A computer analysis of reflex eyelid motion in normal subjects and in facial neuropathy.

OBJECTIVE: To demonstrate how computerized eyelid motion analysis can quantify the human reflex blink. DESIGN: Seventeen normal subjects and 10 patients with unilateral facial nerve paralysis were analyzed. BACKGROUND: Eyelid closure is currently evaluated by systems primarily designed to assess lower/midfacial movements. The methods are subjective, difficult to reproduce, and measure only volitional closure. Reflex closure is responsible for eye hydration, and its evaluation demands dynamic analysis. METHODS: A 60Hz video camera incorporated into a helmet was used to analyze blinking. Reflective markers on the forehead and eyelids allowed for the dynamic measurement of the reflex blink. Eyelid displacement, velocity and acceleration were calculated. The degree of synchrony between bilateral blinks was also determined. RESULTS: This study demonstrates that video motion analysis can describe normal and altered eyelid motions in a quantifiable manner. CONCLUSIONS: To our knowledge, this is the first study to measure dynamic reflex blinks. Eyelid closure may now be evaluated in kinematic terms. This technique could increase understanding of eyelid motion and permit more accurate evaluation of eyelid function. Dynamic eyelid evaluation has immediate applications in the treatment of facial palsy affecting the reflex blink. Relevance No method has been developed that objectively quantifies dynamic eyelid closure. Methods currently in use evaluate only volitional eyelid closure, and are based on direct and indirect observer assessments. These methods are subjective and are incapable of analyzing dynamic eyelid movements, which are critical to maintenance of corneal hydration and comfort. A system that quantifies eyelid kinematics can provide a functional analysis of blink disorders and an objective evaluation of their treatment(s).

Therapeutic alliance and the retention of couples in conjoint alcoholism treatment.

Differences were investigated in the degree to which less versus more experienced therapists formed a therapeutic alliance with their clients and how these differences were related to retaining couples in treatment. Two raters, using the Vanderbilt Therapeutic Alliance Scale (VTAS) and the Vanderbilt Negative Indicators Scale (VNIS), coded 15-minute audiotaped segments of the first treatment session for 66 couples participating in a randomized clinical trial of three types of couple therapy for alcoholism. Ten therapists, whose experience ranged from 15 years of postdoctoral practice to a 1 year predoctoral practicum, administered the treatment. Results indicated that the more experienced therapists scored significantly higher on the VTAS and lower on the VNIS than did the less experienced therapists. Therapists' scores on these scales were significantly related to number of treatment sessions attended and number of couples completing treatment, but not to treatment outcomes.

Maintaining change after conjoint behavioral alcohol treatment for men: outcomes at 6 months.

AIM: To compare the effectiveness of standard behavioral couples therapy for alcohol problems to two maintenance enhanced therapies. DESIGN: Randomized clinical trial. SETTING: Outpatient substance abuse treatment clinic. PARTICIPANTS: Ninety males with alcohol abuse or dependence and their female partners. INTERVENTIONS: Weekly, outpatient therapy in one of three randomly assigned conditions: Alcohol Behavioral Couples Therapy (ABCT), Alcoholics Anonymous plus ABCT (AA/ABCT) or Relapse Prevention plus ABCT (RP/ABCT). FINDINGS: The men significantly reduced the frequency of drinking and heavy drinking during treatment. During the first 6 months post-treatment, 65.7% of male subjects were classified as improved on a composite measure of drinking and drinking-related consequences. Compared to baseline levels, the percentage of abstinent days increased and heavy drinking days decreased, but the three conditions did not differ. Two outcome variables favored the purely behavioral treatment conditions (ABCT and RP/ABCT) over the AA/ABCT condition: time to the first heavy drinking day was longer for subjects in the ABCT condition than subjects in the AA/ABCT condition, and subjects in the RP/ABCT condition tended to have shorter drinking episodes than subjects in the AA/ABCT condition. Subjects who complied with post-treatment maintenance plans were more likely to be abstinent than subjects who did not. CONCLUSIONS: Results favored the two behavioral conditions and did not suggest additional benefit from combining AA with behavioral couples therapy, but those who did attend AA showed a positive impact.

