Biomedical subjects

A W Blume

Publications and source records attributed to A W Blume.

12 recordsLinked to original sources

PubMed2001

Brief intervention for heavy-drinking college students: 4-year follow-up and natural history.

OBJECTIVES: This study examined long-term response to an individual preventive intervention for high-risk college drinkers relative to the natural history of college drinking. METHODS: A single-session, individualized preventive intervention was evaluated within a randomized controlled trial with college freshmen who reported drinking heavily while in high school. An additional group randomly selected from the entire screening pool provided a normative comparison. Participant self-report was assessed annually for 4 years. RESULTS: High-risk controls showed secular trends for reduced drinking quantity and negative consequences without changes in drinking frequency. Those receiving the brief preventive intervention reported significant additional reductions, particularly with respect to negative consequences. Categorical individual change analyses show that remission is normative, and they suggest that participants receiving the brief intervention are more likely to improve and less likely to worsen regarding negative drinking consequences. CONCLUSIONS: Brief individual preventive interventions for high-risk college drinkers can achieve long-term benefits even in the context of maturational trends.

Adolescent↗

PubMed2000

Nefazodone treatment of major depression in alcohol-dependent patients: a double-blind, placebo-controlled trial.

Depression is the most common comorbid psychiatric illness in patients with alcohol dependence. This double-blind study tested the efficacy of nefazodone versus placebo for the treatment of depression in actively drinking alcohol-dependent patients who were also participating in weekly group treatment for alcoholism. Sixty-four subjects with major depression disorder and alcohol dependence with a history of at least one prior episode of depression when not drinking were randomly assigned to receive 12 weeks of either nefazodone or placebo and participated in a weekly psychoeducational group on alcoholism. Subjects were assessed every 2 weeks for depression, anxiety, side effects, and drinking frequency. Subjects taking nefazodone were significantly more likely to complete the study (62%) than those taking placebo (34%). Analyses of covariance using drinks per week as a time-dependent covariate showed lower Hamilton Rating Scale for Depression scores at week 8 for end-point analysis and at weeks 8 and 12 for completers. The endpoint analysis demonstrated a significantly greater response in the nefazodone group (48%) than in the placebo group (16%). Both groups showed a similarly significant decrease in the average number of alcoholic drinks consumed per day over the course of the study. Although the number of adverse effects was significantly greater for the nefazodone group, there were no severe adverse events, and nefazodone was well tolerated. Nefazodone is a safe and effective antidepressant to use in a population of alcohol-dependent patients with depression who have a high degree of comorbidity. Nefazodone treatment was superior to placebo in alleviating depression in these patients but did not add any advantage over the psychoeducational group in terms of drinking outcomes.

Adolescent↗

PubMed2000

Assessment of psychological factors associated with adherence to medication regimens among adult patients with asthma.

Nonadherence with asthma medications is a significant problem associated with unnecessary functional limitations. The development of measures to assess psychological factors important to adherence with medication regimens among adult patients with asthma is described in the present report. The results indicated that the reliability and validity of the newly designed measures were adequate. Patients that did not perceive a need to take their medications as prescribed or those already taking their medications as prescribed had better pulmonary function. The results are discussed in terms of their implications for future studies, such as motivational interventions to enhance adherence with asthma medications.

Administration, Inhalation↗

PubMed2000

Executive cognitive function and heavy drinking behavior among college students.

Executive cognitive functions (ECFs) seem important for motivating change and self-regulation of problem drinking. Evidence for executive cognitive deficits have been found among heavy-drinking college students. Although college students who abuse alcohol often experience a variety of negative consequences related to their drinking behavior, executive cognitive dysfunction may interfere with recognizing consequences and responding skillfully to avoid future harm. Fifty college students with drinking problems completed assessments of ECFs. Greater negative drinking consequences and short-term memory function significantly predicted greater awareness of drinking problems. ECF may be an important factor for motivation to change drinking behavior among college students.

Adult↗

PubMed1998

Predictors of treatment adherence among asthma patients in the emergency department.

This study examined predictors of treatment adherence among 120 adult patients with asthma at two emergency departments (EDs). Structured medical chart reviews were performed for characteristics hypothesized to be associated with treatment adherence difficulties. Sixty percent of subjects had evidence of nonadherence with asthma treatment. Several variables were associated with nonadherence including younger age, more utilization of ED services (more ED visits, using the ED for medication refills), certain treatment characteristics (receiving more medications in the ED, not being prescribed prednisone at discharge), and not keeping post-discharge follow-up appointments. Further research should be directed at enhancing self-management skills and decreasing inappropriate ED use among nonadherent patients.

Adolescent↗

PubMedDate not supplied

Loss and readiness to change substance abuse.

Little empirical study has been done on specific content targets for cognitive-behavioral interventions at each stage of change among substance abusers. Clinical observation has noted losses to be associated with decisions to change, but this relationship has not been studied empirically. 110 dually diagnosed psychiatric inpatients completed self-report questionnaires on losses and Readiness to Change. Total number of losses correlated with precontemplation, contemplation, and overall readiness to change scores. In addition, several individual losses accounted for statistically significant variability in each stage of change. These data suggest that focus upon specific losses may motivate change in dually diagnosed substance abusers.

Adolescent↗

PubMedDate not supplied

Motivating drinking behavior change depressive symptoms may not be noxious.

