Assessment of automated craving across substances and across cultures: stability-analysis of the Craving Automated Scale (CAS).

BACKGROUND: The transition from hedonic to compulsive use in Substance Use Disorders (SUD) is a critical point in SUD progression and hence relevant for assessment and treatment. To measure the habitual patterns of substance consumption, the Craving Automated Scales (CAS) for alcohol (CAS-A), substances (CAS-S) and cigarette smoking (CAS-CS) were developed and introduced to different countries. In this study, we aimed to investigate the structural stability of CAS across substances and cultures. METHODS: This study analyzed the CAS-scores of a sample of 370 participants in Germany, China and the UK, including 262 opioid-users, 65 smokers and 43 alcohol-users. We performed stability analyses to check the stability (i. e. factorial invariance) of factor solutions. Based on confirmed stability of the general factor (gfactor) solution and the calculations rule obtained in the previous validation of CAS-alcohol (CAS-A), the factor structures of CAS-A, CAS-S and CAS-CS were compared. RESULTS: The gfactor solutions based on calculations rule shows good stability, with the mean stability coefficients of 0.990 and 0.977 for CAS-S and CAS-CS respectively. The gfactor patterns were similar for CAS-A, CAS-S and CAS-CS, as well as across samples (Germany, China and the UK), with most factor-loadings larger than 0.7. Based on these findings, CAS-S and CAS-CS were also associated with established clinical measures of SUD. CONCLUSIONS: Our findings suggest the two-gfactor solution based on a proposed calculation rule has a high stability across substances and cultures. This could be in line with common neurobiological mechanisms underlying habitual substance use. Moreover, comparing CAS with established clinical tools suggests that CAS might assess the automated behavior in substance consumption in a more sophisticated way.

• The two-gfactor solution of the Craving Automated Scale has a good stability.• The Craving Automated Scale can be used across substances.• The Craving Automated Scale is associated with established SUD measures.

A Further Test of the Impact of Online Gaming on Psychological Wellbeing and the Role of Play Motivations and Problematic Use.

The impact of increased online gaming play time on psychological wellbeing was examined focusing on the Multiplayer Online Battle Arena (MOBA) game genre. This relationship was explored with respect to motivators for playing and resilience factors. A cross-sectional, online questionnaire design was employed with participants (N = 165) to examine the relationship between weekly average hours played and psychological wellbeing. Five previously reported motivators for playing were tested as mediating variables. In addition, exploratory analyses were conducted to determine the moderating effects of self-esteem and self-efficacy on 'escapist' gaming and psychological wellbeing. Results revealed a significant correlation with higher levels of play time associated with poorer psychological wellbeing. This relationship was partially mediated by 'escapist' motivation. Self-esteem was found to moderate the negative impact of 'escapist' gaming on psychological wellbeing. Research and the associated clinical implications are discussed.

Predicting drinking outcomes: Evidence from the United Kingdom Alcohol Treatment Trial (UKATT).

AIMS: To explore client characteristics that predict drinking outcomes using data from the UK Alcohol Treatment Trial (UKATT). METHODS: Multiple linear regression was used to determine if there were any characteristics, measured before the start of treatment, that could predict drinking outcomes at three and 12months, as measured by percent day abstinent (PDA) and drinks per drinking day (DDD) over the preceding 90days. RESULTS: Lower baseline DDD score and greater confidence to resist drinking predicted lower DDD at both three and twelve months following entry to treatment. In addition to baseline PDA and having greater confidence to resist heavy drinking, female gender, aiming for abstinence, more satisfaction with family life and a social network that included less support for drinking were predictors of percent days abstinent. CONCLUSIONS: Overall the strongest and most consistent predictors of outcome were confidence to avoid heavy drinking and social support for drinking. More predictors were identified for percent of days abstinent than for drinks per drinking day. For percent of days abstinent, a number of client characteristics at baseline consistently predicted outcome at both month three and month twelve.

Pilot randomised trial of a brief intervention for comorbid substance misuse in psychiatric in-patient settings.

OBJECTIVE: This proof of principle study evaluated the effectiveness and feasibility of a brief motivational intervention, delivered in mental health in-patient settings, to improve engagement in treatment for drug and alcohol misuse. METHOD: A randomised controlled trial using concealed randomisation, blind, independent assessment of outcome at 3 months. Participants were 59 new adult admissions, to six acute mental health hospital units in one UK mental health service, with schizophrenia related or bipolar disorder diagnoses, users of community mental health services and also misusing alcohol and/or drugs. Participants were randomised to Brief Integrated Motivational Intervention (BIMI) with Treatment As Usual (TAU), or TAU alone. The BIMI took place over a 2-week period and encouraged participants to explore substance use and its impact on mental health. RESULTS: Fifty-nine in-patients (BIMI n = 30; TAU n = 29) were randomised, the BIMI was associated with a 63% relative odds increase in the primary outcome engagement in treatment [OR 1.63 (95% CI 1.01-2.65; P = 0.047)], at 3 months. Qualitative interviews with staff and participants indicated that the BIMI was both feasible and acceptable. CONCLUSION: Mental health hospital admissions present an opportunity for brief motivational interventions focussed on substance misuse and can lead to improvements in engagement.

