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Biomedical subjects

H J Shaffer

Publications and source records attributed to H J Shaffer.

At least 19 recordsLinked to original sources
PubMed2001

Reducing resistance and denial by exercising ambivalence during the treatment of addiction.

Stage change models and motivational enhancement therapies have significantly influenced the therapeutic tactics clinicians employ in the treatment of addictive behaviors. While motivational enhancement strategies have addressed client ambivalence to increase motivation to change, this article suggests that focusing on ambivalence during treatment has even wider clinical utility than previously thought. Resistance reduction concentrates on exercising ambivalence without an investment in clients changing, thereby strengthening client tolerance for ambivalent thoughts and feelings. Exercising ambivalence reduces resistance to treatment and change by validating a wide array of possible outcomes through detailed exploration of how a behavior pattern works for a client. Since resistance reduction does not require clients to want to change for therapy to progress, exploring the decision-making process becomes paramount. A general discussion of the resistance reduction model, ambivalence, and how clients present for treatment precedes clinical case examples.

Adult↗
PubMed2000

Awareness of gambling-related problems, policies and educational programs among high school and college administrators.

This brief report summarizes a survey of high school and college representatives and their awareness toward gambling-related problems. The Massachusetts Council on Compulsive Gambling developed a survey instrument to review the policies and training programs of 20 high schools and 10 colleges that were located within the catchment areas of Massachusetts Department of Public Health state-sponsored gambling treatment programs. The results revealed that there is an important discrepancy between the prevalence of gambling-related problems among young people and the awareness of these problems among educators. High school and colleges evidence a paucity of existing gambling-related regulations or policies. There is little opportunity for students and educators to learn within the school setting about gambling and its potential hazards. Without sufficient in-service education and training for faculty and staff, there is little likelihood that this group of educators can engage in the early identification or prevention efforts that are so vital to advancing the health and welfare of young people.

Journal Article↗
PubMed2000

Trends in bio-behavioral gambling studies research: quantifying citations.

Both the National Gambling Impact Study Commission and the National Academy of Sciences have evaluated the current state of gambling studies research in general while making specific suggestions for future efforts in the psychological and biomedical areas in particular. Recognizing the importance of evaluating the state of the field on a macro level, this paper considers and categorizes several decades of psychological and biomedical gambling research. By examining the number of references to gambling in two major bibliographic databases, quantifiable trends and observations are presented about gambling-related psychological and biomedical research. Two trends in particular are salient: the rate at which gambling-related articles are published in scholarly journals is increasing, and the plurality of these articles deals with issues of cognition and personality as related to gambling.

Journal Article↗
PubMed2000

"Computer addiction": a critical consideration.

Problems related to intemperate Internet use are examined within the conceptual framework of addiction. It is argued that empirical support for the construct validity of computer addiction has yet to emerge, that defining the construct as a unique psychiatric disorder is therefore premature, and that, in most cases, excessive computer use may be symptomatic of other, more primary disorders. Greater caution and rigor are urged in investigating and treating problems related to intemperate computer use.

Behavior, Addictive↗
PubMed2000

Social workers employed in substance abuse treatment agencies: a training needs assessment.

This article describes the results of an assessment of the substance abuse treatment training needs of social workers working in randomly selected substance abuse treatment facilities in New England. This assessment revealed that clinical supervision related to substance abuse treatment had not been available to a significant percentage of the respondents throughout their careers. Despite limited previous training experience and considerable barriers to current training, social workers surveyed in this study reported significantly higher levels of knowledge and skill than other substance abuse treatment providers in 10 of 12 substance abuse treatment areas investigated. Despite these high levels of knowledge and skill, respondents reported considerable need for and interest in additional substance abuse treatment training. This study identified the areas of assessment, advanced clinical techniques, and dual diagnosis as priorities for future training among social workers working in substance abuse treatment facilities.

Adult↗
PubMed1999

A new brief screen for adolescent substance abuse.

OBJECTIVE: To develop a brief alcohol and other drug (AOD) screening test for adolescents. METHODS: A 9-item test was constructed by combining and modifying items from several AOD assessments, and administered concurrently with the Personal Involvement With Chemicals Scale (PICS), the criterion standard. SETTING: A hospital-based adolescent clinic. SUBJECTS: Fourteen- to 18-year-old patients consecutively arriving for routine medical care who were known to have used AOD. MEASURES: Internal consistency of the 9 items was calculated using the Cronbach alpha. The relationship between the brief screen and PICS raw score was determined by stepwise linear regression analysis. The PICS T score has been shown to correctly classify substance abuse treatment need as no treatment (T<35), brief office intervention (T = 35-40), outpatient or short-term treatment (T = 41-54), and inpatient or long-term treatment (T> or =55). Sensitivity and specificity rates for predicting a PICS T score of 55 or higher were calculated from 2 x 2 tables. RESULTS: Ninety-nine adolescents were tested (70.7% female, 36.4% black, 32.3% white, 19.2% Hispanic, mean age, 16.3 years). The 9 items had good internal consistency (Cronbach alpha = .79). Stepwise linear regression analysis identified 6 items whose total combined score was highly correlated with PICS (Pearson r = 0.84, P<.01). This model correctly classified 86% of subjects according to the PICS criteria. Two or more yes answers had a sensitivity of 92.3% and specificity of 82.1% for intensive AOD treatment need. The 6 items were arranged into a mnemonic (CRAFFT). CONCLUSIONS: Further research must confirm the test's psychometric properties in a general clinic population. However, CRAFFT seems promising as a brief AOD screening test.

