Rudolf Moos
Professor of Psychiatry and Behavioral Sciences, Emeritus
Psychiatry and Behavioral Sciences - Stanford/VA Aging Clinical Research Center
Academic Appointments
Honors & Awards
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Distinguished Contribution Award, Division of Community Psychology - American Psychological Association (1983)
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Seymour Sarason Award, Society for Community Research and Action - American Psychological Association (2002)
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Outstanding Achievement in Health Services Research, Department of Veterans Affairs (1999)
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Distinguished Research Award, Association of Medical School Psychologists (1998)
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Lazarsfeld Award, American Evaluation Association (1992)
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MERIT Award, National Institute on Alcohol Abuse and Alcoholism (1988)
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Hofheimer Award for Research, American Psychiatric Association (1975)
Professional Education
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B.A., University of California, Psychology (1956)
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Ph.D., University of California, Psychology (1960)
Current Research and Scholarly Interests
Our research group works primarily on psychiatric program evaluation and the quality of health care. The studies focus heavily on health care programs and the context, process, outcome, and cost of care. To guide our work, we use a conceptual framework that encompasses the characteristics and quality of psychiatric programs; it also focuses on how patients' life contexts, especially stressful life circumstances and social resources, and patients' coping responses, affect the selection, duration, process, and outcome treatment.
Some ongoing projects focus primarily on life stressors and coping among healthy and high risk groups. In this area, we are developing new procedures by which to assess life stressors and social resources in stess-prevention and resistance; examining the concurrent and predictive associations between life context and coping factors and problem drinking among late-middle-aged adults; and focusing on the influence of psychiatric disorders such as alcohol abuse and depression on the family members of affected individuals.
All Publications
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Binge Drinking and Alcohol Problems Among Moderate Average-Level Drinkers.
American journal of preventive medicine
2022; 63 (3): 324-330
Abstract
INTRODUCTION: A significant amount of binge drinking among adults escapes public health scrutiny because it occurs among individuals who drink at a moderate average level. This observational study examined the role of a binge pattern of drinking in predicting alcohol problems among moderate drinkers in a U.S. national sample of adults.METHODS: Participants were 1,229 current drinkers aged ≥30 years from 2 waves of the study of Midlife Development in the United States, with a 9-year time lag (2004-2015) (analyzed in 2021‒2022). Negative binomial regression analyses were used to examine the number of alcohol problems, and binary logistic regression analyses were used to examine multiple (≥2) alcohol problems.RESULTS: Independent of the average level of drinking, binge drinking was linked with an almost 3 times increase in the number of concurrent alcohol problems and a 40% increase in the number of alcohol problems prospectively 9 years later. Moderate average level drinkers accounted for most cases of binge drinking and multiple alcohol problems. Among moderate drinkers, binge drinking was linked with a close to 5 times increase in concurrent multiple alcohol problems and a >2 times increase in multiple alcohol problems prospectively 9 years later.CONCLUSIONS: These results substantially broaden an increasing recognition that binge drinking is a public health concern among adults. Moderate average-level drinkers should be included in efforts to reduce alcohol problems in adults. These findings are applicable to primary and secondary prevention of alcohol problems with the potential to advance population health.
View details for DOI 10.1016/j.amepre.2022.03.021
View details for PubMedID 35987558
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History of drinking problems diminishes the protective effects of within-guideline drinking on 18-year risk of dementia and CIND.
BMC public health
1800; 21 (1): 2319
Abstract
OBJECTIVE: To examine the moderating effect of older adults' history of drinking problems on the relationship between their baseline alcohol consumption and risk of dementia and cognitive impairment, no dementia (CIND) 18years later.METHOD: A longitudinal Health and Retirement Study cohort (n=4421) was analyzed to demonstrate how older adults' baseline membership in one of six drinking categories (non-drinker, within-guideline drinker, and outside-guideline drinker groups, divided to reflect absence or presence of a history of drinking problems) predicts dementia and CIND 18years later.RESULTS: Among participants with no history of drinking problems, 13% of non-drinkers, 5% of within-guideline drinkers, and 9% of outside-guideline drinkers were classified as having dementia 18-years later. Among those with a history of drinking problems, 14% of non-drinkers, 9% of within-guideline drinkers, and 7% of outside-guideline drinkers were classified with dementia. With Non-Drinker, No HDP as reference category, being a baseline within-guideline drinker with no history of drinking problems reduced the likelihood of dementia 18years later by 45%, independent of baseline demographic and health characteristics; being a baseline within-guideline drinker with a history of drinking problems reduced the likelihood by only 13% (n.s.). Similar patterns obtained for the prediction of CIND.CONCLUSIONS: For older adults, consuming alcohol at levels within validated guidelines for low-risk drinking may offer moderate long-term protection from dementia and CIND, but this effect is diminished by having a history of drinking problems. Efforts to predict and prevent dementia and CIND should focus on older adults' history of drinking problems in addition to how much alcohol they consume.
View details for DOI 10.1186/s12889-021-12358-4
View details for PubMedID 34949174
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Strong associations among PTSD, pain, and alcohol and drug use disorders in VA primary care patients.
Drug and alcohol dependence
2021; 223: 108699
Abstract
PTSD, pain, and alcohol and drug use disorders (AUD and DUDs) are prevalent, debilitating, and costly. Clinicians benefit from understanding the co-occurrence among these conditions, especially cocaine and opioid use disorders. This is the first study to examine (1) the odds of having one condition in the presence of one of the other conditions, and (2) the extent to which having PTSD, pain, or an AUD raises the odds of having a DUD in VA primary care patients.We used cross-sectional archival data from 1283 primary care patients recruited in VA primary care clinics. Pain was measured by the numeric rating scale. PTSD, AUD, and DUDs (i.e., cannabis, opioid, cocaine, and any drug use disorder) were measured by the Mini International Diagnostic Interview. We conducted logistic regression analyses to examine the odds of having one condition in the presence of other conditions.A total of 14.9 % of patients had PTSD, 52.8 % of patients had moderate or severe pain, 12.8 % had an AUD, and 10.4 % had any DUD. Patients who had one condition (PTSD, pain, AUD, or DUD) were highly likely to have one or more of the other conditions, with or without controlling for demographic variables.VA Patients who had PTSD, moderate or severe pain, or an AUD were highly likely to have an opioid or cocaine use disorder, and therefore should be screened for DUDs in VA primary care.
View details for DOI 10.1016/j.drugalcdep.2021.108699
View details for PubMedID 33862323
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Screen of drug use: Diagnostic accuracy for stimulant use disorder.
Addictive behaviors
2020; 112: 106614
Abstract
AIMS: Stimulant misuse, overdose, and related deaths have increased dramatically. Identifying and referring individuals with stimulant use disorder to treatment may reduce misuse and overdose. This study validated the 2-item Screen of Drug Use (SoDU; Tiet et al., 2015) to screen for stimulant use disorder (and for cocaine and amphetamine use disorders) in a VA primary care setting, and to establish its concurrent diagnostic validity among diverse subgroups of patients, including age, gender, race/ethnicity, marital status, educational level, and PTSD status.METHODS: Archival data from 1283 VA primary care patients recruited in California were examined. This predominantly male sample matched general VA primary care patient population characteristics. A total of 79 individuals (6.2%) met criteria for a stimulant use disorder. The criterion for having a stimulant use disorder was a DSM-IV cocaine use disorder and/or amphetamine use disorder diagnosis based on the Mini International Diagnostic Interview.RESULTS: For stimulant use disorder, the 2-item SoDU was 93.67% sensitive (95% confidence interval [CI], 85.84%-97.91%), and 89.12% specific (95% CI, 87.22%-90.82%). When tested in diverse subgroups of patients, the sensitivity ranged from 66.67% to 100% and specificity ranged from 76.81% to 94.17%. When a follow-up question was added, the sensitivity was unchanged and the specificity was 99%, with lower false positive rate.CONCLUSIONS: The SoDU, especially with a follow-up question, is an appropriate instrument for routine screening of stimulant use disorder in VA primary care settings. It has good concurrent diagnostic validity for diverse groups of patients.
View details for DOI 10.1016/j.addbeh.2020.106614
View details for PubMedID 32896784
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Screen of drug use: Diagnostic accuracy for cannabis use disorder
ADDICTIVE BEHAVIORS
2019; 95: 184–88
View details for DOI 10.1016/j.addbeh.2019.02.010
View details for Web of Science ID 000472703300029
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Screen of drug use: Diagnostic accuracy for opioid use disorder
DRUG AND ALCOHOL DEPENDENCE
2019; 198: 176–79
View details for DOI 10.1016/j.drugalcdep.2019.01.044
View details for Web of Science ID 000469306800028
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Screen of drug use: Diagnostic accuracy for opioid use disorder.
Drug and alcohol dependence
2019; 198: 176–79
Abstract
AIMS: Opioid related deaths have more than tripled in recent years. Identifying and referring individuals with opioid use disorder (OUD) to treatment is one of the promising approaches to reduce opioid related deaths. However, using urine toxicology to identify opioid misuse is not reliable. This study validates the Screen of Drug Use (SoDU) to screen for OUD in the primary care setting, and establish its concurrent diagnostic validity among diverse subgroups of patients, including age, gender, race/ethnicity, marital status, educational level, and PTSD status.METHODS: We used data from 1283 primary care patients recruited in the VA in CA. This sample matched patient characteristics general VA population with mean age=62, and 95% men. A total of 10.4% met DSM-5 criteria for any drug use disorder and 2.7% met criteria for OUD (with or without other drug use disorders). An opioid use abuse or dependence diagnosis based on the Mini International Diagnostic Interview was used as the criterion for having a DSM-5 opioid use disorder.RESULTS: The SoDU was 100% sensitive (95% confidence interval [CI], 89.9%-100%), and 86.3% specific (95% CI, 84.3%-88.1%). When tested in subgroups of patients, the SoDU maintained 100% sensitivity in all subgroups. Specificity ranged from 74.5% to 94.2% for diverse subgroups of patients.CONCLUSIONS: The SoDU is an appropriate instrument to screen for opioid use disorder in primary care. It is brief, easy to use, and has good concurrent diagnostic validity for diverse groups of patients.
View details for PubMedID 30947051
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Screen of drug use: Diagnostic accuracy for cannabis use disorder.
Addictive behaviors
2019; 95: 184–88
Abstract
OBJECTIVE: As cannabis has been legalized for medicinal and recreational use, rates of cannabis misuse and cannabis use disorder (CUD) have increased. However, only a small percentage of individuals with CUD seek treatment. A practical screening instrument is needed to detect CUD in primary care (PC) to address the needs of individuals with CUD. This study seeks to validate the 2-item Screen of Drug Use (SoDU) to help detect CUD in the PC setting.METHOD: We used archival data from 1283 patients recruited in the Department of Veterans Affairs (VA) PC clinics. A total of 51 individuals (4%) met DSM-IV criteria for CUD (abuse or dependence; with or without other drug use disorders). A diagnosis of CUD based on the Mini International Diagnostic Interview (MINI) was used as the criterion. Concurrent diagnostic properties of the SoDU were examined against the MINI.RESULTS: The SoDU was 100% sensitive (95% confidence interval [CI], 93.00% - 100%), and 87.50% specific (95% CI, 85.53% - 89.23%). When tested in subgroups of patients varying in age, gender, race/ethnicity, marital status, educational level, and PTSD status, the SoDU maintained 100% sensitivity in all subgroups; specificity ranged from 76.26% to 94.34%.CONCLUSIONS: The SoDU is an appropriate instrument to help identify CUD in primary care. It is brief, easy to use, and has good concurrent diagnostic validity for diverse groups of patients.
View details for PubMedID 30933714
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Drinking Level Versus Drinking Pattern and Cigarette Smoking Among Older Adults
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2018; 42 (4): 795–802
Abstract
There is a lack of research on the role of alcohol consumption in cigarette smoking among older adults, and the few studies on alcohol use and smoking with older adults have failed to distinguish between average level and pattern of drinking as predictors of smoking. The main purpose of this study was to examine the independent contributions of average level versus pattern of drinking as predictors of cigarette smoking among older adults. A subsidiary purpose was to examine the link between continued smoking and mortality among older smokers.We investigated average level and pattern of drinking as predictors of current smoking among 1,151 older adults at baseline and of continued smoking and mortality among the subset of 276 baseline smokers tracked across 20 years. We used multiple linear and logistic regression analyses and, to test mediation, bias-corrected bootstrap confidence intervals.A high level of average drinking and a pattern of episodic heavy drinking were concurrently associated with smoking at baseline. However, only episodic heavy drinking was prospectively linked to continued smoking among baseline smokers. Continued smoking among baseline smokers increased the odds of 20-year mortality and provided an indirect pathway through which heavy episodic drinking related to mortality.Smokers who misuse alcohol are a challenging population for smoking cessation efforts. Older adults who concurrently misuse alcohol and smoke cigarettes provide a unique target for public health interventions.
View details for PubMedID 29417610
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Diagnostic accuracy of a two-item Drug Abuse Screening Test (DAST-2)
ADDICTIVE BEHAVIORS
2017; 74: 112–17
Abstract
Drug use is prevalent and costly to society, but individuals with drug use disorders (DUDs) are under-diagnosed and under-treated, particularly in primary care (PC) settings. Drug screening instruments have been developed to identify patients with DUDs and facilitate treatment. The Drug Abuse Screening Test (DAST) is one of the most well-known drug screening instruments. However, similar to many such instruments, it is too long for routine use in busy PC settings. This study developed and validated a briefer and more practical DAST for busy PC settings.We recruited 1300 PC patients in two Department of Veterans Affairs (VA) clinics. Participants responded to a structured diagnostic interview. We randomly selected half of the sample to develop and the other half to validate the new instrument. We employed signal detection techniques to select the best DAST items to identify DUDs (based on the MINI) and negative consequences of drug use (measured by the Inventory of Drug Use Consequences). Performance indicators were calculated.The two-item DAST (DAST-2) was 97% sensitive and 91% specific for DUDs in the development sample and 95% sensitive and 89% specific in the validation sample. It was highly sensitive and specific for DUD and negative consequences of drug use in subgroups of patients, including gender, age, race/ethnicity, marital status, educational level, and posttraumatic stress disorder status.The DAST-2 is an appropriate drug screening instrument for routine use in PC settings in the VA and may be applicable in broader range of PC clinics.
View details for PubMedID 28609724
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Late-Life Drinking Problems: The Predictive Roles of Drinking Level vs. Drinking Pattern
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2017; 78 (3): 435-441
Abstract
Research on late-middle-aged and older adults has focused primarily on average level of alcohol consumption, overlooking variability in underlying drinking patterns. The purpose of the present study was to examine the independent contributions of an episodic heavy pattern of drinking versus a high average level of drinking as prospective predictors of drinking problems.The sample comprised 1,107 adults ages 55-65 years at baseline. Alcohol consumption was assessed at baseline, and drinking problems were indexed across 20 years. We used prospective negative binomial regression analyses controlling for baseline drinking problems, as well as for demographic and health factors, to predict the number of drinking problems at each of four follow-up waves (1, 4, 10, and 20 years).Across waves where the effects were significant, a high average level of drinking (coefficients of 1.56, 95% CI [1.24, 1.95]; 1.48, 95% CI [1.11, 1.98]; and 1.85, 95% CI [1.23, 2.79] at 1, 10, and 20 years) and an episodic heavy pattern of drinking (coefficients of 1.61, 95% CI [1.30, 1.99]; 1.61, 95% CI [1.28, 2.03]; and 1.43, 95% CI [1.08, 1.90] at 1, 4, and 10 years) each independently increased the number of drinking problems by more than 50%.Information based only on average consumption underestimates the risk of drinking problems among older adults. Both a high average level of drinking and an episodic heavy pattern of drinking pose prospective risks of later drinking problems among older adults.
View details for Web of Science ID 000401680600014
View details for PubMedID 28499111
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Diagnostic accuracy of a two-item screen for drug use developed from the alcohol, smoking and substance involvement screening test (ASSIST)
DRUG AND ALCOHOL DEPENDENCE
2016; 164: 22-27
Abstract
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a screening instrument to detect substance use in primary care (PC). To screen for illicit substances (excluding tobacco and alcohol), the ASSIST consists of 8-57 questions and requires complicated scoring. To improve the efficiency of screening of drug misuse in PC, this study constructed and validated a two-item screen for drug use from the ASSIST.Guided by previous reviews, the ASSIST was revised. Patients were recruited in VA primary care clinics (N=1283). Half of the sample was used to develop the ASSIST-Drug; the other half was used to validate it. The Mini International Neuropsychiatric Interview (MINI) and the Inventory of Drug Use Consequences were the criterion measures.A brief, two-item ASSIST-Drug was constructed. Based on the development sample, the ASSIST-Drug was 94.1% sensitive and 89.6% specific for drug use disorders. Based on the validation sample, it was 95.4% sensitive and 87.8% specific. The ASSIST-Drug also had comparable sensitivity and specificity to identify drug use negative consequences, as well as for diverse subgroups of patients in terms of gender, age, race/ethnicity, marital status, educational levels, and post traumatic stress disorder status.The ASSIST-Drug may be a useful screening tool for PC settings. It is reliable, brief, and easy to remember, administer and score. It is sensitive and specific for drug use disorders and drug use negative consequences, and the predictive properties are consistent across subgroup of patients.
View details for DOI 10.1016/j.drugalcdep.2016.03.029
View details for Web of Science ID 000378468800004
View details for PubMedID 27234660
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Al-Anon newcomers: benefits of continuing attendance for six months
AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE
2016; 42 (4): 441-449
Abstract
Al-Anon Family Groups, a 12-step mutual-help program for people concerned about another person's drinking, is the most widely used form of help by Concerned Others.This longitudinal study examined newcomers' outcomes of attending Al-Anon. Aims were to better understand early gains from Al-Anon to inform efforts in the professional community to facilitate concerned others' attendance of and engagement in Al-Anon.We compared two groups of Al-Anon newcomers who completed surveys at baseline and 6 months later: those who discontinued attendance by the 6-month follow-up (N = 133), and those who were still attending Al-Anon meetings (N = 97); baseline characteristics were controlled in these comparisons.Newcomers who sustained participation in Al-Anon over the first 6 months of attendance were more likely than those who discontinued participation during the same period to report gains in a variety of domains, such as learning how to handle problems due to the drinker, and increased well-being and functioning, including reduced verbal or physical abuse victimization. Newcomers to Al-Anon reported more personal gains than drinker-related gains. The most frequent drinker gain was a better relationship with the Concerned Other; attendees were more likely to report this, as well as daily, in-person contact with the drinker.Al-Anon participation may facilitate ongoing interaction between Concerned Others and drinkers, and help Concerned Others function and feel better. Thus, short-term participation may be beneficial. Health-care professionals should consider providing referrals to Al-Anon and monitoring early attendance.
View details for DOI 10.3109/00952990.2016.1148702
View details for Web of Science ID 000378966100010
View details for PubMedID 27120262
View details for PubMedCentralID PMC4976777
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Social Processes Explaining the Benefits of Al-Anon Participation
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2015; 29 (4): 856-863
Abstract
This study examined social processes of support, goal direction, provision of role models, and involvement in rewarding activities to explain benefits of participating in Al-Anon, a 12-step mutual-help program for people concerned about another person's substance use. Newcomers to Al-Anon were studied at baseline and 6 months later, at which time they were identified as having either sustained attendance or dropped out. Among both newcomers and established Al-Anon members ("old-timers"), we also used number of Al-Anon meetings attended during follow-up to indicate extent of participation. Social processes significantly mediated newcomers' sustained attendance status versus dropped out and outcomes of Al-Anon in the areas of life context (e.g., better quality of life, better able to handle problems due to the drinker), improved positive symptoms (e.g., higher self-esteem, more hopeful), and decreased negative symptoms (e.g., less abuse, less depressed). Social processes also significantly mediated newcomers' number of meetings attended and outcomes. However, among old-timers, Al-Anon attendance was not associated with outcomes, so the potential mediating role of social processes could not be examined, but social processes were associated with outcomes. Findings add to the growing body of work identifying mechanisms by which 12-step groups are effective, by showing that bonding, goal direction, and access to peers in recovery and rewarding pursuits help to explain associations between sustained Al-Anon participation among newcomers and improvements on key concerns of Al-Anon attendees. Al-Anon is free of charge and widely available, making it a potentially cost-effective public health resource for help alleviating negative consequences of concern about another's addiction.
View details for DOI 10.1037/adb0000067
View details for Web of Science ID 000367460900004
View details for PubMedCentralID PMC4702510
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Appropriate Screening for Substance Use vs Disorder Reply
JAMA INTERNAL MEDICINE
2015; 175 (12): 1998–99
View details for PubMedID 26641357
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Substance abuse and batterer programmes in California, USA: factors associated with treatment outcomes
HEALTH & SOCIAL CARE IN THE COMMUNITY
2015; 23 (6): 642-653
Abstract
The association between substance abuse and intimate partner violence is quite robust. A promising area to improve treatment for the dual problems of substance abuse and violence perpetration is the identification of client characteristics and organisational and programme factors as predictors of health outcomes. Therefore, we examined associations of client, organisational and programme factors with outcomes in community health settings. Directors of 241 substance use disorder programmes (SUDPs) and 235 batterer intervention programmes (BIPs) reported outcomes of programme completion and substance use and violence perpetration rates at discharge; data collection and processing were completed in 2012. SUDPs having more female, non-white, younger, uneducated, unemployed and lower income clients reported lower completion rates. In SUDPs, private, for-profit programmes reported higher completion rates than public or private, non-profit programmes. SUDPs with lower proportions of their budgets from government sources, and higher proportions from client fees, reported better outcomes. Larger SUDPs had poorer programme completion and higher substance use rates. Completion rates in SUDPs were higher when clients could obtain substance- and violence-related help at one location, and programmes integrated violence-prevention contracting into care. In BIPs, few client, organisational and programme factors were associated with outcomes, but the significant factors associated with programme completion were consistent with those for SUDPs. Publicly owned and larger programmes, and SUDPs lacking staff to integrate violence-related treatment, may be at risk of poorer client outcomes, but could learn from programmes that perform well to yield better outcomes.
View details for DOI 10.1111/hsc.12178
View details for Web of Science ID 000362553200006
View details for PubMedID 25470658
View details for PubMedCentralID PMC4573371
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Anticoagulation in Atrial Fibrillation: Impact of Mental Illness
AMERICAN JOURNAL OF MANAGED CARE
2015; 21 (11): E609-E617
Abstract
To characterize warfarin eligibility and receipt among Veterans Health Administration (VHA) patients with and without mental health conditions (MHCs).Retrospective cohort study.This observational study identified VHA atrial fibrillation (AF) patients with and without MHCs in 2004. We examined unadjusted MHC-related differences in warfarin eligibility and warfarin receipt among warfarin-eligible patients, using logistic regression for any MHC and for specific MHCs (adjusting for sociodemographic and clinical characteristics).Of 125,670 patients with AF, most (96.8%) were warfarin-eligible based on a CHADS2 stroke risk score. High stroke risk and contraindications to anticoagulation were both more common in patients with MHC. Warfarin-eligible patients with MHC were less likely to receive warfarin than those without MHC (adjusted odds ratio [AOR], 0.90; 95% CI, 0.87-0.94). The association between MHC and warfarin receipt among warfarin-eligible patients varied by specific MHC. Patients with anxiety disorders (AOR, 0.86; 95% CI, 0.80-0.93), psychotic disorders (AOR, 0.77; 95% CI, 0.65-0.90), and alcohol use disorders (AOR 0.62, 95% CI 0.54-0.72) were less likely to receive warfarin than patients without these conditions, whereas patients with depressive disorders and posttraumatic stress disorder were no less likely to receive warfarin than patients without these conditions.Compared with patients with AF without MHCs, those with MHCs are less likely to be eligible for warfarin receipt and, among those eligible, are less likely to receive such treatment. Although patients with AF with MHC need careful assessment of bleeding risk, this finding suggests potential missed opportunities for more intensive therapy among some individuals with MHCs.
View details for Web of Science ID 000379911700003
View details for PubMedID 26735294
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Longitudinal changes in somatic symptoms and family disagreements among depression and community groups: a 23-year study
BMC PSYCHIATRY
2015; 15
Abstract
Few longitudinal studies describe the relationship between somatic symptoms and family disagreements. We examined changes over time in somatic symptoms, family disagreements, their interrelationships, and whether these patterns differed between individuals treated for depression (depression group) and individuals from the same community (community group).We followed participants in the depression (N = 423) and community (N = 424) groups for 23 years (the community group was matched to the depression group on socioeconomic status, gender, and marital status). All participants were age 18+ and completed surveys at baseline, 1, 4, 10, and 23 year follow-ups. We assessed somatic symptoms and family disagreements at each time point and used latent growth curve modeling to examine change in these constructs over time.Somatic symptoms and family disagreements changed differently over time. Somatic symptoms decreased between baseline and the 10 year follow-up, but increased between the 10 and 23 year follow-ups, whereas family disagreements decreased linearly over time. Somatic symptoms and family disagreements were higher at baseline and declined at a faster rate in the depression compared to the community group. The relationship between changes in somatic symptoms and changes in family disagreements was also stronger in the depression group: a larger decrease in somatic symptoms was associated with a larger decrease in family disagreements.Longitudinal changes in somatic symptoms and family disagreements differ between depression and community groups. Individuals treated for depression had more somatic symptoms and family disagreements at baseline and improved at a faster rate compared to individuals in the community. Somatic symptoms and family disagreements may be important targets when treating depression, given the strong interrelationship among these factors in individuals with depression.
View details for DOI 10.1186/s12888-015-0619-2
View details for Web of Science ID 000362538200001
View details for PubMedID 26449276
View details for PubMedCentralID PMC4599756
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Screen of Drug Use: Diagnostic Accuracy of a New Brief Tool for Primary Care.
JAMA internal medicine
2015; 175 (8): 1371-1377
Abstract
Illicit drug use is prevalent, and primary care provides an ideal setting in which to screen for drug use disorders (DUDs) and negative consequences of drug use (NCDU). Comprehensive reviews have concluded that existing drug use screening instruments are not appropriate for routine use in primary care.To develop and validate a screening instrument for drug use.We revised items drawn from existing screening instruments and conducted signal detection analyses to develop the new instrument. We approached 3173 patients at 2 primary care clinics in a US Department of Veterans Affairs health care system from February 1, 2012, through April 30, 2014. A total of 1300 (41.0%) patients consented to the study, of whom 1283 adults were eligible (mean [SD] age, 62.2 [12.6] years). In the last 12 months, 241 (18.8%) participants reported using illicit drugs or prescription medication for a nonmedical purpose, and 189 (14.7%) reported 1 or more NCDU. A total of 133 (10.4%) patients met DSM-IV criteria for a DUD. The sample was randomly divided first to develop the measure and then to validate it.The Mini-International Diagnostic Interview was used as the criterion for DUDs, and the Inventory of Drug Use Consequences was used as the criterion for NCDU.The screening instrument has 2 questions. The first is, "How many days in the past 12 months have you used drugs other than alcohol?" Patients meet that criterion with a response of 7 or more days. The second question asks, "How many days in the past 12 months have you used drugs more than you meant to?" A response of 2 or more days meets that criterion. The screening instrument was 100% sensitive and 93.73% specific for DUDs (643 patients); when replicated in the second half of the sample (640 patients), it was 92.31% sensitive and 92.87% specific. The screening instrument was 93.18% sensitive and 96.03% specific for NCDU (643 patients); when replicated in the second half of the sample (640 patients), it was 83.17% sensitive and 96.85% specific.The 2-item screen of drug use has excellent statistical properties and is a brief screening instrument for DUDs and problems suitable for busy US Department of Veterans Affairs primary care clinics.
View details for DOI 10.1001/jamainternmed.2015.2438
View details for PubMedID 26075352
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Drinking Level, Drinking Pattern, and Twenty-Year Total Mortality Among Late-Life Drinkers
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2015; 76 (4): 552-558
Abstract
Research on moderate drinking has focused on the average level of drinking. Recently, however, investigators have begun to consider the role of the pattern of drinking, particularly heavy episodic drinking, in mortality. The present study examined the combined roles of average drinking level (moderate vs. high) and drinking pattern (regular vs. heavy episodic) in 20-year total mortality among late-life drinkers.The sample comprised 1,121 adults ages 55-65 years. Alcohol consumption was assessed at baseline, and total mortality was indexed across 20 years. We used multiple logistic regression analyses controlling for a broad set of sociodemographic, behavioral, and health status covariates.Among individuals whose high level of drinking placed them at risk, a heavy episodic drinking pattern did not increase mortality odds compared with a regular drinking pattern. Conversely, among individuals who engage in a moderate level of drinking, prior findings showed that a heavy episodic drinking pattern did increase mortality risk compared with a regular drinking pattern. Correspondingly, a high compared with a moderate drinking level increased mortality risk among individuals maintaining a regular drinking pattern, but not among individuals engaging in a heavy episodic drinking pattern, whose pattern of consumption had already placed them at risk.Findings highlight that low-risk drinking requires that older adults drink low to moderate average levels of alcohol and avoid heavy episodic drinking. Heavy episodic drinking is frequent among late-middle-aged and older adults and needs to be addressed along with average consumption in understanding the health risks of late-life drinkers.
View details for Web of Science ID 000356911200007
View details for PubMedID 26098030
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The Challenges of Afghanistan and Iraq Veterans' Transition from Military to Civilian Life and Approaches to Reconnection
PLOS ONE
2015; 10 (7)
Abstract
Afghanistan and Iraq veterans experienced traumas during deployment, and disrupted connections with friends and family. In this context, it is critical to understand the nature of veterans' transition to civilian life, the challenges navigated, and approaches to reconnection. We investigated these issues in a qualitative study, framed by homecoming theory, that comprised in-depth interviews with 24 veterans. Using an inductive thematic analysis approach, we developed three overarching themes. Military as family explored how many veterans experienced the military environment as a "family" that took care of them and provided structure. Normal is alien encompassed many veterans experiences of disconnection from people at home, lack of support from institutions, lack of structure, and loss of purpose upon return to civilian life. Searching for a new normal included strategies and supports veterans found to reconnect in the face of these challenges. A veteran who had successfully transitioned and provided support and advice as a peer navigator was frequently discussed as a key resource. A minority of respondents-those who were mistreated by the military system, women veterans, and veterans recovering from substance abuse problems-were less able to access peer support. Other reconnection strategies included becoming an ambassador to the military experience, and knowing transition challenges would ease with time. Results were consistent with and are discussed in the context of homecoming theory and social climate theory. Social support is known to be protective for veterans, but our findings add the nuance of substantial obstacles veterans face in locating and accessing support, due to disconnection and unsupportive institutions. Larger scale work is needed to better understand how to foster peer connection, build reconnection with family, and engage the broader community to understand and support veterans; interventions to support reconnection for veterans should be developed.
View details for DOI 10.1371/journal.pone.0128599
View details for Web of Science ID 000358153000016
View details for PubMedCentralID PMC4489090
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The impact of posttraumatic stress disorder on cannabis quit success
AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE
2015; 41 (4)
Abstract
Though a growing number of US Veterans are being diagnosed with cannabis use disorders, with posttraumatic stress disorder (PTSD) observed as the most frequently co-occurring psychiatric disorder among this population, no research has investigated the impact of PTSD diagnosis on cannabis quit success.The present study sought to determine the impact of PTSD on cannabis use following a self-guided quit attempt.Participants included 104, primarily male, cannabis-dependent US Veterans (Mage = 50.90 years, SDage = 9.90). The study design was prospective and included an assessment immediately prior to the quit attempt, and assessments weekly for the first 4 weeks post-quit, and then monthly through 6 months post-quit.Results indicated that PTSD diagnosis was not associated with time to first lapse or relapse. However, individuals with PTSD used more cannabis at baseline and evidenced a slower initial decline in cannabis use immediately following the quit attempt. All findings were significant after accounting for alcohol and tobacco use across the cessation period, as well as co-occurring mood and anxiety disorder diagnoses.Findings highlight the potential utility of interventions for individuals with cannabis use disorder and co-occurring PTSD, particularly early in a cessation attempt.
View details for DOI 10.3109/00952990.2015.1043209
View details for Web of Science ID 000359112400010
View details for PubMedID 26043369
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Family conflict and somatic symptoms over 10 years: A growth mixture model analysis
JOURNAL OF PSYCHOSOMATIC RESEARCH
2015; 78 (5): 459-465
Abstract
While family conflict and somatic symptoms are mutually associated, few longitudinal studies have examined multiple (heterogeneous) trajectory subgroups for family conflict and somatic symptoms and their covariation over time. The aim of this study was to identify heterogeneous trajectory subgroups for family conflict and somatic symptoms and their joint trajectories.A representative sample of 424 community participants completed surveys at baseline and 1-, 4-, and 10-year follow-ups. Family conflict and somatic symptoms were assessed at each wave. Covariates (age, gender, marital status, education, and medical conditions) were assessed at baseline. Growth mixture modeling (GMM) was used to identify heterogeneous trajectory subgroups for family conflict and somatic symptoms. A parallel process GMM was used to examine joint trajectory subgroup membership between family conflict and somatic symptoms.There were three trajectory subgroups for family conflict: stable low; worsening; and improving, and three somewhat similar trajectory subgroups for somatic symptoms: stable low; stable moderate; and improving. Family conflict and somatic symptom trajectory subgroup memberships were jointly associated. Individuals who had stable low family conflict were most likely to follow a stable low somatic symptom trajectory. Individuals who improved in family conflict were most likely to continue to have stable low somatic symptoms or improve in somatic symptoms. Moreover, individuals who had stable moderate somatic symptoms were most likely to show worsening family conflict.This study demonstrates heterogeneous family conflict and somatic symptom trajectories and indicates that these trajectories covary over time.
View details for DOI 10.1016/j.jpsychores.2015.01.013
View details for Web of Science ID 000352926600008
View details for PubMedID 25684248
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The Challenges of Afghanistan and Iraq Veterans' Transition from Military to Civilian Life and Approaches to Reconnection.
PloS one
2015; 10 (7)
Abstract
Afghanistan and Iraq veterans experienced traumas during deployment, and disrupted connections with friends and family. In this context, it is critical to understand the nature of veterans' transition to civilian life, the challenges navigated, and approaches to reconnection. We investigated these issues in a qualitative study, framed by homecoming theory, that comprised in-depth interviews with 24 veterans. Using an inductive thematic analysis approach, we developed three overarching themes. Military as family explored how many veterans experienced the military environment as a "family" that took care of them and provided structure. Normal is alien encompassed many veterans experiences of disconnection from people at home, lack of support from institutions, lack of structure, and loss of purpose upon return to civilian life. Searching for a new normal included strategies and supports veterans found to reconnect in the face of these challenges. A veteran who had successfully transitioned and provided support and advice as a peer navigator was frequently discussed as a key resource. A minority of respondents-those who were mistreated by the military system, women veterans, and veterans recovering from substance abuse problems-were less able to access peer support. Other reconnection strategies included becoming an ambassador to the military experience, and knowing transition challenges would ease with time. Results were consistent with and are discussed in the context of homecoming theory and social climate theory. Social support is known to be protective for veterans, but our findings add the nuance of substantial obstacles veterans face in locating and accessing support, due to disconnection and unsupportive institutions. Larger scale work is needed to better understand how to foster peer connection, build reconnection with family, and engage the broader community to understand and support veterans; interventions to support reconnection for veterans should be developed.
View details for DOI 10.1371/journal.pone.0128599
View details for PubMedID 26132291
View details for PubMedCentralID PMC4489090
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AGE-SENSITIVE PSYCHOSOCIAL TREATMENT FOR OLDER ADULTS WITH SUBSTANCE ABUSE
Substance Use and Older People
2015: 314–39
View details for Web of Science ID 000362748700024
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Patient-centered feedback on the results of personality testing increases early engagement in residential substance use disorder treatment: a pilot randomized controlled trial.
Addiction science & clinical practice
2015; 10: 9-?
Abstract
Patient-centered models of assessment have shown considerable promise for increasing patients' readiness for mental health treatment in general, but have not been used to facilitate patients' engagement in substance use disorder (SUD) treatment. We developed a brief patient-centered intervention using assessment and feedback of personality data and examined its acceptability and efficacy to increase early engagement in residential SUD treatment.Thirty patients entering a 90-day residential SUD treatment program were randomly assigned to a feedback (n = 17) or control (n = 13; assessment-only) condition. Normal-range personality was assessed with the NEO Personality Inventory-Revised (NEO PI-R). Patients were re-interviewed one month after treatment entry to obtain information on their satisfaction with the intervention, as well as their adjustment to the residential milieu. Electronic medical records were reviewed to obtain information on patients' length of stay in the program and discharge status. Univariate ANOVAs and chi-square tests were conducted to examine group differences on outcomes.Patients' ratings indicated strong satisfaction with the feedback intervention and expectations that it would have a positive impact on their treatment experiences. Among patients who had not previously been treated in the residential program, the feedback intervention was associated with more positive relationships with other residents in treatment and a stronger alliance with the treatment program one month after treatment entry. The feedback intervention was also associated with a longer length of stay in treatment, although this effect did not reach statistical significance.The findings highlight the clinical utility of providing SUD patients with patient-centered feedback based on the results of personality testing, and provide preliminary support for the acceptability and efficacy of this intervention to facilitate early engagement in residential SUD treatment.
View details for DOI 10.1186/s13722-015-0030-9
View details for PubMedID 25928427
View details for PubMedCentralID PMC4421926
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Men and Women Who Attend Al-Anon: Gender Differences in Reasons for Attendance, Health Status and Personal Functioning, and Drinker Characteristics
SUBSTANCE USE & MISUSE
2015; 50 (1): 53-61
Abstract
Although Al-Anon Family Groups (Al-Anon) is the most common source of help for people concerned about someone else's drinking, only 16% of members are men. To identify gender differences, we compared demographics, reasons for attendance, health status, and personal functioning, and drinker characteristics of 174 men and women attending Al-Anon. Men and women were similar in most areas; however, some key differences emerged. Men reported better overall mental health than women, and described some differing concerns and drinker characteristics. With this information, healthcare providers may facilitate men's participation in Al-Anon by addressing their unique concerns and possible barriers to attendance.
View details for DOI 10.3109/10826084.2014.957772
View details for Web of Science ID 000345899600007
View details for PubMedID 25245105
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Coping Strategies Predictive of Adverse Outcomes among Community Adults
JOURNAL OF CLINICAL PSYCHOLOGY
2014; 70 (12): 1183-1195
Abstract
To examine associations between coping strategies at baseline and adverse outcomes 13 years later, and whether gender and age moderated these associations.Participants (N = 651) completed a survey on demographic characteristics, coping strategies, and psychosocial outcomes (negative life events, alcohol consumption, drinking problems, and suicidal ideation).At the follow-up (N = 521), more use of avoidance coping was associated with more drinking problems and suicidal ideation at follow-up. Men high in avoidance coping reported more alcohol consumption and suicidal ideation at follow-up than did men low on avoidance coping. Younger adults high in avoidance coping reported more negative life events at follow-up than did younger adults low on avoidance coping.Reliance on avoidance coping may be especially problematic among men and younger adults.
View details for DOI 10.1002/jclp.21924
View details for Web of Science ID 000345230200005
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Coping strategies predictive of adverse outcomes among community adults.
Journal of clinical psychology
2014; 70 (12): 1183-1195
Abstract
To examine associations between coping strategies at baseline and adverse outcomes 13 years later, and whether gender and age moderated these associations.Participants (N = 651) completed a survey on demographic characteristics, coping strategies, and psychosocial outcomes (negative life events, alcohol consumption, drinking problems, and suicidal ideation).At the follow-up (N = 521), more use of avoidance coping was associated with more drinking problems and suicidal ideation at follow-up. Men high in avoidance coping reported more alcohol consumption and suicidal ideation at follow-up than did men low on avoidance coping. Younger adults high in avoidance coping reported more negative life events at follow-up than did younger adults low on avoidance coping.Reliance on avoidance coping may be especially problematic among men and younger adults.
View details for DOI 10.1002/jclp.21924
View details for PubMedID 23629952
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Mental illness and intensification of diabetes medications: an observational cohort study
BMC HEALTH SERVICES RESEARCH
2014; 14
Abstract
Mental health condition (MHC) comorbidity is associated with lower intensity care in multiple clinical scenarios. However, little is known about the effect of MHC upon clinicians' decisions about intensifying antiglycemic medications in diabetic patients with poor glycemic control. We examined whether delay in intensification of antiglycemic medications in response to an elevated Hemoglobin A1c (HbA1c) value is longer for patients with MHC than for those without MHC, and whether any such effect varies by specific MHC type.In this observational study of diabetic Veterans Health Administration (VA) patients on oral antiglycemics with poor glycemic control (HbA1c ≥8) (N =52,526) identified from national VA databases, we applied Cox regression analysis to examine time to intensification of antiglycemics after an elevated HbA1c value in 2003-2004, by MHC status.Those with MHC were no less likely to receive intensification: adjusted Hazard Ratio [95% CI] 0.99 [0.96-1.03], 1.13 [1.04-1.23], and 1.12 [1.07-1.18] at 0-14, 15-30 and 31-180 days, respectively. However, patients with substance use disorders were less likely than those without substance use disorders to receive intensification in the first two weeks following a high HbA1c, adjusted Hazard Ratio 0.89 [0.81-0.97], controlling for sex, age, medical comorbidity, other specific MHCs, and index HbA1c value.For most MHCs, diabetic patients with MHC in the VA health care system do not appear to receive less aggressive antiglycemic management. However, the subgroup with substance use disorders does appear to have excess likelihood of non-intensification; interventions targeting this high risk subgroup merit attention.
View details for DOI 10.1186/1472-6963-14-458
View details for Web of Science ID 000343734700001
View details for PubMedCentralID PMC4282515
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Predictors of 30-year mortality in depressed and comparison samples.
Journal of affective disorders
2014; 165: 114-119
Abstract
Although higher rates of depression and lower rates of social behaviors (i.e., social support and activities) and physical activities are associated with mortality, the independent contribution of each of these factors needs examination.A prospective sample of 848 individuals (55% female) was used; half were clinically depressed at baseline; the other half comprised a comparison sample matched on census tract, gender, and marital status. Depressive symptoms, social behaviors, and physical activities were examined as time-varying predictors of mortality over a 30-year period using multiple imputation for missing data and Cox proportional hazards regression, controlling for demographic factors and health risk factors.By the end of the study, 137 individuals from the depressed sample and 99 individuals from the comparison sample had died. Although the mortality rate is higher in the depressed sample, after controlling for demographic, health risk factors, social behaviors, and physical activity, there was no significant difference in mortality between the depressed and control samples. Among participants in the depressed sample, reduced participation in social activities was significantly associated with a higher risk of mortality.Frequency and intensity of activities were not assessed and all data except for mortality were self-report.Promoting social engagement through activities may hold promise for delaying mortality among individuals who are depressed. Potential methods to promote social engagement and factors such as positive emotions that should be considered in future studies are discussed.
View details for DOI 10.1016/j.jad.2014.04.031
View details for PubMedID 24882187
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Al-Anon Family Groups' Newcomers and Members: Concerns about the Drinkers in their Lives
AMERICAN JOURNAL ON ADDICTIONS
2014; 23 (4): 329-336
Abstract
Despite Al-Anon's widespread availability and use, knowledge is lacking about the drinkers in attendees' lives. We filled this gap by describing and comparing Al-Anon newcomers' and members' reports about their "main drinker" (main person prompting initial attendance).Al-Anon's World Service Office mailed a random sample of groups, yielding completed surveys from newcomers (N = 362) and stable members (N = 265).Newcomers' and members' drinkers generally were comparable. They had known their drinker for an average of 22 years and been concerned about his or her's drinking for 9 years; about 50% had daily contact with the drinker. Most reported negative relationship aspects (drinker gets on your nerves; you disagree about important things). Newcomers had more concern about the drinker's alcohol use than members did, and were more likely to report their drinkers' driving under the influence. Drinkers' most frequent problem due to drinking was family arguments, and most common source of help was 12-step groups, with lower rates among drinkers of newcomers. Concerns spurring initial Al-Anon attendance were the drinker's poor quality of life, relationships, and psychological status; goals for initial attendance reflected these concerns.The drinker's alcohol use was of less concern in prompting initial Al-Anon attendance, and, accordingly, the drinker's reduced drinking was a less frequently endorsed goal of attendance.Family treatments for substance use problems might expand interventions and outcome domains beyond abstinence and relationship satisfaction to include the drinker's quality of life and psychological symptoms and in turn relieve concerns of family members.
View details for DOI 10.1111/j.1521-0391.2014.12122.x
View details for Web of Science ID 000338116600002
View details for PubMedID 24628725
View details for PubMedCentralID PMC4362684
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Newcomers to Al-Anon family groups: Who stays and who drops out?
ADDICTIVE BEHAVIORS
2014; 39 (6): 1042-1049
Abstract
Al-Anon Family Groups (Al-Anon), a 12-step mutual-help program for people concerned about another's drinking, is the most widely used form of help for concerned others (COs) in the US. This study assessed the prevalence of dropout, and predictors of dropout, in the six months following newcomers' initial attendance at Al-Anon meetings. Al-Anon's World Service Office mailed a random sample of groups, which subsequently yielded a sample of 251 newcomers who completed surveys at baseline and 6 months later. At the 6-month follow-up, 57% of newcomers at baseline had dropped out (had not attended any Al-Anon meetings during the past month). At baseline, individuals who later dropped out of Al-Anon were less likely to have been referred to Al-Anon by their drinker's health care provider, and reported less severe problems than individuals who continued to attend, but dropouts were more often concerned about their drinker's psychological health; newcomers with these concerns may have found them incompatible with Al-Anon's philosophy. Dropouts reported high rates of problems, suggesting that COs who drop out of Al-Anon would benefit from ongoing help and support.
View details for DOI 10.1016/j.addbeh.2014.02.019
View details for Web of Science ID 000335632700005
View details for PubMedID 24630826
View details for PubMedCentralID PMC4120873
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Episodic Heavy Drinking and 20-Year TotalMortality Among Late- Life Moderate Drinkers
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2014; 38 (5): 1432-1438
Abstract
Analyses of moderate drinking have focused overwhelmingly on average consumption, which masks diverse underlying drinking patterns. This study examined the association between episodic heavy drinking and total mortality among moderate-drinking older adults.At baseline, the sample was comprised of 446 adults aged 55 to 65; 74 moderate drinkers who engaged in episodic heavy drinking and 372 regular moderate drinkers. The database at baseline also included a broad set of sociodemographic, behavioral, and health status covariates. Death across a 20-year follow-up period was confirmed primarily by death certificate.In multiple logistic regression analyses, after adjusting for all covariates, as well as overall alcohol consumption, moderate drinkers who engaged in episodic heavy drinking had more than 2 times higher odds of 20-year mortality in comparison with regular moderate drinkers.Among older moderate drinkers, those who engage in episodic heavy drinking show significantly increased total mortality risk compared to regular moderate drinkers. Episodic heavy drinking-even when average consumption remains moderate-is a significant public health concern.
View details for DOI 10.1111/acer.12381
View details for Web of Science ID 000334657200030
View details for PubMedID 24588326
View details for PubMedCentralID PMC4141768
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Al-Anon Family Groups: Newcomers and Members
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2013; 74 (6): 965-976
Abstract
Empirical knowledge is lacking about Al-Anon Family Groups (Al-Anon), the most widely used form of help by people concerned about another's drinking, partly because conducting research on 12-step groups is challenging. Our purpose was to describe a new method of obtaining survey data from 12-step group attendees and to examine influences on initial Al-Anon attendance and attendees' recent life contexts and functioning.Al-Anon's World Service Office sent a mailing to a random sample of groups, which subsequently yielded surveys from newcomers (n = 359) and stable members (n = 264).Reasons for groups' nonparticipation included having infrequent newcomers and the study being seen as either contrary to the 12 Traditions or too uncomfortable for newcomers. Main concerns prompting initial Al-Anon attendance were problems with overall quality of life and with the Al-Anon trigger (a significant drinking individual), and being stressed and angry. Goals for Al-Anon attendance were related to the following concerns: better quality of life, fewer trigger-related problems, and less stress. Members reported better functioning in some of these domains (quality of life, relationship with the trigger) but did not differ from newcomers on physical and psychological health. Newcomers were more likely to have recently drunk alcohol and to have obtained treatment for their own substance misuse problems.This method of collecting data from 12-step group attendees yielded valid data and also was seen by many in Al-Anon as consistent with the Traditions. Both newcomers and members had aimed to improve their overall quality of life and well-being through Al-Anon, and, indeed, members were more satisfied with their quality of life than were newcomers.
View details for Web of Science ID 000326768500018
View details for PubMedID 24172125
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Life stressors and resources and the 23-year course of depression.
Journal of affective disorders
2013; 150 (2): 370-377
Abstract
BACKGROUND: Life stressors and personal and social resources are associated with depression in the short-term, but little is known about their associations with the long-term course of depression. The current paper presents results of a 23-year study of community adults who were receiving treatment for depression at baseline (N=382). METHODS: Semi-parametric group-based modeling was used to identify depression trajectories and determine baseline predictors of belonging to each trajectory group. RESULTS: There were three distinct courses of depression: high severity at baseline with slow decline, moderate severity at baseline with rapid decline, and low severity at baseline with rapid decline. At baseline, individuals in the high-severity group had less education than those in the moderate-severity group, and more medical conditions than those in the moderate- and low-severity groups. Individuals in the high- and moderate-severity groups evidenced less psychological flexibility, and relied more on avoidance coping than individuals in the low-severity group. LIMITATIONS: Results are limited by use of self-report and lack of information about depression status and life events in the periods between follow-ups. CONCLUSIONS: These results assist in identifying groups at high risk for a long-term course of depression, and will help in selecting appropriate interventions that target depression severity, coping skills and management of stressors.
View details for DOI 10.1016/j.jad.2013.04.022
View details for PubMedID 23688913
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Receipt of cervical cancer screening in female veterans: impact of posttraumatic stress disorder and depression.
Women's health issues : official publication of the Jacobs Institute of Women's Health
2013; 23 (3): e153-9
Abstract
We evaluated receipt of cervical cancer screening in a national sample of 34,213 women veterans using Veteran Health Administration facilities between 2003 and 2007 and diagnosed with 1) posttraumatic stress disorder (PTSD), or 2) depression, or 3) no psychiatric illness.Our study featured a cross-sectional design in which logistic regression analyses compared receipt of recommended cervical cancer screening for all three diagnostic groups.Cervical cancer screening rates varied minimally by diagnostic group: 77% of women with PTSD versus 75% with depression versus 75% without psychiatric illness were screened during the study observation period (p < .001). However, primary care use was associated with differential odds of screening in women with versus without psychiatric illness (PTSD or depression), even after adjustment for age, income and physical comorbidities (Wald Chi-square (2): 126.59; p < .0001). Specifically, among low users of primary care services, women with PTSD or depression were more likely than those with no psychiatric diagnoses to receive screening. Among high users of primary care services, they were less likely to receive screening.Psychiatric illness (PTSD or depression) had little to no effect on receipt of cervical cancer screening. Our finding that high use of primary care services was not associated with comparable odds of screening in women with versus without psychiatric illness suggests that providers caring for women with PTSD or depression and high use of primary care services should be especially attentive to their preventive healthcare needs.
View details for DOI 10.1016/j.whi.2013.03.002
View details for PubMedID 23660429
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Predictors of substance use disorder treatment outcomes among patients with psychotic disorders
SCHIZOPHRENIA RESEARCH
2013; 146 (1-3): 28-33
Abstract
Although integrated approaches are recommended and effective for treating patients with co-occurring substance use and psychotic disorders (SUD-PSY), many patients receive standard, nonintegrated substance use disorder (SUD) treatment. Research has yet to investigate how patients with co-occurring substance use and psychotic disorders respond to standard SUD treatment, an issue we address here. In a naturalistic follow-up of 236 male SUD-PSY patients receiving 12-step facilitation or cognitive-behavioral-oriented SUD treatment, we found that patients (1) demonstrated significant improvements in proximal outcomes (e.g., approach coping) from treatment intake to discharge, and in distal outcomes (e.g., psychiatric symptoms, substance use frequency) from treatment intake to 1- and 5-year follow-ups, and (2) tended to have similar outcomes whether they received 12-step facilitation or cognitive-behavioral SUD treatment. Patients who (3) were more involved in treatment, as reflected by more positive perceptions of and more satisfaction, tended to experience better proximal outcomes and engage in more continuing care, and those who (4) experienced better proximal outcomes tended to have better psychiatric and substance use outcomes in the years following treatment. Our results suggest that SUD-PSY patients can benefit from standard SUD treatments, even though it may not directly address their psychiatric disorders.
View details for DOI 10.1016/j.schres.2013.02.003
View details for Web of Science ID 000317336500005
View details for PubMedID 23453585
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Dually diagnosed patients' benefits of mutual-help groups and the role of social anxiety
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2013; 44 (2): 216-223
Abstract
There is debate about whether dually diagnosed patients benefit from mutual-help groups (MHGs), partly because social anxiety may make participation problematic. We examined dually diagnosed patients' participation in MHGs and outcomes at 6, 12, and 24 months post-treatment, and the extent to which social anxiety was associated with participation. We also examined whether MHG participation and social anxiety were related to outcomes, and whether social anxiety moderated associations between participation and outcomes. We found high rates of MHG participation. Among patients who attended at least one meeting, outcomes were positive. Social anxiety was not associated with levels of MHG participation, but more participation was associated with better outcomes. When social anxiety moderated associations between MHG participation and outcomes, patients with more social anxiety benefited more from participation. Treated dually diagnosed patients participate in, and benefit from, MHGs, and participation and benefits are comparable, or even strengthened, among more socially-anxious patients.
View details for DOI 10.1016/j.jsat.2012.05.007
View details for Web of Science ID 000312479200009
View details for PubMedID 22763197
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Prevalence and Nature of Criminal Offending in a National Sample of Veterans in VA Substance Use Treatment Prior to the Operation Enduring Freedom/Operation Iraqi Freedom Conflicts
PSYCHOLOGICAL SERVICES
2013; 10 (1): 54-65
Abstract
This study evaluated the prevalence and types of criminal arrest among 99,512 male veterans in substance use disorder (SUD) treatment across 150 VA facilities from 1998 to 2001. Participants were assessed with the Addiction Severity Index (ASI), which includes detailed information about lifetime criminal activity. A majority of the patients (58.2%) had three or more previous arrests, with 46.0% reporting one or more criminal convictions. Criminal arrests were frequent and varied. A majority of patients (69.3%) had at least one arrest that was not due to drug possession, drug sale, or intoxication. Nearly 24% reported at least one arrest for a violent crime. Patterns of arrest for specific crimes varied across SUD diagnostic categories. Screening for specific types of offending is informative and viable. Existing VA SUD treatment is a potentially underrecognized point of intervention for justice involvement among veterans.
View details for DOI 10.1037/a0030504
View details for Web of Science ID 000315002500006
View details for PubMedID 23148768
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Age-Related Concomitants of Obtaining Mental Health Care in Adulthood
AMERICAN JOURNAL OF HEALTH BEHAVIOR
2013; 37 (2): 269-276
Abstract
To examine the associations between predisposing and need factors and receipt of mental health care and to examine age as a moderator of these associations.Participants (N=521) were surveyed as part of a larger study on health and adaptation.Obtaining mental health care was predicted by more reliance on approach coping, and more depressive and medical symptoms. Interactions of age x depressive symptoms and age x gender revealed that middle-aged adults with more depressive symptoms and middle-aged men were less likely to obtain care.Middle-aged men and middle-aged adults with depression may not be obtaining needed mental health care.
