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This study examines predictors of alcohol use disorders (AUDs) among an urban American Indian cohort who were followed from approximately age 11 to age 20. Approximately 27% of the sample had a lifetime diagnosis of alcohol abuse or dependence. The results indicated that externalizing, but not internalizing, behaviors, family conflict, and school liking served as significant predictors of an AUD. Neither having an alcoholic mother nor an alcoholic father was found to be significantly predictive of an alcohol use disorder at ages 19 and 20. Finally, early alcohol initiation was a substantial predictor of an AUD and acted as a partial mediator.

Objectives. Although American Indians and Alaska Natives have high rates of substance abuse, few data about treatment services for this population are available. We used national data from 1997-2002 to describe recent trends in organizational and financial arrangements. Methods. Using data from the Indian Health Service (IHS), the Substance Abuse and Mental Health Services Administration, the National Institute on Alcohol Abuse and Alcoholism, the Henry J. Kaiser Family Foundation, and the Census Bureau, we estimated the number of American Indians served by substance abuse treatment programs that apparently are unaffiliated with either the IHS or tribal governments. We compared expected and observed IHS expenditures. Results. Half of the American Indians and Alaska Natives treated for substance abuse were served by programs (chiefly in urban areas) apparently unaffiliated with the IHS or tribal governments. IHS substance abuse expenditures were roughly what we expected. Medicaid participation by tribal programs was not universal. Conclusions. Many Native people with substance abuse problems are served by programs unaffiliated with the IHS. Medicaid may be key to expanding needed resources.

Objective: The objective of this study was to test whether an intensive case management intervention would be effective with a group of homeless chronic public inebriate clients. The primary goals of the case management were to improve the financial and residential stability of the clients and to reduce their use of alcohol. Method: Subjects (N = 298, 81% male) were interviewed at baseline, randomly assigned to treatment and control conditions and given follow-up interviews at 6month intervals for 2 years. Case management services were provided for the duration of the project. Follow-up rates for the first three interviews averaged 82%. Results: Repeated measures MANCOVAs showed significant group differences favoring the case-managed group in all three areas targeted by the intervention: total income from public sources, nights spent in 'own place' out of the previous 60 nights and days drinking out of the previous 30 days. The results held whether the three variables were analyzed jointly or separately and for alternative measures of drinking and homelessness. Although statistically significant, the group differences are generally not large. Conclusions: The results indicate that case management had a beneficial effect on the clients receiving it. This effect may have been the result of an increase in services received by the case-managed clients. (J. Stud. Alcohol 59: 523-532, 1998), A study was conducted to evaluate the effectiveness of intensive case management intervention concerning homeless alcoholics. The goal of this project was to improve their living conditions and reduce the use of alcohol. The results indicated that intensive case management benefited those receiving it., This article reports the results of a randomized clinical trial of the effectiveness of a program of intensive case management services for a group of homeless, high frequency users of [...]

An open trial of transdermal nicotine replacement for smoking cessation was conducted. Over a 7-month period, all patients admitted to the inpatient alcohol and drug treatment unit of the Seattle Veterans Affairs Medical Center (n = 207) were offered the opportunity to participate in an open trial of transdermal nicotine replacement for smoking cessation. Forty-nine (23.7%) elected to attempt cessation with transdermal nicotine during their inpatient treatment episodes. These subjects received no psychosocial treatments directed specifically at smoking cessation. They smoked a mean of 28.5 (SD = 16.4) cigarettes per day and obtained a mean score of 8.3 (SD = 1.9) on the Fagerstrom Test for Nicotine Dependence. Subjects remained on transdermal nicotine an average of 18.8 (SD = 8.2) days with desire to resume smoking the major reason for discontinuation. Seven subjects (14.3%) self-reported tobacco abstinence at 21 days, and 5 (10.2%) self-reported abstinence as outpatients at 6 weeks. These results show that a substantial proportion of alcohol- and drug-dependent patients entering inpatient treatment are willing to attempt alcohol and illicit drug cessation and tobacco cessation simultaneously and that transdermal tricotine holds promise as a treatment modality in this population. Keywords - nicotine dependence; alcohol dependence; drug dependence; transdermal nicotine; smoking cessation

