Reported practices, attitudes, and confidence levels of primary care physicians regarding patients who abuse alcohol and other drugs.

The American Medical Association recommends that physicians screen all patients for alcohol and other drug abuse so that substance-abusing patients can be referred for appropriate treatment. A 1991 survey of primary care physicians in Baltimore and Cumberland revealed that only 41% routinely screened their patients for alcohol problems and only 20% screened for other drug problems. These levels, as well as the levels at which Maryland physicians counsel, refer, and otherwise treat substance-abusing patients, are well below levels recommended by the AMA. The role that attitudes, confidence, and education play in determining physicians' practice patterns in regard to substance abuse is explored.

Physician estimates of substance abuse in Baltimore and Cumberland: 1991.

By identifying and counseling substance abusers within their own practices, primary care physicians can play a major role in reducing levels of substance abuse. How proficient area physicians are in identifying substance abuse is examined by comparing physician estimates of substance abuse in their patient populations with local and national statistics.

Trends in criminal activity and drug use over an addiction career.

The present study, involving 132 narcotic addicts with multiple periods of addiction, examines trends in criminal activity and drug use over successive periods of addiction and successive periods of nonaddiction during an average 15-year addiction career. Significant decreases over successive addiction periods were found for four (of five) categories of crime: theft, violence, drug distribution, and "other" crime (primarily gambling). These results appear to be accounted for by a disproportionately high level of crime during the first addiction period. Criminal activity, most notably theft and violence, decreased over successive periods of nonaddiction, though not significantly. Although more evidence is needed, a particularly large addiction vs nonaddiction disparity in crime rates for Hispanic addicts revealing a low propensity for crime when not addicted suggests that crime reduction may be a reasonable objective in the treatment of these individuals. With regard to drug use over the addiction career, the most dramatic increases over time were found for illicit methadone and cocaine. Rates of heroin and marijuana use declined. Generally, nonnarcotic drug use, other than use of cocaine and Valium, tended to decrease progressively over time regardless of addiction status. These results, along with findings relevant to the "maturing out of addiction," are discussed.

The consistency of types of criminal behavior over preaddiction, addiction, and nonaddiction status periods.

Using self-report information provided by 250 male admissions to methadone maintenance/detoxification clinics in Baltimore and New York City, separate criminal typologies were derived for prior periods of addiction and nonaddiction in the community. Although far more crime was committed during periods of addiction, comparison of the typologies indicated highly consistent individual patterns regarding the kinds of crime that were committed over periods of addiction and nonaddiction. The association between early deviant behavior and later criminal involvement over an addiction career was determined by relating preaddiction characteristics to both the addiction and nonaddiction typologies. It was found that crime patterns established before addiction, although intensified by addiction, tended to persist throughout the addiction career. Correspondence between the present typology results and those found in an earlier Baltimore sample of 354 addicts was high with respect to both the number and descriptive characteristics of the types derived. Implications of this research with regard to the early identification of the most criminally prone individuals are discussed.

Differences among treatment clinic types in attitudes toward narcotic addiction.

Factor analysis of data from a general survey of attitudes and opinions concerning narcotic addiction and its treatment revealed 10 major dimensions, five of which were likely to have significant implications for drug abuse intervention strategies. For these latter dimensions, differences were determined among clients and staff according to type of treatment clinic (three types involving the provision of methadone maintenance in various combinations with other treatments and one involving the use of abstinence only). The most pronounced differences were between the methadone clinics and those offering abstinence only. Both the clients and staff of abstinence clinics were more skeptical concerning treatment effectiveness, were more negative regarding the use of narcotic drugs, and were more disposed to the use of ex-addict counselors and group procedures in treatment.

MMPI-168 profiles of male narcotic addicts by ethnic group and city.

MMPI-168 profiles were obtained on 225 male narcotic addicts who were attending methadone maintenance clinics in Baltimore and New York City during 1983 and 1984. Data were collected on Black and White (Anglo, other than Hispanic) addicts in Baltimore and on Black, Hispanic, and White addicts in New York City. In general, the profiles indicated high levels of psychopathology, with particularly high elevations on the F, D, PD, PT, and Sc scales. Consistent across cities and in agreement with earlier findings, profiles of Whites indicated somewhat more maladjustment than those for Blacks, while the profiles of Hispanics displayed essentially the same levels of disturbance as those for Whites. Comparisons by city revealed greater deviance for New York City subjects, a finding more evident among Whites than among Blacks.

Attitudes toward narcotic addiction.

