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J W Langenbucher

Publications and source records attributed to J W Langenbucher.

10 recordsLinked to original sources
PubMed2001

Assessment of alcohol tolerance in adolescents.

OBJECTIVE: To improve assessment of the DSM-IV alcohol tolerance criterion in adolescents, this study tested the performance of a minimum percentage increase in drinking quantity, and a proxy measure of tolerance (i.e., average heavy-drinking quantity per occasion) in identifying adolescents with alcohol dependence. METHOD: Two adolescent samples were examined. In one sample (N = 415, 58% male, 79% white, 57% clinical), a modified version of the SCID was used to determine DSM-IV alcohol diagnoses, and lifetime drinking history data were collected by interview. In the second sample (N = 470, 60% male, 76% white, 100% clinical), the Adolescent Diagnostic Interview was used to determine DSM-IV alcohol diagnoses and to collect data on initial- and current-drinking quantities needed to become intoxicated. The performance of a percentage increase and average heavy-drinking quantity in identifying those with dependence was evaluated using receiver operating characteristic analysis. RESULTS: The utility of a percentage increase definition was limited by the high degree of variability in initial-drinking quantities. Percentage increase may underassign the tolerance symptom when initial-drinking quantities are high and overassign the symptom when initial-drinking quantities are low. Average heavy-drinking quantity per occasion, combined with a minimum frequency of drinking, demonstrated better performance than any percentage increase definition. CONCLUSIONS: Alternatives to a change-based (e.g., percentage increase) definition of tolerance warrant study due to limits of change-based definitions when initial-drinking quantity shows a high degree of variability. The variability in initial-drinking quantity may reflect individual differences in initial sensitivity that need to be considered in tolerance assessment.

Adolescent↗
PubMed2000

Diagnostic concordance of DSM-III, DSM-III-R, DSM-IV and ICD-10 alcohol diagnoses in adolescents.

OBJECTIVE: Little is known about the validity of diagnostic criteria for alcohol use disorders (AUDs) when applied to adolescents. This study examined the diagnostic concordance of DSM-III, DSM-III-R, DSM-IV and ICD-10 AUDs in a sample of adolescents with a broad range of alcohol problem severity. METHOD: Participants were 413 adolescents (250 male), ages 13 to 19, drawn from clinical and community sources. AUDs were assessed using the Structured Clinical Interview for the DSM (SCID), modified to make diagnoses in the four nosological systems. Diagnostic agreement for lifetime diagnoses was quantified with the kappa statistic. RESULTS: Agreement was fair to high across the three categories of alcohol dependence, alcohol abuse and no alcohol diagnosis (kappa = 0.51 to 0.76); for alcohol dependence (kappa = 0.51 to 0.83); and for the categories of any AUD versus no AUD (kappa = 0.55 to 0.96). Concordance was very low for alcohol abuse diagnoses (kappa = 0.10 to 0.23), with the exception of DSM-III-R and DSM-IV (kappa = 0.62). Dependence was superior to abuse in the degree of temporal overlap in diagnostic agreements. CONCLUSIONS: Similar to findings with adults, diagnostic concordance among adolescents tended to be fair to high for alcohol dependence and very low for alcohol abuse. The data highlight the inconsistency across nosological systems in the conceptual framework and definition of the alcohol abuse category.

Adolescent↗
PubMed1999

Psychopathology: description and classification.

DSM-IV's strong empirical base has yielded an instrument with good to excellent reliability and improved validity. Diagnostic reliability depends on both the clarity and validity of diagnostic criteria and the changeability of disorders over time: The reliability of schizophrenic spectrum disorders, personality disorders, and some childhood and adolescent disorders remains problematic. Findings on diagnostic validity appear paradoxical: Attempts to validate schizophrenic spectrum disorders with neurobiological and genetic-familial validators have been only modestly successful, whereas the tripartite personality trait model has differentiated a range of depressive and anxiety disorders. Research on comorbidity has identified several highly comorbid disorders (substance-related disorders, personality disorders, depression, and anxiety) as well as some adverse consequences of comorbidity. The advantages of dimensional approaches to diagnosis have largely been demonstrated conceptually; ultimate conclusions about the strengths and weaknesses of dimensional and syndromal methods await substantial additional empirical research.

Adolescent↗
PubMed1996

Alcohol treatment and health care system reform.

After reviewing the empirical literature, we suggest that advances in the assessment and treatment of alcohol problems have the following important implications for health care system reform: (1) alcohol use disorders and problems associated with alcohol use are prevalent and are complicated by various comorbid conditions, and they result in large costs to the health care system and to society; (2) alcohol treatment generally results in reduced drinking and more efficient use of health care resources; (3) specific treatments have demonstrated effectiveness; (4) screening and assessment instruments with excellent sensitivity to the heterogeneity of alcohol problems have been developed; (5) evidence that specific treatments have differential effectiveness with different patients groups is accumulating; and (6) good evidence exists for the effectiveness of brief interventions, particularly with less severe and chronic alcohol problems. These findings suggest that alcohol treatment services in a reformed health care system should include (1) universal coverage for alcohol treatment, including full benefits for outpatient care; (2) a rational system of assessment and triage for treatment, including an increased emphasis on screening and brief interventions in primary medical care settings; (3) a full range of treatment services that vary in intensity; and (4) addictions treatment provider incentives and contingencies to provide treatments of proven effectiveness. When fully implemented, an efficient approach to the treatment of alcohol-related problems will result in one of the largest pools of cost savings in a reformed American health care system.

