The importance and difficulty of drug research in developing countries: a report from Kabul as timely reminder.
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Adolescent↗
Biomedical subjects
J Westermeyer
Publications and source records attributed to J Westermeyer.
Effects of childhood physical abuse on course and severity of substance abuse.
The present study sought to assess the course and severity of Substance Related Disorder (SRD) in relation to childhood physical abuse (CPA) using retrospective data on CPA and current indices of substance use, abuse, and related morbidity. A total of 642 patients were assessed, of whom 195 (30.4%) experienced CPA, were assessed in two university medical centers with Alcohol-Drug Programs located within departments of psychiatry. A research assistant obtained demographic data, family history of substance abuse, problems related to substance abuse, and treatment of substance abuse. Data on severity included two measures of SRD-associated problems (one patient-rated and one psychiatrist-rated), substance abuse vs. dependence, self-help activities, and previous treatment. The study found that patients with CPA were more likely to be women, have lower socioeconomic status, and have more extended family members with substance abuse. Their substance abuse was more severe on five out of six severity measures. Patients with CPA showed more lifetime treatment on three out of four measures. Physical abuse during childhood resulted in a more morbid course of substance abuse later in adulthood. Although female gender and lower SES were both associated with CPA, the relationships were separate (i.e., women did not have lower SES).
Adult↗
Self-help strategies among patients with substance use disorders.
The objective of this study was to determine (1) the type and extent of self-help efforts among patients presenting for treatment of substance use disorders, and (2) the association of self-help with demographic and clinical characteristics. A retrospective report of life self-help methods, current demographic characteristics, and current and lifetime clinical characteristics was used. Six hundred and forty-two patients in treatment for substance use disorder were interviewed at one of two university medical centers with Alcohol-Drug Programs located within departments of psychiatry. A research associate (RA) interviewed patients regarding seven types of self-help involving specific, mutually exclusive behaviors and rated the patient's lifetime self-help methods. The patient, RA, and addiction psychiatrists provided demographic, familial, and clinical information. Most patients (78%) had tried one or more types of self-help, with a mean of 2.7 methods per patient. They more frequently chose methods related to the substance (decreasing amounts or frequency, or changing substance type) or joining a self-help group than methods that involved changing friends, residence, or occupation/job/school. Certain patterns of self-help tended to occur together (e.g., changing substance frequency and dose), whereas others appeared more independent (e.g., joining a self-help group). Some self-help approaches occurred mostly in association with other methods rather than alone (e.g., changing occupation/job/school). More self-help was associated with higher socioeconomic class, more relatives with substance use disorder, greater severity of substance use disorder, and more treatment for substance use disorder. Self-help tends to occur more often after exposure to addicted relatives or addiction treatment. Clinicians and public adult education should promulgate self-help methods in the general population.
Adult↗
Detection and diagnosis of alcoholism in hospitalized patients.
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Adult↗
Alcoholism and co-morbid psychiatric disorders among American Indians.
Much of the data reported here regarding American Indian (AI) people has originated from specific areas with particular peoples. Thus, one must be cautious in applying information from one tribe to the hundreds of tribes living across the United States. As with any people, psychiatric disorder may be a pre-existing rationale for using alcohol. Or alternatively, alcohol may lead to various psychiatric disorders, such as organic mental conditions, posttraumatic stress disorder, or other conditions. A third alternative is that both alcoholism and other psychiatric disorder merely happen to affect the same person by chance. Recognizing alcoholism and treating it in a timely manner before disabling or even permanent psychiatric disorders ensue are key strategies. In addition, clinicians must be able to recognize and then either treat or refer co-morbid patients for appropriate care. Some psychiatric disorders, such as panic disorder, posttraumatic stress disorder, and various organic mental disorders may occur more often in some AI groups. Other co-morbid conditions, such as eating disorders, may occur less often among AI patients with alcoholism. It could be argued that resources should go solely to preventive efforts, thereby negating the need for psychiatric services. However, successful prevention of alcoholism may hinge upon, and increase the need for greater psychiatric services in AI communities.
Adult↗
Health of Albanians and Serbians following the war in Kosovo: studying the survivors of both sides of armed conflict.
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Albania↗
Addiction, community and state: a review.
