developed to help in deciding proper intervention techniques for nicotine-dependent subjects. The six domains identified in the questionnaire include loss of control, consequences of use, social skills deficit, self-efficacy, social support for smoking and concern for healthy life-style. The scale includes 32 items split into two subscales of 16 items each. The two subscales showed positive results in predicting smoking status six months after the training.

The Common Alcoholic Logistic Revised Scale (CAL-R), which is developed to screen patients treated for alcoholism, can be used with both MMPI and MMPI-2. Tests of a criterion group of 1221 alcoholics and a contrast sample of 7621 non-alcoholic patients proved that CAL-R is as effective as CAL.

The National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine have refined the definition of alcoholism to include current ideas so that the term is used in an understandable, scientifically and medically correct manner. The new proposed definition takes into account the fact that alcoholism is a disease with biological and psychosocial factors . Its causes, symptoms, complications and treatment are dependent on environmental and physical considerations. The new definition includes genetic vulnerability, basic behavior changes, and the concept of denial. This revised definition more closely matches the definition of alcoholism found in Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised, and the proposed tenth revision of the International Classification of Diseases. The new definition should encourage earlier diagnosis and treatment by professionals and nonprofessionals., To establish a more precise use of the term alcoholism, a 23-member multidisciplinary committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine conducted a 2-year study of the definition of alcoholism in the light of current concepts. The goals of the committee were to create by consensus a revised definition that is (1) scientifically valid, (2) clinically useful, and (3) understandable by the general public. Therefore, the committee agreed to define alcoholism as a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic. (JAMA. 1992;268:1012-1014)

Current Definitions and Diagnostic Criteria and Their Implications for Treatment The definition of alcoholism has evolved to reflect recent insights concerning the heterogeneity of the disease and the multiple factors […]

We developed a MMPI alcoholism scale based on adult medical patient samples. Our criterion group consisted of 736 inpatients (525 males; 211 females) diagnosed as having alcoholism according to DSM-III criteria. Three contrast samples that totaled 13,120 individuals were used for control purposes. MMPI items were chosen by means of logistic regression. The 33 items yielded by this procedure formed a provisional scale (CA for common alcoholism logistic) that worked equally well for males and females. With new cross-validation samples, with sensitivity (proportion of alcoholics correctly identified) set at 90%, the specificity (proportion of nonalcoholics correctly identified) ranged from 90% to 96% for selected contrast samples. We conclude that this scale shows promise as a screening device in similar populations.

Patients with medical or social problems related to alcohol abuse or alcohol dependence frequently are seen in the health care delivery system. Direct and indirect screening methods are available, but contemporary data describing their combined effectiveness have not been reported. We determined the sensitivity of (a) an empirically derived, item-weighted, relatively "indirect" screening measure for alcohol misuse (the Common, Alcohol, Logistic [CAL] scale for the MMPI), (b) a "direct" approach to screening for alcohol misuse (the Self-Administered Alcohol Screening Test [SAAST]), and (c) their combined application. We obtained the responses to both measures from an archival sample of 361 medical patients (89 women, 272 men) who had been diagnosed with alcohol dependence by DSM-III-R criteria. The CAL scale and the SAAST both demonstrated high sensitivity. However, results favored the simultaneous use of a direct-in this study, the SAAST-and an indirect-in this study, the CAL scale-screening procedure. [ABSTRACT FROM AUTHOR]

Nine patients with bipolar mood disorder and concurrent substance dependence were treated in an 18-bed inpatient addiction unit over a 3-month period. A multidisciplinary team approach used a medicalized Minnesota model and stressed the establishment of a positive diagnosis and individualization of management strategies for each patient. Clinically significant affective symptoms that required acute psychiatric intervention developed in several patients during hospitalization. Manic symptoms developed in three patients during sedative withdrawal, requiring the team to differentiate manic symptoms from physiologic withdrawal; and two patients became severely depressed, requiring pharmacologic management and suicide-prevention strategies. Summary: Our experience with the patients in this case series supports the contention that there is no simple, uniform approach to the substance-dependent patient with bipolar disorder. Treatment teams must be prepared to differentiate complex syndromes and to manage manic, depressive, and addictive behaviors. [ABSTRACT FROM AUTHOR]

