Alcohol consumption and cognitive function in late life: a longitudinal community study.

OBJECTIVE: To examine the association between alcohol use and cognitive decline in a longitudinal study of a representative elderly community sample free of dementia at baseline. METHODS: Cognitive functions and self-reported drinking habits were assessed at 2-year intervals over an average of 7 years of follow-up. Cognitive measures, grouped into composites, were examined in association with alcohol consumption. Trajectory analyses identified latent homogeneous groups with respect to alcohol use frequency over time, and their association with average decline over the same period in each cognitive domain. Models controlled for age, sex, education, depression, smoking, general mental status (Mini-Mental State Examination [MMSE]), performance on the given test at baseline, and subsequent new-onset dementia during follow-up. RESULTS: The authors found three homogeneous trajectories that they characterized as no drinking, minimal drinking, and moderate drinking. Few heavy drinkers were identified in this elderly cohort. Compared to no drinking, both minimal and moderate drinking were associated with lesser decline on the MMSE and Trailmaking tests. Minimal drinking was also associated with lesser decline on tests of learning and naming. These associations were more pronounced when comparing current drinkers to former drinkers (quitters) than to lifelong abstainers. CONCLUSION: In a representative elderly cohort over an average of 7 years, a pattern of mild-to-moderate drinking, compared to not drinking, was associated with lesser average decline in cognitive domains over the same period.

Reliability and validity of the Panic Disorder Severity Scale: replication and extension.

UNLABELLED: The Panic Disorder Severity Scale (PDSS) is a recently developed seven-item instrument to rate overall severity of Panic Disorder. The scale has previously shown good psychometric properties in a sample of Panic Disorder patients with no more than mild agoraphobia. The purpose of this paper is to confirm reliability and validity, to provide an estimate of a cut-score discriminating the presence or absence of current DSM-IV Panic Disorder, and to determine the factor structure of the instrument. PROCEDURES: 104 psychiatric outpatients, including 54 with current Panic Disorder, underwent structured diagnostic assessment and the PDSS interview. The PDSS was repeated within 3-17 days. RESULTS: we confirmed reliability and validity of the instrument and found a one-factor solution fit the data. A cut-off score of eight identifies patients with current panic with a sensitivity of 83.3%, and a specificity of 64%. CONCLUSION: the PDSS is a simple, reliable instrument for use in Panic Disorder studies. A cut-score of eight may be useful as a tool to screen patients in settings such as primary care, for diagnosis-level symptoms.

Traumatic grief treatment: a pilot study.

OBJECTIVE: The effects of a treatment program targeting debilitating grief symptoms were tested in a pilot study. METHOD: Twenty-one individuals experiencing traumatic grief were recruited for participation, and 13 completed the full 4-month protocol. The treatment protocol used imaginal re-living of the death, in vivo exposure to avoided activities and situations, and interpersonal therapy. RESULTS: Significant improvement in grief symptoms and associated anxiety and depression was observed for both completer and intent-to-treat groups. CONCLUSIONS: The traumatic grief treatment protocol appears to be a promising intervention for debilitating grief.

Reliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale (SIGH-A).

The Hamilton Anxiety Rating Scale, a widely used clinical interview assessment tool, lacks instructions for administration and clear anchor points for the assignment of severity ratings. We developed a Structured Interview Guide for the Hamilton Anxiety Scale (SIGH-A) and report on a study comparing this version to the traditional form of this scale. Experienced interviewers from three Anxiety Disorders research sites conducted videotaped interviews using both traditional and structured instruments in 89 participants. A subset of the tapes was co-rated by all raters. Participants completed self-report symptom questionnaires. We observed high inter-rater and test-retest reliability using both formats. The structured format produced similar but consistently higher (+ 4.2) scores. Correlation with a self-report measure of overall anxiety was also high and virtually identical for the two versions. We conclude that in settings where extensive training is not practical, the structured scale is an acceptable alternative to the traditional Hamilton Anxiety instrument.

Smoking behavior among casino employees: self-report validation using plasma cotinine.

The veracity of behavioral self-reports is often challenged, particularly when the motivation to avoid stigma and win social approval holds potential to introduce bias into the data collected. This study employed plasma cotinine tests to validate the self-reports of tobacco use collected from 3,841 casino employees as part of a comprehensive health survey. Rates of discordance were calculated by comparing employee self-reports with results from plasma colinine tests. This study provides evidence that casino employees can provide valid self-report data. Further, discordance rates of self-reported tobacco use vary according to operational definitions of tobacco use. These findings highlight the methodological importance of recognizing the inherent heterogeneity of smoking behavior.

"Computer addiction": a critical consideration.

Problems related to intemperate Internet use are examined within the conceptual framework of addiction. It is argued that empirical support for the construct validity of computer addiction has yet to emerge, that defining the construct as a unique psychiatric disorder is therefore premature, and that, in most cases, excessive computer use may be symptomatic of other, more primary disorders. Greater caution and rigor are urged in investigating and treating problems related to intemperate computer use.

Social workers employed in substance abuse treatment agencies: a training needs assessment.

