Four year MMPI changes in abstinent and drinking alcoholics

Patterns of alcohol use between genders: a cross-cultural evaluation

INTRODUCTION

Alcohol use by men and women is very much influenced by social habits and customs. Cultural peculiarities and biological differences between the sexes require more focused and standardized studies. The objective was to systematize information on patterns of alcohol use between the sexes.

METHOD

A literary review (1972-2004) identified 96 publications (Lilacs, Scielo, Medline) and some related books.

RESULTS AND CONCLUSIONS

Men drank more and presented more problems (legal, family, social, clinical, traumas and mortality) associated with alcohol use; the consequences of alcohol use in developing countries with low death rates is even higher. Women can face more discrimination by using alcohol as well as worse health problems when they abuse drinking (liver, pancreas, and central and peripheral nervous system problems, psychiatric comorbidity, etc.); sexual abuse is more commonly associated with women than discussing the different responses to treatment. As for social roles/responsibilities exercised by women, there are indications that marriage, employment, and children have a good influence, discouraging alcohol use, while divorce, unemployment, and no children contribute to higher consumption. For both sexes, religion was a protective factor for alcohol use; acculturation was a strong influence in the pattern of alcohol use, and alcohol worsened the evolution of existing psychiatric disorders.

Risks of combined alcohol/medication use in older adults

BACKGROUND

Many older adults (ie, those aged >65 years) drink alcohol and use medications that may be harmful when consumed together.

OBJECTIVE

This article reviews the literature on alcohol and medication interactions, with a focus on older adults.

METHODS

Relevant articles were identified through a search of MEDLINE and International Pharmaceutical Abstracts (1966-August 2006) for English-language articles. The following medical subject headings and key words were used: alcohol medication interactions, diseases worsened by alcohol use, and alcohol metabolism, absorption, and distribution. Additional articles were identified by a manual search of the reference lists of the identified articles, review articles, textbooks, and personal reference sources.

RESULTS

Many older adults drink alcohol and take medications that may interact negatively with alcohol. Some of these interactions are due to age-related changes in the absorption, distribution, and metabolism of alcohol an medications. Others are due to disulfiram-like reactions observed with some medications, exacerbation of therapeutic effects and adverse effects of medications when combined with alcohol, and alcohol's interference with the effectiveness of some medications.

CONCLUSIONS

Older adults who drink alcohol and who take medications are at risk for a variety of adverse consequences depending on the amount of alcohol and the type of medications consumed. It is important for clinicians to know how much alcohol their older patients are drinking to be able to effectively assess their risks and to counsel them about the safe use of alcohol and medications. Similarly, it is important for older adults to understand the potential risks of their combined alcohol and medication use to avoid the myriad of problems possible with unsafe use of these substances..

The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview

AIMS

As part of a larger study to estimate the global burden of disease attributable to alcohol: to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and to combine exposure and risk estimates to determine regional and global alcohol-attributable fractions (AAFs) for major disease and injury categories. DESIGN, METHODS, SETTING: Systematic literature reviews were used to select diseases related to alcohol consumption. Meta-analyses of the relationship between alcohol consumption and disease and multi-level analyses of aggregate data to fill alcohol-disease relationships not currently covered by individual-level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi-level analyses with prevalence data.

FINDINGS

Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed.

CONCLUSIONS

Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.

Adherence to substance abuse treatment: clinical utility of two MMPI-2 scales

In this study, we examined the ability of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Addiction Acknowledgment scale (AAS; Weed, Butcher, McKenna, & Ben-Porath, 1992) and Negative Treatment Indicators scale (TRT; Butcher, Graham, Williams, & Ben-Porath, 1990) to predict adherence to and outcomes from substance abuse treatment. There was no evidence that the AAS was related to treatment adherence or outcome in our sample. However, results did reveal a significant positive relation between scores on the TRT scale and readmission to the hospital. Further analyses identified an optimal score for use in similar clinical populations and settings, and characteristics of high and low scorers. Compared to low scorers, high TRT scorers were more likely to not return for treatment after an initial screening interview. If they did return for treatment, high TRT scorers were more likely to experience fewer treatment days and to be rated as having lower motivation, poorer participation, and poorer comprehension of program materials. These findings provide promising initial evidence of the utility of the TRT scale for identifying patients who may be at a high risk for unsuccessful substance abuse treatment.