Behavioral couples treatment of alcohol and drug use disorders: current status and innovations.

Research suggests that Behavioral Couples Therapy (BCT), tailored to treat alcohol problems, produces significant reduction in alcohol consumption and improvement in marital functioning. Having established basic clinical protocols for Alcohol Behavioral Couples Therapy (ABCT) and provided support for their efficacy, clinical researchers around the country continue to develop and study new applications of the basic ABCT treatment models, such as adding relapse prevention or Alcoholics Anonymous components. Recent research supporting the heterogeneity in the population of individuals with alcohol problems has prompted some researchers on ABCT to consider additional adaptations of the treatment models for specific subgroups of alcoholics, and for particular individual and couples characteristics. Adaptation of ABCT to treat new populations such as drug abusers, female alcoholics, and problem drinkers is under investigation. The current article provides an overview of theoretical and clinical aspects of ABCT, and research on efficacy of the basic model and on areas of innovation and adaptation to new populations. Directions for future research on ABCT are suggested.

Marital functioning in early versus late-onset alcoholic couples.

Current knowledge about alcohol and marital functioning is limited by restrictive sample selection, inattention to the literature on individual-based alcoholic subtypes, and lack of research linking individual differences among alcoholics to marital functioning. The present study was designed to study marital functioning of alcoholics in light of current alcohol typologies. Subjects were part of a larger study on conjoint treatment of alcoholic males and their female partners. Four typologies-including Type 1/2, In-Home/Out-of-home, Steady/Episodic, and Early/Late Onset-were tested for replicability and discriminant validity before linking them to marital functioning. Discriminant validity was found only for the Early (59%)-versus Late (41%)-Onset typology;thus, further analyses linked only this typology with marital functioning. At baseline, Early-Onset couples reported more marital instability, and the females in these couples were more distressed. During treatment, Early-Onset couples reported higher daily marital satisfaction than Late-Onset couples. Regardless of age of onset, males reported higher marital satisfaction than their spouses during treatment, but their satisfaction did not increase during treatment. Female partners' marital satisfaction increased during treatment. Female partners of Late-Onset males reported particularly low marital satisfaction during treatment. Parsing the sample according to the early-/late-onset typology yielded different predictors of marital satisfaction for males and females within each subtype. For female partners of Early-Onset alcoholics, psychological distress unrelated to her partner's drinking severity was most associated with her own marital satisfaction, whereas marital adjustment of female partners of Late-Onset alcoholics was most associated with the male's level of perceptual accuracy regarding her needs. This pattern was reversed for the males; marital adjustment of Early-Onset alcoholics was most associated with his partner's perceptual accuracy of his needs, whereas marital functioning of Late-Onset alcoholics was best accounted for by his own psychological distress.

Sources of motivation in a couples outpatient alcoholism treatment program.

This study examines sources of motivation to seek treatment. Participants were 105 male alcoholics and their non-alcoholic female partners who participated in a study of three different approaches to the conjoint treatment of alcoholism. Participants' sources of motivation were coded from responses to questions at the initial clinical screening interview. Sources of motivation were classified as "internal" or "external." More participants had internal sources of motivation (74%) than external sources. Participants with internal sources of motivation scored higher on the Michigan Alcoholism Screening Test than participants with external sources of motivation, but did not differ on other measures of pretreatment severity of alcohol problems. About half of the participants (53%) cited their partner as a primary source of motivation to seek treatment. Other sources of motivation cited were: increasing problems with alcohol, mental health problems, and physical health problems. There was greater variability among internal sources of motivation than among external sources of motivation. Participants' partners but not the male participants themselves, experienced an increase in marital satisfaction from pre- to within-treatment when the participant was motivated to come to treatment by his partner.

The Drinking-Related Locus of Control Scale: the factor structure with treatment-seeking outpatients.

