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Bowns R, Loeffelman JE, Steinley D, Sher KJ. A brief young adult alcohol problems screening test: Short form development using combinatorics. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-7. [PMID: 35882065 DOI: 10.1080/07448481.2022.2095870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 06/15/2023]
Abstract
Objective: To develop a shortened form of the Young Adult Alcohol Problems Screening Test1 (YAAPST; original length = 27 items) using a novel combinatorial approach. Participants: 489 college freshmen, half of whom were above average risk for alcohol use disorder based upon family history, attending a large, Midwestern University followed prospectively for 16-17 years across 7 measurement occasions (waves). Methods: Using an exhaustive combinatorial approach, we evaluated all possible combinations of questions and questionnaire length. Each candidate short-form was evaluated using part-whole correlations, alpha coefficients, and polyserial correlations with DSM-III criteria. Results: The 12-item scale, the Brief-YAAPST, was chosen as the best candidate short-form as this scale had the fewest items while maintaining strong reliability and validity. Conclusions: Complete enumeration optimization effectively produced a 12-item short form with minimal loss of reliability and validity making the Brief-YAAPST a desirable assessment alternative when there are concerns about participant or client burden.
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Affiliation(s)
- Rachel Bowns
- Florida State University, Tallahassee, FL, United states
| | | | | | - Kenneth J Sher
- Department of Psychological Science, University of Missouri, Columbia, MO, United States
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Cho MK, Kim MY. Factors Affecting Problem Drinking Among Korean Adolescents Based on an Ecological Model. J Addict Nurs 2020; 31:180-193. [PMID: 32868610 DOI: 10.1097/jan.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to identify the factors affecting problem drinking among adolescents in Korea. METHODS This survey involved 68,043 adolescents who participated in the Korea Youth Risk Behavior Web-Based Survey conducted in 2015. The data were analyzed using the PASW Statistics 23.0 program. RESULTS The subjects were aged 14.96 ± 1.74 years (mean ± standard deviation), including 52.1% male subjects and 53.0% high school students. Most of the drinkers started drinking during their middle school years (13,906 students, 51.6%). Among the 11,021 adolescent drinkers, 7,391 (67.1%) reported at least one of six behavioral problems related to drinking. Problem drinking behaviors involved (a) drinking alcohol to relieve stress; (b) drinking alcohol alone; (c) receiving advice from family or friends to reduce alcohol consumption; (d) driving a motorcycle or riding a bicycle after drinking alcohol, or riding on a motorcycle or a car with a drunk driver at the steering wheel; (e) memory loss after drinking alcohol; and (f) arguing with others after drinking alcohol. The overall problem-drinking score was 1.36 ± 1.42 (range: 0-6). A regression model that included individual (5.7%), interpersonal (3.6%), social (0.3%), contextual (11.7%), and drinking (6.6%) behaviors as predictors accounted for 27.9% of the variance in problem drinking (Wald F = 70.10, p < .001). CONCLUSION The drinking levels as well as method and ease of alcohol purchase were the most significant variables predicting problem drinking by adolescents in Korea.
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Affiliation(s)
- Mi-Kyoung Cho
- Mi-Kyoung Cho, PhD, RN, Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju-si, South Korea. Mi Young Kim, PhD, RN, College of Nursing, Hanyang University, Seoul, South Korea
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Chung T, Cornelius J, Clark D, Martin C. Greater Prevalence of Proposed ICD-11 Alcohol and Cannabis Dependence Compared to ICD-10, DSM-IV, and DSM-5 in Treated Adolescents. Alcohol Clin Exp Res 2017; 41:1584-1592. [PMID: 28667763 DOI: 10.1111/acer.13441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/25/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Proposed International Classification of Diseases, 11th edition (ICD-11), criteria for substance use disorder (SUD) radically simplify the algorithm used to diagnose substance dependence. Major differences in case identification across DSM and ICD impact determinations of treatment need and conceptualizations of substance dependence. This study compared the draft algorithm for ICD-11 SUD against DSM-IV, DSM-5, and ICD-10, for alcohol and cannabis. METHODS Adolescents (n = 339, ages 14 to 18) admitted to intensive outpatient addictions treatment completed, as part of a research study, a Structured Clinical Interview for DSM SUDs adapted for use with adolescents and which has been used to assess DSM and ICD SUD diagnoses. Analyses examined prevalence across classification systems, diagnostic concordance, and sources of diagnostic disagreement. RESULTS Prevalence of any past-year proposed ICD-11 alcohol or cannabis use disorder was significantly lower compared to DSM-IV and DSM-5 (ps < 0.01). However, prevalence of proposed ICD-11 alcohol and cannabis dependence diagnoses was significantly higher compared to DSM-IV, DSM-5, and ICD-10 (ps < 0.01). ICD-11 and DSM-5 SUD diagnoses showed only moderate concordance. For both alcohol and cannabis, youth typically met criteria for an ICD-11 dependence diagnosis by reporting tolerance and much time spent using or recovering from the substance, rather than symptoms indicating impaired control over use. CONCLUSIONS The proposed ICD-11 dependence algorithm appears to "overdiagnose" dependence on alcohol and cannabis relative to DSM-IV and ICD-10 dependence, and DSM-5 moderate/severe use disorder, generating potential "false-positive" cases of dependence. Among youth who met criteria for proposed ICD-11 dependence, few reported impaired control over substance use, highlighting ongoing issues in the conceptualization and diagnosis of SUD.