Changes in families of alcoholics during a post-treatment period

This article focuses on the changes experienced in families of alcoholics during a post-treatment period. 35 families were assessed on measures of family interaction (Self-Report Family Inventory), parental symptoms of psychological distress (Brief Symptom Inventory) and emotional and behavioural problems in children (Child Behaviour Check List, CBCL). The assessments were done at the beginning of the treatment programme and again between 6 and 12 months later (follow-up). Children of alcoholics showed significantly fewer symptoms of ADHD and conduct disorder, and spouses experienced a lower general level of psychological distress and fewer symptoms of depression at follow-up compared to the first assessment. The alcoholics showed no improvement in symptoms of psychological distress but experienced significantly more symptoms of phobic anxiety at follow-up. We found no improvement in measures of family interaction in the follow-up period. Improvement in children's and spouses' psychosocial functioning in the follow-up period was unrelated to alcoholics' restitution. For specific CBCL dimensions, we found better treatment effects for older children (>11 years), for boys and for children of alcoholics in outpatient treatment. Taking into account the small study population, the relatively short follow-up period and the fact that all initial data were gathered after the alcoholic had been in treatment for a while, the results of this study should be interpreted with some caution and need to be validated in other studies.

Five-year course of major depression: effects of comorbid alcoholism

Some patients enter psychiatric treatment with clear cases of both major depression and alcoholism. While assumptions are often made about the relationships of these two conditions, little empirical evidence exists on the effects of sustained remissions in alcoholism on sustained remissions in depression. 127 patients with both disorders at treatment entry were studied over a 5-year period. Survival analyses with time-dependent covariates indicating alcoholism status were used to investigate remissions and relapses in major depression. Remission in alcoholism strongly and significantly increased the chances of remission in depression and were also related to reduced chances of depression relapse, although at a weaker level.

Depression and relapses in treated chronic alcoholics

In a sample of 99 male alcoholics at an alcoholics' rehabilitation clinic we recorded drinking/abstinence behavior and depression up to 1 year after discharge. Seventy-eight patients completed the inpatient therapy, and of these, 39 respondents were recorded up to the final follow-up point. Generally, the initial, markedly elevated depression scores had declined significantly by the end of the inpatient treatment. In the abstainers, the depression scores continued to fall after release and remained low throughout the entire observation period. In patients who resumed alcohol use, relapses were accompanied by immediate, sharp increases in the scores, but declined upon a return to abstinence.

Abstinence, reasons for not drinking, and life satisfaction

This study examines the reasons given for not drinking by abstinent alcoholics with varying lengths of sobriety. A Reasons for Not Drinking Scale is tested, as well as the Purpose in Life Questionnaire and Life Satisfaction Scale. Subjects are 60 males from a VA population. Results show that subjects with less education and those treated in a detoxification setting are more likely to endorse negative reasons for not drinking. Individuals with short and long abstinence have a higher level of life "dissatisfaction" than those with moderate periods of abstinence. The study suggests that purpose in life, life satisfaction, and reasons for not drinking are important measures of progress in treatment and movement through phases of recovery.

An examination of recent suicides in remote Australia: further information from the Kimberley

Aboriginal suicide has emerged as an issue of public concern only within the recent past. Within the last decade there has been a substantial increase from levels that were previously low. Under the shadow of the Royal Commission into Aboriginal Deaths in Custody these increases, involving primarily young adult males, raise serious questions. Two years ago the author examined a series of suicides that had occurred in one area of remote Aboriginal Australia, the Kimberly region of Western Australia. This paper examines suicides that have occurred in the following two years, with comparisons both with the previous suicides, and with a group of age-matched Aborigines from the general Kimberly population drawn from a random sample survey.

Drug and alcohol dependence and psychiatric populations: the need for diagnosis, intervention, and training

The comorbidity of psychiatric disorders and alcohol and drug dependence is high. The prevalence rate for each disorder is high as determined by studies in general and patient populations. Moreover, the severity of the course is likely to be greater when the two disorders are combined, prompting the attention of clinicians and researchers. Of importance, the intoxication and withdrawal from alcohol and drugs produce psychiatric symptoms and syndromes that can mimic psychiatric disorders. The prevalence rates for comorbidity of both categories of disorders vary according to the populations studied, methodological approaches used, and duration of longitudinal follow-up postdiagnosis of the disorders. It is evident from a review of the literature that there is a growing urgency for proper diagnosis, improved training programs, and treatment intervention strategies for alcohol and drug dependence in psychiatric populations. Suggestions for broad assessment and specific interventions for alcohol/drug dependence in psychiatric settings are offered, and increased time in psychiatric residency training is recommended.

