... Login to save citations to My List. Citation. Database: PsycINFO. [Book; Authored Book]. Wome... more ... Login to save citations to My List. Citation. Database: PsycINFO. [Book; Authored Book]. Women at risk: Domestic violence and women's health. Stark, Evan; Flitcraft, Anne. Thousand Oaks, CA, US: Sage Publications, Inc. (1996). xxi, 264 pp. Abstract. ...
... Citation. Database: PsycINFO. [Book; Authored Book]. Policing domestic violence: Experiments ... more ... Citation. Database: PsycINFO. [Book; Authored Book]. Policing domestic violence: Experiments and dilemmas. ... In "Policing Domestic Violence," criminologist Lawrence Sherman confronts the tough questions raised by this controversial approach to a complex social problem. ...
Jama-journal of The American Medical Association, 2010
You are seeing this message because your Web browser does not support basic Web standards. Find o... more You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better. ... Add to CiteULike Add to Connotea Add to ...
Jama-journal of The American Medical Association, 1995
To determine the incidence, 1-year prevalence, and cumulative prevalence of domestic violence (DV... more To determine the incidence, 1-year prevalence, and cumulative prevalence of domestic violence (DV) among female emergency department (ED) patients. Descriptive written survey. Two teaching EDs, two hospital walk-in clinics, and one private hospital ED in Denver, Colo. Of 833 women presenting during 30 randomly selected 4-hour time blocks, 648 (78%) agreed to participate. Most respondents were young (median age, 34 years) and unemployed (62%); half (49%) had annual household incomes less than $10,000. Domestic violence was defined as an assault, threat, or intimidation by a male partner. Acute DV (incidence) and past DV exposure (1-year prevalence and cumulative prevalence) were determined. The incidence of acute DV among the 418 women with a current male partner was 11.7% (95% confidence interval [CI], 8.7% to 15.2%). Only 11 (23%) of these 47 women subjected to acute DV presented for care because of trauma, and only six (13%) either told staff about DV or were asked about DV by ED professionals. Among 230 women without current partners, 13 (5.6%) reported an episode of DV within the previous 30 days. For the entire sample, the cumulative lifetime prevalence of DV exposure was 54.2% (95% CI, 50.2% to 58.1%). Women exposed to acute or prior DV were more likely than unexposed women to have made suicide attempts (26% vs 8%; P < .001) and to report excessive ethanol use (24% vs 13%; P = .001). The incidence of acute DV is not as common among women visiting an ED as previously reported, although the cumulative prevalence of DV is strikingly high. Women who have experienced DV are seldom identified by ED professionals.
Journal of Consulting and Clinical Psychology, 2003
With a national household probability sample of 4,023 telephone-interviewed adolescents ages 12-1... more With a national household probability sample of 4,023 telephone-interviewed adolescents ages 12-17, this study provides prevalence, comorbidity, and risk-factor data for posttraumatic stress disorder (PTSD), major depressive episode (MDE), and substance abuse/dependence (SA/D). Roughly 16% of boys and 19% of girls met criteria for at least 1 diagnosis. Six-month PTSD prevalence was 3.7% for boys and 6.3% for girls, 6-month MDE prevalence was 7.4% for boys and 13.9% for girls, and 12-month SA/D prevalence was 8.2% for boys and 6.2% for girls. PTSD was more likely to be comorbid than were MDE and SA/D. Results generally support the hypothesis that exposure to interpersonal violence (i.e., physical assault, sexual assault, or witnessed violence) increases the risk of these disorders and of diagnostic comorbidity.
Objective. Concerns exist that stimulant therapy of youths with attention-deficit/hyperactivity d... more Objective. Concerns exist that stimulant therapy of youths with attention-deficit/hyperactivity disorder (ADHD) may result in an increased risk for subsequent substance use disorders (SUD). We investigated all long-term studies in which pharmacologically treated and untreated youths with ADHD were examined for later SUD outcomes.