Depression often hinders behavior change among people who abuse alcohol; it adversely affects self-efficacy and is associated with poor outcomes. However, the Transtheoretical Stages of Change Model suggests that personal discomfort, namely if the costs of drinking outweigh the benefits, may lead to behavior change. Often such alcohol-related consequences are associated with depression. Seventy-five alcohol-abusing participants, ages 18-50, completed the Beck Depression Inventory (BDI), Losses Of Significance Self-report Questionnaire-Revised (LOSS-QR), Situational Confidence Questionnaire-42 (SCQ-42), the Brief Readiness to Change Questionnaire (RTC), and the Steady Pattern Chart (SP) at baseline and again 3 months later. BDI scores were significantly associated with all three RTC stage scores. LOSS-QR scores significantly predicted BDI scores but SCQ-42 scores did not. Interestingly, BDI scores did not predict changes in drinking rates over time. Greater levels of depressive symptoms, perhaps associated with awareness of negative drinking consequences, may promote rather than hinder motivation to change drinking behavior among people.

Adolescent↗

PubMedDate not supplied

Specific classes of symptoms predict readiness to change scores among dually diagnosed patients.

The Transtheoretical Stages of Change model hypothesizes that disadvantages of substance abuse must outweigh advantages before change occurs. This study examined whether substance-related sequelae predicted readiness to change scores. A total of 150 dually diagnosed patients were administered the CAGE questionnaire (CAGE is an acronym for questions about substance use: Cutting down, Annoyed by criticism, feel Guilty, Early morning usage), which was scored for mood and behavior symptoms; a checklist of 12 physical, intrapersonal, and environmental symptoms; and the Brief Readiness to Change questionnaire (RTC). Regression analyses suggested that more physical and mood symptoms were predictive of higher total RTC (R2 = .11); physical, mood, and behavioral symptoms were predictive of higher contemplation scores (R2 = .17), whereas fewer physical symptoms were predictive of higher precontemplation scores (R2 = .05). The results suggest that the relative severity of physical, mood, and behavior symptoms may be important factors related to the contemplation of change among dually diagnosed patients.

Adult↗

PubMedDate not supplied

Regret, substance abuse, and readiness to change in a dually diagnosed sample.

The transtheoretical stages of change model posits that increased readiness to change is associated with greater awareness of the negative consequences of substance use. Experiencing regrets implies a greater awareness of these consequences. Eighty dually diagnosed patients completed a 22-item Measure of Substance-Related Regret (MSR) that assessed the intensity, type, idiographic importance of, and emotions associated with regrets related to substance use and the Brief Readiness to Change Questionnaire. The MSR yielded a global measure of regret that accounted for statistically significant amounts of variance in total readiness-to-change scores (R2 = .30). Global scores also predicted precontemplation and contemplation stage scores, whereas total fear scores associated with regrets predicted action scores. Regret seems to play a complex yet important role in the decision to change substance abuse.

Adult↗

PubMedDate not supplied

Recent important substance-related losses predict readiness to change scores among people with co-occurring psychiatric disorders.

The transtheoretical model posits that contemplating change in substance abuse involves weighing the costs of substance use against the benefits. One of the common aversive consequences of substance misuse is personal loss. Indeed, higher total number of losses of unspecified recency and importance have predicted greater motivation to change substance use patterns. A sample of 110 participants with co-occurring Axis I psychiatric and substance use disorders completed a questionnaire measuring recent important substance-related losses (LOSS-QR) and the Brief Readiness to Change questionnaire (RTC). The LOSS-QR yielded scores for frequency, importance, and association of substance misuse with recent losses. Total recent important substance-related loss scores were positively and significantly correlated with total RTC. Hierarchical regression analyses found that identifying losses as substance related and important accounted for significant amounts of variance in total RTC, and identifying losses as substance related predicted precontemplation and contemplation scores. As hypothesized by the transtheoretical model, awareness of substance-related losses seems to be important for people with comorbid psychiatric disorders contemplating behavior change.

Adolescent↗

PubMedDate not supplied

Neurocognitive dysfunction in dually-diagnosed patients: a potential roadblock to motivating behavior change.

Substance abuse has been associated with cognitive dysfunction, such as problems with attention, reasoning, and memory. Certain psychiatric disorders also have been associated with cognitive difficulties, thus placing dually-diagnosed patients at high risk for cognitive impairment that could interfere with successful entry into or completion of therapy. Twenty-two dually-disordered inpatients were administered the Brief Readiness to Change Questionnaire to measure levels of motivation to change substance use, and a neuropsychological test battery that included the Wechsler Adult Intelligence Scale-Revised (WAIS-R), the Halstead Category Test (HCT), and the Wechsler Memory Scale-Revised (WMS-R). Higher general intellectual, executive, and memory functioning were significantly related to greater scores in readiness to change substance abuse in this sample. Cognitive ability may be an important variable to consider in the motivation and treatment of dually-diagnosed patients.

Adolescent↗

PubMedDate not supplied

Integrating harm reduction therapy and traditional substance abuse treatment.

One-size-fits-all therapy has not worked well for a majority of substance users seeking help. New approaches to substance abuse treatment are desperately needed. Traditional models of service delivery offer little, if any, help to people who may not choose abstinence as a goal. To address this concern, the Bridging the Gap Conference was sponsored by the San Francisco Department of Public Health. The overall goals of the conference were to improve standards of care, develop best practice principles for integrating harm reduction approaches into traditional substance abuse services, and increase the accessibility of quality services to people in need of alcohol and drug treatment. G. Alan Marlatt gave a keynote address on the integration of harm reduction therapy into traditional treatment services, an expanded version of which is presented in this article. Such integration would broaden the scope of services available to a larger group of consumers of substance abuse treatment. Furthermore, harm reduction therapy would infuse traditional treatment practices with scientifically-based pragmatism that pays close attention to individual and community public health needs. Because of its tolerance of treatment goals other than abstinence, harm reduction therapy offers the greatest hope to expand the availability of substance abuse services to people who have not benefited from traditional abstinence-based treatment models.

Health Personnel↗