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Stein LI, Barry KL, Van Dien G, Hollingsworth
EJ and Sweeney JK. (1999) Work and social support: A comparison
of consumers who have achieved stability in ACT and clubhouse programs.
Community Mental Health Journal; Vol 35(2): 193-204.
A current debate in the field is whether consumers
with serious mental illness, who have achieved stability in Assertive
Community Treatment programs, can be transferred to less intensive
services. To bring some data to bear on this question, this study
compared consumers and members, who have achieved stability, in
either an Assertive Community Treatment (ACT) or a clubhouse program,
on domains of vocational activity, social relationships/loneliness,
and community integration. The 59 stable clients from the 2 programs
who were interviewed, reported similar vocational activity, similar
experiences with social relationships and social networks, and
similar community integration. Clients in both groups were less
lonely than previously reported in the literature. Study results
indicate, that for those clients who have achieved stability,
there are sufficient similarities between consumers in the 2 programs,
to suggest a potential for movement from more to less extensive
programs with less disruption than previously assumed possible.
Valenstein M, Klinkman M,
Becker S, Blow FC, Barry KL, Sattar A, and Hill EM. (1999) Concurrent
treatment of patients with depression in the community: Provider
practices, attitudes, and barriers to collaboration. Journal
of Family Practice; Vol 48(3): 180-187.
This study describes the perceptions of primary
care physicians (PCPs), mean age 45.7 yrs, of the frequency of
concurrent treatment of depressed patients in community settings,
the degree of collaboration between co-treating providers, and
factors associated with greater interaction and collaboration.
A survey was distributed to a stratified, random sample of 276
eligible family physicians in Michigan. Primary analyses were
descriptive statistics (point estimation) of PCP practice patterns.
Secondary analyses explored predictors of collaboration with multivariable
regression. Analyses were conducted on 160 of the 162 returned
surveys (59%). PCPs reported that they co-treated approximately
30% of their depressed patients with mental health providers (MHPs).
They made contact with co-treating MHPs in approximately 50% of
shared cases; however, provider contact seldom included joint
treatment planning. PCPs perceived collaborative treatments to
be more problematic when patients were enrolled in managed care
programs. In multivariable regression, co-location of MHP and
PCP practices (in the same building) was strongly associated with
increased interaction and collaboration.
Blow FC, Barry KL, Copeland
LA, McCormick RA, Lehmann LS, and Ullman E. (1999) Repeated assaults
by patients in VA hospital and clinic settings. Psychiatric Services;
Vol 50(3): 390-394.
Sought to determine the prevalence of repeated
assaults on staff and other patients and characteristics of patients
who commit repeated assaults in the Veterans Health Administration
of the Department of Veterans Affairs (VA). Patients in VA medical
centers and freestanding outpatient clinics who committed 2 or
more assaults in fiscal years 1995 and 1996 were identified. For
each repeatedly assaultive patient (RAP), structured information,
including incident reports, was obtained for all assault occasions.
A total of 153 VA facilities responded, for a response rate of
99%. The survey identified 8,968 incidents of repeated assault
by 2,233 patients, for a mean of 4.02 assaults per patient in
the 2-yr study period. In 92% of the incidents, the assaultive
patient had a primary or secondary psychiatric diagnosis. The
mean age of the RAPs was 62 yrs. 98% of the RAPs were male, and
76.6% were Caucasian. At least 16% of the assaulters, 22% of the
patients assaulted, and 20% of the staff assaulted required medical
attention for injuries, which, along with the number of lost work
days, indicates that repeated assaults are costly. It is concluded
that RAPs represent major challenges to their own safety as well
as to that of other patients and staff.
Fleming MF , Manwell LB, Barry
KL, Adams W, and Stauffacher EA. (1999) Brief physician advice for
alcohol problems in older adults: A randomized community-based trial.
Journal of Family Practice; Vol. 48(5): 378-384.
A controlled clinical trial (Project GOAL--Guiding
Older Adult Lifestyles) tested the efficacy of brief physician
advice in reducing the alcohol use and use of health care services
of older adult problem drinkers. 43 family physicians and internists
participated. Of the 6073 patients screened, 158 Ss (aged 65+
yrs) were randomized into 71 controls or an intervention group
of 87 Ss. Intervention Ss received 2 10 to1 5-min physician-delivered
counseling sessions that included advice, education, and contracting
using a scripted workbook. 146 patients (92.4%) participated in
the 12-mo follow-up. No significant differences were found between
the control and intervention groups at baseline in alcohol use,
age, socioeconomic status, depression, onset of alcohol use, smoking
status, activity level, or use of mood-altering drugs. Intervention
Ss demonstrated a significant reduction in 7-day alcohol use,
episodes of binge drinking, and frequency of excessive drinking
compared with controls at 3, 6, and 12 mo after the intervention.