Overall functioning and criteria of progress in rehabilitation of alcohol abusers: longitudinal analyses of changes

The aim was to compare alcohol consumption and vocational adjustment as criteria of rehabilitation progress of alcoholics, with regard to links to concomitant changes in functioning in other life areas. Thirty-four advanced alcohol abusers in rehabilitation were examined twice with an interval of 2 years between each examination. Change scores in alcohol consumption and work capacity were correlated with change scores in social network, activities, life-satisfaction, psychological well-being, psychiatric symptoms, and biomedical functioning. Improved drinking habits were connected with some changes in overall functioning, however not solely in a favorable direction. Negative mood changes were especially noteworthy. Improvements in vocational adjustment, on the other hand, appeared to be somewhat more unequivocally and encompassingly associated with amelioration in the wider range of functioning. The results indicate that drinking measures alone are not sufficient indicators of progress in rehabilitation and underscores the need of more global criteria of general adjustment.

Predicting the posttreatment depressive state of an alcoholic patient

Seventy-eight patients admitted to an alcohol treatment program were studied to identify variables capable of forecasting a patient's posttreatment depressive state. Factor analysis reduced a large number of items to 12 factors. Pearson correlations showed that Factor VII--Physical and Neurological Complaints and the pretreatment depressive state were both significantly (p = .002) correlated to the posttreatment depressive state. Multiple regression yielded a significant equation (p = .001) confirming that an alcoholic patient who has a high level of pretreatment depression and physical/neurological complaints, and who exhibits little or no irritability or agitation will tend to sustain a high level of posttreatment depression.

Long-term recovery in alcoholics

A cross-sectional study of alcoholics who varied widely in duration of abstinence was combined with a four-year follow-up study of the same subjects. Together, the data demonstrated a course of recovery in abstinent alcoholics measured in three ways: severity of symptoms, probability of relapse, and work history. Additionally, the subjects showed high rates of smoking cessation. By every measure, the course of recovery seemed essentially the same in men and women. The recovery process was most rapid in the early years of abstinence but continued for 10 or more years. It was suggested that keys to full recovery in alcoholics are abstinence and time, which are necessary for recovery from a protracted withdrawal syndrome and brain dysfunction, for the repair of social relationships, for vocational rehabilitation, and for abstinence itself to become stable.

Diagnosis of alcoholism

Alcoholism is among the most prevalent of the difficult diseases to establish diagnoses in medicine. This article outlines a number of steps to help in identifying the alcoholic patient. These include: a careful history, several laboratory blood tests, simple paper-and-pencil tests, and recognition of alcohol-related medical disorders.

Locus of control, life events and treatment outcome in alcohol dependent patients

We investigated the relationship of locus of control and life events to outcome of treatment at 6 months in 67 patients with alcohol dependence. Outcome was less favourable in patients with pre-treatment scores indicating external locus of control than in those with internal locus of control. Furthermore, patients with relapse in the follow-up period experienced more independent life events with moderate to severe objective negative impact than those with more favourable outcome. These results suggest that locus of control may be of clinical use in formulating treatment and prognosis, and that the occurrence of life events may influence outcome. The results are discussed in relation to strategies for treatment and prevention of relapse.

An application of an MMPI classification system for predicting outcome in a small clinical sample of alcoholics

The purpose of this study was to apply Conley and Prioleau's MMPI classification system to predict drinking and adjustment outcome for a sample of 113 inpatient alcoholics. Although a dual grouping (termed "reactive" and "essential") of the original six MMPI subtypes was found to be more useful for this sample size, the findings, nevertheless, supported the predictive value of this MMPI classification system. The "essential" group, derived from a triad of Psychopathic and Schizoform MMPI types was rated as drinking significantly more often during 4 years after treatment than the "reactive" group, derived from a triad of Neurotic and Classic MMPI types (Fisher's p = .02). Females classified as the "essential" MMPI group were rated as having significantly poorer adjustment (Fisher's p = .007) than females classified as the "reactive" MMPI group.