Studies of psychiatric and social risk factors for child maltreatment have been limited by retros... more Studies of psychiatric and social risk factors for child maltreatment have been limited by retrospective methodologies and reliance on officially reported or identified samples. Using data from both Waves I and II of the National Institute for Mental Health's Epidemiologic Catchment Area survey, 7,103 parents from a probabilistic community sample who did not self-report physical abuse or neglect of their children at Wave I were followed to determine the risk factors associated with the onset of self-reported physical abuse or neglect identified at Wave II. Social factors considered included age, socioeconomic status, social support, education, household size, and gender. In addition, several psychiatric disorders, including substance abuse disorders and depression were examined. Risk models were developed using hierarchical logistic regression. Physical abuse and neglect were found to have distinct sets of risk factors, with minimal overlap between the groups. Social and demographic variables were found to be limited predictors of maltreatment, while substance abuse disorders were strongly associated with the onset of both abuse and neglect (relative risks = 2.90 and 3.24 respectively). Depression was found to be a strong risk factor for physical abuse (relative risk = 3.45). Implications of the findings are discussed in terms of major causal models of maltreatment.Les études des facteurs de risque psychiatriques et sociaux sont limitées par l'utilisation de méthodologies rétrospectives et la dépendance d'échantillons identifiés ou rapportés officiellement. Sept mille cent et trois parentsont été identifiés sur la base des données provenant des premières et deuxièmes vagues de l'étude “Epidemiologic Catchement Area” de l'Institut National pour la Santé Mentale. Ils sont issus d'un échantillon représentatil de la communauté, qui n'avaient pas spontanément signalés d'abus physiques ou de négligence de leurs enfants au cours de la première vague. Ils ont été suivis pour déterminer les facteurs de risque associés à l'apparition d'un autosignalement d'abus physique ou de négligence, identifié dans la seconde vague. Les facteurs sociaux considérés incluaient l'âge, le statu socio-économique, le soutien social, l'éducation, la taille du ménage et le sexe. Plusieurs affections psychiatriques parmi lesquelles les abus de drogue et la dépression ont aussi été examinées. Des modèles de risque ont été développés en utilisant une régression logistique hiérarchisée. Les abus sexuels et la négligence se sont révélés avoir des groupes distincts de facteurs de risque avec une superposition minime entre les groupes. Les variables sociales et démographiques se sont révélées peu prédictives de maltraitance par opposition aux abus de drogue, qui étaient fortement associés avec l'émergence d'abus comme la négligence (risque relatif = 2.90 et 3.24). La dépression est appartie comme un facteur de risque important de l'abus physique (risque relatif 3.45). Les implications de ces données sont discutées sous l'angle des modèles de causes majeures de la maltraitance.Los estudios psiquiátricos y de factores de riesgo social del maltrato a los niños, han estado limitados por metodologías retrospectivas y por apoyarse en muestras reportadas o identificadas oficialmente. Utilizando los datos del “Waves I” y el “Waves II” del area de investigación epidemiológica del Instituto Nacional de Salud Mental, de 7,103 padres y madres de una muestra comunitaria probabilística que no se auto-reportó como habiendo abusado fisicamente ni ser negligentes de sus hijos e hijas en el “Wave I”; se les hizo el sequimiento para determinar los factores de riesgo asociados con la presentación de abuso físico o negligencia autoreportado que fue identificado en el “Wave II.” Los factores sociales considerados incluyeron edad, status socioeconómico, manuntención social, educación, tamaño de la vivienda y género. Además, se examinaron varios desórdenes psiquiátricos, incluyendo desórdenes de abuso de sustancias y depresión. Se desarrollaron los modelos de riesgo utilizando regresión loigística en jerarquía. Se encontró que el abuso físico y la negligencia tienen conjuntos distintos de factores de riesgo, con obreposición mínima entre los grupos. Las variables sociales y demográficas se encontró que eran predictores limitados de maltrato, mientras que los desórdenes de abuso de sustancias estaban fuertemente asociados con la presentación tnato del abuso como de la negligencia (riesgos relativos = 2.90 y 3.24 respectivamente). Se encontró que la depresión era un factor de riesgo fuerte para el abuso fíisico (riesgo relativo = 3.45). Se discuten las implicaciones de los resultados en términos de los modelos causales principales de tratamiento.