There was a 34% reduction in 7-day alcohol use, 74% reduction
in mean number of binge-drinking episodes, and 62% reduction in
the percentage of older adults drinking more than 21 drinks per
week in intervention Ss compared with controls.
Booth BM, Blow FC & Cook
CA. (2001). Persistence of Impaired Functioning and Psychological
Distress After Medical Hospitalization for Men with Co-Occuring
Psychiatric and Substance Use Disorder. Jnl Gen Internal Medicine,
16:57-65.
Objective: To measure the persistence of impaired
health-related quality of life (HRQL) and psychological distress
associated with co-occuring psychiatric and substance use disorders
in a longitudinal sample of medically hospitalized male veterans.
Design: A ransom sample followed observationally for 1 year after
study enrollment.
Setting: Inpatient medical and surgical wards at three university-affiliated
Department of Veterans Affairs Medical Centers.
Patients/Participants: A random sample of 1,007 admissions to
medical and surgical inpatient services, excluding women and admissions
for psychiatric reasons. A subset of participants (n=736) was
designated for longitudinal follow-up assessments at 3 and 12
months after study enrollment. This subset was selected to include
all possible participants with study-administered psychiatric
diagnoses (52%) frequency-matched by date of study enrollment
to approximately equivalent numbers of participants without psychiatric
diagnoses (48%).
Measurements and Main Results: All participants were administered
a computerized, structured psychiatric diagnostic interview for
thirteen psychiatric disorders (including substance use) and received
longitudinal assessments at 3 and 12 months on a multidimensional
measure of HRQL, the SF-36, and a measure of psychological distress,
the Symptom Checklist, 90-item version. On average, HRQL declined
and psychological distress increased over time (P<.05). Psychiatric
disorders were associated with significantly greater impairments
in functioning and increased distress on all measures (P<.001)
except physical functioning (P<.05). These results were replicated
in the patients (n=130) who received inpatient or outpatient mental
health or substance abuse services.
Conclusions: General medical physicians need to evaluate the mental
health status of their hospitalized and seriously ill patients.
Effective mental health interventions can be initiated posthospitalization,
either immediately in primary care or through referral to appropriate
specialty care, and should improve health functioning over time.
Blow FC. (2000). Treatment
of Older Women With Alcohol Problems: Meeting the Challenge for
a Special Population. Alcoholism: Clinical and Experimental Research,
24(8):1257-1266.
As a larger proportion of the U.S. population
reaches late life, there are new challenges to providing quality
health care services for this group. Record numbers of adults
over 60 are seeking health care for acute and chronic conditions.
Older women represent the largest single group of health care
users in this country. Twelve percent of older women regularly
drink in excess of recommended guidelines (no more than one drink
per day or seven drinks per week) and can be considered at-risk
drinkers. Problems related to alcohol use and misuse can seriously
affect many of the health concerns common among older women, including
chronic illness and depression. Older women have specific risks
and vulnerabilities to alcohol use, which include a swifter progression
to alcohol-related illness. However, women in later life who have
alcohol problems are underscreened and underdiagnosed, have significant
barriers in accessing health care, and respond differentially
to standard specialized treatment protocols. To date, research
on these topics has been limited. Furthermore, there is a paucity
of research focused on treatment outcomes for elderly adults with
alcohol problems, with almost no emphasis on women. This paper
presents the state of knowledge about alcohol health services
for older women and provides recommendations for necessary future
health services research on this vulnerable population.
Blow FC & Barry KL. (2000).
Older Patients with at-risk and problem drinking patterns: new developments
in brief interventions. J Geriatr Psych Neur, 13(3):115-123.
The relationship between alcohol and some of the
most prevalent physical and mental health issues of older adulthood
and the fact that a large percentage (up to 60% in randomized
clinical trials) of older at-risk drinkers may need either more
intense or innovative approaches to help them cut down or stop
drinking have led to new development sin alcohol screening and
brief interventions with older adults. Technological and content
innovations are critical elements in providing rapid, effective
interventions with a spectrum of alcohol use problems in later
adulthood. Both primary and specialty care providers can be trained
to provide motivational brief alcohol interventions targeted to
the older patient. Novel approaches to screening, brief interventions,
and brief therapies can be combined with the use of new technologies
to facilitate implementation in a range of health care settings.