View details for DOI 10.5993/AJHB.37.2.14
View details for Web of Science ID 000309362200014
View details for PubMedID 23026108
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Alcoholics Anonymous and Reduced Impulsivity: A Novel Mechanism of Change
SUBSTANCE ABUSE
2013; 34 (1): 4-12
Abstract
ABSTRACT Reduced impulsivity is a novel, yet plausible, mechanism of change associated with the salutary effects of Alcoholics Anonymous (AA). Here, the authors review their work on links between AA attendance and reduced impulsivity using a 16-year prospective study of men and women with alcohol use disorders (AUDs) who were initially untreated for their drinking problems. Across the study period, there were significant mean-level decreases in impulsivity, and longer AA duration was associated with reductions in impulsivity. In turn, decreases in impulsivity from baseline to Year 1 were associated with fewer legal problems and better drinking and psychosocial outcomes at Year 1, and better psychosocial functioning at Year 8. Decreases in impulsivity mediated associations between longer AA duration and improvements on several Year 1 outcomes, with the indirect effects conditional on participants' age. Findings are discussed in terms of their potential implications for research on AA and, more broadly, interventions for individuals with AUDs.
View details for DOI 10.1080/08897077.2012.691448
View details for Web of Science ID 000313669700002
View details for PubMedID 23327499
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One-year outcomes of telephone case monitoring for patients with substance use disorder
ADDICTIVE BEHAVIORS
2012; 37 (10): 1069-1074
Abstract
Many patients treated for substance use disorder (SUD) do not achieve lasting recovery from a single episode of treatment and require continuing care. The current randomized clinical trial investigated whether in-person continuing care as usual (CCAU) following intensive outpatient SUD treatment leads to better SUD outcomes when compared with telephone case monitoring (TCM).This study randomized 667 intensive SUD outpatients to telephone case monitoring versus face-to-face continuing care as usual at two sites. Patients completed data at baseline, 3 and 12months with telephone interviews. Data of interest include self-report of substance use, psychiatric symptoms, quality of life, and treatment satisfaction. We also evaluated potential interaction effects for distance to VA provider, SUD severity, and presence of co-morbid psychiatric disorder.Participants randomized to the telephone case monitoring condition substantially engaged with face-to-face continuing care resulting in cross-over contamination. We addressed this issue by using randomization as an instrumental variable to evaluate the impact of telephone case monitoring (contamination adjusted, intent to treat analysis). Instrumental variable analyses indicated significant benefit of telephone case monitoring for drug and alcohol percent days abstinent and psychiatric symptom outcomes at 3-months follow-up, but not at 12-month follow-up. No interaction analyses were significant.Participants receiving telephone case monitoring achieved better short term outcomes in terms of substance use and psychiatric symptoms. The "on treatment" effects suggests the need for future studies to investigate consumer (patient) perspectives on the optimal duration of telephone case monitoring and use of alternative monitoring methods such as text messaging.
View details for DOI 10.1016/j.addbeh.2012.03.009
View details for Web of Science ID 000307205200001
View details for PubMedID 22651986
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Suicidal ideation in adult offspring of depressed and matched control parents: Childhood and concurrent predictors
JOURNAL OF MENTAL HEALTH
2012; 21 (5): 459-468
Abstract
Suicidal ideation predicts suicide behaviors; however, research is needed on risk factors for suicidal ideation in adults, a common developmental period for first suicide attempts.To examine childhood and concurrent predictors of suicidal ideation among 340 adult offspring of depressed and matched control parents.Parents were assessed at baseline, and adult offspring were assessed 23 years later.Offspring who reported past-month suicidal ideation (7%) had parents who, 23 years earlier, reported suicidal ideation, psychological inflexibility and use of avoidance coping. Offspring experiencing suicidal ideation were more likely to be unemployed and more depressed, consumed more alcohol and had more drinking problems. They were more anxious and inflexible, had weaker social ties and less cohesive families and had more negative life events and used more avoidance coping. A childhood risk index predicted offspring's suicidal ideation above and beyond concurrent factors.Along with concurrent risk factors, poor parental functioning may confer long-term risk for adult suicidal ideation. Interventions to prevent the transmission of suicidal ideation to offspring should focus on ameliorating parental risk factors.
View details for DOI 10.3109/09638237.2012.694504
View details for Web of Science ID 000308950800005
View details for PubMedID 22978501
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Commentary on Laslett et al. (2012): Integrating substance use disorder and child welfare interventions
ADDICTION
2012; 107 (10): 1794-1795
View details for DOI 10.1111/j.1360-0443.2012.03983.x
View details for Web of Science ID 000308577700016
View details for PubMedID 22962957
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Addressing substance abuse and violence in substance use disorder treatment and batterer intervention programs
SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY
2012; 7
Abstract
Substance use disorders and perpetration of intimate partner violence (IPV) are interrelated, major public health problems.We surveyed directors of a sample of substance use disorder treatment programs (SUDPs; N=241) and batterer intervention programs (BIPs; N=235) in California (70% response rate) to examine the extent to which SUDPs address IPV, and BIPs address substance abuse.Generally, SUDPs were not addressing co-occurring IPV perpetration in a formal and comprehensive way. Few had a policy requiring assessment of potential clients, or monitoring of admitted clients, for violence perpetration; almost one-quarter did not admit potential clients who had perpetrated IPV, and only 20% had a component or track to address violence. About one-third suspended or terminated clients engaging in violence. The most common barriers to SUDPs providing IPV services were that violence prevention was not part of the program's mission, staff lacked training in violence, and the lack of reimbursement mechanisms for such services. In contrast, BIPs tended to address substance abuse in a more formal and comprehensive way; e.g., one-half had a policy requiring potential clients to be assessed, two-thirds required monitoring of substance abuse among admitted clients, and almost one-half had a component or track to address substance abuse. SUDPs had clients with fewer resources (marriage, employment, income, housing), and more severe problems (both alcohol and drug use disorders, dual substance use and other mental health disorders, HIV + status). We found little evidence that services are centralized for individuals with both substance abuse and violence problems, even though most SUDP and BIP directors agreed that help for both problems should be obtained simultaneously in separate programs.SUDPs may have difficulty addressing violence because they have a clientele with relatively few resources and more complex psychological and medical needs. However, policy change can modify barriers to treatment integration and service linkage, such as reimbursement restrictions and lack of staff training.
View details for DOI 10.1186/1747-597X-7-37
View details for Web of Science ID 000310745900001
View details for PubMedID 22958624
View details for PubMedCentralID PMC3489609
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Iraq and Afghanistan Veterans' Experiences Living with their Parents after Separation from the Military
CONTEMPORARY FAMILY THERAPY
2012; 34 (3): 362–75
View details for DOI 10.1007/s10591-012-9196-4
View details for Web of Science ID 000412551600005
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Iatrogenic Effects of Psychosocial Interventions: Treatment, Life Context, and Personal Risk Factors
SUBSTANCE USE & MISUSE
2012; 47 (13-14): 1592-1598
Abstract
Between 7% and 15% of individuals who participate in psychosocial interventions for substance use disorders may be worse off after treatment than before. Intervention-related predictors of iatrogenic effects include lack of bonding; lack of goal direction and monitoring; confrontation, criticism, and high emotional arousal; models and norms for substance use; and stigma and inaccurate expectations. Life context and personal predictors include lack of support, criticism, and more severe substance use and psychological problems. Ongoing monitoring and safety standards are needed to identify and counteract adverse consequences of intervention programs.
View details for DOI 10.3109/10826084.2012.705710
View details for Web of Science ID 000311680600074
View details for PubMedID 23186483
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Rudolf H. Moos on Steven Sussman's "Perspectives of 'Functional Failure'" Psychosocial Processes that Help Overcome Functional Failure
SUBSTANCE USE & MISUSE
2012; 47 (13-14): 1460–61
View details for DOI 10.3109/10826084.2012.725625
View details for Web of Science ID 000311680600031
View details for PubMedID 23186440
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Al-Anon Family Groups: Origins, Conceptual Basis, Outcomes, and Research Opportunities
JOURNAL OF GROUPS IN ADDICTION & RECOVERY
2012; 7 (2-4): 279–96
View details for DOI 10.1080/1556035X.2012.705713
View details for Web of Science ID 000214087100013
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Wine Consumption and 20-Year Mortality Among Late-Life Moderate Drinkers
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2012; 73 (1): 80-88
Abstract
This study examined level of wine consumption and total mortality among 802 older adults ages 55-65 at baseline, controlling for key sociodemographic, behavioral, and health status factors. Despite a growing consensus that moderate alcohol consumption is associated with reduced total mortality, whether wine consumption provides an additional, unique protective effect is unresolved.Participants were categorized in three subsamples: abstainers, high-wine-consumption moderate drinkers, and low-wine-consumption moderate drinkers. Alcohol consumption, sociodemographic factors, health behavior, and health problems were assessed at baseline; total mortality was indexed across an ensuing 20-year period.After adjusting for all covariates, both high-wine-consumption and low-wine-consumption moderate drinkers showed reduced mortality risks compared with abstainers. Further, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine were older, were more likely to be male, reported more health problems, were more likely to be tobacco smokers, scored lower on socioeconomic status, and (statistical trend) reported engaging in less physical activity. Controlling only for overall ethanol consumption, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine showed a substantially increased 20-year mortality risk of 85%. However, after controlling for all covariates, the initial mortality difference associated with wine consumption was no longer significant.Among older adults who are moderate drinkers, the apparent unique effects of wine on longevity may be explained by confounding factors correlated with wine consumption.
View details for Web of Science ID 000298898400012
View details for PubMedID 22152665
View details for PubMedCentralID PMC3237714
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Coping trajectories in later life: A 20-year predictive study
AGING & MENTAL HEALTH
2012; 16 (3): 305-316
Abstract
Information about aging-related change in coping is limited mainly to results of cross-sectional studies of age differences in coping, and no research has focused on predictors of aging-related change in coping behavior. To extend research in this area, we used longitudinal multilevel modeling to describe older adults' (n = 719; baseline M = 61 years) 20-year, intraindividual approach and avoidance coping trajectories, and to determine the influence of two sets of predictors (threat appraisal and stressor characteristics; gender and baseline personal and social resources) on level and rate of change in these trajectories.Over the 20-year study interval, participants declined in the use of approach coping and most avoidance coping strategies, but there was significant variation in this trend. In simultaneous predictive models, female gender, more threat appraisal, stressor severity, social resources, and depressive symptoms, and fewer financial resources were independently associated with higher initial levels of coping responses. Having more social resources, and fewer financial resources, at baseline in late-middle-age predicted faster decline over time in approach coping. Having more baseline depressive symptoms, and fewer baseline financial resources, hastened decline in use of avoidance coping. Independent of other variables in these models, decline over time in approach coping and avoidance coping remained statistically significant.Overall decline in coping may be a normative pattern of coping change in later life. However, it also is modifiable by older adults' stressor appraisals, their stressors, and the personal and social resources they possess at entry to later life, in late-middle-age.
View details for DOI 10.1080/13607863.2011.628975
View details for Web of Science ID 000305976300006
View details for PubMedID 22394319
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Risk of future trauma based on alcohol screening scores: a two-year prospective cohort study among US veterans.
Addiction science & clinical practice
2012; 7 (1): 6-?
Abstract
Severe alcohol misuse as measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is associated with increased risk of future fractures and trauma-related hospitalizations. This study examined the association between AUDIT-C scores and two-year risk of any type of trauma among US Veterans Health Administration (VHA) patients and assessed whether risk varied by age or gender.Outpatients (215, 924 male and 9168 female) who returned mailed AUDIT-C questionnaires were followed for 24 months in the medical record for any International Statistical Classification of Diseases and Related Health Problems (ICD-9) code related to trauma. The two-year prevalence of trauma was examined as a function of AUDIT-C scores, with low-level drinking (AUDIT-C 1-4) as the reference group. Men and women were examined separately, and age-stratified analyses were performed.Having an AUDIT-C score of 9-12 (indicating severe alcohol misuse) was associated with increased risk for trauma. Mean (SD) ages for men and women were 68.2 (11.5) and 57.2 (15.8), respectively. Age-stratified analyses showed that, for men≤50 years, those with AUDIT-C scores≥9 had an increased risk for trauma compared with those with AUDIT-C scores in the 1-4 range (adjusted prevalence, 25.7% versus 20.8%, respectively; OR=1.24; 95% confidence interval [CI], 1.03-1.50). For men≥65 years with average comorbidity and education, those with AUDIT-C scores of 5-8 (adjusted prevalence, 7.9% versus 7.4%; OR=1.16; 95% CI, 1.02-1.31) and 9-12 (adjusted prevalence 11.1% versus 7.4%; OR=1.68; 95% CI, 1.30-2.17) were at significantly increased risk for trauma compared with men≥65 years in the reference group. Higher AUDIT-C scores were not associated with increased risk of trauma among women.Men with severe alcohol misuse (AUDIT-C 9-12) demonstrate an increased risk of trauma. Men≥65 showed an increased risk for trauma at all levels of alcohol misuse (AUDIT-C 5-8 and 9-12). These findings may be used as part of an evidence-based brief intervention for alcohol use disorders. More research is needed to understand the relationship between AUDIT-C scores and risk of trauma in women.
View details for DOI 10.1186/1940-0640-7-6
View details for PubMedID 22966411
View details for PubMedCentralID PMC3414833
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Evaluating the environments of residential care settings
THERAPEUTIC COMMUNITIES
2012; 33 (2-3): 76–85
View details for DOI 10.1108/09641861211291559
View details for Web of Science ID 000448959100002
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Building the first step: a review of low-intensity interventions for stepped care.
Addiction science & clinical practice
2012; 7 (1): 26-?
Abstract
Within the last 30 years, a substantial number of interventions for alcohol use disorders (AUDs) have received empirical support. Nevertheless, fewer than 25% of individuals with alcohol-related problems access these interventions. If several intensive psychosocial treatments are relatively effective, but most individuals in need do not access them, it seems logical to place a priority on developing more engaging interventions. Accordingly, after briefly describing findings about barriers to help-seeking, we focus on identifying an array of innovative and effective low-intensity intervention strategies, including telephone, computer-based, and Internet-based interventions, that surmount these barriers and are suitable for use within a stepped-care model. We conclude that these interventions attract individuals who would otherwise not seek help, that they can benefit individuals who misuse alcohol and those with more severe AUDs, and that they can facilitate subsequent help-seeking when needed. We note that these types of low-intensity interventions are flexible and can be tailored to address many of the perceived barriers that hinder individuals with alcohol misuse or AUDs from obtaining timely help. We also describe key areas of further research, such as identifying the mechanisms that underlie stepped-care interventions and finding out how to structure these interventions to best initiate a program of stepped care.
View details for DOI 10.1186/1940-0640-7-26
View details for PubMedID 23227807
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Alcoholics Anonymous attendance, decreases in impulsivity and drinking and psychosocial outcomes over 16 years: moderated-mediation from a developmental perspective
ADDICTION
2011; 106 (12): 2167-2177
Abstract
To examine whether decreases in impulsivity account for links between Alcoholics Anonymous (AA) attendance and better drinking and psychosocial outcomes, and whether these mediational 'effects' are conditional on age.A naturalistic study in which individuals were assessed at baseline, and 1, 8 and 16 years later.Participants initiated help-seeking through the alcohol intervention system (detoxification programs, information and referral centers).Individuals with alcohol use disorders and no prior history of substance abuse treatment at baseline [n=628; 47% women; mean age=34.7 years (standard deviation=9.4)].Self-reports of impulsivity and drinking pattern at baseline and year 1, duration of AA (number of weeks) in year 1 and drinking (alcohol use problems, self-efficacy to resist drinking) and psychosocial outcomes (emotional discharge coping, social support) at baseline and follow-ups.Controlling for changes in drinking pattern, decreases in impulsivity were associated with fewer alcohol use problems, better coping and greater social support and self-efficacy at year 1, and better coping and greater social support at year 8. Decreases in impulsivity statistically mediated associations between longer AA duration and improvements on all year 1 outcomes and indirect effects were moderated by participant age (significant only for individuals 25 years of age or younger).Decreased impulsivity appears to mediate reductions in alcohol-related problems over 8 years in people attending Alcoholics Anonymous.
View details for DOI 10.1111/j.1360-0443.2011.03522.x
View details for Web of Science ID 000296534200018
View details for PubMedID 21631626
View details for PubMedCentralID PMC3208772
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Intensive referral to 12-step dual-focused mutual-help groups
DRUG AND ALCOHOL DEPENDENCE
2011; 118 (2-3): 194-201
Abstract
This study implemented and evaluated procedures to help clinicians effectively refer dually diagnosed (substance use and psychiatric disorders) patients to dual-focused mutual-help groups (DFGs).Using a cohort cyclical turnover design, individuals with dual diagnoses beginning a new outpatient mental health treatment episode (N=287) entered a standard- or an intensive-referral condition. Participants provided self-reports of 12-step mutual-help (DFG and substance-focused group [SFG]) attendance and involvement and substance use and psychiatric symptoms at baseline and six-month follow-up. The intensive referral intervention focused on encouraging patients to attend DFG meetings.Compared to patients in the standard condition, those in the intensive referral intervention were more likely to attend and be involved in DFGs and SFGs, and had less drug use and better psychiatric outcomes at follow-up. Attending more intensive-referral sessions was associated with more DFG and SFG meeting attendance. More need fulfillment in DFGs, and more readiness to participate in SFGs, were associated with better alcohol and psychiatric outcomes at six months. However, only 23% of patients in the intensive-referral group attended a DFG meeting during the six-month follow-up period.The intensive referral intervention enhanced participation in both DFGs and SFGs and was associated with better six-month outcomes. The findings suggest that intensive referral to mutual-help groups focus on its key components (e.g., linking patients to 12-step volunteers) rather than type of group.
View details for DOI 10.1016/j.drugalcdep.2011.03.019
View details for Web of Science ID 000296173800016
View details for PubMedID 21515004
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Impulsivity Is an Independent Predictor of 15-Year Mortality Risk Among Individuals Seeking Help for Alcohol-Related Problems
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2011; 35 (11): 2082-2092
Abstract
Although past research has found impulsivity to be a significant predictor of mortality, no studies have tested this association in samples of individuals with alcohol-related problems or examined moderation of this effect via socio-contextual processes. The current study addressed these issues in a mixed-gender sample of individuals seeking help for alcohol-related problems.Using Cox proportional hazard models, variables measured at baseline and Year 1 of a 16-year prospective study were used to predict the probability of death from Years 1 to 16 (i.e., 15-year mortality risk). There were 628 participants at baseline (47.1% women); 515 and 405 participated in the follow-up assessments at Years 1 and 16, respectively. Among Year 1 participants, 93 individuals were known to have died between Years 1 and 16.After controlling for age, gender, and marital status, higher impulsivity at baseline was associated with an increased risk of mortality from Years 1 to 16; however, this association was accounted for by the severity of alcohol use at baseline. In contrast, higher impulsivity at Year 1 was associated with an increased risk of mortality from Years 1 to 16, and remained significant when accounting for the severity of alcohol use, as well as physical health problems, emotional discharge coping, and interpersonal stress and support at Year 1. In addition, the association between Year 1 impulsivity and 15-year mortality risk was moderated by interpersonal support at Year 1, such that individuals high on impulsivity had a lower mortality risk when peer/friend support was high than when it was low.The findings highlight impulsivity as a robust and independent predictor of mortality and suggest the need to consider interactions between personality traits and socio-contextual processes in the prediction of health-related outcomes for individuals with alcohol use disorders.
View details for DOI 10.1111/j.1530-0277.2011.01560.x
View details for Web of Science ID 000296532800019
View details for PubMedID 21631544
View details for PubMedCentralID PMC3167944
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The influence of co-occurring axis I disorders on treatment utilization and outcome in homeless patients with substance use disorders
ADDICTIVE BEHAVIORS
2011; 36 (9): 941-944
Abstract
The current study examined the relationship between co-occurring substance use and Axis I psychiatric disorders and treatment utilization and outcome among homeless individuals (N=365) who participated in an episode of intensive outpatient substance use treatment. Compared to patients without a co-occurring diagnosis, homeless patients with a diagnosis of major depressive disorder or PTSD participated in more substance use treatment. Diagnostic status did not predict 12-month alcohol or drug treatment outcome. Substance use treatment programs appear to successfully engage homeless individuals with major depressive disorder and PTSD in treatment. Such individuals appear to achieve similar benefits from standard substance use treatment as do homeless individuals without such disorders.
View details for DOI 10.1016/j.addbeh.2011.05.001
View details for PubMedID 21620571
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Alcohol Screening Scores and the Risk of New-Onset Gastrointestinal Illness or Related Hospitalization
JOURNAL OF GENERAL INTERNAL MEDICINE
2011; 26 (7): 777-782
Abstract
Excessive alcohol use is associated with a variety of negative health outcomes, including liver disease, upper gastrointestinal bleeding, and pancreatitis.To determine the 2-year risk of gastrointestinal-related hospitalization and new-onset gastrointestinal illness based on alcohol screening scores.Retrospective cohort study.Male (N = 215, 924) and female (N = 9,168) outpatients who returned mailed questionnaires and were followed for 24 months.Alcohol Use Disorder Identification Test-Consumption Questionnaire (AUDIT-C), a validated three-item alcohol screening questionnaire (0-12 points).Two-year risk of hospitalization with a gastrointestinal disorder was increased in men with AUDIT-C scores of 5-8 and 9-12 (OR 1.54, 95% CI = 1.27-1.86; and OR 3.27; 95% CI = 2.62-4.09 respectively), and women with AUDIT-C scores of 9-12 (OR 6.84, 95% CI = 1.85 - 25.37). Men with AUDIT-C scores of 5-8 and 9-12 had increased risk of new-onset liver disease (OR 1.49, 95% CI = 1.30-1.71; and OR 2.82, 95% CI = 2.38-3.34 respectively), and new-onset of upper gastrointestinal bleeding (OR 1.28, 95% CI = 1.05-1.57; and OR 2.14, 95% CI = 1.54-2.97 respectively). Two-year risk of new-onset pancreatitis in men with AUDIT -C scores 9-12 was also increased (OR 2.14; 95% CI = 1.54-2.97).Excessive alcohol use as determined by AUDIT-C is associated with 2-year increased risk of gastrointestinal-related hospitalization in men and women and new-onset liver disease, upper gastrointestinal bleeding, and pancreatitis in men. These results provide risk information that clinicians can use in evidence-based conversations with patients about their alcohol consumption.
View details for DOI 10.1007/s11606-011-1688-7
View details for Web of Science ID 000291701200019
View details for PubMedID 21455813
View details for PubMedCentralID PMC3138581
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Family Support and Depressive Symptoms: A 23-Year Follow-Up
JOURNAL OF CLINICAL PSYCHOLOGY
2011; 67 (3): 215-223
Abstract
We examined change in family support and depressive symptoms over the course of 23 years and included the potential moderators of gender and participation in treatment. A sample of 373 depressed individuals provided data in five waves, with baseline, 1-year, 4-year, 10-year, and 23-year follow-ups. Multilevel modeling was used to evaluate longitudinal relationships between variables. Higher family support was associated with less depression at baseline and predicted a steeper trajectory of recovery from depression over 23 years. This relationship was moderated by gender, such that women with supportive families reported the most rapid recovery from depression. Evaluating family context may be clinically relevant when beginning treatment with a depressed patient, particularly for female patients.
View details for DOI 10.1002/jclp.20765
View details for Web of Science ID 000286693800001
View details for PubMedID 21254050
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Twenty-Year Alcohol-Consumption and Drinking-Problem Trajectories of Older Men and Women
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2011; 72 (2): 308-321
Abstract
The aim of this study was to describe older adults' 20-year alcohol-consumption and drinking-problem trajectories, identify baseline predictors of them, and determine whether older men and women differ on late-life drinking trajectory characteristics and predictors.Two-group simultaneous latent growth modeling was used to describe the characteristics and baseline predictors of older community-residing men's (n = 399) and women's (n = 320) 20-year drinking trajectories. Chi-square difference tests of increment in fit of latent growth models with and without gender invariance constraints were used to determine gender differences in drinking trajectory characteristics and predictors.Unconditional quadratic growth models best described older individuals' within-individual, 20-year drinking trajectories, with alcohol consumption following an average pattern of delayed decline, and drinking problems an average pattern of decline followed by leveling off. On average, older men declined in alcohol consumption somewhat later than did older women. The best baseline predictors of more rapid decline in alcohol consumption and drinking problems were drinking variables indicative of heavier, more problematic alcohol use at late middle age.The course of alcohol consumption and drinking problems from late middle age onward is one of net decline, but this decline is neither swift nor invariable. Gender differences in the timing of decline in drinking suggest that ongoing monitoring of alcohol consumption may be especially important for older men. Further research is needed to identify factors known at late middle age that prospectively explain long-term change in late-life use of alcohol.
View details for Web of Science ID 000288570800015
View details for PubMedID 21388604
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Driving While Intoxicated Among Individuals Initially Untreated for Alcohol Use Disorders: One- and Sixteen-Year Follow-Ups
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2011; 72 (2): 173-184
Abstract
This study examined associations between frequency of driving while intoxicated (DWI) at baseline and obtaining alcohol-related help at follow-up, and between obtaining help and subsequent reductions in DWI. It also examined improvements on personal functioning and life context indices as mediators between obtaining help and reduced occurrences of DWI.A total of 628 individuals who were initially untreated for alcohol use problems completed a baseline inventory; follow-ups were 1, 3, and 16 years later.More extended participation in outpatient treatment and Alcoholics Anonymous (AA) during Year 1 was associated with a lower likelihood of DWI at the 1-year follow-up. More extended participation in AA through Year 3 was associated with a lower likelihood of DWI at the 16-year follow-up. Improvement on personal functioning and life context indices was associated with reduced risk of subsequent occurrences of DWI. Decreases in drinking-related problems, impulsivity, and drinking to reduce tension mediated associations between more AA participation and reductions in DWI at 1 year.Among initially untreated individuals, sustained mutual help may be associated with a reduced number of occurrences of DWI via fewer drinking consequences and improved psychological functioning and coping. Treatment providers should attend to these concomitants of DWI and consider actively referring individuals to AA to ensure ongoing AA affiliation.
View details for Web of Science ID 000288570800001
View details for PubMedID 21388590
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Commentary on Lopez-Quintero et al. (2011): Remission and relapse - the Yin-Yang of addictive disorders
ADDICTION
2011; 106 (3): 670-671
View details for DOI 10.1111/j.1360-0443.2010.00003284.x
View details for Web of Science ID 000287032500033
View details for PubMedID 21299675
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Personal, family and social functioning among older couples concordant and discordant for high-risk alcohol consumption
ADDICTION
2011; 106 (2): 324-334
Abstract
This study compares the personal, family and social functioning of older husbands and wives concordant or discordant for high-risk alcohol consumption and identifies predictors of changes in concordance and high-risk consumption. Design, Participants,Three groups of couples were identified at baseline and followed 10 years later: (i) concordant couples in which husbands and wives engaged in low-risk alcohol consumption (n = 54); (ii) concordant couples in which husbands and wives engaged in high-risk alcohol consumption (n = 38); and (iii) discordant couples in which one partner engaged in high-risk alcohol consumption and the other partner did not (n = 75). At each follow-up, husbands and wives completed an inventory that assessed their personal, family and social functioning.Compared to the low-risk concordant group, husbands and wives in the high-risk concordant group were more likely to rely on tension-reduction coping, reported more friend approval of drinking, and were less involved in religious activities; however, they did not differ in the quality of the spousal relationship. The frequency of alcohol consumption declined among husbands in discordant couples, but not among husbands in concordant couples. Predictors of high-risk drinking included tension-reduction coping, friend approval of drinking and, for husbands, their wives' level of drinking.High-risk and discordant alcohol consumption do not seem to be linked to decrements in family functioning among older couples in long-term stable marriages. The predictors of heavy alcohol consumption among older husbands and wives identify points of intervention that may help to reduce their high-risk drinking.
View details for DOI 10.1111/j.1360-0443.2010.03115.x
View details for Web of Science ID 000285922300018
View details for PubMedID 20883458
View details for PubMedCentralID PMC3017234
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Painful Medical Conditions and Alcohol Use: A Prospective Study among Older Adults
PAIN MEDICINE
2011; 12 (7): 1049-1059
Abstract
To determine associations between older adults' baseline painful medical conditions and their 10-year drinking behavior, and whether personal and life context characteristics moderate these associations.At baseline, then, 1, 4, and 10 years later, late-middle-aged community residents (M = 61 years; N = 1,291) were surveyed regarding their painful medical conditions, use of alcohol, and personal and life context characteristics. Latent growth modeling was used to determine concurrent and prospective relationships between painful medical conditions and 10-year drinking behavior, and moderating effects of personal and life context characteristics on these relationships.At baseline, individuals reporting more numerous painful medical conditions consumed alcohol less frequently, but had more frequent drinking problems, than did individuals with fewer such conditions. Being female and having more interpersonal social resources strengthened the association between painful medical conditions and less ethanol consumed. For men more so than women, more numerous painful medical conditions were associated with more frequent drinking problems. Baseline painful medical conditions alone had no prospective effect on 10-year change in drinking behavior, but being older and having more interpersonal social resources made it more likely that baseline painful medical conditions would predict decline over time in frequency of alcohol consumption and drinking problems.Late-middle-aged individuals who have more numerous painful medical conditions reduce alcohol consumption but nonetheless remain at risk for more frequent drinking problems. Gender, age, and interpersonal social resources moderate the influence of painful medical conditions on late-life alcohol use. These results imply that older individuals with pain are at little immediate or long-term risk for increased alcohol consumption, but clinicians should remain alert to drinking problems among their older pain patients, especially men.
View details for DOI 10.1111/j.1526-4637.2011.01156.x
View details for Web of Science ID 000292697100011
View details for PubMedID 21668742
View details for PubMedCentralID PMC3146463
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Processes that Promote Recovery from Addictive Disorders
ADDICTION RECOVERY MANAGEMENT: THEORY, RESEARCH AND PRACTICE
2011: 45–66
View details for DOI 10.1007/978-1-60327-960-4_4
View details for Web of Science ID 000285318300004
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Depressive Symptoms, Friend and Partner Relationship Quality, and Posttreatment Abstinence
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2011; 72 (1): 141-150
View details for Web of Science ID 000285798500016
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12-step self-help group participation as a predictor of marijuana abstinence
ADDICTION RESEARCH & THEORY
2011; 19 (1): 76-84
View details for DOI 10.3109/16066359.2010.499182
View details for Web of Science ID 000286815000011
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Depressive symptoms, friend and partner relationship quality, and posttreatment abstinence.
Journal of studies on alcohol and drugs
2011; 72 (1): 141-150
Abstract
This study employed a prospective design to examine the role of friend and partner relationship quality 1 year following substance use disorder treatment in the association between depressive symptoms at discharge from treatment and abstinence from substance use 2 years after treatment.The sample consisted of 1,453 male veterans who used alcohol and at least one other substance in the 3 months before treatment admission, who completed treatment, and who were abstinent from substances during the 2 weeks before discharge.Fewer depressive symptoms at treatment discharge predicted better relationship quality with friends and a partner at 1-year follow-up, as well as abstinence from substance use at 2-year follow-up. Furthermore, friend and partner relationship quality at 1 year predicted abstinence from substance use at 2 years. Friend relationship quality at 1 year mediated part of the association between fewer depressive symptoms at treatment discharge and abstinence at 2-year follow-up.A stronger focus in treatment on reducing depressive symptoms and enhancing the quality of patients' relationships with their friends and partner may increase the likelihood of long-term abstinence.
View details for PubMedID 21138721
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Violence victimization, help-seeking, and one- and eight-year outcomes of individuals with alcohol use disorders
ADDICTION RESEARCH & THEORY
2011; 19 (1): 22-31
View details for DOI 10.3109/16066359.2010.507891
View details for Web of Science ID 000286815000005
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Spirituality and Religiosity in Context
SUBSTANCE USE & MISUSE
2010; 45 (14): 2386–88
View details for Web of Science ID 000283686600007
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Late-Life Alcohol Consumption and 20-Year Mortality
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2010; 34 (11): 1961-1971
Abstract
Growing epidemiological evidence indicates that moderate alcohol consumption is associated with reduced total mortality among middle-aged and older adults. However, the salutary effect of moderate drinking may be overestimated owing to confounding factors. Abstainers may include former problem drinkers with existing health problems and may be atypical compared to drinkers in terms of sociodemographic and social-behavioral factors. The purpose of this study was to examine the association between alcohol consumption and all-cause mortality over 20 years among 1,824 older adults, controlling for a wide range of potential confounding factors associated with abstention.The sample at baseline included 1,824 individuals between the ages of 55 and 65. The database at baseline included information on daily alcohol consumption, sociodemographic factors, former problem drinking status, health factors, and social-behavioral factors. Abstention was defined as abstaining from alcohol at baseline. Death across a 20-year follow-up period was confirmed primarily by death certificate.Controlling only for age and gender, compared to moderate drinkers, abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social-behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers.Findings are consistent with an interpretation that the survival effect for moderate drinking compared to abstention among older adults reflects 2 processes. First, the effect of confounding factors associated with alcohol abstention is considerable. However, even after taking account of traditional and nontraditional covariates, moderate alcohol consumption continued to show a beneficial effect in predicting mortality risk.
View details for DOI 10.1111/j.1530-0277.2010.01286.x
View details for Web of Science ID 000283594000017
View details for PubMedID 20735372
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Associations Between AUDIT-C and Mortality Vary by Age and Sex
POPULATION HEALTH MANAGEMENT
2010; 13 (5): 263-268
Abstract
We sought to determine the sex- and age-specific risk of mortality associated with scores on the 3-item Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) questionnaire using data from a national sample of Veterans Health Administration (VHA) patients. Men (N = 215,924) and women (N = 9168) who completed the AUDIT-C in a patient survey were followed for 24 months. AUDIT-C categories (0, 1-4, 5-8, 9-12) were evaluated as predictors of mortality in logistic regression models, adjusted for age, race, education, marital status, smoking, depression, and comorbidities. For women, AUDIT-C scores of 9-12 were associated with a significantly increased risk of death compared to the AUDIT-C 1-4 group (odds ratio [OR] 7.09; 95% confidence interval [CI] = 2.67, 18.82). For men overall, AUDIT-C scores of 5-8 and 9-12 were associated with increased risk of death compared to the AUDIT-C 1-4 group (OR 1.13, 95% CI = 1.05, 1.21, and OR 1.63, 95% CI = 1.45, 1.84, respectively) but these associations varied by age. These results provide sex- and age-tailored risk information that clinicians can use in evidence-based conversations with patients about the health-related risks of their alcohol consumption. This study adds to the growing literature establishing the AUDIT-C as a scaled marker of alcohol-related risk or "vital sign" that might facilitate the detection and management of alcohol-related risks and problems.
View details for DOI 10.1089/pop.2009.0060
View details for Web of Science ID 000282463400005
View details for PubMedID 20879907
View details for PubMedCentralID PMC3135896
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Sexual Violence, Posttraumatic Stress Disorder, and the Pelvic Examination: How Do Beliefs About the Safety, Necessity, and Utility of the Examination Influence Patient Experiences?
JOURNAL OF WOMENS HEALTH
2010; 19 (7): 1271-1280
Abstract
Sexual violence and posttraumatic stress disorder (PTSD) have been linked to increased reports of distress and pain during the pelvic examination. Efforts to more fully characterize these reactions and identify core factors (i.e., beliefs about the examination) that may influence these reactions are warranted.This descriptive, cross-sectional study examines the relationship between sexual violence, PTSD, and women's negative reactions to the pelvic examination. Additional analyses highlight how maladaptive beliefs about the safety, necessity, and utility of the pelvic examination may contribute to these reactions. Materials andA total of 165 eligible women veterans were identified via medical record review and mailed a survey that assessed: (1) background information; (2) history of sexual violence; (3) current symptoms of posttraumatic stress disorder; (4) fear, embarrassment, distress, and pain during the pelvic examination; and (5) core beliefs about the examination. Ninety women (55% response rate) completed the survey.Women with both sexual violence and PTSD reported the highest levels of examination related fear: chi(2) = 18.8, p < .001; embarrassment: chi(2) = 21.2, p < .001; and distress: chi(2) = 18.2, p < .001. Beliefs that the examination was unnecessary or unsafe or not useful were more commonly reported in this group and were associated with higher levels of examination-related fear and embarrassment.Women with sexual violence and PTSD find the pelvic examination distressing, embarrassing, and frightening. Efforts to develop interventions to help reduce distress during the examination are warranted.
View details for DOI 10.1089/jwh.2009.1673
View details for Web of Science ID 000279428800007
View details for PubMedID 20509787
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Predictors of longitudinal substance use and mental health outcomes for patients in two integrated service delivery systems
DRUG AND ALCOHOL DEPENDENCE
2010; 110 (1-2): 92-100
Abstract
Individuals who have both substance use disorders and mental health problems have poorer treatment outcomes. This study examines the relationship of service utilization and 12-step participation to outcomes at 1 and 5 years for patients treated in one of two integrated service delivery systems: the Department of Veterans Affairs (VA) system and a health maintenance organization (HMO).Sub-samples from each system were selected using multiple criteria indicating severity of mental health problems at admission to substance use disorder treatment (VA=401; HMO=331). Separate and multiple group structural equation model analyses used baseline characteristics, service use, and 12-step participation as predictors of substance use and mental health outcomes at 1 and 5 years following admission.Substance use and related problems showed stability across time, however, these relationships were stronger among VA patients. More continuing care substance use outpatient visits were associated with reductions in mental health symptoms in both groups, whereas receipt of outpatient mental health services was associated with more severe psychological symptoms. Participation in 12-step groups had a stronger effect on reducing cocaine use among VA patients, whereas it had a stronger effect on reducing alcohol use among HMO patients. More outpatient psychological services had a stronger effect on reducing alcohol use among HMO patients.Common findings across these two systems demonstrate the persistence of substance use and related psychological problems, but also show that continuing care services and participation in 12-step groups are associated with better outcomes in both systems.
View details for DOI 10.1016/j.drugalcdep.2010.02.013
View details for Web of Science ID 000279577200013
View details for PubMedID 20338696
View details for PubMedCentralID PMC2885543
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Spouses of Older Adults With Late-Life Drinking Problems: Health, Family, and Social Functioning
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2010; 71 (4): 506-514
Abstract
This study focuses on the health, family, and social functioning of spouses of late-life remitted and continuing problem drinkers, and on predictors of spouses' alcohol-related functioning and depressive symptoms.Three groups of spouses were compared at baseline and a 10-year follow-up: (a) spouses (n = 73) of older adults who had no drinking problems at baseline or follow-up, (b) spouses (n = 25) of older adults who had drinking problems at baseline but not follow-up, and (c) spouses (n = 69) of older adults who had drinking problems at both baseline and follow-up. At each contact point, spouses completed an inventory that assessed their alcohol-related, health, family, and social functioning.At baseline, compared with spouses of problem-free individuals, spouses of older adults whose drinking problems later remitted reported more alcohol consumption, poorer health, more depressive symptoms, and less involvement in domestic tasks and social and religious activities. At the 10-year follow-up, spouses of remitted problem drinkers were comparable to spouses of problem-free individuals, but spouses of continuing problem drinkers consumed more alcohol, incurred more alcohol-related consequences, and had friends who approved more of drinking. Overall, spouses whose friends approved more of drinking and whose partners consumed more alcohol and had drinking problems were likely to consume more alcohol and to have drinking problems themselves.Spouses of older adults whose late-life drinking problems remit can attain normal functioning; however, spouses of older adults with continuing late-life drinking problems experience some ongoing deficits.
View details for Web of Science ID 000279410800005
View details for PubMedID 20553658
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Depression and vulnerability to incident physical illness across 10 years
JOURNAL OF AFFECTIVE DISORDERS
2010; 123 (1-3): 222-229
Abstract
While considerable research exists on the role of physical illness in initiating depressive reactions, the role of depression in the onset of physical illness is much less studied. Moreover, whereas almost all previous research on depression and incident physical illness has involved specific physical illnesses, the present study examines the link between depression and incident physical illness more generally.The study followed 388 clinically depressed patients who were entering treatment for unipolar depressive disorders and 404 matched community controls across 10 years. In self-report surveys, sociodemographic and health behavior data were indexed at baseline and physician-diagnosed medical conditions were indexed at baseline and at 1, 4, and 10 years during the follow-up period.After accounting for prior physical illness and key demographic and health behavior factors, membership in the depressed group was significantly linked to physical illness during the follow-up period. In these prospective analyses, depressed patients showed an almost two-thirds higher likelihood of experiencing physical illness during the follow-up period compared to community controls. The prospective association between depression and subsequent physical illness was evident for both less serious and more serious physical illness.Although participants were asked to report only physician-diagnosed conditions, the association between depression and physical illness may have been due to depressed individuals perceiving themselves as more ill than they were.The World Health Organization has included the co-morbidity between depression and chronic physical illness among its ten concerns in global public health. The current findings broaden the growing awareness of the co-morbidity between depression and physical illness to encompass a vulnerability of depressed individuals to physical illness more generally.
View details for DOI 10.1016/j.jad.2009.10.006
View details for Web of Science ID 000277894900030
View details for PubMedID 19880190
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MENTAL ILLNESS AND GLYCEMIC CONTROL: DRILLING DEEPER
33rd Annual Meeting of the Society-of-General-Internal-Medicine/Session on Innovations in Medical Education
SPRINGER. 2010: 333–333
View details for Web of Science ID 000277282300276
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Patterns and Predictors of Late-Life Drinking Trajectories: A 10-Year Longitudinal Study
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2010; 24 (2): 254-264
Abstract
This study examines the extent of group-level and intra-individual decline in alcohol consumption among adults as they traverse a 10-year interval spanning late-middle to early-old age. Further, it identifies key baseline predictors of these adults' 10-year drinking trajectories. Community residents (n = 1,291; age 55 to 65 years at baseline) were assessed at 4 points over a 10-year interval on demographic and health characteristics, coping responses, social context, and alcohol consumption. Descriptive cross-wave statistics, and multilevel regression analyses, indicated that in the sample overall, participants' 10-year patterns of alcohol consumption were relatively stable. However, men's patterns, and those of individuals drinking beyond recommended alcohol consumption guidelines at baseline, were more variable and showed steeper rates of decline, than did those of women and individuals drinking within recommended levels. Contrary to expectation baseline use of substances to reduce tension and heavier reliance on avoidance coping predicted faster rate of decline in alcohol consumption. Post hoc prospective mediation analyses suggested that this may have occurred because these and other baseline predictors heighten risk of developing new health problems which, in turn, motivate reduced alcohol consumption.
View details for DOI 10.1037/a0018592
View details for Web of Science ID 000279069600008
View details for PubMedID 20565151
View details for PubMedCentralID PMC2891546
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Social and Financial Resources and High-Risk Alcohol Consumption Among Older Adults
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2010; 34 (4): 646-654
Abstract
This study examined long-term mutual predictive associations between social and financial resources and high-risk alcohol consumption in later life.A sample of 55- to 65-year-old older adults (n = 719) was surveyed at baseline and 10 years and 20 years later. At each contact point, participants completed an inventory that assessed social and financial resources and alcohol consumption.Over the 20-year interval, there was evidence of both social causation and social selection processes in relation to high-risk alcohol consumption. In support of a social causation perspective, higher levels of some social resources, such as participation in social activities, friends' approval of drinking, quality of relationship with spouse, and financial resources, were associated with a subsequent increased likelihood of high-risk alcohol consumption. Conversely, indicating the presence of social selection, high-risk alcohol consumption was associated with subsequent higher levels of friends' approval of drinking and quality of the spousal relationship, but lower quality of relationships with extended family members.These findings reflect mutual influence processes in which older adults' social resources and high-risk alcohol consumption can alter each other. Older adults may benefit from information about how social factors can affect their drinking habits; accordingly, information about social causation effects could be used to guide effective prevention and intervention efforts aimed at reducing the risk that late-life social factors may amplify their excessive alcohol consumption.
View details for DOI 10.1111/j.1530-0277.2009.01133.x
View details for Web of Science ID 000275916900008
View details for PubMedID 20102567
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Do Parental Stressors and Avoidance Coping Mediate Between Parental Depression and Offspring Depression? A 23-Year Follow-Up
FAMILY RELATIONS
2010; 59 (2): 121-135
View details for DOI 10.1111/j.1741-3729.2010.00590.x
View details for Web of Science ID 000277980800002
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Late-life and life history predictors of older adults' high-risk alcohol consumption and drinking problems
DRUG AND ALCOHOL DEPENDENCE
2010; 108 (1-2): 13-20
Abstract
This prospective, longitudinal study focused on late-life and life history predictors of high-risk alcohol consumption and drinking problems during a 20-year interval as adults matured from age 55-65 to 75-85.A sample of older community residents (N=719) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 10 and 20 years later.At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems, and personal and life context factors. Participants also provided information about their life history of drinking and help-seeking.Older adults who, at baseline, had more friends who approved of drinking, relied on substances for tension reduction, and had more financial resources were more likely to engage in high-risk alcohol consumption and to incur drinking problems at 10- and 20-year follow-ups. With respect to life history factors, drinking problems by age 50 were associated with a higher likelihood of late-life high-risk alcohol consumption and drinking problems; having tried to cut down on drinking and participation in Alcoholics Anonymous were associated with a lower likelihood of high-risk consumption and problems.Specific late-life and life history factors can identify older adults likely to engage in excessive alcohol consumption 10 and 20 years later. Targeted screening that considers current alcohol consumption and life context, and history of drinking problems and help-seeking, could help identify older adults at higher risk for excessive or problematic drinking.
View details for DOI 10.1016/j.drugalcdep.2009.11.005
View details for Web of Science ID 000276376600003
View details for PubMedID 19969428
View details for PubMedCentralID PMC2835829
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Changes in ambivalence mediate the relation between entering treatment and change in alcohol use and problems
ADDICTIVE BEHAVIORS
2010; 35 (4): 367-369
Abstract
The present study examined the role of ambivalence about change as (1) a predictor of subsequent heavy alcohol use and drinking problems and (2) a mediator of change between entering treatment and heavy alcohol use and drinking problems among individuals self-referring for treatment with an alcohol use disorder. A sample of 439 individuals (49.9% female) who initiated help-seeking was surveyed at baseline, and at 1 year and 3 year follow-ups on domains of alcohol-related and personal functioning. A series of regression analyses indicated that a measure reflecting ambivalence significantly predicted subsequent heavy alcohol use and related problems and mediated changes between entering treatment and heavy alcohol use and related problems. The findings highlight one mechanism associated with treatment seeking, initiation of and engagement in treatment, and reduction in heavy alcohol use and related problems.
View details for DOI 10.1016/j.addbeh.2009.10.024
View details for Web of Science ID 000275135900013
View details for PubMedID 19926399
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Retired Status and Older Adults' 10-Year Drinking Trajectories
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2010; 71 (2): 165-168
Abstract
Little research has examined the role of retirement in shaping late-life drinking careers, and it has generally been limited to cross-sectional designs or short-term follow-ups that emphasize group-level comparisons of retirees and nonretirees. The purpose of this study was to determine the following: (a) the effect of retired status on older adults' 10-year within-person drinking trajectories and (b) whether age, gender, income, health, and problem-drinker status account for or moderate this effect.We first estimated older adults' (baseline M= 62 years; n = 595) 10-year within-person drinking trajectories using three successively predictive multilevel regression models: unconditional growth, retired status alone, and retired status controlling for covariates. Next, we determined whether inclusion of Retired Status x Covariate interactions would improve prediction of the trajectories.Participants' drinking frequency declined moderately over the 10-year interval, and retired status hastened the decline. However, this effect disappeared once covariates were added to the model: Baseline poorer health, lower income, and current problem-drinker status predicted steeper decline in drinking frequency, whereas former problem-drinker status predicted slower decline. Lower income and current drinking problems also predicted steeper declines in amount of alcohol consumed. There were no statistically significant or uniquely contributive interactions between retired status and age, gender, health, income, or drinking problems for predicting late-life drinking trajectories.Baseline health, income, and problem-drinking history are more important than retired status for predicting older adults' long-term within-person drinking trajectories. These factors-and recency of drinking problems-should be considered in future studies of retirement and late-life drinking patterns.
View details for Web of Science ID 000276278700001
View details for PubMedID 20230712
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ALCOHOL CONSUMPTION AND DRINKING PROBLEMS AMONG OLDER ADULTS
ADDICTION
2010; 105 (3): 568–69
View details for Web of Science ID 000274307200031
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The Structure of Late-Life Depressive Symptoms Across a 20-Year Span: A Taxometric Investigation
PSYCHOLOGY AND AGING
2010; 25 (1): 142-156
Abstract
Past studies of the underlying structure of depressive symptoms have yielded mixed results, with some studies supporting a continuous conceptualization and others supporting a categorical one. However, no study has examined this research question with an exclusively older adult sample, despite the potential uniqueness of late-life depressive symptoms. In the present study, the underlying structure of late-life depressive symptoms was examined among a sample of 1,289 individuals across 3 waves of data collection spanning 20 years. The authors employed a taxometric methodology using indicators of depression derived from the Research Diagnostic Criteria (R. L. Spitzer, J. Endicott, & E. Robins, 1978). Maximum eigenvalue analyses and inchworm consistency tests generally supported a categorical conceptualization and identified a group that was primarily characterized by thoughts about death and suicide. However, compared to a categorical depression variable, depressive symptoms treated continuously were generally better predictors of relevant criterion variables. These findings suggest that thoughts of death and suicide may characterize a specific type of late-life depression, yet a continuous conceptualization still typically maximizes the predictive utility of late-life depressive symptoms.
View details for DOI 10.1037/a0018514
View details for Web of Science ID 000275984800013
View details for PubMedID 20230135
View details for PubMedCentralID PMC2850820
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Patients With Dual Diagnoses or Substance Use Disorders Only: 12-Step Group Participation and 1-Year Outcomes
SUBSTANCE USE & MISUSE
2010; 45 (4): 613-627
Abstract
We compared outpatients (regional facility) with substance use and psychiatric (N = 199) or only substance use (N = 146) disorders on baseline and one-year symptoms (93% follow-up), and treatment and 12-step group participation over the year (2005). We examined whether diagnostic status moderated associations between participation and outcomes (Addiction Severity Index) with regressions. At follow-up, dual diagnosis patients had more severe symptoms, despite comparable treatment. The groups were comparable on 12-step participation, which was associated with better outcomes. However, associations of participation with better outcomes were weaker for dual diagnosis patients. Study (VA HSR&D-funded) implications and limitations are noted and research suggested.
View details for DOI 10.3109/10826080903452421
View details for Web of Science ID 000274881900009
View details for PubMedID 20141467
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Mental illness-related disparities in length of stay. Algorithm choice influences results
JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT
2010; 47 (8): 709-718
Abstract
Methodological challenges arise when one uses various Veterans Health Administration (VHA) data sources, each created for distinct purposes, to characterize length of stay (LOS). To illustrate this issue, we examined how algorithm choice affects conclusions about mental health condition (MHC)-related differences in LOS for VHA patients with diabetes nationally (n = 784,321). We assembled a record-level database of all fiscal year (FY) 2003 inpatient care. In 10 steps, we sequentially added instances of inpatient care from various VHA sources. We processed databases in three stages, truncating stays at the beginning and end of FY03 and consolidating overlapping stays. For patients with MHCs versus those without MHCs, mean LOS was 17.7 versus 13.6 days, respectively (p < 0.001), for the crudest algorithm and 37.2 versus 21.7 days, respectively (p < 0.001), for the most refined algorithm. Researchers can improve the quality of data applied to VHA systems redesign by applying methodological considerations raised by this study to inform LOS algorithm choice.
View details for DOI 10.1682/JRRD.2009.08.0112
View details for Web of Science ID 000285074300006
View details for PubMedID 21110246
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Patients with Substance Use and Personality Disorders: A Comparison of Patient Characteristics, Treatment Process, and Outcomes in Swiss and US Substance Use Disorder Programs
AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE
2010; 36 (1): 66-72
Abstract
Cross-cultural comparisons may increase our understanding of different models of substance use treatment and help identify consistent associations between patients' characteristics, treatment conditions, and outcomes.The aim of the study was to compare matched samples of substance use disorder (SUD) patients with personality disorders (PD) in Swiss and the United States (U.S.) residential SUD treatment programs and examine the relationship of program characteristics to 1-year outcomes.A prospective, naturalistic design was used to compare 132 demographically matched Swiss and U.S. male patients drawn from a sample of 10 Swiss and 15 U.S. public treatment programs. Patients completed comparable inventories at admission, discharge, and 1-year follow-up.Compared to Swiss SUD-PD patients, U.S. SUD-PD patients had more severe substance use and psychosocial problems at admission and follow-up. More intensive treatment and a stronger emphasis on patients' involvement were related to better outcomes for both Swiss and U.S. SUD-PD patients. Conclusion: There may be some cross-cultural consistency in the associations between treatment characteristics and SUD-PD patients' outcomes.Treatment evaluation findings from representative programs in one country may apply elsewhere and contribute to our overall knowledge about how to improve SUD-PD patients' outcomes.
View details for DOI 10.3109/00952990903575806
View details for Web of Science ID 000274855000012
View details for PubMedID 20141400
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BASELINE ABSTINENCE MAY MODERATE SUBSTANCE USE DISORDER INTERVENTION EFFECTS
JOURNAL OF DRUG ISSUES
2010; 40 (1): 141-154
View details for Web of Science ID 000277657000008
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Older adults' health and late-life drinking patterns: A 20-year perspective
AGING & MENTAL HEALTH
2010; 14 (1): 33-43
Abstract
This study focused on the associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems.A sample of 719 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption and this survey was followed 10 years and 20 years later.Health-related problems increased and alcohol consumption and drinking problems declined over the 20-year interval. Medical conditions, depressive symptoms, medication use, and acute health events were associated with a higher likelihood of abstinence; acute health events were also associated with less alcohol consumption. In contrast, reliance on alcohol to reduce pain was linked to more alcohol consumption. Moreover, an individual's overall health burden and reliance on alcohol to reduce pain were associated with more drinking problems. Reliance on alcohol to reduce pain potentiated the association between health burden, alcohol consumption and drinking problems.Older adults who have more health problems and rely on alcohol to manage pain are at elevated risk for drinking problems. Health care providers should target high-risk older adults, such as those who drink to reduce pain, for screening and brief interventions to help them identify new ways to cope with pain and curtail their drinking.
View details for DOI 10.1080/13607860902918264
View details for Web of Science ID 000274553300003
View details for PubMedID 20155519
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Parental Depression as a Moderator of Secondary Deficits of Depression in Adult Offspring
CHILD PSYCHIATRY & HUMAN DEVELOPMENT
2009; 40 (4): 575-588
Abstract
This study examined whether having a depressed parent intensifies the secondary deficits that often co-occur with offspring's depression symptoms. The sample was adult offspring of parents who had been diagnosed with depression 23 years earlier (N = 143) and demographically matched nondepressed parents (N = 197). Respondents completed mailed questionnaires. After controlling for demographic factors, offspring who were more depressed experienced more impairment: physical dysfunction, pain, and disability; anxiety, smoking, and drinking-related problems; poorer social resources; negative events and severe stressors; and reliance on emotional discharge coping. Parental status (depressed or not depressed) was not directly related to offspring impairment once offspring depression symptoms were controlled. However, parental status moderated associations between offspring's depression severity and their impairment: relationships between depression and impairments were generally stronger for offspring of depressed parents than for offspring of nondepressed parents. Depressed individuals who are offspring of depressed parents may be at particular risk for the secondary deficits of depression.
View details for DOI 10.1007/s10578-009-0145-x
View details for Web of Science ID 000269883500007
View details for PubMedID 19455416
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Dually diagnosed patients' responses to substance use disorder treatment
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2009; 37 (4): 335-345
Abstract
Few studies have investigated whether dually diagnosed patients with co-occurring substance use and psychiatric disorders (DD) respond as well to substance use disorder (SUD) treatments as patients with SUD do. Here we assessed whether male veteran DD and SUD patients with alcohol dependence diagnoses differed in the process and outcomes of residential SUD treatment. The main findings showed that (a) DD patients did not perceive SUD programs as positively as patients with SUD did and had worse proximal outcomes at discharge from treatment; (b) DD patients did as well as SUD patients on 1- and 5-year substance use outcomes but had worse psychiatric outcomes; and (c) patients who perceived treatment more positively and had better outcomes at discharge had better longer term outcomes. Thus, residential SUD programs are relatively effective in reducing DD patients' substance use problems; however, they are less successful in engaging DD patients in treatment and addressing their psychiatric problems.
