Biomedical subjects

J Langenbucher

Publications and source records attributed to J Langenbucher.

16 recordsLinked to original sources

PubMed2001

Changes in alcoholic patients' coping responses predict 12-month treatment outcomes.

Patient subtypes (Types A and B alcoholism), determinants, and outcomes associated with changes in coping responses of 133 alcoholic patients in the year following admission to treatment were examined. In general, patients' use of avoidance coping declined and use of approach coping increased. Type B patients used more avoidance coping than did Type A patients, but the subtypes did not differ in rate of change in coping. As a determinant of coping, cognitive appraisal of threat showed a trend toward predicting avoidance coping at 6- and 12-month follow-ups. Decreased cognitive avoidance coping (e.g., daydreaming) predicted fewer alcohol, psychological, and interpersonal problems. Increased behavioral approach coping (e.g.. taking action) predicted lower severity of alcohol problems. Further study of changes in the cognitive aspects of coping (i.e., appraisals and cognitive avoidance coping) is needed to determine mechanisms underlying cognitive processes associated with treatment outcomes.

Adaptation, Psychological↗

PubMed2001

Clinical features of pathological gambling in an addictions treatment cohort.

This study examined the prevalence and descriptive psychopathology of pathological gambling in a heterogeneous treatment sample of 372 substance users. About 14% of male participants and 10% of female participants were identified as presumptive pathological gamblers (PGs) on the South Oaks Gambling Screen (SOGS). The authors contrasted 49 PGs with 323 participants who were not pathological gamblers (NPGs) on a host of variables measuring premorbid risk, pathological patterns of substance use, consequences of use, and psychiatric comorbidity. PGs showed more disturbance than NPGs on some measures of premorbid risk, pathological substance use, social consequences of use, and psychiatric comorbidity. Gambling status may be an important comorbid condition in addictions treatment settings and a significant covariate in research.

Adult↗

PubMed2001

State-level treatment outcome studies using administrative databases.

State substance dependence administrative databases contain both administrative and clinical information on large numbers of patients collected over extended time periods. Access to other state databases--employment, criminal behavior, and Medicaid--has also been achieved in some instances. Such data could prove an important source for the evaluation of long-term treatment outcomes and their determinants. This selected review describes and evaluates the treatment outcome and cost-related findings of the most advanced studies using these databases. A number of these studies have shown that completion of substance dependence treatment is associated with reduced societal costs. Some of these studies have focused on significant subpopulations of patients, including pregnant women and adolescents. A shortcoming of the findings of most of these studies concerns their use of noncompleter or non-randomly collected comparison groups. The utility of these databases can be enhanced by coupling them with clinical research treatment outcome evaluation approaches.

Data Collection↗

PubMed2001

The validity of self-reported cost events by substance abusers. Limits, liabilities, and future directions.

The following review considers data on the validity of self-reports in addict populations, and then it discusses (a) the types of cost-related questions and the assumptions underlying them that are useful to the evaluation of addictions treatment, (b) both internal and external sources of invalidity, (c) the limits on cost-related information that is gathered from administrative databases, (d) methods for assessing measure validity, and (e) the means for improving the validity of self-reports of cost events. With some important exceptions, addicts provide valid data about both medical and criminal cost events. Skilled socioeconomic researchers able to monetarize these events should be able to produce significant cost of illness, cost offset, cost-benefit, and cost-effectiveness research using self-report data.

Humans↗

PubMed2000

Adolescents are not adults: developmental considerations in alcohol users.

Much of the work in adolescent substance abuse assessment and treatment has been a direct transport from tools and modalities used in adult substance use populations. There was a consensus among symposium participants that developmental issues are important in assessment, evaluation, and treatment of adolescents with substance use disorders. These issues directly impact outcome at all levels. Presentations from the symposium may be helpful for conceptualizing the problems of adolescent substance use as well as formulating strategies for future research. Information from the symposium may be viewed as a springboard for future research and clinical intervention in adolescent substance abuse.

Adolescent↗

PubMed2000

Toward the DSM-V: the Withdrawal-Gate Model versus the DSM-IV in the diagnosis of alcohol abuse and dependence.

The Diagtnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) classifies as dependent many cases of mild alcohol problems. DSM-IV diagnoses have modest relationships with predictive and some concurrent validators and often improperly sequence the onset of abuse versus dependence, perhaps due to insufficient emphasis on physiological features. Testing reliability, syndrome prevalence, syndrome sequencing, and concurrent and predictive validity, this study contrasted the DSM-IV with the Withdrawal-Gate Model (WGM), in which alcohol withdrawal is necessary and sufficient for the dependence diagnosis. Clinical samples of adults (baseline n = 318) and adolescents (baseline n = 214) meeting abuse or dependence were assessed for DSM-IV alcohol symptoms and external measures of problem severity and reinterviewed at 6 (adults) and 12 months (adults and adolescents). Among DSM-IV dependent cases, the WGM shifted 32% of adults and 80% of adolescents to the abuse category, making both categories more symptomatically severe, but had a negligible effect on the prevalence of total alcohol diagnoses. The WGM was more reliable than the DSM-IV and temporally sequenced abuse before dependence in a greater number of cases. The WGM was superior to the DSM-IV in concurrent and predictive validity on most measures. Future diagnostic systems may be more reliable and valid if they require evidence of withdrawal for substance dependence.

Adolescent↗

PubMed1997

The comorbidity of alcoholism and personality disorders in a clinical population: prevalence rates and relation to alcohol typology variables.

This study assessed prevalence rates and overlap among Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; DSM-III-R; American Psychiatric Association, 1987) personality disorders in a multisite sample of 366 substance abusers in treatment. In addition, the relation of antisocial personality disorder (APD), borderline personality disorder (BPD), and paranoid personality disorder (PPD) to alcohol typology variables was examined. Structured diagnostic interviews and other measures were administered to participants at least 14 days after entry into treatment. Results indicated high prevalence rates for APD and non-APD disorders. There was extensive overlap between Axis I disorders and personality disorders, and among personality disorders themselves. APD, BPD, and PPD were linked to more severe symptomatology of alcoholism and other clinical problems. However, only APD and BPD satisfied subtyping criteria, after controlling for other comorbidity. Implications for classifying alcoholics by comorbid disorders are discussed.

Adult↗

PubMed1997

Physiological alcohol dependence as a "specifier" of risk for medical problems and relapse liability in DSM-IV.

OBJECTIVE: This study tested the ability of DSM-IV physiological alcohol dependence to predict multiple indices of medical problems and relapse behavior. It also tested the ability of three additional variables--DSM-IV nonphysiological dependence, an alternative dichotomous criterion for coding physiological dependence and a dimensional measure of physiological dependence--to predict medical problems and relapse behavior in alcoholism. METHOD: A heterogeneous group of 365 patients was recruited from eight addictions treatment programs in the northeastern United States. A multidimensional assessment battery able to diagnose the presence of physiological dependence according to each of three systems--the criteria of DSM-IV, alternative dichotomous criteria and a dimensional scale-- was administered about 2 weeks after admission, and 241 subjects were reinterviewed 6 months later. The three systems were compared for their ability to predict a variety of external measures of medical complications and relapse liability. RESULTS: Physiological alcohol dependence as diagnosed by DSM-IV bore no relationship to either risk for medical problems or relapse behavior. Further analyses showed that this failure was due to operational problems of physiological dependence in DSM-IV, rather than to a lack of conceptual merit for physiological dependence per se as a course specifier. Use of alternative criteria for coding physiological dependence which are difficult and less internally consistent, and use of a dimensional measure, found improved relationships with the external validators. CONCLUSIONS: Contrary to early reports, physiological dependence can serve as a course specifier for alcohol problems, but must be more sensitively scaled than it was in DSM-IV. Tests of alternative options suggest that a multistage criterion to replace DSM-IV's dichotomous criterion is the best remedy.

Adolescent↗

PubMed1996

Measuring diagnostic agreement.

