The influence of psychiatric comorbidity on the course and outcome in a nationwide representative sample (n = 351) of treatment-seeking substance users over a 28-month period was studied prospectively. The patients were administered the Diagnostic Interview Schedule and a questionnaire on drinking history. At 16 and 28 months after admission the patients returned a questionnaire on drinking history and mental health. In cases of those lacking information on either follow-up (45%), details on drinking status was obtained from informants. Completely abstinent were 16%. Generalized anxiety disorder and/or social phobia at the index admission predicted abstinence during the follow-up [odds ratio (OR) = 0.25], whereas onset of alcoholism among these patients after age 25 years predicted a worse prognosis (OR = 13.5). Also increasing number of social consequences related to abuse (OR = 1.3) and drinking more than the median (OR = 2.1) predicted a poor outcome. The abstinent group had significantly better mental health at follow-up. The patients with comorbid psychiatric disorders at admission were worse at follow-up. Although substance use disorders and comorbid psychiatric disorders have to a certain degree separate courses, there is nevertheless significant interaction between them. Early treatment and recognition of comorbid psychiatric disorders among substance abusers is necessary.
The present study was conducted to provide a nationwide survey of acceptance of nonabstinence goals and related alcoholism treatment practices by Canadian alcoholism treatment services.
A random sample of 335 Canadian alcoholism treatment service agencies were mailed a 4-page questionnaire designed to assess acceptance of moderate drinking as a drinking goal and related alcoholism treatment practices.
Acceptance varied by type of service, with considerably more acceptance by outpatient programs (62%) and mixed inpatient/outpatient programs (43%) than inpatient/detoxification/ correctional facilities (27%) and halfway houses (16%). Two-thirds of the respondents who reported moderate drinking as unacceptable in their own agencies categorically rejected moderation for all alcoholism clients.
Individuals seeking services in Canadian alcoholism treatment agencies are more likely to have a choice of drinking goals if they present to an outpatient program than a residential institution, and Canadian agencies appear more accepting of moderation goals than American programs, but less accepting than British and Norwegian service agencies.
This exploratory study evaluated the benefits of adding auricular acupuncture to a 21-day outpatient structured psychoeducational treatment program for women with concurrent substance use problems, anxiety, and depression. Women receiving acupuncture (n = 185) reported having reduced physiological cravings for substances, felt significantly less depressed, less anxious, and were better able to reflect on and resolve difficulties than women in the control group (n = 101). It was found that auricular acupuncture, as an adjunct therapy to a comprehensive psychoeducational treatment program for women with addictions, shows promise in being an effective, more viable treatment alternative to anxiolytics.
This study explores how antisocial behavior among adolescents at age 14 is related longitudinally to their daily smoking, heavy alcohol use, and illicit drug use (hashish and amphetamines) at age 17. The sample of 9th graders (n = 1293) attending compulsory schools in Reykjavik, Iceland participated in the study and in the follow-up 3 years later. The focus is on a subgroup of 17-year-old adolescents who had not experimented with cigarette smoking, alcohol consumption, or illicit drug use at age 14. Even after eliminating from the study those who had experimented with smoking at age 14 and those whose peers smoked, the adolescents who showed more signs of antisocial behavior at age 14 were more likely to smoke daily at age 17. Similar findings were revealed for illicit drug use at age 17. Further, with regard to alcohol use, adolescents who had not experimented with alcohol but showed indications of antisocial behavior at age 14 were more likely to drink heavily at each episode at age 17 if their parents drank.
Health service prevention of alcohol problems is based on screening and primarily involves motivational counselling. Screening may take the form of routine enquiries about drinking habits. Motivational counselling consists in two parts, assessment of readiness to change, and counselling adapted to the readiness to change. Alcohol problems do not generally require intervention by a specialist, but rather by an observer who suggests a change. Doctors and health care authorities alike should pursue the prevention of alcohol problems by such methods as a matter of policy, as this is a demonstrably effective approach which would enable both the need and costs of health care to be reduced.
On the basis of a prospective random sample investigation of 611 alcohol-related visits to the four psychiatric emergency units of the City of Copenhagen, demographic variables, referral sources and dispositions of treatment are described. On every 10th day throughout 1985 all visits were registered. The distribution of all variables except age and sex deviate significantly from those of non-alcohol-related visits. Thus fewer alcoholics cohabit and more are divorced. 25% of the alcohol-related visits resulted in an overnight stay in the unit, while 10% resulted in admission to the psychiatric ward. For non-alcohol-related visits the proportions were the reverse.
This study investigates the effects of alcohol, drug intoxication and withdrawal symptoms on the mental state of criminal suspects and the nature of their confession. A total of 359 sentenced prisoners were approached on admission and 96% agreed to participate in the study. They completed a specially designed Confession Questionnaire, which asked them questions about their reasons for confessing to the police, their attitude towards their confession, their mental state at the time of the confession and the extent to which they had been under the influence of alcohol and drug intoxication at the time of crime and police interview. The confession rate for the sample was very high (92%), with serious traffic violators having the highest confession rate (95%) and sex offenders the lowest (83%). The findings illustrate that the "perception of proof", "internal need to confess" and "external pressure" are the main reasons why suspects confess. However, subjects were identified who had experienced a typical "prisoner's dilemma" phenomenon during the police interview because of a co-defendant. Alcohol and drug intoxication was very commonly reported both at the time of the offence and the police interview, but these were related to the nature of their offence. Although intoxication and withdrawal symptoms did not appear to seriously impair their coping during the police interview it was consistently reported as having made them confused.
Although alcohol and drug problems are prevalent in the population at large and among patients in general hospitals, they have not been a major concern of consultation-liaison psychiatry. A setting in which all psychiatric consultations are directed to such problems, the Clinical Institute of the Addiction Research Foundation, is described, and parameters of its consultation experience are explored. It is suggested that dealing with alcohol and drug problems should become an integral aspect of consultation-liaison psychiatry. Such a development may prove to be especially fruitful in teaching a comprehensive approach to patient care.
