Spatial dynamics of alcohol availability, neighborhood structure and violent crime.

OBJECTIVE: This study examined the relationship between neighborhood social structure, alcohol outlet densities and violent crime in Camden, New Jersey. METHOD: Data pertaining to neighborhood social structure, violent crime and alcohol density were collected for 98 block groups, and analyzed using bivariate, multivariate and spatial analyses. RESULTS: Each type of analysis showed that those areas with high alcohol outlet densities experienced more violent crime than low-density areas, after controlling for neighborhood social structure. In the multivariate regression analysis, alcohol outlet densities explained close to one fifth of the variability in violent crime rates across block groups--more than any one of the neighborhood structural variables included in the analysis. These findings were replicated in the spatial analysis, which also showed that alcohol outlet densities contributed significantly to violent crime within target block groups but not in adjacent block groups. CONCLUSIONS: High alcohol outlet density is associated with high rates of violent crime in this urban community. Spatial analysis suggests that alcohol outlets elevate the rate of violent crime within the immediate neighborhood context, not in surrounding neighborhoods.

Perfectionism in women with binge eating disorder.

OBJECTIVE: This study examined self-oriented (SOP), socially prescribed (SPP), and other-oriented (OOP) perfectionism in 127 obese women with binge eating disorder (BED). METHOD: Relationships between eating disorder and general psychopathology variables and SOP, SPP, and OOP were assessed. Levels of SOP, SPP, and OOP in the BED sample were compared with those of 32 normal weight women with bulimia nervosa (BN) and 60 obese non-eating-disordered individuals (NED). Structural equation modeling (SEM) was used to test models of the maintenance of BED. RESULTS: Only SPP was significantly associated with eating disorder variables related to BED. All three groups demonstrated similar levels of SPP and OOP. BN and BED groups scored significantly higher than the NED group on SOP only. SEM resulted in two models with good fits. DISCUSSION: Further research is needed on the roles of SPP and SOP in BED and on weight and shape overconcern in BED maintenance models.

Changes in alcoholic patients' coping responses predict 12-month treatment outcomes.

Patient subtypes (Types A and B alcoholism), determinants, and outcomes associated with changes in coping responses of 133 alcoholic patients in the year following admission to treatment were examined. In general, patients' use of avoidance coping declined and use of approach coping increased. Type B patients used more avoidance coping than did Type A patients, but the subtypes did not differ in rate of change in coping. As a determinant of coping, cognitive appraisal of threat showed a trend toward predicting avoidance coping at 6- and 12-month follow-ups. Decreased cognitive avoidance coping (e.g., daydreaming) predicted fewer alcohol, psychological, and interpersonal problems. Increased behavioral approach coping (e.g.. taking action) predicted lower severity of alcohol problems. Further study of changes in the cognitive aspects of coping (i.e., appraisals and cognitive avoidance coping) is needed to determine mechanisms underlying cognitive processes associated with treatment outcomes.

Drinking and driving: pre-driving attitudes and perceptions among Brazilian youth.

The aim of this study was to investigate driving under the influence of alcohol (DUI) risk profiles and predictors in a sample of pre-driving Brazilian youth, in the context of Brazil's new Traffic Code. Data were obtained in the Traffic Department in São Paulo from a sample of 2166 individuals. Subjects displayed a low level of knowledge about the laws and few believed the penalties would actually be enforced for those engaging in DUI. Findings suggest that changes in DUI laws in Brazil and elsewhere should be accompanied by enforcement and education in order to enhance levels of knowledge and credibility of the sanctions.

Substance use and driving: the coexistence of risky and safe behaviors.

AIMS: Two risky behaviors (driving after drinking/getting drunk, riding with drinking drivers) and two safe behaviors (deciding not to drive under the influence of alcohol (DUI), preventing someone else from DUI) were examined in relation to use frequency and friends' DUI to determine whether individuals tend to engage in both types of behaviors. DESIGN: Self-report questionnaires were administered to a random sample of 1233 young adults in New Jersey (USA) on two occasions (mean age 21 and mean age 28). Structural equation modeling was used to assess the goodness of fit of a hypothesized model of cross-sectional and longitudinal relationships. FINDINGS: Relationships between the four behaviors were strongly positive for men and women at both occasions and were substantially accounted for by use frequency and friends' DUI. At the later age, however, it was necessary to add non-recursive pathways to the model, which were different for men and women. CONCLUSIONS: Findings suggest that (1) riding with drinking drivers plays an important role in the maintenance of the other behaviors and (2) most individuals vacillate between risky and safe behaviors indicating that drinking contexts are best viewed as risky decision-making situations requiring individuals to choose between riskier and safer courses of action.

