Psychometric evaluation of the short form inventory of drinking situations (IDS-42) in a community-recruited sample of substance-abusing women.

PURPOSE: We investigated the psychometric properties (factor structure, internal consistency reliability, concurrent validity) of the Short Form Inventory of Drinking Situations (IDS-42) in women substance abusers. METHODS: A sample of 297 substance-abusing women was recruited from the community. The women completed the IDS-42 and the three-factor Drinking Motives Questionnaire (DMQ). RESULTS: Confirmatory factor analyses of IDS-42 items suggested a hierarchical structure for the scale. Eight factors (corresponding to Marlatt and Gordon's eight heavy drinking situations) provided the best model fit at the lower-order level, and three factors (i.e., Negatively Reinforcing vs. Positively Reinforcing vs. Temptation Situations) provided the best model fit at the higher-order level. Lower- and higher-order IDS-42 subscales were shown to possess adequate-to-high levels of internal consistency. The eight lower-order IDS-42 factors demonstrated excellent concurrent validity with conceptually similar DMQ subscale scores. Across the entire sample of female substance abusers, a higher frequency of heavy drinking was reported in Positively Reinforcing Situations and Unpleasant Emotions Situations, as compared to other heavy drinking situations. IMPLICATIONS: Results support the IDS-42's good psychometric properties and demonstrate its utility as a tool in identifying situation-specific antecedents to heavy drinking among women substance abusers.

Efficacy of brief coping skills interventions that match different personality profiles of female substance abusers.

Female substance abusers recruited from the community were randomly assigned to receive 1 of 3 brief interventions that differentially targeted their personality and reasons for drug use. The 90-min interventions were: (a) a motivation-matched intervention involving personality-specific motivational and coping skills training, (b) a motivational control intervention involving a motivational film and a supportive discussion with a therapist, and (c) a motivation-mismatched intervention targeting a theoretically different personality profile. Assessment 6 months later (N = 198) indicated that only the matched intervention proved to be more effective than the motivational control intervention in reducing frequency and severity of problematic alcohol and drug use and preventing use of multiple medical services. These findings indicate promise for a client-treatment matching strategy that focuses on personality-specific motives for substance abuse.

Validation of a system of classifying female substance abusers on the basis of personality and motivational risk factors for substance abuse.

This study explored the validity of classifying a community-recruited sample of substance-abusing women (N = 293) according to 4 personality risk factors for substance abuse (anxiety sensitivity, introversion-hopelessness, sensation seeking, and impulsivity). Cluster analyses reliably identified 5 subtypes of women who demonstrated differential lifetime risk for various addictive and nonaddictive disorders. An anxiety-sensitive subtype demonstrated greater lifetime risk for anxiolytic dependence, somatization disorder, and simple phobia, whereas an introverted-hopeless subtype evidenced a greater lifetime risk for opioid dependence, social phobia, and panic and depressive disorders. Sensation seeking was associated with exclusive alcohol dependence, and impulsivity was associated with higher rates of antisocial personality disorder and cocaine and alcohol dependence. Finally, a low personality risk subtype demonstrated lower lifetime rates of substance dependence and psychopathology.

Functional associations among trauma, PTSD, and substance-related disorders.

This review article presents several potential functional pathways which may explain the frequent co-occurrence of PTSD and substance abuse disorders in traumatized individuals. Emerging empirical studies which have examined these potential pathways are reviewed, including studies on relative order of onset, PTSD patients' perceptions of various drug effects, comparisons of PTSD patients with and without comorbid substance use disorders, and correlational studies examining the relations between severity of specific PTSD symptom clusters and substance disorder symptoms. Research on the acute and chronic effects of alcohol and other drugs on cognitive and physiological variables relevant to PTSD intrusion and arousal symptoms is reviewed to highlight ways in which these two sets of PTSD symptoms might be functionally interrelated with substance abuse. Finally, based on these findings, recommendations are made for the treatment of individuals with comorbid PTSD-substance use disorders.

Long-acting injectable bromocriptine does not reduce relapse in alcoholics.

