Journal of substance abuse最新文献

Daily measurements of drinking are used to measure alcohol consumption, validate retrospective questionnaires, and examine associations between drinking and other behaviors. The advantages of using daily reports include reducing retrospective biases and forgetting of drinking occasions; disadvantages include increased costs and potential for reactivity. Methodological issues to consider in using daily reports include reporting method (written, telephone, electronic), reporting interval, data collection period, respondent attrition, and missing data. Compared to retrospective reports, daily reports result in more reported drinking occasions but similar average quantity consumed, and correlations between retrospective and daily measures are generally high. The utility of daily reports depends on the research question and the purpose of the measurements.

Social epidemiological traditions of asking about problems related to drinking are considered. The issue of the attribution of the problem to drinking, and variations in formulations concerning this, are discussed. Social problems from drinking are inherently properties of social interactions, so that they are composed both of behaviour deemed problematic and of a reaction by another. Most items measuring social harm asked of the drinker him/herself are concerned with major social roles, and problems in the particular life area of the role (work, family, friendships, etc.). Some ask the respondent to attribute the problems to alcohol, some ask about others' attributions to alcohol, and some ask about “objective” problem indicators, although these usually have the respondent's attribution to drinking built in. The possibility of a more systematic way of covering different aspects of interactional problems, as reported by the drinker, is considered. Traditions of questioning the person on the other side of the interaction — i.e., items about others' troubles with drinking, and the effect of these on the respondent — are also discussed, and possibilities for bringing questions asked of the drinker and questions asked of interacting others into the same frame are considered.

The paper addresses the experiences of measuring and monitoring patterns of alcohol consumption and consequences in Mexico, provides an overview of alcohol use and problems, describes local cultural values that influence patterns of drinking, and discusses measurement implications.

Purpose. This study addressed the utility of collateral informants for validating self-reported substance use by psychiatric outpatients. Methods. Participants were 92 men and women with severe and persistent Axis I disorders, attending outpatient programs at a public psychiatric facility. As part of a substance use assessment, each participant identified a collateral who would provide information about the participant's substance use in the last month. The collaterals consisted of family (35%), peers (23%), and others (40%) who were primarily mental health staff. Results. Comparisons of participant and collateral reports showed high percent agreement with significant but modest measures of association. The likelihood that collateral reports will have information value (i.e., corroborate or exceed self-reports) was greater when the topic is illicit drug use and the frequency of contact is once a week or more. In this sample, siblings were more likely to be uninformative than other types of collaterals, whereas treatment staff were comparable to other types of collaterals in the information value of their corroborative reports. Overall, the collateral reports rarely provided more information than was provided by the participants themselves. Implications. This pattern is consistent with the pattern observed in non-psychiatric samples and supports the accuracy of self-reported substance use by psychiatric outpatients.

Purpose: Using reports from both partners, this study estimated prevalence rates of intimate partner violence (IPV) among white, black, and Hispanic couples in the U.S., and assessed the contribution of drinking patterns, psychosocial, and other sociodemographic factors to the risk of partner violence. Methods: A multistage area probability sample consisting of 555 white, 358 black, and 527 Hispanic couples in the U.S. household population was interviewed in 1995. Logistic regression analyses revealed that predictors of IPV vary by ethnicity. Results: Rates of male-to-female (MFPV) and female-to-male partner violence (FMPV) were highest among black couples (23% and 30%), followed by Hispanic (17% and 21%), and white couples (12% and 16%). Between 27 percent and 41 percent of the men, and 4 percent and 24 percent of the women were drinking at the time of the violent incident. Implications: Black and Hispanic couples are at higher risk for IPV than white couples and should be targeted for prevention intervention. The interrelationships among IPV, alcohol consumption, and ethnicity are complex. These findings suggest that future attempts at modeling IPV should be ethnically sensitive and, ideally, include separate analyses of each ethnic group.

Purpose. A central question pertinent to the efficacy of safe rides (SRs) in preventing driving while intoxicated (DWI) is whether individuals at high risk for DWI use them. Methods. Barroom surveys (N=472) and in situ breath tests (N=51) were conducted as part of an assessment of an alternative transportation intervention in a Maryland community. Bivariate analyses and stepwise logistic regression were performed comparing 42 barroom respondents who reported using a SR in the last 12 months to non-users. Results. Bivariate analyses showed that SR users drank more frequently outside the home and achieved higher estimated blood alcohol concentrations (BACs) when they did. Also, they were more likely to be heavy drinkers, to have driven when feeling intoxicated, and to have been arrested for DWI. Although SR users were more likely to ride with an intoxicated driver, they were also more likely to use a designated driver (DD). Stepwise logistic regression showed SR users were more likely to be heavy drinkers and to use DDs. In situ breath test data showed SR users' BACs ranged from 0.031 to 0.248, with a mean of 0.146. Implications. SR programs attract drinkers at high risk for DWI. DWI prevention efforts would benefit from future research exploring how at-risk drinkers make drinking and driving decisions.