Clinical features of pathological gambling in an addictions treatment cohort.

This study examined the prevalence and descriptive psychopathology of pathological gambling in a heterogeneous treatment sample of 372 substance users. About 14% of male participants and 10% of female participants were identified as presumptive pathological gamblers (PGs) on the South Oaks Gambling Screen (SOGS). The authors contrasted 49 PGs with 323 participants who were not pathological gamblers (NPGs) on a host of variables measuring premorbid risk, pathological patterns of substance use, consequences of use, and psychiatric comorbidity. PGs showed more disturbance than NPGs on some measures of premorbid risk, pathological substance use, social consequences of use, and psychiatric comorbidity. Gambling status may be an important comorbid condition in addictions treatment settings and a significant covariate in research.

Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: within treatment and posttreatment findings.

This study evaluated the short-term effectiveness of cognitive-behavioral treatment (CBT) for substance abuse delivered in a community setting. At entry into outpatient community substance abuse treatment, participants (N = 252) were randomly assigned to 3 conditions: high-standardization CBT, low-standardization CBT, and treatment as usual. Treatment consisted of 12 weekly individual therapy sessions. There was a significant decrease in substance use from baseline, with participants reporting being abstinent on 90% of within-treatment days and 85% of days during the 6 months posttreatment. However, there were no significant differences in outcomes across conditions. Findings do not support the hypothesis that disseminating CBT to community settings will improve outcomes and suggest that standard substance abuse counseling may be more effective than previously thought.

Toward the DSM-V: the Withdrawal-Gate Model versus the DSM-IV in the diagnosis of alcohol abuse and dependence.

The Diagtnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) classifies as dependent many cases of mild alcohol problems. DSM-IV diagnoses have modest relationships with predictive and some concurrent validators and often improperly sequence the onset of abuse versus dependence, perhaps due to insufficient emphasis on physiological features. Testing reliability, syndrome prevalence, syndrome sequencing, and concurrent and predictive validity, this study contrasted the DSM-IV with the Withdrawal-Gate Model (WGM), in which alcohol withdrawal is necessary and sufficient for the dependence diagnosis. Clinical samples of adults (baseline n = 318) and adolescents (baseline n = 214) meeting abuse or dependence were assessed for DSM-IV alcohol symptoms and external measures of problem severity and reinterviewed at 6 (adults) and 12 months (adults and adolescents). Among DSM-IV dependent cases, the WGM shifted 32% of adults and 80% of adolescents to the abuse category, making both categories more symptomatically severe, but had a negligible effect on the prevalence of total alcohol diagnoses. The WGM was more reliable than the DSM-IV and temporally sequenced abuse before dependence in a greater number of cases. The WGM was superior to the DSM-IV in concurrent and predictive validity on most measures. Future diagnostic systems may be more reliable and valid if they require evidence of withdrawal for substance dependence.

Effective long-term treatment of obesity: a continuing care model.

BACKGROUND: Despite the well-documented success of behavioral techniques in producing temporary weight loss, treatment is typically followed by weight regain. The maintenance of treatment effects may therefore be the greatest challenge in the long-term management of obesity, and continuous care may be necessary to achieve it. OBJECTIVE: To describe the design and evaluate the effectiveness of the Trevose Behavior Modification Program, a potentially widely replicable self-help weight loss program offering continuous care. DESIGN: A description of the course of all subjects (n=171) who entered the Trevose program during 1992 and 1993. SUBJECTS: One hundred and forty-six women aged 44.1+/-11.7 y with a body mass index (BMI, kg/m2) of 33.2+/-4.4, and 25 men aged 49. 0+/-19.6 with a BMI of 35.1+/-5.2 enrolled in the Trevose program during 1992-1993. RESULTS: Mean duration of treatment was 27.1 months, with 47.4% of members still in treatment at 2 y and 21.6% at 5 y. Mean intent-to-treat weight loss was 13.7+/-0.5% of initial weight, or 12.8+/-0.5 kg. As long as they remained in treatment, almost all participants lost at least 5% of their initial weight and at least 83% lost more than 10%. Members completing 2 y of treatment lost an average of 19.3% of their initial body weight (17.9 kg); at 5 y the loss was still 17.3% (15.7 kg). After leaving the program, subjects regained weight but remained 4.7% (4.5 kg) below their pretreatment weight. CONCLUSION: A low-cost program offering treatment of indefinite duration produced large long-term weight losses and may be suitable for widespread replication.

Guided and unguided self-help for binge eating.