View details for DOI 10.1016/j.jsat.2009.03.012
View details for Web of Science ID 000271666300003
View details for PubMedID 19540699
View details for PubMedCentralID PMC3292216
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Treatment, Alcoholics Anonymous, and 16-Year Changes in Impulsivity and Legal Problems Among Men and Women With Alcohol Use Disorders
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2009; 70 (5): 714-725
Abstract
The link between impulsive personality traits and alcohol use disorders (AUDs) is well established. No studies, however, have investigated whether receipt of help for AUDs predicts change in impulsivity or whether such change is associated with relevant outcomes such as legal problems. The present study examined predictive associations between the duration of help for AUDs (Alcoholics Anonymous [AA], professional treatment) and impulsivity and legal problems over 16 years in men and women with AUDs.Participants who were initially untreated for their AUDs (n(men) = 332, n(women) = 296) completed follow-up telephone interviews at 1 and 16 years after their baseline assessment.Impulsivity and legal problems declined between baseline and the 1-year and 16-year follow-ups among both women and men. A longer duration of participation in AA predicted a decline in impulsivity at both follow-up assessments, and, in turn, a decline in impulsivity predicted a decline in legal problems at Years 1 and 16. In addition, a longer duration of participation in AA predicted fewer legal problems at Year 1, and this association was moderated by gender (significant in men) and impulsivity (significant for individuals with higher baseline scores).The results highlight the potential for AA and professional treatment to reduce the expression of impulsivity and related disinhibitory traits and legal problems in individuals with AUDs.
View details for Web of Science ID 000269979800010
View details for PubMedID 19737496
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Integrating Anxiety Sensitivity, Distress Tolerance, and Discomfort Intolerance: A Hierarchical Model of Affect Sensitivity and Tolerance
BEHAVIOR THERAPY
2009; 40 (3): 291-301
Abstract
The purpose of the present investigation was to concurrently examine the latent dimensional and hierarchical structure of anxiety sensitivity (AS) and two key theoretically relevant and related affect (in)tolerance and sensitivity constructs: distress tolerance and discomfort intolerance. These constructs were measured using the Anxiety Sensitivity Index (Reiss, Peterson, Gursky, & McNally, 1986), the Distress Tolerance Scale (Simons & Gaher, 2005), and the Discomfort Intolerance Scale (Schmidt, Richey, & Fitzpatrick, 2006). A total of 229 individuals (124 females; M(age)=21.0 years, SD=7.5) without current Axis I psychopathology participated by completing a battery of self-report questionnaires. A two-stage exploratory factor analysis was conducted to examine the lower- and higher-order latent structural relations among the variables. The factor solution was subsequently evaluated in relation to negative affectivity, anxious arousal, and anhedonic depression. AS and distress tolerance appeared to be related to one another as distinct lower-order facets of a common higher-order affect tolerance and sensitivity factor, whereas discomfort intolerance did not appear to demonstrate similar relations with either AS or distress tolerance at the lower-order or higher-order levels. A unique pattern of association with theoretically-relevant criterion variables was observed between the affect tolerance and sensitivity higher-order factor, the AS and distress tolerance lower-order factors, and the discomfort intolerance factor. Findings are discussed in the context of theoretical and clinical implications and future directions for the study of affect tolerance and sensitivity in relation to emotional vulnerability.
View details for Web of Science ID 000270065800009
View details for PubMedID 19647530
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Older adults' alcohol consumption and late-life drinking problems: a 20-year perspective
ADDICTION
2009; 104 (8): 1293-1302
Abstract
The aim of this study was to identify changes in patterns of alcohol consumption over a 20-year interval among older women and men, and to examine the associations between guideline-defined excessive drinking and late-life drinking problems. DESIGN, PARTICIPANTS AND MEASURES: A community sample of 719 adults between 55 and 65 years of age who consumed alcohol at or prior to baseline participated in a survey of alcohol consumption and drinking problems and was followed 10 years and 20 years later.The likelihood of excessive drinking declined over the 20-year interval as adults matured into their 70s and 80s. However, at ages 75-85, 27.1% of women and 48.6% of men consumed more than two drinks per day or seven drinks per week. At comparable guideline levels of alcohol consumption, older men were more likely to have drinking problems than were older women. Consumption of more than two drinks per day or seven drinks per week was identified as a potential conservative guideline for identifying excessive drinking associated with an elevated likelihood of drinking problems.A substantial percentage of older adults who consume alcohol engage in guideline-defined excessive drinking and incur drinking problems. The finding that older men may be more likely than older women to experience problems when they drink beyond guideline levels suggests that alcohol guidelines for men should not be set higher than those for women.
View details for DOI 10.1111/j.1360-0443.2009.02604.x
View details for Web of Science ID 000268028000010
View details for PubMedID 19438836
View details for PubMedCentralID PMC2714873
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Depressive symptoms, drinking problems, and smoking cessation in older smokers
ADDICTIVE BEHAVIORS
2009; 34 (6-7): 548-553
Abstract
This study modeled the predictive association between depressive symptoms and smoking cessation in a sample of 442 late-middle-aged smokers; assessments occurred at four time-points across a 10-year period. In addition, the study examined the role of baseline drinking problems in moderating the relationship between depressive symptoms and smoking cessation. Findings supported hypotheses. More depressive symptoms prospectively predicted a lower likelihood of smoking cessation. In addition, the presence of baseline drinking problems strengthened the relationship between depressive symptoms and a lower likelihood of smoking cessation. Understanding the mechanisms underlying depression and cigarette smoking among older adults is applicable to secondary prevention and treatment and suggests additional public health benefits from treating depression in older persons.
View details for DOI 10.1016/j.addbeh.2009.03.020
View details for Web of Science ID 000266738400010
View details for PubMedID 19372009
View details for PubMedCentralID PMC2752429
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Characteristics of depressed and nondepressed adult offspring of depressed and matched nondepressed parents
JOURNAL OF AFFECTIVE DISORDERS
2009; 113 (1-2): 56-65
Abstract
Our aim was to compare adults who were depressed or nondepressed offspring of depressed or matched nondepressed parents on functioning.Participants were adult children of depressed (n=143) or nondepressed (n=197) parents who participated in a larger study. They completed self-report measures of depression symptoms, medical conditions and pain, family and social functioning, life stressors and coping, and help used for mental health problems.In the depressed-parent group, depressed offspring had poorer personal functioning than did nondepressed offspring. Factors associated with offspring depressed status were being unmarried and having a diagnosed medical condition, more severe pain, a more severe recent stressor, and more reliance on emotional discharge coping. In the nondepressed-parent offspring, factors associated with depressed status were more disability, family disagreements and disorganization, negative events, and reliance on emotional discharge coping. Depressed offspring of depressed parents had more severe depression than depressed offspring of nondepressed parents; they also had more medical conditions, pain, disability, and severe stressors and, accordingly, relied more on approach coping. In contrast, nondepressed offspring of depressed or nondepressed parents were quite similar on functioning.Measures were self-report and participants were not followed continuously.Because parental depression increased the risk of impairment among depressed offspring, family history should be considered in the treatment of depression. Offspring of depressed parents who are not experiencing depression are often able to maintain normal functioning in adulthood.
View details for DOI 10.1016/j.jad.2008.04.023
View details for Web of Science ID 000263007500006
View details for PubMedID 18562014
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Patients' abstinence status affects the benefits of 12-step self-help group participation on substance use disorder outcomes
DRUG AND ALCOHOL DEPENDENCE
2009; 99 (1-3): 115-122
Abstract
Studies measuring the effectiveness of 12-step self-help group attendance have yielded mixed results but none of the prior studies have accounted for the potential impact of interim abstinence status.Participants were 1683 patients with substance use disorders (SUD) from 88 community residential facilities. Self-report data were collected at baseline and 1- and 4-year follow-ups, and included measures of SUD severity, social resources, coping, and 12-step self-help group attendance. We tested the hypothesis that 12-step self-help group attendance is more effective for non-abstinent patients than for abstinent patients. We also controlled for self-selection effects by using propensity score analyses and we cross-validated our results in a second sample of patients (N=2173).Sample 1. Patients abstinent at 1-year post-treatment who attended 12-step self-help group meetings were no more likely to be abstinent at 4 years than abstinent patients who did not attend. However, for patients not abstinent at 1 year, a significant improvement in abstinence rates at 4 years emerged for those who attended 12-step self-help groups compared to those who did not (42% vs. 28.9%). A similar pattern emerged for SUD problems. There were no benefits from 12-step self-help group attendance for patients abstinent at 1 year, but non-abstinent patients who attended 12-step self-help groups had significantly fewer problems at 4 years. Sample 2. The cross-validation yielded consistent results as 12-step self-help group attendance led to higher abstinence rates and fewer SUD problems only among patients non-abstinent at interim assessment.Individual's abstinence status should be considered when evaluating the potential influence of 12-step self-help group attendance on SUD outcomes. In addition, increased clinical resources should focus on assessing patients after discharge and on improving linkage of non-abstinent patients to self-help groups.
View details for DOI 10.1016/j.drugalcdep.2008.07.005
View details for Web of Science ID 000262700500013
View details for PubMedID 18778901
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Treated and untreated remission from problem drinking in late life: Post-remission functioning and health-related quality of life
DRUG AND ALCOHOL DEPENDENCE
2009; 99 (1-3): 150-159
Abstract
To evaluate the post-remission status of older remitted problem drinkers who achieved stable remission without treatment.The post-remission drinking behavior, health-related functioning, life context, coping, and help-seeking of older, untreated (n=330) and treated (n=120) former problem drinkers who had been remitted for a minimum of 6 years were compared twice over the course of 6 years to each other and to lifetime nonproblem drinkers (n=232). Analyses considered the impact of severity of drinking problem history.Untreated remitters were more likely than treated remitters to continue to drink, exhibited fewer chronic health problems and less depressive symptomatology, and were less likely to smoke. Untreated remitters' life contexts were somewhat more benign than those of treated ones, and they were less likely to describe a coping motive for drinking and engage in post-remission help-seeking. Although untreated remitters more closely resembled lifetime nonproblem drinkers than did treated remitters, both untreated and treated remitter groups exhibited worse health-related functioning, more financial and interpersonal stressors, and more post-remission help-seeking than did lifetime nonproblem drinkers.Regardless of whether late-life remission was gained without or with treatment, prior drinking problems conveyed a legacy of health-related and life context deficits.
View details for DOI 10.1016/j.drugalcdep.2008.07.020
View details for Web of Science ID 000262700500017
View details for PubMedID 18829184
View details for PubMedCentralID PMC2673086
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Assessing spirituality/religiosity in the treatment environment: The Treatment Spirituality/Religiosity Scale
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2008; 35 (4): 427-433
Abstract
There has been much interest in measuring and evaluating the role of spirituality/religiosity (S/R) in substance use disorder (SUD) treatment. This study presents the initial evaluation of a new measure of S/R in the treatment environment: the Treatment Spirituality/Religiosity Scale (TSRS). The TSRS has 10 items and can be completed by both patient and staff to measure the emphasis on S/R in a given treatment program, which may have important implications for patient-program fit. Data on the TSRS were gathered from 3,018 patients and 329 staff members from 15 residential SUD treatment programs within the Department of Veterans Affairs Health Care System. The TSRS showed good internal consistency (alpha = .77), a single-factor structure, close agreement between patients and staff members (r = .93), and good discriminant validity. The TSRS appears to be a brief, easily administered, and potentially useful measure of the emphasis on S/R in residential SUD treatment programs.
View details for DOI 10.1016/j.jsat.2008.02.002
View details for Web of Science ID 000260800700009
View details for PubMedID 18424049
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Depressive Symptoms, Health Behaviors, and Risk of Cardiovascular Events in Patients With Coronary Heart Disease
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
2008; 300 (20): 2379–88
Abstract
Depressive symptoms predict adverse cardiovascular outcomes in patients with coronary heart disease, but the mechanisms responsible for this association are unknown.To determine why depressive symptoms are associated with an increased risk of cardiovascular events.The Heart and Soul Study is a prospective cohort study of 1017 outpatients with stable coronary heart disease followed up for a mean (SD) of 4.8 (1.4) years.Participants were recruited between September 11, 2000, and December 20, 2002, from 12 outpatient clinics in the San Francisco Bay Area and were followed up to January 12, 2008.Baseline depressive symptoms were assessed using the Patient Health Questionnaire (PHQ). We used proportional hazards models to evaluate the extent to which the association of depressive symptoms with subsequent cardiovascular events (heart failure, myocardial infarction, stroke, transient ischemic attack, or death) was explained by baseline disease severity and potential biological or behavioral mediators.A total of 341 cardiovascular events occurred during 4876 person-years of follow-up. The age-adjusted annual rate of cardiovascular events was 10.0% among the 199 participants with depressive symptoms (PHQ score > or = 10) and 6.7% among the 818 participants without depressive symptoms (hazard ratio [HR], 1.50; 95% confidence interval, [CI], 1.16-1.95; P = .002). After adjustment for comorbid conditions and disease severity, depressive symptoms were associated with a 31% higher rate of cardiovascular events (HR, 1.31; 95% CI, 1.00-1.71; P = .04). Additional adjustment for potential biological mediators attenuated this association (HR, 1.24; 95% CI, 0.94-1.63; P = .12). After further adjustment for potential behavioral mediators, including physical inactivity, there was no significant association (HR, 1.05; 95% CI, 0.79-1.40; P = .75).In this sample of outpatients with coronary heart disease, the association between depressive symptoms and adverse cardiovascular events was largely explained by behavioral factors, particularly physical inactivity.
View details for DOI 10.1001/jama.2008.711
View details for Web of Science ID 000261150800020
View details for PubMedID 19033588
View details for PubMedCentralID PMC2677371
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Predictors of changes in alcohol-related self-efficacy over 16 years
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2008; 35 (2): 148-155
Abstract
Self-efficacy is a robust predictor of short- and long-term remission after treatment. This study examined the predictors of self-efficacy in the year after treatment and 15 years later. A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years. Predictors of self-efficacy at 1 year included improvement from baseline to 1 year in heavy drinking, alcohol-related problems, depression, impulsivity, avoidance coping, social support from friends, and longer duration of participation in Alcoholics Anonymous (AA). Female gender, more education, less change in substance use problems, and impulsivity during the first year predicted improvement in self-efficacy over 16 years. Clinicians should focus on keeping patients engaged in AA, addressing depressive symptoms, improving patient's coping, and enhancing social support during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.
View details for DOI 10.1016/j.jsat.2007.09.003
View details for Web of Science ID 000258799100006
View details for PubMedID 18037604
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Continuing care after inpatient psychiatric treatment for patients with psychiatric and substance use disorders
PSYCHIATRIC SERVICES
2008; 59 (9): 982-988
Abstract
This observational study examined the association between continuing outpatient care for a psychiatric disorder, a substance use disorder, or both and decreased risk of readmission to psychiatric care after an index episode of inpatient psychiatric treatment.Treatment records from all patients with co-occurring substance use and psychiatric disorders discharged from an inpatient psychiatric setting in the Department of Veterans Affairs (VA) between July 1, 2004, and June 30, 2005 (N=26,826), were used to determine the impact of psychiatric and substance use disorder continuing care on readmission to inpatient psychiatric treatment in the 90 days after discharge.Over 23% (6,280 of 26,826) of patients with both a psychiatric disorder and a substance use disorder who received inpatient psychiatric treatment in the VA were readmitted for additional psychiatric care within 90 days of discharge. Survival analyses indicated that receiving continuing care for a substance use disorder (hazard ratio [HR]=.84, 95% confidence interval [CI]=.77-.92, p<.001) in the 30 days after discharge from the index episode was associated with a lower likelihood of rehospitalization. Psychiatric continuing care was not associated with risk of rehospitalization. A supplementary analysis indicated that substance use disorder continuing care was still associated with a reduced risk of rehospitalization over the 12 months after discharge, although the overall magnitude of the association was diminished (HR=.92, 95% CI=.86-.99, p=.02).Readmission to inpatient psychiatric treatment was common for patients with co-occurring disorders, and these observational findings indicate that continuing care for a substance use disorder was associated with lower risk of early readmission.
View details for Web of Science ID 000258833200006
View details for PubMedID 18757590
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Gender differences in social influences and stressors linked to increased drinking
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2008; 69 (5): 695-702
Abstract
To explore reasons for gender differences in problem-drinking prevalence and to compare the experiences of problem-drinking women and men, this article examines gender differences in exposure and drinking reactivity to social influences and stressors during adulthood.A community sample of 831 older adults (347 women and 484 men; average age=69), comprising problem and nonproblem drinkers, provided information about their drinking histories. Respondents indicated whether they had experienced particular social influences and stressors during adulthood (exposure) and, if so, whether they had increased alcohol consumption in response (reactivity).Overall, women were more likely than men to report exposure to a partner's drinking, family interpersonal problems, death of someone close, and emotional distress. Men reported more exposure to peers' drinking and workplace problems and were more likely to report drinking reactivity to social influences and stressors. Among problem drinkers, gender differences in exposure to social influences and stressors paralleled those in the overall sample, but gender differences in reactivity were minimal.Gender differences in exposure to social influences and stressors generally do not help explain men's higher problem-drinking prevalence, but men's overall greater drinking reactivity corresponds with their propensity to develop problem drinking. Problem-drinking women and men tend to be exposed to somewhat different social influences and stressors but share a tendency to respond to these experiences with increased drinking. Information about experiences that may place upward pressure on drinking for men and women can inform efforts to prevent and treat alcohol-use disorders.
View details for Web of Science ID 000259205200008
View details for PubMedID 18781244
View details for PubMedCentralID PMC2575387
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Family support, family income, and happiness: A 10-year perspective
JOURNAL OF FAMILY PSYCHOLOGY
2008; 22 (3): 475-483
Abstract
This study examined the role of 2 central aspects of family life--income and social support--in predicting concurrent happiness and change in happiness among 274 married adults across a 10-year period. The authors used hierarchical linear modeling to investigate the relationship between family income and happiness. Income had a small, positive impact on happiness, which diminished as income increased. In contrast, family social support, measured by 3 subscales, Cohesion, Expressiveness, and Conflict, showed a substantial, positive association with concurrent happiness, even after controlling for income. Furthermore, family income moderated the association between family social support and concurrent happiness; family social support was more strongly associated with happiness when family income was low than when family income was high. In addition, change in family social support was positively related to change in happiness, whereas change in family income was unrelated to change in happiness. These findings suggest that happiness can change and underscore the importance of exploring more deeply the role that family relationships play in facilitating such change.
View details for DOI 10.1037/0893-3200.22.3.475
View details for Web of Science ID 000256628500015
View details for PubMedID 18540776
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Screening psychiatric patients for illicit drug use disorders and problems
CLINICAL PSYCHOLOGY REVIEW
2008; 28 (4): 578-591
Abstract
Illicit drug use is prevalent but under-detected among psychiatric patients. This paper reviews the need for a valid, practical screening instrument for detecting drug problems and disorders among psychiatric patients, and describes the appropriateness of existing screening instruments for this purpose.Research literature on illicit drug screening instruments is reviewed.All existing instruments lack one or more of the following characteristics that would enable them to be used routinely in psychiatric settings: brief and easy to administer, demonstrated validity for male and female psychiatric patients, measuring illicit drug use problems without confounding with alcohol use problems, and assessing drug problems over an optimal timeframe for screening (e.g., past 12 months).Current instruments are not appropriate for routine drug screening of psychiatric patients. A brief, easy to use drug screen should be developed and validated on male and female psychiatric patients for routine screening of drug disorders and problems.
View details for DOI 10.1016/j.cpr.2007.08.002
View details for Web of Science ID 000254931100003
View details for PubMedID 17900773
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Predictors of 4-year outcome of community residential treatment for patients with substance use disorders
ADDICTION
2008; 103 (4): 671-680
Abstract
This study examined systematically how predictors of substance use disorder (SUD) treatment outcome worked together over time and identified mediators and moderators of outcome.The MacArthur model was applied in this naturalistic study to identify how baseline, discharge and 1-year follow-up factors worked together to predict 4-year improvement in substance-related problems.Eighty-eight community residential facilities were selected based on geographic representativeness, number of patient referrals and type of treatment orientation.Of 2796 male patients who completed intake assessments, 2324 were assessed at the 1-year follow-up and 2023 at the 4-year follow-up.Self-report measures of symptom severity, functioning, social resources and coping, treatment and involvement in Alcoholics Anonymous (AA) were collected at baseline and at 1- and 4-year follow-ups. Provider-rated treatment participation measures were obtained at discharge.Greater substance use severity, more psychiatric symptoms, more prior arrests and stronger belief in AA-related philosophy at treatment entry predicted improvement significantly in substance-related problems 4 years later. At the 1-year follow-up, being employed and greater use of AA-related coping predicted outcome significantly. AA-related coping at 1 year mediated the relationship partially between belief in AA philosophy at treatment entry and 4-year outcome.The findings highlight the unique and positive impact of AA involvement on long-term SUD treatment outcome and extend understanding of why AA is beneficial for patients.
View details for Web of Science ID 000253981700021
View details for PubMedID 18339113
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Active ingredients of substance use-focused self-help groups
ADDICTION
2008; 103 (3): 387-396
Abstract
This paper provides an overview of some of the probable active ingredients of self-help groups in light of four related theories that identify common social processes that appear to underlie effective psychosocial treatments for and continuing remission from these disorders.Social control theory specifies active ingredients such as bonding, goal direction and structure; social learning theory specifies the importance of norms and role models, behavioral economics and behavioral choice theory emphasizes involvement in rewarding activities other than substance use, and stress and coping theory highlights building self-efficacy and effective coping skills. A review of existing studies suggests that the emphasis on these active ingredients probably underlies some aspects of the effectiveness of self-help groups.Several issues that need to be addressed to enhance understanding of the active ingredients of action of self-help groups are discussed, including consideration of indices of Alcoholics Anonymous (AA) affiliation as active ingredients, identification of personal characteristics that may moderate the influence of active ingredients on substance use outcomes, examination of whether active ingredients of self-help groups, can amplify or compensate for treatment, identification of potential detrimental effects of involvement in self-help groups and focusing on the link between active ingredients of self-help groups and other aspects of the overall recovery milieu, such as the family and social networks.
View details for DOI 10.1111/j.1360-0443.2007.02111.x
View details for Web of Science ID 000252964600008
View details for PubMedID 18269361
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Substance misuse among older adults: a neglected but treatable problem
ADDICTION
2008; 103 (3): 347–48
View details for DOI 10.1111/j.1360-0443.2007.02096.x
View details for Web of Science ID 000252964600001
View details for PubMedID 18205895
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Functioning status of adult children of depressed parents: a 23-year follow-up
58th Annual Meeting of the Institute-on-Psychiatric-Services
CAMBRIDGE UNIV PRESS. 2008: 343–52
Abstract
We compared adult offspring of depressed or control parents who were followed for 23 years. Comparisons were on depression symptoms, physical functioning and disability, social functioning, and utilization of help and coping. Also examined was whether the parent's course of depression (stably remitted, partially remitted, non-remitted) was associated with offspring functioning.Depressed parents successfully followed at 23 years (n=248, 82%) identified 215 adult offspring; 67% returned questionnaires. Matched control parents successfully followed (n=235, 79%) identified 261 adult offspring; 68% completed questionnaires.Adult offspring of depressed parents were more impaired than adult offspring of controls (with gender and education controlled) in the domains of depression and disability, and obtained more help for mental health problems. They also reported more severe recent stressors and relied more on active cognitive coping and seeking alternative rewards to cope. Adult offspring of depressed and control parents were comparable in a number of domains: psychiatric and behavioral problems other than depression, physical functioning and pain, social functioning, and hospitalizations and medication use for depression. Adult offspring of parents with a non-remitted course of depression were the most likely to show impaired functioning compared with controls.Having a parent with depression is associated with more depression and disability in adulthood, but does not have debilitating effects in other life domains. Nonetheless, it may be important for offspring of depressed parents, particularly offspring of parents with a non-remitting depression course, to recognize their elevated risk of depression and potential need for help.
View details for DOI 10.1017/S0033291707002073
View details for Web of Science ID 000254481600006
View details for PubMedID 17988421
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Context and mechanisms of reactivity to assessment and treatment
ADDICTION
2008; 103 (2): 249-250
View details for Web of Science ID 000252318800012
View details for PubMedID 18199303
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Conversation with Rudolf Moos
ADDICTION
2008; 103 (1): 13-23
View details for DOI 10.1111/j.1360-0443.2007.02069.x
View details for Web of Science ID 000251501900005
View details for PubMedID 18081610
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Predictors of Dually Diagnosed Patients' Psychiatric Symptom Exacerbation During Acute Substance Use Disorder Treatment
JOURNAL OF DUAL DIAGNOSIS
2008; 4 (1): 55-74
View details for DOI 10.1300/J374v04n01_04
View details for Web of Science ID 000207707600004
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How and why twelve-step self-help groups are effective.
Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism
2008; 18: 393-412
View details for PubMedID 19115781
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Problem-free drinking over 16 years among individuals with alcohol use disorders
DRUG AND ALCOHOL DEPENDENCE
2008; 92 (1-3): 116-122
Abstract
Limited data exist on the rates and long-term stability of non-problem drinking in individuals who sought help for an alcohol use disorder.A sample of initially untreated individuals with alcohol use disorders (n=420) was surveyed at baseline and 1 year and was re-assessed at 8 and 16 years.In the 6 months prior to the 1-year assessment, 36% (n=152) of participants reported abstinence from alcohol, 48% (n=200) reported drinking with problems, and 16% (n=68) reported non-problem drinking. At each follow up, 16-21% of the sample reported non-problem drinking. Compared to individuals in the abstinent and problem-drinking groups, individuals who were drinking in a problem-free manner at 1 year had reported, at baseline, fewer days of intoxication, drinks per drinking day, alcohol dependence symptoms, and alcohol-related problems, less depression, and more adaptive coping mechanisms. Over time, 48% of participants who engaged in non-problem drinking at 1 year continued to report positive outcomes (either non-problem drinking or abstinence) throughout the long-term follow-up, whereas 77% of those abstaining at 1 year reported positive outcomes throughout the same time period. Additionally, 43% of individuals with problematic alcohol consumption at 1 year reported positive outcomes over the remaining follow-up interval, a rate that was not significantly different from the rate of positive outcomes of 48% observed in those with initial problem-free drinking.Although some individuals report non-problem drinking a year after initially seeking help, this pattern of alcohol use is relatively infrequent and is less stable over time than is abstinence. An accurate understanding of the long-term course of alcohol use and problems could help shape expectations about the realistic probability of positive outcomes for individuals considering moderate drinking as a treatment goal.
View details for DOI 10.1016/j.drugalcdep.2007.07.006
View details for Web of Science ID 000252707200016
View details for PubMedID 17719186
View details for PubMedCentralID PMC2212608
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Treated and untreated alcohol-use disorders - Course and predictors of remission and relapse
EVALUATION REVIEW
2007; 31 (6): 564-584
Abstract
The research described here focused on personal, life context, and help-related factors to trace the long-term course of treated and untreated alcohol-use disorders. A group of 461 individuals who sought help for alcohol problems was surveyed at baseline and 1, 3, 8, and 16 years later. Compared with individuals who remained untreated, individuals who entered treatment and/or Alcoholics Anonymous (AA), and participated in these modalities for a longer interval, were more likely to attain remission. Personal resources associated with social learning, stress and coping, behavior economic, and social control theories predicted the maintenance of remission.
View details for DOI 10.1177/0193841X07306749
View details for Web of Science ID 000250718900004
View details for PubMedID 17986708
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Spousal similarity in coping and depressive symptoms over 10 years
JOURNAL OF FAMILY PSYCHOLOGY
2007; 21 (4): 551-559
Abstract
Following a baseline sample of 184 married couples over 10 years, the present study develops a broadened conceptualization of linkages in spouses' functioning by examining similarity in coping as well as in depressive symptoms. Consistent with hypotheses, results demonstrated (a) similarity in depressive symptoms within couples across 10 years, (b) similarity in coping within couples over 10 years, and (c) the role of coping similarity in strengthening depressive similarity between spouses. Spousal similarity in coping was evident for a composite measure of percent approach coping as well as for component measures of approach and avoidance coping. The role of coping similarity in strengthening depressive symptom similarity was observed for percent approach coping and for avoidance coping. These findings support social contextual models of psychological adjustment that emphasize the importance of dynamic interdependencies between individuals in close relationships.
View details for DOI 10.1037/0893-3200.21.4.551
View details for Web of Science ID 000251771100001
View details for PubMedID 18179327
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Participation in specific treatment components predicts alcohol-specific and general coping skills
ADDICTIVE BEHAVIORS
2007; 32 (8): 1669-1680
Abstract
This study identified which aspects of substance abuse treatment in community residential facilities (CRFs) were correlated with patients' post-treatment coping. A total of 2376 patients supplied demographic information and completed measures at baseline (coping and abstinence self-efficacy) and one year after treatment (coping, level of drug and alcohol use, and substance-related problems). Staff provided information about treatment orientation and patients' participation in treatment (e.g., life skills training, vocational counseling). The data were used to predict coping 1 year after treatment. As expected, higher levels of general approach coping and alcohol-specific coping and lower levels of general avoidance coping were associated with less 1-year alcohol and drug use and fewer drinking problems. Patients' greater level of participation in life skills counseling predicted more approach coping at 1 year. In addition, positive social relationships and participation in 12-step self-help groups predicted less general avoidance coping and more alcohol-specific coping at 1 year post-treatment. Life skills training, 12-step self-help groups, and enhancement of supportive relationships during CRF treatment for substance abuse are related to healthy coping. Future research should examine the effect of these components in less intensive programs and with women.
View details for DOI 10.1016/j.addbeh.2006.11.023
View details for Web of Science ID 000247302800011
View details for PubMedID 17182195
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Substance use-disorder treatment and a decline in attempted suicide during and after treatment
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2007; 68 (4): 503-509
Abstract
Suicide attempts are common in patients being treated for substance-use disorders (SUDs). However, little is known about the frequency of suicidal behavior during and after SUD treatment or about aspects of treatment that predict subsequent suicidal behavior. The present study examines whether treatment setting, length of treatment, and availability/use of psychiatric services are associated with a reduced likelihood of a suicide attempt during and 1 year after treatment.A national sample of 3,733 patients was assessed at the start of an episode of SUD treatment and again at discharge and/or 1 year after treatment. Mixed-model logistic regression analyses examined treatment-related predictors of in-treatment and posttreatment suicide attempts.The rate of suicide attempts was significantly lower in the year following treatment (4%) than in the year before treatment (9%). Additionally, a total of 2% of patients reported a suicide attempt during treatment. Suicide attempts made during treatment were less likely in patients treated in residential as compared with outpatient settings. A longer course of treatment was associated with a lower likelihood of a posttreatment suicide attempt.A sizable minority of patients report a suicide attempt either during or within 1 year after completion of SUD treatment. Even after controlling for baseline suicidality, aspects of the SUD treatment episode are associated with a lower risk of a future suicide attempt. Treatment providers should consider placing patients in residential settings to reduce suicide attempts made during treatment and providing a longer course of treatment to reduce the likelihood of suicide following treatment.
View details for Web of Science ID 000248734200003
View details for PubMedID 17568953
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Spirituality/religiosity promotes acceptance-based responding and 12-step involvement
DRUG AND ALCOHOL DEPENDENCE
2007; 89 (1): 66-73
Abstract
Previous investigations have observed that spirituality/religiosity (S/R) is associated with enhanced 12-step involvement. However, relatively few studies have attempted to examine the mechanisms for this effect. For the present investigation, we examined whether acceptance-based responding (ABR) - awareness or acknowledgement of internal experiences that allows one to consider and perform potentially adaptive responses - accounted for the effect of S/R on 12-step self-help group involvement 2 years after a treatment episode.Data were collected as part of a multi-site treatment outcome study with 3698 substance-dependent male veterans recruited at baseline. Assessments were conducted at baseline, discharge, 1-year follow-up, and 2-year follow-up. We utilized structural equation modeling to examine the relationships among latent variables of S/R, ABR, and 12-step involvement over time.In the final model, S/R was not directly related to 12-step involvement at 2-year follow-up. However, S/R predicted enhanced ABR at 1-year follow-up after accounting for discharge levels of ABR. In turn, ABR at 1-year follow-up predicted increased 12-step involvement at 2-year follow-up after accounting for discharge levels of 12-step involvement.S/R promotes the use of post-treatment self-regulation skills that, in turn, directly contribute to ongoing 12-step self-help group involvement.
View details for DOI 10.1016/j.drugalcdep.2006.12.004
View details for Web of Science ID 000246445200008
View details for PubMedID 17229532
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Theory-based processes that promote the remission of substance use disorders
CLINICAL PSYCHOLOGY REVIEW
2007; 27 (5): 537-551
Abstract
Four related theories about the personal and social resources that shield individuals from developing substance use disorders and foster the process of remission from these disorders are described. These theories are social control theory, behavioral economics and behavioral choice theory, social learning theory, and stress and coping theory. Next, the social processes specified by these theories are highlighted, including the provision of support, goal direction, and monitoring; engagement in rewarding activities other than substance use, exposure to abstinence-oriented norms and models, and attempts to build self-efficacy and coping skills. Then, a review of the literature considers evidence about the association between the personal and social resources specified by the four theories and remission from substance use disorders. The discussion highlights several issues that need to be addressed to enhance our understanding of the protective resources involved in stable remission, such as how to develop integrated measures of the key resources and specify their associations with substance use outcomes, the extent to which the resources amplify or compensate for the influence of treatment, and how treatment and continuing care can be tailored to strengthen the protective resources that promote remission.
View details for DOI 10.1016/j.cpr.2006.12.006
View details for Web of Science ID 000246951300001
View details for PubMedID 17254686
View details for PubMedCentralID PMC1940243
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Theory-based active ingredients of effective treatments for substance use disorders
DRUG AND ALCOHOL DEPENDENCE
2007; 88 (2-3): 109-121
Abstract
This paper describes four related theories that specify common social processes that protect individuals from developing substance use disorders and may underlie effective psychosocial treatments for these disorders: social control theory, behavioral economics and behavioral choice theory, social learning theory, and stress and coping theory. It then provides an overview of the rationale and evidence for four effective psychosocial treatments for substance use disorders: motivational interviewing and motivational enhancement therapy, 12-step facilitation treatment, cognitive-behavioral treatment and behavioral family counseling, and contingency management and community reinforcement approaches. The presumed active ingredients of these treatments are described in terms of how they exemplify the social processes highlighted by the four theories. The identified common components of effective treatment include support, goal direction, and structure; an emphasis on rewards that compete with substance use, a focus on abstinence-oriented norms and models, and attempts to develop self-efficacy and coping skills. Several issues that need to be addressed to enhance our understanding of the active ingredients involved in effective treatment are discussed, including how to develop measures of these ingredients, how well the ingredients predict outcomes and influence conceptually comparable aspects of clients' life contexts, and how much their influence varies depending upon clients' demographic and personal characteristics.
View details for DOI 10.1016/j.drugalcdep.2006.10.010
View details for Web of Science ID 000246069000001
View details for PubMedID 17129682
View details for PubMedCentralID PMC1896183
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Upward pressures on drinking: Exposure and reactivity in adulthood
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2007; 68 (3): 437-445
Abstract
The purpose of this study was to identify the situations most commonly linked with increased drinking for different life periods and for nonproblem and problem drinkers.A community sample of older adults (average age 69 years; 42% women), consisting of 480 nonproblem and 351 problem drinkers, provided information about their life history of drinking. For each of three life periods (early adulthood, early middle age, and late middle age), respondents indicated whether they experienced particular situations (exposure) and, if so, whether they increased their alcohol consumption in response to these situations (reactivity). These situations included social influences and stressors.Exposure to social influences and to stressors varied across life periods, as did drinking reactivity. Overall, the social influences of having peers or a partner who drank and the stressors of family interpersonal problems and emotional distress were common experiences and also were among the most likely to be linked with increased alcohol consumption. Compared with nonproblem drinkers, problem drinkers reported significantly higher levels of exposure to social influences and to stressors and also were much more reactive to them.Prevention and treatment of alcohol use disorders can be tailored to take into account variations in exposure and reactivity to situations that may place upward pressure on drinking.
View details for Web of Science ID 000248712900015
View details for PubMedID 17446984
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Predictors of a suicide attempt one year after entry into substance use disorder treatment
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2007; 31 (4): 635-642
Abstract
The present study examined the patient intake and treatment-related risk factors associated with a suicide attempt in the 30 days before a 1-year posttreatment assessment.A national sample of 8,807 patients presenting for treatment of substance use disorders (SUDs) in the Department of Veterans Affairs healthcare system were assessed at treatment intake and follow-up. Using the MacArthur Model, the risk and protective factors for suicide attempt were identified at baseline and during treatment.At follow-up, 4% (314/8,807) of the patients reported a suicide attempt within the past 30 days. Baseline predictors of a suicide attempt before follow-up included elevated suicidal/psychiatric symptoms, more recent problematic alcohol use, and longer duration of cocaine use. Contact with the criminal justice system was a protective factor that reduced the likelihood of a future suicide attempt. Greater engagement in SUD treatment was also associated with a reduction in suicide risk.More involvement in SUD treatment reduced the likelihood of a future suicide attempt in high-risk patients. Substance use disorder treatment providers interested in reducing future suicidal behavior may want to concentrate their efforts on identifying at-risk individuals and actively engaging these patients in longer treatment episodes.
View details for DOI 10.1111/j.1530-0277.2007.00348.x
View details for Web of Science ID 000244976200013
View details for PubMedID 17374043
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Avoidance coping strategies moderate the relationship between self-efficacy and 5-year alcohol treatment outcomes
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2007; 21 (1): 108-113
Abstract
Both self-efficacy and coping strategies are important determinants of functioning for substance use disorder patients, yet little is known about their interrelationship. This study examined the relationship between abstinence self-efficacy and cognitive components of coping (positive reappraisal, cognitive avoidance) for male participants (n = 2,596) from 15 residential substance use disorder treatment programs who were assessed at treatment entry, discharge, and 5-year follow-up. Cognitive avoidance coping moderated the effects of self-efficacy on alcohol use at 5 years, whereas positive reappraisal coping was largely unrelated to outcomes. Specifically, for patients with low self-efficacy, reliance on avoidance coping strategies was associated with poorer alcohol use outcomes, but as self-efficacy increased, the negative influence of avoidance coping strategies diminished.
View details for DOI 10.1037/0893-164X.21.1.108
View details for Web of Science ID 000245149300011
View details for PubMedID 17385960
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Protective resources and long-term recovery from alcohol use disorders
DRUG AND ALCOHOL DEPENDENCE
2007; 86 (1): 46-54
Abstract
This study examined indices of personal and social resources drawn from social learning, behavioral economics, and social control theories as predictors of medium- and long-term alcohol use disorder outcomes.Individuals (N = 461) who initiated help-seeking for alcohol-related problems were surveyed at baseline and 1, 3, 8, and 16 years later. At baseline and each follow-up, participants provided information about their personal and social resources and alcohol-related and psychosocial functioning.In general, protective resources associated with social learning (self-efficacy and approach coping), behavioral economics (health and financial resources and resources associated with Alcoholics Anonymous), and social control theory (bonding with family members, friends, and coworkers) predicted better alcohol-related and psychosocial outcomes. A summary index of protective resources associated with all three theories significantly predicted remission. Protective resources strengthened the positive influence of treatment on short-term remission and partially mediated the association between treatment and remission.Application of social learning, behavior economic, and social control theories may help to identify predictors of remission and thus to allocate treatment more efficiently.
View details for DOI 10.1016/j.drugalcdep.2006.04.015
View details for Web of Science ID 000242868700005
View details for PubMedID 16769181
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Substance use disorder treatment programs in Switzerland and the USA: Program characteristics and 1-year outcomes
DRUG AND ALCOHOL DEPENDENCE
2007; 86 (1): 75-83
Abstract
This study compared matched samples of substance use disorder (SUD) patients in Swiss and United States (US) residential treatment programs and examined the relationship of program characteristics to patients' substance use and psychosocial functioning at a 1-year follow-up.The study used a prospective, naturalistic design and a sample of 10 public programs in the German-speaking part of Switzerland and 15 US public treatment programs.A total of 358 male patients in Swiss programs were matched on age, marital status and education with 358 male patients in US programs. A total of 160 Swiss and 329 US patient care staff members also participated.Patients completed comparable inventories at admission, discharge and 1-year follow-up to assess their substance use and psychological functioning and receipt of continuing care. Staff members reported on program characteristics and their beliefs about substance use.Compared to Swiss patients, US patients had more severe substance use and psychological problems at intake and although they did not differ on abstinence and remission at follow-up, had somewhat poorer outcomes in other areas of functioning. Swiss programs were longer and included more individual treatment sessions; US programs included more group sessions and were more oriented toward a disease model of treatment. Overall, length of program, treatment intensity and 12-step orientation were associated with better 1-year outcomes for patients in both Swiss and US programs.The sample of Swiss and US programs studied here differed in patient and treatment characteristics; however, in general, there were comparable associations between program characteristics and patients' 1-year outcomes. These findings suggest that associations between treatment processes and patients' outcomes may generalize from one cultural context to another.
View details for DOI 10.1016/j.drugalcdep.2006.05.017
View details for Web of Science ID 000242868700008
View details for PubMedID 16782286
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Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: Two-year clinical and utilization outcomes
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2007; 31 (1): 64-68
Abstract
Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients' health care costs in the first year after treatment, but such initially impressive effects may wane over time. This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step-based (n=887 patients) or cognitive-behavioral (CB, n=887 patients) treatment programs. The 12-step-based programs placed substantially more emphasis on 12-step concepts, had more staff members "in recovery," had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs. The 2-year follow-up assessed patients' substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) versus CB (37.0%) programs. Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs. In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p=0.01).Promoting self-help group involvement appears to improve posttreatment outcomes while reducing the costs of continuing care. Even cost offsets that somewhat diminish over the long term can yield substantial savings. Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.
View details for DOI 10.1111/j.1530-0277.2006.00273.x
View details for Web of Science ID 000243022200009
View details for PubMedID 17207103
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Healthcare work environments
CAMBRIDGE HANDBOOK OF PSYCHOLOGY, HEALTH AND MEDICINE, 2ND EDITION
2007: 439–44
View details for Web of Science ID 000298164400097
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Personal and treatment-related predictors of abstinence self-efficacy
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2007; 68 (1): 126-132
Abstract
To understand better the relationship between substance-use disorder treatment and abstinence self-efficacy, more information is needed about what factors predict greater abstinence self-efficacy.Participants (n = 2,350) from 88 community residential facilities were assessed at treatment entry and 1-year follow-up. Treatment providers reported on patients' engagement in specific components of treatment. After examining univariate associations with self-efficacy, a multiple regression analysis was used to test a model of patient- and treatment-related predictors of self-efficacy 1 year after treatment.More years of education, lower baseline substance- related problems, and higher baseline confidence in abstinence were associated with higher posttreatment self-efficacy. After controlling for these patient factors, patients who were more engaged in skills-training activities and who inspired providers' confidence in their ability to remain abstinent had higher 1-year self-efficacy.The development of higher levels of posttreatment abstinence self-efficacy is driven not only by what a patient brings to treatment but by the activities a patient engages in during treatment. Because of the close relationship between self-efficacy and treatment outcomes, providers may want to target patients with low self- efficacy for interventions that focus on skills-training techniques.
View details for Web of Science ID 000248712600016
View details for PubMedID 17149526
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Coping, symptoms, and functioning outcomes of patients with posttraumatic stress disorder
JOURNAL OF TRAUMATIC STRESS
2006; 19 (6): 799-811
Abstract
This study examines the association between approach coping and better functioning outcomes and the reciprocal relationships between coping and posttraumatic stress disorder (PTSD) symptoms in patients diagnosed with PTSD. Posttraumatic stress disorder patients receiving services in five VA health care systems were randomly selected and surveyed at baseline and followed 10 months later. Analyses of longitudinal data using structural equation modeling techniques showed that more approach coping predicted better family and social functioning. Cognitive avoidance coping predicted more PTSD symptoms, and more PTSD symptoms predicted more approach coping and more behavioral avoidance coping. Approach coping may enable patients with chronic PTSD to establish and maintain better relationships with family and friends, despite continuing PTSD.
View details for DOI 10.1002/jts.20185
View details for Web of Science ID 000243184200005
View details for PubMedID 17195979
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Exacerbation of psychiatric symptoms during substance use disorder treatment
PSYCHIATRIC SERVICES
2006; 57 (12): 1758-1764
Abstract
This study examined psychiatric symptom exacerbation (or deterioration) among patients treated for substance use disorders. The study examined several questions. What is the prevalence of deterioration during residential treatment? Compared with patients who show improvement in psychiatric symptoms, do those with deterioration of symptoms report poorer functioning during treatment and one year after treatment entry? Do patients who experience deterioration of symptoms one year after treatment entry enter treatment with more problems and poorer coping skills? Is the prevalence of deterioration associated with treatment orientation, and do patients whose psychiatric symptoms deteriorate view the treatment environment more negatively than patients whose symptoms improve?A total of 3,322 male patients were recruited at 15 residential substance abuse treatment programs in the Department of Veterans Affairs health care system between 1992 and 1995. On the basis of changes in psychiatric symptoms during treatment, these patients were categorized as having either deteriorated or improved psychiatric symptoms. Patients whose symptoms deteriorated were compared with a matched group of patients with improved symptoms.A total of 426 patients (13 percent) reported a worsening of psychiatric symptoms during treatment. Compared with patients in the improved group (N=426), patients in the deteriorated group reported more psychiatric problems and substance use one year after treatment. Patients in the deteriorated group were more likely to have a psychotic diagnosis, lower self-efficacy, and more reliance on coping by expression of emotions and to view the treatment experience more negatively.Thirteen percent of the patients experienced an exacerbation of psychiatric symptoms during residential substance use disorder treatment. Improved monitoring procedures, such as regular assessments for changes in psychiatric symptoms, are needed to routinely obtain information about declines in psychiatric conditions during treatment.
View details for Web of Science ID 000242534500013
View details for PubMedID 17158491
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Predictors of 16-year mortality among individuals initiating help-seeking for an alcoholic use disorder
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2006; 30 (10): 1711-1720
Abstract
We examined rates and predictors of mortality in individuals (47% women) who had just initiated help-seeking for their alcohol use disorders (AUDs) at the start of the study (n=628) and were followed for 16 years.For both women and men, the observed-to-expected mortality ratio (1.4) was lower than rates found in samples of treated individuals with AUDs, suggesting that those initiating help-seeking careers have better chances of long-term survival. Of the individuals for whom cause of death was known, 68% died of alcohol-related causes. Men were more likely to die than were women. When gender was controlled, individuals who were older and unmarried and had more alcohol dependence symptoms at baseline were more likely to die over the 16-year period. When these baseline characteristics were controlled, better drinking outcomes at 1 year were associated with a lower likelihood of subsequent death. The combination of a shorter duration of inpatient/residential care and better drinking outcomes at 1 year was related to a lower probability of death, as was the combination of a longer duration of outpatient care or Alcoholics Anonymous attendance and better drinking outcomes at 1 year.Efforts should be made to help providers identify individuals who are not responding positively to inpatient or residential treatment and intervene to motivate participation in continuing outpatient care and community 12-step self-help groups to reduce the likelihood of a chronic and fatal AUD course.
View details for DOI 10.1111/j.1530-0277.2006.00206.x
View details for Web of Science ID 000240818600015
View details for PubMedID 17010138
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Gender, treatment and self-help in remission from alcohol use disorders.
Clinical medicine & research
2006; 4 (3): 163-174
Abstract
To examine gender differences in the influence of treatment, self-help groups and life context and coping factors on remission among initially untreated individuals with alcohol use disorders.A naturalistic study in which individuals were assessed at baseline and 1, 8 and 16 years later.Participants initiated help-seeking with the alcoholism service system by contacting an information and referral service or detoxification program.A total of 461 individuals with alcohol use disorders (50% women).Participants were assessed by mail surveys and telephone interviews on participation in professional treatment and Alcoholics Anonymous (AA), alcohol-related functioning and indices of life context and coping.Compared to men, women were more likely to participate in treatment and AA, and to experience better alcohol-related and life context outcomes. In general, women and men who participated in treatment and/or AA for a longer duration were more likely to achieve remission. However, women benefited somewhat more than men from extended participation in AA. Continuing depression and reliance on avoidance coping were more closely associated with lack of remission among men than among women.Compared to men, women with alcohol use disorders were more likely to obtain help and achieve remission. Women tended to benefit more from continued participation in AA and showed greater reductions in depression and avoidance coping than men did. These findings identify specific targets for clinical interventions that appear to be especially beneficial for women and that may also enhance the likelihood of recovery among men.
View details for PubMedID 16988095
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Recovery management (Book Review)
ADDICTION
2006; 101 (9): 1367
View details for DOI 10.1111/j.1360-0443.2006.01623.x
View details for Web of Science ID 000239617700023
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Predictors of engagement in continuing care following residential substance use disorder treatment
DRUG AND ALCOHOL DEPENDENCE
2006; 84 (1): 93-101
Abstract
Patients in intensive SUD programs who subsequently participate in continuing care for a longer interval have better outcomes than those who participate for a shorter interval. We sought to identify patient and program factors associated with duration of engagement in SUD continuing care after residential/inpatient treatment.Patients (n=3032) at 15 geographically diverse SUD residential treatment programs provided data on demographics, symptom patterns, recovery resources, and perceptions of treatment environment. We identified patient characteristics associated with the number of consecutive months of engagement in continuing care. We then consolidated and classified risk factors into an integrated model.Being African American, having more SUD and psychiatric symptoms, more resources for recovery, and perceiving the treatment staff as being supportive were associated with longer engagement in continuing care. African Americans' engagement in continuing care was 17% longer than Caucasians'. The positive effect of being African American was partially mediated by having taken actions toward changing use, and by the presence of psychotic symptoms.These results extend previous research on the predictors of continuing care engagement after residential SUD programs. Clinicians can use information about characteristics that put patients at risk for shorter engagement in continuing care to target patients who might benefit from interventions to increase engagement in continuing care.
View details for DOI 10.1016/j.drugalcdep.2005.12.010
View details for Web of Science ID 000240231600010
View details for PubMedID 16417977
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Treated and untreated individuals with alcohol use disorders: Rates and predictors of remission and relapse
INTERNATIONAL JOURNAL OF CLINICAL AND HEALTH PSYCHOLOGY
2006; 6 (3): 513-526
View details for Web of Science ID 000240570700002
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Therapeutic alliance and the relationship between motivation and treatment outcomes in patients with alcohol use disorder
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2006; 31 (2): 157-162
Abstract
Although motivational readiness to change predicts alcohol use disorder (AUD) treatment outcomes, little is known about treatment aspects that are helpful for patients with low motivation. We examined whether a positive therapeutic alliance is particularly beneficial for patients entering AUD treatment with low motivation. Among Project MATCH outpatients (n = 753), we tested the influence of motivation, therapeutic alliance, and their interaction on 6-month and 1-year alcohol use. The impact of motivation on alcohol use varied depending on therapists' perceptions of alliance. Interactions involving treatment compliance did not mediate the Motivation x Alliance interaction. Thus, a positive therapeutic relationship may be particularly important for patients with low motivation, but mechanisms underlying this possible patient-treatment "match" remain to be determined.
View details for DOI 10.1016/j.jsat.2006.04.001
View details for Web of Science ID 000240397300010
View details for PubMedID 16919743
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Predictors of outcome for patients with substance-use disorders five years after treatment dropout
JOURNAL OF STUDIES ON ALCOHOL
2006; 67 (5): 685-693
Abstract
Few studies focus on the outcome of patients after they drop out of substance-use disorder (SUD) treatment, and there appear to be no prior studies of the long-term outcomes of these patients. The aim of this study is to determine how well such patients do after dropping out of treatment and to identify predictors of differential outcomes.Patients in 15 residential SUD treatment programs were assessed at treatment entry and at 5-year follow-up on their frequency and severity of substance use, expectancies and beliefs about substance use, and social resources and stressors. Patients who dropped out and stayed out of treatment (n = 193) were compared with those who completed treatment (n = 3,204). Predictors of 5-year SUD problems among dropouts were identified.In general, dropouts and treatment completers did not differ significantly on their levels of SUD problems at 5 years. At baseline, patients who dropped out reported more involvement in 12-step organizations and greater cognitive impairment and more closely identified with the label "drug addict" than "alcoholic." Lower severity of SUD, lower self-efficacy, fewer positive substance- use expectancies, and less stress from social networks predicted fewer SUD problems at 5 years among dropouts.In addition to focusing on substance use, providers should address the adequacy of patients' social support and counter positive substance-use expectancies at the earliest stages of treatment before patients drop out.
View details for Web of Science ID 000239368700005
View details for PubMedID 16847536
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Long-Term Patterns and Predictors of Successful Stressor Resolution in Later Life.
International journal of stress management
2006; 13 (3): 253-272
Abstract
At 1 year, 4 years, and 10 years after baseline, late-middle-aged adults reported whether they had successfully resolved their most important stressor of the past year. Compared to individuals who never resolved focal stressors over the 10-year interval, those who always did consistently showed less negative stressor appraisal, less reliance on avoidance coping, and less use of exploratory relative to directed coping responses, independent of type and severity of focal stressor. Less use of exploratory relative to directed coping and having more social resources, fewer health problems, and fewer depressive symptoms at baseline predicted more stressor resolution over the next 10 years. These predictors are promising foci for prospective efforts to optimize ways in which aging adults manage late-life stressors.
View details for PubMedID 18084636
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Acceptance and relationship context: a model of substance use disorder treatment outcome
ADDICTION
2006; 101 (8): 1167-1177
Abstract
This study presented and tested a model of behavior change in long-term substance use disorder recovery, the acceptance and relationship context (ARC) model. The model specifies that acceptance-based behavior and constructive social relationships lead to recovery, and that treatment programs with supportive, involved relationships facilitate the development of these factors.This study used a prospective longitudinal naturalistic design and controlled for baseline levels of study variables.The model was tested on a sample of 2549 patients in 15 residential substance use disorder treatment programs.Acceptance-based responding (ABR), social relationship quality (SRQ), treatment program alliance (TPA) and substance use-related impairment were assessed using interviews and self-report questionnaires.TPA predicted ABR and SRQ and, in turn, ABR predicted better 2-year and 5-year treatment outcomes. The baseline-controlled model accounted for 41% of the variance in outcome at 2-year follow-up and 28% of the variance in outcome at 5-year follow-up. CONCLUSIONS Patients from treatment programs with an affiliative relationship network are more likely to respond adaptively to internal states associated previously with substance use, develop constructive social relationships and achieve long-term treatment benefits.
View details for DOI 10.1111/j.1360-0443.2006.01506.x
View details for Web of Science ID 000238879200014
View details for PubMedID 16869846
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Physical activity, exercise coping, and depression in a 10-year cohort study of depressed patients
JOURNAL OF AFFECTIVE DISORDERS
2006; 93 (1-3): 79-85
Abstract
Epidemiological research examining the relationship between physical activity and depression has been conducted almost exclusively with community samples. We examined associations between physical activity, exercise coping, and depression in a sample of initially depressed patients, using four waves of data spanning 10 years.A cohort (n=424) of depressed adults completed measures of physical activity, exercise coping, depression, and other demographic and psychosocial constructs at baseline, 1-year, 4-years, and 10-years, with a 90% wave-to-wave retention rate. Multilevel modeling was used to analyze individual depression trajectories.More physical activity was associated with less concurrent depression, even after controlling for gender, age, medical problems, and negative life events. Physical activity counteracted the effects of medical conditions and negative life events on depression. However, physical activity was not associated with subsequent depression. The findings for exercise coping were comparable.Measures of physical activity and exercise coping encompassed a limited set of activities and did not include information about duration or intensity.Our results suggest that more physical activity is associated with reduced concurrent depression. In addition, it appears that physical activity may be especially helpful in the context of medical problems and major life stressors. Clinically, encouraging depressed patients to engage in physical activity is likely to have potential benefits with few obvious risks.
