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D S Hasin

Publications and source records attributed to D S Hasin.

At least 37 records · Page 2Linked to original sources
PubMed1992

Empirical subtypes of DSM-III-R alcohol dependence: United States, 1988.

The purpose of the present study was to quantify the degree of heterogeneity of the DSM-III-R alcohol dependence category by comparing the number of potential subtypes of dependence to those empirically observed in a general population survey. Forty-one percent (n = 189) of the 466 potential subtypes of DSM-III-R alcohol dependence were observed, indicating that the category is indeed heterogeneous, but not as heterogeneous as theoretically predicted. Variations in the number, percent and configuration of empirical subtypes of dependence are discussed in terms of coincident morbidity, premature death from alcoholism or death from other competing causes, reporting biases and differences in drinking patterns. The predominance of the 'tolerance' 'withdrawal' and 'impaired control over drinking' criteria among the empirically observed subtypes of dependence are examined within the context of the physiological dependence subtype proposed for the DSM-IV category of alcohol dependence and difficulties encountered in operationalizing these diagnostic criteria. The relevance of study findings to the validation of diagnostic categories in psychiatry is also highlighted.

Adolescent↗
PubMed1992

Severity of DSM-III-R alcohol dependence: United States, 1988.

One method of subtyping alcohol dependence is according to severity. Over 4000 respondents in a US national survey who met criteria for DSM-III-R alcohol dependence were classified as mildly, moderately or severely dependent, and the characteristics of each group were examined. The proportion of males was higher in the moderate and severe groups, and the greatest proportions of cases were concentrated in the younger ages in all three groups. A clear increasing gradient from the mild to severe group was found for early age at first drink, heavy alcohol consumption, family history of alcohol problems, social pressure to reduce drinking, and helpseeking, treatment or AA for drinking. Implications for further analyses are discussed.

Adolescent↗
PubMed1992

DSM-III-R and the proposed DSM-IV alcohol use disorders, United States 1988: a nosological comparison.

The purpose of the present study was to compare DSM-III-R and the proposed DSM-IV diagnostic criteria for alcohol abuse and dependence in a representative sample of the United States general population. Alcohol abuse and dependence diagnostic categories were contrasted in terms of prevalence and overlap. The prevalence of DSM-III-R diagnoses of alcohol abuse and dependence combined (8.63%) was greater than the corresponding DSM-IV diagnoses (6.00%). Disaggregation of abuse and dependence diagnoses showed that the major discrepancy between the classification systems resided between the abuse categories. Reasons for the discrepancies are discussed in terms of differences in the content of the DSM-III-R and DSM-IV abuse categories, in the relationship that each abuse category shares with its respective dependence category, and the impact of the DSM-III-R duration criterion.

Adolescent↗
PubMed1990

The natural history of alcohol abuse: implications for definitions of alcohol use disorders.

Is the DSM-III-R category of alcohol abuse validly differentiated from the DSM-III-R category of alcohol dependence, or is abuse primarily a mild, prodromal condition that typically deteriorates into dependence? A 4-year longitudinal epidemiologic study of male drinkers provided data to answer this question. The study used identical questions at baseline and follow-up. At follow-up, 70% of the subjects who were initially classified as alcohol abusers were still abusers or were classified as remitted. This contrasted significantly with outcome in the subjects who initially reported alcohol dependence. Although additional research is needed, these results indicate that alcohol abuse often has a course distinct from that of alcohol dependence.

Adult↗
PubMed1990

Male and female differences in liver cirrhosis mortality in the United States, 1961-1985.

Changes in the social roles of American women have led to questions about convergence in drinking practices and alcohol-related problems between men and women. To address this issue, we utilized mortality data for liver cirrhosis derived from United States death certificates for the years 1961 to 1985. Using age-adjusted rates, we found no evidence of a major shift toward convergence in cirrhosis mortality over this time period for the total population. When age-specific rates were examined, we found evidence for increasing divergence in liver cirrhosis mortality rates for those under the age of 55, whereas the general trend among the older age groups was toward convergence. Straightforward interpretation of the results is hampered by the lack of research in related areas, but the findings do suggest that greater public and professional education may serve a preventive purpose for older U.S. females.

Adult↗
PubMed1990

Alcohol problems increase while physician attention declines. 1967 to 1984.