This will give mental health specialty providers additional strategies
for addressing the complex needs of older at-risk drinkers using
a family of efficient and effective approaches.
Blow FC, Ullman E, Barry
KL, Bingham CR, Copeland LA, McCormick R & Van Stone W. (2000).
The Effectiveness of Specialized Treatment Programs for Veterans
With Serious and Persistent Mental Illness: A Three-Year Follow-Up.
American Journal of Orthopsychiatry, 70(3): 389-400.
This is the first study to test concurrently the
effectiveness of four treatment programs for patients with serious
mental illness. Three-year outcome data on utilization and functioning
demonstrated important positive changes for seriously mentally
ill veterans enrolled in specialized, enhanced inpatient and community
case management treatment programs, when compared to patients
in an enhanced day treatment program or traditional standard care.
Blow FC, Walton MA, Chermack
ST, Barry KL, Coyne JC, Gomberg ESL & Mudd SA. (2000). The relationship
between alcohol problems and health functioning of older adults
in primary care settings. Journal of Am Geriatric Soc, 48:769-774.
Examined the relationship between alcohol use
and health functioning in a sample of older adults screened in
primary care settings. 8,578 older adults (aged 55-97 yrs) with
regularly scheduled appointments in primary care clinics were
screened. Ss were categorized based on alcohol consumption levels
as abstainers, low-risk drinkers, and at-risk drinkers. Dependent
variables were eight SF-36 health functioning scales. 61% of Ss
were abstainers, 31% were low-risk drinkers, and 7% were at-risk
drinkers. ANCOVAs found significant effects of drinking status
on General Health, Physical Functioning, Physical Role Functioning,
Bodily Pain, Vitality, Mental Health, Emotional Role, and Social
Functioning, controlling for age and gender, with low-risk drinkers
scoring significantly better than abstainers. At-risk drinkers
had significantly poorer mental health functioning than low-risk
drinkers.
Blow FC, Walton MA, Chermack
ST, Mudd SA, Brower KJ & Comstock, M.A. Older Adult Treatment
Outcome following Elder-Specific Inpatient Alcoholism Treatment.
Journal of Substance Abuse Treatment, 19(1): 67-75.
This study examined multidimensional 6-month outcomes
of elder-specific inpatient alcoholism treatment for 90 participants
over the age of 55. At baseline, physical health functioning was
similar to that reported by seriously medically ill inpatients
in other studies while psychosocial functioning was worse, and
nearly one third of the sample had comorbid psychiatric disorders.
Based on 6-month outcomes, participants were classified into the
following groups: Abstainers, Non-Binge Drinkers, and Binge Drinkers.
The groups did not differ on any baseline measures (demographics,
drinking history, alcohol symptoms and age of onset, comorbidity,
or length of treatment). General health improved between baseline
and follow-up for all groups. Psychological distress decreased
for Abstainers and Non-Binge Drinkers, but did not change for
Binge Drinkers. Results suggest that a large percentage of older
adults who receive elder-specific treatment attain positive outcomes
across a range of outcome measures.
Chermack ST, Fuller BE
& Blow FC. (2000). Predictors of expressed partner and non-partner
violence among patients in substance abuse treatment. Drug and
Alcohol Dependence, 58, pp.43-54.
This study examined reports of expressed partner
and non-partner violence among men (n=126) and women (n=126) in
the 12 months prior to substance abuse treatment. Rates of violence
were 57% for partner, 53% for non-partner, and 75% collapsing
across partner and non-partner relationships. Factors associated
with partner and non-partner violence severity differed substantially.
Partner violence was predicted by age, marital status, and drug
problem severity. Non-partner violence was predicted by gender,
income, alcohol and drug problem severity. The results highlight
that individuals in substance abuse treatment are at high risk
for violence, and targeted screening and intervention approaches
should be routine in addictions treatment.
Chermack ST, Stoltenberg
SF, Fuller BF & Blow FC. (2000). Gender differences in the development
of substance-related problems: The impact of family history of alcoholism,
family history of violence and childhood conduct problems. Journal
Study Alcohol, 61(6):845-852.