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Affiliation(s)
- Tammy Chung
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jack Cornelius
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Duncan Clark
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher Martin
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Martin CS, Langenbucher JW, Chung T, Sher KJ. Truth or consequences in the diagnosis of substance use disorders. Addiction 2014; 109:1773-8. [PMID: 24913314 PMCID: PMC4441015 DOI: 10.1111/add.12615] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/25/2014] [Accepted: 04/29/2014] [Indexed: 01/09/2023]
Abstract
AIMS This commentary critically evaluates the use of substance-related negative psychosocial and health consequences to define and diagnose alcohol and other substance use disorders. METHODS Narrative review. RESULTS The consequences of substance use cause much suffering and are major public health and economic problems. However, there are a number of conceptual and measurement problems with using consequences as diagnostic criteria for substance disorders. Data indicate that substance-related consequences introduce systematic bias and degrade the validity of diagnostic systems. CONCLUSIONS Negative psychosocial and health consequences of substance use should play a fundamentally reduced role in modern diagnostic systems for, and definitions of, addictive disorders.
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Affiliation(s)
- Christopher S. Martin
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center of Alcohol Studies, Rutgers University, Piscataway, NJ, USA
| | | | - Tammy Chung
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kenneth J. Sher
- University of Missouri-Columbia, Columbia, MO, USA
- Midwest Alcohol Research Center, Washington University School of Medicine, St Louis, MO, USA
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Tarrahi MJ, Rahimi-Movaghar A, Zeraati H, Amin-Esmaeili M, Motevalian A, Hajebi A, Sharifi V, Radgoodarzi R, Hefazi M, Fotouhi A. Agreement between DSM-IV and ICD-10 criteria for opioid use disorders in two Iranian samples. Addict Behav 2014; 39:553-7. [PMID: 24286705 DOI: 10.1016/j.addbeh.2013.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to determine the agreement between the two systems in opioid users in the general population and a clinical sample. Two series of data were used in this study. The first was the data of 236 home-residing opioid abusers aged 15-64, who had previously participated in the Iran Mental Health Survey (IranMHS) in 2011, and the second was the data of 104 general psychiatry patients from inpatient or outpatient wards of two psychiatry hospitals in Tehran. Opioid use disorders were evaluated with CIDI-version 2.1. The disorders were assessed in all participants who used opioid substances for at least 5 times during the past 12months. In the sample from the general population, the agreement between the two systems on the diagnosis of dependence was excellent (0.81). The agreement between the two systems on the diagnosis of abuse and harmful use was 0.41. In the clinical sample, the agreement between the two systems on the diagnosis of dependence or any opioid use disorder was 0.96 and 0.93, respectively. The agreement between abuse and harmful use was 0.9 and -0.02 with and without regarding hierarchy, respectively. The inter-rater reliability of both DSM-IV and ICD-10 systems for all diagnosis was more than 0.95. The results of the diagnosis of dependence in the two systems had a weak concordance with treatment. The diagnostic criteria of DSM-IV and ICD-10 regarding dependence are very similar and the diagnosis produced by each system is concordant with the other system. However, the two systems have noticeable discrepancies in the diagnosis of abuse and harmful use. The discrepancies result from their conceptual differences and necessitate further revision in the definition of these disorders in the two systems.
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Jones KD, Gill C, Ray S. Review of the ProposedDSM-5Substance Use Disorder. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2012. [DOI: 10.1002/j.2161-1874.2012.00009.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lee HK, Chou SP, Cho MJ, Park JI, Dawson DA, Grant BF. The prevalence and correlates of alcohol use disorders in the United States and Korea--a cross-national comparative study. Alcohol 2010; 44:297-306. [PMID: 20570084 DOI: 10.1016/j.alcohol.2010.02.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 01/20/2010] [Accepted: 02/10/2010] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to compare the prevalence rates of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition 12-month diagnoses of alcohol use disorders between the United States and South Korea using two large nationally representative surveys. Cross-tabulations were used to derive weighted prevalences of alcohol abuse and dependence, and odds ratio derived from linear logistic regression analyses were used to determine the relationships between alcohol abuse and dependence across sociodemographic characteristics of the general population samples. The prevalence of 12-month alcohol abuse was greater in the United States (5.3%) than Korea (2.0%), whereas the rate of alcohol dependence was greater in Korea (5.1%) compared with the United States (4.4%). The odds of abuse were significantly greater among men, and in the youngest age groups in both countries. There was increased odds of 12-month dependence among men, and those who were employed or never married in each country. Further, the rates of abuse and dependence in the United States and of abuse in Korea decreased as a function of age, a result that did not generalize to dependence among Koreans. The implications of the results of this study are discussed in terms of national differences between the United States and Korea as the result of gender roles and drinking patterns, and the need to understand the potential influence of the cultural applicability and specificity of psychiatric assessment interviews across countries.