Journal of The American Academy of Child and Adolescent Psychiatry, 1998
To review and synthesize the recent scientific literature on adolescent substance abuse, covering... more To review and synthesize the recent scientific literature on adolescent substance abuse, covering natural history, epidemiology, etiology, comorbidity, assessment, treatment, and prevention, and to highlight areas for future research.Studies of adolescent substance abuse were reviewed with the focus on substance abuse and dependence rather than substance use.There has been a sharp recent resurgence in adolescent drug use. Biological factors, including genetic and temperament characteristics, as well as family environment factors, are emerging as important etiological variables. Comorbidity with other psychiatric disorders, particularly with conduct disorder, is frequent and complicates treatment. New assessment instruments are available for clinical and research use. Among treatment modalities, family-based interventions have received the most study.The past decade has seen growth in the volume and sophistication of research on adolescent substance abuse and in the conceptualization of this problem. Further research is needed, particularly on the significance of comorbid conditions and on individualized and effective treatment approaches. J. Am. Acad. Child Adolesc. Psychiatry, 1998, 37(3):252–261.
During the past several years, there has been a renewed national concern about drug abuse, culmin... more During the past several years, there has been a renewed national concern about drug abuse, culminating in the current "war on drugs." In this review, we emphasize that even though child or teenage drug use is an individual behavior, it is embedded in a sociocultural context that strongly determines its character and manifestations. Our focus is on psychoactive substances both licit (cigarettes and alcohol) and illicit (e.g., cannabis and cocaine). We feel that it is critical to draw a distinction between use and abuse of drugs and to do so from a multidimensional perspective that includes aspects of the stimulus (drug), organism (individual), response, and consequences. Our selective review of substance use and abuse among children and adolescents covers epidemiology (patterns and extent of drug use), etiology (what generates substance use), prevention (how to limit drug use), treatment (interventions with drug users), and consequences (effects and outcomes of youthful drug use).
The search for the one causal influence to account for youthful drug use has always failed. An al... more The search for the one causal influence to account for youthful drug use has always failed. An alternate approach is advocated and tested that relates exposure to and impact of various types of psychosocial risk factors to understanding substance use. Data were obtained from 2,926 students in the 7th, 9th, and 11th grades. Twelve risk factors were selected and tested. These 12 variables were able to explain over 50% of the variance in a measure of general drug use. A unit-weighted, summed index of risk factors was linearly related to use and abuse (heavy use) of cigarettes, alcohol, cannabis, cocaine, hard drugs, and a composite substance use score. Differential exposure to and impact of risk factors on drug-taking behaviors were tested for differences by sex, age, ethnicity, and type of school attending. Patterns of exposure were somewhat different than patterns of vulnerability and impact, and can partially account for the status-group differences in drug use.
The CIDI-SAM is a fully-structured interview that ascertains DSM-III, DSM-III-R, Feighner, RDC an... more The CIDI-SAM is a fully-structured interview that ascertains DSM-III, DSM-III-R, Feighner, RDC and ICD-10 diagnoses for alcohol, tobacco and nine classes of psychoactive drugs, h was designed at the request of the WHO/ADAMHA Task Force on Psychiatric Assessment instruments to expand the substance abuse sections of the CIDI. Using a test-retest design, the diagnostic and item reliabilities of this instrument were tested in a sample of 39 patients in substance abuse treatment at three St. Louis treatment facilities. Kappa values and their 95% confidence intervals, and Yule's Y values are reported. The average kappa for DSM-III substance disorders was 0.84, for DSM-III-R it was 0.82. We report, on the average, excellent kappa values for individual alcohol and drug symptoms. We also ascertained from the respondent's themselves the reasons why answers to specific questions might have been discordant. The findings from this unique,‘discrepancy interview’are reported.
Journal of Consulting and Clinical Psychology, 2000
A national household probability sample of 4,023 adolescents aged 12 to 17 years was interviewed ... more A national household probability sample of 4,023 adolescents aged 12 to 17 years was interviewed by telephone about substance use, victimization experiences, familial substance use, and posttraumatic reactions to identify risk factors for Diagnostic and Statistical Manual of Mental Disorders-(4th ed.; American Psychiatric Association, 1994 ) defined substance abuse/dependence. Age and ethnicity data were available for 3,907 participants. Major findings were (a) adolescents who had been physically assaulted, who had been sexually assaulted, who had witnessed violence, or who had family members with alcohol or drug use problems had increased risk for current substance abuse/dependence; (b) posttraumatic stress disorder independently increased risk of marijuana and hard drug abuse/dependence; and (c)
Increasing public exposure to gambling as a recreational option is leading to increased pathologi... more Increasing public exposure to gambling as a recreational option is leading to increased pathological gambling. The prevalence and correlates of substance abuse in a population of severe pathological gamblers is investigated. The results indicate a high rate of alcohol abuse and drug abuse in this population and in their biological families. The implications of these findings for clinicians working with pathological gamblers and substance abusers are discussed.