OBJECTIVE: The psychometric properties of the Drinking-Related Locus of Control Scale (DRIE) were investigated when the distribution of DRIE scores taken from a sample of outpatient men was found to be skewed toward an internal locus of control, and numerous items on the scale showed little or no variability. METHOD: The DRIE was administered to 93 treatment-seeking, male alcoholics meeting DSM-II-R criteria for alcohol abuse or dependence who attended a clinical screen and baseline assessment for a larger study designed to examine the efficacy of conjoint marital therapy in the treatment of alcoholism. Subjects were recruited through newspaper, radio and television announcements, letters to physicians, employee assistance programs, outpatient treatment programs and detoxification centers. Subjects were either married or in a cohabitating relationship with a nonalcoholic, female partner. RESULTS: A factor analysis with a Procrustes rotation failed to replicate the three factor structure identified by previous researchers and consequently the reliability coefficients of the corresponding subscales were found to be low. Several items were endorsed as internal by more than 95% of the sample, showing little or no variability among subjects. An independent factor analysis, which excluded the items endorsed predominantly as internal, identified a single factor structure comprised of first person statements about helplessness and an inability to abstain from drinking. CONCLUSIONS: One possible explanation for the difference in the factor structure is that the current investigation employed outpatient subjects rather than inpatient subjects, who have been the focus of most research on the control orientation of alcoholics to date. A second possible explanation may be found in the sociodemographic makeup of the current sample which is younger, better educated and has less severe drinkers than the sample of veterans in the study that established the original factor structure of the DRIE.

Issues in the implementation of a randomized clinical trial that includes Alcoholics Anonymous: studying AA-related behaviors during treatment.

OBJECTIVE: The purpose of this study is to examine implementation of a randomized clinical trial and within treatment behavior when AA is included as an element of treatment. Special attention is given to the measurement of compliance, use of treatment skills, and the nature and extent of involvement with AA during the active phase of treatment. METHOD: Subjects, 90 male alcoholics and their female partners seeking conjoint, outpatient behavioral alcoholism treatment, were randomly assigned to one of three treatments: alcohol-focused behavioral marital therapy (ABMT), ABMT plus AA/Alanon (AA/ABMT), or ABMT plus relapse prevention (RP/ABMT). Within treatment data are reported for the 68 couples who completed at least five treatment sessions. Measures included: treatment attrition, number of treatment sessions, attendance at AA and Alanon, use of AA and Alanon skills, compliance with homework assignments and drinking during treatment. RESULTS: Several aspects of within treatment behavior were examined: (1) Attrition: There was no differential attrition across treatment conditions, with 24.4% of couples discontinuing treatment prior to the fifth session. (2) AA and Alanon attendance: Subjects in the AA/ABMT treatment were more likely to attend AA (91.7% attended at least one AA meeting; 58.3% attended at least one Alanon meeting) than were subjects in the other treatment conditions (18% attended at least one AA meeting and 14% at least one Alanon meeting). Subjects in the AA/ABMT condition attended significantly more AA and Alanon meetings than did subjects in the other treatment conditions. (3) Homework compliance: Subjects generally showed no differences in compliance with homework assignments, but spouses in the AA/ABMT condition completed less condition-specific homework (37.2%, versus 67.8% for the RP/ABMT spouses) because of low utilization of Alanon. (4) Use of AA-related skills: Subjects reported using AA-related skills more frequently in the AA/ABMT condition than in the other treatment conditions. (5) Patterns of attendance: Analyses of AA attendance during treatment revealed three patterns: positive attendance, characterized by regular AA attendance or increasing use of AA across treatment; negative attendance, characterized by decreased AA attendance over time; and nonattendance, characterized by none or infrequent and erratic attendance. CONCLUSIONS: Randomized clinical trials can be used to study AA. Use of multiple measures of treatment compliance and examination of patterns of AA utilization use over time provide more complex views of the patterns of involvement with AA than do simple descriptive reports of attendance.

Loss of control and inability to abstain: the measurement of and the relationship between two constructs in male alcoholics.