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Affiliation(s)
- Hae Kook Lee
- National Institute on Alcohol Abuse and Alcoholism, U.S. National Institute of Health, Bethesda, MD 20892, USA
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Abstract
BACKGROUND Differences in the ICD-10 and DSM-IV definitions for the same disorder impede international communication and research efforts. The forthcoming parallel development of DSM-V and ICD-11 offers an opportunity to harmonise the two classifications. AIMS This paper aims to facilitate the harmonisation process by identifying diagnostic differences between the two systems. METHOD DSM-IV-TR criteria sets and the ICD-10 Diagnostic Criteria for Research were compared and categorised into those with identical definitions, those with conceptually based differences and those in which differences are not conceptually based and appear to be unintentional. RESULTS Of the 176 criteria sets in both systems, only one, transient tic disorder, is identical. Twenty-one per cent had conceptually based differences and 78% had non-conceptually based differences. CONCLUSIONS Harmonisation of criteria sets, especially those with non-conceptually based differences, should be prioritised in the DSM-V and ICD-11 development process. Prior experience with the DSM-IV and ICD-10 harmonisation effort suggests that for the process to be successful steps should be taken as early as possible.
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Affiliation(s)
- Michael B First
- New York State Psychiatric Institute, Columbia University Department of Psychiatry, 1051 Riverside Drive - Unit 60, New York, NY 10032, USA.
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Koskinen J, Löhönen J, Koponen H, Isohanni M, Miettunen J. Prevalence of alcohol use disorders in schizophrenia--a systematic review and meta-analysis. Acta Psychiatr Scand 2009; 120:85-96. [PMID: 19374633 DOI: 10.1111/j.1600-0447.2009.01385.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Our aim was to present recent studies of alcohol use disorders (AUDs) in patients with schizophrenia, estimate overall prevalence and characteristics affecting the prevalence of AUDs. METHOD We conducted a search using three literature databases and a manual search on articles published in 1996-2008. Meta-regression was used to study how prevalence is affected by different study characteristics. Articles that reported diagnoses according to DSM or ICD diagnostic systems were included. RESULTS Altogether 60 studies met our criteria. The median of current AUD prevalence was 9.4% (inter-quartile range, IQR 4.6-19.0, 18 studies) and median of lifetime AUD prevalence 20.6% (IQR 12.0-34.5, 47 studies). In studies using DSM-III-R median prevalence was higher than that in studies using DSM-IV, ICD-9 or ICD-10 (32/17/11/6%). CONCLUSION Approximately every fifth patient with schizophrenia had lifetime AUD diagnosis. When contrasted with the most recent review, there might be a descending trend in AUD prevalence in patients with schizophrenia.
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Affiliation(s)
- J Koskinen
- Department of Psychiatry, University of Oulu and Oulu University Hospital, Oulu, Finland.
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Deas D, Roberts JS, Grindlinger D. The utility of DSM‐IV criteria in diagnosing substance abuse/dependence in adolescents. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/1465989042000271200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Martin CS, Chung T, Langenbucher JW. How should we revise diagnostic criteria for substance use disorders in the DSM-V? JOURNAL OF ABNORMAL PSYCHOLOGY 2008; 117:561-75. [PMID: 18729609 DOI: 10.1037/0021-843x.117.3.561] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This article reviews literature on the validity and performance characteristics of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) diagnostic criteria for substance use disorders (SUDs) and recommends changes in these criteria that should be considered for the next edition of the DSM (DSM-V). Substantial data indicate that DSM-IV substance abuse and substance dependence are not distinct categories and that SUD criteria are best modeled as reflecting a unidimensional continuum of substance-problem severity. The conceptually and empirically problematic substance abuse diagnosis should be abandoned in the DSM-V, with substance dependence defined by a single set of criteria. Data also indicate that various individual SUD criteria should be revised, dropped, or considered for inclusion in the DSM-V. The DSM-V should provide a framework that allows the integration of categorical and dimensional approaches to diagnosis. Important areas for further research are noted.
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Affiliation(s)
- Christopher S Martin
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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King KM, Chassin L. Adolescent stressors, psychopathology, and young adult substance dependence: a prospective study. J Stud Alcohol Drugs 2008; 69:629-38. [PMID: 18781237 PMCID: PMC2575393 DOI: 10.15288/jsad.2008.69.629] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Revised: 04/02/2008] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There is much theory, but sparse empirical evidence, supporting the notion that internalizing symptoms and negative affect are the mechanism by which exposure to stressful life events influence the development of substance-use disorders in adolescence and young adulthood. However, many empirical studies have shown that, in addition to elevations in internalizing symptoms, exposure to stressful life events also produces elevations in externalizing behaviors and conduct problems, which are important risk factors for substance-use disorders. The current study tested adolescent externalizing and internalizing symptoms as competitive mediators of the effects of stressors on young adult drug dependence. METHOD Data from an ongoing study of children of alcoholics (n=223) and matched controls (n=204) were collected in two annual interviews in adolescence and two follow-ups in young adulthood. RESULTS Experiencing stressful life events during adolescence led to increases in both externalizing and internalizing symptoms, but only externalizing symptoms mediated the later effects of adolescent stressors on young adult drug dependence. CONCLUSIONS These findings suggest that understanding how stressors produce elevations in behavioral problems may provide important insights into understanding how broad environmental risk factors lead to substance dependence and suggests that processes other than affect regulation may operate in the pathway from the experiences of stressors to substance use and disorder.