... 146 Page 162. SCALE ABUSE MEDICAL EMP-SUP FAM-SOC LEGAL PSYCHOLOGICAL TABLE I VALIDITY OF ASI... more ... 146 Page 162. SCALE ABUSE MEDICAL EMP-SUP FAM-SOC LEGAL PSYCHOLOGICAL TABLE I VALIDITY OF ASI SCALES 524 MALE VETERAN SUBSTANCE ABUSE CLIENTS INDEPENDENT VARIABLES CORR. ... D.; Lester Luborsky, Ph. D.; Charles P. O'Brien, MD, Ph. ...
Substance use prevention studies published between 1980 and 1990 are reviewed for content, method... more Substance use prevention studies published between 1980 and 1990 are reviewed for content, methodology and behavioral outcomes. Studies were classified based on the inclusion of 12 content areas: Information, Decision Making, Pledges, Values Clarification, Goal Setting, Stress Management, Self-Esteem, Resistance Skills Training, Life Skills Training, Norm Setting, Assistance and Alternatives. Six groups of programs (Information/Values Clarification, Affective Education, Social Influence, Comprehensive, Alternatives and Incomplete programs) are identified. Reports are analyzed for two major threats to validity, selection bias and statistical power. Program groups generally have similar selection biases but have important differences in statistical power. Comprehensive and Social Influence programs are found to be most successful in preventing the onset of substance use.
A sample of 253 children of alcoholics (COAs) and 237 children of nonalcoholics (non-COAs) were c... more A sample of 253 children of alcoholics (COAs) and 237 children of nonalcoholics (non-COAs) were compared on alcohol and drug use, psychopathology, cognitive ability, and personality. COAs reported more alcohol and drug problems, stronger alcohol expectancies, higher levels of behavioral undercontrol and neuroticism, and more psychiatric distress in relation to non-COAs. They also evidenced lower academic achievement and less verbal ability than non-COAs. COAs were given Diagnostic Interview Schedule alcohol diagnoses more frequently than non-COAs. The relation between paternal alcoholism and offspring alcohol involvement was mediated by behavioral undercontrol and alcohol expectancies. Although gender differences were found, there were few Gender X Family History interactions; the effects of family history of alcoholism were similar for men and women. When gender effects were found, they showed greater family history effects for women.
Jama-journal of The American Medical Association, 2010
To examine whether the addition of counseling, medical care, and psychosocial services improves t... more To examine whether the addition of counseling, medical care, and psychosocial services improves the efficacy of methadone hydrochloride therapy in the rehabilitation of opiate-dependent patients. Random assignment to one of three treatment groups for a 6-month clinical trial: (1) minimum methadone services (MMS)--methadone alone (a minimum of 60 mg/d) with no other services; (2) standard methadone services (SMS)--same dose of methadone plus counseling; or (3) enhanced methadone services (EMS)--same dose of methadone plus counseling and on-site medical/psychiatric, employment, and family therapy. The methadone maintenance program of the Philadelphia (Pa) Veterans Affairs Medical Center. Ninety-two male intravenous opiate users in methadone maintenance treatment. While methadone treatment alone (MMS) was associated with reductions in opiate use, 69% of these subjects had to be "protectively transferred" from the trial because of unremitting use of opiates or cocaine, or medical/psychiatric emergencies. This was significantly different from the 41% of SMS subjects and 19% of EMS subjects who met the criteria. End-of-treatment data (at 24 weeks) showed minimal improvements among the 10 MMS patients who completed the trial. The SMS group showed significantly more and larger improvements than did the MMS group; and the EMS group showed significantly better outcomes than did the SMS group. Minimum methadone services subjects who had been "protectively transferred" to standard care showed significant reductions in opiate and cocaine use within 4 weeks. Methadone alone (even in substantial doses) may only be effective for a minority of eligible patients. The addition of basic counseling was associated with major increases in efficacy; and the addition of on-site professional services was even more effective.
