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Biomedical subjects

B S Moos

Publications and source records attributed to B S Moos.

At least 19 recordsLinked to original sources
PubMed2005

Older adults' health and changes in late-life drinking patterns.

This study focused on the prospective associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems. A sample of 1,291 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption, and was followed one year, four years, and 10 years later. Health-related problems increased and alcohol consumption and drinking problems declined over the 10-year interval. Medical conditions, physical symptoms, medication use, and acute health events predicted a higher likelihood of abstinence and less frequent and lower alcohol consumption. However, overall health burden predicted more subsequent drinking problems, even after controlling for alcohol consumption and a history of heavy drinking and increased drinking in response to stressors. Among older adults, increased health problems predict reduced alcohol consumption but more drinking problems. Older adults with several health problems who consume more alcohol are at elevated risk for drinking problems and should be targeted for brief interventions to help them curtail their drinking.

Aged↗
PubMed2001

Predictors of deterioration among patients with substance-use disorders.

The purpose of this study was to identify patients with substance-use disorders who deteriorate during treatment, and to examine baseline predictors of deterioration. Three groups of 872 patients each, matched on number of problems at baseline, were selected from a larger sample based on their treatment outcome (improved, nonresponsive, deteriorated). Deterioration was predicted by younger age and African-American race; four aspects of patients' history (psychiatric symptoms, arrests, prior drug treatment, and recent inpatient or residential care); and having no close friends. Patients who had both an alcohol and a drug diagnosis, a personality-disorder diagnosis, and those who had a shorter episode of care and fewer outpatient-mental-health visits, also were more likely to deteriorate.

Adolescent↗
PubMed2000

Global assessment of functioning (GAF) ratings: determinants and role as predictors of one-year treatment outcomes.

OBJECTIVE: To assess the adequacy of global ratings of patients' psychosocial functioning, which are an integral part of the current system for obtaining multidimensional psychiatric diagnoses and are embodied by the Global Assessment of Functioning (GAF) Scale as AXIS V of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994). METHOD: We identified a sample of 1,688 patients with substance use disorders, many of whom also had psychiatric disorders; examined the determinants of GAF ratings; and focused on how well these ratings predicted patients' one-year symptom and psychosocial functioning outcomes. RESULTS: Patients' clinical diagnoses and psychiatric symptoms were stronger predictors of GAF ratings than was their social and occupational functioning. Moreover, GAF ratings were only minimally associated with patients' one-year psychological, social, and occupational functioning outcomes. CONCLUSIONS: These findings raise serious questions about the conceptual and clinical value of the current standard method of assessing psychiatric and substance abuse patients' global functioning.

Adult↗
PubMed2000

Inpatient substance abuse care and the outcome of subsequent community residential and outpatient care.

AIM: To compare participation in treatment and 1-year substance use, symptom and functioning outcomes between patients with substance use disorders who did versus those who did not have an episode of inpatient care immediately prior to an episode of community residential and outpatient mental health care. DESIGN: Two matched groups of 257 patients each with substance use disorders were assessed at entry to and discharge from a community residential facility (CRF) and at a 1-year follow-up. FINDINGS: Patients in the two treatment groups received a comparable amount of CRF and outpatient mental health care. Nevertheless, patients who had prior inpatient care were more likely to be employed at 1-year follow-up. In addition, when they entered CRF care directly, patients with co-morbid psychiatric disorders were more likely to continue use of alcohol and drugs in the CRF and less likely to complete the program. These patients also experienced more distress and psychiatric symptoms, and were less likely to be employed at the 1-year follow-up. CONCLUSIONS: Among patients who seek treatment at Department of Veterans Affairs (VA) facilities, those who have both substance use and psychiatric disorders and enter CRF care directly have somewhat worse outcomes than those who have an immediately prior episode of inpatient care.

Adult↗
PubMed1999

Outcomes of four treatment approaches in community residential programs for patients with substance use disorders.