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Affiliation(s)
- Kevin M. King
- Department of Psychology, University of Washington, P.O. Box 351525, Seattle, Washington 98195
| | - Laurie Chassin
- Department of Psychology, University of Washington, P.O. Box 351525, Seattle, Washington 98195
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Chung T, Martin CS, Cornelius JR, Clark DB. Cannabis withdrawal predicts severity of cannabis involvement at 1-year follow-up among treated adolescents. Addiction 2008; 103:787-99. [PMID: 18412757 PMCID: PMC4437205 DOI: 10.1111/j.1360-0443.2008.02158.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIMS Controversy exists regarding the inclusion of cannabis withdrawal as an indicator of dependence in the next revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). This study contrasted the concurrent and predictive validity of three operational definitions of cannabis withdrawal in a sample of treated adolescents. DESIGN Prospective study of treated adolescents with 1-year follow-up. SETTING AND PARTICIPANTS Adolescents (n=214) were recruited from intensive out-patient treatment programs for substance abuse, and followed at 1 year (92% retention). Youth who were included in the analyses reported regular cannabis use. MEASUREMENTS The number of DSM-IV cannabis abuse and dependence symptoms at baseline and 1-year follow-up, past year frequency of cannabis use at baseline and follow-up, and periods of abstinence at 1-year follow-up. Cannabis withdrawal was defined based on (i) the presence of two or more cannabis withdrawal symptoms; (ii) a definition proposed by Budney and colleagues (2006) that requires four or more withdrawal symptoms (four-symptom definition); and (iii) the use of latent class analysis to identify subgroups with similar cannabis withdrawal symptom profiles. FINDINGS AND CONCLUSIONS All three definitions of cannabis withdrawal demonstrated some concurrent validity. Only the four-symptom and latent class-derived definitions of withdrawal predicted severity of cannabis-related problems at 1-year follow-up. No cannabis withdrawal definition predicted frequency of use at follow-up. Further research is needed to determine the clinical utility and validity of the four-symptom definition, as well as alternative definitions of cannabis withdrawal, to inform revisions leading to DSM-V and ICD-11.
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Affiliation(s)
- Tammy Chung
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Buckner JD, Timpano KR, Zvolensky MJ, Sachs-Ericsson N, Schmidt NB. Implications of comorbid alcohol dependence among individuals with social anxiety disorder. Depress Anxiety 2008; 25:1028-37. [PMID: 18781667 PMCID: PMC2778209 DOI: 10.1002/da.20442] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUD) yet the nature of this comorbidity remains unclear. To better understand these associations, we first examined whether SAD was related to AUD above and beyond relevant covariates. Second, we examined the psychosocial impairment associated with the comorbidity of SAD and AUD versus SAD without AUD. Third, the temporal sequencing of SAD and AUD among comorbid individuals was examined. METHODS Participants included 5,877 (50% females) adults from the National Comorbidity Survey. RESULTS As predicted, SAD was related to alcohol dependence (not abuse) after controlling for relevant conditions, indicating that SAD is linked to more severe alcohol impairment and that this link is not better accounted for by other pathology. Results also supported the hypothesis that the addition of alcohol dependence to SAD resulted in greater impairment across a variety of domains relative to SAD without alcohol dependence (e.g., greater rates of health care utilization, other psychiatric diagnoses, health problems, and greater interpersonal stress). Additionally, for the majority of comorbid individuals, SAD onset predated alcohol dependence onset, suggesting SAD increases vulnerability for misusing alcohol. CONCLUSIONS Together, these data lend support for the contention that SAD may serve as a risk for alcohol dependence and indicate that the co-occurrence of these two conditions may result in greater personal and public health care costs.