... Login to save citations to My List. Citation. Database: PsycINFO. [Book; Authored Book]. Wome... more ... Login to save citations to My List. Citation. Database: PsycINFO. [Book; Authored Book]. Women at risk: Domestic violence and women's health. Stark, Evan; Flitcraft, Anne. Thousand Oaks, CA, US: Sage Publications, Inc. (1996). xxi, 264 pp. Abstract. ...
... Citation. Database: PsycINFO. [Book; Authored Book]. Policing domestic violence: Experiments ... more ... Citation. Database: PsycINFO. [Book; Authored Book]. Policing domestic violence: Experiments and dilemmas. ... In "Policing Domestic Violence," criminologist Lawrence Sherman confronts the tough questions raised by this controversial approach to a complex social problem. ...
Jama-journal of The American Medical Association, 2010
You are seeing this message because your Web browser does not support basic Web standards. Find o... more You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better. ... Add to CiteULike Add to Connotea Add to ...
Jama-journal of The American Medical Association, 1995
To determine the incidence, 1-year prevalence, and cumulative prevalence of domestic violence (DV... more To determine the incidence, 1-year prevalence, and cumulative prevalence of domestic violence (DV) among female emergency department (ED) patients. Descriptive written survey. Two teaching EDs, two hospital walk-in clinics, and one private hospital ED in Denver, Colo. Of 833 women presenting during 30 randomly selected 4-hour time blocks, 648 (78%) agreed to participate. Most respondents were young (median age, 34 years) and unemployed (62%); half (49%) had annual household incomes less than $10,000. Domestic violence was defined as an assault, threat, or intimidation by a male partner. Acute DV (incidence) and past DV exposure (1-year prevalence and cumulative prevalence) were determined. The incidence of acute DV among the 418 women with a current male partner was 11.7% (95% confidence interval [CI], 8.7% to 15.2%). Only 11 (23%) of these 47 women subjected to acute DV presented for care because of trauma, and only six (13%) either told staff about DV or were asked about DV by ED professionals. Among 230 women without current partners, 13 (5.6%) reported an episode of DV within the previous 30 days. For the entire sample, the cumulative lifetime prevalence of DV exposure was 54.2% (95% CI, 50.2% to 58.1%). Women exposed to acute or prior DV were more likely than unexposed women to have made suicide attempts (26% vs 8%; P < .001) and to report excessive ethanol use (24% vs 13%; P = .001). The incidence of acute DV is not as common among women visiting an ED as previously reported, although the cumulative prevalence of DV is strikingly high. Women who have experienced DV are seldom identified by ED professionals.
Journal of Consulting and Clinical Psychology, 2003
With a national household probability sample of 4,023 telephone-interviewed adolescents ages 12-1... more With a national household probability sample of 4,023 telephone-interviewed adolescents ages 12-17, this study provides prevalence, comorbidity, and risk-factor data for posttraumatic stress disorder (PTSD), major depressive episode (MDE), and substance abuse/dependence (SA/D). Roughly 16% of boys and 19% of girls met criteria for at least 1 diagnosis. Six-month PTSD prevalence was 3.7% for boys and 6.3% for girls, 6-month MDE prevalence was 7.4% for boys and 13.9% for girls, and 12-month SA/D prevalence was 8.2% for boys and 6.2% for girls. PTSD was more likely to be comorbid than were MDE and SA/D. Results generally support the hypothesis that exposure to interpersonal violence (i.e., physical assault, sexual assault, or witnessed violence) increases the risk of these disorders and of diagnostic comorbidity.
Objective. Concerns exist that stimulant therapy of youths with attention-deficit/hyperactivity d... more Objective. Concerns exist that stimulant therapy of youths with attention-deficit/hyperactivity disorder (ADHD) may result in an increased risk for subsequent substance use disorders (SUD). We investigated all long-term studies in which pharmacologically treated and untreated youths with ADHD were examined for later SUD outcomes.