Objective: This study examined gender differences
regarding the relative influence of family history of alcoholism
(FHA) and family history of violence (FHV) on reported childhood
conduct problems (CCP) and adult problems with alcohol, drugs
and violence. Method: The participants were 110 men and 103 women
with alcohol-related problems recruited within 30 days of enrolling
in treatment for substance abuse or dependence. Participants completed
self-report measures of pretreatment violence, FHV, CCP, substance
use and consequences, and demographics; a semi-structured interview
was used to assess FHA. Results: Structural equation modeling
(SEM) analyses revealed gender differences with regard to the
influence of FHA and FHV as important factors in the development
of childhood and adult behavioral problems. For women, the influence
of FHA on subsequent childhood conduct problems and adult problems
with alcohol was accounted for by FHV. For men, FHA was not directly
associated with CCP or adult problems with alcohol and violence,
but was associated with adult drug problems. For both men and
women, FHV was associated with CCP, and CCP were associated with
adult problems with drugs and violence. Conclusions: Overall,
the analyses illustrate the relative importance of FHV as a risk
factor in the developmental course leading to problems with drugs
and violence among individuals with alcohol-related problems enrolled
in treatment for substance abuse or dependence. Further, there
was evidence that women may be impacted more than men by family
background variables (both FHA and FHV) in terms of the development
of adult problems with alcohol, drugs and violence.
Curran GM, Stoltenberg
SF, Hill EM, Mudd SA, Blow FC & Zucker RA. (1999). Gender differences
in the relationships among SES, family history of alcoholism and
alcohol dependence. Journal of Studies on Alcohol, 60,
825-832.
Objective: Potential moderator and mediator roles
of several measures of socioeconomic status (SES) were investigated
for the relationship between a family history of alcoholism (FH)
and alcohol dependence symptoms in adulthood. Method: These analyses
were performed with a sample of 931 men and 385 women participating
in studies at the Alcohol Research Center, University of Michigan.
Hierarchical multiple regression equations were used to assess
whether SES mediated and moderated relationships between FH and
alcohol dependence symptoms. Results: In general, measures of
SES (education, occupation, personal and household income) were
more important predictors of alcohol dependence symptoms among
men, while FH was a stronger predictor among women. In the female
sample, measures Of personal and household income interacted with
family history such that the influence of family history on adult
alcohol dependence symptoms was significantly stronger among low
income women. Measures of SES and FH were additively related to
alcohol dependence symptoms among men. Education partially meditated
the relationship between family history and alcohol dependence
symptoms among men, indicating that the influence of family history
on subsequent alcohol problems among men may be partially due
to familial alcoholism's negative effect on educational attainment.
Conclusions: The results of this study suggest the influence of
FH on alcohol dependence varies according to SES and gender, and
point to the usefulness of examining potential moderators and
mediators of family history of alcohol use disorders.
Flynn
HA. (2000). Comparison of Cross-Sectional and Daily Reports in Studying
the Relationship between Depression and Use of Alcohol in Response
to Stress in College Students. Alcoholism: Clinical and Experimental
Research 24 (1), 48-52.
This study focused methodological issues
as possible sources of equivocal findings regarding the relationship
between depressed mood and alcohol use in response to stress in
a college student population. Findings may differ when these variables
are examined cross-sectionally versus longitudinally. Daily depression
and alcohol coping were assessed both cross-sectionally and repeatedly
over time in 125 college students. Participants were assessed at
baseline using a diagnostic self-report measure of depression as
well as a measure of typical coping style. In addition, daily measures
of stress, symptoms of depression and coping were completed for
45 consecutive days. Different relationships between mood and alcohol
use were found when depressed individuals were analyzed separately
from those who were not depressed. These findings have implications
for research design as well as clinical assessment when examining
the relationships between alcohol use and mood, suggesting that
cross-sectional measures of mood and alcohol use may obscure differences
as assessed repeatedly over time. In addition, these findings lend
support for the utility of frequent assessment of symptoms of depression
when implementing or evaluating programs that target coping skills
in college students.
Depression after Alcohol
Treatment as a Risk Factor for Relapse among Male Veterans (Heather
A. Flynn, Ph.D.)
We examined the association between relapse-to-drinking
and depressive symptomatology measured during inpatient treatment
for alcohol disorder and 3 months post-treatment. Data were obtained
from 298 veterans who completed 21-day inpatient treatment. Three-,
six-, nine-, and twelve-month follow-up interviews were conducted.