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Affiliation(s)
- Julia D. Buckner
- Department of Psychology, Yale University School of Medicine, New Haven, Connecticut,Correspondence to: Julia D. Buckner, Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, USA.
| | - Kiara R. Timpano
- Department of Psychology, Florida State University, Tallahassee, Florida
| | | | | | - Norman B. Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida
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Saunders JB. Substance dependence and non-dependence in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD): can an identical conceptualization be achieved? Addiction 2006; 101 Suppl 1:48-58. [PMID: 16930161 DOI: 10.1111/j.1360-0443.2006.01589.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND This review summarizes the history of the development of diagnostic constructs that apply to repetitive substance use, and compares and contrasts the nature, psychometric performance and utility of the major diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) diagnostic systems. METHODS The available literature was reviewed with a particular focus on diagnostic concepts that are relevant for clinical and epidemiological practice, and so that research questions could be generated that might inform the development of the next generation of DSM and ICD diagnoses. RESULTS The substance dependence syndrome is a psychometrically robust and clinically useful construct, which applies to a range of psychoactive substances. The differences between the DSM fourth edition (DSM-IV) and the ICD tenth edition (ICD-10) versions are minimal and could be resolved. DSM-IV substance abuse performs moderately well but, being defined essentially by social criteria, may be culture-dependent. ICD-10 harmful substance use performs poorly as a diagnostic entity. CONCLUSIONS There are good prospects for resolving many of the differences between the DSM and ICD systems. A new non-dependence diagnosis is required. There would also be advantages in a subthreshold diagnosis of hazardous or risky substance use being incorporated into the two systems. Biomedical research can be drawn upon to define a psychophysiological 'driving force' which could underpin a broad spectrum of substance use disorders.
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Affiliation(s)
- John B Saunders
- School of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
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Zhou Q, King KM, Chassin L. The roles of familial alcoholism and adolescent family harmony in young adults' substance dependence disorders: mediated and moderated relations. JOURNAL OF ABNORMAL PSYCHOLOGY 2006; 115:320-31. [PMID: 16737396 DOI: 10.1037/0021-843x.115.2.320] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the prospective relations among family history density of alcoholism (FHD), adolescent family harmony, and young adults' alcohol and drug dependence. Family harmony was rated by mothers and fathers in adolescence, and young adults' substance dependence diagnoses were obtained through structured interviews. Higher FHD predicted lower adolescent family harmony, which in turn increased young adults' odds of being diagnosed with drug dependence (with and without alcohol dependence) compared to no diagnoses or to alcohol dependence only. Family harmony also interacted with FHD such that the protective effect of family harmony on young adults' drug dependence with or without alcohol dependence decreased as FHD rose, and was nonsignificant at high levels of FHD. The findings suggest the importance of distinguishing among alcohol and drug dependence disorders and examining their differential etiological pathways, and also suggest that the protective effects of harmonious family environments on substance dependence may be limited at high levels of FHD.
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Affiliation(s)
- Qing Zhou
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA
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Stein LAR, Graham JR. Ability of substance abusers to escape detection on the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) in a juvenile correctional facility. Assessment 2005; 12:28-39. [PMID: 15695741 PMCID: PMC2860861 DOI: 10.1177/1073191104270838] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The ability of respondents to underreport successfully on substance abuse and validity scales of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) was evaluated. Incarcerated teens (67 substance abusing, 59 non-substance abusing) completed the MMPI-A twice: once under standard instructions (SI) and once under instructions to fake good (FG). Under SI, substance scales correctly classified about 60% to 85% of adolescents. Under FG, substance- and non-substance-abusing juveniles produced lower scores on substance scales. However, the Lie Scale (L) was able to detect more than 75% of deceptive profiles and about 77% of honest profiles. When scale L and the best substance scale were used in combination, only about 18% of faking substance abusers were not identified as either substance abusers or as underreporting. For feigning substance abusers, only about 10% of substance abusers were detected, with about 72% being categorized as faking and needing further assessment.
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Affiliation(s)
- L A R Stein
- Brown University; The Rhode Island Training School, USA
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Chung T, Martin CS, Winters KC. Diagnosis, course, and assessment of alcohol abuse and dependence in adolescents. RECENT DEVELOPMENTS IN ALCOHOLISM : AN OFFICIAL PUBLICATION OF THE AMERICAN MEDICAL SOCIETY ON ALCOHOLISM, THE RESEARCH SOCIETY ON ALCOHOLISM, AND THE NATIONAL COUNCIL ON ALCOHOLISM 2005; 17:5-27. [PMID: 15789857 DOI: 10.1007/0-306-48626-1_1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Risk for the onset of an alcohol use disorder (AUD) peaks during adolescence and the transition to young adulthood, highlighting the public health significance of alcohol use by adolescents. This chapter summarizes recent research on the diagnosis, course, and assessment of adolescent AUDs. This review focuses on developmental considerations in assessment of AUD criteria, the prevalence of DSM-IV AUDs among adolescents, typical alcohol symptom profiles in youth, and limitations of DSM-IV AUD criteria when applied to adolescents. In addition, studies of AUD course in adolescents, as well as factors influencing the course of AUDs are summarized. The chapter also provides an overview of brief alcohol screening instruments and other measures used in more comprehensive assessment of AUDs in adolescents.
