Biomedical subjects

D S Hasin

Publications and source records attributed to D S Hasin.

At least 19 recordsLinked to original sources

PubMed2006

A low-cost, sustainable intervention for drinking reduction in the HIV primary care setting.

Excess drinking poses multiple substantial health risks to HIV-infected individuals. However, no published intervention studies have focused on drinking reduction as the main outcome in HIV primary care patients. An intervention in this setting must place minimal demands on pressured staff and resources. This pilot study tested such an intervention, which consisted of brief Motivational Interviewing (MI) and HealthCall, an automated daily telephone self-monitoring system based on Interactive Voice Response (IVR), designed to extend and enhance the effects of brief MI. Thirty-one patients entered the study, received a 30-minute MI and were instructed in daily use of the IVR system. They received graphical feedback on their daily drinking from the HealthCall database after 30 days. A statistically significant decrease in drinking was found over time, both as reported in daily IVR calls (beta = - 0.01, se 0.01, p=.03) and in follow-up interviews (beta = - 0.04, se 0.12, p=.02) at 60 days. The proportion of daily calls made supported the feasibility of the intervention. The results indicate that HealthCall is acceptable to a disadvantaged HIV patient population, and preliminary data support the efficacy of this intervention in reducing harmful drinking among HIV primary care patients.

Adult↗

PubMed2001

Reliability and discriminant validity of the Type I/II and Type A/B alcoholic subtype classifications in untreated problem drinkers: a test of the Apollonian--Dionysian hypothesis.

The present study tested the hypothesis that there are two broad groups of problem drinkers: the Apollonian-Dionysian distinction. Apollonian drinkers are defined by a later onset of alcohol problems, a slower developmental course, and less problem severity. Dionysian drinkers are defined by more severe alcohol problems, an earlier onset, and worse prognosis. The discriminant validity and classification agreement of five operations of the Apollonian-Dionysian model were tested in a general population (n=8643) and community sample (n=664). A kappa-means cluster analysis supported the Apollonian-Dionysian distinction. Dionysian problem drinkers were more likely to be males, report greater alcohol consumption, more alcohol related antisocial behavior, have a current DSM-IV alcohol dependence diagnosis, and comorbid depression. Apollonian problem drinkers were more prevalent in the general population and reported less severe drinking problems. Classification agreement was stronger for subtype models that incorporate dimensions of alcohol use and/or the frequency of negative consequences. Babor's Type A-Type B model demonstrated the strongest reliability and consistency over time.

Adolescent↗

PubMed2000

Concurrent and predictive validity of the Substance Dependence Severity Scale (SDSS).

This study investigated the concurrent and predictive validity of the Substance Dependence Severity Scale (SDSS), a clinician-administered interview designed to assess the severity and frequency of DSM-IV dependence symptoms for a range of substances. A total of 172 (107 males and 66 females) treated substance users participated in the study. Of those, 89% (n=153) received at least one follow-up interview within 1-6 months of an initial assessment. For alcohol, cocaine and heroin, convergent and discriminant validity was supported by significant relationships between SDSS scores at baseline and other baseline measures of substance use consequences, such as the Addiction Severity Index (ASI), as well as significant relationships between SDSS change scores from baseline to follow-up and change scores of other measures of consequences. SDSS scores were significantly associated with time to first post treatment use of alcohol, cocaine and heroin, although the nature of the associations was complex. Scale applications and areas for further study are discussed.

Adolescent↗

PubMed2000

Substance Dependence Severity Scale (SDSS): reliability and validity of a clinician-administered interview for DSM-IV substance use disorders.

No existing diagnostic interview assesses severity of dependence based on DSM-IV criteria across a range of substances. The Substance Dependence Severity Scale (SDSS) was designed to serve this purpose, consisting of substance-specific scales of both severity and frequency of DSM-IV criteria. This study investigated the reliability and validity of the SDSS. The test-retest reliability of the SDSS in 175 (112 male and 63 female) treated substance users ranged from good to excellent for alcohol, cocaine, heroin and sedatives (interclass correlation coefficients (ICCs)=0.75-0.88 for severity, 0.67-0.85 for frequency). Results for cannabis were lower, ranging from fair to good (ICCs=0.50-0.62). Results for joint rating and internal consistency reliability were comparable to test-retest findings. In addition to indicators of concurrent validity, scale applications are presented and discussed.

Adolescent↗

PubMed2000

When acute-stage psychosis and substance use co-occur: differentiating substance-induced and primary psychotic disorders.