We used multiple logistic regression to assess the association
between relapse and baseline/three-months post-treatment measures
of depression (Beck Depression Inventory), controlling for important
covariates. Our results showed that 1) the mild-to-moderately
depressed (BDI = 14-19) at 3-months post-treatment were on average
2.9 times more likely than the non-depressed to have relapsed
across follow-ups, and 2) the severely symptomatic (BDI = 20+)
at 3 months post-treatment were on average 4.9 times more likely
to have relapsed across follow-ups. Other analyses revealed that
those with persistent depressive symptomatology reported at both
baseline and 3 months post-treatment did not experience worse
outcomes that those who reported symptomatology at 3 months post-treatment
alone. These findings support the recommendation that follow-up
assessment of depression in individuals following treatment is
critical to inform intervention strategies.
Kales HC, Blow FC, Bingham
CR, Copeland LA & Mellow AM. (2000). Race and inpatient psychiatric
diagnoses among elderly veterans. Psych Serv, 51:795-800.
Limited data exist on differential rates of psychiatric
diagnoses between ethnocultural groups in the elderly population.
The purpose of this study was to examine more closely the issue
of race and rates of psychiatric diagnoses among elderly inpatients.
Ss included 23,758 veterans aged 60 yrs or over admitted in 1994
to acute inpatient units in Department of Veterans Affairs hospitals.
Psychiatric diagnosis determined inclusion in 1 of 6 diagnostic
groups: cognitive, mood, psychotic, substance use, anxiety, and
other disorders. The study also assessed rates of psychiatric
diagnoses among patients admitted to psychiatric units only and
by age group and treatment setting, such as the size of the hospital
and whether it had an academic affiliation. Compared with elderly
Hispanic and White patients, a significantly higher proportion
of elderly African-American patients were diagnosed as having
cognitive disorders and substance use disorders, and a significantly
lower proportion were diagnosed as having mood and anxiety disorders.
Hispanic and African-American patients had significantly higher
rates of psychotic diagnoses than White patients. For all diagnoses
except cognitive disorders, these differential rates were also
found among patients admitted to psychiatric units only.
Kales HC, Blow FC, Bingham
CR, Roberts JS, Copeland LA & Mellow AM. (2000). Race, psychiatric
diagnosis, and mental health care utilization in older patients.
Am Journal Geriatric Psychiatry, 8(4):1-9.
Evaluated the impact of race on mental health
care utilization among older patients within given clinical psychiatric
diagnoses by examining a retrospective sample of 23,718 elderly
veterans (mean age 69.7 yrs) treated in Department of Veterans
Affairs inpatient facilities in 1994. Significant racial differences
in mental health care utilization found over a subsequent 2-year
period were related to outpatient (but not inpatient) care; for
instance: 1) African American patients with psychotic disorders
had significantly fewer outpatient psychiatric visits; and 2)
African American patients with substance abuse disorders had significantly
more psychiatric visits than Caucasian patients in their respective
groups. It is concluded that although inpatient utilization appeared
to be similar among races, the few differences found in outpatient
psychiatric utilization may be associated with such factors as
treatment compliance, treatment efficacy, access to mental health
care, or possible clinician bias.
Kales HC, Blow FC, Copeland
LA, Bingham CR, Krammer EE & Mellow AM. (1999). Health care utilization
by older patients with coexisting dementia and depression. American
Journal of Psychiatry, 156, 550-556.
Compared elderly patients who had coexisting dementia
and depression with elderly patients who had either disorder alone
in terms of their utilization of inpatient and outpatient services.
Ss were 7,115 veterans aged 60+ yrs who had been discharged from
inpatient units. Outcome measures were analyzed for a 2-yr period.
Ss with coexisting dementia and depression had significantly more
psychiatric inpatient days than the other 2 study groups and more
medical inpatient days and nursing home readmissions than Ss with
depression alone. Ss with coexisting dementia and depression had
significantly more total inpatient days than the other 2 groups.
Ss with coexisting dementia and depression did not utilize more
outpatient resources than the other study groups; in fact, they
had significantly fewer medical, psychiatric, and total visits
than Ss with depression alone.
Maio RF, Shope JT, Blow
FC, Copeland LA, Gregor MA, Brockmann LM, Weber JE & Metrou ME.