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Affiliation(s)
- Tammy Chung
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213, USA
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Laukkanen E, Honkalampi K, Hintikka J, Hintikka U, Lehtonen J. Suicidal ideation among help-seeking adolescents: association with a negative self-image. Arch Suicide Res 2005; 9:45-55. [PMID: 16040579 DOI: 10.1080/13811110590512930] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Self-image and factors associated with suicidal ideation were studied among adolescents (N=168, age 17.7+/-2.3 years, 72% girls) seeking psychiatric assessment. The Structured Clinical Interview, Beck Depression Inventory and Offer Self-Image Questionnaire were used. Suicidal ideation (SI) was reported by 64% of subjects, of whom 20% received no psychiatric diagnosis and 58% had depressive disorders. SI in boys associated with being bullied at school and talking about one's problems only with friends, and in girls with a negative attitude towards the future and a negative self-image of one's own mental health. Because suicidal ideation frequently occurs without formal psychiatric diagnosis it should be assessed separately. Special attention should be paid to adolescents' negative self-perception.
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Affiliation(s)
- Eila Laukkanen
- Kuopio University Hospital, Department of Psychiatry, Kuopio, Finland.
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21
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Abstract
AIM To examine clinically relevant research on the development, course and outcomes of adolescence alcohol use disorders (AUDs). METHODS Observational studies with adolescent samples were selected for inclusion based on systematic assessment of AUDs and clinical relevance. The literature was searched using Medline and Psychinfo. Articles on childhood predictors, characteristics, course, complications and adult outcomes of adolescent AUDs were reviewed. RESULTS The developmental trajectory toward adolescent AUDs begins with the emergence of childhood mental disorders. These problems are transmitted from parent to child in a developmentally specific fashion, reflect psychological dysregulation dimensions and predict adolescent AUDs. While most DSM-IV AUD diagnostic criterion items are valid for adolescents, tolerance and impaired control items are problematic, and some adolescents with significant alcohol problems are not identified by this diagnostic system. Understanding the psychosocial and biomedical complications that accompany AUDs requires attention to factors other than alcohol involvement itself, including childhood maltreatment and comorbid psychopathology. While some adolescents with AUDs manifest chronic alcohol dependence in adulthood, a substantial proportion overcome alcohol problems and transition to abstinence or normative drinking. CONCLUSIONS Developmentally specific phenotypic characteristics define the natural history of adolescent AUDs, inform clinical assessment and provide the developmental context for treatment research. While alcohol consumption may be the primary treatment focus, other important consequences, comorbidities and complications need to be addressed for successful developmental outcomes to result.
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Affiliation(s)
- Duncan B Clark
- University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Breuer JP, Neumann T, Heinz A, Kox WJ, Spies C. [The alcoholic patient in the daily routine]. Wien Klin Wochenschr 2004; 115:618-33. [PMID: 14603733 DOI: 10.1007/bf03040467] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic alcohol abuse is of significant clinical and economic relevance. A major part of internal medical pathology is associated with chronic alcoholism. 50% of all accidents with subsequent traumatic injuries are related to alcohol intake. Patients who are chronic alcohol abusers have prolonged hospital stays and substantial increases in postoperative morbidity. A sophisticated diagnosis of alcoholism within standard clinical routine is often difficult, and in most cases the treatment of alcohol-related diseases and complications is protracted and requires increased energy expenditure by the treating physicians. In surgical patients, chronic alcohol abuse is associated with a 3- to 4-fold risk of infections, sepsis, cardiac and bleeding complications. Therefore, the patients themselves, along with the general practitioner and an in-hospital interdisciplinary team should cooperate in medical and operative treatment in order to attain better clinical outcome. Each patient history should include a detailed assessment of the quantity of daily alcohol intake. Alcoholic diagnostic regimens including questionnaires (i.e. CAGE, AUDIT) in combination with specific laboratory markers (CDT, GGT, MCV), if implemented, could prove valuable, especially in cases where major surgical procedures are considered. Strict abstinence by alcoholic patients with organ pathology in medical and elective surgical settings as well as the prophylactic treatment of pre-operative alcohol withdrawal appear to be useful strategies to reduce the risk of complications. Short-term interventions are associated with reduced alcohol intake and decreased incidence of re-trauma. Considering the clinical relevance of alcohol abuse, sufficient screening, interventions, and open approaches to address alcohol problems should be important components of the daily clinical routine in outpatient clinics, emergency rooms, in GPs' offices and in general hospitals.
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Affiliation(s)
- Jan-Philipp Breuer
- Klinik für Anästhesiologie und operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Gemeinsame Einrichtung von Freier Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Deutschland
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Clark DB, Bukstein O, Cornelius J. Alcohol use disorders in adolescents: epidemiology, diagnosis, psychosocial interventions, and pharmacological treatment. Paediatr Drugs 2003; 4:493-502. [PMID: 12126453 DOI: 10.2165/00128072-200204080-00002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Alcohol (ethanol) abuse and dependence are the most common substance use disorders among adolescents. Binge drinking occurs in up to one-third of adolescents, and alcohol use disorders occur in about 6% of this age group. Adolescents with alcohol use disorders also typically have problems with other substances and comorbid mental disorders. Validated measures are available for the clinical detection and diagnosis of adolescent alcohol use disorders and related problems. Psychosocial interventions promoting abstinence are the most common treatments for alcohol use disorders, with empirical support particularly strong for family-based approaches. Pharmacological interventions may diminish the effects of alcohol withdrawal, prevent a return to alcohol consumption, or treat comorbid mental disorders. In this population, pharmacological interventions require further investigation and, where indicated, are generally considered to be supplementary to psychosocial approaches.