Exploring treatment attendance and its relationship to outcome in a randomized controlled trial of treatment for alcohol problems: secondary analysis of the UK Alcohol Treatment Trial (UKATT).

AIMS: To identify client characteristics that predict attendance at treatment sessions and to investigate the effect of attendance on outcomes using data from the UK Alcohol Treatment Trial. METHODS: Logistic regression was used to determine whether there were characteristics that could predict attendance and then continuation in treatment. Linear regression was used to explore the effects of treatment attendance on outcomes. RESULTS: There were significant positive relationships between treatment attendance and outcomes at Month 3. At Month 12, these relationships were only significant for dependence and alcohol problems for those randomized to motivational enhancement therapy (MET). There were significant differences between groups in attendance, with MET clients more likely to attend than clients allocated to social behaviour and network therapy (SBNT). MET clients were also more likely to attend all sessions (three sessions) compared with SBNT (eight sessions). MET clients with larger social networks and those with confidence in their ability not to drink excessively were more likely to attend. SBNT clients with greater motivation to change and those with more negative short-term alcohol outcome expectancies were more likely to attend. No significant predictors were found for retention in treatment for MET. For those receiving SBNT, fewer alcohol problems were associated with continuation in treatment. CONCLUSION: Attending more sessions was associated with better outcomes. An interpretation of these findings is that, to improve outcomes, methods should be developed and used to increase attendance rates. Different characteristics were identified that predicted attendance and continuation in treatment for MET and SBNT.

Setting standards for training and competence: the UK alcohol treatment trial.

AIMS: To examine factors that influence the recruitment and training of therapists and their achievement of competence to practise two psychological therapies for alcohol dependence, and the resources required to deliver this. METHODS: The protocol for the UK Alcohol Treatment Trial required trial therapists to be competent in one of the two trial treatments: Social Behaviour and Network Therapy (SBNT) or Motivational Enhancement Therapy (MET). Therapists were randomised to practise one or other type of therapy. To ensure standardisation and consistent delivery of treatment in the trial, the trial training centre trained and supervised all therapists. RESULTS: Of 76 therapists recruited and randomised, 72 commenced training and 52 achieved competence to practise in the trial. Length of prior experience did not predict completion of training. However, therapists with a university higher qualification, and medical practitioners compared to other professionals, were more likely to complete. The average number of clients needed to be treated before the trainee achieved competence was greater for MET than SBNT, and there was a longer duration of training for MET. CONCLUSIONS: Training therapists of differing professional backgrounds, randomised to provide a specific therapy type, is feasible. Supervision after initial training is important, and adds to the training costs.

Ways of coping and the health of relatives facing drug and alcohol problems in Mexico and England.

AIMS: To compare two contrasting socio-cultural groups in terms of parameters relating to the stress - coping - health model of alcohol, drugs and the family, and to test hypotheses derived from the model in each of the two groups separately. DESIGN: Cross-sectional, comparative and correlational, using standard questionnaire data, supplemented by qualitative interview data to illuminate the findings. PARTICIPANTS: One hundred close relatives, mainly partners or parents, from separate families in Mexico City, and 100 from South West England. Data sources. Coping Questionnaire (CQ), Family Environment Scale (FES), Symptom Rating Test (SRT), Semi-structured interview. FINDINGS: Mean symptom scores were high in both groups, and not significantly different. The hypothesis that relatives in Mexico City, a more collectivist culture, would show more tolerant - inactive coping was not supported, but there was support for the prediction that relatives in South West England would show more withdrawal coping. This result may be as much due to differences in poverty and social conditions as to differences in individualism - collectivism. As predicted by the stress - coping - health model, tolerant - inactive coping was correlated with symptoms, in both groups, after controlling for family conflict, but there was only limited support for a moderating role of coping. Wives of men with alcohol problems in Mexico City, and wives of men with other drug problems in South West England, reported particularly high levels of both engaged and tolerant - inactive coping. CONCLUSIONS: Tolerant - inactive coping may be bad for relatives' health: causality may be inferred but is not yet proved. Certain groups are more at risk of coping in this way. Qualitative data help understand the nature of tolerant - inactive coping and why it occurs despite the view of relatives themselves that it is counter-productive.

Drug and alcohol problems amongst individuals with severe mental health problems in an inner city area of the UK.