View details for DOI 10.1016/j.jad.2006.02.013
View details for Web of Science ID 000238773300010
View details for PubMedID 16545873
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The long-term course of depression: Comparing VA and non-VA patients
25th Congress of the Collegium-Internationale-Neuro-Psychopharmacologicum (CINP)/29th Annual Meeting of the Canadian-College-of-Neuropsychopharmacology
CAMBRIDGE UNIV PRESS. 2006: S129–S129
View details for Web of Science ID 000239495500505
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End-of-treatment outcomes in cognitive-behavioral treatment and 12-step substance use treatment programs: Do they differ and do they predict 1-year outcomes?
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2006; 31 (1): 41-50
Abstract
This study examined changes in treatment-related proximal outcomes from intake to follow-up, associations between continuing care and maintenance of proximal outcome gains, correlations between specific proximal outcomes and substance use outcomes, and potential mediators of treatment effects for 12-step versus cognitive-behavioral (CB) substance use disorder (SUD) treatment. The participants were 1,873 male veterans seeking SUD treatment at five CB-oriented and five 12-step-oriented VA inpatient/residential SUD programs. Patterns of change in proximal outcomes were similar across the two program types. After discharge, attendance at 12-step groups, but not outpatient treatment, was associated with greater maintenance on most proximal outcomes. Only a few proximal outcomes at discharge were associated with 1-year substance use; most 1-year proximal outcomes were associated with 1-year substance use. Having a sponsor, reading 12-step materials, attending 12-step meetings, and having an abstinence goal appeared to mediate the greater effects of 12-step programs (relative to CB programs) on abstinence.
View details for DOI 10.1016/j.jsat.2006.03.008
View details for Web of Science ID 000239128900006
View details for PubMedID 16814009
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Participation in treatment and alcoholics anonymous: A 16-year follow-up of initially untreated individuals
JOURNAL OF CLINICAL PSYCHOLOGY
2006; 62 (6): 735-750
Abstract
This study focused on the duration of participation in professional treatment and Alcoholics Anonymous (AA) for previously untreated individuals with alcohol use disorders. These individuals were surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. Compared with individuals who remained untreated, individuals who obtained 27 weeks or more of treatment in the first year after seeking help had better 16-year alcohol-related outcomes. Similarly, individuals who participated in AA for 27 weeks or more had better 16-year outcomes. Subsequent AA involvement was also associated with better 16-year outcomes, but this was not true of subsequent treatment. Some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA.
View details for DOI 10.1002/jclp.20259
View details for Web of Science ID 000237766500010
View details for PubMedID 16538654
View details for PubMedCentralID PMC2220012
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Suicide attempts among substance use disorder patients: An initial step toward a decision tree for suicide management
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2006; 30 (6): 998-1005
Abstract
Little empirical data are available to develop profiles of patients who attempt suicide or to formulate a decision tree for suicide management. This study identifies profiles of patients who have a high risk of suicide attempt and takes a first step toward developing a decision tree to classify high-risk patients.Based on a cross-sectional, nationwide cohort of substance use disorder patients (N=34,251) in 150 Veterans Affairs (VA) facilities, a total of 5,671 patients who reported suicidal ideation in the 30 days before intake assessment were included in receiver operating characteristic (ROC) analyses to identify the 30-day risk of an actual suicide attempt. Clinical diagnostic and Addiction Severity Index interview data were used.Results provide an initial decision tree to classify high-risk patients with sensitivity ranging from 0.33 to 0.89, and specificity, from 0.42 to 0.87. The factors included in the decision tree encompass history of prior suicide attempts, current drinking to intoxication, current cocaine use, first occasion of suicidal ideation, and difficulty controlling violent behavior.To our knowledge, this is the first attempt to use empirical data to provide information to eventually establish a decision tree for clinical management of patients with suicidal ideation. The findings show that profiles of patients who are at high risk of suicide attempts can be effectively identified using ROC, with relatively good sensitivity and specificity.
View details for DOI 10.1111/j.1530-0277.2006.00114.x
View details for Web of Science ID 000237810900012
View details for PubMedID 16737458
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Course of recovery from alcoholism
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2006; 30 (6): 1079-1090
Abstract
This article represents the proceedings of a symposium at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California, organized and chaired by Kamilla L. Venner. This symposium integrated current empirical research on the course of recovery from alcoholism from multiple perspectives, an aim that is consistent with NIAAA's new focus on the process of recovery. The presentations and presenters were as follows: (1) The Role of Community Services and Informal Support on 7-Year Drinking Outcomes in Treated and Untreated Drinkers, by Helen Matzger; (2) The Sequence of Recovery Events in a Native American Sample, by Kamilla L. Venner; (3) Transformational Change in Recovery, by Alyssa A. Forcehimes; (4) Social Settings and Substance Use: Contextual Factors in Recovery, by Rudolf H. Moos; and (5) A Broader View of Change in Drinking Behavior, by discussant Mark L. Willenbring. A theme connecting the presentations was that treatment is but one discrete aspect to recovery and that sustained recovery is often influenced by an individual interaction with others within a social context. Collectively, presentations underscored the need to think more broadly about factors contributing to the remission of alcohol dependence.
View details for DOI 10.1111/j.1530-0277.2006.00121.x
View details for Web of Science ID 000237810900022
View details for PubMedID 16737468
View details for PubMedCentralID PMC2911355
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Self-efficacy, therapeutic alliance, and alcohol-use disorder treatment outcomes
JOURNAL OF STUDIES ON ALCOHOL
2006; 67 (3): 465-472
Abstract
High abstinence self-efficacy reliably predicts better treatment outcomes for patients with alcohol use disorders, but little is known about aspects of treatment that may be particularly beneficial for patients who enter treatment with low self-efficacy. This study examines whether the relationship between self-efficacy and treatment outcomes is influenced by the quality of the therapeutic alliance in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a multisite clinical trial of three treatments for alcohol use disorders.Information on 785 patients in the outpatient sample of Project MATCH was used to test for an interaction between baseline self-efficacy and therapeutic alliance in relation to 1-year alcohol use outcomes.A significant interaction was found between self-efficacy and the therapists' perception of the therapeutic alliance predicting I1year drinking outcomes. Patients with low self-efficacy who established a strong treatment alliance, as judged by the therapist, experienced I1year outcomes that were superior to those of patients with low self-efficacy with poorer treatment alliance and comparable with those of patients with high self-efficacy. Therapeutic alliance was not strongly related to the outcomes of patients with high baseline self-efficacy.In patients who are treated for alcohol-use disorders, a positive therapeutic alliance may counteract the negative impact of a low baseline self-efficacy. Potential reasons why the therapist's perception of the alliance may be particularly important for patients with low self-efficacy are discussed.
View details for Web of Science ID 000236676600017
View details for PubMedID 16608158
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Predictors of untreated remission from late-life drinking problems
JOURNAL OF STUDIES ON ALCOHOL
2006; 67 (3): 354-362
Abstract
Studies of mixed-aged samples have suggested that a majority of problem drinkers achieve remission "naturally", without formal treatment. We sought to describe the life history predictors of untreated remission among older adults.We compared 330 older untreated remitters to 120 older treated remitters and to 130 untreated nonremitters.A majority (73%) of remitted, older problem drinkers attained remission without any formal treatment for drinking problems. Compared with treated remitters, late-life untreated remitters were more likely to be women and had completed more schooling, reached their peak alcohol consumption and ceased development of new drinking problems earlier, had much less severe drinking and depression histories, and were less likely to have received any advice to reduce consumption. Compared with untreated nonremitters, untreated remitters were more likely to be women, reached their peak alcohol consumption and stopped developing new drinking problems almost a decade earlier, had somewhat less severe drinking histories, were less likely to have been advised to reduce consumption, and were more likely to have reacted to late-life health problems by reducing their alcohol consumption.Many late-life problem drinkers with milder drinking problems achieve remission without treatment or advice to reduce consumption. However, a notable percentage of untreated older individuals who have more severe drinking problems could benefit from public health efforts to aid detection of late-life drinking problems and interventions aimed at reducing alcohol consumption. Results suggest that such interventions should highlight the negative health consequences of excessive late-life drinking.
View details for Web of Science ID 000236676600003
View details for PubMedID 16608144
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Pretreatment and during treatment risk factors for dropout among patients with substance use disorders
ADDICTIVE BEHAVIORS
2006; 31 (3): 450-460
Abstract
The aim of this study was to use pretreatment and treatment factors to predict dropout from residential substance use disorder program and to examine how the treatment environment modifies the risk for dropout.This study assessed 3649 male patients at entry to residential substance use disorder treatment and obtained information about their perceptions of the treatment environment.Baseline factors that predicted dropout included younger age, greater cognitive dysfunction, more drug use, and lower severity of alcohol dependence. Patients in treatment environments appraised as low in support or high in control also were more likely to drop out. Further, patients at high risk of dropout were especially likely to dropout when treated in a highly controlling treatment environment.Better screening of risk factors for dropout and efforts to create a less controlling treatment environment may result in increased retention in substance use disorder treatment.
View details for DOI 10.1016/j.addbeh.205.05.024
View details for Web of Science ID 000236053400008
View details for PubMedID 15979244
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Rates and predictors of relapse after natural and treated remission from alcohol use disorders
ADDICTION
2006; 101 (2): 212-222
Abstract
This study examined the rates and predictors of 3-year remission, and subsequent 16-year relapse, among initially untreated individuals with alcohol use disorders who did not obtain help or who participated in treatment and/or Alcoholics Anonymous in the first year after recognizing their need for help.A sample of individuals (n = 461) who initiated help-seeking was surveyed at baseline and 1 year, 3 years, 8 years and 16 years later. Participants provided information on their life history of drinking, alcohol-related functioning and life context and coping.Compared to individuals who obtained help, those who did not were less likely to achieve 3-year remission and subsequently were more likely to relapse. Less alcohol consumption and fewer drinking problems, more self-efficacy and less reliance on avoidance coping at baseline predicted 3-year remission; this was especially true of individuals who remitted without help. Among individuals who were remitted at 3 years, those who consumed more alcohol but were less likely to see their drinking as a significant problem, had less self-efficacy, and relied more on avoidance coping, were more likely to relapse by 16 years. These findings held for individuals who initially obtained help and for those who did not.Natural remission may be followed by a high likelihood of relapse; thus, preventive interventions may be indicated to forestall future alcohol problems among individuals who cut down temporarily on drinking on their own.
View details for DOI 10.1111/j.1360-0443.2006.01310.x
View details for Web of Science ID 000234876100013
View details for PubMedID 16445550
View details for PubMedCentralID PMC1976118
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Older adults' coping with negative life events: Common processes of managing health, interpersonal, and financial/work stressors
INTERNATIONAL JOURNAL OF AGING & HUMAN DEVELOPMENT
2006; 62 (1): 39-59
Abstract
This study examined how older adults cope with negative life events in health, interpersonal, and financial/work domains and whether common stress and coping processes hold across these three domains. On three occasions, older adults identified the most severe negative event they faced in the last year and described how they appraised and coped with that event, their ambient chronic stressors, and event and functioning outcomes. The stress and coping process was largely consistent across the three life domains. Individuals who appraised events as challenging and relied more on approach coping were more likely to report some benefit from those events. Individuals who experienced more chronic stressors and favored avoidance coping were more likely to be depressed and to have late-life drinking problems. Chronic stressors, as well as approach and avoidance coping, were predictably associated with overall outcomes in all three event domains. These findings provide a basis for preventive interventions that may help older adults' address the most prevalent stressors of aging more effectively.
View details for Web of Science ID 000234660800003
View details for PubMedID 16454482
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Brief report: Utility of a short screening scale for DSM-IV PTSD in primary care
JOURNAL OF GENERAL INTERNAL MEDICINE
2006; 21 (1): 65-67
Abstract
To evaluate Breslau's 7-item screen for posttraumatic stress disorder (PTSD) for use in primary care.One hundred and thirty-four patients were recruited from primary care clinics at a large medical center. Participants completed the self-administered 7-item PTSD screen. Later, psychologists blinded to the results of the screen-interviewed patients using the Clinician Administered PTSD Scale (CAPS). Sensitivity, specificity, and likelihood ratios (LR) were calculated using the CAPS as the criterion for PTSD.The screen appears to have test-retest reliability (r=.84), and LRs range from 0.04 to 13.4.Screening for PTSD in primary care is time efficient and has the potential to increase the detection of previously unrecognized PTSD.
View details for DOI 10.1111/j.1525-1497.2005.00292.x
View details for Web of Science ID 000235163600011
View details for PubMedID 16423126
View details for PubMedCentralID PMC1484617
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Recent sexual abuse, physical abuse, and suicide attempts among male veterans seeking psychiatric treatment
PSYCHIATRIC SERVICES
2006; 57 (1): 107-113
Abstract
This study examined the rates of sexual and physical abuse and suicide attempts among male and female patients and focused on the associations between sexual and physical abuse and recent suicide attempts among men.Data were examined for a cohort of patients aged 19 years and older who were seeking treatment for substance use disorders, other psychiatric disorders, or both from the Department of Veterans Affairs (VA) between July 1997 and September 1997. Almost all the patients in the sample (more than 99 percent) had a substance use disorder. Patients were interviewed with the Addiction Severity Index about lifetime and recent (past 30 days) sexual and physical abuse and recent suicide attempts. Because of the low prevalence of suicide attempts in the past 30 days and limited representation of female patients in this sample, the data for female patients were used only to conduct descriptive analyses to compare the prevalence of sexual and physical abuse and suicide attempts between genders.The sample comprised 34,245 patients (33,236 males and 1,009 females). Compared with male patients, female patients were ten times as likely to have been sexually abused in the past 30 days and four times as likely to have been physically abused. Among male patients, bivariate analyses showed that those who had been recently sexually or physically abused were more likely than those who had not experienced such abuse to have attempted suicide recently (odds ratios of 4.8 and 3.0, respectively). After controlling for demographic and diagnostic factors, multivariate logistic regression analyses indicated that recent sexual abuse, recent physical abuse, and lifetime sexual abuse were significantly associated with a higher likelihood of a recent suicide attempt among male patients.Female patients were more likely than their male counterparts to experience sexual and physical abuse. Recent and lifetime history of sexual abuse and recent physical abuse were independent risk factors for recent suicide attempts among men who were seeking treatment. The results suggest that clinicians who identify suicide attempts and suicidal tendencies among male patients should routinely assess for sexual or physical abuse.
View details for Web of Science ID 000234469000018
View details for PubMedID 16399970
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Sixteen-year changes and stable remission among treated and untreated individuals with alcohol use disorders
DRUG AND ALCOHOL DEPENDENCE
2005; 80 (3): 337-347
Abstract
This study examined changes over a 16-year interval and predictors of stable remission among previously untreated individuals with alcohol-use disorders who did not obtain help or who entered either alcoholics anonymous (AA) or professional treatment in the first year after initially seeking help.A sample of individuals (N = 461) who initiated help-seeking was surveyed at baseline and 1, 3, 8, and 16 years later. In addition to providing information on life history of drinking at each contact point, participants described their current alcohol-related and psychosocial functioning and life context, and coping responses.Irrespective of whether or not individuals obtained help, their alcohol-related functioning, life context, and coping improved. However, individuals who obtained help (AA or treatment) in the first year improved more and were more likely to achieve stable remission than those who did not. Nevertheless, the factors associated with stable remission were comparable for individuals who did and those who did not obtain timely help.Compared with individuals who do not obtain timely help, those who enter either AA or treatment relatively soon after initiating help-seeking improve more quickly and achieve higher long-term remission rates.
View details for DOI 10.1016/j.drugalcdep.2005.05.001
View details for Web of Science ID 000234100800007
View details for PubMedID 15946805
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Treatment for dual diagnosis patients in the psychiatric and substance abuse systems.
Mental health services research
2005; 7 (4): 229-242
Abstract
The purpose of this study was to describe and compare the extent to which psychiatric and substance abuse programs treating dual diagnosis patients in the residential and outpatient modalities offered the components recommended for this client group. Surveys were completed by managers of 753 programs in the Department of Veterans Affairs that had a treatment regimen oriented to dual diagnosis patients. Programs within both the psychiatric and substance abuse systems had some of the key services of integrated treatment (e.g., assessment and diagnosis, crisis intervention, counseling targeted at psychiatric and at substance use problems, medications, patient education, HIV screening and counseling, family counseling and education). However, compared to psychiatric programs, substance abuse programs were more likely to offer some of these services and other critical components (e.g., a cognitive-behavioral treatment orientation, assignment of a single case manager to each patient). Outpatient psychiatric programs were particularly lacking on key management practices (e.g., use of clinical practice guidelines, performance monitoring of providers) and services (e.g., detoxification, 12-step meetings) of integrated treatment. Generally, differences between psychiatric and substance abuse programs appeared to involve difficulties in developing treatment that is fully oriented toward the co-occurring diagnosis. To improve the provision of high-quality dual-focused care, we recommend planners' use of cross-system teams and applications of recently produced tools designed to increase programs' ability to deliver integrated care to dually disordered individuals.
View details for PubMedID 16320106
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Sequencing the lifetime onset of alcohol-related symptoms in older adults: Is there evidence of disease progression?
JOURNAL OF STUDIES ON ALCOHOL
2005; 66 (6): 756-765
Abstract
The purpose of this study was to evaluate evidence of orderly symptom progression in alcohol-use disorders (disease-progression model).A sample of community-residing older problem drinkers provided information about their life history of drinking, including the age at which they had experienced alcohol-related symptoms that correspond to criteria for alcohol abuse and dependence. Symptom sets and possible sequences were formulated separately for women and men, based on the average number of years from drinking initiation to symptom onset and on symptom prevalence. We assessed how well the ordering of symptoms experienced by individual respondents matched the sequences derived with these group-level measures; we also assessed whether individuals progress from alcohol abuse to dependence as is implied in some conceptualizations of alcohol-use disorders.Half or more of these older adults experienced symptom onset in an order that was inconsistent with the possible symptom sequences derived from group-level analysis (e.g., reversals from the expected order or concurrent onset of symptoms expected to occur sequentially). Similarly, alcohol abuse did not appear to be a precursor to the development of alcohol dependence in individual patterns of symptom onset.Although group-level results based on the number of years from drinking initiation to symptom onset or on symptom prevalence may seem to point to orderly progression in the development of alcohol-related symptoms, these group-level results do not capture individual experiences very well. In this community-residing sample of problem drinkers, most of whom had never sought treatment, there was marked variability in the course of symptom development, which raises questions about the utility of a disease-progression model.
View details for Web of Science ID 000233091200006
View details for PubMedID 16459937
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Paths of entry into alcoholics anonymous: Consequences for participation and remission
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2005; 29 (10): 1858-1868
Abstract
This study compared individuals with alcohol use disorders who, in the first year after initiating help-seeking, entered Alcoholics Anonymous (AA) only, entered professional treatment and AA together, or entered professional treatment onlyA sample of initially untreated individuals (N = 362) was surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. At each contact point, participants described their participation in AA and treatment and their current alcohol-related functioning. They also described their reasons for entering AA and/or treatment and the perceived benefits of these sources of helpCompared with individuals who initially participated only in treatment but later entered AA, those who entered treatment and AA together participated in AA longer and more frequently and were more likely to achieve remission. Among individuals who initially participated only in AA, those who later entered treatment had poorer remission outcomes than those who did not enter treatment. Longer duration of participation in AA was associated with a higher likelihood of remission at all four follow-ups; individuals who dropped out of AA were more likely to relapse or remain nonremitted.Compared with individuals who participated only in professional treatment in the first year after they initiated help-seeking, individuals who participated in both treatment and AA were more likely to achieve remission. Individuals who entered treatment but delayed participation in AA did not appear to obtain any additional benefit from AA.
View details for DOI 10.1097/01.alc.0000183006.76551.5a
View details for Web of Science ID 000233153200012
View details for PubMedID 16269916
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Predictors of 5-year mortality following inpatient/residential group treatment for substance use disorders
ADDICTIVE BEHAVIORS
2005; 30 (7): 1300-1316
Abstract
This study examined the prevalence and predictors of 5-year mortality following treatment for substance use disorders. The predictors were assessed at baseline, at discharge, and at a 1-year follow-up for 3698 male veterans, and included demographic, substance use, medical, and psychological functioning, social support, and continuing care. The annual mortality rate was 2.38%, with an observed/expected ratio of 3.05. After accounting for significant demographic, substance use, psychological, and medical conditions, not having a spouse or partner at intake independently predicted 5-year mortality. After accounting for intake variables, more depression at discharge and more medical conditions, a diagnosis of HIV or AIDS, more ounces of ethanol on a maximum drinking day, and lack of a spouse or partner at the 1-year follow-up independently predicted 5-year mortality. Unexpectedly, good quality relationships were related to a higher mortality risk. Results can be used to increase at-risk patients' motivation for recovery.
View details for DOI 10.1016/j.addbeh.2005.01.005
View details for Web of Science ID 000230980000004
View details for PubMedID 16022928
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Stress generation, avoidance coping, and depressive symptoms: A 10-year model
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2005; 73 (4): 658-666
Abstract
This study examined (a) the role of avoidance coping in prospectively generating both chronic and acute life stressors and (b) the stress-generating role of avoidance coping as a prospective link to future depressive symptoms. Participants were 1,211 late-middle-aged individuals (500 women and 711 men) assessed 3 times over a 10-year period. As predicted, baseline avoidance coping was prospectively associated with both more chronic and more acute life stressors 4 years later. Furthermore, as predicted, these intervening life stressors linked baseline avoidance coping and depressive symptoms 10 years later, controlling for the influence of initial depressive symptoms. These findings broaden knowledge about the stress-generation process and elucidate a key mechanism through which avoidance coping is linked to depressive symptoms.
View details for DOI 10.1037/0022-006X.73.4.658
View details for Web of Science ID 000232113700009
View details for PubMedID 16173853
View details for PubMedCentralID PMC3035563
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Deterioration following alcohol-use disorder treatment in project MATCH
JOURNAL OF STUDIES ON ALCOHOL
2005; 66 (4): 517-525
Abstract
This study examines the prevalence and predictors of deterioration during the three months following treatment in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a multisite clinical trial of three different treatments for alcohol-use disorders.The outpatient and aftercare samples of Project MATCH were examined to identify the prevalence of deterioration, as reflected by a decline in percent days abstinent between the 3 months prior to baseline and the 3 months immediately following treatment. Analyses of predictors of deterioration were based on baseline sociodemographic and psychological factors, including substance-related and psychiatric symptoms and treatment-related factors, including treatment type, treatment duration and therapeutic alliance.Approximately 10% (91/927) of patients in the outpatient sample and 7% (50/738) of patients in the aftercare sample deteriorated in the 3 months following treatment. Primary predictors of deterioration in the outpatient sample were lower baseline severity of alcohol dependence, higher baseline depression, fewer sessions of treatment and lower ratings of therapeutic alliance. The only factor associated with deterioration in the aftercare sample was fewer sessions of treatment.Despite the general positive response of patients to alcohol-use disorder treatment, researchers and treatment providers need to be aware of the potential for deterioration in a sizable minority of patients. Potential methods for identifying patients at risk for deterioration early in treatment are discussed.
View details for Web of Science ID 000231369500009
View details for PubMedID 16240559
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The influence of partner status, relationship quality and relationship stability on outcomes following intensive substance-use disorder treatment
JOURNAL OF STUDIES ON ALCOHOL
2005; 66 (4): 497-505
Abstract
Addiction treatment studies examining the influence of patients' partners suggest that partner behaviors affect patients' substance-use outcomes. We examine the influence of having a partner at treatment entry as well as the influence of the general quality of support and substance-using status of the partner, on outcomes following treatment for substance-use disorder. We also examine the influence of relationship stability on treatment outcomes and examine baseline partner behaviors that may predict relationship stability.A prospective, intact-group design was utilized with data analyzed using logistic regression. Participants (N = 3,014) from 15 intensive substanceuse disorder treatment programs were assessed at treatment entry and 1-year postdischarge.Although patients with partners possessed a more favorable clinical profile, their outcomes were no better than those of their single counterparts. However, patients whose relationships lasted through the first year posttreatment had better outcomes than patients whose relationships ended. Relationships with more positive partner behaviors and fewer negative partner behaviors at intake were more likely to remain intact over the course of the first year posttreatment. Positive partner behaviors did not enhance patients' outcomes directly, but partner interpersonal stressors and patients' belief that their partner had a substance-use problem had a significant, deleterious impact on patients' substance-use outcomes.Clinicians should routinely assess the quality of patients' relationships with partners. If deleterious partner behaviors exist, empirically supported interventions (e.g., behavioral couples therapy) could be utilized to reduce these behaviors and ultimately reduce relapse risk.
View details for Web of Science ID 000231369500007
View details for PubMedID 16240557
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The interplay between life stressors and depressive symptoms among older adults
JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES
2005; 60 (4): P199-P206
Abstract
This study examined mutual predictive associations between life stressors and depressive symptoms in later life. A sample of late-middle-aged and older adults (N = 1,291) was surveyed at baseline and 1 year, 4 years, and 10 years later. At each contact point, participants completed an inventory that assessed chronic and acute life stressors and depressive symptoms. Over the 10-year interval, there was evidence of both social causation and social selection processes: More life stressors were associated with subsequent increases in depressive symptoms (social causation), and more depressive symptoms were associated with subsequent increases in stressors (social selection or stress generation). These findings reflect a mutual influence process in which life stressors and depressive symptoms can alter each other.
View details for Web of Science ID 000230190300005
View details for PubMedID 15980287
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Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers
ADDICTION
2005; 100 (6): 777-786
Abstract
Most older adults report having recently experienced pain, and many older adults have late-life drinking problems. However, to our knowledge, the intersection of pain and alcohol misuse by older adults has not been studied. This research focuses on the implications of pain for older individuals who have problems with alcohol.Longitudinal survey. SETTING, PARTICIPANTS AND MEASUREMENT: Older community-residing adults (n = 401) were classified as problem and non-problem drinkers. At baseline and 3 years later they were asked to provide information about their pain, use of alcohol to manage pain, drinking behavior, chronic health problems and recent serious injury.At baseline, older problem drinkers reported more severe pain, more disruption of daily activities due to pain and more frequent use of alcohol to manage pain than did older non-problem drinkers. More pain was associated with more use of alcohol to manage pain; this relationship was stronger among older adults with drinking problems than among those without drinking problems. Among older men, more baseline drinking problems interacted with use of alcohol to manage pain to predict more health problems and serious injury 3 years later. Among older women, more baseline drinking problems interacted with use of alcohol to manage pain to predict more drinking problems 3 years later.The results highlight the importance of monitoring the drinking behavior of older patients who present with pain complaints, especially patients who have pre-existing problems with alcohol.
View details for DOI 10.1111/j.1360-0443.2005.01074.x
View details for Web of Science ID 000229583900011
View details for PubMedID 15918808
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Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence, predictors, prevention
ADDICTION
2005; 100 (5): 595-604
Abstract
To examine the prevalence and personal and intervention-related predictors of potential iatrogenic effects associated with psychosocial interventions for substance use disorders and provide a conceptual framework to guide further research on such effects.A review of relevant studies focuses on the prevalence and predictors of potential iatrogenic effects of psychosocial treatment and prevention programs for substance use disorders.Between 7% and 15% of patients who participate in psychosocial treatment for substance use disorders may be worse off subsequent to treatment than before. In addition, several controlled trials of substance use prevention have shown some apparent iatrogenic effects, including more positive expectations about substance use and a rise in alcohol use and alcohol-related problems. Probable person-related predictors of deterioration associated with treatment include younger age and unmarried status, more serious current diagnoses and substance use problems and more psychiatric and interpersonal problems. Probable intervention-related predictors of deterioration include lack of bonding; lack of monitoring; confrontation, criticism and high emotional arousal; deviancy modeling; and stigma, low or inappropriate expectations and lack of challenge.A significant minority of individuals with substance use problems appear to deteriorate during or shortly after participation in treatment or prevention programs. Safety standards and monitoring procedures are needed to routinely identify potential adverse consequences of intervention programs; research is needed to clarify whether deterioration is due to iatrogenic effects of interventions and to identify new approaches to counteract any such effects.
View details for DOI 10.1111/j.1360-0443.2005.01073.x
View details for Web of Science ID 000228641800006
View details for PubMedID 15847616
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Coping strategies moderate the relationhip between self-efficacy and functioning after substance use disorder treatment
28th Annual Meeting of the Research-Society-on-Alcoholism
WILEY-BLACKWELL. 2005: 160A–160A
View details for Web of Science ID 000229375901331
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Substance use disorder patients who are mandated to treatment: Characteristics, treatment process, and 1-and 5-year outcomes
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2005; 28 (3): 213-223
Abstract
A substantial number of patients with substance use disorders (SUDs) are mandated to treatment by the justice system. However, little is known about their characteristics and how they fare during treatment and in the longer term compared with nonmandated, justice-system-involved patients and patients not involved in the justice system. This prospective study (n=2,095) examined differences in pretreatment characteristics, treatment perceptions and satisfaction, during-treatment changes, and 1- and 5-year outcomes among these three types of patients and tested whether differences in pretreatment characteristics or during-treatment changes could help explain posttreatment outcome similarities or differences. Mandated patients had a less severe clinical profile at treatment intake, yet this did not account for their observed similar/better outcomes, which appeared because of the similar therapeutic gains made during treatment. Treatment perceptions and satisfaction were also comparable across groups. These findings appear to support the idea that judicial mandates can provide an opportunity for offenders with SUDs to access and benefit from needed treatment.
View details for DOI 10.1016/j.jsat.2004.10.014
View details for Web of Science ID 000229093100001
View details for PubMedID 15857721
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The 8-year course of alcohol abuse: Gender differences in social context and coping
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2005; 29 (4): 612-621
Abstract
The aim of this study was to compare women (n=230) and men (n=236) who had alcohol use disorders in terms of social context and coping methods and in terms of changes in these indices associated with participation in professional treatment and Alcoholics Anonymous (AA).Initially untreated problem drinkers were followed up for 8 years.Women and men did not differ in regard to the type of help received, but women had longer professional treatment. At baseline, women had more stressors and fewer resources from family and relied more on avoidance coping and drinking to cope. During the next 8 years, women, more so than men, increased on approach coping and reduced their use of avoidance coping and drinking to cope. When baseline status was controlled, women had better social resource, coping, and drinking outcomes than men did at 1 year and 8 years. A longer duration of professional treatment during year 1 was associated with improved approach coping among men but not women. A longer duration of AA attendance during year 1 and the full 8 years was associated with more resources from friends, more use of approach coping, and less drinking to cope. In turn, more friends resources and approach coping and less drinking to cope were associated with better drinking outcomes. Decreases in avoidance coping and drinking to cope were more strongly associated with better drinking outcomes among men than among women.It may be important to target men for formal services or self-help to increase their use of approach coping in efforts to maintain abstinence. Women's strategies for improving their social context need further explication to be adapted for transfer to male problem drinkers.
View details for DOI 10.1097/01.ALC.0000158832.07705.22
View details for Web of Science ID 000228577100016
View details for PubMedID 15834227
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Justice in health care decision-making: patients' appraisals of health care providers and health plan representatives.
Social justice research
2005; 18 (1): 63-81
Abstract
This study describes the development of two versions of a Health Care Justice Inventory (HCJI). One version focuses on patients' interactions with their providers (HCJI-P) and the other focuses on patients' interactions with the representatives of their health plans (HCJI-HP). Each version of the HCJI assesses patients' appraisals of their interactions (with either their Provider or representatives of their Health Plan) along three common dimensions of procedural justice: Trust, Impartiality, and Participation. Both the Provider and Health Plan scales assess indices that are relatively independent of patients' demographic characteristics. In addition, patients' appraisals of their interactions with their provider were only moderately related to their appraisals of their interactions with representatives of their health plan, indicating that the Provider and Health Plan scales tap distinct aspects of patients' overall experience with the health care system. Overall, procedural justice dimensions were significantly related to patient satisfaction in both the Provider and the Health Plan contexts. As predicted, procedural justice factors were more strongly tied to patient satisfaction in the provider than in the Health Plan context, and health care decisions based on distributive justice principles of Need (rather than Equity or Equality) were most closely tied to patient satisfaction in both contexts.
View details for PubMedID 16021741
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The development and initial validation of the Terminally Ill Grief or Depression Scale (TIGDS)
INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH
2005; 14 (4): 202-212
Abstract
Patients often experience 'preparatory-grief' as they cope with the dying process. Some may be depressed. The Terminally Ill Grief or Depression Scale (TIGDS), comprising grief and depression sub-scales, is a new self-report measure designed to differentiate between preparatory-grief and depression in adult inpatients. The initial 100-item inventory was assembled based on literature review, interviews with clinicians and dying patients and then shortened to 42 items based on consensus expert opinion. Validity and reliability were tested in a sample of 55 terminally ill adults. The consensus clinical opinion was used as the gold standard to differentiate between preparatory grief and depression. The intra-class correlation coefficient was high (it was calculated to estimate the test-retest reliability for the 47 patients who had completed the TIGDS twice--retest was administered 2 to 7 days after the initial test), ranging from 0.86 (grief) to 0.97 (depression). The validity of TIGDS was assessed using a receiver operating characteristic curve analysis, comparing the first test with the clinical criterion. The first and only variable and cut-point was the depression score (chi-square = 18.4, p < 0.001, cut point = 3). The sensitivity of the TIGDS was 0.727 and specificity was 0.886 for the depression = 3 cutoff score. The construct validity of the TIGDS was tested by comparing with the Hospital Anxiety and Depression Scale (HADS). The TIGDS depression subscale showed strong convergent validity and the TIGDS grief subscale showed strong discriminant validity with the HADS total score.
View details for DOI 10.1002/mpr.8
View details for Web of Science ID 000234094000003
View details for PubMedID 16395873
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Older adults' health and changes in late-life drinking patterns
AGING & MENTAL HEALTH
2005; 9 (1): 49-59
Abstract
This study focused on the prospective associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems. A sample of 1,291 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption, and was followed one year, four years, and 10 years later. Health-related problems increased and alcohol consumption and drinking problems declined over the 10-year interval. Medical conditions, physical symptoms, medication use, and acute health events predicted a higher likelihood of abstinence and less frequent and lower alcohol consumption. However, overall health burden predicted more subsequent drinking problems, even after controlling for alcohol consumption and a history of heavy drinking and increased drinking in response to stressors. Among older adults, increased health problems predict reduced alcohol consumption but more drinking problems. Older adults with several health problems who consume more alcohol are at elevated risk for drinking problems and should be targeted for brief interventions to help them curtail their drinking.
View details for DOI 10.1080/13607860412331323818
View details for Web of Science ID 000226265400007
View details for PubMedID 15841832
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High-risk alcohol consumption and late-life alcohol use problems
AMERICAN JOURNAL OF PUBLIC HEALTH
2004; 94 (11): 1985-1991
Abstract
We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems.A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later.Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals.Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.
View details for Web of Science ID 000224780800034
View details for PubMedID 15514241
View details for PubMedCentralID PMC1448573
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Outcomes of substance use disorder treatment in suicidal and nonsuicidal male patients
JOURNAL OF STUDIES ON ALCOHOL
2004; 65 (5): 643-650
Abstract
Numerous studies report high rates of substance-related problems and psychopathology in substance use disorder (SUD) patients with a history of a suicide attempt. However, little is known about the response of suicidal SUD patients to treatment. This study examined the treatment outcomes of suicidal and nonsuicidal SUD patients who were followed for 5 years.A total of 2099 male SUD patients were recruited from 15 Department of Veterans Affairs residential alcohol and drug treatment programs and were assessed at four points (treatment entry, discharge, and 1 and 5 years later). Approximately 7% (n = 156) of the patients reported a suicide attempt in the 3 months prior to the start of treatment.Although patients with a recent suicide attempt reported severe patterns of alcohol use and elevated psychiatric symptoms at baseline, they showed significant improvements in both of these domains at discharge from residential treatment, and these improvements were still evident at 1-year and 5-year follow-ups. Suicidal SUD patients were no more likely to leave treatment early than were nonsuicidal patients, and they received slightly longer and more individualized treatment.Despite a more severe pattern of alcohol use and psychiatric symptoms at baseline, suicidal SUD patients benefitted substantially from residential SUD treatment. These findings imply that suicidal SUD patients can be treated effectively within SUD treatment settings.
View details for Web of Science ID 000224590700012
View details for PubMedID 15536775
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The interplay between help-seeking and alcohol-related outcomes: divergent processes for professional treatment and self-help groups
DRUG AND ALCOHOL DEPENDENCE
2004; 75 (2): 155-164
Abstract
This study examined the influence of self-selection, as reflected in alcohol-related functioning, on the duration of professional treatment and Alcoholics Anonymous (AA), and the influence of social causation, as reflected in the duration of treatment and AA, on alcohol-related outcomes. A sample of alcoholic individuals was surveyed at baseline and 1, 3, and 8 years later. At each point, participants completed an inventory that assessed participation in treatment and AA since the last assessment and alcohol-related functioning. There were divergent processes of self-selection and social causation with respect to the duration of participation in professional treatment and AA. Individuals with more severe alcohol-related problems obtained longer episodes of professional treatment, but this self-selection process was much less evident for AA. Longer participation in professional treatment in the first year predicted better alcohol-related outcomes; however, the duration of subsequent treatment was not associated with better subsequent outcomes. In contrast, longer participation in AA consistently predicted better subsequent alcohol-related outcomes. These findings are consistent with a need-based model of professional treatment, in which more treatment is selected by and allocated to individuals with more severe problems, and an egalitarian model of self-help, in which need factors play little or no role in continued participation.
View details for DOI 10.1016/j.drugalcdep.2004.01.016
View details for Web of Science ID 000223312800005
View details for PubMedID 15276221
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Depression and 24-hour urinary cortisol in medical outpatients with coronary heart disease: The heart and soul study
BIOLOGICAL PSYCHIATRY
2004; 56 (4): 241–47
Abstract
In patients with coronary heart disease (CHD), depression leads to worse cardiovascular outcomes. Depression has been associated with increased cortisol in medically healthy patients, suggesting that cortisol may act as a mediator in the pathway between depression and cardiovascular events. However, it is not known whether depression is associated with elevated cortisol levels in patients with CHD.We examined the association between depression (assessed by the Computerized Diagnostic Interview Schedule) and 24-hour urinary cortisol in 693 medical outpatients with known CHD.Of 693 participants, 138 (20%) had current depression. Depressed participants had greater mean cortisol levels than those without depression (42 +/- 25 vs. 36 +/- 20 microg/day, p <.01). With each increasing quartile of cortisol concentration the frequency of depression increased (p <.01). Participants in the highest quartile of cortisol had a twofold increased odds of having depression, compared with those in the lowest quartile (odds ratio [OR] 2.1, 95% confidence interval [CR] 1.2-3.6, p =.01). This association remained strong after adjusting for potential confounding variables (OR 2.4, 95% CI 1.3-4.4, p <.01). In this cross-sectional analysis, elevated cortisol was not associated with worse cardiac function.In patients with CHD,depression is associated with elevated cortisol levels.
View details for DOI 10.1016/j.biophysch.2004.06.003
View details for Web of Science ID 000223327300005
View details for PubMedID 15312811
View details for PubMedCentralID PMC2776670
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Posttraumatic stress disorder, anger and hostility, and physical health status
JOURNAL OF NERVOUS AND MENTAL DISEASE
2004; 192 (8): 563-566
Abstract
Accumulating evidence suggests that posttraumatic stress disorder (PTSD) is linked to both objective and subjective indices of poorer health. Less is known about processes that may explain this association. This study examined anger/hostility as a possible mediator and moderator of PTSD and health status among a sample of 134 medical patients. Participants completed a structured interview of PTSD and questionnaires assessing health perceptions and anger and data on physician-diagnosed illnesses were gathered from computerized databases. Trait anger and anger-in partially explained the association between PTSD and poorer general health perceptions. There was a significant association between anger-in and the presence of a circulatory disorder only in patients with PTSD.
View details for DOI 10.1097/01.nmd.0000135650.71761.0b
View details for Web of Science ID 000223277800007
View details for PubMedID 15387159
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Ten-year patterns of alcohol consumption and drinking problems among older women and men
ADDICTION
2004; 99 (7): 829-838
Abstract
This study focused on changes in 10-year patterns of alcohol consumption among older women and men, late-life and life history predictors of drinking problems, and gender differences in these predictors.A sample of late-middle-aged community residents (N = 1291) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 1 year, 4 years and 10 years later.At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems and health-related and life context factors. Participants also provided information about their life history of drinking.Over the 10 years, the proportion of individuals who consumed alcohol declined. Among individuals who continued to drink, women and men showed comparable declines in alcohol consumption, minor concomitants of alcohol consumption and drinking problems. In addition to the amount of alcohol consumption, smoking, friends' approval of drinking and avoidance coping consistently predicted late-life drinking problems. With respect to life history factors, heavy drinking, drinking problems and increased drinking in response to life events were related to a higher likelihood of late-life drinking problems; obtaining help from family members and friends and, among men, participation in Alcoholics Anonymous, were related to a lower likelihood of problems.Older women and men show comparable declines in alcohol consumption and drinking problems. Specific late-life social context and coping variables, and life history indices, are risk factors for late-life drinking problems among both women and men.
View details for DOI 10.1111/j.1360-0443.2004.00760.x
View details for Web of Science ID 000222414300005
View details for PubMedID 15200578
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Protection from etymologic infection
ADDICTION
2004; 99 (7): 923–24
View details for DOI 10.1111/j.1360-0443.2004.00787.x
View details for Web of Science ID 000222414300016
View details for PubMedID 15200589
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VA practice patterns and practice guidelines for treating posttraumatic stress disorder
JOURNAL OF TRAUMATIC STRESS
2004; 17 (3): 213-222
Abstract
Little is known about how recent ISTSS practice guidelines (E. B. Foa, T. M. Keane, & M. J. Friedman, 2000) compare with prevailing PTSD treatment practices for veterans. Prior to guideline dissemination, clinicians in 6 VA medical centers were surveyed in 1999 (n = 321) and in 2001 (n = 271) regarding their use of various assessment and treatment procedures. Practices most consistent with guideline recommendations included psychoeducation, coping skills training, attention to trust issues, depression and substance use screening, and prescribing of SSRIs, anticonvulsants, and trazodone. PTSD and trauma assessment, anger management, and sleep hygiene practices were provided less consistently. Exposure therapy was rarely used. Additional research is needed on training, clinical resources, and organizational factors that may influence VA implementation of guideline recommendations.
View details for Web of Science ID 000221686900004
View details for PubMedID 15253093
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The consequences of non-remitted depression on health care utilization and productivity: A 23-year follow-up
24th CINP Congress
CAMBRIDGE UNIV PRESS. 2004: S338–S338
View details for Web of Science ID 000224663002063
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The long-term burden of depression: Personal and social resources and health outcomes
24th CINP Congress
CAMBRIDGE UNIV PRESS. 2004: S170–S170
View details for Web of Science ID 000224663001045
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Stress generation in depressed patients and community controls
JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY
2004; 23 (3): 390-412
View details for Web of Science ID 000222272900008
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Help-seeking careers: Connections between participation in professional treatment and Alcoholics Anonymous
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2004; 26 (3): 167-173
Abstract
This study examined the relationships between participation in professional treatment and Alcoholics Anonymous (AA) among 473 initially untreated individuals with alcohol use disorders. These individuals were assessed at baseline and at 1-year, 3-year, and 8-year followups. There were moderate positive concurrent associations between the duration of participation in professional treatment and in AA. More important, a longer duration of treatment in year 1 was associated with more sustained participation in AA in years 2 and 3, which was associated with less time in treatment in years 4 through 8. The strength of these findings varied somewhat in relation to whether individuals chose to enter treatment or AA first. The findings suggest that referral and alliance processes contribute to a positive association between the duration of an initial episode of treatment and subsequent AA, and then extended participation in AA contributes to better alcohol-related outcomes and reduced need for subsequent treatment.
View details for DOI 10.1016/S0740-5472(03)00190-9
View details for Web of Science ID 000220939400006
View details for PubMedID 15063909
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Unipolar depression, life context vulnerabilities, and drinking to cope
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2004; 72 (2): 269-275
Abstract
This study followed baseline samples of 424 unipolar depressed patients and 424 community controls across 10 years to investigate the association between depression and alcohol-related coping and to examine how life context vulnerabilities underlie the risk for depressed individuals to rely on drinking to cope. Findings supported all hypotheses. Depressed patients engaged in more drinking to cope than did community controls. Within individuals, more negative life events and less family support were associated with more drinking to cope across the 4 observations. Depressed patients experienced more negative life events and less family support than did community controls. These underlying life context vulnerabilities explained the relationship between depressed patient status and drinking to cope.
View details for DOI 10.1037/0022-006X.72.2.269
View details for Web of Science ID 000220442400011
View details for PubMedID 15065960
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Long-term influence of duration and frequency of participation in Alcoholics Anonymous on individuals with alcohol use disorders
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2004; 72 (1): 81-90
Abstract
This study examined the influence of the duration and frequency of a baseline episode of participation in Alcoholics Anonymous (AA) among 473 individuals with alcohol use disorders on 1-year and 8-year outcomes and the effect of additional participation and delayed participation on outcomes. Compared with individuals who did not participate, individuals who affiliated with AA relatively quickly, and who participated longer, had better 1-year and 8-year alcohol-related outcomes. Individuals who continued to participate, and those who continued longer, had better alcohol-related outcomes than did individuals who discontinued participation, but individuals who delayed participation in AA had no better outcomes than those who never participated. In general, the frequency of participation was independently associated only with a higher likelihood of abstinence.
View details for DOI 10.1037/0022.006X.72.1.81
View details for Web of Science ID 000188534900008
View details for PubMedID 14756617
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Posttraumatic stress disorder and health status among female and male medical patients
JOURNAL OF TRAUMATIC STRESS
2004; 17 (1): 1-9
Abstract
Posttraumatic stress disorder (PTSD) is associated with objective health problems in specific populations, such as Vietnam veterans. Less is known about PTSD and health among medical samples, especially PTSD patients with different etiologic traumas. This study examined PTSD and health in medical patients within the Department of Veterans Affairs healthcare system. A total of 134 patients completed an interview and questionnaires. Data on physician-diagnosed illnesses were gathered from medical records. PTSD diagnosis and symptoms were associated with a higher likelihood of circulatory and musculoskeletal disorders. In addition, PTSD symptoms were associated with more medical conditions. PTSD symptoms and diagnoses were also associated with poorer health related quality of life. Most of these findings remained significant after controlling for comorbid depressive, generalized anxiety disorder, and panic attack symptoms. Overall, gender did not moderate the relationship between PTSD and poorer health.
View details for Web of Science ID 000188745900001
View details for PubMedID 15027787
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Dispositional and contextual perspectives on coping: Toward an integrative framework
JOURNAL OF CLINICAL PSYCHOLOGY
2003; 59 (12): 1387-1403
Abstract
The clinical disciplines have witnessed a rapidly growing literature on the conceptualization and measurement of coping and on the role of coping in confronting stressful life circumstances and maintaining adaptive functioning. This literature has spawned a diversity of concepts and contrasting perspectives on the determinants and effects of coping. To address this complexity, we comment on dispositional and contextual perspectives on the coping process, describe the domains of coping styles and coping skills, and review some measures of these constructs. Next, we present a conceptual framework that integrates key aspects of these constructs and use the framework to guide a selective review of the linkages between personal and social resources, coping skills, and adaptive functioning. We then consider applications of the framework to clinical practice.
View details for DOI 10.1002/jclp.10229
View details for Web of Science ID 000186685700012
View details for PubMedID 14618606
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Dispositional and contextual perspectives on coping: Introduction to the special issue
JOURNAL OF CLINICAL PSYCHOLOGY
2003; 59 (12): 1257-1259
View details for DOI 10.1002/jclp.10218
View details for Web of Science ID 000186685700001
View details for PubMedID 14618595
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Coping, treatment planning, and treatment outcome: Discussion
JOURNAL OF CLINICAL PSYCHOLOGY
2003; 59 (10): 1151-1167
Abstract
The articles presented in this issue are discussed within the context of the general literature on coping and coping style. The focus of this special issue was to determine if these articles are both consistent with extant research and advance the field. We identify at least two general definitions of coping, as used in these articles. We refer to one definition as reflecting one's "coping style." This is largely a descriptive concept and closely related to one's enduring behavioral traits. It is closely related to other personality characteristics such as introversion-extroversion, stability, etc. The other definition of "coping" in the literature is much more specific to stressful environments and to the changes noted in one's behavior and cognitions during times of stress, than the first definition. We refer to this broad stress response as one's "coping response." Coping response, unlike coping style, includes both a cognitive and an affective component. We conclude that it may be advantageous to differentiate between these two broad definitions in future research. We also conclude that the articles in this issue provide information that advances the field's understanding of coping styles and coping responses.
View details for DOI 10.1002/jclp.10216
View details for Web of Science ID 000185526000012
View details for PubMedID 12968279
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Coping and coping styles in personality and treatment planning: Introduction to the special series
JOURNAL OF CLINICAL PSYCHOLOGY
2003; 59 (10): 1045–47
Abstract
Coping is a complex process. It is variously described as a situational and as a trait-like response, as a response to stress and as a disposition to respond to change. In this article, we review the current research on coping within the context of considering the contributions of the articles presented in this series. We present two broad views of coping, the more general one under the title of "coping response" defines coping as containing emotional, behavioral, and cognitive qualitites. It is generally considered to be a stress-specific pattern by which an individual's perceptions, emotions, and behaviors prepare for adapting and changing. The more narrow view of coping is described here as "coping style" and represents a more observable but general style of interacting. In this usage, coping is a trait-like variable that is activated when an environment changes in some way. It resembles other personality qualities and describes dispositions to respond in certain ways. In this article, we consider the implications and extant knowledge about coping within these two definitions, with special consideration to the prediction of treatment processes and outcomes. The articles in this series are discussed both in terms of extant research on these two views of coping and in terms of their contributions to the available literature on coping and coping responses.
View details for DOI 10.1002/jclp.10196
View details for Web of Science ID 000185526000001
View details for PubMedID 12968268
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Risk factors for nonremission among initially untreated individuals with alcohol use disorders
JOURNAL OF STUDIES ON ALCOHOL
2003; 64 (4): 555-563
Abstract
This study identified risk factors for 1-year and 8-year nonremission among initially untreated individuals with alcohol use disorders and examined whether a longer duration of professional treatment or Alcoholics Anonymous (AA) increased the likelihood of remission, moderated the influence of risk factors on remission status and reduced modifiable risk factors.A sample of individuals with alcohol use disorders (N = 473) was recruited at alcoholism information and referral centers and detoxification units and was surveyed at baseline and 1 year, 3 years and 8 years later. At each contact, participants completed an inventory that assessed their alcohol-related problems and personal characteristics and their participation in treatment and AA since the last assessment.An 11-item baseline risk index was associated with 1-year nonremission. Longer duration of treatment and AA in the first year predicted remission and a decline in modifiable risk factors. In addition, longer duration of AA increased the likelihood of remission more among high-risk than among low-risk individuals. The risk factors at 1 year were associated with 8-year nonremission; longer duration of additional treatment or AA was associated with a higher likelihood of 8-year remission and further reductions in modifiable risk factors.Referral counselors and treatment providers can identify high-risk individuals early in their help-seeking career and intervene to reduce the likelihood of a chronic course of their alcohol use disorder.
View details for Web of Science ID 000184411400014
View details for PubMedID 12921198
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Models of standard and intensive outpatient care in substance abuse and psychiatric treatment
ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH
2003; 30 (5): 417-436
Abstract
Intensive outpatient mental health programs are proliferating rapidly. However, findings suggest that intensive treatment may be no more effective than standard treatment. This study compared standard to intensive outpatient programs, within both the psychiatric and substance abuse systems of care, on organization, staffing, and treatment orientation; clinical management practices; and services. A total of 723 (95% of those eligible) Department of Veterans Affairs programs were surveyed nationwide. Psychiatric intensive programs have responded appropriately to their more severely ill patients in terms of the amount and orientation of care, and having a rehabilitation focus. However, the relative lack of basic psychiatric services in psychiatric intensive programs, and the overall similarity of substance abuse standard and intensive programs, may explain why intensive programs have not yielded patient outcomes that are superior to those of standard programs. Mental health system planners should consider differentiating intensive programs using broader criteria and methods.
View details for Web of Science ID 000184800500003
View details for PubMedID 12940684
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A ten-year follow-up of older former problem drinkers: Risk of relapse and implications of successfully sustained remission
JOURNAL OF STUDIES ON ALCOHOL
2003; 64 (3): 367-374
Abstract
This study examines the risk, predictors of relapse and the effects of successfully sustained remission on the drinking behavior, functioning, life context, coping and help seeking of older adults who were problem drinkers earlier in life.Older former problem drinkers (n = 447) were prospectively followed for 10 years and compared to lifetime nonproblem drinkers.Of former problem drinkers, 31% (n = 141) died over the 10-year interval, a rate 1.6 times higher than that of lifetime nonproblem drinkers. Among surviving former problem drinkers, although relapse was relatively uncommon (11%), a less severe drinking history, heavier baseline alcohol consumption, and lower baseline income were associated with relapse. The majority (63%) of former problem drinkers who successfully achieved sustained remission continued to drink alcohol, though at levels below those consumed by older lifetime nonproblem drinkers (n = 339). Stably remitted problem drinkers who were abstinent (SRAs) generally reported more severe drinking histories, greater functioning and life context deficits and more help seeking than did stably remitted problem drinkers who were nonabstinent (SRNs). Although SRAs and SRNs both experienced improvements in functioning over the 10-year interval, they continued to experience financial, health-related and life context deficits relative to older lifetime nonproblem drinkers.Results suggest there are long-term costs associated with earlier drinking problems, even when remission is maintained. Both current drinking behavior and drinking history are worth considering when making recommendations regarding older adults' alcohol consumption.
View details for Web of Science ID 000183221500008
View details for PubMedID 12817825
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Dropout from 12-step self-help groups: Prevalence, predictors, and counteracting treatment influences
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2003; 24 (3): 241-250
Abstract
Attendance at 12-step self-help groups is frequently recommended as an adjunct to professional substance use disorder (SUD) treatment, yet patient dropout from these groups is common. This study assessed the prevalence, predictors, and treatment-related factors affecting dropout in the first year following treatment for 2,778 male patients. Of these, 91% (2,518) were identified as having attended 12-step groups either in the 90 days prior to, or during, treatment. At 1-year followup 40% had dropped out. A number of baseline factors predicted dropout. Importantly, patients who initiated 12-step behaviors during treatment were less likely to drop out. Further findings suggest patients at highest risk for dropout may be at lower risk if treated in a more supportive environment. Clinicians may decrease the likelihood of dropout directly, by screening for risk factors and focusing facilitation efforts accordingly, and indirectly, by increasing the supportiveness of the treatment environment, and facilitating 12-step involvement during treatment.
View details for DOI 10.1016/S0740-5472(03)00021-7
View details for Web of Science ID 000183659600008
View details for PubMedID 12810145
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PTSD treatment and 5-year remission among patients with substance use and posttraumatic stress disorders
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2003; 71 (2): 410-414
Abstract
Given the high prevalence of comorbid substance use and posttraumatic stress disorders (SUD-PTSD), how to best treat these patients is a pressing concern for SUD providers. PTSD treatment may play an important role in patients' recovery. One hundred male SUD-PTSD patients who attended SUD treatment completed 1-. 2-, and 5-year follow-ups. Outpatient treatment information was gathered from Veterans Affairs databases. PTSD treatment and 12-Step group attendance in the 1st year predicted 5-year SUD remission. Patients who received PTSD treatment in the first 3 months following discharge and those who received treatment for a longer duration in Year 1 were more likely to be remitted in Year 5. The receipt of PTSD-focused treatment immediately after SUD treatment may enhance long-term remission.