(2000). Adolescent injury in the emergency department: opportunity
for alcohol interventions? Annals of Emergency Medicine, 35(3):
252-257.
Study Objective: Alcohol, the most commonly used
substance among adolescents, is frequently associated with injury.
Little is known regarding the drinking characteristics of injured
adolescents. Such data are critical for developing emergency department
interventions to decrease alcohol-related injury among adolescents.
We sought to describe the drinking characteristics of injured
adolescents and to describe the relationship of injury severity
and mechanisms with drinking characteristics. METHODS: This study
was a prospective cohort study performed in a university hospital
(sampled May 1, 1995, to July 15, 1995) and a large urban teaching
hospital (sampled May 1, 1996, to August 1, 1996). The participants
were aged 12 to 20 years, presenting within 6 hours of an injury.
We performed a saliva alcohol test and self-administered questionnaire.
Age, sex, E-code, injury severity score (ISS), and ED disposition
were recorded. An alcohol frequency/quantity index was calculated.
Descriptive statistics and 95% confidence intervals were calculated.
RESULTS: Two hundred sixty-three patients with a mean age of 17
years and a mean ISS of 2.1 (SD 3.5) were recruited. One hundred
fifty-two (50%) were males, and 33 (13%) were admitted. Ten (4%)
patients had a positive saliva alcohol test response. On average,
within the last year, these adolescents had 1.7 adverse alcohol
consequences. Sixty percent drank in unsupervised settings, and
36% reported drinking 5 or more drinks in a row. CONCLUSION: Alcohol
use/misuse is a substantial problem among injured adolescents
regardless of severity or mechanism of injury. ED physicians should
consider screening/intervention or primary prevention of alcohol
problems for all injured adolescents.
Roberts JS, Blow FC,
Copeland LA, Barry KL & VanStone W. (2000). Age-group differences
in treatment outcomes for male veterans with severe schizophrenia:
A three-year longitudinal study. J of Ger Psychology Neurology,
13(2): 78-86.
Treatment outcomes in later-life schizophrenia
are poorly understood and of serious concern for clinicians and
mental health policy makers. Age-group differences were examined
for 499 male veterans with severe schizophrenia enrolled in enhanced
treatment programs at 12 Veterans Affairs hospitals. Participants
were separated into three age groups (20-39 years, 40-59 years,
60 years and above), with the following outcomes assessed at enrollment
and 1 and 3 years afterwards: psychiatric symptomatology, global
functioning, impairment in Instrumental Activities of Daily Living
(IADL), and hospital use. All three age groups experienced significant
improvement in psychiatric symptoms over time. The oldest group
fared worse than younger patients in terms of global functioning
and generally required more inpatient services and assistance
with IADL. Innovative programming is needed to meet the special
needs of the growing population of older adults with schizophrenia.
Walton MA, Blow FC, Booth
BM. (In press). A Comparison of Substance Abuse Patients' and
Counselors' Perceptions of Relapse Risk: Relationship to Actual
Relapse. Journal of Substance Abuse Treatment, 19:161-169.
This study compared substance abuse patients'
and their counselors' perceptions of relapse risk during treatment
and evaluated whether these perceptions predict actual relapse
2 years later. Participants (N = 240) completed the Relapse Risk
Index (RRI), which assesses confidence in abilities and need for
services across four domains: coping skills, social support, resources,
and leisure activities. Participants reported greater confidence
and greater needs than counselors reported. Determinants of counselors'
relapse risk perceptions included income, whereas participants'
perceptions were related to polysubstance use. Counselors' ratings
of coping skills predicted alcohol relapse; counselors' ratings
did not predict drug relapse. Participants' ratings of coping
skills and leisure activities predicted alcohol relapse; social
support predicted drug relapse. When including background characteristics,
counselors' ratings did not predict alcohol or drug relapse; participants'
ratings predicted alcohol relapse but not drug relapse. Findings
suggest the potential utility of considering patient perceptions
to understand and possibly prevent relapse.
Walton MA, Mudd SA, Blow
FC, Chermack ST & Gomberg ESL. (2000). Stability in the drinking
habits of older problem drinkers recruited from nontreatment settings.
Journal of Substance Abuse Treatment 18:169-177.