Physician intervention holds the potential to arrest excess drinking in medical patients, but little information has been available on trends over time in medical attention to this problem. Three epidemiologic studies in which nationally representative samples of US adults were interviewed about their drinking practices and problems provide some data on this issue. Analyses of data from these three studies (conducted in 1967, 1979, and 1984) indicate that multiple alcohol problems and at least one occasion of recent heavy alcohol consumption have increased over time in the general population. At the same time, the probability of a physician recommending reduction in drinking declined for both males and females. When only male subjects with multiple alcohol problems were considered, physician recommendations to reduce drinking did not decline significantly between 1967 and 1984. However, the sharp decline over time in physician's medical advice to female subjects with multiple alcohol problems was statistically significant. Similar results were found for physician attention to drinking among the more inclusive group of subjects with at least one recent occasion of heavy drinking. Implications of these findings are discussed.

Adult↗
PubMed1989

Screening for major depression among alcoholics: an application of receiver operating characteristic analysis.

When comparing several screening tests designed to detect the same disease, methodological problems arise in determining which is most accurate. We have previously demonstrated that receiver operating characteristic (ROC) methodology can provide a set of statistical procedures which allow for objective comparisons of screening tests. In this report, ROC methodology is brought to a different substantive area: the detection of clinical depression among treated alcoholics. In a sample of hospitalized alcoholics, we compared the accuracies of several commonly used screening tests for depressive disorders, as well as comparing each of these with a screening test for anxiety disorders. No test offered a statistically significant advantage over any other, and all did poorly in detecting clinically diagnosed major depression. The performance of the screening tests was worst when the non-depressed comparison group included subjects with remitted disorder, but was still poor when the comparison group did not include such potentially 'noisy' subjects. Factors contributing to the difficulty of screening for clinical depression are discussed, as well as suggestions for improvements in future screening efforts.

Adult↗
PubMed1989

RDC alcoholism in patients with major affective syndromes: two-year course.

The authors examined the 2-year course of alcoholism as defined by Research Diagnostic Criteria (RDC) in 127 newly admitted patients with major affective syndromes and concurrent alcoholism at intake. The cumulative probability of remission (at least 6 months free of alcohol problems) in these patients was 0.67. Many of the remissions began within a few weeks of intake; the remaining were distributed over the follow-up period. Of the patients without remissions, 17% died, half by suicide. Diagnoses of schizoaffective disorder, indicators of alcohol dependence, and previous chronicity of alcohol problems predicted poor outcome of alcoholism, but none of these variables predicted subsequent relapse.

Adult↗
PubMed1988

Screening for current drug use disorders in alcoholics: an application of receiver operating characteristic analysis.

The major objectives of the present study were 2-fold: (1) to demonstrate the superiority of receiver operating characteristic (ROC) methodology in the comparison of screening tests that yield continuous values; and (2) to identify the best screening indicator of current drug use disorders in alcoholics. We evaluated the ability of the screening tests to detect drug use disorder (DUD) according to the research diagnostic criteria. Results showed that the language of addiction - drug version and the reasons for drug use (RDU) screening tests offered excellent detectability for current DUD. The accuracy of both tests was reduced as the result of broadening the clinical spectrum in the comparative group. Implications of these findings to the neglected topic of clinical and co-morbid spectrums in screening test evaluation is presented. Issues surrounding the use of psychiatric diagnoses as standards, assessment of efficacy, the role of screening in defining subthreshold disorder, and the use of biochemical screening as an adjunct to the questionnaire approach are also discussed.

Adult↗
PubMed1988

Severity of alcohol dependence and social/occupational problems: relationship to clinical and familial history.

We examined the relationship of major depression, aspects of antisocial personality disorder, family history of alcoholism, treatment history, and onset of alcohol problems to the severity of alcohol dependence and severity of social/occupational problems due to alcohol. Subjects were 111 randomly sampled patients in alcohol rehabilitation. The predictor variables formed different patterns of relationships with alcohol dependence and with social/occupational problems. Implications of the findings for future research are discussed.

Adult↗
PubMed1988

Cocaine and heroin dependence compared in poly-drug abusers.

Concerns about cocaine dependence are increasing, in some ways replacing heroin as the focus of highest concern. We compared cocaine and heroin dependence by levels of cocaine and heroin use in poly-drug users. While dependence indicators differed markedly between regular and sporadic users of these drugs, cocaine dependence indicators did not differ from heroin dependence indicators. Implications of the findings are discussed.