Substances such as alcohol, cocaine, amphetamine, and cannabis can produce psychotic reactions in individuals who are otherwise free of serious mental illness. However, persons with primary psychotic disorders, such as schizophrenia and bipolar disorder, who use these substances often present for treatment with signs and symptoms similar to those whose psychosis resulted from the use of drugs alone. While it is often difficult to distinguish substance-induced from primary psychoses, especially early in the course of treatment, this differential diagnosis has important implications for treatment planning. To help clinicians distinguish these two types of presentations, the authors first review the types of psychotic symptoms that can co-occur with substance use. They discuss the prevalence and patterns of substance use that have been found in patients with schizophrenia and other primary psychotic disorders and review the negative outcomes associated with substance use in this population. The prevalence of and types of symptoms and problems associated with psychotic symptoms that occur as a result of substance use alone are also reviewed. The authors describe assessment procedures for differentiating substance-induced and primary psychotic disorders. They stress the importance of accurately establishing the temporal relationship between the substance use and the onset and continuation of psychotic symptoms in making a differential diagnosis, as well as the importance of being familiar with the types of psychological symptoms that can occur with specific substances. The authors review the utility and limitations of a number of diagnostic instruments for assessing patients with co-occurring psychosis and substance use problems, including The Addiction Severity Index, The Michigan Alcohol Screening Test, and diagnostic interviews such as the Schedule for Affective Disorders and Schizophrenia and the Structured Clinical Interview for DSM. They then discuss the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), an instrument that has been developed to address the lack of a diagnostic interview that is suitable for assessing the comorbidity of substance use and psychiatric disorders. The article concludes with a discussion of the importance of an appropriate match between diagnosis and treatment and the current state of our knowledge concerning the most appropriate types of treatment interventions for patients with substance-induced psychosis and those with dual diagnoses.

Journal Article↗

PubMed2000

Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study.

OBJECTIVES: This study sought to test the relationships between relative body weight and clinical depression, suicide ideation, and suicide attempts in an adult US general population sample. METHODS: Respondents were 40,086 African American and White participants interviewed in a national survey. Outcome measures were past-year major depression, suicide ideation, and suicide attempts diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The primary predictor was relative body weight, treated both continuously (i.e., body mass index [BMI]) and categorically in logistic regression analyses. Covariates included age, income and education, disease status, and drug and alcohol use. RESULTS: Relative body weight was associated with major depression, suicide attempts, and suicide ideation, although relationships were different for men and women. Among women, increased BMI was associated with both major depression and suicide ideation. Among men, lower BMI was associated with major depression, suicide attempts, and suicide ideation. There were no racial differences. CONCLUSIONS: Differences in BMI, or weight status, were associated with the probability of past-year major depression, suicide attempts, and suicide ideation. Longitudinal studies are needed to differentiate the causal pathways and mechanisms linking physical and psychiatric conditions.

Adult↗

PubMed1999

Suicidal ideation among the United States drinking population: results from the National Longitudinal Alcohol Epidemiologic Survey.

OBJECTIVE: Data from a national representative sample of adults was used to identify major risk factors of suicidal ideation among the U.S. drinking population. METHOD: Data from a sample of 18,352 current drinkers, 18 years of age and older, were analyzed by means of multiple logistic regression analysis. In these analyses, multivariate associations were examined between risk factors for suicidal ideation and the occurrence of suicidal ideation. RESULTS: For men and women, past year major depression and alcohol dependence were identified as risk factors of suicidal ideation, with major depression having the more sizable impact. Suicidal ideation was increased among men with a past alcohol use disorder, and elevated among women who had used drugs nonmedically and developed a drug use disorder during the past year. The occurrence of a recent physical illness and lifetime treatment for major depression among men and women increased the risk of suicidal ideation, while marriage was protective against ideation for both sexes. Unemployment and having a family history of alcoholism increased the risk of suicidal ideation among men, but not women. CONCLUSIONS: Major findings are discussed in terms of the impact of severity versus chronicity of psychopathology on suicidal ideation, gender roles and differential engagement in suicidal ideation, and the recognition and treatment of major depression as the single most important intervention in reducing suicidal behavior.

Adolescent↗

PubMed1999

Drinking to cope with negative affect and DSM-IV alcohol use disorders: a test of three alternative explanations.