This study compared the relative short- and longer-term efficacy of therapist-guided and unguided use of a cognitive behavioral self-help manual for binge eating [Fairburn, C. G. (1995). Overcome binge eating. New York: The Guilford Press.] Forty women (82.5% with binge eating disorder) were randomized to one of the two treatment levels. Results indicate that both conditions represent viable means of treating binge eating. Overall, patients improved their eating behavior, eliminated any inappropriate compensatory behaviors, reduced their shape concern, weight concern, and other symptoms of eating-related psychopathology, and improved their general psychological functioning. The guided self-help condition was notably superior in reducing the occurrence of binge eating and its associated symptomatology, as well as lowering interpersonal sensitivity. A high degree of general psychopathology was a negative prognostic indicator. The implications for a stepped-care approach to treating binge eating are discussed.

Using social indicators to inform community drug and alcohol prevention policy.

In recent years, the federal government has begun to require state agencies to allocate drug prevention resources according to the needs of local communities. The methods by which this is to be accomplished have not been described, and most published social indicator studies in the field of drug abuse research have used county-level data which are too insensitive to local needs to be of use in resource allocation decisions. The present study describes a needs assessment in drug abuse prevention in the state of New Jersey using municipal-level social indicator data. In addition, it examines the extent to which the resource allocation of one state prevention agency can be predicted by the municipal-level social indicators. Thirty-six social indicators pertaining to 508 municipalities were used in the study, and data were analyzed using principal component analysis and hierarchical regression analysis. Five factors were extracted from the principal component analysis, two of which clearly describe "high risk" municipalities and one of which clearly describes "low risk" municipalities. The regression analysis showed that these factors explained very little of the variance in the state agency's drug prevention spending. The study shows that social indicators can be used to distinguish between different levels of need for drug prevention services at a municipal level, and that these data can be used to inform decisions concerning resource allocation.

Psychological versus pharmacological treatments of bulimia nervosa: predictors and processes of change.

This article extends the acute outcome findings from a study comparing psychological and pharmacological interventions for bulimia nervosa (B.T. Walsh et al., 1997) by examining 3 additional domains: predictive factors, therapeutic alliance, and time course of change. One hundred twenty women were randomized to cognitive-behavioral therapy (CBT), supportive psychotherapy (SPT) plus antidepressant medication or a placebo, or a medication-alone condition. Results indicate that high baseline frequencies of binge eating and vomiting, as well as a positive history of substance abuse or dependence, are negative prognostic indicators. Although a greater overall therapeutic alliance may increase the likelihood of remission, symptom change over the course of treatment may have as much of an impact on patient ratings of alliance as the reverse. CBT was significantly more rapid than SPT in reducing binge eating and vomiting frequencies.

Domestically violent and nonviolent male inmates' responses to their partners' requests for condom use: testing a social-information processing model.

This study used a model derived from social-information processing theory to investigate how men with a history of domestic violence would react to a condom request. The study used path analysis to examine men's attributional and evaluative responses as potential predictors of coercion and condom use compliance. Men responded to a hypothetical situation in which their main partner requested that they use a condom. Among 100 county jail inmates, men who used severe forms of domestic violence differed from moderately violent and nonviolent men in their tendency to react negatively to condom requests. Condom-specific attributions were significant predictors of condom use and coercive actions but were not consistently different across abuse groups. Attributions that increased the likelihood of negative responding were infidelity, selfishness, competition for dominance, or suspicion of the man's fidelity.

Alcohol availability and domestic violence.

The purpose of this study was to examine the relationship among sociodemographic variables, alcohol outlet density, and rate of domestic violence in New Jersey. Data were obtained for the 223 largest municipalities in the state and were examined using factor analysis and bivariate and multivariate analyses. Three sociodemographic factors were extracted through factor analysis. These explained 58% of the variance among municipalities in rates of domestic violence. One factor--termed social disadvantage--explained the greatest amount of unique variance (42%). Alcohol outlet density added nothing to the sociodemographic model and did not interact with any of the three sociodemographic factors. The findings show that, in the state of New Jersey, higher levels of alcohol outlet density are not geographically associated with higher rates of domestic violence. These findings may be due to limitations in the data sets employed in the study, limitations of the macrolevel analysis employed, and/or the complex nature of the relationship between alcohol use and domestic violence.

Violent crime and alcohol availability: relationships in an urban community.