This article describes the results of an assessment of the substance abuse treatment training needs of social workers working in randomly selected substance abuse treatment facilities in New England. This assessment revealed that clinical supervision related to substance abuse treatment had not been available to a significant percentage of the respondents throughout their careers. Despite limited previous training experience and considerable barriers to current training, social workers surveyed in this study reported significantly higher levels of knowledge and skill than other substance abuse treatment providers in 10 of 12 substance abuse treatment areas investigated. Despite these high levels of knowledge and skill, respondents reported considerable need for and interest in additional substance abuse treatment training. This study identified the areas of assessment, advanced clinical techniques, and dual diagnosis as priorities for future training among social workers working in substance abuse treatment facilities.

Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis.

OBJECTIVES: This study developed prevalence estimates of gambling-related disorders in the United States and Canada, identified differences in prevalence among population segments, and identified changes in prevalence over the past 20 years. METHODS: A meta-analytic strategy was employed to synthesize estimates from 119 prevalence studies. This method produced more reliable prevalence rates than were available from any single study. RESULTS: Prevalence estimates among samples of adolescents were significantly higher than estimates among samples of adults for both clinical (level 3) and subclinical (level 2) measures of disordered gambling within both lifetime and past-year time frames (e.g., 3.9% vs 1.6% for lifetime estimates of level 3 gambling). Among adults, prevalence estimates of disordered gambling have increased significantly during the past 20 years. CONCLUSIONS: Membership in youth, treatment, or prison population segments is significantly associated with experiencing gambling-related disorders. Understanding subclinical gamblers provides a meaningful opportunity to lower the public health burden associated with gambling disorders. Further research is necessary to determine whether the prevalence of disordered gambling will continue to increase among the general adult population and how prevalence among adolescents will change as this cohort ages.

Gambling, drinking, smoking and other health risk activities among casino employees.

BACKGROUND: This study examined the prevalence of level 3 (pathological) gambling and a variety of other health risks among casino employees. METHODS: A sample of 3841 full-time casino employees representing four geographic sites was surveyed about gambling, drinking, smoking, and other health risk behaviors. In addition, respondents were asked about their use of the employee assistance program (EAP) and perceived obstacles towards using the EAP. RESULTS: This study found that casino employees have a higher prevalence of past-year level 3 (pathological) gambling behavior than the general adult population, but a lower prevalence of past-year level 2 (problem) gambling than the general adult population. In addition, casino employees have higher prevalence of smoking, alcohol problems, and depression than the general adult population. Furthermore, these risk behaviors tend to cluster. The majority of non-smoking respondents in this sample were exposed to second-hand smoke. Employees reported low participation in the company's EAP. CONCLUSIONS: The results of this study suggest that casino management should consider (1) improving problem gambling screening for employees who visit EAPs, even if employees present other problems (e.g., alcohol problems) as their primary concern, (2) increasing employees' awareness of EAPs, (3) increasing health promotion and education through channels other than company EAPs, and (4) creating smoke-free working areas.

A new brief screen for adolescent substance abuse.

OBJECTIVE: To develop a brief alcohol and other drug (AOD) screening test for adolescents. METHODS: A 9-item test was constructed by combining and modifying items from several AOD assessments, and administered concurrently with the Personal Involvement With Chemicals Scale (PICS), the criterion standard. SETTING: A hospital-based adolescent clinic. SUBJECTS: Fourteen- to 18-year-old patients consecutively arriving for routine medical care who were known to have used AOD. MEASURES: Internal consistency of the 9 items was calculated using the Cronbach alpha. The relationship between the brief screen and PICS raw score was determined by stepwise linear regression analysis. The PICS T score has been shown to correctly classify substance abuse treatment need as no treatment (T<35), brief office intervention (T = 35-40), outpatient or short-term treatment (T = 41-54), and inpatient or long-term treatment (T> or =55). Sensitivity and specificity rates for predicting a PICS T score of 55 or higher were calculated from 2 x 2 tables. RESULTS: Ninety-nine adolescents were tested (70.7% female, 36.4% black, 32.3% white, 19.2% Hispanic, mean age, 16.3 years). The 9 items had good internal consistency (Cronbach alpha = .79). Stepwise linear regression analysis identified 6 items whose total combined score was highly correlated with PICS (Pearson r = 0.84, P<.01). This model correctly classified 86% of subjects according to the PICS criteria. Two or more yes answers had a sensitivity of 92.3% and specificity of 82.1% for intensive AOD treatment need. The 6 items were arranged into a mnemonic (CRAFFT). CONCLUSIONS: Further research must confirm the test's psychometric properties in a general clinic population. However, CRAFFT seems promising as a brief AOD screening test.

Assessing substance abuse treatment provider training needs: screening skills.

Screening instruments for substance abuse can be expeditious and effective clinical tools. A training needs assessment conducted with a randomly selected sample of substance abuse treatment providers (n = 1684) in licensed facilities in New England identified the adequacy of training, interest in training, clinical skill, and training need in the use of 13 substance abuse screening instruments. The results revealed that New England substance abuse treatment providers are not skilled in the use of screening instruments and have a high level of training need in this area. Differences in screening skill were found among the New England states. In addition, women and those with less treatment experience have lower screening skill; similarly, women, those having less experience in the field, and social workers and nurses evidenced higher training need in screening. The discussion considers skill, adequacy of training, training interest, and training need. The conclusion suggests that one approach to the coexisting increased need for screening skills due to managed care requirements and the lack of interest in these skills is to study managed care marketplace demands to determine training priorities.