OBJECTIVE: Treatment approaches used in community residential facilities for patients with substance use disorders were identified, and patients' participation in treatment and case-mix-adjusted one-year outcomes for substance use, symptoms, and functioning in facilities with different treatment approaches were examined. METHODS: A total of 2,376 patients with substance use disorders treated in a representative sample of 88 community residential facilities were assessed at entry to and discharge from the facility and at one-year follow-up. The community residential facilities were classified into four types based on the major emphasis of the treatment program: therapeutic community, psychosocial rehabilitation, 12-step, and undifferentiated. RESULTS: Patients in programs that used the therapeutic community, psychosocial rehabilitation, and 12-step approaches had comparable one-year outcomes in symptoms and functioning that were better than those of patients in undifferentiated programs. A more directed treatment orientation, a longer episode of care, and completion of care were independently related to better one-year outcomes. These findings held for patients with only substance use disorders and for patients with both substance use and psychiatric disorders. CONCLUSIONS: Community residential programs that have a more directed treatment orientation and that motivate patients to complete treatment have better substance use outcomes. As an increasingly important locus of specialized care, community residential facilities need to develop and maintain more differentiated and distinctive treatment orientations.

Adult↗
PubMed1999

Long-term treatment careers and outcomes of previously untreated alcoholics.

OBJECTIVE: The aim of this project was to describe treatment selection and outcomes over an 8-year follow-up period for 466 individuals who had drinking problems and had not yet received formal treatment at baseline. METHOD: By the 8-year follow-up, individuals had self-selected into one of four groups: no-treatment (n = 78); completed treatment (help was received only in Years 1-3 of follow-up; n = 230); additional treatment (help was received in Years 1-3, with more help in Years 4-8; n = 134); and delayed treatment (no help was received until Years 4-8 of follow-up; n = 24). RESULTS: Compared with individuals who remained untreated, the completed treatment group had more severe drinking problems and depression at baseline, but better drinking outcomes at both the 3- and 8-year follow-ups. At 3 years, the additional treatment group perceived their drinking problem as being more serious than did the untreated group and was more likely to have drinking-related problems; by 8 years, individuals who had obtained additional treatment were more likely to be abstinent, but still perceived their drinking problems as being more serious. Compared to individuals who completed treatment in Years 1-3, additional treatment group members had more severe drinking and functioning problems at 3 and 8 years. More involvement with formal outpatient treatment or AA was associated with more improvement on drinking indices. CONCLUSIONS: Persons with alcohol use disorders who elect to enter formal treatment or AA relatively soon after acknowledging their drinking problems experience better drinking-related outcomes than do those who receive no help or who delay receiving help. Accordingly, referral processes should ensure that problem drinkers enter self-help or formal treatment quickly.

Adult↗
PubMed1998

Family and extrafamily resources and the 10-year course of treated depression.

A group of 313 depressed patients and 284 controls was assessed at baseline (treatment intake for the patients) and at 1-year, 4-year, and 10-year follow-ups. Stably remitted patients achieved levels of family and extrafamily resources that were comparable with those of the controls. Although partially remitted and nonremitted patients' social resources improved, they continued to show deficits in these areas relative to controls and stably remitted patients. Several indexes of social resources predicted stable remission: more family independence, fewer family arguments and less conflict, and more helpful friends and activities with friends. Assessment of social resources at treatment intake and short-term follow-ups can help identify and provide intervention foci for patients at risk for nonremission of depression.

Adult↗
PubMed1998

The staff workplace and the quality and outcome of substance abuse treatment.

OBJECTIVE: The study examined the connection between the staff work environment and staff members' beliefs about treatment, the quality of the treatment environment, patients' involvement in treatment and self-help activities, and patients' improvement during treatment. METHOD: Patient care staff (N = 329) in 15 substance abuse treatment programs reported on the characteristics of their work environment and on their beliefs and treatment orientations about substance abuse. Patients in these programs (N = 3,228) reported on the treatment environment, their participation in treatment and self-help activities, and their treatment goals, confidence in achieving these goals, and coping skills at intake to and discharge from treatment. RESULTS: Staff in supportive and goal-directed work environments were more likely to espouse disease model beliefs and a 12-step orientation toward substance abuse treatment. These work environments were associated with more supportive and goal-directed treatment environments. Patients in these treatment environments participated in more substance abuse, educational and social, and family treatment services, were more involved in self-help groups (as indicated by attending more meetings, reading 12-step materials, and having a sponsor and friends in such groups), were more satisfied with the program, improved more during treatment (as indicated by abstinence goals and confidence in maintaining abstinence, less depression, and more substance abuse and general coping skills), and were more likely to participate in outpatient mental health care after discharge. CONCLUSIONS: More goal-directed work environments are associated with more goal-directed treatment environments and patients' engagement in treatment and improvement. The staff work environment is an important component of the substance abuse treatment system.