Dopamine is one of several neurotransmitters that may mediate alcohol intake and dependence. A randomized, double-blind, placebo-controlled international, multicentre study was conducted to assess the effects of a long-acting injectable preparation of bromocriptine, a dopamine agonist, (Parlodel-LAR) in reducing relapse in 366 moderately/severely dependent alcoholics (DSM-III-R), drinking approximately 200 g alcohol (14.5 standard drinks) per day. After detoxification they were randomized to receive six monthly injections of bromocriptine 25 mg (n = 120), bromocriptine 50 mg (n = 124), placebo (n = 122). Brief psychosocial treatment was allowed. At 6 months there were no significant differences between treatment groups in rates of relapse to any drinking or to drinking > or = 5 days per month and > or = 3 drinks per day. Pre-treatment alcohol intake did not determine response. Efficacy ratings by subjects and investigators and adverse events, reported by 51% of subjects, did not differ between treatments. The results of this large study, in which compliance was enhanced by Parlodel-LAR, do not indicate that bromocriptine is efficacious in the maintenance of abstinence or reduced drinking. Possible reasons for the discrepancy between these conclusions and those of some previous clinical trials, in which bromocriptine was reported to reduce symptoms of alcohol withdrawal and dependence, are discussed.

Efficacy of buspirone in alcohol dependence: a review.

The five published controlled studies on the effects of buspirone in alcoholism treatment are reviewed. They have been conducted mostly in alcoholics with comorbid anxiety. Significant differences in favor of the medication were observed in several psychopathological measures (anxiety, depression, hostility, interpersonal sensitivity, and global psychopathology). In only two studies were alcohol craving and consumption found influenced. Metaanalysis showed positive effects of buspirone on treatment retention, as well as on anxiety. It can be concluded that the main effect of buspirone in the treatment of alcoholism is not on ethanol consumption per se, but on associated psychopathological symptoms. A favorable safety profile and a lack of interaction with alcohol make buspirone a useful pharmacological adjunct in the treatment of alcoholism.

Buspirone in the treatment of alcohol dependence: a placebo-controlled trial.

A double-blind controlled study of the effects of buspirone on alcohol dependence and associated symptoms in ambulatory alcoholics showed a marked improvement in both treatment and control groups. However, significant differences in favor of the medication were observed in several psychopathological measures, but not in measures of alcohol consumption. Contrary to a majority of prior controlled trials of buspirone in alcoholics, subjects were not selected on the basis of comorbid generalized anxiety; rather, the study tested the hypothesis of a direct effect on craving and consumption, independent from an anxiolytic effect. This hypothesis was not confirmed.

Effects of cerebral electrical stimulation on alcoholism: a pilot study.

Cerebral electrical stimulation (CES), born from research on electroanesthesia in the seventies, consists of the application of a pulsating current of small intensity (usually less than 1 mA, and below the threshold of perception) through the skull, e.g., in daily 30-min sessions. Claims of biological effectiveness (neurochemical, hormonal and EEG changes, naloxone-reversible analgesia in rats, etc.) and of clinical effectiveness (anxiety, depression, cognitive functions in alcoholics) have often relied on poorly controlled data. A recent controlled study in the treatment of opiate withdrawal has been positive. The present double-blind controlled study compares active CES with sham stimulation in 64 alcohol-dependent males. Over 4 weeks, both treatment groups improved significantly in most aspects. In the active treatment group additional significant improvement was observed in week-end alcohol consumption, and in two psychological measures: depression and stress symptoms index, but not in general drinking behavior.

Alcohol-related dementia in the institutionalized elderly.

This study examined the distribution of alcohol-related and other dementias in a sample of 130 cognitively impaired residents of long-term care facilities in a Northern Ontario community. Study procedures entailed standardized psychiatric, neurological, and neuropsychological evaluations. Diagnoses of dementia of the Alzheimer type (DAT) and vascular dementia were based on criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. The diagnosis of alcohol-related dementia (ARD) was based on extensive review of medical history to assess before alcohol abuse and stabilization or improvement in cognitive functioning following institutionalization in conjunction with no other identifiable cause of dementia. ARD comprised 24% of this population compared with DAT (35%), vascular dementia (19%), and other causes (22%). The ARD group was, on average, 10 years younger than the other groups. It had nearly twice the average length of institutionalization and had milder cognitive impairment on both clinical ratings and neuropsychological tests. A diagnosis of ARD was present in the medical records for only 25% of patients in this group. These findings suggest that ARD may be more common than previously suspected in the distribution of dementias in long-term care facilities.

Screening for alcoholism in general hospitals.

