Inhalant use among urban American Indian youth.

AIMS: To assess the prevalence of inhalant use among urban American Indian youth and to examine differences between inhalant users and non-users. DESIGN: Baseline (T1) self-report questionnaires completed in 5th-6th grade and at seven annual follow-up assessments (T2-T8). SETTINGS: Seattle metropolitan area. PARTICIPANTS: Two hundred and twenty-four Indian youth. MEASUREMENTS: Youth-completed measures of substance use, ethnic self-identity, involvement in traditional Indian activities, family conflict, family history of alcoholism, peer and sibling deviance, self-esteem, delinquency, aggression, anxiety, depression, sensation seeking, conduct disorder and alcohol dependence. FINDINGS: Lifetime inhalant use was reported by 12.3% of adolescents. At T1, inhalant users had significantly lower perceived self-worth and average annual household incomes and significantly greater density of familial alcoholism and expression of aggressive and delinquent conduct than non-users. Aggressive behavior was the most important T1 predictor of inhalant use. Lifetime conduct and alcohol dependence disorders were 3.3 and 2.6 times more prevalent among inhalant users than non-users at T5. Inhalant users had more extensive deviant peer networks, were more sensation-seeking, and evidenced lower perceived self-worth than non-users at T8. CONCLUSIONS: Inhalant use was less prevalent in this particular sample of urban Indian adolescents than in most studies of reservation Indian youth. As with other studies of inhalant abuse, aggressive and delinquent males of low SES and low-perceived self-worth with family histories of alcohol dependence, were at highest risk for inhalant use.

Chemical aversion treatment of alcohol dependence.

Developments in the application of chemical aversion therapy to the treatment of alcohol dependence are discussed. Historical factors leading to the early use of chemical aversion therapies are delineated and the theoretical underpinnings of chemical aversion interventions are evaluated. Ethical and procedural considerations are addressed and an assessment of the efficacy of the therapy is attempted. Future research activities that would lead to refinement of chemical aversion therapy protocols are highlighted. The effectiveness of chemical aversion treatment of alcohol dependence is discussed vis-a-vis production of condition alcohol-aversion and treatment outcome.

Diagnostic concordance of DSM-III-R, DSM-IV, and ICD-10 inhalant use disorders.

The diagnostic concordance of DSM-III-R, DSM-IV, and ICD-10 inhalant use disorders was assessed using the sample of lifetime inhalant users (n=76) participating in the DSM-IV Field Trial for Substance Use Disorders. Substantially smaller proportions of lifetime inhalant users met DSM-IV inhalant abuse or dependence criteria than met comparable DSM-III-R or ICD-10 criteria. DSM-III-R and ICD-10 performed similarly, although DSM-III-R tended to be more inclusive vis-à-vis diagnoses of inhalant dependence. Kappa coefficients indicated a moderate degree of concordance between the three nosologies for inhalant use disorder diagnosis rates. Inclusion of possible withdrawal symptomatology criteria (that are not normally included) in the DSM-IV and ICD-10 criteria sets for inhalant dependence exerted little effect on diagnosis rates.

Clinical issues related to the costs of alcoholism.

Alcohol (ethanol) use disorders are prevalent in many countries and are associated with significant social and health costs. Little is known, however, about the comparative cost effectiveness of treatments for alcoholism. Pharmacoeconomic evaluations are largely (if not wholly) absent from the alcoholism treatment outcome database. We discuss pharmacological approaches to the treatment of alcohol withdrawal and dependence, describing agents that ameliorate withdrawal symptoms, deter alcohol consumption, reduce alcohol craving and produce conditioned alcohol aversion. Cost-relevant clinical considerations are elucidated and recommendations for cost-conscious pharmacological treatment of alcohol dependence are proffered.

Substance dependent American Indian veterans: a national evaluation.

