PubMed Health⌕ Search

Biomedical subjects

J N Chappel

Publications and source records attributed to J N Chappel.

At least 19 recordsLinked to original sources
PubMed1999

Twelve-step and mutual-help programs for addictive disorders.

Psychiatrists may wonder why both addiction treatment and the 12-step programs recommend abstinence. In his 50-year follow-up of two groups of alcoholics, Vaillant compared those who established secure abstinence with those who continued to drink. Secure abstinence was associated with: Living longer Better mental health Better marriages Being more responsible parents Being successful employees In considering the various routes to secure recovery, Vaillant recommended that clinicians: Offer the patient a nonchemical substitute for alcohol Remind the patient ritually that even one drink can lead to pain and relapse Repair the social and medical damage that the patient has experienced Restore the patient's self-esteem The preponderance of the research data now available indicates that the 12-step programs of AA, NA, Cocaine Anonymous, and Al-Anon are most helpful for alcohol-dependent and other drug-addicted patients as they seek to achieve secure, long-term abstinence. A growing number of clinicians is recommending that physicians become more knowledgeable and skilled in referring and supporting patients in working 12-step programs of recovery. Specific recommendations include: 1. Be familiar with 12-step activities and tools. These include meetings, home groups, sponsors, the Twelve Steps and Twelve Traditions, books, pamphlets, and slogans. To be able to discuss the meanings and applications of these tools for recovery is useful. Physicians can select those that are most suitable for the individual, recognizing that meeting attendance might not be the most important activity. 2. Support referral by facilitating a meeting between the patient and a temporary contact from the 12-step program. This means becoming familiar with local 12-step programs. Phoning the local AA or NA central office or hot line makes connecting patients to someone who will take them to a meeting that same day possible. AA and NA have committees whose members are interested in working with physicians to help get patients to meetings and to get information to physicians. These are the Cooperation with the Professional Community, Treatment Facilities, and Hospitals and Institutions committees. 3. Work with the resistance of patients. Many addicted patients are resistant to the idea of attending 12-step or mutual-help programs. Reminders of their painful personal database associated with the use of alcohol or other drugs can help break through denial. Involvement of family members and friends in the network therapy developed by Galanter can be effective in reducing resistance. Being patient and persistent in developing the therapeutic alliance helps to maintain contact during the first difficult year of recovery. Physicians should be prepared to work with patients as long as necessary to stabilize their sobriety. Zweben has suggested ways psychotherapy can help deepen work with the steps. 4. Help dual diagnosis patients understand AA's and NA's singleness of purpose. These programs work only with addiction; they do not try in any way to deal with other mental disorders. All patients have to say is, "I want to stop drinking or using drugs," and they will be welcomed and accepted at meetings (see Tradition 3). If they talk only about their psychiatric symptoms or medications, someone may suggest that they go elsewhere for help. Occasionally, well-intentioned AA or NA members tell patients to stop taking their medications. The authors always direct patients to the pamphlet The AA Member: Medications and Other Drugs. This pamphlet tells AA members not to play doctor and to take the medications their doctors prescribe. Copies of the pamphlet are widely available at many AA meetings, or they can be ordered by physicians from Alcoholics Anonymous World Services, General Service Office, Box 459, Grand Central Station, New York, NY 10163 (212-870-3400). 5. Get comfortable with the spiritual dimensions of healing. Zweber and Brown offer good suggestions for getting com

Alcohol-Related Disorders↗
PubMed1998

Substance use disorders. Difficulties in diagnoses.

Patients attempt, consciously or unconsciously, to minimize or disguise their substance use, in part to preserve shreds of self-respect, avoid guilt and shame, and avoid the real or imagined criticism of others. It is ironic that substance users not only use the substance to gain access to pleasant events or escape or avoid unpleasant events, but also to deny, minimize, or disguise that very use for the same reasons.

Adolescent↗
PubMed1994

Advances in the treatment of alcoholism.

The Council on Scientific Affairs of the California Medical Association presents the following inventory of items of progress in psychiatry. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of these items of progress in psychiatry that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Psychiatry of the California Medical Association, and the summaries were prepared under its direction.

Alcoholism↗
PubMed1993

Long-term recovery from alcoholism.

AA has demonstrated success in steadily increasing membership, with no loss of the proportion of those with over 5 years of sobriety. It has been recognized as effective long-term treatment for alcoholism by psychiatrists and psychoanalysts experienced in treatment of the addictions. The triennial membership surveys of AA have shown stability in 1. A 50% dropout rate within the first 3 months of starting AA. Only 41% of those in the first year will remain in the Fellowship for another year. 2. Roughly equal numbers of those with less than 1 year, 1 to 5 years, and over 5 years of sobriety, with an average length of sobriety of about 4 years. 3. Members having a sponsor (85%) and belonging to a home group (88%). 4. Attendance by members of about three meetings a week, regardless of duration of sobriety. 5. Members telling their doctor that they are in AA, but not helping him or her learn about the program. The survey data also indicate that AA is changing in the following ways: 1. The number of women members has increased to more than one third the total membership. 2. An increasing number of young people, under 30 years of age, to more than one fifth the total. 3. A decreasing number of older people, over 50 years of age, to just under one fourth the total. 4. An increasing number of members who were also addicted to other drugs (46%). Psychiatrists can use these data and knowledge of AA to 1. Increase the effectiveness of referrals of alcoholic patients to AA regardless of age, sex, race, or other characteristics. All are welcome and can benefit. 2. Deal with resistance, which occurs when patients begin to make contact with AA. 3. Help alcoholic patients through the difficult first year of sobriety. 4. Encourage their alcoholic patients to use AA as a program for personal growth and development. 5. Helping dually addicted patients use AA's singleness of purpose to facilitate their recovery. 6. Cooperate with alcohol and drug treatment programs in helping patients transfer to AA and work on an effective program of recovery. 7. Work with members of the local AA Treatment Facilities and Cooperation with the Professional Community Committees in helping alcoholic patients enter and use AA. 8. Provide psychiatric treatment for AA members in ways that support and sustain their program of recovery, especially by avoiding dependence-producing medications.