View details for DOI 10.1037/0022-006X.71.2.410
View details for Web of Science ID 000181602000021
View details for PubMedID 12699036
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Trends in acute mental health care: Comparing psychiatric and substance abuse treatment programs
JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH
2003; 30 (2): 145-160
Abstract
This study compared psychiatric and substance abuse acute care programs, within both inpatient and residential modalities of care, on organization and staffing, clinical management practices and policies, and services and activities. A total of 412 (95% of those eligible) Department of Veterans Affairs' programs were surveyed nationwide. Some 40% to 50% of patients in psychiatric and substance abuse programs, in both inpatient and residential venues of care, had dual diagnoses. Even though psychiatric programs had a sicker patient population, they provided fewer services, including basic components of integrated programs, than substance abuse programs did. Findings also showed that there is a strong emphasis on the use of clinical practice guidelines, performance monitoring, and obtaining client satisfaction and outcome data in mental health programs. The author's suggest how psychiatric programs might better meet the needs of acutely ill and dually diagnosed patients (e.g., by incorporating former patients as role models and mutual help groups, as substance abuse programs do; and by having policies that balance patient choice with program demand).
View details for Web of Science ID 000186480400001
View details for PubMedID 12710369
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Major depression in patients with substance use disorders: relationship to 12-Step self-help involvement and substance use outcomes
ADDICTION
2003; 98 (4): 499-508
Abstract
Many patients treated for substance use disorders (SUDs) who become involved in 12-Step self-help groups have improved treatment outcomes. However, due to high rates of psychiatric comorbidity and major depressive disorder (MDD), among SUD patients in particular, concerns have been raised over whether these benefits extend to dual diagnosis patients. This study examined the influence of comorbid MDD among patients with SUDs on 12-Step self-help group involvement and its relation to treatment outcome.A quasi-experimental, prospective, intact group design was used with assessments completed during treatment, and 1 and 2 years postdischarge.A total of 2161 male patients recruited during in-patient SUD treatment, of whom 110 had a comorbid MDD diagnosis (SUD-MDD) and 2051 were without psychiatric comorbidity (SUD-only).SUD-MDD patients were initially less socially involved in and derived progressively less benefit from 12-Step groups over time compared to the SUD-only group. However, substance use outcomes did not differ by diagnostic cohort. In contrast, despite using substantially more professional out-patient services, the SUD-MDD cohort continued to suffer significant levels of depression.Treatment providers should allocate more resources to targeting depressive symptoms in SUD-MDD patients. Furthermore, SUD-MDD patients may not assimilate as readily into, nor benefit as much from, traditional 12-Step self-help groups such as Alcoholics Anonymous, as psychiatrically non-comorbid patients. Newer, dual-diagnosis-specific, self-help groups may be a better fit for these patients, but await further study.
View details for Web of Science ID 000182031800013
View details for PubMedID 12653819
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Addictive disorders in context: Principles and puzzles of effective treatment and recovery
110th Annual Convention of the American-Psychological-Association
EDUCATIONAL PUBLISHING FOUNDATION. 2003: 3–12
Abstract
To consider key issues in understanding effective treatment and recovery, the author reviews selected principles and unresolved puzzles about the context of addictive disorders and the structure, process, and outcome of treatment. The principles focus on the process of problem resolution, the duration and continuity of care, treatment provided by specialist versus nonspecialist providers, alliance and the goals and structure of treatment, characteristics of effective interventions, and the outcome of treatment versus remaining untreated. The unresolved puzzles involve how to concepualize service episodes and treatment careers, connections between the theory and process of treatment effective patient-treatment matching strategies, integration of treatment and self-help, and the development of unified models to encompass life context factors and treatment within a common framework.
View details for DOI 10.1037/0893-164X.17.1.3
View details for Web of Science ID 000181590300001
View details for PubMedID 12665076
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Treatment and outcomes of older patients with alcohol use disorders in community residential programs
JOURNAL OF STUDIES ON ALCOHOL
2003; 64 (2): 219-226
Abstract
To determine whether older patients with alcohol use disorders receive equitable treatment in community residential facilities.Older male veterans with alcohol use disorders who were treated in 63 community residential facilities (CRFs) were matched with young and middle-aged male veterans in these programs (n = 190 in each age group) on demographic variables and dual-diagnosis status. Patients were assessed at program intake and were followed 1 year and 4 years after treatment entry. Program staff provided information on use of services and on program characteristics.Although they had similar alcohol consumption and dependence symptoms at treatment entry, older patients experienced fewer alcohol-related problems and had fewer symptoms of psychological distress than did young and middle-aged patients. Controlling for initial differences, older patients did at least as well as young and middle-aged patients at both follow-ups. Older, middle-aged and young patients had equivalent treatment involvement in the CRF, participation in continuing outpatient care and involvement in self-help groups. Similar factors predicted better outcomes for older and younger patients, including a longer stay in the CRF, more counseling, involvement in supportive relationships with other residents, continuing outpatient substance abuse care and participation in self-help groups following residential treatment. Both older and younger patients showed similar benefits across varied treatment orientations.Older patients fare at least as well as younger patients in these age-integrated, community-based programs, and they respond in similar ways to treatment experiences and program factors.
View details for Web of Science ID 000182065000009
View details for PubMedID 12713195
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Older and younger patients with substance use disorders: Outpatient mental health service use and functioning over a 12-month interval
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
2003; 17 (1): 42-48
Abstract
This observational study compared a nationwide sample of older patients with substance use disorders (n = 3,598; age > 55) with a demographically and diagnostically matched sample of younger patients on initial functioning, subsequent outpatient mental health service use, and 12-month follow-up outcomes. Older patents were initially functioning a well as or better than younger patients according to substance use, psychiatric, family, and legal criteria. The groups received comparable amounts of outpatient mental health care. At a 12-month follow-up, older patients generally had better substance use and functioning outcomes than did younger patients. The findings suggest that older patients with substance use disorders are keeping pace with demographically and diagnostically comparable younger patients in obtaining specialized outpatient mental health services and that they have positive treatment prognoses.
View details for DOI 10.1037/0893-164X.17.1.42
View details for Web of Science ID 000181590300005
View details for PubMedID 12665080
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Social contexts: Transcending their power and their fragility
110th Annual Convention of the American-Psychological-Association
SPRINGER/PLENUM PUBLISHERS. 2003: 1–13
Abstract
For more than four decades, my colleagues and I have examined how social contexts and individuals influence each other. To provide a perspective on this work, I describe some lessons we have learned: situational influence exemplifies both the power and fragility of social contexts; common aspects of settings underlie their power, for better and for worse; individuals' health and well-being is affected by powerful forces in eight domains; and intervention programs are powerful settings that encompass risks as well as rewards. I then note some unresolved questions, such as how to balance the risks and rewards of powerful environments, how to better understand the interplay between individuals and the social contexts they select and create, how to learn from the fact that many people overcome the power of traumatic social contexts, and how to apply our knowledge to balance the risks and rewards of individual and community contexts.
View details for Web of Science ID 000181917200001
View details for PubMedID 12741686
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Long-term influence of duration and intensity of treatment on previously untreated individuals with alcohol use disorders
ADDICTION
2003; 98 (3): 325-337
Abstract
This study examined the influence of the duration and intensity of the first episode of treatment for previously untreated individuals with alcohol use disorders on short-term and long-term outcomes, and the effect of additional treatment and delayed treatment on outcomes.A sample of alcoholic individuals (n = 473) was recruited at alcoholism information and referral centers and detoxification units and was surveyed at baseline and 1 year, 3 years and 8 years later.At each contact point, participants completed an inventory that assessed their treatment utilization since the last assessment and their current alcohol-related, psychological and social problems.Compared with individuals who remained untreated, individuals who entered treatment relatively quickly and who obtained a longer duration of treatment had better short- and long-term alcohol-related outcomes and better short-term social functioning. Individuals who obtained a longer duration of additional treatment had better alcohol-related outcomes than individuals who obtained no additional treatment but, among individuals who delayed treatment entry, the duration of treatment was not associated with treatment outcomes. In general, the intensity of treatment was not related to better outcomes.Rapid entry into treatment and the duration of treatment for alcohol use disorders may be more important than the intensity of treatment. Treatment providers should consider structuring their programs to emphasize continuity, rather than intensity of care.
View details for Web of Science ID 000181291700011
View details for PubMedID 12603232
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Drinking to cope and alcohol use and abuse in unipolar depression: A 10-year model
JOURNAL OF ABNORMAL PSYCHOLOGY
2003; 112 (1): 159-165
Abstract
This study examined drinking to cope with distress and drinking behavior in a baseline sample of 412 unipolar depressed patients assessed 4 times over a 10-year period. Baseline drinking to cope operated prospectively as a risk factor for more alcohol consumption at 1-, 4-, and 10-year follow-ups and for more drinking problems at 1- and 4-year follow-ups. Findings elucidate a key mechanism in this process by showing that drinking to cope strengthened the link between depressive symptoms and drinking behavior. Individuals who had a stronger propensity to drink to cope at baseline showed a stronger connection between depressive symptoms and both alcohol consumption and drinking problems.
View details for DOI 10.1037/0021-843X.112.1.159
View details for Web of Science ID 000181290700016
View details for PubMedID 12653424
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Outcomes at 1 and 5 years for older patients with alcohol use disorders
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2003; 24 (1): 43-50
Abstract
Older patients with alcohol use disorders who had gone through residential treatment were compared with matched groups of young and middle-aged patients (N = 432 in each age group) on their 1- and 5-year outcomes, use of continuing care services, and outcome predictors. Older patients had better outcomes than did young and middle-aged patients but had comparable levels of continuing substance abuse care and 12-step self-help group involvement. Similar factors predicted outcomes across the age groups. Longer duration of continuing substance abuse care and greater self-help group involvement were related to better outcomes, as were patients' attitudes and coping strategies at program discharge. The findings indicate that older patients with alcohol use disorders respond to age-integrated substance abuse treatment programs at least as well as do younger patients and are equally involved in formal and informal continuing substance abuse care.
View details for Web of Science ID 000181924400005
View details for PubMedID 12646329
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Physical and sexual abuse history and addiction treatment outcomes
JOURNAL OF STUDIES ON ALCOHOL
2002; 63 (6): 683-687
Abstract
Prior research on patients with substance use disorders has shown that lifetime physical or sexual abuse is associated with more impaired functioning at treatment intake. The present study sought to determine whether physical or sexual abuse also predicted treatment response (posttreatment outcomes) of individuals with substance use disorders.Male (n = 19,989) and female (n = 622) veterans with substance use disorders were assessed with the Addiction Severity Index (ASI) early in treatment and reassessed an average of 12 months later. Treatment outcomes were compared for patients who did and did not report prior physical or sexual abuse in the initial ASI interview.Lifetime physical or sexual abuse predicted worse outcomes in six of seven domains of functioning, after controlling for baseline functioning, psychiatric diagnoses and demographic variables. Although women were more likely than men to report being abused, the effect of abuse on treatment outcomes was similar for both genders. Psychiatric problems at baseline mediated the effect of abuse history on outcomes. Abuse history moderated the effect of treatment intensity (contacts per month) on outcomes: More frequent treatment contacts were more beneficial for abused patients than for nonabused patients.Individuals with substance use disorders who have a history of physical or sexual abuse may have higher risk for problematic treatment outcomes as a result of greater psychiatric problems, deficits in social support and possible difficulties in establishing treatment alliance. Clinicians may consider increasing the duration and intensity of treatment to temper the negative effects of abuse on later functioning.
View details for Web of Science ID 000180155700006
View details for PubMedID 12529068
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Psychiatric comorbidity, continuing care and mutual help as predictors of five-year remission from substance use disorders
JOURNAL OF STUDIES ON ALCOHOL
2002; 63 (6): 709-715
Abstract
In a cohort of 2,595 male patients in VA intensive treatment programs for substance use disorders (SUD), we tested whether psychiatric comorbidity, outpatient care and mutual help group attendance during the first two follow-up years predicted remission status at Year 5, controlling for covariates.Logistic regression modeling of longitudinal data was used to test the hypotheses.Dual diagnosis patients were less likely to be in remission at Year 5 than SUD-only patients. Outpatient care was at best only weakly related to Year 5 remission status. By contrast, mutual help involvement substantially improved the chances of substance use remission at Year 5 for both SUD-only and dual diagnosis patients. Mutual help involvement did not, however, offset the poorer prognosis for dual diagnosis patients.Because mutual help groups specifically targeted to individuals with comorbid substance use and psychiatric disorders are currently rare, further research is recommended to investigate whether they are more effective than standard SUD mutual help groups in facilitating the recovery of persons with dual diagnoses.
View details for Web of Science ID 000180155700009
View details for PubMedID 12529071
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Symptom severity, amount of treatment, and 1-year outcomes among dual diagnosis patients
ADMINISTRATION AND POLICY IN MENTAL HEALTH
2002; 30 (1): 35-54
Abstract
This study reports on associations among symptom severity, amount of treatment, and 1-year outcomes in a national sample of 8,622 dual diagnosis patients, who were classified at treatment entry into low-, moderate-, and high-severity groups. Patients with more severe symptoms at intake had poorer 1-year outcomes. Higher severity patients did not receive adequate "doses" of care: Compared with low-severity patients, they had a shorter duration of care, although a longer duration was associated with improved outcomes; they also were less likely to receive outpatient substance abuse treatment, although more intensive treatment was associated with better drug outcomes. High-severity patients improved more on drug and legal outcomes, but less on psychiatric and family/social outcomes, than low-severity patients did when treatment was of longer duration or higher intensity. Dual diagnosis patients with highly severe symptoms would likely benefit from a longer episode of care that includes substance abuse and psychiatric outpatient treatment.
View details for Web of Science ID 000180050500003
View details for PubMedID 12546255
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Gender differences in help-utilization and the 8-year course of alcohol abuse
ADDICTION
2002; 97 (7): 877-889
Abstract
The aim of this study was to compare initially untreated women and men problem drinkers on help-utilization and outcomes over 8 years.At the time of the 8-year follow-up, individuals (N=466, 49% female) had self-selected into four groups: no help, Alcoholics Anonymous (AA) only, formal treatment only or formal treatment plus AA.At baseline and 1, 3 and 8 years later, participants completed measures of drinking and functioning.Women were generally worse off than men on baseline drinking and functioning indices. In keeping with their poorer baseline status, women were more likely to participate in AA, and had longer in-patient stays during the next year. When women's baseline status was controlled, women had better outcomes than did men at 1 and 8 years. Generally, women and men did not differ on the extent to which obtaining help, or a particular type of help, was related to improved outcomes. Regarding drinking outcomes, women benefited more than did men from more AA attendance during years 2-8 of follow-up.The results suggest that although alcoholism interventions were designed primarily for men, they are currently delivered in ways that are also useful to women. Problem-drinking women appear to benefit from sustained participation in AA, which emphasizes bonding with supportive peers to maintain abstinence.
View details for Web of Science ID 000176684600017
View details for PubMedID 12133127
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Long-term use of VA mental health services by older patients with substance use disorders
PSYCHIATRIC SERVICES
2002; 53 (7): 836-841
Abstract
The authors studied long-term patterns and predictors of use of mental health services by older surviving patients with substance use disorders in the Veterans Affairs (VA) health care system.In this prospective longitudinal study, patient treatment records were used to determine long-term (ten-year) patterns and predictors of use of VA mental health services in a nationwide cohort of 10,678 surviving patients with a substance use disorder who were 55 years of age or older. The patients were categorized into three groups based on diagnosis during the index episode: patients with alcohol or drug abuse or dependence, patients with alcohol or drug psychosis, and patients with both a substance use and a psychiatric disorder. Most of the patients had alcohol use disorders.Over the ten-year period, successively fewer patients obtained outpatient and inpatient mental health care. Among patients who did obtain such care, the intensity of service use increased. Medical care did not substitute for mental health treatment. Younger age, being unmarried, and having a more severe disorder were associated with a greater likelihood of mental health service use over the ten-year period. Patients with a dual diagnosis were significantly more likely to obtain outpatient mental health care. Treatment on a residential care unit and longer initial hospital stay were associated with a lower rate of mental health readmissions.Of the substantial number of patients with substance use disorders who survive into old age, those with more long-standing substance use problems and with dual diagnoses have the greatest need for long-term mental health treatment.
View details for Web of Science ID 000176610600010
View details for PubMedID 12096166
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Global assessment of functioning ratings and the allocation and outcomes of mental health services
PSYCHIATRIC SERVICES
2002; 53 (6): 730-737
Abstract
The Global Assessment of Functioning (GAF) is an integral part of the standard multiaxial psychiatric diagnostic system. The purpose of including the GAF in DSM-IV as a tool for axis V assessment is to enable clinicians to obtain information about global functioning to supplement existing data about symptoms and diagnoses and to help predict the allocation and outcomes of mental health treatment. The purpose of this study was to examine the value of the GAF as part of a systemwide program for monitoring the allocation and outcomes of mental health care services.Clinicians used the GAF to assess global functioning among 9,854 patients with psychiatric or substance use disorders, or both, who were already participating in an outcomes monitoring program of the Department of Veterans Affairs. A longitudinal prospective follow-up design was used.Patients' clinical diagnoses and symptoms were stronger predictors of GAF ratings than was their social or occupational functioning. GAF-rated impairment was associated with the provision of inpatient or residential care and outpatient psychiatric care, but patients with greater levels of impairment did not receive more treatment. GAF ratings were only minimally associated with treatment outcomes. No robust associations were found between GAF ratings and outcomes as assessed by clinician interview or by patients' self-report at follow-up.Including GAF ratings in a program for predicting the allocation and outcomes of mental health care is of questionable value. Research is needed to determine whether systematic training and ongoing validity checks would enhance the contribution of the GAF in monitoring service use and outcomes.
View details for Web of Science ID 000175927100013
View details for PubMedID 12045311
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Relationship of treatment orientation and continuing care to remission among substance abuse patients
PSYCHIATRIC SERVICES
2002; 53 (5): 595-601
Abstract
The authors examined whether continuing outpatient mental health care, the orientation of the treatment program (12-step, cognitive-behavioral, or eclectic), and involvement in self-help groups were linked to substance abuse patients' remission status two years after discharge.The data were from a cohort of 2,805 male patients who were treated through one of 15 Department of Veterans Affairs substance abuse programs. Remission was defined as abstinence from illicit drug use and abstinence from or nonproblem use of alcohol during the previous three months. The relationships of the three variables to remission were tested with regression models that controlled for baseline characteristics.About a quarter of the study participants (28 percent) were in remission two years after discharge. Intake characteristics that predicted remission at two years included less severe substance use and psychiatric problems, lower expected disadvantages and costs of discontinuing substance use, and having abstinence as a treatment goal. No significant relationship emerged between treatment orientation and remission status two years later. Involvement in outpatient mental health care during the first follow-up year and participation in self-help groups during the last three months of that year were associated with a greater likelihood of remission at the two-year follow-up.The results extend previously published one-year outcome findings showing that cognitive-behavioral and 12-step treatment programs result in similar remission rates. Patients who enter intensive substance abuse treatment with polysubstance use, psychiatric symptoms, or significant emotional distress have more difficulty achieving remission. Routinely engaging patients in continuing outpatient care is likely to yield better outcomes. The duration of such care is probably more important than the number of sessions.
View details for Web of Science ID 000175286300014
View details for PubMedID 11986510
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Life stressors, social resources, and coping skills in youth: Applications to adolescents with chronic disorders
JOURNAL OF ADOLESCENT HEALTH
2002; 30 (4): 22-29
Abstract
After setting out a conceptual framework that focuses on how personal and social resources aid adolescents in managing acute and chronic stressors, I describe methods by which to assess adolescents' family environments and specific life stressors and social resources, and the approach and avoidance coping responses adolescents use to manage life stressors. I then review some research that employs these concepts and methods to focus on the families and life contexts, and coping skills, of youth with chronic medical disorders, including juvenile rheumatic disease (JRD). I close by drawing implications for assessment and intervention and describing some fruitful areas for future research, such as examining the reciprocal linkages between parental and youth behavior, how adolescents' personal characteristics shape their life context, and how life crises and transitions enhance adolescents' development and maturation.
View details for Web of Science ID 000174924300004
View details for PubMedID 11943571
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Children of parents with unipolar depression: A comparison of stably remitted, partially remitted, and nonremitted parents and nondepressed controls
CHILD PSYCHIATRY & HUMAN DEVELOPMENT
2002; 32 (3): 165-185
Abstract
This study reports on 122 families with a depressed parent at baseline and matched nondepressed control families. The 10-year course of depression in parents was characterized as stably-, partially-, or non-remitted. At the 10-year follow-up, children of stably-remitted parents had more psychological distress, physical problems, and disturbance than children of controls. Unexpectedly, children of stably-remitted parents had as much distress and disturbance as children of partially- or non-remitted parents. Stably-remitted families emphasized independence less, and organization more, in comparison to controls at 10 years; partially- and non-remitted families were less cohesive and more conflicted than controls. More severe initial or current parental depression was associated with poorer child adaptation, and family functioning explained children's outcomes above and beyond parents' depression. Children living with parents treated for depression are at risk for problems irrespective of the parent's course, perhaps due to poor family functioning.
View details for Web of Science ID 000174212800001
View details for PubMedID 11893169
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The mystery of human context and coping: An unraveling of clues
109th Annual Convention of the American-Psychological-Association
SPRINGER/PLENUM PUBLISHERS. 2002: 67–88
Abstract
Community and clinical psychology share a fundamental focus: to understand the interplay between human contexts, coping, and adaptation. To highlight recent progress in this area, I offer a guiding conceptual framework and discuss 8 propositions about environment and coping. The propositions consider such issues as patterns of social climate and coping and their links to personal development and dysfunction, the connections between ongoing life circumstances and intervention programs, the role of personal characteristics in matching individuals and environments, and the value of placing specific settings in an ecological context. I then focus on 8 enigmas, such as how to identify conceptually unifying dimensions of diverse social contexts, how to model the processes involved in person-environment transactions, how to understand the link between adversity and personal growth, how to examine the generality of models across ethnic and cultural groups, and how to enhance positive carryover from intervention programs to ongoing life contexts. I close by addressing some implications of these issues for a vision of a dynamic community psychology.
View details for Web of Science ID 000174553500006
View details for PubMedID 11928778
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How well are clinicians following dementia practice guidelines?
ALZHEIMER DISEASE & ASSOCIATED DISORDERS
2002; 16 (1): 15-23
Abstract
Although there are numerous clinical guidelines regarding the management of dementia, there have been few studies on their implementation in practice. Clinicians in six United States Department of Veterans Affairs medical centers (n = 200, 85% response rate) were surveyed regarding their use of practices recommended in the California Workgroup Guidelines for Alzheimer's Disease Management. The majority of providers (89% to 73%) reported that they routinely conducted neurological examinations, obtained histories from caregivers, discussed the diagnosis with the patient's family, discussed durable power of attorney, and made legally-required reports of drivers with dementia. Roughly two-thirds of providers said they routinely conducted cognitive screening examinations, screened for depression, reported elder abuse, and discussed care needs and decision-making issues with patients' families. Only half of all outpatient providers implemented caregiver support practices for at least half of their patients. Clinicians' choices of medications for cognition, mood, and behavior problems were broadly consistent with current practice guidelines. These results suggest possible priorities for quality improvement efforts. Further research is needed to clarify reasons for particular gaps between guidelines and practice and to identify specific targets for intervention.
View details for Web of Science ID 000174273000003
View details for PubMedID 11882745
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Prognosis of older patients in mixed-age alcoholism treatment programs
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2002; 22 (1): 33-43
Abstract
Older patients were compared with matched groups of younger and middle-aged patients in inpatient alcohol treatment programs (N=432 in each age group). Compared with other patients, older patients had poorer physical health and lower cognitive status at treatment entry, but they were drinking less and reported fewer drinking-related problems, fewer psychological symptoms, more social support, more adaptive coping, and fewer barriers to abstinence. Older patients had positive views of the programs and, except for less family therapy and problem-focused counseling, received comparable treatment to that received by other patients. At discharge, older patients showed significant change in most areas targeted for treatment. Better initial status was the strongest predictor of better discharge functioning. Patients with higher cognitive functioning and stronger treatment motivation and those who experienced more interpersonal support and who received more specialized treatment services showed better-than-expected improvement. The age groups showed similar outcomes, prognostic factors, and response to different treatment orientations.
View details for Web of Science ID 000174116900004
View details for PubMedID 11849905
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Risk factors for symptom exacerbation among treated patients with substance use disorders
ADDICTION
2002; 97 (1): 75-85
Abstract
The purpose of this study was to develop an index of risk factors to identify patients prospectively with substance use disorders whose substance use symptoms exacerbate during or shortly after treatment, and to identify characteristics of care that may reduce the likelihood of exacerbation.On the basis of data obtained from a nation-wide outcomes monitoring system, a group of 2809 treated patients experienced an exacerbation of their substance use symptoms. These patients were matched on baseline substance abuse problems with 5618 patients who remained stable or improved.Risk factors for substance use symptom exacerbation included younger age, non-married status and residential instability; long-term use of drugs, prior arrests, prior alcohol treatment, alcohol and drug abuse or dependence diagnoses, cocaine abuse or dependence and more severe self-rated drug problems; and psychiatric problems. High-risk patients who obtained a longer episode of mental health care were less likely to experience an exacerbation of symptoms.Clinicians can identify at treatment entry patients whose substance use symptoms are likely to exacerbate and, by providing these patients a longer duration of care, may reduce the likelihood of symptom exacerbation.
View details for Web of Science ID 000173342700011
View details for PubMedID 11895273
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Predictors of deterioration among patients with substance-use disorders
JOURNAL OF CLINICAL PSYCHOLOGY
2001; 57 (12): 1403-1419
Abstract
The purpose of this study was to identify patients with substance-use disorders who deteriorate during treatment, and to examine baseline predictors of deterioration. Three groups of 872 patients each, matched on number of problems at baseline, were selected from a larger sample based on their treatment outcome (improved, nonresponsive, deteriorated). Deterioration was predicted by younger age and African-American race; four aspects of patients' history (psychiatric symptoms, arrests, prior drug treatment, and recent inpatient or residential care); and having no close friends. Patients who had both an alcohol and a drug diagnosis, a personality-disorder diagnosis, and those who had a shorter episode of care and fewer outpatient-mental-health visits, also were more likely to deteriorate.
View details for Web of Science ID 000172517300005
View details for PubMedID 11745584
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Residential alternatives for older Americans
JOURNAL OF ARCHITECTURAL AND PLANNING RESEARCH
2001; 18 (3): 194-207
View details for Web of Science ID 000171469400003
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Individual and contextual predictors of involvement in twelve-step self-help groups after substance abuse treatment
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
2001; 29 (4): 537-563
Abstract
Drawing on ecological and narrative theories of self-help groups, this study tests a multilevel model predicting self-help group involvement among male veterans who received inpatient substance abuse treatment. Following K. Maton (1993), the study moves beyond the individual-level of analysis to encompass variables in the treatment and post-treatment social ecology. Surveys administered to patients (N = 3,018) and treatment staff (N = 329) assessed these predictor domains and self-help group involvement 1 year after discharge. A hierarchical linear model fit to the data indicates that greater involvement in 12-step groups after discharge is predicted by the compatibility between personal and treatment belief systems. The implications of these findings for efforts to facilitate transitions between inpatient professional treatment and community-based self-help groups are discussed.
View details for PubMedID 11554152
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Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2001; 25 (5): 711-716
Abstract
Twelve-step-oriented inpatient treatment programs emphasize 12-step treatment approaches and the importance of ongoing attendance at 12-step self-help groups more than do cognitive-behavioral (CB) inpatient treatment programs. This study evaluated whether this difference in therapeutic approach leads patients who are treated in 12-step programs to rely less on professionally provided services and more on self-help groups after discharge, thereby reducing long-term health care costs.A prospective, quasi-experimental comparison of 12-step-based (N = 5) and cognitive-behavioral (n = 5) inpatient treatment programs was conducted. These treatments were compared on the degree to which their patients participated in self-help groups, used outpatient and inpatient mental health services, and experienced positive outcomes (e.g., abstinence) in the year following discharge. Using a larger sample from an ongoing research project, 887 male substance-dependent patients from each type of treatment program were matched on pre-intake health care costs (N = 1774). At baseline and 1-year follow-up, patients' involvement in self-help groups (e.g., Alcoholics Anonymous), utilization and costs of mental health services, and clinical outcomes were assessed.Compared with patients treated in CB programs, patients treated in 12-step programs had significantly greater involvement in self-help groups at follow-up. In contrast, patients treated in CB programs averaged almost twice as many outpatient continuing care visits after discharge (22.5 visits) as patients treated in 12-step treatment programs (13.1 visits), and also received significantly more days of inpatient care (17.0 days in CB versus 10.5 in 12-step), resulting in 64% higher annual costs in CB programs ($4729/patient, p < 0.001). Psychiatric and substance abuse outcomes were comparable across treatments, except that 12-step patients had higher rates of abstinence at follow-up (45.7% versus 36.2% for patients from CB programs, p < 0.001).Professional treatment programs that emphasize self-help approaches increase their patients' reliance on cost-free self-help groups and thereby lower subsequent health care costs. Such programs therefore represent a cost-effective approach to promoting recovery from substance abuse.
View details for Web of Science ID 000168773500012
View details for PubMedID 11371720
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Successful remission of late-life drinking problems: A 10-year follow-up
JOURNAL OF STUDIES ON ALCOHOL
2001; 62 (3): 322-334
Abstract
This study sought to determine (1) the rate and predictors of long-term remission among a sample of untreated late-life problem drinkers and (2) whether successfully remitted older problem drinkers attain levels of functioning and life contexts comparable to those of lifetime nonproblem drinkers at a 10-year follow-up.We compared 140 older baseline problem drinkers who were successful in achieving long-term remission to 184 baseline problem drinkers whose drinking problems did not remit over the course of 10 years and to 339 lifetime nonproblem drinkers, on functioning and life contexts at baseline and at 4- and 10-year follow-ups.Being female, having more recent onset of drinking problems, fewer and less severe drinking problems, friends who approved less of drinking, and drinking less and drinking less frequently at baseline predicted long-term remission. In many regards, long-term remitted problem drinkers attained levels of functioning and life context similar to those of lifetime nonproblem drinkers. However, remitted problem drinkers continued to report more incipient drinking problems, depressive symptoms, health and financial stressors, psychoactive medication use, reliance on avoidance coping strategies and less social support from friends than did lifetime nonproblem drinkers at the 10-year follow-up.About a third (30%) of an untreated sample of late-life problem drinkers succeeded in attaining stable, long-term remission. The functioning and life contexts of untreated remitted problem drinkers improved significantly over time; however, some deficits persisted at follow-up.
View details for Web of Science ID 000169236000007
View details for PubMedID 11414342
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Outpatient mental health care, self-help groups, and patients' one-year treatment outcomes
JOURNAL OF CLINICAL PSYCHOLOGY
2001; 57 (3): 273-287
Abstract
To examine the association between the duration and amount of outpatient mental health care, participation in self-help groups, and patients' casemix-adjusted one-year outcomes.A total of 2,376 patients with substance use disorders, 35% of whom also had psychiatric disorders, were assessed at entry to treatment and at a one-year follow-up. Information about the duration and amount of outpatient mental health care was obtained from a centralized health services utilization database.Patients who obtained regular outpatient mental health care over a longer interval and patients who attended more self-help group meetings had better one-year substance use and social functioning outcomes than did patients who were less involved in formal and informal care. The amount of outpatient mental health care did not independently predict one-year outcomes.The duration of outpatient mental health care and the level of self-help involvement are independently associated with less substance use and more positive social functioning. The provision of low intensity treatment for a longer time interval may be a cost-effective way to enhance substance abuse and psychiatric patients' long-term outcomes.
View details for Web of Science ID 000168866000002
View details for PubMedID 11241359
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Drinking to cope, emotional distress and alcohol use and abuse: A ten-year model
JOURNAL OF STUDIES ON ALCOHOL
2001; 62 (2): 190-198
Abstract
This study examines the ability of baseline drinking to cope to predict drinking behavior across an ensuing 10-year period. In addition, it examines whether a propensity to consume alcohol to cope with stressors strengthens the link between emotional distress and drinking behavior.The study uses survey data from a baseline sample of 421 adults (54% women) assessed four times over a 10-year period (i.e., baseline and 1-, 4- and 10-year follow-ups).Baseline drinking to cope was associated with more alcohol consumption and drinking problems at all four observations across the 10-year interval. Baseline drinking to cope also predicted increases in both alcohol consumption and drinking problems in the following year. Moreover, change in drinking to cope was positively linked to changes in both alcohol consumption and drinking problems over the interval. Individuals who had a stronger propensity to drink to cope at baseline showed a stronger link between both anxiety and depressive symptoms and drinking outcomes.Findings demonstrate the power of alcohol-related coping strategies in predicting long-term drinking behavior and they illustrate one way in which such coping is linked to alcohol use and abuse. More broadly, they underscore the importance of considering individual differences in emotion-based theories of drinking behavior.
View details for Web of Science ID 000168189800007
View details for PubMedID 11327185
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Predictors and outcomes of outpatient mental health care - A 4-year prospective study of elderly medicare patients with substance use disorders
MEDICAL CARE
2001; 39 (1): 39-49
Abstract
Many elderly inpatients have substance use disorders; recent treatment guidelines suggest that they should receive regular outpatient mental health care after discharge from hospital.The prevalence, predictors, and outcomes of outpatient mental health care obtained by elderly Medicare patients with substance use disorders were examined.A longitudinal prospective follow-up was performed.Data from Medicare Provider Analysis and Review Record and Part B Medicare Annual Data were used to identify elderly inpatients with substance use disorders (n = 4,961) and determine their outpatient mental health care 4 years following hospital discharge.Only 12% to 17% of surviving elderly substance abuse patients received outpatient mental health care in each of 4 years after discharge. Cumulatively over 4 years, approximately 18% of surviving patients obtained diagnostic/evaluative mental health services, 22% obtained psychotherapy, and 9% received medication management. Of patients who obtained outpatient mental health care, 57% made 10 or fewer outpatient mental health visits over the entire 4 years. Younger, non-black, and female patients were more likely to obtain mental health outpatient care, as were patients with prior substance-related hospitalizations, dual diagnoses, and fewer medical conditions. Prompt outpatient mental health care was predictively associated with higher likelihood of mental health readmissions and, among patients with drug disorders, lower mortality.Very few elderly Medicare substance abuse patients obtain outpatient mental health care, perhaps because of health or economic barriers.
View details for Web of Science ID 000165984300006
View details for PubMedID 11176542
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A comparative, process-effectiveness evaluation of VA substance abuse treatment.
Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism
2001; 15: 373-391
Abstract
Over 3,000 patients from 15 VA inpatient, substance abuse treatment programs showed considerable improvement from intake to a one-year follow-up. Patients in 12-step programs, as opposed to cognitive-behavioral (CB) or eclectic programs, and those with more extended continuing outpatient mental health care and 12-step self-help group involvement, were more likely to be abstinent and free of substance use problems at follow-up. Consistent with their better one-year outcomes, patients in 12-step programs improved more between intake and discharge than CB patients on proximal outcomes assumed to be specific to 12-step treatment (e.g., disease model beliefs) and as much or more on CB proximal outcomes. Proximal outcomes assessed at treatment discharge and follow-up were, at best, modestly related to one-year substance use and other outcomes. No evidence was found that CB or 12-step treatment is more beneficial for certain types of patients.
View details for PubMedID 11449754
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Self-help group participation among substance use disorder patients with posttraumatic stress disorder
JOURNAL OF SUBSTANCE ABUSE TREATMENT
2001; 20 (1): 25-32
Abstract
Debate has ensued about whether substance use disorder (SUD) patients with comorbid posttraumatic stress disorder (PTSD) participate in and benefit from 12-step groups. One hundred fifty-nine SUD-PTSD and 1,429 SUD-only male patients were compared on participation in 12-step activities following an index episode of treatment. Twelve-step participation was similar for SUD patients with and without PTSD. PTSD patients with worldviews (e.g., holding disease model beliefs) that more closely matched 12-step philosophy participated more in 12-step activities. Although greater participation was associated with better concurrent functioning, participation did not prospectively predict outcomes after case mix adjustment. An exception was that greater participation predicted decreased distress among PTSD patients whose identity was more consistent with 12-step philosophy. In summary, PTSD patients participate in and benefit from 12-step participation; continuing involvement may be necessary to maintain positive benefits.
View details for Web of Science ID 000167491300005
View details for PubMedID 11239725
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Elderly Medicare inpatients with substance use disorders: Characteristics and predictors of hospital readmissions over a four-year interval
JOURNAL OF STUDIES ON ALCOHOL
2000; 61 (6): 891-895
Abstract
(1) To describe the characteristics and 4-year readmissions of elderly Medicare inpatients with substance use disorders; (2) to determine whether their readmissions are elevated relative to case controls'; and (3) to examine gender differences in characteristics and predictors of readmissions among elderly inpatients with substance use disorders.Health Care Financing Administration Medicare Provider Analysis and Review data were used to identify elderly patients with substance use disorders and their case controls, and to determine patient characteristics and readmissions over a 4-year interval following hospital discharge.Of elderly inpatients with substance use disorders (N = 22,768), 37% were women, 11% were black, 22% had previous, substance-related hospitalizations, 14% had concomitant psychiatric disorders and 9% had accident-related diagnoses. Among surviving patients with substance use disorders (N = 12,417), 73% were rehospitalized, a higher rate than among case controls (69%). Women with substance use disorders were more likely to have a psychiatric or accident diagnosis at the index episode than were men with substance use disorders.Many women and a disproportionate number of blacks constitute elderly Medicare inpatients with substance use disorders. These patients often have prior substance-related hospitalizations, psychiatric comorbidities, and accidents involving poisoning, adverse drug reactions and falls. They make costly, relatively heavy use of inpatient health services. Elderly women with substance use disorders may benefit from treatment that focuses on their psychiatric disorders and accident risk. Diagnostic information available at discharge can be used to identify patients at higher risk for subsequent rehospitalization and to plan treatment accordingly.
View details for Web of Science ID 000165874700015
View details for PubMedID 11188495
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Specialty mental health care improves patients' outcomes: Findings from a nationwide program to monitor the quality of care for patients with substance use disorders
JOURNAL OF STUDIES ON ALCOHOL
2000; 61 (5): 704-713
Abstract
To describe the implementation of a nationwide program to monitor the quality of treatment for substance use disorders in the Department of Veterans Affairs, and to examine how the provision of outpatient mental health care, and the duration and intensity of care, relate to patients' outcomes.Clinicians completed a baseline Addiction Severity Index (ASI) on more than 34,000 patients with substance use disorders; more than 21,000 (63%) were reassessed with the ASI an average of 12 months later. Nationwide health service utilization databases were used to obtain information about patients' diagnoses and their use of services during an index episode of care.On average, patients who received specialty outpatient mental health care experienced better risk-adjusted outcomes than did patients who did not receive such care. Patients who had longer index episodes of mental health care improved more than did those who had shorter episodes. There was some evidence that the duration of care contributed more to better outcomes among patients with only substance use disorders, whereas the intensity of care was more important for patients with both substance use and psychiatric disorders.The provision of specialty outpatient mental health care, and longer episodes of specialty care, were associated with better risk-adjusted substance use, symptom and social functioning outcomes for patients with substance use disorders. More emphasis should be placed on ensuring that these patients enter specialty care and on keeping them in treatment.
View details for Web of Science ID 000089557900011
View details for PubMedID 11022810
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Long-term outcomes of alcohol use disorders: Comparing untreated individuals with those in alcoholics anonymous and formal treatment
JOURNAL OF STUDIES ON ALCOHOL
2000; 61 (4): 529-540
Abstract
The aim of this study was to examine how the type and timing of help received over 8 years by previously untreated problem drinking individuals were linked to drinking and functioning outcomes.At the time of the 8-year follow-up, individuals (N= 466, 51% male) had self-selected into four groups: no treatment (n = 78), Alcoholics Anonymous (AA) only (n = 66), formal treatment only (n = 74), or formal treatment plus AA (n = 248).Individuals who received some type of help--AA, formal treatment or both--were more likely to be abstinent at 8 years than were untreated individuals. Although the AA only group was better off than the formal treatment only group at 1 and 3 years, the informally and formally treated groups were equivalent on drinking outcomes at 8 years. Similarly, despite the formal treatment plus AA group having been better off at 1 and 3 years than the formal treatment only group, the two formal treatment groups were comparable on drinking at 8 years. Both helped and untreated individuals improved between baseline and 1 year on drinking outcomes, but only formally treated individuals showed continued improvement over 8 years on drinking indices. Participation in AA or formal treatment during Year 1 of follow-up was associated with better drinking outcomes at 8 years.Individuals who obtain help for a drinking problem, especially relatively quickly, do somewhat better on drinking outcomes over 8 years than those who do not receive help, but there is little difference between types of help on long-term drinking outcomes.
View details for Web of Science ID 000088042900006
View details for PubMedID 10928723
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Six- and ten-item indexs of psychological distress based on the Symptom Checklist-90
ASSESSMENT
2000; 7 (2): 103-111
Abstract
Clinicians, provider organizations, and researchers need simple and valid measures to monitor mental health treatment outcomes. This article describes development of 6- and 10-item indexes of psychological distress based on the Symptom Checklist-90 (SCL-90). A review of eight factor-analytic studies identified SCL-90 items most indicative of overall distress. Convergent validity of two new indexes and the previously developed SCL-10 were compared in an archival sample of posttraumatic stress disorder patients (n = 323). One index, the SCL-6, was further validated with archival data on substance abuse patients (n = 3,014 and n = 316) and hospital staff (n = 542). The three brief indexes had similar convergent validity, correlating .87 to .97 with the SCL-90 and Brief Symptom Inventory, .49 to .76 with other symptom scales, and .46 to .73 with changes in other symptom measures over time. These results indicate the concise, easily administered indexes are valid indicators of psychological distress.
View details for Web of Science ID 000174445200001
View details for PubMedID 10868247
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Improving the quality of VA care for patients with substance-use disorders - The Quality Enhancement Research Initiative (QUERI) substance abuse module
MEDICAL CARE
2000; 38 (6): S105-S113
View details for Web of Science ID 000087462300011
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Improving the quality of VA care for patients with substance-use disorders: the Quality Enhancement Research Initiative (QUERI) substance abuse module.
Medical care
2000; 38 (6): I105-13
Abstract
Substance-use disorders are costly in both human and economic terms and are highly prevalent among patients in the VA Health Care System. The Quality Enhancement Research Initiative (QUERI) Substance Abuse Module (SAM) seeks to enhance identification and management of patients with substance-use disorders seen in primary care and other medical settings; bolster specialized substance-abuse treatment practices; improve care for patients with multiple comorbidities; and strengthen treatment for high-risk and underserved substance-abuse patient subgroups. This article describes how the SAM will achieve these aims by following the QUERI process steps and conducting an integrated set of research projects that incorporates literature reviews and meta-analyses, naturalistic and randomized controlled trials of promising treatments, studies of barriers to guideline implementation, and outcome-oriented evaluations of the implementation of practice guidelines.
View details for PubMedID 10843275
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Inpatient substance abuse care and the outcome of subsequent community residential and outpatient care
ADDICTION
2000; 95 (6): 833-846
Abstract
To compare participation in treatment and 1-year substance use, symptom and functioning outcomes between patients with substance use disorders who did versus those who did not have an episode of inpatient care immediately prior to an episode of community residential and outpatient mental health care.Two matched groups of 257 patients each with substance use disorders were assessed at entry to and discharge from a community residential facility (CRF) and at a 1-year follow-up.Patients in the two treatment groups received a comparable amount of CRF and outpatient mental health care. Nevertheless, patients who had prior inpatient care were more likely to be employed at 1-year follow-up. In addition, when they entered CRF care directly, patients with co-morbid psychiatric disorders were more likely to continue use of alcohol and drugs in the CRF and less likely to complete the program. These patients also experienced more distress and psychiatric symptoms, and were less likely to be employed at the 1-year follow-up.Among patients who seek treatment at Department of Veterans Affairs (VA) facilities, those who have both substance use and psychiatric disorders and enter CRF care directly have somewhat worse outcomes than those who have an immediately prior episode of inpatient care.
View details for Web of Science ID 000087776600002
View details for PubMedID 10946434
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Changes in services and structure in community residential treatment facilities for substance abuse patients
PSYCHIATRIC SERVICES
2000; 51 (4): 494-498
Abstract
This study examined the extent to which community residential facilities that contract with the Department of Veterans Affairs (VA) to treat substance abuse patients are providing more services and structure to meet the needs of a client population with increasingly severe problems.A nationwide sample of 249 community residential facilities with VA contracts was surveyed in 1995 and again in 1998.In 1998 facilities were more likely than they were in 1995 to have psychiatrists and psychologists available to patients as well as specialized counseling and psychoeducational, rehabilitation, and medical services. Facilities also provided more social and recreational activities, and more structure was provided by discouraging patients' choice of individual daily living patterns. In 1998 the facilities were more likely to admit dual diagnosis patients, those with substance use disorders and psychiatric disorders. Programs that changed toward accepting dual diagnosis patients had more services and structure than programs that consistently accepted only substance abuse patients.Community residential facilities that contract with VA are responding appropriately to an increasingly ill patient population by providing more services and structure.
View details for Web of Science ID 000086278300012
View details for PubMedID 10737825
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Long-term posttreatment functioning among patients with unipolar depression: An integrative model
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2000; 68 (2): 226-232
Abstract
This study tested an integrative structural equation model of posttreatment functioning among 165 depressed patients followed for an average of 9 years after the end of an episode of treatment. The model examined (a) the link between life change and psychosocial resource change and (b) the role of resource change in mediating the relationship between life change and change in depression. An increase in the preponderance of negative over positive life events was associated with a decline in resources and an increase in depressive symptoms. A decline in resources was associated with an increase in depressive symptoms. The association between changes in events and depressive symptoms was completely mediated through resource change. These findings indicate that life stressors contribute to posttreatment depression through an erosion of personal and social resources.
View details for DOI 10.1037//0022-006X.68.2.226
View details for Web of Science ID 000087485300004
View details for PubMedID 10780122
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Global Assessment of Functioning (GAF) ratings: Determinants and role as predictors of one-year treatment outcomes
JOURNAL OF CLINICAL PSYCHOLOGY
2000; 56 (4): 449-461
Abstract
To assess the adequacy of global ratings of patients' psychosocial functioning, which are an integral part of the current system for obtaining multidimensional psychiatric diagnoses and are embodied by the Global Assessment of Functioning (GAF) Scale as AXIS V of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994).We identified a sample of 1,688 patients with substance use disorders, many of whom also had psychiatric disorders; examined the determinants of GAF ratings; and focused on how well these ratings predicted patients' one-year symptom and psychosocial functioning outcomes.Patients' clinical diagnoses and psychiatric symptoms were stronger predictors of GAF ratings than was their social and occupational functioning. Moreover, GAF ratings were only minimally associated with patients' one-year psychological, social, and occupational functioning outcomes.These findings raise serious questions about the conceptual and clinical value of the current standard method of assessing psychiatric and substance abuse patients' global functioning.
View details for Web of Science ID 000086332600001
View details for PubMedID 10775040
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Consistency of self-administered and interview-based Addiction Severity Index composite scores
ADDICTION
2000; 95 (3): 419-425
Abstract
This study assesses the viability of a self-administered version of the Addiction Severity Index for monitoring substance abuse patients' functioning.Patients completed the ASI interview and a self-administered questionnaire containing ASI composite items an average of 4 days apart. Composite scores from both formats were compared using correlations and mean differences.Participants were 316 veterans entering substance abuse treatment in a US Department of Veterans Affairs medical center.Composite scores for alcohol, drug, psychiatric, family, legal and employment problems correlated 0.59-0.87 across formats. Patients endorsed more drug use and psychiatric symptoms by questionnaire than by interview. Medical composite scores correlated only 0.47 across formats.This study and previous research suggest that a self-administered questionnaire can be a feasible alternative to ASI interviews for monitoring substance abuse patients' treatment outcomes.
View details for Web of Science ID 000086059900016
View details for PubMedID 10795362
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Two-year mental health service use and course of remission in patients with substance use and posttraumatic stress disorders
JOURNAL OF STUDIES ON ALCOHOL
2000; 61 (2): 247-253
Abstract
Comorbid diagnoses of substance abuse/dependence and posttraumatic stress disorder (SUD-PTSD) adversely affect substance abuse patients' treatment outcomes. Recently, several practices have been recommended for the treatment of SUD-PTSD patients based on empirical findings, including providing PTSD-specific care. Accordingly, this study examines the association between outpatient PTSD treatment and the long-term course of SUD-PTSD patients.Male substance abuse/dependence patients (N = 125) with a comorbid diagnosis of PTSD completed 1-and 2-year follow-ups. Based on these reports, 26 patients were stably remitted from substance abuse, 39 were partially remitted and 60 were not remitted at either follow-up. These three groups were compared on mental health service use indices gathered from patients' self-reports of inpatient treatment and nationwide Veterans Affairs (VA) databases abstracting outpatient visits.SUD-PTSD patients who attended more outpatient substance abuse, psychiatric and PTSD services in the first year following treatment (and cumulatively over the 2-year follow-up) were more likely to maintain a stable course of remission from substance use in the 2 years following inpatient SUD treatment. When the three types of sessions were examined in regression analyses, PTSD sessions in the second year and the total number of PTSD sessions over the 2 years following the index treatment episode emerged as the most significant predictors of remission. Self-help group participation was also associated with a remitted course for SUD-PTSD patients.These data suggest that PTSD-focused treatment services are an essential treatment component for substance abuse/dependence patients with PTSD.
View details for Web of Science ID 000085926600007
View details for PubMedID 10757135
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Children's health and child-parent relationships as predictors of problem-drinking mothers' and fathers' long-term adaptation
JOURNAL OF SUBSTANCE ABUSE
2000; 11 (1): 103-121
Abstract
This study examined the extent to which children's health status and child-parent relationships affected the severity of problem-drinking parents' alcohol use disorders, as well as the parents' psychological states and marital stressors and resources. These issues were examined using data from an 8-year study of problem-drinking women and men. Generally, over the 8-year period, the children of alcoholic mothers and fathers were comparable on their health status and relationships with their parents. The severity of mothers' and fathers' drinking problems were also generally comparable over this period. Better children's health and child-parent relationships at baseline and 1- and 3-year follow-ups were consistent predictors of mothers' reduced drinking and better psychological states on the subsequent follow-ups. Associations between children's functioning and fathers' adaptation were few and inconsistent. The results support the possibility that an undesirable cycle might be established in which maternal drinking and children's dysfunction coexist in an ever worsening reciprocal relationship.
View details for Web of Science ID 000086170300009
View details for PubMedID 10756517
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Demand characteristics of residential substance abuse treatment programs
JOURNAL OF SUBSTANCE ABUSE
2000; 12 (4): 387-403
Abstract
This study examined the objective demand characteristics of treatment programs in which substance abuse patients, or psychiatric patients, were residing. It also examined associations of objective demand with substance abuse patients' perceived expectations for functioning during treatment and patients' in-program participation.A total of 994 patients living in 79 programs took part.When patients had a substance abuse rather than a psychiatric problem, objective demand was higher: program policies had higher requirements for functioning and more resident control; programs offered fewer health-treatment services; and the physical design provided fewer safety features and social-recreational aids. Compared to substance abuse patients in low-demand programs, patients in high-demand programs perceived the program to have higher expectations, in that the treatment climate exerted more press to develop relationships, set goals, and be organized. Patients in high-demand programs engaged more in self-initiated activities and participated more in treatment services and program-organized events. Substance abuse patients' activity and participation levels were determined jointly by the level of demand and by the expectations for patients' expressiveness and self-understanding of their personal problems.The findings illustrate the importance of considering objective indices of demand in conjunction with perceived expectations to improve patients' treatment outcomes.
View details for Web of Science ID 000169559400006
View details for PubMedID 11452841
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Outcomes of four treatment approaches in community residential programs for patients with substance use disorders
PSYCHIATRIC SERVICES
1999; 50 (12): 1577-1583
Abstract
Treatment approaches used in community residential facilities for patients with substance use disorders were identified, and patients' participation in treatment and case-mix-adjusted one-year outcomes for substance use, symptoms, and functioning in facilities with different treatment approaches were examined.A total of 2,376 patients with substance use disorders treated in a representative sample of 88 community residential facilities were assessed at entry to and discharge from the facility and at one-year follow-up. The community residential facilities were classified into four types based on the major emphasis of the treatment program: therapeutic community, psychosocial rehabilitation, 12-step, and undifferentiated.Patients in programs that used the therapeutic community, psychosocial rehabilitation, and 12-step approaches had comparable one-year outcomes in symptoms and functioning that were better than those of patients in undifferentiated programs. A more directed treatment orientation, a longer episode of care, and completion of care were independently related to better one-year outcomes. These findings held for patients with only substance use disorders and for patients with both substance use and psychiatric disorders.Community residential programs that have a more directed treatment orientation and that motivate patients to complete treatment have better substance use outcomes. As an increasingly important locus of specialized care, community residential facilities need to develop and maintain more differentiated and distinctive treatment orientations.
View details for Web of Science ID 000083933400009
View details for PubMedID 10577876
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Dual diagnosis patients in substance abuse treatment: relationship of general coping and substance-specific coping to 1-year outcomes
ADDICTION
1999; 94 (12): 1805-1816
Abstract
This study examined general and substance-specific coping skills and their relationship to treatment climate, continuing care and 1-year post-treatment functioning among dual diagnosis patients (i.e. co-occurrence of substance use and psychiatric disorders).In a prospective multi-site study, dual diagnosis patients participating in substance abuse treatment were assessed at intake, discharge and at a 1-year follow-up.Patients were recruited from 15 substance abuse treatment programs, which were selected from a larger pool of 174 inpatient treatment programs in the Department of Veterans Affairs Health Care System.A total of 981 male dual diagnosis patients participated in the study.Assessments included general and substance-specific coping skills, treatment climate, continuing outpatient care, abstinence and clinically significant psychiatric symptoms.Dual diagnosis patients modestly improved on general and substance-specific coping skills over the 1-year follow-up period. Patients who were in programs with a 'dual diagnosis treatment climate' and who participated in more 12-Step self-help groups showed slightly more gains in adaptive coping. Both general and substance-specific coping were associated with abstinence, but only general coping was associated with freedom from significant psychiatric symptoms.Enhancing general and substance-specific coping skills in substance abuse treatment may reduce dual diagnosis patients' post-treatment substance use and improve their psychological functioning.
View details for Web of Science ID 000084198800006
View details for PubMedID 10717959
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Alcohol & drug abuse: the transformation of the Veterans Affairs substance abuse treatment system.
Psychiatric services
1999; 50 (11): 1399-1401
View details for PubMedID 10543846
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Effectiveness of treatment for substance abuse and dependence for dual diagnosis patients: A model of treatment factors associated with one-year outcomes
JOURNAL OF STUDIES ON ALCOHOL
1999; 60 (6): 856-866
Abstract
This study examines a model of treatment for substance abuse and dependence for patients with substance use disorders and concomitant psychiatric disorders. The model focuses on five interrelated sets of variables (social background, intake functioning. dual diagnosis treatment orientation, patients' change on proximal outcomes, and aftercare participation) that are hypothesized to affect dual diagnosis patients' 1-year posttreatment outcomes.A total of 981 male dual diagnosis patients completed assessment at intake, discharge and 1-year follow-up. The relative importance of each set of variables as predictors of outcome was estimated by constructing block variables and conducting path analyses.Dual diagnosis patients had a higher abstinence rate at follow-up (39%) than at intake (2%); they also improved on freedom from psychiatric symptoms (from 60% to 68%) and employment (from 20% to 29%). At follow-up, patients in programs with a stronger dual diagnosis treatment orientation showed a higher rate of freedom from psychiatric symptoms (71%) than did patients in weaker dual diagnosis treatment oriented programs (65%); they also were more likely to be employed (34% vs 25%). More change on proximal outcomes and more aftercare participation were also associated with better 1-year outcomes. Patients with less severe psychiatric disorders improved more and responded better to dual diagnosis oriented treatments than did patients with more severe psychiatric disorders.Treatment programs for substance use disorders that adhere to principles of dual diagnosis treatment obtain better outcomes for dual diagnosis patients, especially for patients with less severe psychiatric disorders.