The relationship between violent crime, neighborhood sociodemographic characteristics, and alcohol outlet densities in Newark, New Jersey is reported, thus extending previous research of municipalities at more refined levels of analysis. Alcohol outlet densities were significant predictors in regression models, but rates of violent crime were better predicted in larger units (R2 = .673 for the census tract level vs. .543 at the census block group level). Alcohol outlet densities, however, were more predictive of violent crime at smaller units of analysis (change in R2 with the addition of alcohol outlet densities was .194 at the census tract level vs. .278 at the census block group level). Findings suggest that alcohol outlets represent a form of "undesirable land use" in urban neighborhoods that are a manifestation of increasingly concentrated economic disadvantage in the United States.

Risk of assaultive violence and alcohol availability in New Jersey.

OBJECTIVES: This study examined the relationship between rate of assaultive violence and density of alcohol outlets in New Jersey. METHODS: Data pertaining to assaultive violence, alcohol outlet density, and sociodemographic factors were obtained from municipalities in New Jersey (n = 223) and assessed through bivariate and multivariate analyses. RESULTS: Sociodemographic factors accounted for 70% (R(2)=.70) of the variance in the rate of assaultive violence. Outlet density did not add significantly to the explained variance of this model. CONCLUSIONS: In New Jersey, alcohol outlet density is not geographically associated with higher rates of violence. Alternative methodological and analytic techniques are required to better specify the relationship between alcohol availability and violence.

Effects of an HIV risk reduction project on sexual risk behavior of low-income STD patients.

A 10-hour small-group informational and skill-building intervention was tested among patients (N = 472) attending publicly funded sexually transmitted disease clinics in Maryland, Georgia, and New Jersey. After completing a 90-minute interview concerning HIV risk behaviors, condom use self-efficacy and condom outcome expectancies, participants were randomized to either an intervention or a control condition. Participants in both conditions displayed significant reductions in unprotected encounters and number of partners and increases in condom use. No differences between treatment conditions were observed, indicating that the motivational effects of the interview may have been stronger than the effects of the intervention in this population.

PIP: Sexually transmitted disease (STD) treatment services in low-income communities offer an effective arena for accessing those at greatest risk for HIV infection. This study evaluated an intensive HIV risk reduction program implemented in publicly funded STD clinics in Maryland, Georgia, and New Jersey (US). After completion of a 90-minute interview on HIV risk behaviors, condom use self-efficacy, and condom outcome expectancies, the 472 study participants were randomly assigned to either a 10-hour behavioral intervention designed to increase condom use self-efficacy through modeling and skill building or routine brief counseling. The average age of respondents was 30.1 years; they reported an average of 3.2 lifetime STDs. Participants in both the intervention and control groups reported significant reductions in the number of sexual partners and unprotected sexual encounters and significant increases in condom use at the 90-day follow-up interview, with no significant differences between groups. Four possible moderators of behavior change--gender, crack or heroin use, alcohol problems, and child sex abuse--were not significant. The possibility that the baseline interview, not the intervention, motivated the observed changes in sexual behavior merits consideration.

Age of first use: its reliability and predictive utility.

OBJECTIVE: The purpose of this study was: (1) to assess the utility of age of first licit use and age of first illicit use as predictors of alcohol and drug use at ages 20 and 30; and (2) to examine the reliability of retrospectively recalled ages of onset of use. METHOD: Subjects (N = 839) from the Rutgers Health and Human Development Project provided four waves of longitudinal data spanning the age range from 15 to 31. RESULTS: Retrospective recall of age of onset revealed a fair degree of relative agreement but a lack of absolute agreement because of an upward shift in recalled ages as individuals became older. Repeated measures ANOVAS revealed normative declines in alcohol and drug use from 20 to 30 even though individual differences in use remained quite stable across time. Regression analyses indicated that: (1) age of first licit use as recalled at age 18 did not predict alcohol or drug use at age 20; (2) age of first illicit use was a weak predictor of alcohol use at 20 but a fairly strong predictor of drug use at 20; and (3) neither age predicted use or use consequences at age 30. CONCLUSIONS: In the general population, illicit drug use and heavier alcohol use are, regardless of age of onset, adolescence-limited phenomena for most individuals. Findings suggest that intervention efforts need to be aimed simultaneously at delaying the onset of illicit use and reducing use levels among young adult users.

Selective processing of eating disorder relevant stimuli: does the Stroop Test provide an objective measure of bulimia nervosa?

OBJECTIVE: To evaluate the specificity of the modified Stroop test as an objective measure of bulimia nervosa. METHOD: A modified Stroop Test was administered to patients with bulimia nervosa and two non-clinical control groups of restrained and unrestrained eaters. RESULTS: The data failed to show any specificity in the Stroop effect. Nor did the test provide a useful measure of treatment response. DISCUSSION: Taken in conjunction with previous inconsistent findings, the results of this study call into question the utility of the modified Stroop effect as a specific measure of bulimia nervosa.