Few prospective studies have examined older problem-drinkers
not currently in treatment to determine the stability in alcohol
problems over time. Seventy-eight currently drinking, older adults
meeting a diagnosis of alcohol abuse or dependence were recruited
via advertising to complete a health interview; 48 were approximately
3 years later. Participants were categorized based on alcohol
consumption (risk) and alcohol-related diagnostic symptoms (problem)
at baseline and follow-up. At follow-up, few older adults (11.4%)
were resolved using both risk and problem criteria. Alcohol risk/problem
groups were not significantly stable between baseline and follow-up.
Health problems was the most common reason for changing drinking
habits. Average and maximum consumption at baseline and follow-up
were significant markers of follow-up risk group and follow-up
alcohol-related consequences, respectively, with maximum consumption
being more robust. The course of alcohol problems among older
adults fluctuates over time, and heavy drinking appears to be
the best indicator of problem continuation.
Williams KL, Woods JH (2000)
A Behavioral Economic Analysis of Concurrent Ethanol- and Water-Reinforced
Responding in Different Preference Conditions. Alcoholism: Clinical
Experimental Research 24: 980-986.
The reinforcing properties of orally self-administered
drugs have been evaluated using choice procedures. The preference
for the drug over a non-drug alternative has indicated that the
drug has greater value than the non-drug alternative as a reinforcer
at some drug concentrations. However, at large drug concentrations,
the fluid deliveries of the drug may be equal to or less than
those of the non-drug alternative (while the actual drug intake
(mg/kg) may continue to increase). In this study, behavioral economics
was used to evaluate the reinforcing strength of ethanol in conditions
where baseline ethanol fluid deliveries were greater than, equal
to, or less than those of the concurrently available water. Four
male rhesus monkeys were allowed access to ethanol (2%, 8%, or
32%) and water for 2 hours/day under a fixed ratio 4 (FR4) reinforcement
schedule. At each ethanol concentration, the FR for both fluids
was gradually increased up to FR64. During the FR4 schedule, the
fluid deliveries of ethanol at 2%, 8%, and 32% were greater than,
equal to, and less than those of water, respectively. When the
FR was increased at 2% ethanol, the fluid deliveries and responding
decreased proportionately for both the ethanol and water. At 8%
ethanol, water fluid deliveries and responding decreased more
rapidly than did those of ethanol. At 32% ethanol, the ethanol
fluid deliveries remained the same across all FR's while water
fluid deliveries decreased rapidly with FR increases. At 8% and
32% ethanol, the responding for ethanol relative to water increased
dramatically. In behavioral economic terms, demand for ethanol
was more inelastic regardless of whether the ethanol or water
maintained more absolute fluid deliveries at baseline FR's. Therefore,
reinforcing effects of ethanol should be examined in a variety
of concentration and schedule conditions rather than drawing inferences
regarding reinforcing effects simply based on a preference measure.
Williams KL, Woods JH (1999)
Conditioned Taste Aversion is Produced by Naltrexone Doses that
Reduce Ethanol-Reinforced Responding in Rhesus Monkeys. Alcoholism:
Clinical Experimental Research 23: 708-715.
Clinical trials have shown that naltrexone is
effective in treating alcohol dependence; nausea and dysphoria
have been reported as “side effects” in many of these studies.
In primates, naltrexone reduces reinforced responding for oral
ethanol, sucrose, and phencyclidine. This study was designed to
determine if naltrexone reduces reinforced responding for various
solutions by producing an interoceptive stimulus that may result
in a conditioned taste aversion. Four opioid antagonist-naive
rhesus monkeys responded for solutions from a 2-spout operant
panel for 30 minutes per day. During a conditioning phase, the
monkeys received novel Kool-Aid solutions paired with either saline
or naltrexone (0.32 mg/kg) given 30 minutes prior to the session.
The monkeys then had 7 choice sessions between the saline-paired
solution or the naltrexone-paired solution. During the conditioning
phase, the naltrexone reduced responding after 5 naltrexone/solution
pairings. In addition, a conditioned taste aversion was produced;
the naltrexone-paired solution maintained significantly less responding
than did the saline-paired solution during the choice phase. In
the next phase, the saline and naltrexone were given “unpaired”
from any distinct part of the operant session, and another 7 choice
sessions followed. Naltrexone had no effect when given “unpaired”
from the operant session. Then, another conditioning phase was
undertaken followed by another series of choice sessions. During
the replication of the conditioning, naltrexone reduced responding
by the second pairing, although no conditioned aversion was observed
in the subsequent choice sessions. Thus, given in the same manner
(dose, route, and pretreatment time) as situations in which naltrexone
reduces oral ethanol-, sucrose-, and phencyclidine-reinforced
responding, naltrexone produced a conditioned taste aversion.