View details for Web of Science ID 000083530700018
View details for PubMedID 10606499
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Depression and outpatient medical utilization: A naturalistic 10-year follow-up
ANNALS OF BEHAVIORAL MEDICINE
1999; 21 (4): 317-321
Abstract
The current investigation described the relationship between depression and outpatient medical utilization in a sample of 424 treatment-seeking individuals diagnosed with a depressive disorder and a demographically matched community sample of 424 men and women. This relationship was assessed longitudinally from baseline (intake for the patient sample) to 1-, 4-, and 10-year follow-ups. Patients and community individuals demonstrated distinct patterns of depressive symptoms and outpatient medical utilization: patients declined in symptoms and medical utilization following treatment, although they continued to have higher levels of depressive symptoms and outpatient utilization than controls at each follow-up period. Community controls demonstrated no change from baseline in symptoms or utilization at any follow-up. Higher levels of depressive symptoms was associated with increased outpatient medical utilization over the 10 years, even when age, sex, marital status, medical comorbidity, and patient status were controlled. Results add further evidence for a relationship between symptoms of depression and outpatient utilization by documenting this relationship in a posttreatment sample. Furthermore, the findings underscore the need for long-term follow-ups in investigations of the association between treatment for depression and the outpatient medical utilization of depressed individuals.
View details for Web of Science ID 000085563700008
View details for PubMedID 10721439
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Resource loss, resource gain, and depressive symptoms: A 10-year model
JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY
1999; 77 (3): 620-629
Abstract
This study examined a broadened conceptualization of the stress and coping process that incorporated a more dynamic approach to understanding the role of psychosocial resources in 326 adults studied over a 10-year period. Resource loss across 10 years was significantly associated with an increase in depressive symptoms, whereas resource gain across 10 years was significantly associated with a decrease in depressive symptoms. In addition, change in the preponderance of negative over positive events across 10 years was inversely associated with change in resources during the period. Finally, in an integrative structural equation model, the association between change in life events and depressive symptoms at follow-up was completely mediated through resource change.
View details for Web of Science ID 000082743400014
View details for PubMedID 10510511
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Long-term treatment careers and outcomes of previously untreated alcoholics
JOURNAL OF STUDIES ON ALCOHOL
1999; 60 (4): 437-447
Abstract
The aim of this project was to describe treatment selection and outcomes over an 8-year follow-up period for 466 individuals who had drinking problems and had not yet received formal treatment at baseline.By the 8-year follow-up, individuals had self-selected into one of four groups: no-treatment (n = 78); completed treatment (help was received only in Years 1-3 of follow-up; n = 230); additional treatment (help was received in Years 1-3, with more help in Years 4-8; n = 134); and delayed treatment (no help was received until Years 4-8 of follow-up; n = 24).Compared with individuals who remained untreated, the completed treatment group had more severe drinking problems and depression at baseline, but better drinking outcomes at both the 3- and 8-year follow-ups. At 3 years, the additional treatment group perceived their drinking problem as being more serious than did the untreated group and was more likely to have drinking-related problems; by 8 years, individuals who had obtained additional treatment were more likely to be abstinent, but still perceived their drinking problems as being more serious. Compared to individuals who completed treatment in Years 1-3, additional treatment group members had more severe drinking and functioning problems at 3 and 8 years. More involvement with formal outpatient treatment or AA was associated with more improvement on drinking indices.Persons with alcohol use disorders who elect to enter formal treatment or AA relatively soon after acknowledging their drinking problems experience better drinking-related outcomes than do those who receive no help or who delay receiving help. Accordingly, referral processes should ensure that problem drinkers enter self-help or formal treatment quickly.
View details for Web of Science ID 000080852700001
View details for PubMedID 10463799
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Two-year posttreatment functioning and coping of substance abuse patients with posttraumatic stress disorder
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
1999; 13 (2): 105-114
View details for Web of Science ID 000080888600005
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Symptom-based predictors of a 10-year chronic course of treated depression
JOURNAL OF NERVOUS AND MENTAL DISEASE
1999; 187 (6): 360-368
Abstract
The high likelihood of a chronic course of depression underscores the need to identify at intake patients most at risk for long-term nonremission. In a naturalistic study of 313 unipolar depressed patients, potential symptom-based risk factors were assessed at treatment intake and were used to predict a chronic course of treated depression over a 10-year interval. The prototypic chronically depressed patient was an individual who at baseline experienced more severe symptoms of fatigue, loss of interest in usual activities, trouble sleeping, and thoughts about death or suicide; was not calm, successful, or self-confident; and did not socialize with friends outside the home, and frequently coped with stressors by avoiding other people. A larger number of risk factors was associated with a higher likelihood of experiencing a chronic course. High-risk patients who received more psychological treatment during the index episode were more likely to experience a long-term course of remission or partial remission.
View details for Web of Science ID 000080820000005
View details for PubMedID 10379723
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Reciprocal relations between stressors and drinking behavior: a three-wave panel study of late middle-aged and older women and men
ADDICTION
1999; 94 (5): 737-749
Abstract
To examine reciprocal relations between stressors and drinking behavior among late-middle-aged and older women and men.A community sample of 621 women and 941 men (mean age = 61) provided information about their life stressors and drinking behavior at three times: initial assessment, 1 year later and 4 years later. Structural equation modeling with manifest variables was used to examine cross-temporal relations between stressors and drinking behavior.Stressors did not predict heavier or more frequent drinking. In fact, among women, increased health stressors predicted a reduction of alcohol consumption; among men, increased financial stressors suppressed alcohol consumption. Higher stressor levels in some life domains did foreshadow later drinking problems. More initial drinking problems resulted in more subsequent financial and spouse stressors for both women and men. Contrary to expectation, more frequent alcohol consumption presaged fewer negative life events, health stressors, and financial stressors for women, and fewer health stressors for men.The findings suggest that among older adults there may be a harmful feedback cycle whereby problematic drinking and life stressors exacerbate each other, but also a benign feedback cycle in which moderate alcohol consumption and life stressors reduce each other.
View details for Web of Science ID 000080503700015
View details for PubMedID 10563039
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A comparative evaluation of substance abuse treatment: V. Substance abuse treatment can enhance the effectiveness of self-help groups
151st Annual Meeting of the American-Psychiatric-Association
WILEY-BLACKWELL PUBLISHING, INC. 1999: 558–63
Abstract
Affiliation with Alcoholics Anonymous (AA) and other 12-Step self-help groups is becoming more common at the same time as professional substance abuse treatment services are becoming less available and of shorter duration. As a result of these two trends, patients' outcomes may be increasingly influenced by the degree to which professional treatment programs help patients take maximum advantage of self-help groups. The present study of 3018 treated veterans examined how the theoretical orientation of a substance abuse treatment program affects (1) the proportion of its patients that participate in self-help groups, and, (2) the degree of benefit patients derive from participation in self-help groups. Patients treated in 12-Step and eclectic treatment programs had higher rates of subsequent participation in 12-Step self-help groups than did patients treated in cognitive behavioral programs. Furthermore, the theoretical orientation of treatment moderated the outcome of self-help group participation: As the degree of programs' emphasis on 12-Step approaches increased, the positive relationships of 12-Step group participation to better substance use and psychological outcomes became stronger. Hence, it appears that 12-Step oriented treatment programs enhance the effectiveness of 12-Step self-help groups. Findings are discussed in terms of implications for clinical practice and for future evaluations of the combined effects of treatment and self-help groups.
View details for Web of Science ID 000079269900028
View details for PubMedID 10195833
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A comparative evaluation of substance abuse treatment: II. Linking proximal outcomes of 12-Step and cognitive-behavioral treatment to substance use outcomes
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
1999; 23 (3): 537-544
Abstract
This study examines the linkages in the treatment process chains that are thought to underlie two prevalent approaches to substance abuse treatment, traditional 12-Step treatment and cognitive-behavioral treatment. The focus is on the "proximal outcomes" specified by the two treatment approaches and their relation to "ultimate" substance use outcomes assessed at a 1-year follow-up. A total of 2687 men who received treatment in 15 Department of Veterans Affairs substance abuse treatment programs were assessed at treatment entry, at or near discharge, and at a 1-year follow-up. Based on the results of factor analyses, composite proximal outcomes variables were constructed to assess 12-Step cognitions, 12-Step behaviors, cognitive-behavioral beliefs, substance-specific coping, and general coping. Correlation analyses indicated that some of the proximal outcome composites assessed at treatment discharge were linked to 1-year outcomes, but the relationships were weak (r = .09 to .15). At follow-up, the cross-sectional relationships between the proximal outcome composites and two substance use outcomes were stronger, but still modest in magnitude (r = .16 to .39). The weak predictive findings suggest some mechanism is needed to sustain treatment-induced change on proximal outcomes so that positive ultimate outcomes can be achieved more frequently. In this regard, participation in continuing care was associated with enhanced maintenance of treatment gains on proximal outcomes. However, the modest cross-sectional relationships between proximal and substance use outcomes at follow-up suggest that the theories on which 12-Step and cognitive-behavioral substance abuse treatments are based are not sufficiently comprehensive.
View details for Web of Science ID 000079269900025
View details for PubMedID 10195830
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A comparative evaluation of substance abuse treatment - IV. The effect of comorbid psychiatric diagnoses on amount of treatment, continuing care, and 1-year outcomes
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
1999; 23 (3): 552-557
Abstract
Recent surveys of the substance abuse patient population have shown a striking increase in the proportion of patients with a comorbid psychiatric disorder. In this study, patients with substance abuse and psychotic, anxiety/depressive, or personality disorders were compared with patients with only substance use disorders on treatment experiences and outcomes. Regardless of dual diagnosis status, patients generally improved on both substance use and social functioning outcomes after substance abuse treatment. At the 1-year follow-up, dually diagnosed patients, and patients with only substance use disorders, had comparable substance use outcomes. However, patients with major psychiatric disorders, specifically psychotic and anxiety/depressive disorders, fared worse on psychological symptoms and employment outcomes than did patients with personality disorders and only substance use disorders. Although there were some group differences on the amount of index treatment received and continuing care, the overall pattern of relationships between treatment variables and outcomes was comparable for the patient groups. In addition, there was no diagnostic group by treatment orientation matching effects, which indicated that the dual diagnosis patient groups improved as much in 12-Step as in cognitive-behavioral substance abuse programs.
View details for Web of Science ID 000079269900027
View details for PubMedID 10195832
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A comparative evaluation of substance abuse treatment - III. Examining mechanisms underlying patient-treatment matching hypotheses for 12-Step and cognitive-behavioral treatments for substance abuse
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
1999; 23 (3): 545-551
Abstract
This study examined several hypotheses for matching patients to 12-Step and cognitive-behavioral (CB) treatments in a multisite evaluation of VA inpatient substance abuse programs. A total of 804 male patients in five 12-Step programs, and 1069 male patients in five CB programs completed an intake, discharge, and 1-year follow-up questionnaire. The findings did not support the notion that certain patient characteristics would differentially predict better outcomes after 12-Step and CB treatment This conclusion held when the purest 12-Step and CB programs were used, and when patients who received the full dose of treatment (i.e., treatment completers) were examined separately. Process analyses of the hypothesized mechanisms underlying the patient-treatment matching effects did not yield the expected links among patient characteristics, proximal outcomes, and 1-year outcomes. Our conclusion is that there is no advantage to matching men with substance abuse problems to 12-Step or CB treatments based on the patient attributes measured here.
View details for Web of Science ID 000079269900026
View details for PubMedID 10195831
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A comparative evaluation of substance abuse treatment: I. Treatment orientation, amount of care, and 1-year outcomes
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
1999; 23 (3): 529-536
Abstract
This article first explains the conceptual framework and plan of a naturalistic, multisite evaluation of Department of Veterans Affairs (VA) substance abuse treatment programs. It then examines the effectiveness of an index episode of inpatient treatment and the effectiveness of continuing outpatient care and participation in self-help groups. The study was conducted among 3018 patients from 15 VA programs that emphasized 12-Step, cognitive-behavioral (CB), or eclectic treatment. Casemix-adjusted 1-year outcomes showed that patients in 12-Step programs were the most likely to be abstinent, free of substance abuse problems, and employed at the 1-year follow-up. Patients who obtained more regular and more intensive outpatient mental health care, and those who participated more in 12-Step self-help groups, were more likely to be abstinent and free of substance use problems at the 1-year follow-up. These findings support the effectiveness of 12-Step treatment and show that patients with substance use disorders who become more involved in outpatient care and self-help groups tend to experience better short-term substance use outcomes. Subsequent papers in this section focus on the proximal outcomes of treatment, patients with psychiatric as well as substance use disorders, patient-treatment matching effects, and the link between program treatment orientation and patients' involvement in and the influence of 12-Step self-help groups.
View details for Web of Science ID 000079269900024
View details for PubMedID 10195829
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Gender differences in problem drinking and depression: Different "vulnerabilities?"
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
1999; 27 (1): 25-54
Abstract
This study examines the relationship between stressors and resources and the functioning of a sample of 515 men and women who had a drinking problem. At a one-year follow-up, both women and men had improved on three functioning measures: alcohol consumption, days intoxicated, and depression. There were no gender differences at Time 2 on alcohol consumption, but men had more days intoxicated and women had more symptoms of depression. The impact of stressors and resources varied by life domain, functioning criterion, and gender. Although the predictors varied, the amount of variance in depression accounted for was the same for women and men. The most striking gender difference was the stronger impact of friendships for women on all aspects of functioning. This study provides support for reconsideration of the stress vulnerability of women and men.
View details for Web of Science ID 000079888200002
View details for PubMedID 10234802
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Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse?
20th Annual Meeting of the Research-Society-on-Alcoholism
SPRINGER. 1999: 54–60
Abstract
Self-help groups are the most commonly sought source of help for substance abuse problems, but few studies have evaluated the mechanisms through which they exert their effects on members. The present project evaluates mediators of the effects of self-help groups in a sample of 2,337 male veterans who were treated for substance abuse. The majority of participants became involved in self-help groups after inpatient treatment, and this involvement predicted reduced substance use at 1-year follow-up. Both enhanced friendship networks and increased active coping responses appeared to mediate these effects. Implications for self-help groups and professional treatments are discussed.
View details for Web of Science ID 000085538800009
View details for PubMedID 18425655
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Evaluating and improving VA substance abuse patients ' care
AMERICAN JOURNAL OF MEDICAL QUALITY
1999; 14 (1): 45-54
Abstract
The VA has implemented a nationwide evaluation program to monitor process and outcome of care for substance abuse patients. This program focuses on the changing characteristics of VA substance abuse patients and treatment services and involves outcome-based evaluations of major VA substance abuse treatment modalities. Initial findings show that VA substance abuse patients, including patients with concomitant psychiatric disorders, improve substantially from treatment intake to a 1-year follow-up and that community residential facilities are an important part of the continuum of substance abuse care. Moreover, within broad limits, there is a dose-response relationship between the continuity of outpatient mental health care and better 1-year substance use and psychosocial outcomes. These findings are placed into context as part of an evidence-based initiative to improve the quality of VA mental health care.
View details for Web of Science ID 000083697400007
View details for PubMedID 10446663
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Outcomes of the treatment climate in psychiatric and substance abuse programs
JOURNAL OF CLINICAL PSYCHOLOGY
1998; 54 (8): 1137-1150
Abstract
This study examines how key aspects of the treatment climate are related to program differences in the aggregate behaviors of patients residing in 89 psychiatric or substance abuse facilities. More active support, personal expression, and practical orientation were related to better patient functioning, more patient activity in the facility and in the community, and more use by patients of the program's health-treatment services and social-recreational activities. These results held for both patients' and staff members' consensual perceptions of the treatment climate. On the whole, these aspects of the treatment milieu were especially beneficial for groups of patients with greater psychiatric impairment.
View details for Web of Science ID 000077013900012
View details for PubMedID 9840784
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During treatment changes in substance abuse patients with posttraumatic stress disorder - The influence of specific interventions and program environments
JOURNAL OF SUBSTANCE ABUSE TREATMENT
1998; 15 (6): 555-564
Abstract
Male substance abuse patients with posttraumatic stress disorder (PTSD) (SA-PTSD; N = 140) were compared to patients with only substance use disorders (SA-only; N = 1,262), and those with other Axis I diagnoses (SA-PSY; N = 228) on changes during substance abuse treatment. Diagnoses were determined by chart review, and patients completed questionnaires assessing coping, cognitions, and psychological distress. Although SA-PTSD patients improved on outcomes during treatment, they showed less benefit relative to SA-only patients. At discharge, SA-PTSD patients reported less use of effective coping styles, and endorsed more positive beliefs about substance use than SA-only patients. They had more psychological distress than SA-only and SA-PSY patients. More counseling sessions devoted to substance abuse and family problems, and increased involvement in 12-step activities partially counteracted the negative effects of having a PTSD diagnosis on several outcomes. SA-PTSD patients reported fewer psychological symptoms at discharge in programs that were high in support and order/organization.
View details for Web of Science ID 000077210000009
View details for PubMedID 9845869
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Influence of outpatient treatment and 12-step group involvement on one-year substance abuse treatment outcomes
JOURNAL OF STUDIES ON ALCOHOL
1998; 59 (5): 513-522
Abstract
This study examined whether substance abuse patients self-selecting into one of three aftercare groups (outpatient treatment only, 12-step groups only, and outpatient treatment and 12-step groups) and patients who did not participate in aftercare differed on 1-year substance use and psychosocial outcomes.A total of 3,018 male patients filled out a questionnaire at intake and 1 year following discharge from treatment. Patients were classified into aftercare groups at follow-up using information from VA databases and self-reports.Patients who participated in both outpatient treatment and 12-step groups fared the best on 1-year outcomes. Patients who did not obtain aftercare had the poorest outcomes. In terms of the amount of intervention received, patients who had more outpatient mental health treatment, who more frequently attended 12-step groups or were more involved in 12-step activities had better 1-year outcomes. In addition, patients who kept regular outpatient appointments over a longer time period fared better than those who did not.Encouraging substance abuse patients to regularly attend both outpatient aftercare and self-help groups may improve long-term outcomes.
View details for Web of Science ID 000075215500004
View details for PubMedID 9718103
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The long-term interplay between family and extrafamily resources and depression
JOURNAL OF FAMILY PSYCHOLOGY
1998; 12 (3): 326-343
View details for Web of Science ID 000076081200003
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Predicting the development of late-life late-onset drinking problems: A 7-year prospective study
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
1998; 22 (6): 1349-1358
Abstract
There has been little empirical study of risk factors for the development of late-life late-onset drinking problems. In the current prospective study, we compare two groups of older adults who, at a baseline assessment, were nonproblem drinkers: individuals who developed drinking problems over the course of the next 7 years (n = 77) and those who did not (n = 197). Late-onset problem drinkers reported mild to moderate drinking problems and spontaneous remission rates were high. Compared with stable nonproblem drinkers, late-onset problem drinkers at baseline were more likely to report incipient problems, heavier alcohol consumption, greater friend approval of drinking, more reliance on avoidance coping strategies, were more likely to smoke, and were less likely to have acute medical conditions that could potentially be complicated by alcohol consumption. Contrary to expectation, life stressors did not predict drinking problem onset. However, compared with stable nonproblem drinkers, late-onset problem drinkers were more likely to have a history of responding to stressors and negative affect with increased alcohol consumption.
View details for Web of Science ID 000075956300022
View details for PubMedID 9756052
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Family and extrafamily resources and the 10-year course of treated depression
JOURNAL OF ABNORMAL PSYCHOLOGY
1998; 107 (3): 450-460
Abstract
A group of 313 depressed patients and 284 controls was assessed at baseline (treatment intake for the patients) and at 1-year, 4-year, and 10-year follow-ups. Stably remitted patients achieved levels of family and extrafamily resources that were comparable with those of the controls. Although partially remitted and nonremitted patients' social resources improved, they continued to show deficits in these areas relative to controls and stably remitted patients. Several indexes of social resources predicted stable remission: more family independence, fewer family arguments and less conflict, and more helpful friends and activities with friends. Assessment of social resources at treatment intake and short-term follow-ups can help identify and provide intervention foci for patients at risk for nonremission of depression.
View details for Web of Science ID 000075300400009
View details for PubMedID 9715580
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Risk factors for sustained nonremission of depressive symptoms - A 4-year follow-up
JOURNAL OF NERVOUS AND MENTAL DISEASE
1998; 186 (8): 462-469
Abstract
Previous studies have suggested that a considerable number of depressed patients suffer from sustained or repeated episodes of depressive symptoms. We developed a risk factor index based on data obtained at admission to treatment predicting sustained nonremission of depressive symptoms over 4 years for a sample of 370 unipolar depressed inpatients and outpatients. The six risk factors for sustained nonremitted depression are: less education, more severe initial depressive mood and ideation, secondary major depression, prior treatment, comorbid medical conditions, and fewer close relationships. These findings suggest that identification of these risk factors before selecting treatment type and intensity may improve long-term clinical outcomes.
View details for Web of Science ID 000075368100003
View details for PubMedID 9717863
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Evaluating substance abuse treatment process models: I. Changes on proximal outcome variables during 12-step and cognitive-behavioral treatment
JOURNAL OF STUDIES ON ALCOHOL
1998; 59 (4): 371-380
Abstract
This article provides data on the early linkages in the treatment process chains that are thought to underlie two prevalent approaches to substance abuse treatment-traditional 12-step treatment and cognitive-behavioral treatment. The focus is on the during-treatment changes on "proximal outcomes" that, according to the treatment theory underlying each modality, patients are supposed to undergo or achieve in order to experience a positive "ultimate outcome."In all, 3,228 men receiving treatment in 15 Department of Veterans Affairs substance abuse treatment programs were assessed at treatment entry and at or near discharge from inpatient programs that had desired lengths of stay of 21-28 days.Between intake and discharge, patients in 12-step programs improved more than did C-B patients on proximal outcome variables assumed to be specific to 12-step treatment (e.g., attending 12-step meetings, taking steps), whereas patients in cognitive-behavioral programs made no greater change (and in a few cases, less change) than did 12-step patients on proximal outcome variables assumed to underlie cognitive-behavioral treatment (e.g., self-efficacy, coping skills).These findings suggest that the proximal outcomes thought to be specific to cognitive-behavioral treatment are actually general proximal outcomes of both 12-step and cognitive-behavioral treatment.
View details for Web of Science ID 000074215100002
View details for PubMedID 9647419
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Life circumstances and personal resources as predictors of the ten-year course of depression
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
1998; 26 (2): 255-280
Abstract
A 10-year naturalistic study of 313 patients who entered treatment for unipolar depression and a community comparison group of 284 nondepressed adults was conducted. We compared life stressors, social resources, personal resources, and coping among patients who were remitted (N = 76), partially remitted (N = 146), or nonremitted (N = 91). Compared with the controls and the remitted patients, the partially remitted and nonremitted patients consistently experienced more life stressors and fewer social resources, were less easygoing, and relied more on avoidance coping. A less easygoing disposition, fewer close relationships, and more reliance on avoidance coping were associated with higher odds of experiencing a course of partial remission or nonremission. In addition, more depressive symptoms and medical conditions predicted nonremission.
View details for Web of Science ID 000074892200006
View details for PubMedID 9693692
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Determinants of the treatment climate in psychiatric and substance abuse programs: Implications for improving patient outcomes
JOURNAL OF NERVOUS AND MENTAL DISEASE
1998; 186 (2): 96-103
Abstract
This study examined determinants of the treatment climate in 89 psychiatric and substance abuse programs. Clearer policies giving patients more control, and more health and treatment services, were related to more supportive, autonomous, expressive, and practically oriented milieus. In contrast, more policy choice and daily living assistance were associated with less support, personal expression, and practical orientation. Programs in which staff had more paraprofessionals and better team functioning, and in which patients had more social resources and better mental functioning, tended to be more supportive and to have more emphasis on autonomy, personal expression, and practical orientation. Based on these results, we suggest some guidelines on how to change the treatment milieu to benefit patients' adjustment.
View details for Web of Science ID 000072034900005
View details for PubMedID 9484309
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Understanding the quality and outcome of treatment
SUBSTANCE USE & MISUSE
1998; 33 (14): 2789-2794
View details for Web of Science ID 000077506800006
View details for PubMedID 9869443
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First-time admissions with alcohol-related medical problems: A 10-year follow-up of a national sample of alcoholic patients
JOURNAL OF STUDIES ON ALCOHOL
1998; 59 (1): 89-96
Abstract
We estimated the rate of first-time hospital admission over 10 years with alcohol-related medical problems among a large national sample of patients with diagnosed alcohol abuse disorders.We identified a nationwide cohort of all patients (N = 46,680) discharged in 1980 from all Department of Veterans Affairs (VA) medical centers with alcohol-related diagnoses. Two comparison cohorts also were identified: patients with musculoskeletal disorders (N = 18,231) and a random sample of nonalcoholic patients (N = 45,204). Using secondary databases, ICD-9-CM coded diagnostic information was collected for all VA inpatient admissions these patients experienced over the decade following their index hospitalizations. Admission rates within age strata and age/race standardized rates were computed. Adjusted rate ratios were estimated using Poisson regression.Alcoholic patients were at substantial risk of admission for multiple medical disorders. Admission rates varied for patients of different ages. Those who were between 50 and 59 years of age during their index hospital stay were at the highest risk of admission with an alcohol-related medical disease over the subsequent decade.The admission rates for these medical disorders among alcoholic patients provide an important baseline estimate of individual patients' risk profiles and may help providers set priorities among diagnostic tests.
View details for Web of Science ID A1998YL44100011
View details for PubMedID 9498320
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The staff workplace and the quality and outcome of substance abuse treatment
JOURNAL OF STUDIES ON ALCOHOL
1998; 59 (1): 43-51
Abstract
The study examined the connection between the staff work environment and staff members' beliefs about treatment, the quality of the treatment environment, patients' involvement in treatment and self-help activities, and patients' improvement during treatment.Patient care staff (N = 329) in 15 substance abuse treatment programs reported on the characteristics of their work environment and on their beliefs and treatment orientations about substance abuse. Patients in these programs (N = 3,228) reported on the treatment environment, their participation in treatment and self-help activities, and their treatment goals, confidence in achieving these goals, and coping skills at intake to and discharge from treatment.Staff in supportive and goal-directed work environments were more likely to espouse disease model beliefs and a 12-step orientation toward substance abuse treatment. These work environments were associated with more supportive and goal-directed treatment environments. Patients in these treatment environments participated in more substance abuse, educational and social, and family treatment services, were more involved in self-help groups (as indicated by attending more meetings, reading 12-step materials, and having a sponsor and friends in such groups), were more satisfied with the program, improved more during treatment (as indicated by abstinence goals and confidence in maintaining abstinence, less depression, and more substance abuse and general coping skills), and were more likely to participate in outpatient mental health care after discharge.More goal-directed work environments are associated with more goal-directed treatment environments and patients' engagement in treatment and improvement. The staff work environment is an important component of the substance abuse treatment system.
View details for Web of Science ID A1998YL44100005
View details for PubMedID 9498314
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Policy-relevant program evaluation in a national substance abuse treatment system
JOURNAL OF MENTAL HEALTH ADMINISTRATION
1997; 24 (4): 373-385
Abstract
This article discusses recent trends in public and private substance abuse services and offers suggestions on how the evaluation of such services can inform clinical practice and policy making. This analysis focuses particularly on the Department of Veterans Affairs (VA), which operates the largest substance abuse treatment system in the United States. In recent years, there has been an erosion of services for substance abuse outside the VA. In contrast, due to increased funding from the U.S. Congress, the VA significantly expanded substance abuse treatment from 1990 to 1994. However, efforts to "reinvent" and downsize government initiated a reversal of this growth trend in 1994, and VA services may shrink further as the system becomes more decentralized and adopts managed care strategies from the private sector. Drawing from the VA Program Evaluation and Resource Center's (PERC) experience of evaluating the VA system and working with federal policy makers, this article presents examples and suggestions for making evaluations of substance abuse treatment systems more useful in policy discussions and in day-to-day clinical practice.
View details for Web of Science ID 000070961800001
View details for PubMedID 9364108
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Gender differences in the relations between depressive symptoms and drinking behavior among problem drinkers: A three-wave study
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1997; 65 (3): 392-404
Abstract
Prior research has suggested that the relation between depression and drinking behavior is stronger for women than for men. In a 3-wave study spanning 3 years, we examined the nature of reciprocal relations between depressive symptoms and drinking behavior among women (n = 207) and men (n = 207) seeking detoxification or referral services for their drinking problems. Latent variable structural equation modeling analyses revealed that more baseline depression was associated with less alcohol consumption 1 year later among women and men. However, later on, more depression predicted heavier alcohol consumption, but only among women. Among women and men, heavier alcohol consumption predicted more subsequent depression, although the timing of this effect differed by gender. Reciprocal effects between depression and drinking problems were found only among men.
View details for Web of Science ID A1997XA22300004
View details for PubMedID 9170762
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Social and community resources and long-term recovery from treated and untreated alcoholism
1996 Kettil-Bruun-Society Annual Meeting
ALCOHOL RES DOCUMENTATION INC CENT ALCOHOL STUD RUTGERS UNIV. 1997: 231–38
Abstract
Long-term studies of the course of alcoholism suggest that a variety of factors other than professional treatment influence the process of recovery. This study evaluated the role of demographic factors, baseline alcohol-related problems and depression, professional treatment, Alcoholics Anonymous (AA) and other social and community resources in predicting remission and psychosocial outcome over 8 years.A sample of 628 previously untreated alcoholic individuals was recruited at detoxification units and alcoholism information and referral services. Of these participants, 395 (68.2%) were followed 3 and 8 years later. Most (83.3%) were white (n = 329) and 50.1% (n = 198) were men. At each contact point, participants completed a self-administered inventory that assessed their current problems, treatment utilization, AA participation and quality of relationships.Number of inpatient treatment days received in the 3 years after baseline were not independently related to 8-year remission or psychosocial outcomes. More outpatient treatment in the first 3 years increased the likelihood of 8-year remission, but was not related to psychosocial outcomes. The number of AA meetings attended in the first 3 years predicted remission, lower depression, and higher quality relationships with friends and spouse/partner at 8 years. Extended family quality at baseline also predicted remission and higher quality friendships and family relationships at 8 years.Given that alcoholism is a chronic, context-dependent disorder, it is not surprising that short-term interventions have little long-term impact. Social and community resources that are readily available for long periods are more likely to have a lasting influence on the course of alcoholism.
View details for Web of Science ID A1997WU28900002
View details for PubMedID 9130214
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Social context, coping strategies, and depressive symptoms: An expanded model with cardiac patients
JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY
1997; 72 (4): 918-928
Abstract
This research broadened and refined a resources model of coping to encompass negative as well as positive aspects of social relationships and examined this expanded conceptualization in a 4-year prospective model with 183 cardiac patients (140 men and 43 women). Social support and social stressors in the family and extrafamily domains contributed significantly to a common social context latent construct. In addition, this conceptualization of social context was significantly related to depressive symptoms 4 years later. Especially important conceptually, coping strategies functioned as a mechanism through which both social support and social stressors related to subsequent depressive symptoms. Moreover, positive and negative aspects of social relationships made essentially unique contributions in predicting subsequent coping efforts.
View details for Web of Science ID A1997WT03200018
View details for PubMedID 9108704
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Twelve-step and cognitive-behavioral treatment for substance abuse: A comparison of treatment effectiveness
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1997; 65 (2): 230-240
Abstract
The comparative effectiveness of 12-step and cognitive-behavioral (C-B) models of substance abuse treatment was examined among 3,018 patients from 15 programs at U.S. Department of Veterans Affairs Medical Centers. Across program types, participants showed significant improvements in functioning from treatment admission to a 1-year follow-up. Although 12-step patients were somewhat more likely to be abstinent at the 1-year follow-up, 12-step, C-B, and combined 12-Step-C-B treatment programs were equally effective in reducing substance use and improving most other areas of functioning. The finding of equal effectiveness was consistent over several treatment subgroups: Patients attending the "purest" 12-step and C-B treatment programs, and patients who had received the "full dose" of treatment. Also, patients with only substance abuse diagnoses, those with concomitant psychiatric diagnoses, and patients who were mandated to treatment showed similar improvement at the 1-year follow-up, regardless of type of treatment received. These data provide important new evidence supporting the effectiveness of 12-step treatment.
View details for Web of Science ID A1997WP24900004
View details for PubMedID 9086686
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Posttraumatic stress disorder in substance abuse patients: Relationship to 1-year posttreatment outcomes
PSYCHOLOGY OF ADDICTIVE BEHAVIORS
1997; 11 (1): 34-47
View details for Web of Science ID A1997WN46800004
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Treatment of VA inpatients with diagnoses of substance abuse
PSYCHIATRIC SERVICES
1997; 48 (2): 171-171
View details for Web of Science ID A1997WG88400003
View details for PubMedID 9021845
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Psychosocial adjustment in patients reporting cardiac illness
PSYCHOLOGY & HEALTH
1997; 12 (3): 345-359
View details for Web of Science ID A1997XH38700004
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Participation in community residential treatment and substance abuse patients' outcomes at discharge
JOURNAL OF SUBSTANCE ABUSE TREATMENT
1997; 14 (1): 71-80
Abstract
The study sought to identify patient characteristics that predict participation in substance abuse treatment in community residential facilities (CRFs) and to examine the association between patient characteristics, participation in treatment, and outcomes at discharge from CRFs.A sample of 2,794 patients with substance abuse disorders was assessed at entry into and discharge from a representative set of 88 CRFs nationwide.In general, patients' psychological distress, motivation for treatment, prior involvement in self-help, and social resources predicted more engagement in CRF services and activities; prior inpatient treatment and the history of a psychiatric disorder predicted less engagement. These patient characteristics also predicted outcomes at discharge; more important, participation in treatment was positively and independently associated with such discharge outcomes as completion of the program and moving into stable residence. In addition, there was some evidence that participation in treatment counteracted the negative effects of high-risk patient characteristics on outcome.Participation in treatment is as important a predictor of outcomes at discharge from CRFs as are patient characteristics at intake to treatment. Suggestions are made about how providers can enhance patients' motivation to participate and remain in treatment.
View details for Web of Science ID A1997XH23900011
View details for PubMedID 9218240
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Community residential program policies, services, and treatment orientations influence patients' participation in treatment
JOURNAL OF SUBSTANCE ABUSE
1997; 9: 171-187
Abstract
The study sought to identify community residential program characteristics that predict patients' participation in treatment and to examine the association between these characteristics, participation, and outcomes at discharge from treatment. A sample of 2,790 patients with substance abuse disorders was assessed at entry into and discharge from 87 community residential facilities (CRFs). The CRFs were assessed using a survey that obtained information about program size and staffing, policies and services, and treatment orientation. High expectations for patients' functioning, clear policies, structured programming, a high proportion of staff in recovery from substance abuse problems, and more emphasis on psychosocial treatment were associated with patients' participation in program services and activities. Higher expectations for functioning and a strong treatment orientation enhanced participation more among better functioning patients; program support and structure enhanced participation more among impaired patients. Participation in treatment independently predicted outcomes at discharge even after both patient and program characteristics were controlled. These findings show that community residential program policies, services, and treatment orientations play a key role in influencing patients' engagement in treatment, which, in turn, improves patients' outcomes at discharge.
View details for Web of Science ID 000075017000014
View details for PubMedID 9494948
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The effectiveness of inpatient and outpatient treatment for alcohol abuse: The need to focus on mediators and moderators of setting effects
ADDICTION
1996; 91 (12): 1773-1796
Abstract
Previous reviews have concluded that there was no evidence for the superiority of inpatient over outpatient treatment of alcohol abuse, although particular types of patients might be more effectively treated in inpatient settings. In this review, we first consider the conceptual rationales that have been offered to support inpatient and outpatient treatment. Following that, the results of the relevant research on setting effects are presented. Five studies had significant setting effects favoring inpatient treatment, two studies found day hospital to be significantly more effective than inpatient treatment, and seven studies yielded no significant differences on drinking-related outcome variables. In all but one instance in which a significant effect emerged, patients in the 'superior' setting received more intensive treatment and patients were not 'preselected' for their willingness to accept random assignment to treatment in either setting. Studies finding significant setting effects also conducted more treatment contrasts (18.6 vs. 4.9), on average, and had a mean statistical power level of 0.71 (median 0.79) to detect a medium-sized effect, whereas studies with no significant findings had an average power level of 0.55 (median 0.57). When inpatient treatment was found to be more effective, outpatients did not receive a respite in the form of inpatient detoxification and the studies were slightly less likely to have social stability inclusion criteria and to use random assignment to treatment settings. We consider the implications of our findings for future research, especially the need to examine the conceptual rationales put forward by proponents of inpatient and outpatient treatment, i.e. mediators and moderators of setting effects.
View details for Web of Science ID A1996WB70200003
View details for PubMedID 8997760
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The influence of distance on ambulatory care use, death, and readmission following a myocardial infarction
HEALTH SERVICES RESEARCH
1996; 31 (5): 573-591
Abstract
To examine whether patients admitted for treatment of a myocardial infarction (MI) who live farther from their source of care are less likely to be followed in an outpatient clinic, and whether patients who receive follow-up care are less likely to die or to have a subsequent acute care admission.Department of Veterans Affairs (VA) databases to identify a national sample of 4,637 MI patients discharged in 1992, their use of care, and vital status within the subsequent year. Sociodemographics, comorbid diagnoses, invasive cardiac procedures, hospital teaching status, and distance to patients' admitting hospital were determined.Using these longitudinal data, we examined the relationship between patient characteristics, distance to care, and use of outpatient care after discharge. We then examined the relationship between the use of ambulatory care and subsequent death and readmission.Patients living more than 20 miles from their admitting hospital were less likely to use ambulatory services. Patients receiving ambulatory care were 79 percent as likely to die within the year as those without any follow-up care (95% C.I. = 0.66, 0.94). Patients living more than 20 miles from their admitting hospital were more likely to die independent of their likelihood of receiving VA outpatient follow-up. Among patients who did not die in the subsequent year, those receiving ambulatory care were 33 percent more likely to be readmitted to a VA hospital with a cardiac diagnosis (95% C.I. = 1.12, 1.57).Distance may pose a barrier to outpatient follow-up for some VA patients after a MI. It also may limit patients' ability to access medical care quickly in the event of a recurrent acute event. Ambulatory care after discharge may be an important factor determining survival for patients with cardiac disease.
View details for Web of Science ID A1996VV16000005
View details for PubMedID 8943991
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Addressing self-selection effects in evaluations of mutual help groups and professional mental health services: An introduction to two-stage sample selection models
EVALUATION AND PROGRAM PLANNING
1996; 19 (4): 301-308
View details for Web of Science ID A1996VZ90400003
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Datapoints. Psychiatric services in VA substance abuse treatment programs.
Psychiatric services
1996; 47 (11): 1203-?
View details for PubMedID 8916236
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Psychiatric services in VA substance abuse treatment programs
PSYCHIATRIC SERVICES
1996; 47 (11): 1203-1203
View details for Web of Science ID A1996VP79400007
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Life domains, alcoholics anonymous, and role incumbency in the 3-year course of problem drinking
JOURNAL OF NERVOUS AND MENTAL DISEASE
1996; 184 (8): 475-481
Abstract
This study examined the course of problem drinking among 439 individuals over 3 years, using a life domains perspective that distinguishes life stressors and social resources in different contexts. More severe chronic financial stressors both predicted and were predicted by more alcohol consumption and drinking-related problems. Among social resources, Alcoholics Anonymous was the most robust predictor of better functioning on multiple outcome criteria. Support from friends and extended family also predicted better outcomes; this effect was stronger for individuals who were low on primary role incumbency (i.e., who were unemployed and/or did not have a spouse/partner).
View details for Web of Science ID A1996VD33100004
View details for PubMedID 8752076
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Reduced substance-abuse-related health care costs among voluntary participants in alcoholics anonymous
International Congress on Alcohol and Drug Dependence
AMER PSYCHIATRIC ASSOCIATION. 1996: 709–13
Abstract
This study examined differences in outcomes, alcoholism treatment utilization, and costs between alcoholic individuals with no previous treatment history who chose to attend Alcoholics Anonymous (AA) or to seek help from a professional outpatient alcoholism treatment provider.Participants in this three-year prospective study were recruited at alcoholism information and referral services and at detoxification units in the San Francisco Bay Area. Chi square and t tests and repeated-measures analyses of variance were used to examine data gathered from interviews with 201 participants at baseline and at one and three years.At baseline, participants who chose to attend AA meetings (N = 135) were not significantly different from those who chose professional outpatient treatment (N = 66) in sex, marital status, employment, race, and symptoms of alcohol dependence and depression. However, AA attendees had lower incomes and less education and experienced more adverse consequences of drinking at baseline than did those who sought outpatient care, suggesting somewhat worse prognoses for the AA group. Over the three-year study, per-person treatment costs for the AA group were 45 percent (or $1,826) lower than costs for the outpatient treatment group. Despite the lower costs, outcomes for the AA group at both one and three years were similar to those of the outpatient treatment group.Voluntary AA participation may significantly reduce professional treatment costs. Clinicians, researchers, and policymakers should recognize the potential health care cost offsets offered by AA and other self-help organizations.
View details for Web of Science ID A1996UV45800006
View details for PubMedID 8807683
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Patterns of diagnoses, comorbidities, and treatment in late-middle-aged and older affective disorder patients: Comparison of mental health and medical sectors
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
1996; 44 (6): 682-688
Abstract
To compare the diagnoses, psychiatric and medical comorbidities, and prior and current treatment received by late-middle-aged and older affective disorder patients in mental health and medical service settings and to identify predictors of these patients' length of inpatient care.Department of Veterans Affairs (VA) nationwide databases are used to examine the prevalence, diagnoses, and inpatient and outpatient treatment received by affective disorder patients in mental health and medical units in Fiscal Year 1990.Compared with late-middle-aged and older index medical patients (n = 11,701), index mental health patients (n = 9039) were more likely to have affective psychoses and major depressive disorder and less likely to have depressive disorder NOS. Almost 60% of affective disorder patients in mental health settings had comorbid psychiatric diagnoses; this was true of 30% of patients in medical settings. Moreover, more than 80% of affective disorder patients in mental health settings had concomitant medical disorders. Affective disorder patients also had very high rates of prior mental health and medical care. Patients who had more severe affective disorders and comorbid psychiatric and medical diagnoses had longer episodes of inpatient care; in contrast, more intensive prior medical and mental health outpatient care was associated with shorter episodes of inpatient care.The findings highlight affective disorder patients' high rates of comorbidity and intensive use of health care resources, emphasize the value of outpatient care in reducing the amount of subsequent inpatient care, and underscore the need for closer integration of mental health and medical care.
View details for Web of Science ID A1996UP69200011
View details for PubMedID 8642160
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Alcohol consumption, life context, and coping predict mortality among late-middle-aged drinkers and former drinkers
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
1996; 20 (2): 313-319
Abstract
This study examined mortality risk for individuals in four alcohol consumption categories and identified life context and coping factors that independently predicted mortality among late-middle-aged drinkers and former drinkers (n = 1869). Compared with light drinkers, former drinkers (current abstainers) were at increased mortality risk; moderate drinkers were at decreased risk. Consistent with previous research on older samples, heavy drinkers were not at increased risk. Abstainers' increased risk was reduced in a model that controlled for life context and coping factors. Other independent predictors of mortality included reporting an illness stressor, stressor severity, less participation in activities with friends, greater use of resigned acceptance and alternative rewards coping, and less use of cognitive avoidance and emotional discharge coping. The findings support previous research on the alcohol-mortality relationship among older adults, and highlight the fact that abstainers' life stressors and avoidance coping responses may be more important predictors of their mortality than their abstention.
View details for Web of Science ID A1996UE73700017
View details for PubMedID 8730223
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Effects of work stressors and work climate on long-term care staff's job morale and functioning
RESEARCH IN NURSING & HEALTH
1996; 19 (1): 63-73
Abstract
Relationships between work stressors and work climate, and job morale and functioning were examined. Initial and 8-month follow-up data were obtained from 405 staff in 14 long-term care facilities. Relationship and workload stressors were related to less job satisfaction and intent to stay in the job, and more job-related distress, depression, and physical symptoms. Patient care task stressors were associated with better outcomes. More positive work climates were linked to higher job morale. Initial work stressors predicted poorer functioning, and coworker cohesion predicted more intent to stay in the job at follow-up.
View details for Web of Science ID A1996TR47800008
View details for PubMedID 8552804
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Late-life drinking behavior - The influence of personal characteristics, life context, and treatment
ALCOHOL HEALTH & RESEARCH WORLD
1996; 20 (3): 197-204
View details for Web of Science ID A1996WC83400009
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Late-Life Drinking Behavior: The Influence of Personal Characteristics, Life Context, and Treatment.
Alcohol health and research world
1996; 20 (3): 197-204
Abstract
Alcohol-related problems affect increasing numbers of older adults. Recent studies have begun to investigate problem drinking among older adults based on a conceptual model proposing correlations between personal characteristics, life context (i.e., environmental factors), treatment, and drinking-related outcomes. In a community sample of older problem and nonproblem drinkers, alcohol consumption, life stressors, social resources, and coping responses differed between the two groups, although these factors did not directly and uniformly affect late-life drinking behavior. Furthermore, drinking behavior did not always have the expected effects on older drinkers' life contexts. Findings from a sample of treated alcohol and other drug-abusing older patients demonstrated the importance of providing mental health aftercare for this group.
View details for PubMedID 31798169
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Outcomes of residential treatment of substance abuse in hospital and community-based programs
PSYCHIATRIC SERVICES
1996; 47 (1): 68-74
Abstract
The study sought to determine whether inpatient readmission rates differed for patients with substance use disorders who were treated in either hospital-based or community-based transitional residential care. Length of residential care and intensity of outpatient mental health aftercare were examined as predictors of readmission.Department of Veterans Affairs nationwide databases were used to document readmissions at one- and two-year intervals for male inpatients treated for substance use disorders who were discharged either to hospital-based (N = 2,190) or community-based (N = 4,490) residential care. Patients with and without concomitant psychiatric diagnoses were identified.Patients treated in community-based residential programs had lower one- and two-year readmission rates than patients who received hospital-based residential care. Longer episodes of residential care and more outpatient mental health care were also associated with lower readmission rates. Among patients with concomitant psychiatric disorders, those in hospital-based care benefited more from longer episodes of residential care and more intensive outpatient mental health aftercare. Residential care, longer episodes of care, and more outpatient mental health care were independent predictors of lower one- and two-year readmission rates after patient-based risk factors were controlled.The findings highlight the value of providing adequate amounts of residential and outpatient care for patients in substance abuse treatment, especially patients with concomitant psychiatric disorders.
View details for Web of Science ID A1996TN38700013
View details for PubMedID 8925349
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Recovering substance abuse staff members' beliefs about addiction
JOURNAL OF SUBSTANCE ABUSE TREATMENT
1996; 13 (1): 75-78
Abstract
This study of 329 substance abuse treatment staff assessed how recovery status, in combination with other variables, influences beliefs about the causes and treatment of substance abuse. About 15% (n = 47) of participants were "in recovery" from substance abuse problems; these staff members were not significantly different than nonrecovering staff members on education, age, race/ethnicity, years of clinical experience, or amount of client contact. When examined in a multiple regression equation that also included age, education, and treatment program goals and activities, staff members' recovery status was not associated with endorsement of disease and psychosocial models of substance abuse. However, being in recovery was associated with endorsing an eclectic approach to substance abuse treatment. The importance of recognizing the diversity of beliefs about substance abuse among recovering staff and of acknowledging that multiple influences affect all staff members viewpoints on treatment is discussed.
View details for Web of Science ID A1996UD52700009
View details for PubMedID 8699546
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Late-life problem drinking: Personal and environmental risk factors for 4-year functioning outcomes and treatment seeking
JOURNAL OF SUBSTANCE ABUSE
1996; 8 (2): 167-180
Abstract
Recent research emphasizes the importance of identifying older problem drinkers. However, very little is known about the longitudinal course and predictors of late-life problem drinking. This prospective study of late-life problem drinkers (N = 581) focused on predictors of alcohol consumption, drinking problems, depression, and treatment seeking over a 4-year interval. Heavier baseline alcohol use and being male independently predicted more alcohol consumption 4 years later; more baseline drinking problems and early-onset status independently predicted more drinking problems at follow-up. Independent of other factors, more initial depressive symptoms and chronic health stressors portended more depressive symptoms at follow-up. Individuals who initially sought more treatment, and who had more chronic health and spouse stressors at baseline, were more likely to seek help 4 years later. Heavier reliance on avoidance coping strategies heightened the risk that stressors and friends' approval of drinking would lead to more drinking problems at follow-up. However, for individuals who had more drinking problems at baseline, such environmental risk factors as negative health events and friend stressors predicted fewer subsequent drinking problems.
View details for Web of Science ID A1996VG72600002
View details for PubMedID 8880658
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Parental support, coping strategies, and psychological adjustment: An integrative model with late adolescents
JOURNAL OF YOUTH AND ADOLESCENCE
1995; 24 (6): 633-648
View details for Web of Science ID A1995TK50800001
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SHORT-TERM TREATMENT CAREERS AND OUTCOMES OF PREVIOUSLY UNTREATED ALCOHOLICS
JOURNAL OF STUDIES ON ALCOHOL
1995; 56 (6): 597-610
Abstract
To describe treatment selection and outcomes over a 3-year follow-up period for 439 individuals who had drinking problems and had not yet received formal treatment at baseline.By the 3-year follow-up, individuals had self-selected into one of four groups: no-treatment (n = 70), completed treatment (i.e., help was received only in Year 1 of follow-up: n = 109), additional treatment (i.e., help was received in Year 1, with more help in Years 2 and 3; n = 233), and delayed treatment (i.e., no help was received until Years 2 and 3 of follow-up; n = 27).Compared with individuals who remained untreated, individuals who sought help during Year 1 had more severe drinking problems, poorer psychosocial functioning and more negative life events at baseline; however, treated individuals had better drinking outcomes than untreated persons at the 1- and 3-year follow-ups. Compared to individuals who completed treatment in Year 1, additional treatment group members had more severe drinking problems at baseline and 1 year later, but better drinking outcomes at the 3-year follow-up. Formal treatment in conjunction with Alcoholics Anonymous (AA) was associated with better drinking outcomes than formal treatment alone. In addition, more involvement with formal inpatient or outpatient treatment, or AA, was associated with more improvement on drinking indices.Overall, the findings suggest a reciprocal relationship between individuals' functioning and their participation in alcohol abuse interventions.
View details for Web of Science ID A1995TD65500001
View details for PubMedID 8558890
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PROGRAM CHARACTERISTICS AND READMISSION AMONG OLDER SUBSTANCE-ABUSE PATIENTS - COMPARISONS WITH MIDDLE-AGED AND YOUNGER PATIENTS
JOURNAL OF MENTAL HEALTH ADMINISTRATION
1995; 22 (4): 332-345
Abstract
Older substance abuse patients were compared to middle-aged and younger patients before, during, and after an index episode of inpatient care in 1 of 88 substance abuse treatment programs. Associations between program characteristics and readmission rates adjusted for key differences in the types of patients in different programs varied by age group. Among older patients, more structured program policies, more flexible rules about discharge, more comprehensive assessment, and more outpatient mental health aftercare were associated with lower casemix-adjusted readmission rates. More intensive treatment was associated with higher-than-predicted readmission. By contrast, among younger patients, more family involvement in assessment and treatment, community consultation, and treatment emphasizing the development of social and work skills were associated with lower casemix-adjusted readmission rates. The findings suggest that intensive, directed treatment may be more effective for younger substance abuse patients, whereas a more supportive treatment regimen in a well-organized program and prompt outpatient aftercare may be especially helpful for older patients.
View details for Web of Science ID A1995TB17600001
View details for PubMedID 10172450
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DEPRESSION AND DRINKING BEHAVIOR AMONG WOMEN AND MEN - A 3-WAVE LONGITUDINAL-STUDY OF OLDER ADULTS
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1995; 63 (5): 810-822
Abstract
This 3-wave longitudinal study analyzed latent variable cross-lagged models of the relation between depressive symptoms and drinking behavior separately for 621 late-middle-aged women and 951 late-middle-aged men. Time lags of 1 and 3 years were used. Among women, heavier alcohol consumption predicted less depressive symptomatology 1 and 3 years later, whereas among men, having more depressive symptoms predicted less alcohol consumption later on. Including cross-temporal paths in the women's depression-drinking problems model did not provide a significant improvement over hypothesizing no cross-temporal effects. Among men, however, having more drinking problems was associated with fewer depressive symptoms 3 years later. These findings were robust in follow-up analyses controlling for the effects of socioeconomic and health status.
View details for Web of Science ID A1995RY27500018
View details for PubMedID 7593875
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ENTERING TREATMENT FOR ALCOHOL-ABUSE - A STRESS AND COPING MODEL
ADDICTION
1995; 90 (9): 1223-1240
Abstract
This study used a stress and coping model to examine the process of entering treatment among 515 problem drinkers without prior formal treatment for alcohol abuse who were recruited at alcoholism information/referral (I&R) and detoxification centers. Over a 1-year follow-up period, 76% of the individuals in the sample entered some form of treatment, including Alcoholics Anonymous. People were more likely to enter treatment if they perceived their drinking problem as more severe, had more dependence symptoms, experienced more adverse consequences as a result of drinking, had more symptoms of depression, were more self-derogating, experienced more negative life events in the past year, and/or experienced more stressors in various life domains. Facilitative factors also related positively to treatment entry: people who had sought help from non-formal treatment sources before, who recalled being referred to treatment programs by an I&R center, and/or who received detoxification at a center that had treatment services available on-site, also were more likely to enter treatment. For people with greater resources in multiple life domains the positive effects of days intoxicated, dependence symptoms and stressors on help-seeking were intensified. Overall, the findings suggest that perceived severity of drinking problem plays a central role in the treatment entry process and mediates the effects of many other intrapersonal and environmental variables in generating an impetus or readiness to seek treatment.
View details for Web of Science ID A1995RT99500015
View details for PubMedID 7580820
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2 PATHWAYS OUT OF DRINKING PROBLEMS WITHOUT PROFESSIONAL TREATMENT
ADDICTIVE BEHAVIORS
1995; 20 (4): 427-441
Abstract
This 3-year longitudinal study examined two recovery pathways among 135 problem drinking individuals who never received professional treatment. Almost half (48.3%) of those individuals for whom outcome could be clearly determined became moderate drinkers or stably abstinent. At baseline, individuals who subsequently became abstinent (n = 28) were of low socioeconomic status, had severe drinking problems, and believed their drinking was a very serious problem. Once they began their recovery, they relied heavily on Alcoholics Anonymous as a maintenance factor. In contrast, individuals who became moderate drinkers (n = 29) had higher socioeconomic status and more social support at baseline than did individuals who became abstinent or continued to have drinking problems. A logistic regression on baseline data showed that it was possible to predict which natural recovery pathway an individual drinker would follow. The implications of these findings for alcoholism treatment and policy are discussed.
View details for Web of Science ID A1995RH48600002
View details for PubMedID 7484324
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LONGER EPISODES OF COMMUNITY RESIDENTIAL CARE REDUCE SUBSTANCE-ABUSE PATIENTS READMISSION RATES
JOURNAL OF STUDIES ON ALCOHOL
1995; 56 (4): 433–43
Abstract
The study focuses on whether substance abuse patients who enter a community residential facility (CRF) after discharge from inpatient care obtain more outpatient mental health care and have lower readmission rates than comparable patients discharged directly to the community.A national sample of substance abuse patients (N = 5,176; 99% men) referred to CRFs after inpatient substance abuse care is compared to a matched sample of patients (N = 5,176; 99% men) discharged to the community.Compared with controls, CRF patients were more likely to obtain outpatient mental health aftercare and obtained more intensive care. Patients with longer episodes of CRF care had lower 6-month and 1-year readmission rates than patients who dropped out of CRFs and than matched controls. These findings held for patients who had only alcohol diagnoses, patients who had drug diagnoses and patients who had psychiatric diagnoses in addition to their substance abuse disorders. Longer length of CRF care and more outpatient mental health care were significant predictors of lower readmission rates after other risk factors for readmission were controlled.Longer episodes of community residential care can contribute to better outcomes for substance abuse patients, in part by maintaining patients' involvement in outpatient mental health care. CRFs may play an important role in the continuum of substance abuse patients' care.