The constructs "loss of control" and "inability to abstain" have been used extensively in alcohol research. Examination of the literature, however, reveals inconsistencies in the ways researchers have operationalized and measured these constructs and a dearth of empirical investigation of the validity of the constructs. The current study examines a number of methods of operationalizing loss of control and inability to abstain and investigates the relationship of the two constructs with each other. Ninety-seven male alcoholics who participated in an outpatient conjoint alcoholism treatment study provided data on pre-treatment alcohol consumption and self-report measures of lifetime drinking behavior. Nine interview or questionnaire items that best approximated items used in the literature to measure inability to abstain and loss of control were chosen for analysis. Items measuring both constructs were highly intercorrelated and were associated more strongly with quantity rather than frequency of alcohol consumption, suggesting significant overlap between the constructs. None of the items were associated with a particular drinking pattern. The results provide support for a unitary dimension of impaired control, as used in the alcohol dependence syndrome, and suggest that the value of loss of control and inability to abstain as distinct and meaningful constructs should be reconsidered.

An empirical classification of drinking patterns among alcoholics: binge, episodic, sporadic, and steady.

Steady (daily, continuous) versus nonsteady (binge, episodic, bout, intermittent) drinking pattern have been influential Jellinek's (1960) formulation of delta and gamma drinkers, and are used as variables in various typological systems and drinker profiles. However, definitions of drinking patterns vary widely across studies, and most studies rely on one self-report item to establish a subject's pattern. To systematize and empirically test drinking-pattern schemas, we developed detailed definitions of binge, episodic, sporadic, and steady drinking patterns. A computer algorithm was written in SAS to classify 94 male alcoholics participating in outpatient conjoint therapy, using 6-month pretreatment drinking data from the Timeline Followback Interview. The final classification was: 3 (3%) binge, 33 (35%) episodic, 12 (13%) sporadic, and 40 (43%) steady drinkers. Six (6%) were unclassifiable (due to too few drinking days or too many interruptions to the pattern) by the computer. Episodic, sporadic, and steady drinkers did not differ in demographics, alcohol-related consequences, global psychological distress, or marital satisfaction. Steady drinking was associated with later onset of drinking problems (> 25), while episodic and sporadic drinking were associated with earlier onset. These results are contrary to current use of "binge drinking" as a variable associated with Type 1 alcoholism. Predictive validity analyses indicated that steady drinkers continued to drink more frequently than episodic and sporadic drinkers during treatment and 6 months posttreatment. Also, preliminary data indicate that pretreatment drinking pattern may be predictive of similar within-treatment urge-to-drink patterns. Implications for research and treatment are discussed.

Introduction to the special section: research on the nature and treatment of alcoholism--does one inform the other?

Although the 2 topics of the nature and treatment of alcoholism have both been investigated for years, they are just recently beginning to interface with and complement one another. This special section addresses the interface from both perspectives and covers content areas that touch on current issues, research and treatment trends, and controversies in the alcohol field. The first 2 articles focus on the nature of alcoholism with commentary on implications for treatment, and the second 4 articles shift to examine research on treatment of alcohol problems, with implications for understanding the nature of alcoholism. This introductory article describes the special section, summarizes the articles in the section and integrates the information to discuss areas of increasing interface between research on the nature and treatment of heterogeneous substance abuse problems.

Alcohol and drug abusers subtyped by antisocial personality and primary or secondary depressive disorder.

Our data show that when substance abusers are subtyped simultaneously by antisocial personality disorder and the onset of depression relative to alcohol or drug abuse, groups of people with unique personality and affective profiles are identified. The profiles are represented by measures of affect-related personality variables such as trait anxiety, trait depression, histrionic traits, sensation seeking, and novelty seeking. These measures were chosen in an attempt to show that a "low arousal" personality type may be associated with antisocial personality and may thus indirectly be linked to a certain type (i.e., ASP/nondepressed) of substance abuser. By using a multi-symptomatic typological schema (i.e., a constellation of diagnostic categories rather than just one), we can show that different personality or affective profiles are indeed associated with certain subtypes of substance abusers and that depressed people who use drugs or alcohol are different affectively from antisocial types. We also show that the relationship between "low" and "high" arousal personality profile and subtypes based on co-morbid psychopathology is highlighted even more when we take into account the onset of dysthymia or depression that is primary versus secondary to substance abuse. Our findings are in accord with others' descriptions of the "affective arousal" dimensions of personality and are the first to link these dimensions with subtypes based on ASP and depression.