Studies of psychiatric and social risk factors for child maltreatment have been limited by retros... more Studies of psychiatric and social risk factors for child maltreatment have been limited by retrospective methodologies and reliance on officially reported or identified samples. Using data from both Waves I and II of the National Institute for Mental Health's Epidemiologic Catchment Area survey, 7,103 parents from a probabilistic community sample who did not self-report physical abuse or neglect of their children at Wave I were followed to determine the risk factors associated with the onset of self-reported physical abuse or neglect identified at Wave II. Social factors considered included age, socioeconomic status, social support, education, household size, and gender. In addition, several psychiatric disorders, including substance abuse disorders and depression were examined. Risk models were developed using hierarchical logistic regression. Physical abuse and neglect were found to have distinct sets of risk factors, with minimal overlap between the groups. Social and demographic variables were found to be limited predictors of maltreatment, while substance abuse disorders were strongly associated with the onset of both abuse and neglect (relative risks = 2.90 and 3.24 respectively). Depression was found to be a strong risk factor for physical abuse (relative risk = 3.45). Implications of the findings are discussed in terms of major causal models of maltreatment.Les études des facteurs de risque psychiatriques et sociaux sont limitées par l'utilisation de méthodologies rétrospectives et la dépendance d'échantillons identifiés ou rapportés officiellement. Sept mille cent et trois parentsont été identifiés sur la base des données provenant des premières et deuxièmes vagues de l'étude “Epidemiologic Catchement Area” de l'Institut National pour la Santé Mentale. Ils sont issus d'un échantillon représentatil de la communauté, qui n'avaient pas spontanément signalés d'abus physiques ou de négligence de leurs enfants au cours de la première vague. Ils ont été suivis pour déterminer les facteurs de risque associés à l'apparition d'un autosignalement d'abus physique ou de négligence, identifié dans la seconde vague. Les facteurs sociaux considérés incluaient l'âge, le statu socio-économique, le soutien social, l'éducation, la taille du ménage et le sexe. Plusieurs affections psychiatriques parmi lesquelles les abus de drogue et la dépression ont aussi été examinées. Des modèles de risque ont été développés en utilisant une régression logistique hiérarchisée. Les abus sexuels et la négligence se sont révélés avoir des groupes distincts de facteurs de risque avec une superposition minime entre les groupes. Les variables sociales et démographiques se sont révélées peu prédictives de maltraitance par opposition aux abus de drogue, qui étaient fortement associés avec l'émergence d'abus comme la négligence (risque relatif = 2.90 et 3.24). La dépression est appartie comme un facteur de risque important de l'abus physique (risque relatif 3.45). Les implications de ces données sont discutées sous l'angle des modèles de causes majeures de la maltraitance.Los estudios psiquiátricos y de factores de riesgo social del maltrato a los niños, han estado limitados por metodologías retrospectivas y por apoyarse en muestras reportadas o identificadas oficialmente. Utilizando los datos del “Waves I” y el “Waves II” del area de investigación epidemiológica del Instituto Nacional de Salud Mental, de 7,103 padres y madres de una muestra comunitaria probabilística que no se auto-reportó como habiendo abusado fisicamente ni ser negligentes de sus hijos e hijas en el “Wave I”; se les hizo el sequimiento para determinar los factores de riesgo asociados con la presentación de abuso físico o negligencia autoreportado que fue identificado en el “Wave II.” Los factores sociales considerados incluyeron edad, status socioeconómico, manuntención social, educación, tamaño de la vivienda y género. Además, se examinaron varios desórdenes psiquiátricos, incluyendo desórdenes de abuso de sustancias y depresión. Se desarrollaron los modelos de riesgo utilizando regresión loigística en jerarquía. Se encontró que el abuso físico y la negligencia tienen conjuntos distintos de factores de riesgo, con obreposición mínima entre los grupos. Las variables sociales y demográficas se encontró que eran predictores limitados de maltrato, mientras que los desórdenes de abuso de sustancias estaban fuertemente asociados con la presentación tnato del abuso como de la negligencia (riesgos relativos = 2.90 y 3.24 respectivamente). Se encontró que la depresión era un factor de riesgo fuerte para el abuso fíisico (riesgo relativo = 3.45). Se discuten las implicaciones de los resultados en términos de los modelos causales principales de tratamiento.