View details for DOI 10.15288/jsa.1995.56.433
View details for Web of Science ID A1995RF31800010
View details for PubMedID 7674679
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SOCIAL SUPPORT, COPING, AND DEPRESSIVE SYMPTOMS IN A LATE-MIDDLE-AGED SAMPLE OF PATIENTS REPORTING CARDIAC ILLNESS
HEALTH PSYCHOLOGY
1995; 14 (2): 152-163
Abstract
This study tests a 1-year predictive model of depressive symptoms in a late-middle-aged sample of patients reporting diagnoses of cardiac illness. Results based on 325 individuals (248 men and 77 women) diagnosed with chronic cardiac illness, 71 individuals (52 men and 19 women) diagnosed with acute cardiac illness, and 219 healthy controls (129 men and 90 women) strongly supported the hypotheses. Compared with healthy persons, individuals with chronic and those with acute cardiac illness reported more depressive symptoms at follow-up. Women overall showed more depressive symptoms than did men, and women with cardiac illness were particularly vulnerable to behavioral manifestations of depressive symptoms. Integrative time-lag and prospective structural equation models indicated that, for individuals with cardiac illness, social support and adaptive coping strategies predicted fewer depressive symptoms.
View details for Web of Science ID A1995QM75300009
View details for PubMedID 7789351
- Development and application of new measures of life stressors, social resources, and coping responses. European Journal of Psychological Assessment 1995: 1-13
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STAY IN RESIDENTIAL FACILITIES AND MENTAL-HEALTH-CARE AS PREDICTORS OF READMISSION FOR PATIENTS WITH SUBSTANCE USE DISORDERS
PSYCHIATRIC SERVICES
1995; 46 (1): 66-72
Abstract
This study examined the relationship between substance abuse patients' length of stay in community residential facilities and their outpatient mental health aftercare and readmission for inpatient care.A national sample of 1,070 substance abuse patients referred to community residential facilities after an episode of inpatient care was assessed and followed over four years. Patients were divided into three groups: those with only alcohol-related diagnoses; those with drug-related diagnoses, most of whom also had alcohol diagnoses; and those with concomitant psychiatric diagnoses.Patients who had longer episodes of care in residential facilities were more likely to obtain outpatient mental health aftercare and were less likely to be readmitted for additional substance abuse or psychiatric care in six-month, one-year, and four-year follow-up intervals. Readmission rates among substance abuse patients with psychiatric diagnoses were much higher than rates among patients who had only substance abuse diagnoses. Length of stay in the community residential facility and postdischarge outpatient mental health care remained significant independent predictors of lower readmission after other risk factors for readmission were considered.Transitional community residential care can contribute to substance abuse patients' treatment outcome; however, longer-term supportive care is needed for substance abuse patients with more severe and chronic disorders.
View details for Web of Science ID A1995QL26800014
View details for PubMedID 7895125
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Substance abuse treatment programs and processes: linkages to patients' needs and outcomes.
Journal of substance abuse
1995; 7 (1): 1-8
View details for PubMedID 7655307
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Measuring substance abuse program treatment orientations: the Drug and Alcohol Program Treatment Inventory.
Journal of substance abuse
1995; 7 (1): 61-78
Abstract
Assessment of therapeutic orientation is a significant problem in substance abuse program evaluation. This study reports the initial results of a new approach to measuring treatment orientation through a self-report survey that focuses on distinctive features of substance abuse treatment orientations. The Drug and Alcohol Program Treatment Inventory (DAPTI) assesses treatment goals and activities specific to eight orientations: AA/12 Step, Therapeutic Community, Cognitive-Behavioral, Insight/Psychodynamic, Rehabilitation, Dual Diagnosis, Medical and Marital/Family Systems. We present findings from a nationwide assessment of 327 Veterans Administration (VA) Substance Abuse treatment programs that demonstrate promising subscale internal consistency, discriminant validity, and concurrent validity. In addition, the DAPTI distinguishes between programs with independently verified orientations and between inpatient, extended care, outpatient, and methadone maintenance programs. The DAPTI may be helpful in systematically assessing differences in treatment orientations between different types of programs, such as inpatient, community residential, and outpatient care.
View details for PubMedID 7655312
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Inpatient treatment for substance abuse patients with psychiatric disorders: a national study of determinants of readmission.
Journal of substance abuse
1995; 7 (1): 79-97
Abstract
This study examined the patient case mix and program determinants of 6-month readmission rates and early treatment dropout for 7,711 VA inpatients with both substance abuse and major psychiatric disorders treated in one of 104 substance abuse programs. Patients were treated in one of three types of inpatient programs: explicitly designed dual diagnosis specialty programs, substance abuse programs with a dual diagnosis psychotherapy group or standard substance abuse programs. Dual diagnosis specialty programs differed from regular substance abuse programs in that they had a more severe case mix, a higher 180-day readmission rate, greater dual diagnosis treatment orientation, used more psychotropic medication, had longer lengths of stay, had greater tolerance of relapse and medication noncompliance, and a higher rate of psychiatric aftercare in the 30 days after discharged. Programs with less severe case mix, longer intended and actual length of stay, lower 7-day dropout rates, greater tolerance of problem behavior, 12-step groups, and higher immediate postdischarge utilization of outpatient mental health treatment lower 180-day readmission rates. Programs with less severe patient case mix, more use of psychotropic medications but less of methadone and antabuse, less varied and diverse treatment activities, and low use of patient-led groups had lower dropout rates.
View details for PubMedID 7655313
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ACUTE AND CHRONIC STRESSORS, SOCIAL RESOURCES, AND FUNCTIONING AMONG ADOLESCENTS WITH JUVENILE RHEUMATIC DISEASE
JOURNAL OF RESEARCH ON ADOLESCENCE
1995; 5 (3): 361-385
View details for Web of Science ID A1995QZ52200004
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APPLYING A STRESS AND COPING FRAMEWORK TO RESEARCH ON MUTUAL HELP ORGANIZATIONS
JOURNAL OF COMMUNITY PSYCHOLOGY
1994; 22 (4): 312-327
View details for Web of Science ID A1994PQ01700003
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RATES AND PREDICTORS OF 4-YEAR READMISSION AMONG LATE-MIDDLE-AGED AND OLDER SUBSTANCE-ABUSE PATIENTS
JOURNAL OF STUDIES ON ALCOHOL
1994; 55 (5): 561-570
Abstract
This naturalistic study examines treatment, diagnoses and readmission among late-middle-aged and older (age 55+) substance abuse inpatients (N = 16,066) in Department of Veterans Affairs Medical Centers. Over an interval extending from 4 years before to 4 years after an index episode of care, older substance abuse patients used substantial amounts of inpatient and outpatient treatment. Service use was heaviest among patients with a concomitant psychiatric disorder, and there was no evidence that it declined over time in the overall group. Four-year readmission rates in three diagnostic subgroups (alcohol or drug dependence diagnosis only, alcohol or drug psychoses, substance dependence and/or psychoses with one or more psychiatric diagnoses) were very high (57% to 70%); however, they were somewhat lower among patients with less chronic substance abuse problems. Readmission and multiple readmission were predicted by younger age, unmarried status, more prior service use, alcohol psychosis or psychiatric diagnoses, treatment in a psychiatric unit, and shorter hospital stay. These factors may be used at admission and discharge to identify patients at risk for rehospitalization; inpatient treatment and aftercare can be planned accordingly.
View details for Web of Science ID A1994PE49000006
View details for PubMedID 7990466
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REMISSION OF LATE-LIFE DRINKING PROBLEMS - A 4-YEAR FOLLOW-UP
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
1994; 18 (4): 835-844
Abstract
This 4-year follow-up study compared stably remitted late-life problem drinkers to nonremitted problem drinkers and nonproblem drinkers. At time 1, to-be-remitted drinkers reported less alcohol consumption and fewer drinking problems, more depression and less self-confidence, less spousal support and approval of drinking from friends, and more help-seeking than did to-be-nonremitted drinkers. Remitted drinkers showed improvement in functioning and life context at the 4-year follow-up, but compared with nonproblem drinkers some deficits persisted. Stable remission and abstinence among late-onset drinkers were closely tied to receiving less spousal support and approval from friends for drinking at time 1, whereas help-seeking was a strong predictor of stable remission and abstinence among early-onset problem drinkers. For both late- and early-onset drinkers, abstinence was predicted by initially having more drinking problems, depression, and health stressors.
View details for Web of Science ID A1994PC77400011
View details for PubMedID 7978093
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SOCIAL SUPPORT, APPRAISALS OF EVENT CONTROLLABILITY, AND COPING - AN INTEGRATIVE MODEL
JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY
1994; 66 (6): 1094-1102
View details for Web of Science ID A1994NQ17300010
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DETERMINANTS OF READMISSION FOLLOWING INPATIENT SUBSTANCE-ABUSE TREATMENT - A NATIONAL STUDY OF VA PROGRAMS
MEDICAL CARE
1994; 32 (6): 535-550
Abstract
This study examines program determinants of one aspect of VA inpatient substance abuse treatment program performance. Performance was measured by the ratio of a program's readmission rate to the expected rate for programs with similar patients. Six-month readmission rates in 101 VA treatment programs were analyzed. Preliminary analyses indicated that patient differences across programs accounted for 36% of the variance in readmission rates. Program differences accounted for 47% of the variance in case-mix-adjusted readmission rate. Among program factors selected through a literature review, better than expected readmission performance was associated with having fewer early discharges, a longer intended treatment duration, more patient participation in aftercare, more family or friend assessment interviews, and treating more patients on a compulsory basis. Performance was not related to stress management training, patient attendance at more self-help meetings during treatment, staff characteristics, or average staff costs per patient day. The findings indicate that treatment retention, duration, and increased aftercare may be targeted to reduce high readmission rates. Last, there were only small differences in the model over 30, 60, 90, and 365 day follow-up intervals, suggesting substantial stability of the findings.
View details for Web of Science ID A1994NQ01400001
View details for PubMedID 8189773
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OUTCOME OF TREATMENT FOR ALCOHOL-ABUSE AND INVOLVEMENT IN ALCOHOLICS-ANONYMOUS AMONG PREVIOUSLY UNTREATED PROBLEM DRINKERS
JOURNAL OF MENTAL HEALTH ADMINISTRATION
1994; 21 (2): 145-160
Abstract
A sample of 515 initially untreated problem drinkers was followed for one year after contacting alcohol information and referral or detoxification services. At a one-year follow-up, participants had self-selected into one of four groups: no treatment (24%), Alcoholics Anonymous (AA) only (18%), outpatient treatment (25%), and residential or inpatient treatment (32%); some outpatients also attended AA, and some inpatients also attended AA and/or outpatient programs. These four groups were compared on changes in drinking-related variables, other aspects of functioning, and stressors and resources over the follow-up year. Also examined were associations between amount of treatment and outcomes at one year. All four groups improved on drinking and functioning outcomes but changed less on stressors and resources. Although individuals who received no help improved, persons in the two treatment and the AA-only groups improved more, particularly on drinking-related outcomes. Inpatients were more likely than outpatients or AA-only participants to be abstinent; otherwise, type of intervention had few differential effects. More AA attendance was associated with abstinence among AA-only, outpatient, and inpatient group members. Among outpatients and inpatients, more formal treatment was associated with abstinence and improvement on other drinking-related outcomes.
View details for Web of Science ID A1994NF02900003
View details for PubMedID 10133776
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DIAGNOSTIC SUBGROUPS AND PREDICTORS OF ONE-YEAR RE-ADMISSION AMONG LATE-MIDDLE-AGED AND OLDER SUBSTANCE-ABUSE PATIENTS
JOURNAL OF STUDIES ON ALCOHOL
1994; 55 (2): 173-183
Abstract
This naturalistic study uses data based on clinical records to examine treatment utilization and 1-year re-admission rates among three diagnostic subgroups of late-middle-aged and older substance abuse inpatients in Department of Veterans Affairs (VA) Medical Centers: inpatients with only an alcohol or drug dependence diagnosis (n = 11,652); inpatients with an alcohol or drug psychosis (n = 3,510); and inpatients with an alcohol or drug disorder and a concomitant psychiatric disorder (n = 5,977). As expected, substance abuse patients in the latter two subgroups received more treatment before, during and following an index episode of care than did patients with only an alcohol or drug dependence diagnosis. From a broad perspective, these results indicate a match between treatment services and patient needs. However, relatively few older substance abuse patients received outpatient mental health aftercare; this was true especially of patients with alcohol or drug psychosis diagnoses. The 1-year re-admission rate in the group overall was higher than that usually reported in younger and mixed-age groups of substance abuse patients. Re-admission was predicted by unmarried status (a predisposing factor) and need, as indexed by several diagnostic and treatment characteristics.
View details for Web of Science ID A1994MZ01300007
View details for PubMedID 8189738
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MORTALITY-RATES AND PREDICTORS OF MORTALITY AMONG LATE MIDDLE-AGED AND OLDER SUBSTANCE-ABUSE PATIENTS
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
1994; 18 (1): 187-195
Abstract
This study describes mortality rates and predictors of mortality among late-middle-aged and older (55+) substance abuse inpatients (n = 21,139) in Department of Veterans Affairs (VA) Medical Centers in the 4 years after an index episode of care. A total of 24% of the patients died; this mortality rate was 2.64 times higher than expected. Predictors of earlier mortality included older age and nonmarried status, alcohol psychosis and organic brain disorder diagnoses, and several medical diagnoses, including neoplasms, liver cirrhosis, respiratory, endocrine and metabolic, and blood system disorders. Three proxy indicators of illness severity also predicted mortality: more prior inpatient and outpatient medical care and an index episode in an extended care unit. In contrast, more prior outpatient mental health care and remitted status predicted lower mortality. These diagnostic and treatment indicators can be used to identify patients at heightened risk for premature mortality. Moreover, they show that intensive mental health aftercare and remission of substance abuse may delay mortality, even among older patients who have longstanding substance abuse problems.
View details for Web of Science ID A1994MZ33500031
View details for PubMedID 8198219
- Group Residences for Older Adults: Physical Features, Policies, and Social Climat. New York: Oxford 1994
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WHY DO SOME PEOPLE RECOVER FROM ALCOHOL DEPENDENCE, WHEREAS OTHERS CONTINUE TO DRINK AND BECOME WORSE OVER TIME
ADDICTION
1994; 89 (1): 31–34
Abstract
For more than three decades, my colleagues and I have examined factors that help people overcome adversity, in particular how personal and treatment factors and the broader social context influence recovery from alcoholism. Guided by a demanding Guardian Angel, we have formulated conceptual models that raise key issues, developed tentative measures of key constructs, and conducted long-term naturalistic studies. In an ongoing odyssey of quest and discovery, we have identified interrelated factors that are important to predicting outcomes. These factors include personal resources and specific aspects of treatment, life context, and appraisal and coping. Such basic processes are also broadly relevant to remission and recovery from depression and other disorders. The answers to each question we have addressed point to more intriguing and complex issues to consider before we will grasp the essence of why some people adapt to adversity so much better than others do.
View details for DOI 10.1111/j.1360-0443.1994.tb00846.x
View details for Web of Science ID A1994MT35500010
View details for PubMedID 8148741
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Personal and environmental risk factors as predictors of alcohol use, depression, and treatment-seeking: a longitudinal analysis of late-life problem drinkers.
Journal of substance abuse
1994; 6 (2): 191-208
Abstract
We examined how personal risk factors (prior functioning, male, unmarried, early onset of drinking problems, and avoidance coping) and environmental risk factors (negative life events, chronic stressors, and friends' approval of drinking) predicted changes in older problem drinkers' (N = 659) adaptation over a 1-year interval. Personal risk factors independently predictive of poorer outcomes included poorer prior functioning, being male, and more use of avoidance coping strategies. Of environmental risk factors, negative life events, chronic health and spouse stressors, and having more friends who approved of drinking were independent predictors of poorer follow-up functioning and treatment seeking. Interactions between personal and environmental risk factors helped predict subsequent alcohol consumption and treatment seeking. For example, lighter drinkers were more likely than heavier drinkers to curtail alcohol use in response to new health events; friends more strongly influenced the treatment seeking of unmarried problem drinkers and individuals who used more avoidance coping strategies.
View details for PubMedID 7804018
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PARENTAL RISK AND RESISTANCE FACTORS AMONG CHILDREN WITH JUVENILE RHEUMATIC DISEASE - A 4-YEAR PREDICTIVE STUDY
JOURNAL OF BEHAVIORAL MEDICINE
1993; 16 (6): 571-588
Abstract
Examined the extent to which baseline functioning and parental risk and resistance factors predicted disease-related (functional disability and pain) and psychosocial functioning (social competence and behavior problems) 4 years later among 172 children with juvenile rheumatic disease. The study also examined the extent to which fathers' risk and resistance factors explained patients' adaptation, above and beyond maternal factors. Poorer baseline functioning was a strong risk factor that predicted poorer functioning 4 years later. In addition, parental risk and resistance factors at baseline predicted patients' adjustment after patients' age and baseline functioning were controlled. Mothers' and fathers' personal strain and depressed mood, and fathers' drinking problems, were associated with poorer patient adjustment; mothers' and fathers' social functioning appeared to aid patients' adjustment. Fathers' risk and resistance factors contributed independently from those of mother, to predict patients' outcome.
View details for Web of Science ID A1993MP31200002
View details for PubMedID 8126713
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RELATIONSHIP, TASK AND SYSTEM STRESSORS IN THE HEALTH-CARE WORKPLACE
JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY
1993; 3 (4): 285-298
View details for Web of Science ID A1993MB52700005
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WORK STRESSORS IN HEALTH-CARE - CONTEXT AND OUTCOMES
JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY
1993; 3 (4): 235-242
View details for Web of Science ID A1993MB52700001
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THE CONTEXTS OF ADOLESCENTS CHRONIC LIFE STRESSORS
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
1993; 21 (4): 397-420
Abstract
Proposed and tested a model of the determinants of adolescents' chronic life stressors, consisting of sociodemographic, personal, and contextual stress and coping factors, using baseline and 1-year follow-up data from 259 adolescents who varied in their psychological and physical health. Concurrent regression analyses at Time 1 and at Time 2, and longitudinal regressions that controlled for the levels of chronic stressors 1 year earlier, showed that sociodemographic, personal, and contextual factors each made a significant contribution to predicting adolescents' ongoing stressors with their mother, father, siblings friends and classmates and teachers at school. Personal factors of an emotional temperament and low perceived self-worth, and contextual factors of more negative life events and fewer social resources, were related to more chronic stressors. Suggestions for further development of the model are discussed.
View details for Web of Science ID A1993NE91700001
View details for PubMedID 8192118
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PATTERNS OF DIAGNOSIS AND TREATMENT AMONG LATE-MIDDLE-AGED AND OLDER SUBSTANCE-ABUSE PATIENTS
JOURNAL OF STUDIES ON ALCOHOL
1993; 54 (4): 479-487
Abstract
This study examines the diagnoses and treatment received by a cohort (N = 22,678) of late-middle-aged and older substance abuse patients. More than 23% of substance abuse inpatients admitted to Department of Veterans Affairs (VA) Medical Centers in fiscal year 1987 were 55 years of age or older. Most of these patients had multiple health problems. More than 90% had an alcohol-related diagnosis; almost 30% were diagnosed with a psychiatric disorder; and more than 80% had a medical disorder. Compared with their younger counterparts, older substance abuse patients were less likely to receive specialized inpatient or outpatient treatment specifically directed toward their substance abuse or psychiatric problems. In general, older substance abuse patients received services oriented more toward medical management than toward rehabilitative substance abuse or psychiatric care. These findings imply a need to develop treatment programs tailored to the characteristics and substance abuse problems of older patients, and to encourage more use of specialized outpatient aftercare services by these individuals.
View details for Web of Science ID A1993LJ82800012
View details for PubMedID 8393499
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GENDER DIFFERENCES IN THE INDIVIDUAL CHARACTERISTICS AND LIFE CONTEXTS OF LATE-MIDDLE-AGED AND OLDER PROBLEM DRINKERS
ADDICTION
1993; 88 (6): 781-790
Abstract
This study focuses on gender differences in the individual characteristics and life contexts of late-life problem drinkers. Late-middle-aged women with drinking problems (n = 183) consumed less alcohol, had fewer drinking problems, and reported more recent onset of drinking problems than did their male counterparts (n = 476). They also used more psychoactive medications, were more depressed, and were less likely to seek alcohol treatment. Consistent with a gender role perspective on alcohol abuse, problem-drinking women had more family-related and fewer financial stressors than did problem-drinking men. Contrary to expectation, however, problem-drinking women reported more support from children, extended family members, and friends than did problem-drinking men. Moreover, women who continued to have drinking problems over a 1-year interval reported some unexpected short-term benefits at follow-up, including reduced spouse stressors. Women who had remitted at follow-up experienced less spouse support, and more family-related stressors and depression than did remitted men. They also lost support from extended family members over the 1-year interval. The results suggest a need for screening and treatment efforts tailored more closely to the life circumstances of women with late-life drinking problems.
View details for Web of Science ID A1993LG24000006
View details for PubMedID 8329969
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QUALITY OF CARE AND OUTCOMES OF CHRONIC MENTALLY-ILL PATIENTS IN HOSPITALS AND NURSING-HOMES
HOSPITAL AND COMMUNITY PSYCHIATRY
1993; 44 (3): 241-246
Abstract
Quality of care in three types of facilities in which chronic mentally ill patients reside was examined to determine how it was related to patient functioning and to determine how patients' dependency on others for self-care moderated relationships between quality of care and patient functioning.Discriminant function analyses and multiple regression analyses were used to examine 12-month follow-up data from a Department of Veterans Affairs (VA) study of 294 chronic mentally ill patients in 52 community nursing homes, nine VA nursing home care units, and 43 VA hospital psychiatric units.The three types of facilities were best differentiated by staff and resident characteristics and facility policies. Residents of community nursing homes were more impaired, and staff were less well trained, than in the VA facilities. The community nursing homes had less restrictive policies. Patients who lived in facilities that gave them more control over their daily lives and that had larger proportions of high-functioning patients reported more life satisfaction and vigor. Patients in facilities with more social and recreational activities reported less life satisfaction. The extent to which facility features were beneficial or harmful was related to patients' self-care dependency. Supportive physical features and living-assistance services tended to aid impaired residents, whereas more experienced staff and policies that promoted control by residents tended to aid independent residents.Program managers may need to tailor facility environments to patients' level of functioning to maximize beneficial effects.
View details for Web of Science ID A1993KP04800007
View details for PubMedID 8444434
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The process of treatment selection among previously untreated help-seeking problem drinkers.
Journal of substance abuse
1993; 5 (3): 203-220
Abstract
A sample of 515 untreated problem drinkers was followed up for 1 year after contacting alcohol information and referral or detoxification services. At the 1-year follow-up, participants were placed into one of four treatment status groups: no treatment (24%), Alcoholics Anonymous only (18%), outpatient (25%), and inpatient or residential (32%). Participants with fewer financial resources, more serious drinking problems, and poorer functioning at baseline were more likely to enter inpatient or residential programs than outpatient treatment. Persons who selected AA only for treatment were of lower socioeconomic status than outpatients, and were functioning better than those who opted for treatment in inpatient or residential settings. In general, individuals who entered treatment received a considerable amount of treatment. Poorer baseline functioning was related to attending more AA meetings or outpatient sessions, and to staying longer in inpatient or residential treatment. The results are discussed in the context of a conceptual model of selection into alcoholism treatment.
View details for PubMedID 8312728
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FUNCTIONING AMONG MOTHERS AND FATHERS OF CHILDREN WITH JUVENILE RHEUMATIC DISEASE - A LONGITUDINAL-STUDY
JOURNAL OF PEDIATRIC PSYCHOLOGY
1992; 17 (6): 705-724
Abstract
Examined the adaptation of mothers and fathers of children with juvenile rheumatic disease on two occasions, 1 year apart, using 159 married couples at Time 1, and 111 of these couples at Time 2. A stress and coping model was tested in which parental functioning is determined by ongoing life stressors (patient and spouse dysfunction), family resources, and parents' illness-related coping. Mothers reported more depression than fathers did. However, poorer concurrent functioning among both mothers and fathers was explained partly by patients having more functional disability, pain, and psychosocial problems. In addition, spouse's dysfunction and the parent's use of avoidance coping were related to poorer parental adaptation, both concurrently and 1 year later. The implications of the findings for developing stress and coping models of parental adaptation to having a chronically ill child, and for intervention strategies with parents, patients, and families, are discussed.
View details for Web of Science ID A1992KF36600002
View details for PubMedID 1484334
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A LONGITUDINAL-STUDY OF RISK AND RESISTANCE FACTORS AMONG CHILDREN WITH JUVENILE RHEUMATIC DISEASE
JOURNAL OF CLINICAL CHILD PSYCHOLOGY
1992; 21 (2): 132-142
View details for Web of Science ID A1992JC17800005
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New directions in substance abuse services: programmatic innovations in the Veterans Administration.
Journal of mental health administration
1992; 19 (1): 41-52
Abstract
The purpose of this paper to describe the Department of Veterans Affairs' (VA) recent expansion and enhancement of its substance abuse treatment services. Several treatment innovations are considered from both clinical and administrative perspectives. These services include extended care programs for multiply impaired patients, programs for substance abuse patients with comorbid psychiatry conditions and services designed to improve continuity of care and community re-entry. Emergent themes include a broadening of services to meet the needs of a changing substance abuse population and an emphasis on providing more cost-efficient treatment.
View details for PubMedID 10171035
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THE LONG-TERM COURSE OF TREATED ALCOHOLISM .2. PREDICTORS AND CORRELATES OF 10-YEAR FUNCTIONING AND MORTALITY
JOURNAL OF STUDIES ON ALCOHOL
1992; 53 (2): 142-153
Abstract
This study examines factors related to mortality and 10-year posttreatment functioning for a sample of alcoholic patients who return to their families after an index residential treatment episode. Of the 113 patients followed 2 years after treatment, 20 had died by the time of the 10-year follow-up. Mortality risk was greater among patients who, prior to treatment, consumed more alcohol and were unemployed. Mortality was more strongly associated with medical conditions, liver problems, medication use and lack of confidants assessed 2 years posttreatment. The course for the surviving patients between the 2-year and 10-year follow-ups was one of improvement in terms of alcohol consumption, relative stability in terms of physical symptoms and depression, and an aging-related decline in social activities and employment. Life context and coping factors assessed 2 years after treatment were predictive of long-term outcome. Persons in less stressful life situations, in more cohesive and organized families, and who more frequently used active cognitive coping responses at the 2-year follow-up tended to function better at the 10-year follow-up. Overall, the findings support the value of embedding long-term follow-up studies in a theory of the disorder that is the target of the intervention.
View details for Web of Science ID A1992HF15600005
View details for PubMedID 1313935
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ADAPTATION TO JUVENILE RHEUMATIC DISEASE - A CONTROLLED EVALUATION OF FUNCTIONAL DISABILITY WITH A ONE-YEAR FOLLOW-UP
HEALTH PSYCHOLOGY
1992; 11 (1): 67-76
Abstract
Compared the adaptation of 165 patients with juvenile rheumatic disease (JRD) to that of their healthy siblings. Patients were divided into those with mild functional disability and those with moderate/severe disability. Adaptation in several domains was assessed by parents and children on two occasions 1 year apart. The adjustment difficulties of the JRD children were limited primarily to social functioning but appeared also in the psychological and family problems domains. Compared to "mild" patients, "moderate/severe" patients had more adjustment difficulties; in some areas, mild patients functioned as well as their healthy siblings. Some Time 1 differences were replicated at Time 2. The results help to delineate (a) the specific domains in which children with chronic disease have adjustment difficulties and (b) the factors that put children at risk for developing adjustment problems.
View details for Web of Science ID A1992HE21600009
View details for PubMedID 1559537
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SHORT-TERM PROCESSES OF REMISSION AND NONREMISSION AMONG LATE-LIFE PROBLEM DRINKERS
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
1991; 15 (6): 948-955
Abstract
This prospective study compares alcohol use, functioning, life stressors, social resources, and help-seeking among three groups of older adults: remitted problem drinkers, nonremitted problem drinkers, and nonproblem drinkers. At initial assessment, to-be-remitted problem drinkers had several advantages compared with individuals who would continue to have drinking problems. Specifically, they consumed less alcohol, reported fewer drinking problems, had friends who approved less of drinking, and were more likely to seek help from mental health practitioners. Problem drinkers who remitted improved somewhat over time, but they did not attain the level of functioning or type of life contexts shown by nonproblem drinkers. Time of onset of drinking problems influenced the short-term process of remission: Compared with early-onset individuals, late-onset problem drinkers were more likely to remit over the 1-year interval. The predictors of short-term remission suggested that late-onset problem drinkers may be more reactive to physical health stressors and to social influences than are individuals with more long-standing problems with alcohol.
View details for Web of Science ID A1991GV64800009
View details for PubMedID 1789391
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FUNCTIONING, LIFE CONTEXT, AND HELP-SEEKING AMONG LATE-ONSET PROBLEM DRINKERS - COMPARISONS WITH NONPROBLEM AND EARLY-ONSET PROBLEM DRINKERS
BRITISH JOURNAL OF ADDICTION
1991; 86 (9): 1139-1150
Abstract
We compared the functioning and life contexts of late-middle-aged adults classified as late-onset problem drinkers (n = 229), early-onset problem drinkers (n = 475), and nonproblem drinkers (n = 609). Compared with nonproblem drinkers, late-onset problem drinkers consumed more alcohol and functioned more poorly; they also reported more negative life events and chronic stressors, fewer social resources, and more use of avoidance coping. However, late-onset problem drinkers consumed less alcohol, had fewer drinking problems, functioned better, and had more benign life contexts than did early-onset problem drinkers. We found no evidence of an association between age-related loss events and the onset of late-life drinking problems. Very few problem drinkers sought help specifically for their alcohol abuse, but about 25% did seek treatment from mental health practitioners. Problem drinkers who were functioning more poorly and who reported more life stressors and fewer social resources were more likely to seek help.
View details for Web of Science ID A1991GD27400014
View details for PubMedID 1932886
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A TYPOLOGY OF SOCIAL CLIMATES IN GROUP RESIDENTIAL FACILITIES FOR OLDER-PEOPLE
JOURNALS OF GERONTOLOGY
1991; 46 (3): S160-S169
Abstract
A typology of the social climates of group residential facilities for older people was developed by a cluster analysis of seven social climate attributes obtained on a national sample of 235 nursing homes, residential care facilities, and congregate apartments. The analysis yielded six distinct types of social climate: Supportive, Self-Directed; Supportive, Well-Organized; Open Conflict; Suppressed Conflict; Emergent-Positive; and Unresponsive. Facility and resident characteristics were related to social climate type. In addition, the type of social climate was related to resident adaptation. Supportive, Self-Directed and Supportive, Well-Organized facilities had residents who rated higher in well-being and levels of self-initiated activities and who used fewer health services. A configural approach to describing social climates and their determinants and effects may help to develop more humanistic residential facilities and to better match individual residents to appropriate housing placements.
View details for Web of Science ID A1991FX41600006
View details for PubMedID 2030286
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LIFE STRESSORS, PERSONAL AND SOCIAL RESOURCES, AND DEPRESSION - A 4-YEAR STRUCTURAL MODEL
JOURNAL OF ABNORMAL PSYCHOLOGY
1991; 100 (1): 31-38
Abstract
By extending earlier stress-resistance research with a 1-year time lag, findings with 254 adults show that adaptive personality characteristics and positive family support operate prospectively over 4 years in predicting reduced depression, even when prior depression is controlled. By strengthening knowledge about the determinants and mediational role of coping, the results demonstrate in a 2-group LISREL analysis that the pattern of predictive relations differs under high and low stressors. Under high stressors, personal and social resources relate to future psychological health indirectly, through more adaptive coping strategies. Under low stressors, these resources relate directly to psychological health. The results support the idea that such resources play a causal role in maintaining psychological health, and they suggest the potential for a general, adaptively oriented framework applicable to adjustment under both high and low stressors.
View details for Web of Science ID A1991EX40700004
View details for PubMedID 2005268
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The Drinking Problems Index: a measure to assess alcohol-related problems among older adults.
Journal of substance abuse
1991; 3 (4): 395-404
Abstract
Research on problem drinking among older adults has been hampered by the lack of specialized instruments to assess drinking problems. In this paper, we examine the psychometric properties of a 17-item measure specifically designed to assess drinking problems in this population. The Drinking Problems Index (DPI) exhibits excellent psychometric properties, with an internal consistency reliability estimate of .94, a cross-temporal correlation over a 1-year interval of .66, and cross-sectional correlations with alcohol consumption at two points a year apart of .37 and .42. In addition, the construct validity of the DPI is supported by significant concurrent correlations indicating that persons who have more drinking-related problems experience more depression, have less self-confidence, and participate in fewer social activities. Consistent with the high internal consistency reliability estimate, a factor analysis confirmed that the measure is largely unifactorial. Overall, the findings suggest that the DPI is a reliable and valid instrument for assessing problems associated with drinking in surveys of older persons.
View details for PubMedID 1821293
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THE LONG-TERM COURSE OF TREATED ALCOHOLISM .1. MORTALITY, RELAPSE AND REMISSION RATES AND COMPARISONS WITH COMMUNITY CONTROLS
JOURNAL OF STUDIES ON ALCOHOL
1991; 52 (1): 44-54
Abstract
This study examines the course of alcoholism for a sample of patients who were followed 2 years and 10 years later after an index residential treatment episode. The alcoholic patients were 9.5 times as likely to die as matched community controls over the 8-year interval between the two follow-ups, a ratio considerably higher than that found in previous studies. Of the 83 surviving and successfully followed patients, 57% were classified as remitted at the 10-year follow-up. Of the patients classified as remitted at the 2-year follow-up and recontacted 8 years later, 77% had the same outcome status at the long-term follow-up, 67% of the initially relapsed patients retained that status at the 10-year follow-up. The 10-year remitted patients generally were functioning as well as matched, nonproblem-drinking community controls, whereas the relapsed patients exhibited dysfunction in a number of areas. Retrospective data on drinking patterns during each of the 6 years prior to the 10-year follow-up indicated a slight increase over time in the proportion of patients reporting abstinence or nonproblem drinking, with a concomitant decrease in the proportion indicating heavy or binge drinking. Overall, our data show a substantially elevated mortality risk among these alcoholic patients. For those patients who survive, however, the average course is one of modest improvement.
View details for Web of Science ID A1991EN17200008
View details for PubMedID 1994122
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LIFE STRESSORS, SOCIAL RESOURCES, AND LATE-LIFE PROBLEM DRINKING
PSYCHOLOGY AND AGING
1990; 5 (4): 491-501
Abstract
Life stressors and social resources among late-middle-aged problem and nonproblem drinkers were studied. Problem drinkers (n = 501) reported more negative life events, chronic stressors, and social resource deficits than did nonproblem drinkers (n = 609). In a comparison of problem drinkers, men reported more ongoing stressors involving finances and friends, and fewer resources from children, extended-family members, and friends than did women. Women who are problem drinkers reported more negative life events, more ongoing difficulties with spouses and extended-family members, and fewer resources from spouses. Among both the problem and nonproblem drinkers, more stressors were associated with fewer social resources, but only within certain life domains. Late-middle-aged adults' chronic stressors and social resources helped explain their drinking behavior, depression, and self-confidence even after sex, marital status, and negative life events were considered.
View details for Web of Science ID A1990EM36400003
View details for PubMedID 2278671
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VALIDITY OF THE SHELTERED CARE ENVIRONMENT SCALE - CONCEPTUAL AND METHODOLOGICAL ISSUES
PSYCHOLOGY AND AGING
1990; 5 (4): 569-571
Abstract
The Sheltered Care Environment Scale (SCES) was developed primarily to measure social climate as an attribute of a setting. As such, the SCES was designed to maximize differences between facilities and minimize differences among individuals within a setting. However, Smith and Whitbourne (1990) assessed the validity of the SCES as a measure of individual differences in perceptions of a shared environment. Moreover, they redefined the content coverage of 2 of the SCES subscales (Independence and Physical Comfort), to encompass attributes the SCES is not intended to measure. In general, preliminary evidence indicates that the SCES subscales provide reasonably reliable and valid indices of the social climate of group residential facilities.
View details for Web of Science ID A1990EM36400013
View details for PubMedID 2278681
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DETERMINANTS OF INTERPERSONAL SUPPORT AND SELF-DIRECTION IN GROUP RESIDENTIAL FACILITIES
JOURNALS OF GERONTOLOGY
1990; 45 (5): S184-S192
Abstract
This study examined the determinants of residents' and staff's judgments of interpersonal support and self-direction in group residential facilities for older people. The Multiphasic Environmental Assessment Procedure (MEAP) was used to assess social climate dimensions and their determinants in a national sample of 244 facilities. Residents saw more interpersonal support and self-direction in facilities with more physical resources (comfort and staff facilities) and policies providing more autonomy. A similar pattern was found for staff's perceptions of self-direction. Residents and staff also viewed facilities as providing more interpersonal support and self-direction when residents were more socially competent. Larger facility size was associated with residents' assessments of more conflict, and a higher staff-resident ratio was related to residents' judgments of having less independence and influence. These findings may help to improve residential facilities by suggesting factors that can be targeted in interventions to improve the social climate.
View details for Web of Science ID A1990EN06000002
View details for PubMedID 2394919
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STRESSFUL LIFE CIRCUMSTANCES - CONCEPTS AND MEASURES
STRESS MEDICINE
1990; 6 (3): 171-178
View details for Web of Science ID A1990DT75100001
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Physical design, social climate, and staff turnover in skilled nursing facilities.
The Journal of long term care administration
1990; 18 (2): 22-27
View details for PubMedID 10105764
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CONCEPTUAL AND EMPIRICAL APPROACHES TO DEVELOPING FAMILY-BASED ASSESSMENT PROCEDURES - RESOLVING THE CASE OF THE FAMILY ENVIRONMENT SCALE
FAMILY PROCESS
1990; 29 (2): 199-208
Abstract
This article focuses on the reliability and validity of the Family Environment Scale (FES). The FES subscales generally show adequate internal consistency reliability and stability over time when applied in samples that are diverse; the items also have good content and face validity. An extensive body of research supports the construct, concurrent, and predictive validity of the FES. More generally, reliability and validity are a joint function of scale items and response formats and of the characteristics and diversity of specific samples. To contribute to further advances in family assessment, researchers need to use both conceptual and psychometric criteria rather than rely too heavily on the pursuit of internal consistency reliability and factor analytic approaches to scale construction and validation.
View details for Web of Science ID A1990DK81000009
View details for PubMedID 2373215
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LIFE STRESSORS, RESISTANCE FACTORS, AND IMPROVED PSYCHOLOGICAL FUNCTIONING - AN EXTENSION OF THE STRESS RESISTANCE PARADIGM
JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY
1990; 58 (5): 909-917
Abstract
This study applied a set of factors previously identified as being linked with stress resistance to the prediction of both stable and improved psychological functioning over a 1-year interval with more than 400 community-resident adults. Stable psychological functioning under high stressors is predicted at the beginning of the year by personal and social resources that are linked to functioning through their influence on increased approach coping during the year. In contrast, improved psychological functioning under low stressors is predicted directly by initial resources. As predicted by crisis theory, improved functioning under high stressors is related to an increase in resources during the year. The findings are discussed in the context of an extension of the stress-resistance paradigm beyond illness prevention toward a general, adaptively oriented health framework.
View details for Web of Science ID A1990DE49600015
View details for PubMedID 2348376
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APPROACH AND AVOIDANCE COPING RESPONSES AMONG OLDER PROBLEM AND NONPROBLEM DRINKERS
PSYCHOLOGY AND AGING
1990; 5 (1): 31-40
Abstract
The Coping Responses Inventory (CRI) was used to study coping among older problem and nonproblem drinkers. The CRI organizes coping efforts according to their focus (approach or avoidance) and method (cognitive or behavioral). Compared with nonproblem drinkers, older problem drinkers were more likely to use cognitive and behavioral avoidance responses to manage life stressors. Problem drinkers who experienced more negative life events and more severe stressors used both more approach and more avoidance coping. Those who had more financial and social resources relied more on approach and less on avoidance coping. Problem drinkers who relied more on avoidance coping tended to have more drinking problems and to report more depression and physical symptoms and less self-confidence. Positive reappraisal was associated with less depression and more self-confidence.
View details for Web of Science ID A1990CR69600005
View details for PubMedID 2180432
- Alcoholism Treatment: Context, Process, and Outcome. New York: Oxford. 1990
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LIFE STRESSORS, SOCIAL RESOURCES, COPING, AND THE 4-YEAR COURSE OF UNIPOLAR DEPRESSION
JOURNAL OF ABNORMAL PSYCHOLOGY
1989; 98 (4): 468-477
Abstract
Little is known about the effects of psychosocial factors on the long-term course of unipolar depression. This article examines the 4-year stability and change in life stressors, social resources, and coping, and their effect on the course of treated unipolar depression among 352 men and women. Depressed patients were assessed at treatment intake and at 1-year and 4-year follow-ups. Over the 4 years, patients improved in symptom outcomes, the quality of social resources, and coping responses; there were some declines in life stressors. Life stressors, social resources, and coping were related to patient functioning concurrently, after controlling for demographics, initial treatment, and initial dysfunction severity. Preintake medical conditions and family conflict consistently predicted poorer long-term outcomes. The findings imply that medical conditions and family conflict are important risk factors that predict poorer long-term outcome of depression.
View details for Web of Science ID A1989CC94300015
View details for PubMedID 2592682
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LIFE STRESSORS AND COPING - A LONGITUDINAL ANALYSIS AMONG DEPRESSED AND NONDEPRESSED ADULTS
JOURNAL OF COMMUNITY PSYCHOLOGY
1989; 17 (4): 330-340
View details for Web of Science ID A1989AW55000006
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Life stressors and coping: A longitudinal analysis among depressed and nondepressed adults.
Journal of community psychology
1989; 17 (4): 330-340
Abstract
This article examines the interrelation between negative life events, ongoing life strains, and coping responses in a longitudinal study of clinically depressed and healthy adults. A two-wave, two-variable panel regression analysis revealed moderate stability of both life stressors and coping over a 1-year interval. The connections between life stressors and coping varied by group status and across specific types of stressors and modes of coping. For depressed persons, there was a relatively strong association between chronic strains and emotional discharge coping. Among the controls, negative events were associated with information and support seeking; however, an increase in chronic strains was associated with a decline in problem-solving coping. Overall, the results suggest that changes in stressful aspects of the psychosocial context are related to changes in the coping responses both clinically depressed and healthy adults use to manage specific stressful experiences.
View details for DOI 10.1002/1520-6629(198910)17:4<330::AID-JCOP2290170406>3.0.CO;2-B
View details for PubMedID 35042298
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PERSONAL AND ENVIRONMENTAL DETERMINANTS OF ACTIVITY INVOLVEMENT AMONG ELDERLY RESIDENTS OF CONGREGATE FACILITIES
JOURNALS OF GERONTOLOGY
1989; 44 (4): S139-S148
Abstract
This study examined the personal and environmental factors related to the activity involvement of older people living in congregate residential settings. A sample of 1,428 residents in 42 such settings provided information about their activities, functioning, and background. Measures of facility features were also available. These data show that individuals are more likely to participate in facility-organized activities in settings where overall resident participation is greater, the average functioning of residents is lower, staffing is higher, and the program more structured. Participation in facility activities is not related to personal characteristics. In contrast, involvement in resident-initiated activities, both in the facility and in the community, is related to personal characteristics (being functionally intact, female, and better educated) and to facility features (larger size, lower staffing, greater autonomy and cohesiveness). The impact of some features varies depending on the functional capacity of the individual resident.
View details for Web of Science ID A1989AF95800008
View details for PubMedID 2738317
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CHOICE, CONTROL, AND ADAPTATION AMONG ELDERLY RESIDENTS OF SHELTERED CARE SETTINGS
JOURNAL OF APPLIED SOCIAL PSYCHOLOGY
1989; 19 (8): 636-655
View details for Web of Science ID A1989U954100002
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OWNERSHIP AND QUALITY OF CARE IN RESIDENTIAL FACILITIES FOR THE ELDERLY
GERONTOLOGIST
1989; 29 (2): 209-215
Abstract
The quality of care older people receive in a residential facility is related to its ownership. Nonprofit facilities (N = 44) provided a more comfortable physical environment, more cohesive relationships, and more resident control than proprietary settings (N = 44) matched for size and resident functioning. Veterans facilities (N = 44) offered more services and a more diverse staff, but their policies permitted less resident autonomy and their social climates were less cohesive than community facilities of comparable size and resident functioning.
View details for Web of Science ID A1989U050300012
View details for PubMedID 2753380
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PREFERENCES OF OLDER ADULTS AND EXPERTS FOR POLICIES AND SERVICES IN GROUP LIVING FACILITIES
PSYCHOLOGY AND AGING
1989; 4 (1): 48-56
Abstract
The Policy and Program Information Form-Ideal Form (POLIF-I) was developed to assess preferences of older adults for the policies and services of group living facilities. Compared with older community residents (n = 205), congregate apartment residents (n = 229) prefer facilities that have higher behavioral standards, deemphasize supportive services and formal avenues for resident influence, and emphasize privacy. In contrast to older respondents, experts (n = 44) prefer settings with lower behavioral standards, more supportive services, more resident input, and more privacy. Sociodemographic characteristics (marital status, occupation, education, age, gender) and functional ability are weakly associated with the policy and service preferences of older respondents. The POLIF-I has several applications, including examination of the congruence between residents' preferences and the actual policies and services of group living facilities.
View details for Web of Science ID A1989T491000007
View details for PubMedID 2803612
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THEORY AND METHOD IN TREATMENT EVALUATION
EVALUATION AND PROGRAM PLANNING
1989; 12 (4): 307-316
View details for Web of Science ID A1989CF18800003
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RISK-FACTORS AT INTAKE PREDICT NONREMISSION AMONG DEPRESSED-PATIENTS
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1988; 56 (6): 863-869
View details for Web of Science ID A1988R143600013
View details for PubMedID 3204196
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PREFERENCES OF OLDER ADULTS AND EXPERTS FOR PHYSICAL AND ARCHITECTURAL FEATURES OF GROUP LIVING FACILITIES
GERONTOLOGIST
1988; 28 (1): 84-90
View details for Web of Science ID A1988M047900010
View details for PubMedID 3342997
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LIFE STRESSORS AND SOCIAL RESOURCES - AN INTEGRATED ASSESSMENT APPROACH
SOCIAL SCIENCE & MEDICINE
1988; 27 (9): 999-1002
Abstract
The Life Stressors and Social Resources Inventory (LISRES) is described. The inventory provides an integrated assessment of an individual's life context. It taps both relatively stable and new aspects of life stressors and social resources in eight domains: physical health, home/neighborhood, financial, work, spouse/partner, children, extended family, and friends. The indices were developed on data obtained at two points in time from groups of depressed patients, alcoholic patients, arthritic patients, and healthy adults. The indices are internally consistent, moderately intercorrelated, and relatively stable over time. In addition, they are predictably related to changes in respondents' functioning. Although more developmental work is needed, the LISRES has some potential clinical and research applications and may be helpful in examining the process of stress and coping.
View details for Web of Science ID A1988Q532100015
View details for PubMedID 3227394
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EXOSYSTEM INFLUENCES ON FAMILY AND CHILD FUNCTIONING
JOURNAL OF SOCIAL BEHAVIOR AND PERSONALITY
1988; 3 (4): 113-133
View details for Web of Science ID A1988T763100009
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Assessing life stressors and social resources: applications to alcoholic patients.
Journal of substance abuse
1988; 1 (2): 135-152
Abstract
A growing body of evidence points to the importance of life stressors and social resources in the development and course of alcoholism and other substance abuse disorders. This article describes the Life Stressors and Social Resources Inventory (LISRES), which provides an integrated assessment of life stressors and social resources in eight domains: physical health, home/neighborhood, financial, work, spouse/partner, children, extended family, and friends. The indices were developed on data obtained at two points in time 18 months apart from four demographically comparable groups: alcoholic patients, depressed patients, arthritic patients, and non-problem-drinking adults. As expected, alcoholic patients reported more acute and chronic stressors and fewer social resources than did non-problem-drinking adults. More important, the indices were predictively related to changes in alcohol consumption, drinking problems, depression, and self-confidence. Procedures such as the LISRES have some potential clinical and research applications and may be helpful in examining the process of recovery and relapse in substance abuse disorders.
View details for PubMedID 2980865
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CONCEPTS ON MEASURES OF COPING RESPONSES
ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOANALYSE
1988; 34 (3): 207-225
Abstract
Major types of coping responses are described and the problems with the measurement of coping behavior are discussed. The Coping Response Inventory is introduced. Family and work resources provide a social context for coping: An integrating framework is described. First results of the association between coping responses and the process of remission and relapse in depression and alcohol abuse are presented.
View details for Web of Science ID A1988P573000002
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POSITIVE PERIMENSTRUAL CHANGES - TOWARD A NEW PERSPECTIVE ON THE MENSTRUAL-CYCLE
JOURNAL OF PSYCHOSOMATIC RESEARCH
1988; 32 (1): 31-40
Abstract
Although many women report negative symptoms, the perimenstrual phase also is associated with enhanced mood and performance among some women. However, research on perimenstrual concomitants reflects a sterotypic negative bias that does not encompass the complexity of the phenomena. This paper tries to redress that balance by documenting the prevalence of positive perimenstrual changes. Overall, about 5-15% of women experience increased excitement, energy, and well-being in the perimenstrual phase. Many women also report increased activity, heightened sexuality, and improved performance on certain types of tasks during the perimenstrual phase. Future research should examine why some women report positive perimenstrual changes, the extent to which individual variations in hormone levels can account for differences in women's perimenstrual experience, and how much women differ in their responsiveness to changing hormone levels. The influence of menstrual-related beliefs and expectations on the changes a woman reports also needs to be clarified.
View details for Web of Science ID A1988N741500004
View details for PubMedID 3042993
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PERSON-ENVIRONMENT CONGRUENCE IN WORK, SCHOOL, AND HEALTH-CARE SETTINGS
JOURNAL OF VOCATIONAL BEHAVIOR
1987; 31 (3): 231-247
View details for Web of Science ID A1987L308300003
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SOCIAL SUPPORT AND COPING - A LONGITUDINAL ANALYSIS
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
1987; 15 (5): 653-673
Abstract
This paper examined the interrelation between social support and coping in a longitudinal study of 380 clinically depressed individuals. A two-wave, two-variable panel analysis revealed that connections between support and coping varied by gender and across the specific sources of support and modes of coping examined. In the family context, increases in support were related to increases in problem-solving coping among women and to a decline in emotional discharge coping among men. In the work context, increases in social support were related to a greater reliance on affective regulation among women and to more information/support seeking among men. Overall, the results suggest that specific aspects of support and coping processes jointly mediate the link between stress and adjustment among depressed individuals.
View details for Web of Science ID A1987K651700014
View details for PubMedID 3687850
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PSYCHOSOCIAL RISK AND RESISTANCE FACTORS AMONG CHILDREN WITH CHRONIC ILLNESS, HEALTHY SIBLINGS, AND HEALTHY CONTROLS
JOURNAL OF ABNORMAL CHILD PSYCHOLOGY
1987; 15 (2): 295-308
Abstract
Psychosocial risk and resistance factors within the domains of parental functioning, family stressors, and family resources were examined as predictors of psychological adjustment and physical problems in juvenile rheumatic disease patients (N = 93), their healthy siblings (N = 72), and demographically matched healthy controls (N = 93). Family socioeconomic status and background variables showed few consistent relationships with child functioning. However, a constellation of risk and resistance factors tended to show comparable associations with functioning for patients, siblings, and controls. Higher parental depression and medical symptoms and more family stressors, sibling problems, and burden of illness on the family predicted more problems among the patients. These relationships held when disease duration and severity were controlled. For the siblings, increased parental and patient dysfunction, more family stressors, and less family cohesion and expressiveness were associated with more problems. Although the associations were not as strong, mothers' depression and lack of family cohesion and expressiveness also were related to more adjustment problems among the control children. These findings imply that there may be a general association between certain risk and resistance factors and childhood adaptation.
View details for Web of Science ID A1987J108700012
View details for PubMedID 3497186
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FUNCTIONING AND LIFE CONTEXT AMONG SPOUSES OF REMITTED AND NONREMITTED DEPRESSED-PATIENTS
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1987; 55 (3): 353-360
View details for Web of Science ID A1987H521000011
View details for PubMedID 3597948
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PERSONAL AND CONTEXTUAL DETERMINANTS OF COPING STRATEGIES
JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY
1987; 52 (5): 946-955
Abstract
This study examined personal and contextual predictors of active and avoidance coping strategies in a community sample of over 400 adults and in a sample of over 400 persons entering psychiatric treatment for unipolar depression. Sociodemographic factors of education and income (except for active-cognitive coping), personality dispositions of self-confidence and an easy-going manner, and contextual factors of negative life events and family support each made a significant incremental contribution to predicting active and avoidance coping. Among both healthy adults and patients, active and avoidance coping were positively associated with negative life events. Individuals who had more personal and environmental resources were more likely to rely on active coping and less likely to use avoidance coping. Moreover, for both groups, most of the predictors continued to show significant relations with active and avoidance coping strategies even after the stable component in coping was controlled in a longitudinal design. A comprehensive framework to understand the determinants of coping can be of practical value in suggesting points for therapeutic interventions aimed at fostering more adaptive coping efforts.
View details for Web of Science ID A1987H069000010
View details for PubMedID 3585703
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MEASURING THE SOCIAL CLIMATE OF CONGREGATE RESIDENCES FOR OLDER-PEOPLE - SHELTERED CARE ENVIRONMENT SCALE
PSYCHOLOGY AND AGING
1987; 2 (1): 20-29
Abstract
We developed the Sheltered Care Environment Scale (SCES) to provide researchers and practitioners with a practical means of assessing the social climate in congregate residential settings for the elderly. The SCES, a 63-item yes/no questionnaire that can be completed by residents and staff members of a facility, taps their perceptions of seven dimensions of the social environment. These dimensions concern the quality of relationships, the personal growth orientation present in the facility, and maintenance and change of the social system. The SCES discriminates among settings, has moderate to high internal consistency and split-half reliability, and is sensitive to environmental change against a backdrop of relative stability over time. The SCES reflects actual, agreed-on qualities of a setting and is relatively unaffected by characteristics of the respondent. Normative data are available from a national sample of 244 facilities representing the variety of residential settings available to the elderly.
View details for Web of Science ID A1987G524400004
View details for PubMedID 3268187
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RISK, RESISTANCE, AND PSYCHOLOGICAL DISTRESS - A LONGITUDINAL ANALYSIS WITH ADULTS AND CHILDREN
JOURNAL OF ABNORMAL PSYCHOLOGY
1987; 96 (1): 3-13
View details for Web of Science ID A1987F893200001
View details for PubMedID 3558946
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PSYCHOSOCIAL ADAPTATION IN JUVENILE RHEUMATIC DISEASE - A CONTROLLED EVALUATION
HEALTH PSYCHOLOGY
1987; 6 (4): 343-359
Abstract
Juvenile rheumatic diseases are serious chronic illnesses potentially capable of disrupting a child's development and functioning. This study examined the psychosocial functioning of 43 children with severe rheumatic disease as compared to that of 52 children with a milder or inactive form of rheumatic disease. Both patient groups also were compared to 93 healthy children from demographically matched families. Data were obtained from parent reports, from physician evaluation, and, for children who were old enough, from self-reports. The severe patient group showed more parent-reported psychological and physical problems than both the mild patient group and the healthy controls. Compared to the mild group, the severe group also missed more days of school due to illness. Older children in the severe group were more likely to miss school due to illness and to participate in fewer social activities with their families and friends than the controls; however, the older children reported comparable mood and functioning in other areas. An expanded model is proposed to examine risk and resistance factors predictive of psychological and social dysfunction among children with severe chronic disease.