Adult↗
PubMed1995

Stay in residential facilities and mental health care as predictors of readmission for patients with substance use disorders.

OBJECTIVES: This study examined the relationship between substance abuse patients' length of stay in community residential facilities and their outpatient mental health aftercare and readmission for inpatient care. METHODS: A national sample of 1,070 substance abuse patients referred to community residential facilities after an episode of inpatient care was assessed and followed over four years. Patients were divided into three groups: those with only alcohol-related diagnoses; those with drug-related diagnoses, most of whom also had alcohol diagnoses; and those with concomitant psychiatric diagnoses. RESULTS: Patients who had longer episodes of care in residential facilities were more likely to obtain outpatient mental health aftercare and were less likely to be readmitted for additional substance abuse or psychiatric care in six-month, one-year, and four-year follow-up intervals. Readmission rates among substance abuse patients with psychiatric diagnoses were much higher than rates among patients who had only substance abuse diagnoses. Length of stay in the community residential facility and postdischarge outpatient mental health care remained significant independent predictors of lower readmission after other risk factors for readmission were considered. CONCLUSIONS: Transitional community residential care can contribute to substance abuse patients' treatment outcome; however, longer-term supportive care is needed for substance abuse patients with more severe and chronic disorders.

Adult↗
PubMed1995

Short-term treatment careers and outcomes of previously untreated alcoholics.

OBJECTIVE: To describe treatment selection and outcomes over a 3-year follow-up period for 439 individuals who had drinking problems and had not yet received formal treatment at baseline. METHOD: By the 3-year follow-up, individuals had self-selected into one of four groups: no-treatment (n = 70), completed treatment (i.e., help was received only in Year 1 of follow-up: n = 109), additional treatment (i.e., help was received in Year 1, with more help in Years 2 and 3; n = 233), and delayed treatment (i.e., no help was received until Years 2 and 3 of follow-up; n = 27). RESULTS: Compared with individuals who remained untreated, individuals who sought help during Year 1 had more severe drinking problems, poorer psychosocial functioning and more negative life events at baseline; however, treated individuals had better drinking outcomes than untreated persons at the 1- and 3-year follow-ups. Compared to individuals who completed treatment in Year 1, additional treatment group members had more severe drinking problems at baseline and 1 year later, but better drinking outcomes at the 3-year follow-up. Formal treatment in conjunction with Alcoholics Anonymous (AA) was associated with better drinking outcomes than formal treatment alone. In addition, more involvement with formal inpatient or outpatient treatment, or AA, was associated with more improvement on drinking indices. CONCLUSION: Overall, the findings suggest a reciprocal relationship between individuals' functioning and their participation in alcohol abuse interventions.

Adult↗
PubMed1994

Outcome of treatment for alcohol abuse and involvement in Alcoholics Anonymous among previously untreated problem drinkers.

A sample of 515 initially untreated problem drinkers was followed for one year after contacting alcohol information and referral or detoxification services. At a one-year follow-up, participants had self-selected into one of four groups: no treatment (24%), Alcoholics Anonymous (AA) only (18%), outpatient treatment (25%), and residential or inpatient treatment (32%); some outpatients also attended AA, and some inpatients also attended AA and/or outpatient programs. These four groups were compared on changes in drinking-related variables, other aspects of functioning, and stressors and resources over the follow-up year. Also examined were associations between amount of treatment and outcomes at one year. All four groups improved on drinking and functioning outcomes but changed less on stressors and resources. Although individuals who received no help improved, persons in the two treatment and the AA-only groups improved more, particularly on drinking-related outcomes. Inpatients were more likely than outpatients or AA-only participants to be abstinent; otherwise, type of intervention had few differential effects. More AA attendance was associated with abstinence among AA-only, outpatient, and inpatient group members. Among outpatients and inpatients, more formal treatment was associated with abstinence and improvement on other drinking-related outcomes.

Alcoholics Anonymous↗
PubMed1993

The process of treatment selection among previously untreated help-seeking problem drinkers.

