Geriatric alcohol use disorder: a review for primary care physicians.

Alcohol use disorder in the geriatric population is a growing public health problem that is likely to continue to increase as the baby boomer generation ages. Primary care providers play a critical role in the recognition and management of these disorders. This concise review will focus on the prevalence, risk factors, screening, and clinical management of geriatric alcohol use disorder from a primary care perspective.

Association between scores on the SAAST (a direct measure of alcohol misuse) and CAL scale (an indirect measure of alcohol misuse) among medical patients admitted for treatment of alcohol dependence.

Patients with medical or social problems related to alcohol abuse or alcohol dependence frequently are seen in the health care delivery system. Direct and indirect screening methods are available, but contemporary data describing their combined effectiveness have not been reported. We determined the sensitivity of (a) an empirically derived, item-weighted, relatively "indirect" screening measure for alcohol misuse (the Common, Alcohol, Logistic [CAL] scale for the MMPI), (b) a "direct" approach to screening for alcohol misuse (the Self-Administered Alcohol Screening Test [SAAST]), and (c) their combined application. We obtained the responses to both measures from an archival sample of 361 medical patients (89 women, 272 men) who had been diagnosed with alcohol dependence by DSM-III-R criteria. The CAL scale and the SAAST both demonstrated high sensitivity. However, results favored the simultaneous use of a direct-in this study, the SAAST-and an indirect-in this study, the CAL scale-screening procedure.

Relationship of tobacco use to depressive disorders and suicidality among patients treated for alcohol dependence.

This population-based, retrospective cohort study examined the association of tobacco use and diagnosis of a depressive disorder (DD) and suicide attempts (SA) before and after discharge from an inpatient addiction program (IAP). All 813 Olmsted County, Minnesota residents (537 males, 276 females) admitted for the first time to the IAP for treatment of alcoholism during the period 1972-1983 were studied. Tobacco use status at admission was classified as ever (current or former use) (85.5%), never (8.6%), or missing (5.9%). Subjects were followed through 1994. Current or former use of tobacco was markedly lower among those with a prior diagnosis of DD than those without this diagnosis (73.6% vs. 89.3%, p<0.001). Although females were more likely to have a diagnosis of DD and were less likely to have ever used tobacco than males, gender did not explain the relationship between tobacco use and DD. Tobacco use status was unrelated to a DD diagnosis after discharge from the IAP and was not associated with SA.

Adrenocortical activity and depressive syntoms in alcoholics

Se cuantificaron los niveles plasmáticos de corticosteroides y de cortisol libre en orina de 24 hrs en 53 pacientes alcohólicos hospitalizados. Para evaluar su estado depresivo se usaron criterios diagnósticos de investigación clínica y tres diferentes escalas. No se observó ninguna correlación entre el funcionamiento suprarrenal y los síntomas depresivos. Los pacientes que fueron diagnosticados en forma independiente como deprimidos (47%), tuvieron calificaciones significativamente mayores (P<0.005) en la Escala de Depresión de Hamilton, el Inventario de Depresión de Beck y la Escala de Depresión del Inventario Multifásico de la Personalidad de Minnesota, en comparación con los deprimidos. En los parámetros utilizados para evaluar la función suprarrenal, no se observaron diferencias significativas entre los grupos. En su conjunto, los pacientes alcohólicos tuvieron niveles más altos de corticosteroides plasmáticos a las 8:00 a.m. (P < 0.01) y de cortisol libre en orina (P < 0.001) que un grupo de 42 voluntarios sanos estudiados simultáneamente. Estos resultados indican que la depresión por sí misma, no explica el hipercorticismo moderado de los pacientes alcohólicos

Substance dependence and chronic pain: profile of 50 patients treated in an alcohol and drug dependence unit.

Fifty adult patients with chronic pain and substance dependence were admitted to an inpatient unit for treatment of addiction without primary emphasis on treatment of pain. As a group they had received considerable medical attention for their pain, but relatively little for their addictions. When compared with a group of general medical patients, the study population showed MMPI evidence of considerably more psychopathologic characteristics. MMPI data and family histories of substance dependence did not differentiate the study group from a comparable group in a Pain Management Center.

Substance dependence and chronic pain: experience with treatment and follow-up results.

Fifty patients with chronic pain and substance dependence were admitted to the hospital for treatment of substance dependence. Sixteen patients left treatment prematurely and were noted to have been less flexible in seeking treatment options for relief of pain. Most patients experienced an improved sense of well-being with abstinence, but this was not reflected in pain rating scales. At 1 and 3-4 years follow-up, the group that completed treatment was more outstanding in its commitment to a course of abstinence from drugs and alcohol than the group that had not completed treatment and seemed to experience a greater improvement in overall functioning.