Adolescent↗
PubMed1999

Gambling, drinking, smoking and other health risk activities among casino employees.

BACKGROUND: This study examined the prevalence of level 3 (pathological) gambling and a variety of other health risks among casino employees. METHODS: A sample of 3841 full-time casino employees representing four geographic sites was surveyed about gambling, drinking, smoking, and other health risk behaviors. In addition, respondents were asked about their use of the employee assistance program (EAP) and perceived obstacles towards using the EAP. RESULTS: This study found that casino employees have a higher prevalence of past-year level 3 (pathological) gambling behavior than the general adult population, but a lower prevalence of past-year level 2 (problem) gambling than the general adult population. In addition, casino employees have higher prevalence of smoking, alcohol problems, and depression than the general adult population. Furthermore, these risk behaviors tend to cluster. The majority of non-smoking respondents in this sample were exposed to second-hand smoke. Employees reported low participation in the company's EAP. CONCLUSIONS: The results of this study suggest that casino management should consider (1) improving problem gambling screening for employees who visit EAPs, even if employees present other problems (e.g., alcohol problems) as their primary concern, (2) increasing employees' awareness of EAPs, (3) increasing health promotion and education through channels other than company EAPs, and (4) creating smoke-free working areas.

Adolescent↗
PubMed1999

Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis.

OBJECTIVES: This study developed prevalence estimates of gambling-related disorders in the United States and Canada, identified differences in prevalence among population segments, and identified changes in prevalence over the past 20 years. METHODS: A meta-analytic strategy was employed to synthesize estimates from 119 prevalence studies. This method produced more reliable prevalence rates than were available from any single study. RESULTS: Prevalence estimates among samples of adolescents were significantly higher than estimates among samples of adults for both clinical (level 3) and subclinical (level 2) measures of disordered gambling within both lifetime and past-year time frames (e.g., 3.9% vs 1.6% for lifetime estimates of level 3 gambling). Among adults, prevalence estimates of disordered gambling have increased significantly during the past 20 years. CONCLUSIONS: Membership in youth, treatment, or prison population segments is significantly associated with experiencing gambling-related disorders. Understanding subclinical gamblers provides a meaningful opportunity to lower the public health burden associated with gambling disorders. Further research is necessary to determine whether the prevalence of disordered gambling will continue to increase among the general adult population and how prevalence among adolescents will change as this cohort ages.

Adolescent↗
PubMed1997

Evaluating the impact of a clinical training program in the addictions.

This research examined students who were enrolled in a specialized addiction treatment training program to evaluate the impact of this year-long internship experience on their professional lives. Achieving an 87.5% survey completion rate, the vast majority of program graduates assessed the overall training program and its component activities very positively. The topics and activities associated with "drug dependence" were evaluated more positively than the training events associated with pathological gambling. Furthermore, the majority of program graduates obtained jobs in the addiction field. As a result of the training program, approximately 74.5% of respondents stated that they had changed their beliefs about addiction. In addition, many respondents commented that their participation in the program changed their stereotypes of people with addiction. The findings provide suggestions and guidance for other clinical training programs that can gain from the experiences of fellows who studied at the Norman E. Zinberg Center for Addiction Studies.

Adult↗
PubMed1997

The most important unresolved issue in the addictions: conceptual chaos.

This article suggests that the field of addiction study and treatment remains in a state of conceptual chaos. The addictions is an emerging scientific field that lacks conceptual clarity. To develop the precision necessary for scientific advance, we must begin by developing improved definitions of substance use, abuse, dependence, and addiction. Complicating matters, psychoactive substance use is not a necessary and sufficient cause of addiction. For example, pathological gamblers experience addiction, including tolerance and withdrawal, often in the absence of any drug use. The neurobiology of subjective experience may be a more important factor in helping to explain addictive behaviors. Consequently, this article concludes that it is improper to consider drugs as the necessary precondition for addiction. Better operational definitions will advance addictions research.

Behavior, Addictive↗
PubMed1997

Comparing Hatha yoga with dynamic group psychotherapy for enhancing methadone maintenance treatment: a randomized clinical trial.

