Journal of substance abuse最新文献

Purpose: Craving describes a subjective state, and it remains unclear what people mean when they use the term. However, as with many other subjective states, craving should be able to be described by those who experience it. Methods: To try to understand the descriptors and constituents of craving, 213 clients appearing for treatment for alcohol use disorders were asked to rate the frequency of the occurrence over the past 30 days of a number of events and states that have been historically regarded as part of craving. These clients were also asked to rate the frequency with which they had experienced craving and urges over the same period. Using discriminant function analysis (DFA), some states were elucidated that separated those who reported craving from those who did not. Results and implications: Those who reported craving consistently reported the occurrence of more dysphoric states, more of certain physical feelings associated with thoughts of alcohol, more thoughts of alcohol, and desiring alcohol when confronted with environmental cues. Such descriptions may aid in establishing reliable criteria for understanding the constituents of craving.

Purpose: The co-occurrence of antisocial personality (ASP) and depression among drug-dependent individuals was examined in a sample of federal inmates participating in residential or outpatient drug and alcohol treatment to increase our understanding of the co-occurrence of these disorders. Methods: We examined drug dependence patterns both by the number of drugs of dependence as well as by type of drug, and separately studied men and women. The Diagnostic Interview Schedule (DIS) was used to obtain DSM-III-R diagnostic information on a sample of 609 men and women participating in a multi-site drug treatment evaluation project. Logistic regression results are reported that compared lifetime rates of ASP and major depression by number of drugs of dependency for men and women. ASP and major depression diagnostic rates were also examined by type of drug dependency pattern among men. Results: We found that both the number of drugs as well as the type of drug(s) are related to prevalence patterns for both diagnoses. The high rates of ASP and major depression among specific subgroups of drug-dependent inmates highlight the need for thorough psychiatric assessment and the tailoring of treatment programs to the issues associated with these diagnoses. Implications: Our results suggest that although there are similarities in co-morbidity between men and women, the differences point to the need to study men and women separately.

Purpose: This study examined the reliability and validity of the Inventory to Diagnose Depression (IDD) in alcohol-dependent men and women. The IDD is a self-report instrument that provides a continuous score reflecting depression severity and a DSM-IV major depression diagnosis (MDD).

Methods: Participants (N=57) were administered the IDD, Beck Depression Inventory (BDI), and the mood module of the Structured Clinical Interview for the DSM (SCID).

Results: Internal reliability and item-total correlations were generally good and the IDD severity score correlated highly with the BDI. The diagnostic performance of the IDD using the DSM-IV scoring algorithm was good overall but excellent for currently abstinent participants and fair for participants who had recently consumed alcohol. The IDD cut-off score for identifying cases of depression appears stringent compared to the BDI and SCID.

Implications: The present investigation provides some support for the use of the IDD with abstinent alcoholic outpatient samples when a self-report diagnostic instrument is desirable. For a current drinker, a positive IDD does not distinguish between an alcohol-induced depression and MDD.

Purpose: The economic costs of addiction treatment and ancillary services are of great interest to substance abuse treatment providers, researchers, and policymakers. This paper examines whether a widely used treatment evaluation instrument, the Treatment Services Review (TSR), can be used to estimate the costs of addiction and ancillary services. Methods: The fifth edition of the TSR (TSR-5) is carefully reviewed and critiqued for cost estimation purposes. Unit cost estimates and sources are presented for most of the service delivery units on the TSR-5, and important missing service measures are identified. A cost analysis method is proposed that is based on data from the TSR. Results: A variety of unit cost estimates are offered so that researchers and practitioners will understand how this financial information is compiled. However, the investigation determined that the TSR-5 is not currently structured for a comprehensive cost analysis of treatment services. The potential benefits and limitations of the TSR-5 as a cost analysis tool are identified and explained. In addition, recommended changes to the TSR-5 are suggested and described. Implications: Although not originally developed for economic evaluation purposes, with some modifications and enhancements, the TSR is an instrument that is capable of facilitating an economic cost analysis of addiction treatment and ancillary services. By combining service utilization information from a revised TSR (i.e., TSR-6) with reliable unit cost estimates for those services, future evaluation studies will be able to provide more standardized estimates of the costs of addiction and ancillary services for different types of treatment clients. When joined with outcome data, the TSR-6, along with the proposed cost module, can also be used to determine cost-effectiveness and benefit–cost ratios for subgroups of patients and treatment components.

A thematic conference of the Kettil Bruun Society (KBS) for Social and Epidemiological Research on Alcohol was held in Skarpö, near Stockholm, on April 3–7, 2000. The goals of the meeting were to develop consensus sets of questionnaire items for measuring alcohol consumption and social harm, to delineate statistical and practical concerns related to the aggregation of consumption and harm data and to identify summary measures to be used for descriptive purposes and in analyses of the association between alcohol intake and alcohol-related outcomes. The results of the conference discussions are summarized below, with emphasis on both areas where the conference yielded recommendations for measures and methods of aggregation for analysis, and on areas where consensus could not be obtained and/or where additional research is needed.