Purpose. This report examined a broad range of cognitive functioning in a group of recently abstinent, cocaine-abusing schizophrenic patients (CA+SZ). Methods. Measures of selective and sustained attention, learning and memory, and executive functioning were administered to CA+SZ patients within 72 h of last cocaine use. A comparison group of non-substance-abusing schizophrenic patients (SZ) presenting for inpatient psychiatric treatment were also examined in an identical time frame. We hypothesized that the neurobiological impact of cocaine abuse and acute abstinence would cause CA+SZ to manifest deficits in all domains of cognitive functioning relative to non-abusing SZ patients. Results. Results revealed that CA+SZ displayed significant memory impairment relative to their non-abuser SZ counterparts. No group differences, however, were detected on any other neurocognitive measure. CA+SZ were able to selectively process digit strings during the presence and absence of distracting stimuli, sustain attention, and perform executive functions at performance levels equal to their non-abuser SZ counterparts. Implications. These results are consistent with many past studies that have found CA+SZ patients to manifest memory impairment but have relatively well perserved functioning in other cognitive domains. The results are discussed in terms of the biological concomitants of cocaine abuse and acute abstinence in schizophrenia.

Purpose. Prior longitudinal cohort studies have suggested that reinterviews about drug use often lead to decreased reports of lifetime substance use (recanting). Respondents may edit their answers on reinterview because of perceptions regarding question threat. Since reinterviews usually occur after long periods of time, the influence of inadequate recall (memory), cannot be ruled out. In order to evaluate the relative importance of editing and memory on recanting, we examined a cross-sectional survey administered in 1993 to a probability sample of Illinois students who were in the 7th through 12th grade. Methods. Two sets of self-administered survey questions assessed drug use: the I-SAY drug-use questionnaire, and a supplemental questionnaire asked at the end of the main survey. We compared the rates of “new use” (no use for a drug reported in the I-SAY, use reported for a drug on the supplement) with rates of recanting (use for a drug reported on the I-SAY, no use for a drug reported on the supplement). Results. Recanting was generally more pronounced than new use, especially for cocaine, heroin, marijuana, and inhalants. Those classified as light or inconsistent users on the I-SAY were significantly more likely to recant their drug use reports.

Purpose. Ultra rapid detoxification (URD) has recently gained significant media attention as a promising treatment for opiate addiction. URD combined with follow-up naltrexone was portrayed as a quick and painless initial detoxification, as well as a long-term cure for the addiction. Following the therapeutic initiation of URD, articles began to emerge in the scientific literature. URD was skeptically viewed by the substance addiction treatment community, skepticism initially based on the theoretical understanding of addiction as a bio-psycho-social problem and the belief that detoxification and medication alone cannot provide long-term abstinence. This initial response was later supported by some scientific studies. URD continues to stir controversy, leading to this study. Methods. We used available data to conduct a pilot study of URD, comparing it to traditional 30-day inpatient detoxification programs (IDP) used in Israel in achieving long-term abstinence. A sample of 226 men and women, 18 years or older, who entered detoxification in the IDP (N=87) or in the URD (N=139) were all clients who received treatment in either of these programs between March and September 1996. Eighty-one (92%) of the IDP subjects and eighty-two (60%) of the URD subjects were successfully interviewed by telephone 12 to 18 months after their participation in these programs. Results. The results provide preliminary evidence that URD may be much less effective and more expensive than traditional treatment. No specific subgroup of clients benefited more from URD, although a prospective study employing random assignment might be more successful in identifying such a group. Implications. This study appears to offer justification for the current longer-term bio-psycho-social treatment alternatives for opiate addiction.

Purpose. Investigators who have examined the relationship between work characteristics and off-the-job alcohol consumption or problems have typically assumed a linear or monotonic relationship (e.g., as work pressures increase, so do alcohol consumption and problems). In the present study, we examine this monotonicity assumption by investigating the nature of the relationships between alcohol problems and multiple demographic, work attitude, well-being, and work performance variables. Method. Survey data and data from company records were collected from a large sample of blue- and white-collar employees (N=2,279). Participation was voluntary, confidential, and compensated with a $20 payment. Results. Evidence for several different types of statistical relationships between alcohol problems and other variables were found through both analyses of variance (ANOVA) and covariance (ANCOVA). There were several variables that were linearly related to alcohol problems. There was also some support for a “threshold” effect where only the most problematic drinkers (2.6% of sample) showed declines on job attitude and general well-being indices. In some cases, those who drank but report no alcohol problems showed significantly more positive job and life attitudes than either those who abstained or those who had relatively more alcohol problems. Implications. We conclude that strict linearly based relationships might not necessarily explain the work-to-drink relationship most effectively.