Demographic, clinical, and treatment episode characteristics of 3,087 American Indian veterans discharged from Department of Veterans Affairs hospitals in fiscal year 1991 were examined. Substance use disorders were diagnosed in 46.3 percent of discharged American Indians, compared with 23.4 percent of discharged veterans overall. More than 97 percent of American Indian substance use diagnoses were for alcohol dependence, while rates of other drug use disorders were low. Substance dependent American Indians were younger, and more likely to be male and unmarried, than nondependent American Indians. Psychiatric disorders, particularly personality disorders, depression, and posttraumatic stress disorders, were more prevalent among American Indians diagnosed with substance use disorders, than among nondependent American Indians. American Indians with substance use disorders were similar demographically to the general population of substance dependent veterans. Rates of diagnosed psychiatric disorders and drug dependencies other than alcohol were lower among American Indians receiving substance (alcohol or drug) use diagnoses than among the general population of substance dependent veterans. Rates of rehospitalization following discharge were higher in substance-abusing American Indian veterans than among their counterparts. Potential explanations for these findings are discussed.

Positive by-products of the struggle with chemical dependency.

Focus groups were conducted to identify ways persons in recovery from chemical dependence think they have benefited from their struggles with addiction. Categories of positive by-products were identified independently by two sets of readers. Several of the positive by-products discussed by the focus group participants are commonly reported from other kinds of challenging life experiences. These include increases in self-efficacy, family closeness, closeness with others, compassion and spirituality, and changes in life priorities. Additional positive by-products were discussed by the focus group participants that may be more unique to substance abuse and other similar stressors, including increased self-knowledge, enhanced ability to help offspring with substance abuse-related issues, and decreased naïveté. Ways to incorporate knowledge about these positive by-products into substance abuse treatment programs are introduced.

Practice guidelines in the addictions. Recent developments.

Consensually established principles of clinical conduct, known variously as practice guidelines, standards, protocols, or algorithms, have proliferated throughout medicine over the past decade. Institutional and disciplinary efforts to develop and promulgate guidelines for the treatment of additive disorders have recently been initiated. We review guideline development activities of the American Psychiatric Association, American Psychological Association, American Society of Addiction Medicine, American Nurses Association, National Association of Social Workers, and Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration. Medical care performance and outcome assessments are discussed with attention to the role they can play in evaluating and refining guidelines. Potential effects of guidelines, salutary and deleterious, on clinical practice in the addictions are delineated.

Diagnosis and hospital readmission rates of female veterans with substance-related disorders.

OBJECTIVES: The study examined the prevalence of substance use, psychiatric, and medical disorders in female veterans discharged from VA hospitals. METHODS: The VA discharge abstract database was used to identify women discharged in fiscal year 1991 who received a diagnosis of substance abuse or dependence or substance-induced psychosis (N = 1,698). They were compared with female veterans who did not receive a substance-related diagnosis (N = 12,037). RESULTS: Alcohol and cocaine use disorders were the most prevalent substance use disorders. Women with substance use disorders were more frequently diagnosed as having personality disorders, depression, and posttraumatic stress disorder than women without substance use disorders. Skin and subcutaneous tissue diseases, infectious and parasitic diseases, and digestive diseases were more prevalent among women with substance use disorders than among women in the same age group who did not have substance use disorders. Approximately 44 percent of women with substance use disorders who were discharged during the first six months of fiscal year 1991 were rehospitalized within that year. CONCLUSIONS: Substance use disorders and associated comorbidities are endemic among women treated in VA hospitals. Additional studies examining characteristics of indigent women with substance use disorders are needed.

Assessing the comparative cost-effectiveness of alcoholism treatments: a comment on Holder, Longabaugh, Miller and Rubonis.

