PubMed Health⌕ Search

Biomedical subjects

K C Winters

Publications and source records attributed to K C Winters.

At least 19 recordsLinked to original sources
PubMed2002

Clinical issues in the assessment of adolescent alcohol and other drug use.

Clinicians working with adolescents are routinely faced with the issue that alcohol and other drug (AOD) involvement may be part of the clinical picture either as a primary problem or a contributing factor to other problems or disorders. Fortunately, assessment research in this area has produced several behaviorally oriented and psychometrically sound tools from which to choose for problem identification, referral and treatment of youth suspected of AOD abuse. The aim of this paper is to provide an overview of several issues related to the clinical utility of such assessment tools.

Adolescent↗
PubMed2001

Outcome of Minnesota's gambling treatment programs.

This study measured the outcome of four state-supported outpatient gambling treatment programs in Minnesota. The programs were developed specifically for the treatment of pathological gamblers and offered multiple modalities of treatment including individual, group, education, twelve-step work, family groups, and financial counseling. The therapeutic orientation was eclectic with an emphasis on the twelve steps of Gamblers Anonymous (GA) and a treatment goal of abstinence. The sample included 348 men and 220 women treated between January 1992 and January 1995. A pretest-posttest design was utilized with multidimensional assessments obtained at intake, discharge, six-months, and twelve-months post-discharge. Variables assessed included a range of clinical and outcome variables. At six month follow-up, 28% reported that they had abstained from gambling during the six months following discharge and an additional 20% had gambled less than once per month. Almost half of the sample (48%) showed clinically significant improvement in gambling frequency at six month follow-up. Outcome variables of gambling frequency, SOGS scores, amount of money gambled, number of friends who gamble, psychosocial problems, and number of financial problems, all showed statistically significant improvements from pretreatment to follow-up. The treatment programs yielded outcome results similar to those reported for alcohol and drug abuse treatment programs.

Adult↗
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

Gambling involvement and drug use among adolescents.

The literature on youth gambling often notes the relationship of gambling involvement to drug use. The extent of this association and its importance toward advancing knowledge about the origins and course of adolescent gambling are discussed. The authors contend that (a) adolescent gambling, like drug use, may be a normal part of adolescence from a statistical perspective, (b) claims that the prevalence rate of problem/pathological gambling is comparable or higher than the rate of substance use disorders are not supportable at this time given the weaker methodological studies in the gambling area, (c) while research suggests that similar risk factors may be important determinants for both behavior domains, prospective studies of adolescent development are needed to further clarify which factors are unique and common to adolescent gambling, and (d) greater documentation of the harm associated with adolescent gambling is a major barrier to garnering more prevention and treatment resources for this issue.

Journal Article↗
PubMed2000

Demographic, individual, and interpersonal predictors of adolescent alcohol and marijuana use following treatment.

A vulnerability model of adolescent substance abuse treatment outcome provided the basis for selection of demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of adolescents (N = 225) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 months posttreatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-month follow-up. Peer substance use at intake and 6-month posttreatment both predicted substance use frequency outcomes at 12-month follow-up. Alcohol and marijuana use frequencies at 6-month follow-up also predicted continued use for these substances throughout the remainder of the 1st posttreatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st posttreatment year. Elevated psychological substance dependence at 6-month follow-up was a unique risk factor for subsequent marijuana use. Findings support conceptual models that attempt to explain adolescent substance abuse treatment outcome in terms of relationships among demographic, individual, interpersonal, and treatment factors.

Adolescent↗
PubMed2000

The effectiveness of the Minnesota Model approach in the treatment of adolescent drug abusers.