In an effort to isolate the major dimensions of attitude and expectation regarding narcotic addiction and its treatment and to compare different groups of addict/clients and agency staff on these factors, a comprehensive questionnaire was administered to 900 addict/clients and 237 agency personnel in 25 drug treatment clinics in six states. Results of a factor analysis, which used questionnaire data from all of the 1137 subjects so that direct group comparisons could be made, indicated the presence of 10 major dimensions of attitude and expectation. Results also suggested considerable variation, particularly by status (client vs. staff) and ethnic group, on these dimensions. An additional analysis of staff attitudes and expectations revealed correlations with years of education, ex-addict status, and years of work experience. Such findings suggest the need to consider client/staff characteristics and attitudes in the planning of treatment services for narcotic addicts. An abbreviated (53-item) attitude and expectation questionnaire was developed for this purpose.

The relationship of preaddiction characteristics to the types and amounts of crime committed by narcotic addicts.

Postaddiction crime rates among narcotic (principally heroin) addicts in five different areas (theft, violence, dealing, confidence games, and other crime) were found to be substantially related to a number of preaddiction characteristics, especially criminal activity and drug and alcohol use prior to addiction to narcotics. Early family influences such as lack of religious training, history of parents' arrest, and use of drugs and alcohol by other family members also appear to play an important role. Early identification of extremely crime-prone individuals followed by intensive intervention efforts might reduce the amounts of crime such persons might otherwise commit.

Are words of the Rorschach predictors of disease and death? The case of "whirling".

The frequency with which the word whirling and similar words (whirlall words) were used in Rorschach tests administered to 1154 medical students 20 to 35 years ago has been counted by computer. Subjects (now for the most part physicians in midlife) were assigned to different groups according to their health status as of December 1982. When the proportion of subjects using whirlall words was compared across health groupings, those in the suicide and other deaths groups had used the largest proportions of such words. Subjects were then divided into dead and living groups, and those in the total dead group showed a threefold greater frequency of whirlall words than did those in the living group, a highly significant difference (p less than 0.001). Also, the mean number of Rorschach responses was significantly higher for the dead group as compared with the living group (p less than 0.05) and for the major cancer group as compared with the healthy group (p less than 0.01).

A comparison of three methods for scoring figure drawings.

Figure drawings obtained from 758 white male medical students were scored using three different methods. Method I involved 16 different physical size measurements; Method II involved six separate sophistication of body concept ratings; and Method III involved 42 separate aspects of the drawings weighted in direct proportion to their relative frequency of occurrence in the sample studied (conventionality scoring). Separate factor analyses of the scores derived from each method revealed that Methods I and II each reflect only a single underlying factor, and that these factors are uncorrelated in the population studied. Method III yielded eight meaningful factors, each of which may be construed as an independent area of conventionality/deviancy. An overall conventionality/deviancy score was also derived. It is believed that these three methods of scoring capture most of the variance inherent in existing figure drawing scoring systems, but that use of all three is necessary for a comprehensive analysis.

A multivariate analysis of circulatory data and their relationship to later disease.

Measurements on 21 separate variables involving blood pressure and heart rate were obtained under casual, resting, and controlled conditions as part of the baseline evaluation of 1087 white males participating in a prospective investigation of possible precursors of premature disease and death. These measurements were subjected to a components-type factor analysis with orthogonal rotation of component vectors in an effort to construct statistically independent composites of greater predictive power and generality as well as to minimize problems in interpretation introduced by partially redundant variables. Multivariate and univariate techniques were afterwards used to test differences between groups of subjects who developed specific major disorders and those who remained in good health. Comparison of factor scores with original circulatory measures in a series of prospective analyses revealed that the former had the greater predictive power. Although only the hypertension group could be unequivocally differentiated from all others, a number of nominally-significant findings may provide leads for further research.

Cancer in families of former medical students followed to midlife: prevalence in relatives of subjects with and without major cancer.

In an ongoing longitudinal study of former medical students, now physicians in midlife, the prevalence of cancer among relatives of 46 probands affected by cancer has been compared with that of two control groups of cancer-free probands. Overall, the prevalence of cancer among relatives of the three groups of probands was similar. However, male probands with cancer appeared to have a greater prevalence of cancer among their relatives than did male cancer-free probands, while the corresponding comparisons for the smaller groups of female probands showed the opposite tendency. Among the relatives of cancer probands of either sex, there was evidence of familial clustering of cancer. Where two relatives in a proband's family had the same type of cancer, the two relatives were usually on the same side (paternal or maternal) of the family. Ages at onset of cancer and types of cancer in relatives of the cancer and cancer-free probands did not reveal any significant differences.

Youthful habits of work and recreation and later cancer among physicians.