View details for Web of Science ID A1987H769500005
View details for PubMedID 3608946
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PSYCHOSOCIAL FUNCTIONING OF SIBLINGS OF CHILDREN WITH RHEUMATIC DISEASE
JOURNAL OF PEDIATRICS
1986; 109 (2): 379-383
Abstract
The potential impact of an ill child on other siblings in the family was examined by comparing 72 siblings of children with rheumatic disease with 60 siblings of healthy children from demographically matched families. Psychosomatic, behavioral, emotional, and social problems, as reported by both the parents and the siblings, were investigated. Although siblings of patients with rheumatic disease generally were functioning as well as siblings of healthy children, they reported having more allergies and asthma. A set of vulnerability and protective factors was tested as predictors of sibling functioning. Cohesive and expressive family environments in which mothers and patients with rheumatic disease were functioning adequately promoted better adaptation among the siblings.
View details for Web of Science ID A1986D556300031
View details for PubMedID 3488386
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PERSONALITY, COPING, AND FAMILY RESOURCES IN STRESS RESISTANCE - A LONGITUDINAL ANALYSIS
JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY
1986; 51 (2): 389-395
Abstract
Earlier cross-sectional analyses have made causal inferences about stress-resistance variables problematic. This study used a longitudinal analysis where stress-resistance factors in the areas of personality, coping, and family support assessed at an initial testing were used to predict psychological and physical adjustment one year later, controlling for initial adjustment. The study involved a survey of 245 men and 248 women in randomly selected families in the San Francisco Bay area. Findings demonstrated that feelings of self-confidence, an easy-going disposition, a disinclination to use avoidance coping, and the availability of family support operate jointly to protect individuals from negative psychological consequences of life stress. For women the stress-resistance index also predicted psychosomatic complaints experienced one year after initial testing.
View details for Web of Science ID A1986D443000019
View details for PubMedID 3746619
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PERIMENSTRUAL SYMPTOMS - PREVALENCE AND RISK-FACTORS
PSYCHOSOMATIC MEDICINE
1986; 48 (6): 388-414
Abstract
This article provides an overview of information on the prevalence of perimenstrual symptoms. Overall, at least 40% of women experience some cyclical perimenstrual symptoms. Although most women rate their symptoms as mild, approximately 2%-10% report severe symptoms. Prospective studies of perimenstrual symptoms indicate that retrospective reports are reasonably accurate among women who experience moderate to severe symptoms. However, among the majority of women with few or minimal symptoms, retrospective reports may amplify the cyclicity of variation in comparison to concurrent reports. A variety of risk factors are associated with patterns of symptom reporting and may provide clues to the etiology of perimenstrual symptoms and help to identify women most vulnerable to them. A woman's age and cycle characteristics are predictors of the type and severity of perimenstrual symptoms she experiences. In addition, a history of affective illness may be associated with increased reporting of perimenstrual symptoms. Future research should focus on developing new diagnostic criteria for subtypes of perimenstrual syndromes, exploring positive symptoms and experiences associated with the menstrual cycle, and formulating holistic treatment approaches that view perimenstrual syndromes as psychosomatic conditions.
View details for Web of Science ID A1986D493100002
View details for PubMedID 3529156
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CHILDREN OF PARENTS WITH UNIPOLAR DEPRESSION - A CONTROLLED 1-YEAR FOLLOW-UP
JOURNAL OF ABNORMAL CHILD PSYCHOLOGY
1986; 14 (1): 149-166
Abstract
An earlier cross-sectional study indicated that children's health and adjustment is at risk when their parents are depressed. Here, we report the associated longitudinal changes in children and families when parental depression either remits or continues. Comparisons are made among three groups established at a 1-year follow-up: previously depressed parents whose symptoms have remitted (N = 34 remitted parents), previously depressed parents who continue to be depressed (N = 23 nonremitted parents), and sociodemographically matched control families (N = 95). Although remitted parents and their family social environments improved, their children were still functioning more poorly than children of controls. Both the children and the families of nonremitted parents continued to function more poorly than controls. A social-environmental framework indicates that parents' functioning as well as family stressors and resources are concurrently and predictively linked to children's health.
View details for Web of Science ID A1986A123000014
View details for PubMedID 3950216
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QUALITY OF RESIDENTIAL SETTINGS FOR ELDERLY ADULTS
JOURNALS OF GERONTOLOGY
1986; 41 (2): 268-276
Abstract
Based on the Multiphasic Environmental Assessment Procedure (MEAP), an instrument for evaluating residential settings for elderly adults, eight indices of quality were formulated to cover both the structure and process of care. MEAP data were available for 244 facilities from throughout the United States, including 127 nursing homes (NHs), 55 residential care facilities (RCs), and 62 congregate apartments (APTs). The three types of facilities differed predictably on the quality indices. Nursing homes were more supportive and restrictive than were APTs, and RCs generally scored between NHs and APTs on the quality of care measures. These indices of quality tended to be independent of one another, suggesting that quality of care is multidimensional. Larger facilities and nonprofit facilities tended to score higher on the quality indices, although the effects of size varied somewhat with facility type and ownership. These indices may be useful for describing and comparing settings and for analyzing the correlates of quality.
View details for Web of Science ID A1986A295400020
View details for PubMedID 3950355
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MATCHING PATIENTS WITH TREATMENTS - CONCEPTUAL AND METHODOLOGICAL ISSUES
JOURNAL OF STUDIES ON ALCOHOL
1986; 47 (2): 122-134
Abstract
The current enthusiasm for matching patients with optimal treatments rests on limited conceptual analyses. In addition, much of the existing research on patient-treatment matching has been based on methodological assumptions that are not commensurate with the complexity of the matching problem. Six key conceptual and methodological issues that underlie attempts to match patients with optimal forms of treatment and to conduct research on patient-treatment matching are outlined. The conceptual issues are: selecting effective matching variables, specifying the end result that matching is to enhance and determining the stage(s) in the treatment process at which matching decisions are to be made. The three methodological issues deal with the type of patient-treatment match or interaction effect and include: nonlinear interaction effects, higher-order interaction effects and multilevel interaction effects. Examples clarifying these issues are drawn from the literature on treating alcohol-dependent persons, but the issues are discussed at a broad level that permits generalization to treatment for many disorders. Implications for research on and the practice of "prescriptive treatment" are considered.
View details for Web of Science ID A1986A836100003
View details for PubMedID 3713174
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DIFFICULTY OF FOLLOW-UP AND POSTTREATMENT FUNCTIONING AMONG DEPRESSED-PATIENTS
JOURNAL OF AFFECTIVE DISORDERS
1985; 8 (1): 9-16
Abstract
Evaluations of treatment outcome may obtain positively biased findings by failing to reassess patients who are difficult to follow and who may also be functioning more poorly than those who are successfully followed. We consider whether difficulty of follow-up is related to pre- and posttreatment functioning by reassessing 95% of a sample of 424 depressed patients after a 12-month interval. In contrast to earlier findings with other patient populations (e.g., alcoholic patients), there was no strong or consistent tendency for depressed patients who were more difficult to follow to be functioning more poorly after treatment. Moreover, poor functioning at treatment intake was not predictive of later difficulty of follow-up. However, patients who were younger, single, and of lower occupational level were somewhat more difficult to follow.
View details for Web of Science ID A1985ADH5500002
View details for PubMedID 3156916
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PSYCHOSOCIAL ADJUSTMENT OF ADOLESCENT CHILDREN OF A DEPRESSED, ARTHRITIC, OR NORMAL PARENT
JOURNAL OF ABNORMAL PSYCHOLOGY
1985; 94 (2): 154-164
View details for Web of Science ID A1985AGW3900004
View details for PubMedID 3998283
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LIFE STRESS AND HEALTH - PERSONALITY, COPING, AND FAMILY SUPPORT IN STRESS RESISTANCE
JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY
1985; 49 (3): 739-747
Abstract
The purpose of this study was to extend work on factors that buffer the potentially negative health effects of life stress. Using a survey with a representative community sample, respondents were separated into a Distressed Group (high stress, high distress) and a Stress Resistant Group (high stress, low distress). Findings demonstrated that those who adapted to life stress with little physical or psychological strain were more easy-going and less inclined to use avoidance coping than individuals who became ill under stress. In addition, in the stress resistant group, men were more self-confident and women had better family support than their counterparts in the distressed group. Results are discussed in relation to earlier findings concerning "hardiness," avoidance coping, and the behavioral prescriptions of conventional sex roles.
View details for Web of Science ID A1985AQJ6600015
View details for PubMedID 4045701
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LIFE STRESSORS AND SOCIAL RESOURCES AFFECT POSTTREATMENT OUTCOMES AMONG DEPRESSED-PATIENTS
JOURNAL OF ABNORMAL PSYCHOLOGY
1985; 94 (2): 140-153
View details for Web of Science ID A1985AGW3900003
View details for PubMedID 3998282
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PSYCHOSOCIAL PROCESSES OF REMISSION IN UNIPOLAR DEPRESSION - COMPARING DEPRESSED-PATIENTS WITH MATCHED COMMUNITY CONTROLS
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1985; 53 (3): 314-325
View details for Web of Science ID A1985AJC1000004
View details for PubMedID 4008716
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TREATMENT EXPERIENCES OF ADULTS WITH UNIPOLAR DEPRESSION - THE INFLUENCE OF PATIENT AND LIFE CONTEXT FACTORS
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1984; 52 (1): 119-131
View details for Web of Science ID A1984SJ53500014
View details for PubMedID 6699240
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COPING WITH AN INTRA-INSTITUTIONAL RELOCATION - CHANGES IN RESIDENT AND STAFF BEHAVIOR PATTERNS
GERONTOLOGIST
1984; 24 (5): 495-502
View details for Web of Science ID A1984TN31400009
View details for PubMedID 6437909
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THE ROLE OF PREDISPOSING AND MODERATING FACTORS IN THE STRESS-ILLNESS RELATIONSHIP
JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
1984; 25 (4): 372-393
View details for Web of Science ID A1984AAM5000002
View details for PubMedID 6520359
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SEX AND MARITAL-STATUS IN RELATION TO THE TREATMENT AND OUTCOME OF ALCOHOLIC PATIENTS
SEX ROLES
1984; 11 (1-2): 93-112
View details for Web of Science ID A1984TF85600009
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Environmental assessment and evaluation research: examples from mental health and substance abuse programs.
Evaluation and program planning
1984; 7 (2): 151-167
Abstract
Evaluation researchers have been broadening the traditional client input--"black box" treatment--client outcome paradigm that has guided many evaluations of mental health, substance abuse treatment, and other intervention programs. The points of expansion are in the areas of treatment implementation and treatment processes, as well as "extratreatment" influences on treatment selection, duration, and, especially, outcome. This review illustrates the application of environmental assessment procedures--particularly social climate measures--in four aspects of evaluation research suggested by the more comprehensive model: (a) evaluating treatment implementation; (b) exploring treatment processes; (c) identifying extratreatment influences on client posttreatment functioning; and (d) operationalizing outcome variables. Conceptual and methodological issues raised by these applications are discussed, and the benefits to be derived from an expanded model of evaluation research--especially the greater potential for program improvement--are considered.
View details for PubMedID 10317534
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DEFICIENCIES IN SOCIAL SUPPORT AMONG DEPRESSED-PATIENTS - ANTECEDENTS OR CONSEQUENCES OF STRESS
JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
1984; 25 (4): 438-452
View details for Web of Science ID A1984AAM5000006
View details for PubMedID 6520363
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METHODOLOGICAL ISSUES IN ESTIMATING MAIN AND INTERACTIVE EFFECTS - EXAMPLES FROM COPING SOCIAL SUPPORT AND STRESS-FIELD
JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
1984; 25 (1): 85-98
View details for Web of Science ID A1984SM67000007
View details for PubMedID 6725926
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Life stressors and problem drinking among older adults.
Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism
1984; 2: 267-288
Abstract
Research on the prevalence of excessive drinking among persons age 60 and older is reviewed, and the inadequacy of general criteria for operationally defining problem drinking in this population is pointed out. We critically examine the empirical evidence relating life stressors (e.g., death of a spouse) to the onset of problem drinking in older age and, to a lesser extent, to the continuation of drinking problems into the later stages of the life cycle. Potential mediators and moderators of the stress-problem drinking relationship (e.g., personal coping methods and social resources) have generally been ignored in this research. Life stress is probably best viewed as a component of one or more of several combinations of factors that may trigger or perpetuate drinking problems. A comprehensive conceptual framework to guide future research is presented. The use of such a framework should serve to integrate research on problem drinking among older persons with work in the general field of adaptation to life stress.
View details for PubMedID 6610187
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THE PROCESS OF RECOVERY FROM ALCOHOLISM .3. COMPARING FUNCTIONING IN FAMILIES OF ALCOHOLICS AND MATCHED CONTROL FAMILIES
JOURNAL OF STUDIES ON ALCOHOL
1984; 45 (2): 111-118
Abstract
Families of recovered (N = 54) and relapsed (N = 51) alcoholic patients were studied 2 yr after the patients completed residential treatment and were compared with sociodemographically matched families of community controls (N = 105) on three sets of family-functioning indices--role functioning, family environment and husband-wife congruence. Families of recovered patients were functioning as well as families of controls. Families of relapsed patients showed less cohesion, expressiveness and recreational orientation, and lower agreement about their family environment than matched families of recovered patients and of community controls, and reported more family arguments than families of recovered patients. They also showed altered role functioning, the nonalcoholic spouse performing more household tasks and the alcoholic partner performing fewer. Family functioning was affected by the adequacy of the alcoholic partner's adaptation, and by life events, stressors and spouse's level of dysfunction.
View details for Web of Science ID A1984SR58300001
View details for PubMedID 6727369
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COPING, STRESS, AND SOCIAL RESOURCES AMONG ADULTS WITH UNIPOLAR DEPRESSION
JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY
1984; 46 (4): 877-891
Abstract
We used a stress and coping paradigm to guide the development of indices of coping responses and to explore the roles of stress, social resources, and coping among 424 men and women entering treatment for depression. We also used an expanded concept of multiple domains of life stress to develop several indices of ongoing life strains. Although most prior studies have focused on acute life events, we found that chronic strains were somewhat more strongly and consistently related to the severity of dysfunction. The coping indices generally showed acceptable conceptual and psychometric characteristics and only moderate relationships to respondents' sociodemographic characteristics or to the severity of the stressful event for which coping was sampled. Coping responses directed toward problem solving and affective regulation were associated with less severe dysfunction, whereas emotional-discharge responses, more frequently used by women, were linked to greater dysfunction. Stressors, social resources, and coping were additively predictive of patient's functioning, but coping and social resources did not have stress-attenuation or buffering effects.
View details for Web of Science ID A1984SQ00200014
View details for PubMedID 6737198
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CHRONIC AND NONCHRONIC UNIPOLAR DEPRESSION - THE DIFFERENTIAL ROLE OF ENVIRONMENTAL STRESSORS AND RESOURCES
JOURNAL OF NERVOUS AND MENTAL DISEASE
1984; 172 (2): 65-75
Abstract
There appear to be strong variations in the association between psychosocial factors and the onset and course of depressive disorders. To explore a possible correlate of such variation, we consider whether the role of social-environmental factors may differ between patients with a recurrence of unipolar depression and a recent history of prior treatment (termed chronic patients), patients with unipolar depression but without a recent prior treatment episode (termed nonchronic patients), and a demographically matched group of nondepressed controls. Both chronic and nonchronic patients experienced more stressors and reported fewer social resources than nondepressed controls, but the two patient groups did not differ on these factors. However, correlational analyses indicated that stressors and social resources were significantly related to functioning among nondepressed controls and nonchronic patients, but not among chronic patients. These findings support the value of specifying subgroups of individuals for whom depression is most strongly related to psychosocial factors.
View details for Web of Science ID A1984SC81500001
View details for PubMedID 6693864
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CHANGING HOSPITAL WORK ENVIRONMENTS - AN EXAMPLE OF A BURN UNIT
GENERAL HOSPITAL PSYCHIATRY
1983; 5 (1): 7-13
Abstract
A liaison psychiatrist invited to help a burn unit staff explore problems affecting morale and patient care employed a four-step procedure: (1) assess the work environment systematically; (2) give the staff feedback from this assessment; (3) help the staff plan and institute changes; and (4) reassess. To assess the work environment, the staff completed the Work Environment Scale (WES), a 90-item, true/false questionnaire that measures ten dimensions of the actual and preferred work environment. At the second of 12 bi-weekly meetings, the psychiatrist presented the unit's WES profile and began helping the staff explore and resolve problems. Reassessment six months later revealed statistically significant changes on several pertinent WES scales and reduced discrepancies between actual and preferred work environments on nine of the ten scales. The findings indicate that systemmatic assessment and feedback procedures may help liaison programs improve the quality of hospital work environments and thereby enhance staff performance and morale.
View details for Web of Science ID A1983QK48200002
View details for PubMedID 6840546
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SOCIAL-ENVIRONMENTAL FACTORS AMONG LIGHT AND HEAVY CIGARETTE SMOKERS - A CONTROLLED COMPARISON WITH NONSMOKERS
ADDICTIVE BEHAVIORS
1983; 8 (4): 381-391
Abstract
Support for the importance of psychosocial influences on smoking is limited because the evidence is primarily based on intervention studies which deal with self-selected and thus unrepresentative samples of smokers. There have been few comparisons with nonsmokers on these factors. In this study, we examine the role of psychosocial factors among a representative community sample of smokers and nonsmokers. Heavy smokers were distinguished from nonsmokers by only slightly higher levels of environmental stressors, less supportive social resources, and poorer psychological functioning. Light smokers did not differ from nonsmokers on these factors. Although stressors and resources were correlated with psychological functioning across all respondents, such relationships were not significantly stronger for either heavy or light smokers. These results suggest that psychosocial influences may have differential relevance during the different phases of smoking behavior such as initiation, maintenance, and cessation.
View details for Web of Science ID A1983SD06100008
View details for PubMedID 6677079
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STRESS, COPING, AND DEPRESSION AMONG MARRIED-COUPLES
JOURNAL OF ABNORMAL PSYCHOLOGY
1983; 92 (4): 433-448
View details for Web of Science ID A1983RR13600005
View details for PubMedID 6643822
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COMPARISONS OF CHILDREN OF DEPRESSED AND NONDEPRESSED PARENTS - A SOCIAL-ENVIRONMENTAL PERSPECTIVE
JOURNAL OF ABNORMAL CHILD PSYCHOLOGY
1983; 11 (4): 463-486
Abstract
Several lines of evidence indicate that a parent's depression may be a significant health and adaptational risk factor for his or her children. In a controlled comparison, children of 133 depressed parents had significantly more symptoms of emotional, somatic, and behavioral impairment than did children of 135 nondepressed parents. Additional results suggest that the more negative milieu found among families of depressed parents was a mediator of the effects of parental depression. A social-environmental perspective helped to identify aspects of parents' functioning, family stressors, and resources that were related to children's health. Variations in these stressors and resources were strongly related to the probability of disturbance among children of depressed parents.
View details for Web of Science ID A1983RT21000001
View details for PubMedID 6655148
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SOCIAL-ENVIRONMENTAL FACTORS IN UNIPOLAR DEPRESSION - COMPARISONS OF DEPRESSED-PATIENTS AND NONDEPRESSED CONTROLS
JOURNAL OF ABNORMAL PSYCHOLOGY
1983; 92 (2): 119-133
View details for Web of Science ID A1983QQ41600001
View details for PubMedID 6863728
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PSYCHO-SOCIAL PROCESSES OF RECOVERY AMONG ALCOHOLICS AND THEIR FAMILIES - IMPLICATIONS FOR CLINICIANS AND PROGRAM EVALUATORS
ADDICTIVE BEHAVIORS
1983; 8 (3): 205-218
Abstract
This paper provides an overview of a program of research that has focused on the role of extratreatment factors in the process of recovery and relapse among treated alcoholic patients and their families. Consistent with a systems perspective, patients who controlled their drinking showed improvements in nondrinking aspects of their functioning and members of their families showed improved adjustment as well. Moreover, the posttreatment functioning of these recovered families was comparable to that of a matched nonalcoholic community group. In contrast, relapsed alcoholics and their family members suffered from multidimensional impairments. Extratreatment factors such as environmental stressors, coping responses, and social resources had as much influence on the recovery process as did patients' treatment experiences. New procedures to assess these extratreatment factors are described and methods by which clinicians and researchers can use the resulting information to improve treatment outcome and the specificity of program evaluations are discussed.
View details for Web of Science ID A1983RQ09600001
View details for PubMedID 6666687
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ADAPTATION AND THE QUALITY OF LIFE IN WORK AND FAMILY SETTINGS
JOURNAL OF COMMUNITY PSYCHOLOGY
1983; 11 (2): 158-170
Abstract
The paper describes the development of scales to assess the perceived social-environmental quality of work and family settings. The use of these scales in comparing and contrasting work and family settings and in examining their role as contexts for adaptation and growth is illustrated. Some tentative conclusions about social-environmental influences on individual and family adaptation are drawn and practical applications for planning ecologically oriented interventions are discussed.
View details for Web of Science ID A1983QS16300008
View details for PubMedID 10263341
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THE EXPANDING SCOPE OF ALCOHOLISM-TREATMENT EVALUATION
AMERICAN PSYCHOLOGIST
1983; 38 (10): 1036-1044
View details for Web of Science ID A1983RK16600002
View details for PubMedID 6314859
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THE QUALITY OF SOCIAL SUPPORT - MEASURES OF FAMILY AND WORK RELATIONSHIPS
BRITISH JOURNAL OF CLINICAL PSYCHOLOGY
1983; 22 (SEP): 157-162
View details for Web of Science ID A1983RH24000001
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A CONCEPTUAL-MODEL OF THE FUNCTIONING OF MARRIED PERSONS WITH IMPAIRED PARTNERS - SPOUSES OF ALCOHOLIC PATIENTS
JOURNAL OF MARRIAGE AND THE FAMILY
1983; 45 (1): 23-34
View details for Web of Science ID A1983QD02800002
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Social support and well-being: Implications for prevention programs.
journal of primary prevention
1982; 3 (2): 77-98
Abstract
A variety of prevention programs have assumed that social support has health-promotive and health-protective effects. Although numerous studies have examined the relationship between social support and well-being, the result has been a heterogeneous and complex set of findings. We seek to review and summarize this research as a data base for planning and evaluating prevention programs. To organize our review, we present a model of stress, support, and well-being which distinguishes among several mechanisms through which support may affect well-being. We consider research on each of these mechanisms: thedirect effects of support upon functioning; theindirect effects of support upon functioning through its influence on exposure to environmental stressors; and theinteractive effects of social support in buffering the individual from the maladaptive effects of stress. We then address several implications of this research that need to be considered in the process of designing and evaluating prevention programs: (a) the need to consider the varying mechanisms through which social support has its effects; (b) the need for specificity in developing preventive interventions; and (c) the need to examine relationships among stress, support, and functioning within a broader social context.
View details for DOI 10.1007/BF01324668
View details for PubMedID 24301450
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CHILDREN OF ALCOHOLICS DURING THE RECOVERY PROCESS - ALCOHOLIC AND MATCHED CONTROL FAMILIES
ADDICTIVE BEHAVIORS
1982; 7 (2): 155-163
Abstract
Children of relapsed and recovered alcoholic patients were compared with children from sociodemographically matched control families on a set of indices of emotional and physical status. The children of relapsed alcoholics evidenced more symptoms of emotional disturbance than did the control children. In contrast, the children of recovered alcoholics were functioning as well as the control children. Additional analyses showed that the emotional status of children was related to the emotional, physical, and occupational functioning shown by their alcoholic and their nonalcoholic parent, as well as to family life stressors.
View details for Web of Science ID A1982NL86800006
View details for PubMedID 7102446
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THE CLINICAL USE OF SOCIAL-ECOLOGICAL CONCEPTS - THE CASE OF AN ADOLESCENT GIRL
AMERICAN JOURNAL OF ORTHOPSYCHIATRY
1982; 52 (1): 111-122
View details for Web of Science ID A1982MY85200014
View details for PubMedID 7055217
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WORK STRESS AND THE STRESS-BUFFERING ROLES OF WORK AND FAMILY RESOURCES
JOURNAL OF OCCUPATIONAL BEHAVIOUR
1982; 3 (3): 215-232
View details for Web of Science ID A1982NY63200002
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PSYCHO-SOCIAL THEORY AND RESEARCH ON DEPRESSION - AN INTEGRATIVE FRAMEWORK AND REVIEW
CLINICAL PSYCHOLOGY REVIEW
1982; 2 (2): 213-237
View details for Web of Science ID A1982NU31400007
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FAMILY ENVIRONMENTS AND ADAPTATION - A CLINICALLY APPLICABLE TYPOLOGY
AMERICAN JOURNAL OF FAMILY THERAPY
1982; 10 (2): 26-38
View details for Web of Science ID A1982NU92700003
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SOCIAL SUPPORT AND FUNCTIONING AMONG COMMUNITY AND CLINICAL GROUPS - A PANEL MODEL
JOURNAL OF BEHAVIORAL MEDICINE
1982; 5 (3): 295-311
Abstract
This study examined the relationship between social support and personal functioning in a longitudinal assessment of a representative sample of community men and women. Although there was considerable temporal stability in several indices of support and personal functioning, changes in levels of support during the follow-up period were associated with changes in functioning. These relationships varied according to the individual's gender and the source of support. Family support was more strongly related to functioning among women, while work support was more strongly related to functioning among men. In comparable analyses on patients recovering from alcoholism, levels of support and functioning were more variable over time, and changes in family support were somewhat more strongly related to changes in functioning. The findings are discussed in light of a perspective that considers the role of environmental stressors and resources in adaptation.
View details for Web of Science ID A1982PK77500002
View details for PubMedID 7131546
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THE PROCESS OF RECOVERY FROM ALCOHOLISM .2. COMPARING SPOUSES OF ALCOHOLIC PATIENTS AND MATCHED COMMUNITY CONTROLS
JOURNAL OF STUDIES ON ALCOHOL
1982; 43 (9): 888-909
View details for Web of Science ID A1982QF43100003
View details for PubMedID 7166958
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SOCIAL SUPPORT AND ADJUSTMENT - PREDICTIVE BENEFITS OF SOCIAL CLIMATE INDEXES
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
1982; 10 (4): 403-415
Abstract
This study estimates the relationship between social support and physical and psychological adjustment, using measures that afford a qualitative assessment of social support. Qualitative indices of social support in family (Family Relationships Index) and work (Work Relationships Index) environments were derived from available social climate measures. Respondents were a randomly selected community sample of 267 male and 267 female adult family members. Results support hypotheses that qualitative measures of support in family and work environments predict psychosomatic complaints and depression after variance due to negative life change and quantitative measures of social support is accounted for. While the work environment is a more important source of support for men than women, the family environment provides an especially potent source of support for unemployed women.
View details for Web of Science ID A1982PB77600003
View details for PubMedID 7137128
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The role of coping responses and social resources in attenuating the stress of life events.
Journal of behavioral medicine
1981; 4 (2): 139-157
Abstract
The nature of individual coping responses to stressful life events was explored in a representative adult community sample. Two approaches to the classification of coping strategies were operationalized. Using these measures, small but significant gender and contextual differences in coping were identified. Mood and symptom levels were related to coping responses and to quantitative and qualitative measures of social resources. Measures of coping and social resources attenuated the relationship between undesirable life events and personal functioning.
View details for PubMedID 7321033
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THE PROCESS OF RECOVERY FROM ALCOHOLISM .1. COMPARING ALCOHOLIC PATIENTS AND MATCHED COMMUNITY CONTROLS
JOURNAL OF STUDIES ON ALCOHOL
1981; 42 (5): 383-402
View details for Web of Science ID A1981MB96400001
View details for PubMedID 7278281
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ASSESSING AND EVALUATING RESIDENTIAL ENVIRONMENTS - A SHELTERED LIVING ENVIRONMENTS EXAMPLE
ENVIRONMENT AND BEHAVIOR
1981; 13 (4): 481-508
View details for Web of Science ID A1981MB85400004
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THE USE OF FAMILY ASSESSMENT AND FEEDBACK IN ONGOING FAMILY-THERAPY
AMERICAN JOURNAL OF FAMILY THERAPY
1981; 9 (1): 24-36
View details for Web of Science ID A1981LG89300003
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ENVIRONMENTAL CHOICE AND CONTROL IN COMMUNITY CARE SETTINGS FOR OLDER-PEOPLE
JOURNAL OF APPLIED SOCIAL PSYCHOLOGY
1981; 11 (1): 23-43
View details for Web of Science ID A1981LZ72200003
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COMMUNITY INTEGRATION AMONG ELDERLY RESIDENTS OF SHELTERED CARE SETTINGS
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
1981; 9 (5): 513-526
View details for Web of Science ID A1981NL84600002
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THE SUPRA-PERSONAL ENVIRONMENTS OF SHELTERED CARE SETTINGS
JOURNALS OF GERONTOLOGY
1981; 36 (2): 233-243
Abstract
The Resident and Staff Information Form (RESIF) measures the aggregate characteristics of residents and staff of sheltered care settings (the suprapersonal environment) in terms of nine conceptually unified dimensions. The dimensions include measures of residents' social backgrounds, current functioning, and use of facility services. The development of the RESIF is outlined, nd psychometric characteristics, based on data from 93 representative facilities, are presented. Relationships among RESIF dimensions and between these dimensions and facility characteristics are examined. The data show that the aggregate characteristics of residents vary markedly among facilities. The suprapersonal environment in turn is related to other facility characteristics. Residents who are high on social resources or whose functional abilities are high are likely to be more active and to live in facilities that provide more physical resources, more control, and higher cohesion, organization, and physical comfort. The results indicate the existence of mechanisms of selection and social allocation that determine where a person is likely to live.
View details for Web of Science ID A1981LF10700016
View details for PubMedID 7204905
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LENGTH OF STAY AND PROGRAM COMPONENT EFFECTS IN THE TREATMENT OF ALCOHOLISM - A COMPARISON OF 2 TECHNIQUES FOR PROCESS ANALYSES
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1981; 49 (1): 120-131
View details for Web of Science ID A1981LE50700015
View details for PubMedID 7217465
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CHARACTERISTICS AND PROGNOSES OF ALCOHOLICS WHO BECOME MODERATE DRINKERS AND ABSTAINERS AFTER TREATMENT
JOURNAL OF STUDIES ON ALCOHOL
1981; 42 (1): 94-105
View details for Web of Science ID A1981LL14900010
View details for PubMedID 7230825
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SOCIAL SUPPORT AND PSYCHOLOGICAL DISTRESS - A LONGITUDINAL ANALYSIS
JOURNAL OF ABNORMAL PSYCHOLOGY
1981; 90 (4): 365-370
View details for Web of Science ID A1981MB79700012
View details for PubMedID 7264067
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DETERMINANTS OF THE POST-TREATMENT FUNCTIONING OF ALCOHOLIC PATIENTS - A CONCEPTUAL-FRAMEWORK
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1980; 48 (3): 305-316
View details for Web of Science ID A1980JS79800001
View details for PubMedID 7381090
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DETERMINANTS OF THE SOCIAL ENVIRONMENTS OF SHELTERED CARE SETTINGS
JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
1980; 21 (1): 88-98
View details for Web of Science ID A1980JJ11900009
View details for PubMedID 7365233
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COMMUNITY INTEGRATION AMONG ELDERLY RESIDENTS OF SHELTERED CARE SETTINGS
OXFORD UNIV PRESS INC. 1980: 89–89
View details for Web of Science ID A1980KM20300146
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ASSESSING THE INSTITUTIONAL POLICIES OF SHELTERED CARE SETTINGS
JOURNALS OF GERONTOLOGY
1980; 35 (1): 96-107
Abstract
The Policy and Program Information Form (POLIF) measures the policies and services of sheltered care settings in terms of ten conceptually unified dimensions. The development of the POLIF is described, and psychometric characteristics, based on data from 93 representative facilities, are presented. These data show that facilities providing a higher level of care tend to provide residents with less choice and control. Larger facilities tend to be more selective, to offer more health services and social activities, and to have formal means for transmitting expectations and involving residents in decision making. Sample profiles illustrate the usefulness of this instrument for describing and comparing facilities; additional uses are discussed.
View details for Web of Science ID A1980JA41200012
View details for PubMedID 7350226
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ASSESSING THE PHYSICAL AND ARCHITECTURAL FEATURES OF SHELTERED CARE SETTINGS
JOURNALS OF GERONTOLOGY
1980; 35 (4): 571-583
Abstract
The Physical and Architectural Features Checklist (PaF) measures the physical resources of sheltered care settings in terms of nine conceptually unified and empirically derived dimensions. The development of the PAF is described, and psychometric characteristics, based on data from 93 representative facilities, are presented. These data show that facilities which have more physical resources are seen as attractive by outside observers and pleasant by residents. Larger facilities are more likely to provide barrier-free environments, more flexible physical settings, and more staff facilities. Cost is not related to any PAF dimension; however, nonprofit facilities score higher on several dimensions than do proprietary facilities. Richer physical settings tend to offer residents more policy resources. They are more selective, provide more privacy, allow residents a higher degree of influence and choice, and have clearer policies. Sample profiles illustrate the usefulness of this instrument for describing and comparing facilities; additional uses are discussed.
View details for Web of Science ID A1980JY27900014
View details for PubMedID 7400551
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THE NEED FOR A PARADIGM SHIFT IN EVALUATIONS OF TREATMENT OUTCOME - EXTRAPOLATIONS FROM THE RAND RESEARCH
BRITISH JOURNAL OF ADDICTION
1980; 75 (4): 347-350
View details for Web of Science ID A1980KS91100005
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POST-TREATMENT EXPERIENCES AND TREATMENT OUTCOME OF ALCOHOLIC PATIENTS 6 MONTHS AND 2 YEARS AFTER HOSPITALIZATION
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1980; 48 (1): 17-29
View details for Web of Science ID A1980JK84400005
View details for PubMedID 7365039
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FAMILY CHARACTERISTICS AND THE OUTCOME OF TREATMENT FOR ALCOHOLISM
JOURNAL OF STUDIES ON ALCOHOL
1979; 40 (1): 78-88
Abstract
Families in which the alcoholic patient showed better treatment outcome were higher than the other in cohesion, active-recreational orientation and organization, and lower in conflict and control; they also experienced more positive and fewer negative life events, and reported fewer physical and emotional symptoms and disagreements.
View details for Web of Science ID A1979HA02400009
View details for PubMedID 449340
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ALCOHOL-USE AMONG COLLEGE-STUDENTS - SOME COMPETING HYPOTHESES
JOURNAL OF YOUTH AND ADOLESCENCE
1979; 8 (4): 393-405
Abstract
This paper presents a longitudinal study of alcohol use among college students. Three hypothesized predictors of alcohol use are found to have an independent effect when the other predictors and prior drinking are held constant: the drinking context of the dormitory living group, informal social involvement in college, and lack of commitment to religious and academic values. These predictors are also related to the onset of drinking during the freshman year for those who entered college as abstainers. The pattern varies somewhat for males and females, with the dormitory contextual effect larger for females. Formal involvement in college activities and psychological stress have no independent effect on drinking. The results are discussed in relation to previous work on alcohol use.
View details for Web of Science ID A1979HZ87500002
View details for PubMedID 24317842
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STUDENT PHYSICAL SYMPTOMS AND THE SOCIAL CLIMATE OF COLLEGE LIVING GROUPS
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
1979; 7 (1): 31-43
Abstract
Student physical symptoms were related to the social climates of university living groups. A Physical Symptom Risk Scale, a new subscale of the University Residence Environment Scale, which relates consistently to physical symptom complaints for male, female, and coed living groups, was developed. Living groups characterized by high student physical symptoms were perceived by students as low in involvement and support, high in competition, and low in student influence. The results indicate that certain types of social environments may be "high risk" settings in that they support and possibly facilitate complaints of physical symptoms. These settings may be amenable to early "environmental diagnosis," preventive counseling, and change-oriented social systems intervention.
View details for Web of Science ID A1979GN53100003
View details for PubMedID 453122
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ASSESSING THE SOCIAL ENVIRONMENTS OF SHELTERED CARE SETTINGS
GERONTOLOGIST
1979; 19 (1): 74-82
View details for Web of Science ID A1979GH03900011
View details for PubMedID 263579
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PROGNOSIS OF ALCOHOLIC PATIENTS - COMPARISONS OF ABSTAINERS AND MODERATE DRINKERS
BRITISH JOURNAL OF ADDICTION
1979; 74 (2): 183-188
View details for Web of Science ID A1979GZ54100008
View details for PubMedID 287511
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TREATMENT AND OUTCOME FOR EMPIRICAL SUBTYPES OF ALCOHOLIC PATIENTS
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1979; 47 (1): 25-38
View details for Web of Science ID A1979GJ95900003
View details for PubMedID 85643
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CLASSROOM SOCIAL CLIMATE AND STUDENT ABSENCES AND GRADES
JOURNAL OF EDUCATIONAL PSYCHOLOGY
1978; 70 (2): 263-269
View details for Web of Science ID A1978EX64000022
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TOWARD A MENSTRUAL-CYCLE SYMPTOM TYPOLOGY
JOURNAL OF PSYCHOSOMATIC RESEARCH
1978; 22 (1): 31-40
View details for Web of Science ID A1978EL98600006
View details for PubMedID 625035
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EXPLORATION AND ADJUSTMENT IN HIGH-SCHOOL CLASSROOMS - STUDY OF PERSON-ENVIRONMENT FIT
JOURNAL OF EDUCATIONAL RESEARCH
1978; 72 (1): 52-57
View details for Web of Science ID A1978FU25200011
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SUBJECT-MATTER AND CLASSROOM CLIMATE - TEST OF HOLLANDS ENVIRONMENTAL PROPOSITIONS
AMERICAN EDUCATIONAL RESEARCH JOURNAL
1978; 15 (1): 111-124
View details for Web of Science ID A1978ER68600009
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SOCIAL ENVIRONMENTS OF UNIVERSITY-STUDENT LIVING GROUPS - ARCHITECTURAL AND ORGANIZATIONAL CORRELATES
ENVIRONMENT AND BEHAVIOR
1978; 10 (1): 109-126
View details for Web of Science ID A1978EU37300005
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TYPOLOGY OF JUNIOR HIGH AND HIGH-SCHOOL CLASSROOMS
AMERICAN EDUCATIONAL RESEARCH JOURNAL
1978; 15 (1): 53-66
View details for Web of Science ID A1978ER68600005
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DIFFICULTY OF FOLLOW-UP AND OUTCOME OF ALCOHOLISM-TREATMENT
JOURNAL OF STUDIES ON ALCOHOL
1978; 39 (3): 473-490
Abstract
Patients who are difficult to follow up after alcoholism treatment have poorer treatment outcome than do patients who are followed up more easily.
View details for Web of Science ID A1978EW84700007
View details for PubMedID 651358
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EVALUATION OF A SALVATION ARMY ALCOHOLISM-TREATMENT PROGRAM
JOURNAL OF STUDIES ON ALCOHOL
1978; 39 (7): 1267-1275
Abstract
The functioning and participation of 97 men in a treatment program were analyzed in what was judged to be a cost-effective program for Skid Row alcoholics.
View details for Web of Science ID A1978FP11400013
View details for PubMedID 703325
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EVALUATING ALCOHOLISM-TREATMENT PROGRAMS - INTEGRATED APPROACH
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1978; 46 (5): 1105-1119
View details for Web of Science ID A1978FT88200033
View details for PubMedID 701545
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ENVIRONMENTAL RESOURCES AND POSTTREATMENT FUNCTIONING OF ALCOHOLIC PATIENTS
JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
1977; 18 (3): 326-338
View details for Web of Science ID A1977DT70100008
View details for PubMedID 903601
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PHYSICAL AND EMOTIONAL SYMPTOMS AND CAMPUS HEALTH-CENTER UTILIZATION
SOCIAL PSYCHIATRY
1977; 12 (3): 107-115
View details for Web of Science ID A1977DN18300001
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POSTTREATMENT FUNCTIONING OF ALCOHOLIC PATIENTS - ITS RELATION TO PROGRAM PARTICIPATION
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1977; 45 (5): 829-842
View details for Web of Science ID A1977DW91400014
View details for PubMedID 903445
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TREATMENT EXPERIENCES OF ALCOHOLIC PATIENTS - ANALYSIS OF 5 RESIDENTIAL ALCOHOLISM PROGRAMS
INTERNATIONAL JOURNAL OF THE ADDICTIONS
1977; 12 (7): 953-958
Abstract
Five different residential alcoholism programs were studied to determine the influence of patient attributes on the treatment process. The relationship between patient characteristics and treatment experiences was analyzed separately for each of the five programs. There was no systematic relationship between patient characteristics and the kind or extent of treatment patients received or length of patient stay in treatment. The authors recommend more attention be paid to the type and intensity of treatment in relation to patient characteristics and a routine evaluation of program effectiveness.
View details for Web of Science ID A1977EE46400015
View details for PubMedID 591148
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Monitoring change in community-oriented treatment programs.
Journal of community psychology
1976; 4 (4): 315-326
Abstract
Changes in the social climate of two alcoholism treatment programs were evaluated by repeated assessments with the Community-Oriented Programs Environment Scale (COPES). The programs were similar in size and treatment orientation, but differed in physical and organizational setting, program length, and patient and staff characteristics. Specific and unique changes occurring within the treatment programs resulted in corresponding changes in relevant dimensions of the programs' social climates. The practical utility of COPES evaluations in instituting quality control and evaluating the results of change in community-oriented treatment programs is discussed.
View details for PubMedID 10243948
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TYPOLOGY OF FAMILY SOCIAL ENVIRONMENTS
FAMILY PROCESS
1976; 15 (4): 357-371
Abstract
A sample of 100 families measured on ten dimensions of their social environments was subjected to cluster analysis to develop an empirically based taxonomy of families. Six distinctive clusters of families were indentified: Expression-Oriented, Structure-Oriented, Independence-Oriented, Achievement-Oriented, Moral/Religious-Oriented and Conflict-Oriented. The clusters showed systematic differences in background characteristics such as size, ethnic minority composition, drinking patterns, and family disturbance and incongruence. Some evidence that certain clusters of families are composed of different sub-clusters was presented. An empirically derived taxonomy of the social environments of families may help to understand how different family environments are linked to different family outcomes.
View details for Web of Science ID A1976CP98200001
View details for PubMedID 1026454
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DISTANCE AND UTILIZATION OF A STUDENT HEALTH-CENTER
JOURNAL OF THE AMERICAN COLLEGE HEALTH ASSOCIATION
1976; 24 (3): 159-162
View details for Web of Science ID A1976BM84300010
View details for PubMedID 1254837
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SOCIAL CLIMATE AND MAJOR CHOICE - TEST OF HOLLANDS-THEORY IN UNIVERSITY-STUDENT LIVING GROUPS
JOURNAL OF VOCATIONAL BEHAVIOR
1976; 8 (3): 293-305
View details for Web of Science ID A1976BW16600005
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SOCIAL CLIMATE OF ALCOHOLISM TREATMENT PROGRAMS
ARCHIVES OF GENERAL PSYCHIATRY
1976; 33 (8): 910-916
Abstract
The social climate of four residential alcoholism treatment programs was assessed with the Community-Oriented Programs Environment Scale (COPES). The programs differed in terms of their treatment orientations (aversion-conditioning, milieu therapy) and the sociodemographic characteristics of the patients admitted. Results showed that (1) COPES profiles distinguished between the four alcoholism programs in ways that were consistent with their respective treatment orientations; (2) the type of patient admitted to these programs did not systematically affect their treatment environment; and (3) changes occurring within an alcoholism program resulted in corresponding changes in relevant dimensions of the treatment environment. We also discuss the practical utility of the COPES for assessing alcoholism programs.
View details for Web of Science ID A1976CB68300002
View details for PubMedID 949224
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SEX AND MARITAL-STATUS IN RELATION TO CHARACTERISTICS OF ALCOHOLICS
JOURNAL OF STUDIES ON ALCOHOL
1976; 37 (9): 1302-1312
Abstract
Data on 392 married and unmarried men and women alcoholics suggest that certain social antecedents and drinking patterns represent genuine sex differences and are independent of marital status. However, marital status was related to severity of alcoholism, particularly with respect to personal background characteristics and to psychological functioning at the time of treatment.
View details for Web of Science ID A1976CG77400011
View details for PubMedID 979279
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COLLEGE-STUDENT ABSTAINERS, MODERATE DRINKERS, AND HEAVY DRINKERS - COMPARATIVE ANALYSIS
JOURNAL OF YOUTH AND ADOLESCENCE
1976; 5 (4): 349-360
View details for Web of Science ID A1976CS06800003
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ORGASMIC FREQUENCY AND PLASMA TESTOSTERONE LEVELS IN NORMAL HUMAN MALES
ARCHIVES OF SEXUAL BEHAVIOR
1976; 5 (2): 125-132
Abstract
Twenty males participated in a 2-month study examining the relationship between 8 a.m. plasma testosterone levels and orgasmic frequency. Within subjects, higher levels of testosterone are associated with periods of sexual activity. Over subjects, however, the direction of the relationship is reversed. Mean testosterone levels were higher for sexually less active individuals.
View details for Web of Science ID A1976BQ63500002
View details for PubMedID 1275688
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NEGATIVE AFFECT AND PLASMA TESTOSTERONE - LONGITUDINAL HUMAN STUDY
PSYCHOSOMATIC MEDICINE
1975; 37 (6): 484-491
Abstract
The association between mood and plasma testosterone was investigated. Every second day for 2 months, a Multiple Affect Adjective Checklist was filled out by 20 young men. Blood samples taken at the same time were analyzed for testosterone concentration. Relationships between hostility, anxiety, and depression and plasma testosterone levels were tested both within and across individuals. Intrasubject correlation coefficients between affects and hormone were fairly evenly distributed between positive and negative values, some significant on either side. Intersubject correlation coefficients were all positivie. Between depression and testosterone, the correlation was significant only at the 10% level; between the other two affects and testosterone, the correlations were not significant.
View details for Web of Science ID A1975AY34000002
View details for PubMedID 1202545
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TOWARD A TAXONOMY OF INPATIENT TREATMENT ENVIRONMENTS
JOURNAL OF ABNORMAL PSYCHOLOGY
1975; 84 (3): 181-188
View details for Web of Science ID A1975AE67900001
View details for PubMedID 1133246
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TYPOLOGY OF UNIVERSITY-STUDENT LIVING GROUPS
JOURNAL OF EDUCATIONAL PSYCHOLOGY
1975; 67 (3): 359-367
View details for Web of Science ID A1975AE82900003
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IMPACT OF COED LIVING ON MALES AND FEMALES
JOURNAL OF COLLEGE STUDENT DEVELOPMENT
1975; 16 (6): 459-469
View details for Web of Science ID A1975BD35800003
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UNIVERSITY RESIDENCE ENVIRONMENT SCALE - METHOD FOR DESCRIBING UNIVERSITY STUDENT LIVING GROUPS
JOURNAL OF COLLEGE STUDENT DEVELOPMENT
1974; 15 (5): 357-365
View details for Web of Science ID A1974U116200004
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PATIENT EXPECTATIONS AND ATTENDANCE IN COMMUNITY TREATMENT PROGRAMS
COMMUNITY MENTAL HEALTH JOURNAL
1974; 10 (1): 9-15
View details for Web of Science ID A1974T625400002
View details for PubMedID 4419729
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DETERMINANTS OF PHYSIOLOGICAL-RESPONSES TO SYMBOLIC STIMULI - ROLE OF SOCIAL-ENVIRONMENT
INTERNATIONAL JOURNAL OF PSYCHIATRY IN MEDICINE
1974; 5 (4): 389-399
View details for Web of Science ID A1974AE11500008
View details for PubMedID 4464279
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PSYCHOLOGICAL ENVIRONMENTS - EXPANDING SCOPE OF HUMAN ECOLOGY
AMERICAN PSYCHOLOGIST
1974; 29 (3): 179-188
View details for Web of Science ID A1974S316500004
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BEHAVIORAL ASPECTS OF CHROMOSOMAL DISORDERS
ANNUAL REVIEW OF MEDICINE
1973; 24: 89-102
View details for Web of Science ID A1973P772800009
View details for PubMedID 4268019
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RELATION BETWEEN PSYCHIATRIC WARD ATMOSPHERE AND HELPING BEHAVIOR
JOURNAL OF CLINICAL PSYCHOLOGY
1973; 29 (1): 74-78
View details for Web of Science ID A1973O531000026
View details for PubMedID 4683399
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PERCEIVED WARD CLIMATE AND TREATMENT OUTCOME
JOURNAL OF ABNORMAL PSYCHOLOGY
1973; 82 (2): 291-298
View details for Web of Science ID A1973R182200015
View details for PubMedID 4754370
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CONCEPTUALIZATIONS OF HUMAN ENVIRONMENTS
AMERICAN PSYCHOLOGIST
1973; 28 (8): 652-665
View details for Web of Science ID A1973Q430500002
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EVALUATING DESCRIPTIONS OF PSYCHIATRIC TREATMENT PROGRAMS
AMERICAN JOURNAL OF ORTHOPSYCHIATRY
1973; 43 (3): 401-410
View details for Web of Science ID A1973P539700013
View details for PubMedID 4711083
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SOCIAL ENVIRONMENT OF JUNIOR HIGH AND HIGH-SCHOOL CLASSROOMS
JOURNAL OF EDUCATIONAL PSYCHOLOGY
1973; 65 (1): 93-102
View details for Web of Science ID A1973Q653600013
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CHANGING SOCIAL MILIEUS OF PSYCHIATRIC-TREATMENT SETTINGS
JOURNAL OF APPLIED BEHAVIORAL SCIENCE
1973; 9 (5): 575-593
View details for Web of Science ID A1973R253500002
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Satisfaction with the correctional institution environment: an instance of perceived self-environment similarity.
Journal of personality
1972; 40 (1): 75-87
View details for PubMedID 5013148
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SOCIAL ECOLOGY OF UNIVERSITY STUDENT RESIDENCES
JOURNAL OF EDUCATIONAL PSYCHOLOGY
1972; 63 (6): 513-525
View details for Web of Science ID A1972O293300001
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EXPERIMENTAL INVESTIGATION OF PROCESS AND OUTCOME IN AN ENCOUNTER GROUP
HUMAN RELATIONS
1972; 25 (5): 441-?
View details for Web of Science ID A1972O276400005
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SOCIAL CLIMATES IN PRISON - ATTEMPT TO CONCEPTUALIZE AND MEASURE ENVIRONMENTAL FACTORS IN TOTAL INSTITUTIONS
JOURNAL OF RESEARCH IN CRIME AND DELINQUENCY
1972; 9 (2): 134-148
View details for Web of Science ID A1972P719000006
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CHANGING WARD ATMOSPHERE THROUGH STAFF DISCUSSION OF PERCEIVED WARD ENVIRONMENT
ARCHIVES OF GENERAL PSYCHIATRY
1972; 26 (1): 35-?
View details for Web of Science ID A1972L267000007
View details for PubMedID 5009424
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XYY KARYOTYPE AND CRIMINALITY - REVIEW
JOURNAL OF PSYCHIATRIC RESEARCH
1970; 7 (3): 153-170
View details for Web of Science ID A1970Y279100002
View details for PubMedID 4909567
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GENERALITY AND SPECIFICITY OF STUDENT REACTIONS IN HIGH SCHOOL CLASSROOMS
ADOLESCENCE
1970; 5 (20): 373-390
View details for Web of Science ID A1970I042800001
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DIFFERENTIAL EFFECTS OF SOCIAL CLIMATES OF CORRECTIONAL INSTITUTIONS
JOURNAL OF RESEARCH IN CRIME AND DELINQUENCY
1970; 7 (1): 71-82
View details for Web of Science ID A1970G307800007
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ASSESSMENT OF SOCIAL CLIMATES OF CORRECTIONAL INSTITUTIONS
JOURNAL OF RESEARCH IN CRIME AND DELINQUENCY
1968; 5 (2): 174-188
View details for Web of Science ID A1968ZH12700006
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PSYCHOLOGICAL ASPECTS OF ORAL CONTRACEPTIVES
ARCHIVES OF GENERAL PSYCHIATRY
1968; 19 (1): 87-+
View details for Web of Science ID A1968B433000013
View details for PubMedID 5690587
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POSTPARTUM BLUES SYNDROME - A DESCRIPTION AND RELATED VARIABLES
ARCHIVES OF GENERAL PSYCHIATRY
1968; 18 (1): 16-&
View details for Web of Science ID A1968A414300003
View details for PubMedID 5634686
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MULTIVARIATE STUDY OF PATIENT-THERAPIST SYSTEM
JOURNAL OF CONSULTING PSYCHOLOGY
1967; 31 (2): 119-130
View details for Web of Science ID A1967ZX16800002
View details for PubMedID 6042047
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DIFFERENTIAL EFFECTS OF WARD SETTINGS ON PSYCHIATRIC PATIENTS
JOURNAL OF NERVOUS AND MENTAL DISEASE
1967; 145 (4): 272-&
View details for DOI 10.1097/00005053-196710000-00002
View details for Web of Science ID A1967A359500002
View details for PubMedID 6076015
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DIFFERENTIAL EFFECTS OF WARD SETTINGS ON PSYCHIATRIC STAFF
ARCHIVES OF GENERAL PSYCHIATRY
1967; 17 (1): 75-&
View details for Web of Science ID A19679669300011
View details for PubMedID 4952164
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GLOBULINS AND BEHAVIOR IN SCHIZOPHRENIA
INTERNATIONAL JOURNAL OF NEUROPSYCHIATRY
1966; 2 (1): 20-&
View details for Web of Science ID A19667539900002
View details for PubMedID 4159921
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PSYCHOLOGIC COMPARISONS BETWEEN WOMEN WITH RHEUMATOID-ARTHRITIS AND THEIR NONARTHRITIC SISTERS .1. PERSONALITY TEST AND INTERVIEW RATING DATA
PSYCHOSOMATIC MEDICINE
1965; 27 (2): 135–49
View details for DOI 10.1097/00006842-196503000-00006
View details for Web of Science ID A1965CBX5000006
View details for PubMedID 14276919
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PSYCHOLOGIC COMPARISONS BETWEEN WOMEN WITH RHEUMATOID-ARTHRITIS AND THEIR NONARTHRITIC SISTERS .2. CONTENT-ANALYSIS OF INTERVIEWS
PSYCHOSOMATIC MEDICINE
1965; 27 (2): 150–64
View details for DOI 10.1097/00006842-196503000-00007
View details for Web of Science ID A1965CBX5000007
View details for PubMedID 14276920
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THE RELATIONSHIP OF PERSONALITY TO THE PRESENCE OF RHEUMATOID-FACTOR IN ASYMPTOMATIC RELATIVES OF PATIENTS WITH RHEUMATOID-ARTHRITIS
PSYCHOSOMATIC MEDICINE
1965; 27 (4): 350–60
View details for DOI 10.1097/00006842-196507000-00006
View details for Web of Science ID A1965CBX5200006
View details for PubMedID 14346021
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PERSONALITY CORRELATES OF RAPIDITY OF PROGRESSION OF RHEUMATOID ARTHRITIS
ANNALS OF THE RHEUMATIC DISEASES
1964; 23 (2): 145-&
View details for DOI 10.1136/ard.23.2.145
View details for Web of Science ID A19645017A00008
View details for PubMedID 14130035
View details for PubMedCentralID PMC1010359
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EMOTIONS IMMUNITY + DISEASE - SPECULATIVE THEORETICAL INTEGRATION
ARCHIVES OF GENERAL PSYCHIATRY
1964; 11 (6): 657-&
View details for Web of Science ID A1964CA31900011
View details for PubMedID 14215982
- Psychosocial Treatment for Alcohol Use Disorders. In P.E. nathan & J. M. Gorman(Eds.) A Guide to Treatments that Work New York: Oxford. : 156-166