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Affiliation(s)
- Duncan B Clark
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Tapert SF, Baratta MV, Abrantes AM, Brown SA. Attention dysfunction predicts substance involvement in community youths. J Am Acad Child Adolesc Psychiatry 2002; 41:680-6. [PMID: 12049442 DOI: 10.1097/00004583-200206000-00007] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cognitive impairments influence alcohol and drug treatment outcomes, though little is known about how neurocognition affects the development of harmful substance use patterns. This study examined the influence of adolescent attention functioning on the development of substance use problems in 66 high-risk youths over an 8-year period. METHOD Participants were community youths who were free from any history of substance use disorders, neurological illness, and mood, anxiety, or psychotic disorders at project intake and were administered neuropsychological tests and substance involvement interviews from ages 15 through 23 on average. Substance involvement was assessed by self-report, resource person reports, and randomly sampled toxicology screens. RESULTS Attention/executive functioning scores obtained at the intake neuropsychological assessment significantly predicted substance use and dependence symptoms 8 years later, even after controlling for intake substance involvement, gender, education, conduct disorder, family history of substance use disorders, and learning disabilities. CONCLUSIONS These results suggest that adolescents with limited attentional abilities, but not necessarily attention-deficit/hyperactivity disorder diagnoses, may be at risk for developing more problematic alcohol and drug involvement. Thus prevention and treatment efforts should target youths with attentional difficulties by using programs that are effective for those with compromised concentration and processing abilities.
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Affiliation(s)
- Susan F Tapert
- VA San Diego Healthcare System Psychology Service and University of California San Diego Department of Psychiatry, 92161, USA.
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Ottosson H, Ekselius L, Grann M, Kullgren G. Cross-system concordance of personality disorder diagnoses of DSM-IV and diagnostic criteria for research of ICD-10. J Pers Disord 2002; 16:283-92. [PMID: 12136684 DOI: 10.1521/pedi.16.3.283.22537] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim in this study was to examine the cross-system concordance between the personality disorders (PDs) of DSM-IV and Diagnostic Criteria for Research of ICD-10 Classification of Mental and Behavioral Disorders, 10th rev. (ICD-10) PD diagnoses were made by a structured interview in a clinical psychiatric sample of 138 individuals. Both categorical and dimensional scores for each PD were established. The frequency of patients with a PD diagnosis on either classification who were also positive on the other varied from 26% for the schizoid PDs to 88% for the histrionic PDs. The chance-corrected agreement (Cohen's kappa) ranged from .37 to .94. The dimensional correlation (Pearson's r) between pairs of PD criteria sets was in the range of .79 to .98. In conclusion, when analyzed categorically, some of the PDs of DSM-IV and ICD-10-DCR were only moderately concordant. The reasons appear to be different criteria formulations and arbitrary thresholds for diagnoses. In contrast to categorical diagnoses, dimensional agreement was high, implicating similar trait-concept definitions. The least concordant pair of PD was antisocial (DSM-IV)-dissocial (ICD-10).
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Affiliation(s)
- Hans Ottosson
- Department of Clinical Science, Division of Psychiatry, University Hospital, Umeå, Sweden.
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Stein LA, Graham JR. Use of the MMPI-A to detect substance abuse in a juvenile correctional setting. J Pers Assess 2001; 77:508-23. [PMID: 11781036 DOI: 10.1207/s15327752jpa7703_10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In this study, we examined the ability of the MMPI-A (Butcher et al., 1992) to detect substance abuse problems in a juvenile correctional setting. Specifically, we evaluated the Alcohol/Drug Problem Acknowledgment scale (ACK; Weed, Butcher, & Williams, 1994), the Alcohol/Drug Problem Proneness scale (PRO; Weed et al., 1994), and the MacAndrew Alcoholism Scale-Revised (MAC-R; Butcher et al., 1992) in the prediction of substance abuse. In addition, the incremental validity of ACK in comparison to PRO was evaluated, as was the incremental validity of PRO in comparison to ACK. The sample consisted of 123 boys and girls from ajuvenile correctional facility in Northeastern Ohio. Results indicate that ACK and PRO, but not MAC-R, were related to interviewer ratings of substance abuse. Results point to the superiority of ACK over PRO in substance abuse identification.