While there were earlier surveys of drinking behaviour, the modern tradition of these surveys dates back 50 years ago, and by the 1970s encompassed a number of countries. The paper reviews developments in the modern tradition of drinking surveys. One major tradition asks respondents about very recent drinking occasions, while the other asks the respondent to summarize the behavior over a longer period. While earlier analyses differentiated between frequency of drinking and quantity per occasion, this tradition was swamped by analyses in terms of an overall volume of drinking. Now, however, there is a renewed emphasis on patterns of drinking. Current developments in characterizing drinking patterns are summarized, with the conclusion that frequency of drinking at all, and frequency of heavier drinking occasions, are dimensions important both in terms of the social meaning of drinking and of the relation to potential consequences of drinking.

During the first decades following the end of World War II, registers were the predominant data source in Sweden for studying alcohol-related problems and, before the abolition of the rationing system, also for mapping drinking habits. This was possible due to the strict individual control system of alcohol that dominated in Sweden for many decades. With the gradual shift from individual control to general control in the 1960s and 1970s, the possibility of using registry data was reduced, and for the past 20 years or so they have almost never been used to study the relationship between drinking and social problems. Instead, not only drinking levels and drinking patterns, but also social problems associated with alcohol, have slowly but to an increasing extent been measured by self-reported questions in general population surveys. This paper discusses experiences gained from working with self-reported survey data on alcohol-related social problems in Sweden for the past few years and describes discrepancies between register- and survey-based analyses. Swedish examples suggest that it is unlikely that survey data can be used successfully to estimate the prevalence of serious alcohol-related social problems in society. Survey data may be more suitable for estimating risks associated with different drinking levels and drinking patterns in the general population on an ordinal level. However, there is still much room for improvement in the Swedish alcohol surveys that include questions on alcohol problems.

Background: Alcohol consumption has many different dimensions. For each potential medical or social outcome, different dimensions of consumption may have different relationships. However, these relationships are not independent of each other and this multidimensionality is often mishandled or not taken into consideration at all in current alcohol epidemiology. Objective: To give recommendations on how to aggregate dimensions of alcohol consumption to predict social and medical consequences. Methods: Based on a review of relevant papers, different statistical methods to deal with aggregating dimensions of alcohol consumption in predicting outcomes are compared and discussed. Results: Regression approaches may be used to aggregate different dimensions of alcohol consumption to predict medical and social outcomes. However, the substantive interpretation of regression in general has to be taken into consideration. Conclusions: Future research in alcohol epidemiology should incorporate different dimensions of consumption and should analyze them by regression approaches either using the dummy variable approach or using suitable interaction terms.

Purpose: to explore the range of health care services in substance abuse clinics. Methods: survey of directors of a stratified random sample of 125 substance abuse treatment clinics offering methadone, drug-free therapy, or both, representing 344 clinics participating in the New York State (NYS) Medicaid program. Survey asked about clinic services and referral patterns. We defined five categories of linkage of substance abuse to medical care ranging from unlinked (e.g. referral to distant sites) to highly linked (e.g. on site). To estimate the number of patients served, State data on licensed patient capacity for each clinic were used. Results: This sample represented 344 clinics statewide serving an estimated 60,914 patients. For patients with acute, chronic, or HIV-related medical conditions, weighted analyses showed highly linked care in 54 of the 344 (16%) clinics statewide, serving an estimated 13,741 patients. Unlinked care for all these medical conditions was found for 28% of statewide clinics, serving an estimated 8866 patients. Clinics offering both methadone and drug-free therapy were generally more likely to have medically related services on site. Implications: The extent of medical care services available at substance abuse clinics varies widely. Over one-quarter of clinics offered only loosely connected medical and substance abuse care.

The purpose of this study was to use administrative records of admissions to substance abuse treatment to construct episodes of care for publicly funded clients in Washington State, and then to analyze readmissions to treatment after an index episode. The study population was those clients who began and ended an index episode in 1995 (N=10,284). The population was divided into two groups, which were separately analyzed based on programs run by the Washington State Division of Alcohol and Substance Abuse (DASA) [Alcohol and Drug Abuse Treatment and Support Act (ADATSA) and Non-ADATSA, named for legislation defining these programs]. Clients in each program were followed for 13 months, and proportional hazards regression was used to estimate the relationship between our treatment measures and readmission, controlling for several covariates. We compared clients based on several aspects of treatment, but our primary interest was in comparing clients that completed the index episode with those that did not complete it. For both ADATSA and Non-ADATSA clients, those completing their episode of treatment had significantly lower risks for readmission. Females and those arrested in the year prior to treatment had increased risks of readmission, while males and those receiving a combination of inpatient and outpatient treatments had lower risks of readmission. The discussion concludes with suggestions for improving statewide systems of care.