As clinicians, we are well aware of the importance of drug supply, price, availability, and access in propagating and maintaining illicit drug use, abuse, and addiction. However, we tend to be silent on these topics, leaving them to elected and appointed government leaders. The author proposes that our remaining silent is analogous to an infectious disease expert remaining silent on water supply and sewage in the midst of a cholera epidemic. It is not only unseemly for us to remain silent, it is unprofessional at best and unethical at worst. Governmental means of addressing the social genesis of addiction and illicit drug supply falls under the general rubric of statecraft. Our elected leaders, our appointed governmental leaders, and our publicly supported workers (e.g., police, courts, schools, health care workers, social agencies) can and do exert influences either favoring or counteracting illicit drug supply, use, abuse, and addiction. Public officials can and do learn the exercise of statecraft in addressing a large range of social needs, such as housing, transportation, security, a safe food supply, and so forth. They can and should develop knowledge, skills, and experience in the exercise of statecraft vis-a-vis drugs. This article reviews the relevant literature on this topic. In addition, the author reflects on his observations on "addiction statecraft" in several countries over the past three decades. He underscores the need to consider elements such as community deterioration, corruption of police and other officials, and social anti-drug strategies that have worked as well as those that have not worked. Public leaders must also take stands regarding intervention and treatment programs that are not widely popular, such as those involving methadone. The author argues that we speak out authoritatively on "addiction statecraft." In undertaking such social roles, we must take care to speak out of our own collective wisdom and experience, rather than out of personal bias or personal agendas.
Community Health Services↗
Course, severity, and treatment of substance abuse among women versus men.
OBJECTIVE: To assess the course and severity of substance-related disorder (SRD) in relation to gender. DESIGN: Retrospective data on course were obtained for several indices of substance use, abuse, and related morbidity. SETTING: Two university medical centers with alcohol-drug programs located in departments of psychiatry. SUBJECTS: A total of 642 patients were assessed, of whom 365 (57%) were men and 277 (43%) were women. METHODS: Data on course included demographic characteristics, family history of substance abuse, lifetime use, age at first use, years of use, use in the last year, periods of abstinence, and current diagnosis. Data on severity included two measures of SRD-associated problems (one patient rated and one interviewer rated), substance abuse versus dependence, self-help activities, and previous treatment. RESULTS: Women were more apt to be homemakers; to have a sibling or, if married, a spouse who abused substances; to be less apt to have ever used hallucinogens or inhalants; to have used substances for fewer years; to have used cannabis and inhalants for fewer days in the last year; to have a lower rate of current cannabis abuse/dependence; to have fewer legal problems related to substances (especially driving while intoxicated [DWI] charges); to have fewer outpatient admissions to treatment; to have fewer admissions to substance abuse treatment (all categories together), fewer lifetime days in treatment, and lower overall treatment cost (for all categories of treatment together). CONCLUSIONS: These data confirm earlier reports of a shorter course, less deviant drug usage, and--if married--a substance-abusing spouse. In addition, we found higher rates of familial substance abuse and lower rates of lifetime admissions, treatment days, and total cost of substance abuse treatment. Homemaking responsibilities, a substance-abusing spouse, a male-oriented treatment system, and/or a more rapid course may reduce substance abuse treatment for women.
Adult↗
A cross-cultural review of sudden mass assault by a single individual in the oriental and occidental cultures.
A nonrandom sample of North American cases of sudden mass assault by a single individual (SMASI, n = 30) is compared with a nonrandom sample of Laotian amok cases (n = 18) and other amok studies. Perpetrators in both studies show evidence of social isolation, loss, depression, anger, pathological narcissism, and paranoia, often to a psychotic degree. The term "innovative perpetrator" is reintroduced and expanded upon. Similarities among samples far outweigh differences, leading the authors to conclude that SMASI and its appearance in different cultures is not a culture-bound syndrome.
Adolescent↗
Mental health of women in Afghanistan.
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Afghanistan↗
The role of cultural and social factors in the cause of addictive disorders.
For many centuries, generations of young people were protected from the early onset of addictive disorders. Although addiction to drugs and alcohol had been well known for centuries, widespread addiction has occurred only in recent centuries. Because the human gene pool or human biochemistry did not likely change suddenly to produce this result, social and cultural factors likely have produced widespread addiction. From another perspective, the sociocultural factors that once protected our societies against widespread addiction may have become weakened or inoperative. Our social institutions--our families, schools, religions, neighborhoods, and governments--no longer protect us and our young from addiction as they once did. The failure of traditional social institutions to protect us from addiction does not mean that we must seek drug panaceas only in nonsocietal venues, such as medications and psychotherapies. Rather, we should look to those elements of our institutions that have failed us and seek to bolster them. A gradually evolving body of literature on this topic demonstrates that institutional changes can serve to reduce widespread addiction among us. Moreover, these changes can be implemented at many levels: within our families, schools, friendship groups, workplaces, churches, neighborhoods, and legislatures.