Attrition from conjoint alcoholism treatment: do dropouts differ from completers?

This study addresses patient attrition in order to identify variables associated with retention in conjoint treatment for alcohol abuse and dependence. Subjects were 105 male alcoholics and their partners who participated in a randomized clinical trial of three approaches to conjoint treatment of alcoholism: (a) alcohol and behavioral marital therapy (ABMT); (b) ABMT plus Alcoholics Anonymous and Alanon (AA/ABMT); and (c) ABMT plus relapse prevention (RP/ABMT). Completers (n = 45) attended two assessment and 15-17 treatment sessions. Partial completers (n = 23) left treatment between the 5th and 15th treatment session. Thirty-seven dropouts left treatment between the first assessment session and the 5th treatment session; of these, 22 dropouts completed at least one treatment session (called early treatment dropouts). Of subjects who entered treatment, dropouts from early treatment were least compliant with treatment requirements in the first few sessions, less educated, and less committed to their relationship. Data indicate that therapists with more clinical experience were more likely to retain clients in treatment, regardless of treatment condition. The data do not reflect a linear relationship between most variables studied and a continuum of attrition status from assessment to completion of the program.

Fibrosarcoma of the breast.

A total of 5 583 symptomatic patients were referred for xeromammography at the Mammographic Clinic, Johannesburg General Hospital, between June 1974 and January 1979. Four hundred and fifty-eight carcinomas and 3 sarcomas were recorded. The incidence of carcinoma in our series was 7,9% and that of sarcoma 0,65%, while there was a 0,21% incidence of pure fibrosarcoma. Comparison is made with world literature.

Xerographic parenchymal patterns and breast cancer.

The xerographic mammography records of 3,002 patients with breast disease were reviewed and classified according to the criteria of Wolfe. The parenchymal P2 pattern occurred in 59% of patients with cancer and in only 16,9% patients under the age of 40 without cancer, but the incidence of the DY pattern was much the same in patients with cancer and in those without cancer in almost all the age groups studied. The incidence of the P2 pattern tended to rise slightly in patients without cancer, whereas the incidence of the DY pattern tended to remain the same in all groups. The findings of Wolfe and others have been confirmed by this study, which also supports the suggestion that women under the age of 40 undergo a baseline xerographic examination of the breasts for cancer and that subsequent screening be based on the presence of a P2 pattern. This will involve a selection of 16,9% of the under 40-year-old subjects without cancer who might, on screening be expected to show 60% of the cancers in each decade after the age of 40. This information coupled with other factors indicating a high risk for the development of breast cancer, such as florid epithelial dysplasia, a previous history of breast cancer or a family history of breast cancer, should increase the yield of early carcinomas at a preclinical stage and reduce costs of a screening programme.

Mercury: observations of the 3.4-millimeter radio emission.

Observations of the 3.4-millimeter radio emission from Mercury during 1965 and 1966 yielded the following relationship between average brightness temperature T(B) of the disk and the planetocentric phase angle i: T(B) = 277 (+/- 12) + 97 (+/- 17) cos [i + 29 deg (+/- 10 deg)] degrees K The errors are statistical standard; the phase shift corresponds to a phase lag-that is, the maximum and minimum of insolation lag the maximum and minimum of planetary radiation.

Mercury: anomalous absence from the 3.4-millimeter radio emission of variation with phase.

Radio observations of Mercury at 3.4 millimeters from July to October 1965 showed, contrary to expectation, brightness temperatures of only about 200 degrees K, even when major fractions of Mercury's illuminated hemisphere were observed. There was no significant variation with phase.