Benzodiazepine treatment of anxiety or insomnia in substance abuse patients.
Explore the source record for details and available documents.
Alcoholism↗
Biomedical subjects
E P Nace
Publications and source records attributed to E P Nace.
The lives of female physicians.
Survey data from 113 female physicians, 634 male physicians, and 41 female dentists were compared. Instruments designed to assess work satisfaction, work stress, marital satisfaction, family competence, and psychiatric symptoms and treatment were used, thereby exploring important life domains concurrently. The results suggest that female physicians are much more like both male physicians and female dentists than anticipated. Generally, female physicians describe high levels of work satisfaction, moderate levels of work stress, average-to-high levels of marital satisfaction, and relatively low levels of psychiatric distress. Their lower levels of practice income remain something of an enigma as gender remains the most powerful predictor of income and is not replaced in statistical analyses by specialty, hours worked, or other significant variables. Finally, female physicians who find higher levels of satisfaction in work also report higher levels of marital satisfaction and fewer psychiatric symptoms. For these women, a highly satisfying medical career does not apparently need to be experienced at the cost of marital or personal distress.
Adult↗
Recent developments in alcoholism: inpatient treatment.
The historical role of inpatient treatment for alcoholism is reviewed in terms of its advantages and disadvantages. The factors that have forced a change in the utilization of inpatient treatment include increasing recognition of the heterogeneity of alcoholic patients, negative outcome studies, and cost-containment efforts. The clinical domains that warrant inpatient treatment are outlined, and decisions of treatment placement are necessarily guided by the factors of acuteness, ability, safety, and stabilization.
Aftercare↗
Marital satisfaction in the lives of physicians.
Marital satisfaction data from a large sample of physicians and their spouses and dentists and their spouses suggest that about 85% of professionals and spouses are satisfied with their marriages. High levels of marital satisfaction are associated with high work satisfaction, low work stress, and fewer psychiatric symptoms. These findings do not support the widely held belief that physicians' marriages are more apt to be dysfunctional than those of other persons. The authors discuss this difference from two perspectives: (1) sampling differences and (2) differences between marital assessments from inside and outside the marriage.
Adult↗
Work satisfaction in the lives of physicians.
In a climate that many practitioners find increasingly oppressive, data suggesting the most and least satisfying aspects of medical practice are important. In a joint effort, the Dallas County Medical Society, Timberlawn Psychiatric Hospital, and Timberlawn Psychiatric Research Foundation explored levels of work satisfaction for their relationships with marital satisfaction and psychiatric symptoms as reported by physicians and dentists and their spouses. Most physicians and dentists rate various aspects of direct patient care and service to humanity as highly satisfying aspects of professional life. Physicians highly satisfied with their work are more likely to report high satisfaction in their marriages and fewer psychiatric symptoms. Most spouses of physicians report high levels of marital satisfaction, and high agreement exists between the marital satisfaction ratings of physicians and their spouses. Physicians and dentists are quite similar on the wide range of professional and personal variables surveyed.
Data Collection↗
Work stress in the lives of physicians.
The work stress of physicians is considered high, and many are contemplating leaving the profession. Documenting the specific aspects of practice found to be most stressful is important, and useful insights may be obtained by contrasting physicians who report high and low levels of work stress. Contrasting the work stress of physicians and dentists can be useful for both professions. Accordingly, we surveyed 3156 members of the Dallas County Medical Society and 1273 members of the Dallas County Dental Society plus a large group of their spouses. Although the level of work satisfaction is the most powerful predictor of work stress, other significant predictors are younger age, long working hours, and solo practice. Physicians who report high levels of work stress also report lower levels of marital satisfaction and a higher prevalence of psychiatric symptoms. Dentists are much like physicians in their reports of overall work stress, and the similarities and differences regarding specific stressors suggest the two professions are more alike than different in reporting the stresses of professional practice.
Data Collection↗
Axis II comorbidity in substance abusers.
OBJECTIVE: To assess the complex relationship between substance abuse and personality disorders, the authors determined the prevalence of personality disorders in a group of middle-class substance abusers and compared the subjects who had personality disorders with those who did not. METHOD: The subjects were drawn from patients consecutively admitted to an inpatient substance abuse program in a private psychiatric hospital; they were the first 100 who agreed to participate. Substance dependence was diagnosed according to DSM-III-R, and the patients were assessed with the Structured Clinical Interview for DSM-III-R Personality Disorders, Alcohol Use Inventory, MMPI, Health and Daily Living Form, Shipley Institute of Living Scale, and measures of chemical use and life satisfaction. RESULTS: Of the 100 substance abusers, 57 had personality disorders. These patients differed significantly from the 43 patients without personality disorders in several ways: they had greater involvement with illegal drugs, had different patterns of alcohol use, had greater psychopathology, were less satisfied with their lives, and were more impulsive, isolated, and depressed. CONCLUSIONS: Because of the marked differences between the substance abusers with and without personality disorders, a uniform approach to substance abuse treatment may be inadequate.
Adult↗
Inpatient treatment of alcoholism: a necessary part of the therapeutic armamentarium.
Recent reviews of alcoholism treatment have argued strongly against the efficacy of inpatient treatment for alcoholic patients. This paper briefly considers the findings those reviews were based on and highlights some of the flaws that have led to the conclusion that inpatient treatment for alcoholism is unsuccessful and unnecessary. This paper suggests that the negative reports about inpatient treatment are biased and argues for the effectiveness of inpatient treatment, especially for patients with severe alcohol dependence or extensive social, psychiatric, or medical comorbidity.
Alcoholism↗
The natural history of alcoholism versus treatment effectiveness: methodological problems.