A sample of 515 untreated problem drinkers was followed up for 1 year after contacting alcohol information and referral or detoxification services. At the 1-year follow-up, participants were placed into one of four treatment status groups: no treatment (24%), Alcoholics Anonymous only (18%), outpatient (25%), and inpatient or residential (32%). Participants with fewer financial resources, more serious drinking problems, and poorer functioning at baseline were more likely to enter inpatient or residential programs than outpatient treatment. Persons who selected AA only for treatment were of lower socioeconomic status than outpatients, and were functioning better than those who opted for treatment in inpatient or residential settings. In general, individuals who entered treatment received a considerable amount of treatment. Poorer baseline functioning was related to attending more AA meetings or outpatient sessions, and to staying longer in inpatient or residential treatment. The results are discussed in the context of a conceptual model of selection into alcoholism treatment.

Adult↗
PubMed1991

Short-term processes of remission and nonremission among late-life problem drinkers.

This prospective study compares alcohol use, functioning, life stressors, social resources, and help-seeking among three groups of older adults: remitted problem drinkers, nonremitted problem drinkers, and nonproblem drinkers. At initial assessment, to-be-remitted problem drinkers had several advantages compared with individuals who would continue to have drinking problems. Specifically, they consumed less alcohol, reported fewer drinking problems, had friends who approved less of drinking, and were more likely to seek help from mental health practitioners. Problem drinkers who remitted improved somewhat over time, but they did not attain the level of functioning or type of life contexts shown by nonproblem drinkers. Time of onset of drinking problems influenced the short-term process of remission: Compared with early-onset individuals, late-onset problem drinkers were more likely to remit over the 1-year interval. The predictors of short-term remission suggested that late-onset problem drinkers may be more reactive to physical health stressors and to social influences than are individuals with more long-standing problems with alcohol.

Adaptation, Psychological↗
PubMed1990

Approach and avoidance coping responses among older problem and nonproblem drinkers.

The Coping Responses Inventory (CRI) was used to study coping among older problem and nonproblem drinkers. The CRI organizes coping efforts according to their focus (approach or avoidance) and method (cognitive or behavioral). Compared with nonproblem drinkers, older problem drinkers were more likely to use cognitive and behavioral avoidance responses to manage life stressors. Problem drinkers who experienced more negative life events and more severe stressors used both more approach and more avoidance coping. Those who had more financial and social resources relied more on approach and less on avoidance coping. Problem drinkers who relied more on avoidance coping tended to have more drinking problems and to report more depression and physical symptoms and less self-confidence. Positive reappraisal was associated with less depression and more self-confidence.

Adaptation, Psychological↗
PubMed1984

The process of recovery from alcoholism: III. Comparing functioning in families of alcoholics and matched control families.

Families of recovered (N = 54) and relapsed (N = 51) alcoholic patients were studied 2 yr after the patients completed residential treatment and were compared with sociodemographically matched families of community controls (N = 105) on three sets of family-functioning indices--role functioning, family environment and husband-wife congruence. Families of recovered patients were functioning as well as families of controls. Families of relapsed patients showed less cohesion, expressiveness and recreational orientation, and lower agreement about their family environment than matched families of recovered patients and of community controls, and reported more family arguments than families of recovered patients. They also showed altered role functioning, the nonalcoholic spouse performing more household tasks and the alcoholic partner performing fewer. Family functioning was affected by the adequacy of the alcoholic partner's adaptation, and by life events, stressors and spouse's level of dysfunction.

Alcoholism↗
PubMed1983

Adaptation and the quality of life in work and family settings.

The paper describes the development of scales to assess the perceived social-environmental quality of work and family settings. The use of these scales in comparing and contrasting work and family settings and in examining their role as contexts for adaptation and growth is illustrated. Some tentative conclusions about social-environmental influences on individual and family adaptation are drawn and practical applications for planning ecologically oriented interventions are discussed.

Community Mental Health Centers↗
PubMed1976

A typology of family social environments.

A sample of 100 families measured on ten dimensions of their social environments was subjected to cluster analysis to develop an empirically based taxonomy of families. Six distinctive clusters of families were indentified: Expression-Oriented, Structure-Oriented, Independence-Oriented, Achievement-Oriented, Moral/Religious-Oriented and Conflict-Oriented. The clusters showed systematic differences in background characteristics such as size, ethnic minority composition, drinking patterns, and family disturbance and incongruence. Some evidence that certain clusters of families are composed of different sub-clusters was presented. An empirically derived taxonomy of the social environments of families may help to understand how different family environments are linked to different family outcomes.

Achievement↗