Alcoholics Anonymous↗
PubMed1992

Spirituality and medical practice.

Spirituality is an important aspect of health care that is not often addressed in modern day primary medical practice. Controversy surrounds the role of spiritual issues in medical practice. Some of this stems from confusing spirituality with religion. This paper distinguishes between spiritual and religious issues and reviews the history of these issues in medicine, the growing medical literature in this area, and some practical guidelines for the practicing physician. The authors conclude that, when appropriate, spiritual issues should be addressed in patient care since they may have a positive impact on patient health and behavior, and recommend that the medical model be expanded to a biopsychosocial-spiritual one. The guidelines developed by the American Psychiatric Association provide a useful model for the practicing physician to follow. More research is needed in this area, but the authors conclude that enough is already known to support the inclusion of spiritual issues in medical education.

Holistic Health↗
PubMed1987

Effect of a course on students' attitudes toward substance abuse and its treatment.

From 1978 through 1982, pretests and posttests of second-year medical students' attitudes toward substance abuse and its treatment showed that positive attitude change could be achieved during a substance abuse course. When the course was scheduled in competition with demanding basic science courses, however, the students' attitudes did not become as positive as or became more negative than when the course was part of a less demanding schedule. The course used lectures and reading assignments to provide information on substance abuse and used patient contact to change attitudes toward substance abusers and treatment. Emphasis was placed on patient management problems and small-group discussions. The changes in the students' attitudes are assumed by the authors to be positive, but the link between these attitudes and good clinical practice has not been demonstrated.

Attitude of Health Personnel↗
PubMed1985

The substance abuse attitude survey: an instrument for measuring attitudes.

Although attitudinal objectives in medical education about alcohol and drug misuse are important, adequate instruments for measuring the achievement of such objectives have been lacking. The development of a standardized Substance Abuse Attitude Survey (SAAS) is described. Multiple administrations and factor analyses selected and refined the item pool of the final scale. Five factors were derived from tests completed by 324 noncriterion clinicians: Permissiveness, Treatment Intervention, Nonstereotypes, Treatment Optimism and Nonmoralism. The factor structure was found to be internally consistent over repeated administrations. Validation was obtained by scoring surveys completed by 116 criterion clinicians experienced in treating patients who misuse alcohol and other drugs. The criterion clinicians scored significantly higher than the noncriterion clinicians on the Treatment Intervention and Treatment Optimism factors. The SAAS has been well accepted by medical students and practicing physicians. It has proven useful in developing attitudinal objectives, measuring achievement of these objectives and modifying teaching approaches in both undergraduate and continuing medical education.

Adult↗
PubMed1981

Physician attitudes toward distressed colleagues.

Attitudes and behaviors of physicians toward their impaired colleagues often affect whether the latter seek treatment. Negative responses include (1) silence, usually based on anxiety, ignorance and pessimism; (2) tentative responses based on stereotyped assumptions or distraction by organic problems; (3) judgmental responses that may result in mutual avoidance, and (4) permissive responses that encourage continued use of alcohol or other drugs. Positive responses include (1) confrontation in a concerned, constructive manner as early as possible; (2) assistance to the impaired colleague in obtaining treatment, and (3) education and information sharing to increase awareness of potential and real problems. Educational programs can help physicians develop more positive attitudes toward both impaired colleagues and impaired patients. The emphasis is on active participation. The goals of these programs should include optimism about therapy, using structured treatment approaches that include paraprofessionals and formerly impaired physicians on the treatment team, and the development of confrontational skills on the part of each physician.

Alcoholism↗
PubMed1977

Observation and treatment of neonatal narcotic withdrawal.

A total of 110 infants born to mothers who were either in a methadone maintenance program, using heroin, or recently detoxified, were studied during the neonatal period. Of these infants, 93.6 per cent developed withdrawal symptoms. No significant differences were determined in therapeutic response among those infants treated with methadone, phenobarbital, and diazepam. There was a significant reduction in the frequency of withdrawal symptoms among infants born to mothers whose methadone dose at time of delivery was less than 20 mg (17.9 per cent). It is suggested that reduction of methadone dosage in late pregnancy results in reduced incidence of withdrawal but must be carefully carried out.

Diazepam↗
PubMed1977

Substance abuse attitude changes in medical students.

The authors describe a course in substance abuse given to sophomore medical students with the intention of positively influencing their attitudes toward substance-abusing patients and their treatment. Clinical problem solving and small group discussion were emphasized in addition to field trips. By pretest and posttest measures, significant positive changes were obtained in student attitudes: they reported feeling less upset when they encountered alcoholics, "hard" drug abusers, "soft" drug abusers, compulsive smokers, and obese overeaters as well as having a more positive view of the physician's role in the treatment of substance dependence. Personal experience with alcohol and other drugs was shown to have an influence on attitude changes.

Alcoholism↗