Journal of The American Academy of Child and Adolescent Psychiatry, 1998
To review and synthesize the recent scientific literature on adolescent substance abuse, covering... more To review and synthesize the recent scientific literature on adolescent substance abuse, covering natural history, epidemiology, etiology, comorbidity, assessment, treatment, and prevention, and to highlight areas for future research.Studies of adolescent substance abuse were reviewed with the focus on substance abuse and dependence rather than substance use.There has been a sharp recent resurgence in adolescent drug use. Biological factors, including genetic and temperament characteristics, as well as family environment factors, are emerging as important etiological variables. Comorbidity with other psychiatric disorders, particularly with conduct disorder, is frequent and complicates treatment. New assessment instruments are available for clinical and research use. Among treatment modalities, family-based interventions have received the most study.The past decade has seen growth in the volume and sophistication of research on adolescent substance abuse and in the conceptualization of this problem. Further research is needed, particularly on the significance of comorbid conditions and on individualized and effective treatment approaches. J. Am. Acad. Child Adolesc. Psychiatry, 1998, 37(3):252–261.
During the past several years, there has been a renewed national concern about drug abuse, culmin... more During the past several years, there has been a renewed national concern about drug abuse, culminating in the current "war on drugs." In this review, we emphasize that even though child or teenage drug use is an individual behavior, it is embedded in a sociocultural context that strongly determines its character and manifestations. Our focus is on psychoactive substances both licit (cigarettes and alcohol) and illicit (e.g., cannabis and cocaine). We feel that it is critical to draw a distinction between use and abuse of drugs and to do so from a multidimensional perspective that includes aspects of the stimulus (drug), organism (individual), response, and consequences. Our selective review of substance use and abuse among children and adolescents covers epidemiology (patterns and extent of drug use), etiology (what generates substance use), prevention (how to limit drug use), treatment (interventions with drug users), and consequences (effects and outcomes of youthful drug use).
The search for the one causal influence to account for youthful drug use has always failed. An al... more The search for the one causal influence to account for youthful drug use has always failed. An alternate approach is advocated and tested that relates exposure to and impact of various types of psychosocial risk factors to understanding substance use. Data were obtained from 2,926 students in the 7th, 9th, and 11th grades. Twelve risk factors were selected and tested. These 12 variables were able to explain over 50% of the variance in a measure of general drug use. A unit-weighted, summed index of risk factors was linearly related to use and abuse (heavy use) of cigarettes, alcohol, cannabis, cocaine, hard drugs, and a composite substance use score. Differential exposure to and impact of risk factors on drug-taking behaviors were tested for differences by sex, age, ethnicity, and type of school attending. Patterns of exposure were somewhat different than patterns of vulnerability and impact, and can partially account for the status-group differences in drug use.
The CIDI-SAM is a fully-structured interview that ascertains DSM-III, DSM-III-R, Feighner, RDC an... more The CIDI-SAM is a fully-structured interview that ascertains DSM-III, DSM-III-R, Feighner, RDC and ICD-10 diagnoses for alcohol, tobacco and nine classes of psychoactive drugs, h was designed at the request of the WHO/ADAMHA Task Force on Psychiatric Assessment instruments to expand the substance abuse sections of the CIDI. Using a test-retest design, the diagnostic and item reliabilities of this instrument were tested in a sample of 39 patients in substance abuse treatment at three St. Louis treatment facilities. Kappa values and their 95% confidence intervals, and Yule's Y values are reported. The average kappa for DSM-III substance disorders was 0.84, for DSM-III-R it was 0.82. We report, on the average, excellent kappa values for individual alcohol and drug symptoms. We also ascertained from the respondent's themselves the reasons why answers to specific questions might have been discordant. The findings from this unique,‘discrepancy interview’are reported.
Journal of Consulting and Clinical Psychology, 2000
A national household probability sample of 4,023 adolescents aged 12 to 17 years was interviewed ... more A national household probability sample of 4,023 adolescents aged 12 to 17 years was interviewed by telephone about substance use, victimization experiences, familial substance use, and posttraumatic reactions to identify risk factors for Diagnostic and Statistical Manual of Mental Disorders-(4th ed.; American Psychiatric Association, 1994 ) defined substance abuse/dependence. Age and ethnicity data were available for 3,907 participants. Major findings were (a) adolescents who had been physically assaulted, who had been sexually assaulted, who had witnessed violence, or who had family members with alcohol or drug use problems had increased risk for current substance abuse/dependence; (b) posttraumatic stress disorder independently increased risk of marijuana and hard drug abuse/dependence; and (c)
Increasing public exposure to gambling as a recreational option is leading to increased pathologi... more Increasing public exposure to gambling as a recreational option is leading to increased pathological gambling. The prevalence and correlates of substance abuse in a population of severe pathological gamblers is investigated. The results indicate a high rate of alcohol abuse and drug abuse in this population and in their biological families. The implications of these findings for clinicians working with pathological gamblers and substance abusers are discussed.