Adolescent↗
PubMed1988

Male/female differences in alcohol-related problems: alcohol rehabilitation patients.

Differences in male and female prevalence of drinking problems have been studied previously. However, few studies have focused on gender differences in a range of alcohol-related problems in individuals identified as dysfunctional drinkers. We analyzed such differences in 299 alcohol patients who met DSM-III criteria for alcohol abuse/dependence. Male and female patients differed significantly on heavy consumption patterns and negative social experiences resulting from drinking. However, no significant differences were found in loss of control, dependence, or health problems. The similarities were obtained even though females had been problem drinkers for a shorter number of years. Implications of these results are discussed.

Adolescent↗
PubMed1988

Lifetime psychiatric comorbidity in hospitalized alcoholics: subject and familial correlates.

We classified 123 alcohol rehabilitation patients by their histories of lifetime psychiatric comorbidity, and examined the demographic, social, occupational, treatment, and familial variables characterizing the groups. Diagnostic assessments were made with the SADS-L/RDC. High lifetime prevalences of major depressive disorder and drug use disorder were found. Aspects of treatment history distinguished between patient groups with and without lifetime major depression, but not other personal or familial variables. Patients with lifetime drug use disorders were younger and experienced an earlier onset of alcohol problems and treatment. Those with numerous childhood antisocial symptoms were younger, more likely to be male and unmarried, and less educated, and they had presented earlier for treatment. Subjects with two or more adult antisocial symptoms which occurred when subjects were not drinking or using drugs had a significant increase in family history of antisocial personality disorder. However, adult antisocial behaviors which were not separated from the effects of alcohol or drug use were unrelated to a family history of antisocial personality disorder. Implications of these findings are discussed.

Adult↗
PubMed1987

Psychiatric diagnosis of patients with substance abuse problems: a comparison of two procedures, the DIS and the SADS-L. Alcoholism, drug abuse/dependence, anxiety disorders and antisocial personality disorder.

We compared DSM-III and RDC diagnoses from the DIS to RDC diagnoses from the SADS-L for alcohol and drug use disorders, anxiety disorders and Antisocial Personality Disorder in a group of patients with substance abuse problems. Kappa values for substance use disorders were fairly good. The instruments did not agree well on anxiety disorders, or on Antisocial Personality Disorder. Criterion differences gave rise to some of the disagreement between the instruments on Antisocial Personality Disorder, but the causes of disagreement for the anxiety disorders were not so clear. The implications of these findings are discussed.

Adult↗
PubMed1987

Diagnosing depressive disorders in patients with alcohol and drug problems: a comparison of the SADS-L and the DIS.

The DIS and the SADS-L diagnostic procedures occupy an important position in psychiatric research. We compared these procedures for assessing depressive disorders in patients with substance abuse problems. The two instruments agreed poorly, and the SADS-L produced a considerably higher proportion of cases than the DIS. A number of factors were examined to determine their influence on the agreement obtained for Major Depression. These factors included (1) recency of the disorder, (2) the primary/secondary distinction, (3) clinical experience of the DIS interviewers, (4) numerous subject characteristics and (5) the DIS procedure for differentiating organic from non-organic affective symptomatology, which relies on subjects' attributions of the cause of symptoms. The first four factors did not influence agreement. However, removal of the influence of the fifth factor did increase agreement between the instruments appreciably. Validation evidence favored the SADS-L, although not definitively. Implications of the findings are discussed.

Adolescent↗
PubMed1987

Assessment of specific drug disorders in a sample of substance abuse patients: a comparison of the DIS and the SADS-L procedures.

Both the DIS and the SADS-L interviews offer researchers a procedure for assessing the presence of drug disorders categorized by drug class, as defined by psychiatric nomenclatures. In this study, the performance of the drug section of each interview was compared in a sample of hospitalized substance abuse patients. The classes of drug disorders assessed by both instruments and reported here include narcotics, amphetamines, sedatives and tranquilizers, cannabis, cocaine, and hallucinogens. On a group level, the DIS and SADS-L agreed fairly well for all drug classes except hallucinogens. A within-DIS comparison of DSM-III and Research Diagnostic Criteria (RDC) diagnoses followed the same pattern, except with higher agreement. Distinctions between drug abuse and dependence within a drug class were not as reliable as overall assessments. On only a small proportion of patients did the instruments agree completely for all drug classes within an individual. Implications of the findings for research on drug problems are discussed.

Humans↗