Scores on seven factors derived from a Habits of Work and Recreation Survey administered to 1,038 white male medical students 17 to 35 years ago were used to compare students who subsequently developed some form of major cancer with those who did not. With the Type I error rate controlled through use of multivariate analysis of variance and age and smoking ruled out as possible confounding variables, the two groups were significantly differentiated, primarily in terms of intellectual interests--cancer cases having fewer. Students at or below the overall mean on the intellectual interests measure were more than three times as likely to develop cancer as were students with scores above the mean. In this population, the results appear interpretable in terms of the stamina concept, in which few intellectual interests may reflect an absence of stamina and spontaneity and/or failure to meet subcultural expectations--factors possibly associated with increased cancer risk.

Blood pressure levels in young adulthood as predictors of hypertension and the fate of the cold pressor test.

In a study of the circulatory characteristics of 78 male medical students who later developed hypertension, no relationship was found between response to the cold pressor test and subsequent hypertension. Casual and resting blood pressure and heart rate measurements were all significantly higher in medical school in subjects who later developed hypertension than in two groups of control subjects who have remained in good health. Of the circulatory characteristics measured, a casual systolic pressure value greater than or equal to 125 mmHg in medical school was found to be the most predictive of future hypertension. A significant positive association was also found between parental hypertension and the presence of hypertension in the subject. When the two risk factors--higher casual systolic pressure in youth and parental hypertension--occur together, their predictive power is shown by the odds ratio of 12.65 (x2 = 12.87, 1 d.f., p less than .001).

Family attitudes in youth as a possible precursor of cancer among physicians: a search for explanatory mechanisms.

A measure of youthful family attitudes, the Closeness to Parents Scale, has continued to be predictive of cancer among physicians in a prospective study of medical students. Nonetheless, questions have remained concerning the meaning and reliability of this measure and whether its predictive value is diminishing over time. Perhaps more important, it is necessary to ascertain whether the relationship is the result of some methodological artifact or whether it is mediated by an association with known risk factors, such as smoking, drinking, and radiation exposure. Each of these issues was examined in turn, using a variety of statistical techniques to refine the scale and to equate cancer and control groups with respect to risk factors as well as possible artifacts. In a group of 913 men, it was found that the scale is primarily a function of good father-son relationships and that its association with later cancer persists even after the influence of possible mediating and artifactual variables is statistically controlled. Several possible explanations for these findings are discussed.

Cholesterol levels in young adulthood and subsequent cancer: a preliminary note.

In a study of the serum cholesterol of 30 male medical students who later developed major cancer, no consistent relationship between baseline cholesterol level and cancer was found during follow-up studies extending for up to 33 years. However, different cancer types seemed to have different cholesterol profiles: subjects who developed melanoma or lung cancer had relatively low initial levels, while subjects who developed cancer of the digestive system, brain or urinary bladder tended to have high initial values. Sequential cholesterol measurements made on two men with cancer of the colon are presented. It is suggested that such sequential cholesterol studies combined with knowledge of the types of cancers involved would help to clarify such complex interrelationships as may exist. The implications of a two-population hypothesis are discussed.

Neoplasm and traumatic events in childhood.

Previous research has suggested that certain objectively defined traumatic events occurring in childhood and/or adolescence may be linked to the appearance of neoplasm later in life. The present report examines four such events-parental death, parental divorce, sibling death, and having been the youngest child for less than two years-for their frequency of occurrence within four groups of physician subjects classified according to current health status as follows: major cancer, skin cancer, benign tumor, and healthy controls. All data had been collected while the subjects were in medical school within the context of a long-term, prospectively oriented study. Major cancer subjects were also compared with their cancer-free siblings with respect to length of time spent as youngest child. Although there was a slight tendency for the trend of the findings to be in accord with the hypotheses tested, no statistically significant differences among groups could be demonstrated.

Orthogonal dimensions of individual and group forms of the Rorschach.

Most dimensional analyses of traditional Rorschach scoring categories have either failed to control for differences in total R or have done so by introducing a nonstandard mode of administration. Consequently, the results of such studies may be either distorted or of questionable relevance to more typical situations. The present analyses, which compared both group and individual forms of the Rorschach administered to large samples (over 500 each) of male medical students, controlled for differences in total R by using residualized scores from which the linear effects of R had been partialled. The factor-analytic results are expressed in terms of seven easily interpretable factors (including total R), five of which are similar across forms, and simple formulas for deriving norm-referenced factor scores from the data of individual test administrations are provided.

Family attitudes reported in youth as potential predictors of cancer.

In long-term prospective study of a cohort of former medical students, men who later developed cancer reported different family attitudes in youth from those of their healthy classmates. The items checked on a Family Attitude Questionnaire by the future cancer group indicated a lack of closeness to parents compared with the items checked by the healthy group. Family attitudes of the future mental illness/suicide group resembled those of the cancer group, while those of the essential hypertension and coronary heart disease groups were like those of the healthy group. These prospective findings appear to fit with those of retrospective studies concerning early family relationships in cancer patients.