Adolescent↗
Social resources and social function in comorbid eating and substance disorder: a matched-pairs study.
OBJECTIVE: To assess social resources and function among patients with comorbid Eating Disorder (ED) and substance abuse/dependence, referred to here as Substance Related Disorder (SRD). DESIGN: Descriptive, cross-sectional, comparative. SETTINGS: A university medical center with an Alcohol-Drug Program located within a Department of Psychiatry. SUBJECTS: 70 patients with Substance Related Disorder and Eating Disorder (SRD-ED), matched for gender, age, and race-ethnicity with 70 SRD-only patients. METHODS: A research associate assessed current social resources and social function based on data obtained from patients and collateral sources while blind to the ED status of the patient. Addiction psychiatrists made the diagnoses of SRD and ED and conducted assessments for axis 4 psychosocial stressors and axis 5 psychosocial function. RESULTS: SRD-ED patients had more advantageous social resources than SRD-only patients, including residence with family or friends, more education, higher socioeconomic status, and larger social networks. However, SRD-ED patients manifested martial status, employment, stressors, and coping levels similar to SRD-only patients. CONCLUSIONS: Several alternative explanations exist for these expected though unusual findings. Further analyses will be required to understand this lack of articulation between social resources and social function across two diagnostic groups.
Adolescent↗
Clinical relevance of contemporary cultural psychiatry.
In recent years, the field of cultural psychiatry has gained recognition and accumulated evidence of its clinical relevance. This article examines the intersections of culture and psychopathology and describes five independent but interrelated clinical dimensions that identify and define culture as: a) an interpretive/explanatory tool, b) a pathogenic/pathoplastic agent, c) a diagnostic/nosological factor, d) a therapeutic/protective element, and e) a service/management instrument. Along these lines, conceptual boundaries, clinical findings, specific applications, and research implications for each of the five dimensions are systematically reviewed. Cultural psychiatry adds significantly to the comprehensiveness of psychiatric evaluation and management and addresses prominent issues regarding understanding, classification, diagnosis, and competent treatment of most psychiatric disorders in every society and region of the world. Based on the strength of these clinical dimensions, and on the related educational and research efforts, cultural psychiatry can also contribute decisively to the design of comprehensive mental health policies.
Cultural Characteristics↗
Comorbid dysthymia and substance disorder: treatment history and cost.
OBJECTIVE: The purpose of this study was to determine the treatment history and cost of previous treatment among patients with comorbid substance-related disorder and dysthymia, as compared to patients with substance-related disorder only. METHOD: Retrospective data were obtained regarding past treatment. Treatment cost was calculated on the basis of the 1996 cost of various treatment modalities. The setting was alcohol-drug programs located within departments of psychiatry in two centers. A total of 642 patients were assessed, of whom 39 had substance-related disorder and dysthymia and 308 had substance-related disorder only (the remaining patients had other comorbid conditions). Data collection instruments included an interview-based questionnaire regarding previous psychiatric and substance abuse treatment. Current cost of treatment in various settings was assessed on the basis of a survey of facilities used by patients in this area. RESULTS: Patients with substance-related disorder and dysthymia had received more substance-related disorder treatment in 18 of 20 measures. Patients with substance-related disorder and dysthymia used 4.7 times more substance-related disorder treatment dollars than patients with substance-related disorder only, although their demographic characteristics were similar. Past self-help activities and pharmacotherapy were remarkably similar for both groups. Although substance-related disorder treatment differed considerably between the two groups of patients, other types of psychiatric treatment (i.e., non-substance-related treatment) did not differ between the two groups. CONCLUSIONS: Patients with substance-related disorder and dysthymia are referred to (or seek) substance-related disorder treatment more often than patients with substance-related disorder only but are referred to (or seek) non-substance-related psychiatric treatment no more often than patients with substance-related disorder only. The cost of previous substance-related disorder treatment was several times higher for the patients with substance-related disorder and dysthymia.
Adult↗
Substance use and abuse among patients with comorbid dysthymia and substance disorder.