The article focuses on a study which discusses the age and sex differences in the responses of alcoholics to the Self-Administered Alcoholism Screening Test. Data on 583 patients were used for this study. Each patient was interviewed by a chemical dependency counselor, a psychiatric or medical resident and a supervising psychiatrist with experience in the field of alcoholism. There was a significant tendency for women alcoholics to report a greater incidence of problems with alcohol in other members of their families, especially spouses and siblings. The finding of significant sex differences on five of the six components of alcoholism patterns and consequences has a number of interesting ramifications.

Using criteria for the diagnosis of alcoholism established by the National Council of Alcoholism and by scores on the Self-Administered Alcoholism Screening Test, we compared the prevalence of alcoholism in a group of 99 patients hospitalized for the treatment of psoriasis with that in an age- and sex-matched control group hospitafaed for the treatment of other dermatologic disorders. Alcoholism was diagnosed in 11 psoriatic patients and 3 control patients (0.05 < p < 0.10); 10 of the 11 psoriatic patients were men, and 1 of the 3 control patients was a man ( p < 0.05). These differences, not noted in certain eariier studies, may reflect a basic association between the two diseases in males or indicate that alcohotem contributes to the morbidity of psoriasis. [ABSTRACT FROM AUTHOR]

This research investigates cultural variation in pain inference by quantifying the amount of pain attributed to nine conditions, by means of Thurstone's technique of paired comparisons. Subjects were selected from four cultural groups residing in Western Canada: the Canadian (Anglophone), the Ukrainian, the East Indian, and the Hutterite. Inter group differences were found in both the rank ordering and the quantitative evaluation of the painfulness of nine conditions. The authors conclude that the amount of pain inferred or attributed to these conditions is culturally learned. [ABSTRACT FROM PUBLISHER]

This prospective study compared total plasma lipids, high-density lipoprotein chloesterol (HDL-C), and apolipoproteins A-I (apo A-I) and A-II (apo A-II) in 72 alcoholic patients and in 285 nonalcoholic controls. The HDL-C in the alcoholic group was not significantly different from that in the nonalcoholic controls. Alcoholic men had significantly higher levels of cholesterol and triglycerides and lower levels of apo A-I when compared with nonalcoholic controls. Alcoholic women had significantly higher levels of cholesterol and apo A-II when compared with nonalcoholic controls. Serial measurements in 25 alcoholic patients showed a significant decline in HDL-C, apo A-I, and apo A-II levels during the 4-wk hospital stay. HDL-C demonstrated its expected inverse relationship with plasma triglyceride level and its direct relationship with apo A-I, apo A-II, and the hepatic enzyme aspartate aminotransferase. [ABSTRACT FROM AUTHOR]

This article reports on the screening of medical patients for alcoholism with the Minnesota Multiphasic Personality Inventory (MMPI). Seven alcoholism scales for the MMPI were evaluated for effectiveness in screening medical. Although numerous alcoholism scales for the MMPI have been developed, none has been evaluated for effectiveness in screening medical patients. Therefore, seven scales that appeared to have merit were selected for such evaluation. Each scale was evaluated to determine its ability to identify correctly patients with alcoholism; and to ascertain the degree to which estimates of alcoholism in our samples, based on the results from each scale, agreed with previously reported estimates of prevalence.

This article presents a comparison between the Institutionalized Chronic Alcoholic Scale (ICAS) and MacAndrew scale (MAC) used in screening medical patients for alcoholism. To determine the efficacy of the ICAS in screening medical patients, the ICAS scores from five samples were evaluated. These included a criterion group of inpatients from an alcohol and drug-dependence unit (ADDU), two samples of medical patients, a sample of adult psychiatric inpatients, and a contemporary sample of normal adults. The criterion sample of MMPIs was obtained from 211 women and 525 men hospitalized on an ADDU with primary alcohol dependence. DSM-lII criteria were used for classification purposes.