Objective. To evaluate studies that applied Cloninger's tridimensional theory of personality to substance abusers. Method: Medline and Psychlnfo data bases were searched for studies published between 1986 and mid-1995 that used the Tridimensional Personality Questionnaire (TPQ). A supplemental manual search was conducted to identify additional evaluations of the tridimensional theory. Reports were reviewed if they included substance abusers or related tridimensional traits to substance use measures. Results: Factor analyses did not consistently support the tridimensionality of the TPQ. Novelty Seeking (NS) traits distinguished alcoholics from nonalcoholics, Type B and Type 2 alcoholics from their Type A and Type I counterparts, smokers from nonsmokers, and individuals (substance abusers and nonabusers) with and without antisocial personality disorder (ASPD). Tridimensional traits independently predicted early onset alcohol abuse and serious delinquency in studies that did not employ the TPQ and were significantly associated with concurrent substance abuse among adolescents. Most studies that compared nonalcoholic youth with positive and negative family histories of alcoholism reported nonsignificant TPQ differences or very small effects. Few alcoholics, cigarette smokers or sons of alcoholics displayed Type I (low novelty seeking, high harm avoidance, high reward dependence) or Type 2 (high novelty seeking, low harm avoidance, low reward dependence) TPQ profiles, but rarely were levels of tridimensional traits determined by reference to established norms. Conclusions: NS predicts early onset alcohol abuse and criminality and discriminates alcoholics exhibiting antisocial behavior and persons with ASPD from their nonantisocial counterparts. Findings for the Harm Avoidance (HA) and Reward Dependence TPQ subscales are much less consistent. Some support for the role of elevated HA in intensity of substance use has been adduced. At present, the utility of the TPQ for prevention or clinical purposes is not well established. (J. Stud Alcohol 58: 48-66,1997), Cloninger's tridimensional personality questionnaire (TPQ) gives somewhat confusing results when applied to alcoholism. C.R. Cloninger developed a tridimensional personality and psychopathology assessment tool that rates behavior by novelty seeking, harm avoidances and reward dependence scales. Researchers searched the literature for applications of TPQ to substance abuse and statistically analyzed findings. No conclusive correlations were found for harm avoidance and reward dependence, but higher novelty seeking scores were correlated with early alcohol abuse, criminal behavior, and antisocial personality disorder., ONE OF THE MOST influential personality theories propounded in recent years is Cloninger's 'unified biosocial' model. Cloninger (1986) developed the theory to account for the differences in the susceptibility of [...]

Essential alcoholics differ from reactive alcoholics in having more severe alcoholism with an earlier onset, less education and a lower occupational status, more conflicts with others, lesser number of long lasting friendships, greater degree of antisocial tendencies and behaviors. They also have greater family history of alcoholism, more affected neuropsychological functions, and a lower blood pressure at rest. Previous studies in the field and clinical implications for treatment are discussed.

Demographic, diagnostic, and service utilization characteristics of veterans diagnosed with suicide attempt, substance dependence, both, or neither at discharge from Department of Veterans Affairs (DVA) hospitals in fiscal year 1994 (FY94) were compared using the DVA's discharge abstract database. Four groups of veterans were studied: (1) substance-abusing suicidal inpatients (n = 1,459), (2) substance-abusing nonsuicidal inpatients (n = 123,808), (3) nonsubstance-abusing suicidal inpatients (n = 632), and (4) nonsubstance-abusing nonsuicidal inpatients (n = 402,906). Substance-abusing suicidal veterans had higher rates of substance abuse than substance-abusing nonsuicidal veterans and were more psychiatrically disordered than nonsubstance-abusing suicidal veterans. Substance-abusing suicidal veterans had a higher mean number of inpatient treatment episodes and a larger proportion of discharges against medical advice than the other three inpatient groups. Psychiatric and substance use disorders are more prevalent among substance-abusing suicidal veterans than among veterans with only substance use disorders or suicidal conduct.

The present study examined costs of two residential substance abuse treatment programs designed for urban American Indians and Alaska Natives (AI/ANs). Costs for one agency were well within national norms, while costs at the other program were less than expected from nationwide data. Economies of scale accounted for much of the difference between observed and expected costs. Culturally specific residential substance abuse treatment services can be provided to urban AI/ANs within budgets typically found at mainstream programs. [ABSTRACT FROM AUTHOR]

Investigated the potential utility and validity of a measure of subjective helplessness, the H25. Helplessness is defined as the degree to which the individual perceives him/herself to be unable to influence or control the initiation and outcome of a variety of potentially reinforcing activities. Alcoholic subjects were classified into three levels of self-reported helplessness. An initial multivariate analysis of variance indicated that the groups differed with respect to severity level across a number of dimensions of depressive symptomatology, with the High Helplessness group appearing significantly more depressed on each of the measures than Low Helplessness subjects. Subsequent analyses supported the construct validity of the H25. Those measures found to be most descriminating between groups and most predictive of the level of helplessness reflected a dimension of behavioral retardation consistent with the motivational deficits noted in the learned helplessness model. Recommendations for the future validation of individual difference measures of helplessness are discussed. [ABSTRACT FROM AUTHOR]

Research on the prevention of substance abuse among American Indian and Alaska Native youth offers challenges and demands careful methods. This paper describes such challenges in terms of philosophical, political, and cultural issues surmundiig substance abuse prevention research with American Indian and Alaska Native people. The authors suggest how social work researchers can address these issues through strategies of community 'collaboration, goal sening, and cultural sensitivity. The paper discusses the limits, implications, and future applications of the described strategies for research on the prevention of alcohol and drug abuse among American Indian and Alaska Native youth. [ABSTRACT FROM PUBLISHER]

This article focuses on application of discriminate analysis to level of performance of alcoholics and nonalcoholics on Wechsler-Bellevue and Halstead-Reitan subtests. A number of authors have compared the performance of alcoholic and nonalcoholic Ss on measures of general intelligence and cognitive impairment. The measures frequently used in such studies have included the Wechsler-Bellevue Intelligence Scale, the Wechsler Adult Intelligence Scale and tests derived from the Halstead-Reitan Neuropsychological Test Battery.