Diagnostic agreement tests the reliability and concordance of diagnostic systems. The introduction of measures of agreement with reputations for baserate independence (e.g., Yule's Y and Q), and new studies occasioned by the publication of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) and the International Classification of Diseases--10 (ICD-10; World Health Organization, 1992) make it necessary to study the relationship of illness baserates to measures of agreement. Testing diagnostic concordance for diagnoses of drug dependence from the third edition of the DSM (American Psychiatric Association, 1980) versus DSM-IV diagnoses of drug dependence under 3 baserate conditions, it was found that Yule's Y and Q proved as vulnerable to differences in baserates as kappa or percent agreement and that specificity covaried with baserate rather than being fixed, as most theoretical discussions assume. The uncritical use of Y and Q, therefore, is likely to lead to optimistic interpretations of agreement. Kappa should be preferred for most purposes, although an adjustment to the computational formulas for Y and Q is presented that can diminish their positive bias.

Electronic Data Processing↗

PubMed1994

Diagnostic concordance of substance use disorders in DSM-III, DSM-IV and ICD-10.

Diagnostic concordance of DSM-III, DSM-IV and ICD-10 was tested in a heterogeneous unrestricted sample of 370 clinical cases drawn from a regional consortium. Agreement for abuse/harmful use, dependence, and the collapsed category of 'any diagnosis' was studied across eight drug classes. A probabilistic approach to the cross-classifications based on configural frequency analysis was applied, permitting the computation of four indices of agreement. In contrast to earlier studies, ICD-10 appeared to be the most inclusive system, and often diagnosed cases that were undiagnosed by both DSMs. Generally satisfactory coherence between the ICD-10 harmful use category and the DSM category of abuse was found, but this agreement was often due to a preponderance of negative or undiagnosed cases; disagreement was common on which cases in particular warrant a mild diagnosis. In general, the greatest diagnostic concordance was observed for sedative/hypnotics, opiates and alcohol, the poorest for amphetamines, cocaine and PCP. The analytic approach produced an array of cross-system relationships that are more complex and conditional than those previously reported, and scientists and clinicians are cautioned to study particular drugs, diagnostic levels and measures of concordance before applying cross-system results to their own data or design needs.

Adult↗

PubMed1994

Offsets are not add-ons: the place of addictions treatment in American health care reform.

Addictions treatment is often viewed by policymakers as a costly and inefficient "add-on" to an already overburdened system. This view contradicts a large literature on addictions treatment cost-offsets, which shows that treatment for addictive disorders drives down the demand for health care and promotes more efficient use by both patients and their families.

Alcoholism↗

PubMed1994

The generalizability of the dependence syndrome across substances: an examination of some properties of the proposed DSM-IV dependence criteria.

DSM-III-R and proposed DSM-IV schemes for the diagnosis of psychoactive substance use disorders are based largely on the dependence syndrome concept. However, there is an absence of empirical support for the generalizability of the dependence syndrome across substances. This study examines how consistently proposed DSM-IV dependence criteria function to measure dependence across seven substances: alcohol, cannabis, cocaine, stimulants, hallucinogens, sedatives and opiates. Using structured research diagnostic interviews, dependence diagnoses were determined for 295 American subjects in treatment for alcohol/drug problems. Several factor analytic techniques were used to assess whether criteria formed single dimensions and how consistently individual criteria measured dependence across substances. The ability and consistency of criteria to measure a continuum of severity across substances were also assessed. Only subjects who used the substance at least six times were entered in the analyses. Overall, results provide strong support for the DSM approach for alcohol, cannabis, cocaine, stimulants, sedatives and opiates, but not for hallucinogens. Results indicate that a single strong factor adequately described the criteria for these six substances. All criteria loaded strongly and uniformly on single factors indicating that all were good measures of dependence. Criteria provided a dimensional measure of severity based on several indices for these substances. In addition, four criteria provided relatively stable indicators of high or low severity across these substances. Results did not support the use of dependence criteria for hallucinogens as these criteria did not form a single factor. Results suggest that very few hallucinogen users experience an inability to cut down or control use, a key indicator of loss of control.

Adult↗

PubMed1994

Lifetime DSM-IV diagnosis of alcohol, cannabis, cocaine and opiate dependence: six-month reliability in a multi-site clinical sample.