A majority study of alcoholism treatment concluded that results of treatment were no better than the natural history of untreated alcoholism. This conclusion cannot be considered valid because of methodological problems which render the treated and untreated samples incomparable. The latter methodological problems include age cohort differences between the untreated and treated samples, and differences in socioeconomic status. Other issues confounding the original conclusion are inadequacy of the minimal treatment provided. Major reviews of alcoholism treatment and recent outcome studies indicate that treatment optimism is warranted in contrast to the view that treatment renders no advantage over "natural" outcome.
Adolescent↗
Posttraumatic stress disorder and substance abuse. Clinical issues.
A review of clinical issues relevant to the treatment of individuals with a combination of posttraumatic stress disorder and substance abuse disorder is presented. There are several issues that these two disorders share, including the need for heightened awareness on the part of clinicians, the ability to make the diagnoses, the conceptualization of etiological factors, and the issues of therapeutic attitudes and countertransference problems. In addition, a brief review of relevant therapeutic approaches is presented and treatment priorities discussed.
Alcoholism↗
Epidemiology of alcoholism.
This paper reviews current data on the epidemiology of alcoholism in the United States. The findings from the epidemiologic catchment area study of the National Institute of Mental Health are presented. In addition, a distinction between alcohol abuse and alcohol dependence is possible using similarly obtained epidemiologic data from other randomized household studies. The problem of adolescent alcohol use and abuse is reviewed and populations today which are at particular risk for alcoholism are discussed.
Adolescent↗
Borderline personality disorder and alcoholism treatment: a one-year follow-up study.
One year following treatment, alcoholic patients with a documented borderline personality disorder were compared with alcoholic patients who did not show borderline personality features. Both groups of alcoholic patients showed significant and comparable decreases in alcohol use through the follow-up year. Nonborderline alcoholics showed significant decreases in drug use through the follow-up. Borderline alcoholics showed a significant decrease in drug use for the first 6 months of follow-up, with uncertain results thereafter. Borderline alcoholics also showed significant improvements in their ratings of satisfaction with family, decreased hospitalizations and greater leisure satisfaction. There were also trends toward improvements in their relations with children and self-ratings of health and a decrease in accidents. The study documents that alcoholic patients with severe character pathology can significantly benefit from treatment in a short-term psychiatrically oriented alcoholism treatment program.
Accidents↗
Epidemiology of alcoholism and prospects for treatment.
This chapter reviews current American drinking patterns and the prevalence of problems resulting from alcohol use. The general population is discussed first. Then a look at five subgroups within the population is presented. These groups are older adults, adolescents, women, Blacks, and Hispanics. For the general population as well as each of the five subgroups, the prospects regarding treatment outcome are discussed.
Adolescent↗
A comparison of borderline and nonborderline alcoholic patients.
Attempts to document systemically the presence of borderline personality disorder in alcoholic patients were made in 94 alcoholic patients consecutively admitted to an inpatient alcoholism program. Operational diagnoses of borderline or not borderline used Gunderson's semistructured Diagnostic Interview for Borderlines (DIB). With the use of conservative criteria, 12.8% of alcoholic patients could be designated as having borderline disorders. Borderline alcoholics were significantly younger and were more likely to have a history of drug abuse, suicide attempts, and accidents. Diminished satisfaction with self and family life and a greater tendency to experience craving across a variety of situations was reported.
Accidents↗
A low-cost evaluation of alcoholism treatment in a private psychiatric hospital program.
The authors designed a low-cost evaluation study to examine outcome on an alcoholism specialty unit of a private psychiatric hospital as well as to look at the effects of several post-treatment therapies. Using conservative criteria for good outcome, and accounting for the expected poorer outcome of non-respondents, they found that the program achieved a 58 percent success rate. Use of Alcoholics Anonymous and a covert sensitization exercise developed especially for the program were associated with better outcome in terms of drinking behavior post-hospitalization. It should not be difficult to conduct a similar study in other treatment settings with a low research budget.
Adolescent↗
Understanding the disease in alcoholism.
Explore the source record for details and available documents.
Alcoholism↗
Hypnotizability and outcome in brief psychotherapy.
The relationship between hypnotizability and clinical improvement following brief psychotherapy was investigated. Prior to treatment 32 patients were assessed for hypnotizability utilizing an objective standardized measure of hypnotizability. Measures of psychopathology were obtained at the conclusion of ten sessions and six months post-treatment. A positive relationship was found between outcome and hypnotizability. This was most pronounced at the conclusion of ten sessions. Use of hypnotic techniques as a therapeutic adjunct did not necessarily lead to greater therapeutic effects. Different approaches in using hypnotherapy are indicated depending on the hypnotizability of the patient.
Adjustment Disorders↗
Therapeutic approaches to the alcoholic marriage.
Formulation of a therapeutic approach to the alcoholic marriage requires both an understanding of the theoretical conceptions of spouse pathology, and an understanding of the disease of alcoholism. Theories of psychopathology in the spouse (wife) of the alcoholic were reviewed and found deficient in the light of more objective research. Failure to confirm discreet, specific personality traits in wives of alcoholics parallel similar efforts in the search for an "alcoholic personality." The stress theory of spouse psychopathology enjoys clinical support and a moderate research underpinning. Emphasis is placed on the need for the psychiatrist to be prepared to diagnose alcoholism when evaluating a troubled marriage. The importance of the disease concept of alcoholism and the necessity of establishing conceptual priorities are reviewed. Treating the disease of alcoholism first, followed by marital therapy, is recommended. The treatment of the alcoholic will be more successful if the spouse or family are included in the initial evaluation and subsequent treatment plans.
Adaptation, Psychological↗