In a recently completed study at the North Bay Psychiatric Hospital, a tertiary resource serving a population of about 600,000 in Northern Ontario, systematic screening on admission showed a very high proportion of past or present alcoholism. Fifty-seven percent of the patients were identified as having a life prevalence of (current or past) alcohol-related problems through a combination of a questionnaire and a liver function test. This figure is much higher than what is generally observed in mental hospitals. Does it reflect a widespread prevalence of alcoholism in Northeastern Ontario or is it distorted by the pattern of referral to the North Bay Psychiatric Hospital which typically serves an under-privileged segment of the population? In an attempt to answer this question, this study was carried out in general hospitals (medical and surgical wards). It confirms a higher prevalence of alcohol-related problems (biological, psychological and/or social) in Northern Ontario general hospitals, compared with Southern Ontario general hospitals, using identical methods of screening and assessment in both populations. The regional difference (odds ratio) is more evident in higher social classes. A diagnosis of alcohol abuse or dependence (currently active or in remission) was confirmed in 83.5% of the cases with positive screening who underwent the Diagnostic Interview Schedule (revised). This is a robust confirmation of the value of screening. These findings confirm the importance of systematic screening for alcoholism in general hospitals.

Bromocriptine in the treatment of alcohol dependence.

A double-blind controlled study of the effects of bromocriptine on drinking behavior and associated symptoms in ambulatory alcoholics showed a marked improvement in both treatment and control groups. However, significant differences in favor of the medication were observed in psychopathological measures, and trends in the same direction in most of the other efficacy parameters.

Screening for alcoholism in a psychiatric hospital.

The prevalence of alcoholism is generally underestimated in patients in private practices, general hospitals and psychiatric institutions. Even though the World Health Organization has advocated the concurrent use of laboratory test results and questionnaires for screening, these methods are seldom used together. In this study, patients admitted consecutively to the North Bay Psychiatric Hospital were screened for alcoholism using the Michigan Alcoholism Screening Test (MAST) and gamma-glutamyl-transferase plasma level. Unexpectedly, 56.7% of the entire sample were identified as possible alcoholics; of these, 73.5% were men and 26.5% were women. When rates for men and women were looked at separately, it was found that 66.2% of the men and 40.6% of the women were alcoholic. Participants who tested positive on one or both of the screening tests were offered a more complete evaluation of their drinking behaviour. A diagnosis of alcoholism was confirmed in 88.2% of the patients who agreed to participate further. The question remains whether the high prevalence rates found are a function of the particular sample studied (i.e., patients in a hospital which typically serves a socially disadvantaged sector of the population) or reflects a feature of the general population in this catchment area. A study is currently underway in general hospitals of North Eastern Ontario in an attempt to answer this question.

[The diagnosis of alcoholism in family medicine: a pilot study of the correlation of the Michigan Alcoholism Screening Test and the level of serum gamma-glutamyltransferase]. / Dépistage de l'alcoolisme en médecine familiale: étude pilote de l'association du Michigan Alcoholism Screening Test et le dosage de la gamma-glutamyltransférase sérique.

When used simultaneously, are laboratory and psychosocial methods of screening helpful to detect alcoholism in general practice? To examine this issue, systematic screening with a self-administered Michigan Alcoholism Screening Test and measurement of the plasma gamma-glutamyltransferase level was offered to 435 clients at a family medicine clinic. Whenever a positive finding was obtained the client was free to undergo a more detailed evaluation to confirm the diagnosis. A total of 200 subjects (126 women, 74 men) agreed to undergo screening. The results do not appear to lead to practical consequences among women, in whom no case was identified. In contrast, in the male population a rate of first detection of 9.5% (seven cases) should encourage such screening for alcoholism in family medicine.

[Recent progress in the study of alcoholism]. / Progrès récents dans l'étude de l'alcoolisme.

The phenomenon of denial of alcohol dependence prevails not only in a majority of alcoholics, but also in the diagnostic and therapeutic behavior of many physicians. The reasons for this neglect of alcohol abuse are reviewed. In particular, value judgments rather than scientific data seem to lead a number of physicians to share the recent views of the U.S. Supreme Court on primary alcoholism: a "willful misconduct" rather than an illness. This dichotomy between primary and secondary alcoholism, simplistic in itself, is part of current attempts to describe a spectrum of alcoholic disorders, some more social, some more biological. The biological underpinnings of abnormal drinking behaviour include various abnormalities of cerebral neurotransmitters: dopaminergic, serotonergic, GABA and endogenous opiate systems among others. These abnormalities are partly genetically determined, pre-existing to alcohol abuse and explaining why "alcoholism runs in families", and partly secondary to alcohol abuse. Their understanding may open the road to the use of specific pharmacological adjuvants in alcoholism treatment, in conjunction with psychotherapy, rehabilitation and self-help programs.