Psychiatric research increasingly emphasizes the diagnosis of symptoms and syndromes on a longitudinal basis. This study tests the reliability of lifetime DSM-IV diagnoses of alcohol, cannabis, cocaine and opiate dependence. The CIDI-SAM was administered at intervals not less than six months apart to a multi-site sample of 201 clinical respondents. The reliability of lifetime diagnosis of the syndromes, of the criteria which constitute the syndromes, and of the ages of onset reported for the criteria and for the dependence syndromes as a whole, were studied and the effects of patient characteristics suspected to degrade reliability were examined. There was generally good agreement, statistically, at both the syndrome and criterion level between the two interviews. Lifetime diagnoses for three of the drugs--alcohol, cannabis and opiates--were made at or near levels of agreement generally considered excellent under less strict testing conditions, and cocaine dependence was only marginally below this level. Most criteria showed good reliability and all delivered about equal results when averaged across the four substances, although a relationship between reliability and centrality of the symptom to the individual drug abuse pattern was found. Age of onset was almost uniformly highly reliable. Most patient characteristics bore no detectable relationship to reliability, although patients with multiple drug use patterns may warrant more careful probing by interviewers. Overall, these data indicate that lifetime symptoms and diagnoses can be queried reliably, although they must be reported with less confidence than current state diagnoses.

Age of Onset↗

PubMed1994

Rx for health care costs: resolving addictions in the general medical setting.

The literature on addictions treatment cost offsets suggests that resolving addictive disorders in the general medical setting will drive down the demand for health care, promote more efficient use of care by both patients and their families, and preserve scarce resources that can be deployed more wisely elsewhere. The demand to reduce waste and trim health care expenditures challenges the historic gulf between general medical practice and the management of addictive behaviors. An example of an addiction treatment technology developed in medical settings for use by medical personnel, brief intervention, is reviewed, with reference to its cost-saving potential under health care reform.

Alcoholism↗

PubMed1987

Inpatient treatment of alcoholism: a behavioral approach.

After detoxification has been completed (if needed), a comprehensive assessment of the individual patient's drinking and other problems is the first step in inpatient behavioral treatment of alcoholism. On the basis of the assessment results, treatment is planned and delivered in an individualized manner to achieve three major goals. The first goal of treatment is to facilitate and consolidate the patient's commitment to change by carefully reviewing the evidence from the assessment of negative consequences of the patient's drinking. Alcohol education about the long-term negative consequences of drinking and the use of a decision matrix to clarify the patient's reasons for not drinking also are useful in this regard. The second goal is to stabilize the change in the drinking that occurred when the patient decided to enter the inpatient treatment program. Aversion therapy to decrease desire for alcohol, teaching alternative skills to deal with likely precipitants of renewed alcohol use, and strengthening behaviors incompatible with alcohol abuse all can be used to help maintain abstinence. Antabuse (including behavioral contracting procedures to increase compliance with this drug), along with psychotropic medication for additional psychopathology, are pharmacological interventions that often can be used to stabilize change. A final very important goal is the careful planning of aftercare and post-discharge life to help maintain the changes started during inpatient treatment. A case is presented to illustrate the above notions.

Alcohol Drinking↗

PubMedDate not supplied

Illness severity and self-efficacy as course predictors of DSM-IV alcohol dependence in a multisite clinical sample.

Illness severity and self-efficacy are two constructs of growing interest as predictors of clinical response in alcoholism. Using alternative measures of illness severity (DSM-IV symptom count, Alcohol Dependence Scale, and Addiction Severity Index) and self-efficacy (brief version of the Situational Confidence Questionnaire) rigorously controlled for theoretically important background variables, we studied their unique contribution to multiple indices of relapse, relapse latency, and use of alternative coping behaviors in a large, heterogeneous clinical sample. The Alcohol Dependence Scale contributed to the prediction of 4 of 5 relapse indicators. The SCQ failed to predict relapse behavior or its precursor, coping response. The findings emphasize the predictive validity of severity of dependence as a course specifier and underline the need for more sensitive and externally valid measures of cognitive processes such as self-efficacy for application in future studies of posttreatment behavior.

Adaptation, Psychological↗