OBJECTIVE: Previous studies of drinking motives have demonstrated greater levels of drinking to cope with negative affect among problem drinkers relative to nonproblem drinkers. These findings suggest that the use of alcohol to cope with negative affect may place individuals at greater risk for the development of alcohol problems. However, several alternative explanations exist, each with different intervention implications. This study evaluated three alternative explanations or models: risk-factor, generalizing, and epiphenomena. A cross-sectional design was used to compare levels of self-reported drinking to cope with negative affect between individuals who had current DSM-IV alcohol use disorders and those who did not. METHOD: Participants consisted of a sample of community residents (N = 777, 55% men). All participants completed an in-person structured psychiatric interview and a self-report questionnaire assessing alcohol use, drinking motives, depressive affect, and negative alcohol consequences. RESULTS: Linear regression models yielded significant differences in mean drinking to cope with negative affect scores between participants with a DSM-IV alcohol dependence diagnosis and participants with no diagnosis. These differences remained after controlling for depressive affect and frequency of negative alcohol consequences in three of the four adjusted comparisons. No significant differences in adjusted mean drinking to cope with negative affect scores were demonstrated between subjects with a DSM-IV alcohol abuse diagnosis and those with no diagnosis. CONCLUSIONS: The DSM-IV alcohol dependence and no-diagnosis comparisons were most consistent with the predictions of a risk-factor model. These results provide further evidence that drinking to cope with negative affect may have an etiological role in development of alcohol dependence.

Adolescent↗

PubMed1997

Concordance between ICD-10 alcohol and drug use disorder criteria and diagnoses as measured by the AUDADIS-ADR, CIDI and SCAN: results of a cross-national study.

Agreement between the AUDADIS-ADR, CIDI and SCAN in case identification for ICD-10 alcohol and drug use disorders and diagnostic criteria was investigated in three countries, Luxembourg, Greece and the US. Overall, agreement for ICD-10 dependence diagnoses between the three instruments was fair to good for alcohol, opioids and cocaine, but generally lower for dependence diagnoses for other substance. In contrast, concordance between instruments for harmful use diagnoses was extremely poor for all substances. Implications of these major findings are discussed in terms of the relationship between prevalence, reliability and concordance and indications and cautions regarding cross-instrument comparisons.

Adult↗

PubMed1997

Differentiating DSM-IV alcohol dependence and abuse by course: community heavy drinkers.

The purpose of this study was to investigate the differences in short-term course between DSM-IV alcohol abuse and alcohol dependence in a community sample of men and women. Eight hundred seventy-six individuals were given a baseline interview that included DSM-IV criteria for alcohol use disorders, and were followed up with a similar interview approximately one year later. Group differences were compared with chi-square tests. Multinomial logistic regression analyses were used to test group differences controlling for potential confounders. The course of alcohol abuse and dependence differed significantly from each other, and from individuals with no alcohol diagnosis at baseline. Chronicity was the most common outcome for dependence but not for abuse. Most subjects with baseline diagnoses of abuse received the diagnosis with only one symptom, repeated drunk driving. While the validity of the alcohol dependence diagnosis was supported in this community sample, the results concerning alcohol abuse remain equivocal.

Adult↗

PubMed1996

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

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

Adult↗

PubMed1996

The relationship between DSM-IV alcohol use disorders and DSM-IV major depression: examination of the primary-secondary distinction in a general population sample.

This study examined the primary-secondary distinction with respect to DSM-IV alcohol use disorders and major depression in a large representative sample of the USA. Primary, secondary and concurrent depressives (i.e. the comorbid groups), respondents classified with major depression only and respondents classified with alcohol use disorders only were compared on a large number of sociodemographic, alcohol-related, depression-related and drug-related variables. Results were at variance with a majority of findings from the treatment literature with regard to familial aggregation of alcohol use disorders and sociodemographic, alcohol and depression profiles. Implications of the results are discussed in terms of the diagnostic and prognostic significance of the primary-secondary distinction.

Adolescent↗

PubMed1996

Psychiatric Research Interview for Substance and Mental Disorders (PRISM): reliability for substance abusers.

OBJECTIVE: The purpose of this study was to investigate the reliability of a new semistructured diagnostic interview, the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), for substance-abusing patients. The reliability of psychiatric diagnoses for individuals who drink heavily or use drugs has been shown to be problematic. The PRISM was designed to improve the reliability for such individuals. METHOD: A test-retest reliability study of the PRISM was conducted with 172 patients being treated in dual-diagnosis or substance abuse settings. RESULTS: Good to excellent reliability was shown for many diagnoses, including affective disorders, substance use disorders, eating disorders, some anxiety disorders, and psychotic symptoms. The interview has recently been updated for DSM-IV diagnoses. CONCLUSIONS: The PRISM offers a method of producing psychiatric diagnoses with improved reliability for patients and other research subjects who have problems with alcohol or drugs.