These results suggest that naltrexone-induced nausea and its conditioned
effects should be considered in naltrexone’s effect in alcoholics.
Williams KL, Woods JH (1999)
Naltrexone Reduces Ethanol- and/or Water-Reinforced Responding in
Rhesus Monkeys: Effect Depends upon Ethanol Concentration. Alcoholism:
Clinical Experimental Research. Alcoholism Clinical Experimental
Research 23: 1462-1467.
Background: The opioid antagonist naltrexone reduces
responding for ethanol. If naltrexone produces this effect by
blocking ethanol-induced opioid activity, then naltrexone should
reduce responding for ethanol regardless of level of the ethanol
responding relative to an alternatively available reinforcer.
Additionally, if naltrexone is competitively blocking ethanol-induced
opioid activity, then the naltrexone effect may be surmountable
by increasing ethanol concentration and thus ethanol intake (g/kg).
This study was conducted to determine whether naltrexone will
selectively reduce ethanol-reinforced responding when the ethanol
concentration is varied such that ethanol fluid deliveries are
less than, greater than, or equal to the fluid deliveries of concurrently
available water. Methods: Four adult male rhesus monkeys were
allowed to respond for ethanol or water concurrently for 2 hours
per day. Ethanol concentration was either 2%, 8%, or 32%. On various
days, either saline or naltrexone (0.1 mg/kg) was given intramuscularly
30 minutes prior to the drinking session. Results: When ethanol
fluid deliveries were greater than those of water (at 2% ethanol),
naltrexone reduced responding for ethanol. When the ethanol and
water fluid deliveries were approximately equal (at 8% ethanol),
naltrexone reduced both ethanol and water fluid deliveries. When
water fluid deliveries were greater than those of ethanol (at
32% ethanol), naltrexone reduced responding for water. Conclusions:
Thus, naltrexone reduced responding for the preferred fluid, either
ethanol or water, depending upon ethanol concentration. The effect
was not surmountable by increasing ethanol concentration and therefore
ethanol intake (g/kg). Naltrexone may reduce ethanol-reinforced
responding by a mechanism other than that of blocking ethanol-induced
opioid activity. Naltrexone may be inducing an aversive interoceptive
state.
Williams KL, Pakarinen ED,
Woods JH (1999) Quadazocine Decreases Reinforced-Responding for
Oral Ethanol, Sucrose, and Phencyclidine: Comparison to Naltrexone
Effects. Psychopharmacology 144: 316-322.
Rationale: The endogenous opioid system
may mediate the reinforcing effects of ethanol as well as sweet-tasting
solutions. For example, opioid antagonists, such as naltrexone,
reduce ethanol- and sucrose-reinforced responding in rhesus monkeys.
If these effects are due to blockade of the µ-receptor,
then an opioid antagonist such as quadazocine with a receptor
selectivity profile similar to that of naltrexone should reduce
responding at doses correlated with its µ-selectivity. Objectives:
1) To determine whether quadazocine would reduce responding for
ethanol and sucrose at µ-selective doses, 2) to determine
whether quadazocine and naltrexone would reduce responding for
a bitter-tasting drug solution such as phencyclidine. Methods:
Rhesus monkeys were given access to ethanol, sucrose, or phencyclidine
concurrently with water. Prior to the drinking sessions, quadazocine
(0.032 - 3.2 mg/kg) or saline was injected intramuscularly. During
the phencyclidine experiment, naltrexone (0.1 and 0.32 mg/kg)
was also tested. Results: The highest quadazocine doses (1 and
3.2 mg/kg) reduced ethanol and sucrose fluid deliveries without
affecting the concurrently available water. Quadazocine reduced
the fluid deliveries of both phencyclidine and water when concurrently
available. Naltrexone reduced only phencyclidine fluid deliveries.
Conclusions: The opioid antagonist effect on oral-reinforced responding
is not selective for ethanol or sweet-tasting solutions; responding
for bitter solutions are reduced as well. Quadazocine and NTX
may reduce responding by blocking the µ-receptor because
the relative potency of these antagonists to reduce oral self-administration
was similar to their relative potency to produce withdrawal in
morphine-dependent monkeys. However, water responding was low
in these experiments, and thus, we cannot rule out rate-dependent
effects of the antagonists.
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