BACKGROUND: The extent and impact of drug and alcohol use among those with severe mental health problems has been well documented in the US. However, little is known of the nature of this problem in the UK, particularly in community treatment settings. This paper outlines findings from a large-scale survey conducted across community-based Mental Health and Substance Misuse services, which aimed to ascertain the prevalence of drug and alcohol problems among those with severe mental health problems. METHOD: An assessment instrument was completed by keyworkers for each of their clients, which included mental health diagnosis and an adapted version of the Clinician Rating Scales for Alcohol and Drug Use. RESULTS: From a sample of 3079 clients across services, 1369 clients were identified with a severe mental illness diagnosis. According to their key-workers, 24% of these clients (324/1369) had used alcohol and/or drugs problematically during the past year. These individuals were most likely to have a diagnosis within the schizophrenia cluster, were mainly white males in their mid-30s, and tended to be located within Mental Health services in Assertive Outreach teams and to be higher utilisers of crises/emergency services. CONCLUSIONS: It can be concluded that similar to other studies in inner city areas of the UK, problem substance use is common amongst those with severe mental health problems within Northern Birmingham.

The family and alcohol: effects of excessive drinking and conceptualizations of spouses over recent decades.

There is much debate in the addiction literature about the extent to which excessive drinking affects nondrinking family members. The issue is considered in this review by examining and evaluating research relating to the effects of drinking on children, family systems, and partners of drinkers. The latter group have, historically, been blamed and apologized for their partner's drinking, although more recent theories have adopted a stress and coping paradigm, thus normalizing individuals and their behaviors. Conceptualizations of spouses over the last five decades are described and evaluated in the second part of the review. Finally, the review considers the impact of the recent stress and coping paradigm on clinical interventions for excessive drinkers and their families, and suggestions are made for future research.

Hacia un mejor diagnóstico de conjuntivitis alérgica / Towards the best diagnosis of allergic conjunctivitis

Antecedentes: la conjuntivitis alérgica (CA) tiene una elevada incidencia en la población general y el diagnóstico es realizado por oftalmólogos a través de síntomas y signos oculares característicos. Objetivo: determinar la mejor manera de realizar un diagnóstico preciso de CA. Materiales y métodos: se estudiaron veintidós pacientes con síntomas de CA en el nivel clínico, alergológico e inmunológico antes y después del tratamiento con fumarato de ketoifeno 0,05 por ciento tópico. Resultados: el 83 por ciento de la población estudiada tenía antecedentes familiares de alergia y el 100 por ciento tuvo pruebas cutáneas positivas hacia diferentes alergenos. El 30 por ciento presentó niveles de IgA sérica elevados y el 60 por ciento en lágrimas. Todos los pacientes tuvieron niveles normales de IgA secretoria y lisozima A y valores no detectables de VCAM-1s. El estudio de las moléculas CD29 y HLA-DR sobre células epiteliales conjuntivales antes del tratamiento mostró un marcado incremento en el porcentaje de las mismas con respecto a valores normales. Encontramos correlación entre valores de IgE en lágrimas y eosinófilos (r=0,56; p=0,007); índice de síntomas y signos cardinales e índice de pruebas cutáneas (r=0,50; p=0,032); índice de pruebas cutáneas y eosinófilos conjuntivales (r=0,48; p=0,024); e índice de síntomas y signos cardinales y niveles de IgE sérica (r=0,45; p=0,018). El porcentaje de células CD29+ disminuyó significativamente como consecuencia del tratamiento (p=0,03) mientras que el porcentaje de células HLA-DR+ solo disminuyó en el 41 por ciento de pacientes. Conclusiones: en el diagnóstico de la CA son parámetros críticos los signos y síntomas cardinales, pruebas cutáneas, eosinófilos conjuntivales e IgE en lágrimas (AU)

Hacia un mejor diagnóstico de conjuntivitis alérgica / Towards the best diagnosis of allergic conjunctivitis

Antecedentes: la conjuntivitis alérgica (CA) tiene una elevada incidencia en la población general y el diagnóstico es realizado por oftalmólogos a través de síntomas y signos oculares característicos. Objetivo: determinar la mejor manera de realizar un diagnóstico preciso de CA. Materiales y métodos: se estudiaron veintidós pacientes con síntomas de CA en el nivel clínico, alergológico e inmunológico antes y después del tratamiento con fumarato de ketoifeno 0,05 por ciento tópico. Resultados: el 83 por ciento de la población estudiada tenía antecedentes familiares de alergia y el 100 por ciento tuvo pruebas cutáneas positivas hacia diferentes alergenos. El 30 por ciento presentó niveles de IgA sérica elevados y el 60 por ciento en lágrimas. Todos los pacientes tuvieron niveles normales de IgA secretoria y lisozima A y valores no detectables de VCAM-1s. El estudio de las moléculas CD29 y HLA-DR sobre células epiteliales conjuntivales antes del tratamiento mostró un marcado incremento en el porcentaje de las mismas con respecto a valores normales. Encontramos correlación entre valores de IgE en lágrimas y eosinófilos (r=0,56; p=0,007); índice de síntomas y signos cardinales e índice de pruebas cutáneas (r=0,50; p=0,032); índice de pruebas cutáneas y eosinófilos conjuntivales (r=0,48; p=0,024); e índice de síntomas y signos cardinales y niveles de IgE sérica (r=0,45; p=0,018). El porcentaje de células CD29+ disminuyó significativamente como consecuencia del tratamiento (p=0,03) mientras que el porcentaje de células HLA-DR+ solo disminuyó en el 41 por ciento de pacientes. Conclusiones: en el diagnóstico de la CA son parámetros críticos los signos y síntomas cardinales, pruebas cutáneas, eosinófilos conjuntivales e IgE en lágrimas