Adult↗

PubMed1995

AA and other helpseeking for alcohol problems: former drinkers in the U.S. general population.

Former drinkers comprise 18.5% of the adult U.S. population. However, no epidemiologic data has been published on the histories of seeking help for alcohol problems from Alcoholics Anonymous (AA) or professional or informal sources of help. Using a sample of 8,057 former drinkers surveyed in the 1988 National Health Interview Survey, prevalence and characteristics associated with histories of such helpseeking were investigated. About 7% of the former drinkers had gone to AA or sought other types of help. Characteristics associated with such helpseeking were a diagnosis of DSM-IV alcohol dependence or abuse, a sense of compulsion to drink, social pressure to cut down, and highest ever alcohol consumption. The effects of alcohol consumption were stronger among younger respondents than older ones for professional or informal helpseeking.

Adolescent↗

PubMed1994

Validity of the bi-axial dependence concept: a test in the US general population.

According to the "bi-axial" concept of alcohol dependence, the Alcohol Dependence Syndrome (ADS) constitutes an axis or dimension of alcohol difficulties, while other alcohol-related problems (social, legal, etc.) constitute one or more separate dimensions. The validity of the bi-axial distinction was investigated in a stratified probability sample of 3212 US current drinkers who were interviewed in their households. Indicators of the Alcohol Dependence Syndrome and potentially distinct alcohol-related problems were covered in a structured interview administered by carefully trained interviewers. This interview provided extensive coverage of drinking patterns and problems. Aspects of the ADS covered included narrowing, salience, tolerance, withdrawal, withdrawal relief/avoidance and compulsion/control. Other alcohol problems included difficulties with work, health, the law, general social difficulties and problems in marriage/home life. Confirmatory and exploratory factor analyses were used to determine whether a single factor (dimension) or two or more factors fit the data best. Using all methods, we found that one general factor explained the structure of the data better than a two-factor model or other models for males, females, blacks and whites. Thus, the utility of this approach to distinguishing between types of alcohol problems was challenged, raising some questions about abuse/dependence distinctions in various nomenclatures.

Adult↗

PubMed1994

Nosological comparisons of DSM-III-R and DSM-IV alcohol abuse and dependence in a clinical facility: comparison with the 1988 National Health Interview Survey results.

The purpose of this study was to compare DSM-III-R and proposed formulations of DSM-IV diagnoses of alcohol use disorders in a clinical sample with the same assessment methods used in a large national survey previously reported. Issues included the number of symptoms required for abuse and dependence diagnoses, the effects of requiring evidence of physiological dependence to make the dependence diagnosis (Option 1 vs. Option 2), whether to require a duration criterion, and the concept of alcohol abuse. The diagnostic criteria proposed in the 1991 DSM-IV options book were the criteria investigated in this study. Concordance between DSM-III-R and DSM-IV was closest when the form of DSM-IV used was most similar to DSM-III-R. The duration criterion had much less effect on a dependence diagnosis in this clinical sample than in the general population. DSM-IV Option 2 for alcohol dependence excluded a number of cases from the dependence diagnosis who received such a diagnosis under DSM-III-R and DSM-IV Option 1. Abuse continued to function as a residual category, especially noticeable under increasingly restrictive definitions of dependence, and was rare in both the clinical and general population sample. Implications of the findings for research and other purposes are discussed.

Adolescent↗

PubMed1994

Treatment/self-help for alcohol-related problems: relationship to social pressure and alcohol dependence.

In a 1984 national survey of U.S. adult drinking practices and problems, social pressure to change one's drinking behavior was significantly related in men to a history of alcohol treatment or self-help (AA), as was severity of alcohol dependence. When dependence was added to a model already including social pressure as a predictor of treatment, the fit of the model to the data was significantly improved. Implications of the findings for diagnostic criteria used to define alcohol dependence are discussed, as well as the relationship of the findings to a theoretical model of illness behavior.

Adolescent↗

PubMed1993

Depressive symptoms and DSM-III-R alcohol dependence: general population results.

The DSM-III-R diagnostic criteria for alcohol dependence differ considerably from older criteria. We examined the association of depressive mood and symptoms with alcohol dependence as defined by DSM-III-R in a national sample of 2627 current drinkers. Depressive mood and symptoms were measured with the Center for Epidemiologic Studies Depression scale (CESD). A significant univariate association between CESD scores and DSM-III-R alcohol dependence was confirmed in a multivariate analysis that controlled for demographic characteristics, regular use of drugs, alcohol consumption and recent serious interpersonal loss. Issues in the study of depression and alcohol dependence are considered, and potential future research directions suggested.

Adolescent↗