The article discusses intellectual assessment of alcoholic patients. A study of 867 patients at a Midwestern alcoholism treatment center which used Shipley-Hartford Institute of Living Scale scores indicates that intellectual differences in this population are due to age and socioeconomic differences rather than due to alcoholism. However, these real differences can be used to plan dismissal and rehabilitation policies for individual patients. Intellectual assessment of alcoholic patients usually has examined the effects of alcoholism on cognitive abilities. The search for intellectual deficits associated with alcoholism has been the subject of extensive research and review.

Khantzian (1985) hypothesized that the drug of choice of patients with substance-dependence disorders reflects an attempt at self-medication. Cocaine- and marijuana-dependent inpatients were compared using the MMPI to test this hypothesis. These two groups of patients did not differ on the standard validity and clinical scales of the MMPI, and their scores were basically similar to a group of alcohol-dependent inpatients and a group of psychiatric patients of similar age. There was no single MMPI code type that was characteristic of either group of substance-dependent patients. It appears that drug of choice had little effect on the MMPI scores of these two groups of substance-dependent patients. These results are not consistent with the theory of self-medication. [ABSTRACT FROM AUTHOR]

Results of stepwise discriminant analyses of the Self-Administered Alcoholism Screening Test (SAAST) administered to 181 alcoholics and 123 nonalcoholics in Mexico City were compared with results of a similar analysis of a sample in the United States (Rochester, MN). With sensitivities of 90% and 95%, specificities were 91.1% to 99.2% in the Mexican sample for total score and a nine-item version developed on the Rochester sample. A new nine-item version derived from the Mexican sample gave specificities between 95.1% and 99.2% at 90% and 95% sensitivities, as with the Rochester sample. The two items with greatest predictive power were the same in both cultures. [ABSTRACT FROM AUTHOR]

For a sample of 1156 patients (520 alcoholics and 636 nonalcoholics), discriminant function analyses were performed on the total score, a nine-item version, and a two-item version of the Self-Administered Alcoholism Screening Test (SAAST). With sensitivities set at 90 and 95%, specificities for the total score and nine-item versions ranged from 96.4 to 99.4%. Cross-validation of the nine-item version with the 'jackknife' procedure resulted in only one additional misclassi-fication of the 1156 subjects. Separate analyses of the male and female samples revealed that more items entered the discriminant function for women than for men and resulted in a higher, although clinically nonsignificant, percentage of correct classification for women. The results strongly support the use of either the total score or the nine-item version of the SAAST in large-scale screening for alcoholism in a medical patient population. [ABSTRACT FROM AUTHOR]

The hypothalamic-pituitary-adrenal axis of a group of patients suffering from alcoholism was studied by determining their plasma corticosteroid levels and urinary-free cortisol excretion before and after administration of 2 mg of dexamethasone. The patients were recently abstinent from alcohol and were found to be in a hypersecretory state. However, the axis appeared to be intact because they were able to suppress when steroid was given exogenously. [ABSTRACT FROM AUTHOR]

Fasting free amino acid concentrations in plasma of 20 control and 18 alcoholic subjects were compared in an attempt to validate previous reports that the molar ratio of α-amino- n-butyric acid/leucine (A/L ratio) is a marker for alcoholism. We were unable to confirm the observations of either altered α-amino- n-butyric acid or leucine concentrations or an increased A/L ratio in alcoholic subjects, and we conclude that the A/L ratio is not a biochemical marker for alcoholism. [ABSTRACT FROM AUTHOR]

The authors report on seven patients who met the DSM-III-R criteria for psychoactive substance (alprazolam) dependence. All had withdrawal symptoms, six demonstrated tolerance, and at least four had substantial social or occupational impairment secondary to drug use. All seven patients had begun taking alprazolam as treatment for anxiety or depression. Six patients abused other drugs or alcohol, either in the past or concurrently. Doses of alprazolam ranged from 2 to 12 mg/day, and duration of use was 6 months to 3 years. The potential for dependence should be considered when prescribing alprazolam. [ABSTRACT FROM AUTHOR]