Holder, Longabaugh, Miller and Rubonis (JSA, vol. 53, pp. 517-540, 1991) discuss the shortcomings of the empirical literature relevant to an assessment of the comparative cost-effectiveness of alcoholism treatment modalities. Their analysis is rooted in an attempt to conjoin the literatures pertaining to clinical efficacy and costs of alcohol dependence treatment. Holder et al.'s methodology is flawed in a number of respects and they exceed the bounds of the evidence when they endorse particular treatment modalities as comparatively cost-effective. Generalizations as to the relative cost-effectiveness of particular modalities are forwarded despite the fact that treatments are applied to persons with alcohol problems of widely varying severity. Additional points of contention are raised regarding the authors' selection of acceptable studies and interpretation of findings. Despite these limitations, Holder et al.'s (1991) analysis is a seminal heuristic contribution to the discussion of cost-effectiveness in the alcoholism field.

Citation analysis of 541 articles published in drug and alcohol journals: 1984-1988.

Citation histories of 541 articles published in 1984 in 12 drug and alcohol journals were followed through 1988. Considerable variability in mean citation rates across journals was observed. The mean citation rate for the 541 articles was 3.48. Approximately 71% of the articles examined were cited at least once between 1984 and 1988. The present findings suggest that articles published in drug and alcohol journals may be cited more frequently, and exert their influence longer, than those of the social science literature generally. Qualitative analyses suggest that methodological and review articles tend to be cited most frequently. The need for a comprehensive scientometric examination of the drug and alcohol literature is emphasized as is the potential role of multivariate techniques in the identification of variables predictive of individual article and journal citation rates.

Cloninger's tridimensional theory of personality and psychopathology: applications to substance use disorders.

OBJECTIVE: To evaluate studies that applied Cloninger's tridimensional theory of personality to substance abusers. METHODS: Medline and PsychInfo data bases were searched for studies published between 1986 and mid-1995 that used the Tridimensional Personality Questionnaire (TPQ). A supplemental manual search was conducted to identify additional evaluations of the tridimensional theory. Reports were reviewed if they included substance abusers or related tridimensional traits to substance use measures. RESULTS: Factor analyses did not consistently support the tridimensionality of the TPQ. Novelty Seeking (NS) traits distinguished alcoholics from nonalcoholics, Type B and Type 2 alcoholics from their Type A and Type 1 counterparts, smokers from nonsmokers, and individuals (substance abusers and nonabusers) with and without antisocial personality disorder (ASPD). Tridimensional traits independently predicted early onset alcohol abuse and serious delinquency in studies that did not employ the TPQ and were significantly associated with concurrent substance abuse among adolescents. Most studies that compared nonalcoholic youth with positive and negative family histories of alcoholism reported nonsignificant TPQ differences or very small effects. Few alcoholics, cigarette smokers or sons of alcoholics displayed Type 1 (low novelty seeking, high harm avoidance, high reward dependence) or Type 2 (high novelty seeking, low harm avoidance, low reward dependence) TPQ profiles, but rarely were levels of tridimensional traits determined by reference to established norms. CONCLUSIONS: NS predicts early onset alcohol abuse and criminality and discriminates alcoholics exhibiting antisocial behavior and persons with ASPD from their nonantisocial counterparts. Findings for the Harm Avoidance (HA) and Reward Dependence TPQ subscales are much less consistent. Some support for the role of elevated HA in intensity of substance use has been adduced. At present, the utility of the TPQ for prevention or clinical purposes is not well established.

Inhalant use among antisocial youth: prevalence and correlates.

The current (2.9%), annual (19.6%), and lifetime (34.3%) prevalence of inhalant use among 475 youth (M age = 15.5; SD = 1.5; 87.4% male) on probation in a western state of the United States was assessed. Inhalant users reported significantly less family support and cohesiveness and lower self-esteem, and significantly more lifetime thoughts of suicide and suicide attempts, neighborhood gang activity, peer and parental substance abuse, intentions to engage in illegal behavior, substance-related criminality, and substance abuse than did nonusers. Ethnicity, self-esteem, suicidality, number of substance-using peers, and extent of substance-related criminality significantly discriminated inhalant users from nonusers in a logistic regression analysis. Multiple linear regression analyses indicated that age, perceived school ability, age at initiation of alcohol use, self-esteem, and substance-related criminality significantly predicted age at onset of inhalant use (R2 = .30). Age at initiation of inhalant use, gang membership, truancy, and substance-related criminality significantly predicted lifetime frequency of inhalant use (R2 = .20). Study findings indicate that inhalant-using delinquents evidence significantly greater antisocial attitudes, personal and familial dysfunction, and substance abuse, than do their non-inhalant-using counterparts.