... 146 Page 162. SCALE ABUSE MEDICAL EMP-SUP FAM-SOC LEGAL PSYCHOLOGICAL TABLE I VALIDITY OF ASI... more ... 146 Page 162. SCALE ABUSE MEDICAL EMP-SUP FAM-SOC LEGAL PSYCHOLOGICAL TABLE I VALIDITY OF ASI SCALES 524 MALE VETERAN SUBSTANCE ABUSE CLIENTS INDEPENDENT VARIABLES CORR. ... D.; Lester Luborsky, Ph. D.; Charles P. O'Brien, MD, Ph. ...
Substance use prevention studies published between 1980 and 1990 are reviewed for content, method... more Substance use prevention studies published between 1980 and 1990 are reviewed for content, methodology and behavioral outcomes. Studies were classified based on the inclusion of 12 content areas: Information, Decision Making, Pledges, Values Clarification, Goal Setting, Stress Management, Self-Esteem, Resistance Skills Training, Life Skills Training, Norm Setting, Assistance and Alternatives. Six groups of programs (Information/Values Clarification, Affective Education, Social Influence, Comprehensive, Alternatives and Incomplete programs) are identified. Reports are analyzed for two major threats to validity, selection bias and statistical power. Program groups generally have similar selection biases but have important differences in statistical power. Comprehensive and Social Influence programs are found to be most successful in preventing the onset of substance use.
A sample of 253 children of alcoholics (COAs) and 237 children of nonalcoholics (non-COAs) were c... more A sample of 253 children of alcoholics (COAs) and 237 children of nonalcoholics (non-COAs) were compared on alcohol and drug use, psychopathology, cognitive ability, and personality. COAs reported more alcohol and drug problems, stronger alcohol expectancies, higher levels of behavioral undercontrol and neuroticism, and more psychiatric distress in relation to non-COAs. They also evidenced lower academic achievement and less verbal ability than non-COAs. COAs were given Diagnostic Interview Schedule alcohol diagnoses more frequently than non-COAs. The relation between paternal alcoholism and offspring alcohol involvement was mediated by behavioral undercontrol and alcohol expectancies. Although gender differences were found, there were few Gender X Family History interactions; the effects of family history of alcoholism were similar for men and women. When gender effects were found, they showed greater family history effects for women.
Jama-journal of The American Medical Association, 2010
To examine whether the addition of counseling, medical care, and psychosocial services improves t... more To examine whether the addition of counseling, medical care, and psychosocial services improves the efficacy of methadone hydrochloride therapy in the rehabilitation of opiate-dependent patients. Random assignment to one of three treatment groups for a 6-month clinical trial: (1) minimum methadone services (MMS)--methadone alone (a minimum of 60 mg/d) with no other services; (2) standard methadone services (SMS)--same dose of methadone plus counseling; or (3) enhanced methadone services (EMS)--same dose of methadone plus counseling and on-site medical/psychiatric, employment, and family therapy. The methadone maintenance program of the Philadelphia (Pa) Veterans Affairs Medical Center. Ninety-two male intravenous opiate users in methadone maintenance treatment. While methadone treatment alone (MMS) was associated with reductions in opiate use, 69% of these subjects had to be "protectively transferred" from the trial because of unremitting use of opiates or cocaine, or medical/psychiatric emergencies. This was significantly different from the 41% of SMS subjects and 19% of EMS subjects who met the criteria. End-of-treatment data (at 24 weeks) showed minimal improvements among the 10 MMS patients who completed the trial. The SMS group showed significantly more and larger improvements than did the MMS group; and the EMS group showed significantly better outcomes than did the SMS group. Minimum methadone services subjects who had been "protectively transferred" to standard care showed significant reductions in opiate and cocaine use within 4 weeks. Methadone alone (even in substantial doses) may only be effective for a minority of eligible patients. The addition of basic counseling was associated with major increases in efficacy; and the addition of on-site professional services was even more effective.
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