This study determines the substance use and abuse patterns among patients with comorbid substance-related disorder (SRD) and dysthymia in SRD-dysthymia as compared with patients with SRD only. Differences in use and abuse patterns could be useful for (a) understanding motivations for use, such as self-treatment, and (b) assisting clinicians to identify cases of dysthymia among SRD patients. Retrospective and current data were obtained regarding history of substance use and current SRD diagnoses. Two university medical centers with alcohol-drug programs located within departments of psychiatry were the settings. A total of 642 patients was assessed. of whom 39 had SRD-dysthymia and 308 had SRD only. Data on past usc were collected by a research associate using a questionnaire. Current SRD and dysthymia diagnoses were made by psychiatrists specializing in addiction. The patients with SRD-dysthymia and SRD only did not differ with regard to use of alcohol, tobacco, and benzodiazepines. The patients with SRD-dysthymia started caffeine use at an earlier age, had shorter "use careers" of cocaine, amphetamines, and opiates, and had fewer days of cocaine and cannabis use in the last year. They also had a lower rate of cannabis abuse/dependence. This study indicated that patients with dysthymia and SRD have exposure to most substances of abuse that is comparable to patients with SRD only. However, they selectively use certain substances less often than patients with SRD only. Early use of caffeine may reflect self-treatment for depressive symptoms among patients with SRD-dysthymia.
Adolescent↗
The Minnesota Substance Abuse Problems Scale. Psychometric analysis and validation in a clinical population.
The authors determined interrelationships among 61 items in a scale designed to assess the severity of substance-related disorder (SRD) and develop subscales that measure distinct substance-related areas of dysfunction. They evaluated 642 outpatients with items previously developed among patients with SRDs. Trained interviewers administered the Minnesota Substance Abuse Problem Scales (M-SAPS), which uses responses to yes/no (lifetime) questions. A factor analysis of items was compared with data from patients and addiction psychiatrists to measure the concurrent validity of the M-SAPS factors, yielding 37 items in three factors: Psychiatric-Behavioral Problems (14 items), Social-Interpersonal Problems (11 items), and Addiction-Dependence Symptoms (12 items). These three scales correlate with 10 scales/assessments concurrently collected independently of the M-SAPS, yielding a brief, valid, interviewer-administered, substance-related problem scale that assesses SRD severity in three distinct areas.
Adaptation, Psychological↗
Clinical epidemiology of comorbid dysthymia and substance disorder.
The authors sought to determine the 1-year-period prevalence and demographic characteristics of comorbid substance-related disorder (SRD) and dysthymia, as well as the demographic characteristics of SRD-dysthymia patients as compared with SRD-only patients. Patients being treated at two university medical centers and abstinent less than 2 years were followed prospectively for 6 months to establish the diagnosis of dysthymia. A total of 642 patients were assessed, of whom 39 had SRD-dysthymia and 308 had SRD only. Data collection instruments included a demographic questionnaire and assessment of DSM Axis I psychiatric diagnoses. The 1-year prevalence rate was lower than noted in previous studies where there were less stringent criteria for dysthymia. The rate of dysthymia among these SRD patients closely resembled that observed in a general population study. SRD-dysthymia patients and SRD-only patients did not differ on most demographic characteristics. SRD-dysthymia is not easily detected among recovering SRD patients because of the need for lengthy observation and the absence of special demographic characteristics.
Adult↗
Predictors of hostility in a group of relocated refugees.
The objective of this research was to determine whether early postmigration demographic and psychosocial factors associated with cultural marginality would predict hostility one decade after flight and relocation. In this longitudinal study, participants, who had spent 1 year in a refugee comp, were studied at 1.5, 3.5, and 9 years postrelocation in the United States (i.e., Times 1, 2, and 3). Earlier data were compared with hostility at 9 years. Participants were interviewed primarily in their homes, although a few were interviewed elsewhere at their request (i.e., community center, University of Minnesota clinical offices). The 102 Hmong participants in this study, originally from Laos, comprised the first group of Hmong refugees, aged 15 to 72 years old (M = 31.0, SD = 13.1), to be relocated from Thailand to Minnesota by the Immigration and Naturalization Service in 1976. Hmong research assistants collected these data using a questionnaire format at 1.5, 3.5, and 9 years postrelocation. Hostility was measured using the Hostility subscale of the 90-item Symptom Checklist (SCL-90). Female gender, animistic belief, absence of a leadership role, and high scores on the SCL-Hostility predicted higher SCL-Hostility scores. Increased hostility was associated with greater financial, marital, and mental-emotional problems. This study suggests that demographic factors associated with marginality and loss of control predict hostility in a group of refugee immigrants. Losses and stressors from a decade earlier in Asia did not predict hostility.
Acculturation↗