Synovial chondromatosis in a great horned owl (Bubo virginianus).

A case of synovial chondromatosis in a great horned owl (Bubo virginianus) was found in June 1993. In radiographs of bilateral swelling of the scapulohumeral joint we observed numerous mineralized foci in the soft tissue. The foci were identified by light microscopy as cartilaginous metaplasia. This is the first report of synovial chondromatosis in an owl.

Alcohol abuse in urban Indian adolescents and women: a longitudinal study for assessment and risk evaluation.

Empirical studies of American Indian health and mental health have focused primarily on reservation samples or small cross-sectional school-based or treatment samples. Few studies have addressed these issues among urban American Indian populations. This paper introduces an ongoing ten-year prospective longitudinal study of alcohol abuse, drug abuse, and mental health status in a community sample of urban American Indian adolescents and women. The study uses structured interviews and diagnostic assessments to identify risk factors for, and measure prevalence of, alcohol abuse, drug abuse, and psychopathology in 523 Indian youth and 276 Indian women. Study aims, rationale, research design, methods, sample characteristics, assessment instruments, and substance use prevalence are described, and methodological issues related to conducting longitudinal research are discussed.

Characteristics of substance-abusing veterans attempting suicide: a national study.

Demographic, diagnostic, and service utilization characteristics of veterans diagnosed with suicide attempt, substance dependence, both, or neither at discharge from Department of Veterans Affairs (DVA) hospitals in fiscal year 1994 (FY94) were compared using the DVA's discharge abstract database. Four groups of veterans were studied: (1) substance-abusing suicidal inpatients (n = 1,459), (2) substance-abusing nonsuicidal inpatients (n = 123,808), (3) nonsubstance-abusing suicidal inpatients (n = 632), and (4) nonsubstance-abusing nonsuicidal inpatients (n = 402,906). Substance-abusing suicidal veterans had higher rates of substance abuse than substance-abusing nonsuicidal veterans. Substance-abusing suicidal veterans had a higher mean number of inpatient treatment episodes and a larger proportion of discharges against medical advice than the other three inpatient groups. Psychiatric and substance use disorders are more prevalent among substance-abusing suicidal veterans than among veterans with only substance use disorders or suicidal conduct.

Pharmacological aversion treatment of alcohol dependence. I. Production and prediction of conditioned alcohol aversion.

Eighty-two hospitalized alcoholics receiving pharmacological aversion therapy (PAT) over a 10-day treatment interval completed cognitive, behavioral, and psychophysiological measures evaluating conditioned aversion to alcohol. Pre-post assessments provided convergent support for the efficacy of PAT vis-à-vis production of conditioned aversion to alcohol. Positive alcohol-related outcome expectancies were significantly reduced, whereas confidence that drinking could be avoided in various high-risk situations for consumption was increased following PAT. Behavioral and cardiac rate assessments revealed significant changes following PAT that were specific to alcoholic beverages and potentially reflective of conditioned alcohol aversion. Patients with more extensive pretreatment experiences with alcohol-associated nausea and greater involvement in antisocial conduct appeared to be less susceptible to the PAT conditioning protocol.

Nurses' attitudes toward substance misusers. II. Experiments and studies comparing nurses to other groups.

Experimental investigations of nurses consistently indicate that a patent labeled as a substance misuser is perceived far more negatively across a range of personal attributes than an identical patient who is not so labeled. Comparative evaluations suggest that nurses are less tolerant of social drinking and drug use and are more morally condemnatory of the chemically dependent than are other health-care professionals.