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Affiliation(s)
- L A Stein
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
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Clark DB, Lynch KG, Donovan JE, Block GD. Health problems in adolescents with alcohol use disorders: self-report, liver injury, and physical examination findings and correlates. Alcohol Clin Exp Res 2001. [PMID: 11584156 DOI: 10.1111/j.1530-0277.2001.tb02358.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although adolescent alcohol consumption has been found to be positively correlated with self-reported health problems, few studies have examined other health indicators. This study compared adolescents with alcohol use disorders (AUDs) and a community reference group on self-reported health problems, serum liver enzymes, and physical examination findings. The relevance of negative emotionality to understanding these health problems was also investigated. METHODS The subjects were adolescents with AUDs recruited from clinical programs and classified as having DSM-IV alcohol dependence (n = 71) or alcohol abuse (n = 57) and reference adolescents without AUDs recruited from community sources (n = 131). The assessment of health status included self-reported health problems in 15 areas; serum liver enzyme assays, including gamma-glutamyl transpeptidase, alanine aminotransferase, and aspartate aminotransferase; and physical examination findings. Negative emotionality was determined by systematically combining scores from the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, the Child Behavior Checklist, and the Multidimensional Personality Questionnaire. RESULTS Adolescent AUDs were associated with more self-reported health problems, higher gamma-glutamyl transpeptidase and alanine aminotransferase levels, and more physical examination abnormalities. Negative emotionality was highly correlated with self-reported health problems, mediated the relationship between AUDs and self-reported health problems, and was not correlated with serum liver enzyme levels or physical examination abnormalities. CONCLUSIONS These results indicated that AUDs during adolescence were associated with health problems, including modest but demonstrable liver injury. Self-reported health problems were probably best understood, in this context, as a negative emotionality manifestation.
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Affiliation(s)
- D B Clark
- Pittsburgh Adolescent Alcohol Research Center, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213, USA.
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Sareen J, Chartier M, Kjernisted KD, Stein MB. Comorbidity of phobic disorders with alcoholism in a Canadian community sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2001; 46:733-40. [PMID: 11692976 DOI: 10.1177/070674370104600806] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the relation between phobic disorders and alcoholism in a Canadian community sample. METHOD Data came from the Mental Health Supplement of the Ontario Health Survey. The University of Michigan revision of the Composite International Diagnostic Interview (UM-CIDI) was used to diagnose DSM-III-R psychiatric disorders in 8116 Canadian respondents between ages 15 and 64 years. Since the cross-system agreement (ICD-10 and DSM-III-R or DSM-IV) on the diagnosis of alcohol abuse is much lower than that for alcohol dependence, we also examined a WHO category, "hazardous alcohol use." Logistic regression controlling for age and sex was used to determine odds ratios (ORs) for phobic disorders and alcohol-use diagnoses. RESULTS Individuals with lifetime alcohol abuse or dependence had two- to threefold increased odds of having a phobic disorder. Simple phobia and social phobia with multiple fears were significantly associated (ORs 1.5 to 2) with hazardous alcohol use (which had a prevalence of approximately 10%). CONCLUSIONS Given the early onset of most phobic disorders, the findings suggest that these are a risk factor for hazardous patterns of alcohol use.
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Affiliation(s)
- J Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, M5024 409 Taché Avenue, Winnipeg, MB R2H 2A6.
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Diachronic Substance Use Assessment and the Emergence of Substance Use Disorders. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2001. [DOI: 10.1300/j029v10n04_02] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Spies C, Tonnesen H, Andreasson S, Helander A, Conigrave K. Perioperative Morbidity and Mortality in Chronic Alcoholic Patients. Alcohol Clin Exp Res 2001. [DOI: 10.1111/j.1530-0277.2001.tb02392.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Laukkanen E, Korhonen V, Peiponen S, Nuutinen M, Viinamäki H. A pessimistic attitude towards the future and low psychosocial functioning predict psychiatric diagnosis among treatment-seeking adolescents. Aust N Z J Psychiatry 2001; 35:160-5. [PMID: 11284896 DOI: 10.1046/j.1440-1614.2001.00875.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective was to study factors associated with psychiatric diagnosis among adolescents (n = 164) seeking psychiatric care for mental symptoms. METHOD Psychiatric diagnosis was confirmed by a structured diagnostic interview. Psychosocial functioning was assessed with the Global Assessment of Functioning Scale, and the Beck Depression Inventory and Offer Self-Image Questionnaire were also used. Background data were gathered. RESULTS A majority (76%) of the adolescents met DSM-III-R criteria for psychiatric diagnosis. The self-image was more negative and the Beck score was higher among these adolescents than the others. All who had attempted suicide had a psychiatric disorder. Those diagnosed as having a psychiatric disorder consumed alcohol in order to get drunk more often than others. Continual conflicts with parents and smoking were not associated with the existence of a psychiatric disorder. In logistic regression analysis, low psychosocial functioning (OR = 3.9) and an uncertain or pessimistic attitude towards the future (OR = 9.1) proved to be independent risk factors for psychiatric disorders. CONCLUSIONS Health service staff should be aware of factors associated with psychiatric disorders in adolescents so that they can identify those at high risk.
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Affiliation(s)
- E Laukkanen
- Department of Psychiatry (3703), Kuopio University Hospital, PO Box 1777, FIN-70211, Kuopio, Finland.
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Langenbucher J, Martin CS, Labouvie E, Sanjuan PM, Bavly L, Pollock NK. Toward the DSM-V: The Withdrawal-Gate Model versus the DSM-IV in the diagnosis of alcohol abuse and dependence. J Consult Clin Psychol 2000. [DOI: 10.1037/0022-006x.68.5.799] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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