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Biomedical subjects

H J Shaffer

Publications and source records attributed to H J Shaffer.

28 records · Page 2Linked to original sources
PubMed1986

Narcotic and other drug use: a spectrum.

Zinberg and Lewis foresaw developments in the substance abuse field in particular and in human services in general with the development of a "Spectrum of a Difficult Medical Problem." We believe this spectrum has far reaching implications and value for researchers, theoreticians, planners and practitioners currently in the substance abuse field both in conceptualizing drug involvement with its diversity of potential concerns, as well as planning treatment for drug involved clients. The application of a spectrum need not be limited to the category of drugs known as narcotics; this concept can also be applied to involvement with drugs from other categories, e.g., stimulants, sedative/hypnotics, hallucinogens, etc.

History, 20th Century↗
PubMed1986

Two cases of misdiagnosis: some essentials of intake.

This article traces the history of two clinical cases. The first case describes a substance abusing patient who enacted the part of a narcotics addict. This enactment was affirmed by both alcohol and narcotic treatment programs, leading to a misdiagnosis. The second case describes a substance using client misdiagnosed as a result of assumptions made by the referral source. Biases inherent in the assessment of drug involved patients are illustrated and the utility of the hypotheses testing approach as a method of diagnostic error reduction and correction is discussed.

Adult↗
PubMed1986

Assessment of addictive disorders. The use of clinical reflection and hypotheses testing.

This article examines how a multidimensional conceptual schema (biologic, sociologic, psychodynamic, and behavioral) can be applied directly to clinical practice methods during the assessment of addictive disorders. This practice is offered to minimize some of the conceptual problems often associated with the diagnostic process. Clinical reflection and hypotheses testing are considered as meta-models that can effectively guide the conduct of clinical assessment. The purpose of this approach is to provide a parsimonious means of organizing and verifying clinical information, thus making the assessment process both manageable and teachable. The ability to manage and teach clinical methods is considered as an essential step toward the development of a practice theory in the addictions.

Environment↗
PubMedDate not supplied

Smoking behavior among casino employees: self-report validation using plasma cotinine.

The veracity of behavioral self-reports is often challenged, particularly when the motivation to avoid stigma and win social approval holds potential to introduce bias into the data collected. This study employed plasma cotinine tests to validate the self-reports of tobacco use collected from 3,841 casino employees as part of a comprehensive health survey. Rates of discordance were calculated by comparing employee self-reports with results from plasma colinine tests. This study provides evidence that casino employees can provide valid self-report data. Further, discordance rates of self-reported tobacco use vary according to operational definitions of tobacco use. These findings highlight the methodological importance of recognizing the inherent heterogeneity of smoking behavior.

Adolescent↗
PubMedDate not supplied

Change intolerance to shifts in methadone formulation: a preliminary investigation.

Some patients in methadone maintenance treatment programs have substantial difficulty adjusting to changes in methadone formulation and shifts in other program policies. Clinicians can benefit from the ability to identify individuals who are "at risk" for methadone formulation and other change intolerance. By studying a cohort of 177 patients who were receiving methadone maintenance in a program that changed methadone dispensing formulations, this study revealed significant differences between two underlying patient groups (i.e., change tolerant or intolerant). These patients were distinguished by personal characteristics prior to the formulation change and methadone dose level shifts after the formulation change. Change-intolerant patients experienced formulation-related narcotic withdrawal whereas change-tolerant patients adapted to the new medication format. Gender, treatment history, and methadone abuse were three sociodemographic variables that significantly predicted patients who were intolerant to a methadone formulation change. These findings suggest the need for more research, including plasma and metabolic studies, to clarify the potential biological effects of changes in methadone formulations. In addition, the treatment implications for patients who experience change intolerance are discussed.

Adult↗
PubMedDate not supplied

Assessing substance abuse treatment provider training needs: screening skills.

Screening instruments for substance abuse can be expeditious and effective clinical tools. A training needs assessment conducted with a randomly selected sample of substance abuse treatment providers (n = 1684) in licensed facilities in New England identified the adequacy of training, interest in training, clinical skill, and training need in the use of 13 substance abuse screening instruments. The results revealed that New England substance abuse treatment providers are not skilled in the use of screening instruments and have a high level of training need in this area. Differences in screening skill were found among the New England states. In addition, women and those with less treatment experience have lower screening skill; similarly, women, those having less experience in the field, and social workers and nurses evidenced higher training need in screening. The discussion considers skill, adequacy of training, training interest, and training need. The conclusion suggests that one approach to the coexisting increased need for screening skills due to managed care requirements and the lack of interest in these skills is to study managed care marketplace demands to determine training priorities.

Adult↗
PubMedDate not supplied

Updating and refining prevalence estimates of disordered gambling behaviour in the United States and Canada.

BACKGROUND: This study updates prevalence estimates of gambling-related disorders in the United States and Canada, identifies differences in prevalence estimates among population segments, and identifies changes in prevalence over the past 25 years. METHOD: A meta-analytic strategy guided the synthesis of 180 estimates derived from 146 prevalence studies. RESULTS: Prevalence estimates among adolescent samples were significantly higher than estimates among adult samples for both clinical (level 3) and sub-clinical (level 2) measures of disordered gambling within both lifetime and past-year time frames. Among adults, level 3 prevalence estimates continue to increase significantly. CONCLUSIONS: Membership in youth, treatment, and prison population segments is significantly associated with experiencing gambling-related disorders. Understanding sub-clinical gamblers provides a meaningful opportunity to lower the public health burden associated with gambling disorders. Prospective studies of incidence are necessary to determine whether the prevalence of disordered gambling continues to increase among the adult general population and how adolescent gambling experiences change as this cohort ages.

Adolescent↗