Substance abuse among general psychiatric patients: place of presentation, diagnosis, and treatment

This paper reviews the literature on patients presenting for general psychiatric treatment who are also substance abusers. Place of presentation, diagnosis, and treatment are considered. A considerable portion of patients seen in emergency rooms, as much as half in some settings, are substance abusers, and over a third of general psychiatry admissions have been found to have their presenting problems materially influenced or precipitated by substance abuse. Substance abuse is also frequently found among psychiatric inpatients. Diagnostically, the differentiation of general psychiatric and addictive syndromes can be difficult: primary and secondary affective disorder from consequences of long-term substance abuse; and self-medication patterns from primary general psychiatric syndromes. Treatment studies are often focused on concomitant psychotherapeutic management for patient being treated for addiction. Often, emphasis is placed on pharmacotherapy for enhancing outcome in the dually diagnosed. Qualitatively, new options tailored to this population still remain to be studied, however, as do the changes necessary in the treatment system to assure proper long-term management.

Depression among alcoholics

The relationships of cognition, health status, and age to depression among alcoholics were studied. Eighty male alcoholics in an alcohol treatment unit were rated on health status and given a battery of psychological tests and scales. These included the Hooper VOT (cognition) and several self-rated depression indices: MMPI-Depression, MCMI-Dysthymic, BDI-Total (BDI-Somatic and BDI-Psychological), and the Geriatric Depression Scale (GDS). Results showed that depression was present in this sample at mild clinical levels. Regression analyses showed that age was the most influential factor on the MMPI-D and BDI-Somatic. Age also was most influential on the GDS, with health status contributing. However, except for somatic depression, the amount of explained variance was small. Despite this, it is argued that age is a contributing factor to depression among alcoholics, especially the somatic elements of depression.

Comparison among four measures of depression in younger and older alcoholics

Two hypotheses were tested: (1) The Geriatric Depression Scale (GDS) would be less affected by age in an older alcoholic group than in a younger one. (2) In comparison with other depression scales—Beck Depression Inventory, Depression Scale of MMPI, and Dysthymic Scale of Millon Clinical Multiaxial Inventory—the Geriatric Depression Scale would be the one least affected by age in the older group. To test these hypotheses two groups were formed, containing 36 and 37 subjects, whose mean ages were 32.50 and 53.98 yr. All subjects were administered the four depression scales and tests of cognitive function. The results confirmed the first hypothesis as r was .32 between age and the Geriatric Depression Scale for the younger group and .03 for the older group. The second hypothesis was not confirmed. All four depression scales correlated nonsignificantly with age in the older group. The use of the depression scales for all ages was supported and discussed.

Symptomatology in alcoholics at various stages of abstinence

Evaluation of 312 abstinent alcoholics (163 men and 149 women) with the Symptom Check-List 90 revealed high levels of symptomatology for subjects in the early months of abstinence. Symptomatology decreased progressively with prolonged abstinence, approximating normal levels for subjects abstinent 10 years or more. The levels were similar for men and women. At all stages, for both men and women, symptomatology was highest on the depression, interpersonal sensitivity, and obsessive-compulsive symptom dimensions, with guilt a particularly persistent symptom. It is suggested that the findings depict a long-term process of recovery from active alcoholism and are consistent with the concept of a protracted withdrawal syndrome, an intermediate (partially reversible) brain syndrome, and general psychosocial dysfunction and demoralization consequent to active alcoholism.

Neurological mechanisms underlying inheritance of alcoholism vulnerability

Evidence accrued during the past two decades points to a genetic predisposition for alcoholism. The biological expression of the genetic vulnerability, however, is unknown. This discussion addresses the neurological manifestation of alcoholism vulnerability, including the biochemical, physiological and behavioral characteristics which appear to be associated with an increased risk for alcoholism.

Two MMPI approaches for identifying alcoholics: evaluation and implications for further research

Though contrasting MMPI approaches yield opposing conclusions regarding personalities of alcoholics, the relative efficacy of the approaches has not been evaluated. In this study of 309 domiciliary patients, the alcoholism scale and cluster analytic approaches were compared with respect to the identification of alcoholics and excessive-drinking subjects. The MacAndrew Alcoholism Scale significantly identified alcoholics; however, there was no identification with the profiles of the clinical scales generated by the cluster analytic technique. The conclusions suggest the greater efficacy of the alcoholism scale approach and suggest that the clustering strategy might be more fruitfully applied to alcoholism scales.