Tolerate, engage or withdraw: a study of the structure of families coping with alcohol and drug problems in south west England and Mexico City.

AIMS: To explore the structure underlying individual differences in the ways family members cope with drinking or drug problems. DESIGN: Cross-sectional interview and questionnaire study of a series of family members in two contrasting socio-cultural groups. SETTING: Mexico City and South West England. PARTICIPANTS: Two hundred and seven family members from separate families, three-quarters women, one-quarter men, mostly partners or parents. DATA: Long semi-structured interviews; the Coping Questionnaire (CQ). FINDINGS: Factor and subscale analyses of the CQ data and textual analysis of the interview reports were used to test the hypothesis that the underlying structure to coping could be described in terms of eight or nine coherent and distinct ways of coping. Neither form of analysis gave strong support to this hypothesis. CONCLUSIONS: It is concluded that the structure of coping can best be described in terms of three broad coping positions: tolerating, engaging and withdrawing. These conclusions challenge some previous assumptions about functional and dysfunctional ways of coping with excessive appetitive behaviour in the family.

Active AIDS surveillance: hospital-based case finding in a metropolitan California county.

OBJECTIVES: Health departments that use passive surveillance alone cannot be sure of the level of complete and accurate reporting of acquired immunodeficiency syndrome (AIDS) cases. We sought to develop a model of active AIDS case reporting using limited county resources. METHODS: A validation study of AIDS case reporting using discharge diagnosis codes was undertaken to assess underreporting. Hospital-specific protocols for active surveillance were developed. RESULTS: The validation study revealed that 24% of AIDS cases in all hospitals were not reported through passive surveillance in 1990. In the first 3 months of 1991, active surveillance identified nine unreported cases (69% of the total cases reported) in one hospital. These underreporting estimates far exceed the 15% national underreporting rate estimated by the Centers for Disease Control. CONCLUSIONS: A method of hospital-based case finding was developed and serves as the model for implementing an ongoing program of active surveillance needed to ensure complete, accurate, and timely reporting of diagnosed AIDS cases. Application of this model may be helpful in attempts to minimize underreporting.

Violent behaviour and interpretative bias: an experimental study of the resolution of ambiguity in violent offenders.

The present study used an information-processing approach to investigate differences in interpretation of sentences which were ambiguous for violent or neutral meaning across three groups of subjects: violent offenders, non-violent offender controls and a group of non-offender controls. Subjects were presented with unambiguous and ambiguous sentences. The ambiguous sentences were selected so that they could be interpreted in either a threatening or neutral manner. A recognition memory test indicated that both offender groups were more likely to interpret violent ambiguous sentences in a threatening fashion, with the opposite being shown by the non-offender group. This difference was found to be significant. A control condition suggested that the interpretative bias was specific to violent material and not a general anxiety response. Furthermore, the tendency to infer violent threat was found to correlate with hostility. The results are discussed in relation to cognitive theories of anger and aggression.

[Esophageal involvement in progressive systemic sclerosis]. / El compromiso del esófago en la esclerosis sistemica progresiva.

The authors present 17 patients with progressive systemic sclerosis studied at the Hospital Nacional de Gastroenterología "Dr. Carlos Bonorino Udaondo" (Buenos Aires), in the period between 1976-1980. Clinical, radiological, endoscopical and manometrical studies of the digestive tract was performed, showing frequent compromise in this collagen disease.

El compromiso del esofago en la esclerosis sistemica progresiva. / Esophageal involvement in progressive systemic sclerosis

Se presentan 17 pacientes portadores de esclerosis sistemica progresiva estudiados durante los anos 1976-1980 en el Hospital Nacional de Gastroenterologia Dr. Bonorino Udaondo. Se realizaron estudios clinicos, radiologicos, endoscopicos y manometricos del tubo digestivo,evidenciando el frecuente compromiso del mismo en esta colagenopatia. Se comparan nuestros hallazgos gastrointestinales con estadisticas similares de otros autores