Alcoholism↗
PubMed1996

On criterion weighting in the DSM-IV.

Differential weighting of illness signs and symptoms has surfaced recurrently in psychiatric nosology. Six alternately weighted algorithms for diagnosing alcohol dependence in accordance with the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), based on statistical, unit, rational and random criterion weighting systems, were used to predict an array of concurrent validators and 6-month drinking outcomes in a regional clinical sample of 365 participants. Comparable predictive efficiency across all algorithms, including the randomly weighted versus statistical best-fit model, was observed. Further analyses and geometric modeling suggested that this was due to the extremely high internal consistency of the DSM-IV criteria. An alternative strategy that favors factorially complex, less homogeneous criteria was used to develop an experimental DSM-IV algorithm from an array of 39 candidate criteria. This algorithm had extremely low internal consistency, high difficulty, and complex factor loadings. Differential weighting of its criteria produced a good range of efficiencies, predictive power for rational models exceeding the random weight model, and a best-fit algorithm with substantial surplus predictive power. These results illustrate an emerging conflict in nosology between 2 opposing trends: a press for the promulgation of criterion arrays with high internal consistency and a clear desire to assign some criteria extra weight for prognosis or decision making. Both cannot be had in the same algorithm. An alternative approach emphasizing diagnostic criteria with complex structures can satisfy the multiple demands of brevity, validity, and weighting performance.

Adult↗
PubMed1996

Staging in the onset of DSM-IV alcohol symptoms in adolescents: survival/ hazard analyses.

OBJECTIVE: This research examined staging in the time to onset of DSM-IV alcohol symptoms in adolescents. Consistent staging in the onset of symptoms provides important tests of the construct validity of diagnostic systems, and aids the development of early case identification strategies. METHOD: The Structured Clinical Interview for the DSM (SCID), adapted to assess DSM-IV alcohol abuse and dependence symptoms, was used to determine time to symptom onset in 102 male and 97 female adolescent drinkers with and without alcohol use disorders. The sample provided a broad range of drinking practices and alcohol-related problems. Symptom onset patterns were examined using survival-hazard analyses. RESULTS: Survival and hazard data suggested three stages of alcohol problems distinguished by time to onset: heavy and heedless drinking with associated social and role obligation problems, psychological dependence, and withdrawal. This three-stage model fit both the male and female data, and described staging patterns in 70% of the subjects. CONCLUSIONS: The symptom onset model suggested a first stage of adolescent alcohol symptoms characterized by heavy and heedless drinking with associated interpersonal and role obligation problems. The data did not support the construct validity of DSM-IV alcohol abuse when applied to adolescents, and suggested staging among DSM-IV alcohol dependence symptoms. Implications for the diagnosis and early identification of adolescent alcohol problems are discussed.

Adolescent↗
PubMed1995

DSM-III, DSM-IV and ICD-10 as severity scales for drug dependence.

The construct of illness severity serves many scientific and clinical functions. This study tested the performance as severity scales of three systems for diagnosing drug dependence--DSM-III, DSM-IV and ICD-10--in a multisite regional sample of 370 clinical subjects. Both lifetime and current severity of four drug problems--alcohol, cannabis, cocaine and opiate dependence--was studied in three stages: (a) item difficulty and internal consistency analysis; (b) probabilistic modeling of distribution behavior; and (c) concurrent validation against a set of independent measures. All three systems, for most drugs correlated with most test variables, had good to excellent concurrent validity. Unexpectedly, DSM-III showed in some instances better item behavior, composite score behavior and concurrent validity than the other systems, though DSM-IV and ICD-10 are based on slimmer generic algorithms, and may represent a good balance between simplicity and concurrent validity. Results suggest that the design of future diagnostic algorithms start at the item level and strive for moderate levels of both internal consistency and difficulty. Composite score distributions can then be modeled in field research, and necessary item corrections can be made before the algorithm is widely promulgated.

Adult↗
PubMed1995

Onset and staging of DSM-IV alcohol dependence using mean age and survival-hazard methods.

Orderly onset of psychiatric symptoms has implications for both case detection and the construct validity of the underlying illness. Mean age and survival-hazard techniques were used to study the onset of alcohol abuse and dependence (as defined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Association, 1994) in 369 clinical cases drawn from a heterogeneous regional sample. The methods provided a similar general pattern of symptom sequencing, though only survival-hazard analysis described a punctuated onset of alcoholism in 3 discrete stages: alcohol abuse, dependence, and accommodation to the illness. This model survived a rigorous program of tests for goodness of fit and described the majority of the sample, supporting the construct validity of both alcohol abuse as a discrete first illness phase and of dependence as a set of core constructs distinct from and succeeding abuse. The specific strengths of survival-hazard analysis as a research tool in illness staging research are discussed.

Adult↗