BACKGROUND: As more methadone treatment programs are funded in an attempt to curb substance abuse and HIV infection among i.v. drug users, more cost effective treatment approaches are being sought. OBJECTIVES: To investigate whether clients in outpatient methadone maintenance treatment who practice weekly Hatha yoga in a group setting experience more favorable treatment outcomes than those who receive conventional group psychodynamic therapy. METHODS: After a 5-day assessment period, 61 patients were randomly assigned to methadone maintenance enhanced by traditional group psychotherapy (ie, conventional methadone treatment) or an alternative Hatha yoga therapy (ie, alternative methadone treatment). Patients were followed for 6 months and evaluated on a variety of psychological, sociological, and biological measures. The revised Symptom Check List provided the primary psychological measures; the Addiction Severity Index provided various indices of addictive behaviors. RESULTS: The evidence revealed that there were no meaningful differences between traditional psychodynamic group therapy and Hatha yoga presented in a group setting. Both treatments contributed to a treatment regimen that significantly reduced drug use and criminal activities. Psychopathology at admission was significantly related to program participation regardless of treatment group. DISCUSSION: In addition to examining the characteristics of patients who present for treatment, this study identifies unexpected staff issues that complicate the integration of alternative and traditional treatment strategies. CONCLUSION: Alternative methadone treatment is not more effective than conventional methadone treatment, as originally hypothesized. However, some patients may benefit more from alternative methadone treatment than conventional methadone treatment. Additional research is necessary to determine characteristics that identify patients who might benefit from alternative methadone treatment.

Adult↗
PubMed1992

Patterns of substance use among methadone maintenance patients. Indicators of outcome.

Critics often cite the use of illicit drugs among methadone maintenance patients as evidence of this treatment modality's failure. The fact that methadone maintenance treatment does not lead quickly to abstinence in most clients can be a disappointment to treatment professionals and the public. By studying a cohort of 41 patients for their first year in a methadone maintenance program, this study revealed significant trends of diminished narcotic and cocaine use. However, increased benzodiazepine use was also identified. More importantly, this study patterns of drug using that predicted less drug use at the end of one year of treatment. These findings reflect the need for additional research to clarify the meaning of illicit drug use by methadone maintenance patients. In addition, the implications for providing, stopping, and determining effective drug treatment are discussed.

Comorbidity↗
PubMed1988

Cocaine psychosis and AIDS: a contemporary diagnostic dilemma.

This article examines some of the differential diagnostic considerations associated with the interaction between advanced cocaine psychosis and the neuropsychiatric manifestations of AIDS-Spectrum Disorders. A clinical case is presented to illustrate the potential for institutional countertransference in the treatment of substance abusing patients. The role of a multi-dimensional hypotheses testing model in cocaine related cases is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1987

The epistemology of "addictive disease": the Lincoln-Douglas debate.

This research was conducted to examine the social perception of "addictive disease." This study provided an opportunity to gain insight into a representative sample of terms and phrases that were denotative of disease and then factor analyzed how these items clustered to reveal a spectrum of underlying factors that contribute to the perception of disease. It was expected and confirmed that subjects could discriminate between behavioral and biological disorders. In addition, the results support the view that the addictive "disease" model is a symbolic substitute for the moral turpitude model which it replaced. Finally, the findings support the view that non-physicians are capable of making fine distinctions among a number of biologically related "diseases." These results suggest that it may be important for health care providers to carefully and instrumentally apply their language to facilitate patient compliance with treatment protocols.

Adolescent↗
PubMed1986

On smokeless tobacco, addictive behavior and warning labels.

This article will offer three primary positions: First, it will support the use of a warning label on containers of smokeless tobacco and second, suggest that an alternative to the present warning statement be considered. The Massachusetts Department of Public Health--presently the first state to consider a warning label for smokeless tobacco--proposes a label that would read as follows: WARNING: Use of snuff is addictive and may cause mouth cancer and other mouth disorders. Third, this article will suggest that a warning label will not have any notable impact on the public health. In order to support these positions, the following discussion will briefly examine the relationship between chemical dependency, addictive behavior, tobacco smoking, and the use of warning labels as a deterrant to the use of smokeless tobacco.

Attitude to Health↗
PubMed1986

Conceptual crises and the addictions: a philosophy of science perspective.

This article examines the field of addictions and suggests that it is in the midst of a conceptual crisis. As a result of its immaturity, the addiction's field evidences energy, naivete, curiosity, intensely conflicting and polarized explanations of its identity and purpose, anomalous research findings, and few "facts." From a philosophy of science perspective, these characteristics are considered as indicators of the developmental stages that are associated with the evolution of scientific disciplines. A philosophy of science perspective is applied to the history of the substance abuse field and the consequent implications examined. A discussion of normal science, language, the role of paradigms, and scientific reductionism is included.

Humans↗