AIMS: The treatment outcome of drug-abusing adolescents treated with a 12-Step approach. DESIGN: The study compares drug use outcome data at 6 and 12 months post-treatment among three groups of adolescents: those who completed treatment, those who did not and those on a waiting list. Also, among treatment completers, residential and outpatient samples were compared on outcome. SETTING: The treatment site is located in the Minneapolis/St Paul area of Minnesota. PARTICIPANTS: Two hundred and forty-five drug clinic-referred adolescents (12-18 years old), all of whom met at least one DSM-III-R substance dependence disorder. One hundred and seventy-nine subjects received either complete or incomplete 12-Step, Minnesota Model treatment and 66 were waiting list subjects. MEASUREMENTS: In addition to demographics and clinical background variables, measures included treatment involvement, treatment setting and drug use frequency at intake and follow-up. FINDINGS: Absolute and relative outcome analyses indicated that completing treatment was associated with far superior outcome compared to those who did not complete treatment or receive any at all. The percentage of treatment completers who reported either abstinence or a minor lapse for the 12 months following treatment was 53%, compared to 15 and 28% for the incompleter and waiting list groups, respectively. CONCLUSIONS: Favorable treatment outcome for drug abuse was about two to three times more likely if treatment was completed. Also, there were no outcome differences between residential and outpatient groups. Alcohol was the most common drug used during the follow-up period, despite cannabis being the preferred drug at intake.

Adolescent↗
PubMed2000

Adolescent substance abuse treatment outcome: the role of substance abuse problem severity, psychosocial, and treatment factors.

A structural equation model incorporating substance abuse problem severity, psychosocial risk and protection, and treatment variables examined adolescent drug abuse treatment outcome pathways across 6- and 12-month follow-up points. Findings on resiliency factors and an empirical method adapted from previous research were used to select and assign 10 psychosocial factors to either a multiple protective factor index or a risk factor index. Gender, substance abuse problem severity, treatment modality, treatment length, and aftercare participation were also examined as outcome predictors. The findings suggest that treatment intensity decisions may be better informed by pretreatment psychosocial risk level rather than by substance abuse problem severity. The present study also suggests that drug-abusing adolescents who receive sufficiently long treatment, participate in aftercare, and possess at least 1 individual or interpersonal protective factor during their recovery process have the best chance to maintain gains made during treatment.

Adolescent↗
PubMed1999

A new multiscale measure of adult substance abuse.

Several assessment measures exist in the adult substance abuse field, but the majority of them are either screening tools or are limited to alcohol use. Current trends in drug abuse patterns and the service care industry suggest the need for sophisticated and comprehensive instrumentation. This paper focuses on the design and psychometric properties of a 270-item, multiscale, self-report inventory for measuring a wide range of problems associated with adult substance abuse. The Personal Experience Inventory for Adults consists of problem severity and psychosocial risk scales, validity indicators, and problem screens. Basic reliability and validity data will be summarized.

Adult↗
PubMed1999

The DSM-IV criteria for adolescent alcohol and cannabis use disorders.

OBJECTIVE: The aims of this study are to compare DSM-IV criteria for alcohol and cannabis use disorders with its predecessor, DSM-III-R, and to examine the validity of the new criteria in an adolescent drug clinic sample. METHOD: During evaluation, a sample of 772 adolescents (63% boys, 77% white) were administered a structured interview of diagnostic symptoms and additional problem severity measures. Independent staff ratings of problem severity and treatment referral were collected as well. RESULTS: Compared to its predecessor, DSM-III-R, application of the DSM-IV criteria for alcohol and cannabis users resulted in more abuse assignments and fewer dependence assignments. The shift in assignments appeared to be largely due to a lowering of the abuse threshold, rather than to a tightening of the dependence criteria. The external validity data generally supported the DSM-IV abuse and dependence distinction in adolescents, and the newer criteria were as valid as the older criteria. CONCLUSIONS: In contrast to DSM-III-R, the DSM-IV system yields more abuse cases and fewer dependence cases among adolescent alcohol and cannabis abusers. Validity evidence for the new criteria are defensible, yet the findings are seen as a starting point for discussing the need for tailoring substance use disorder criteria for adolescents.

Adolescent↗
PubMed1998

Diagnosis and assessment of alcohol use disorders among adolescents.

The diagnostic criteria for alcohol use disorders (AUDs) (i.e., alcohol abuse and alcohol dependence) as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were developed largely from research and clinical experience with adults. Little is known about the validity of these criteria when applied to adolescents. Recent epidemiological and clinical studies of AUDs and their symptoms among adolescents have indicated that the DSM-IV criteria have significant limitations when applied to this age group. Diagnostic interviews and screening tools for adolescent AUDs are discussed. Numerous instruments are available that have shown moderate-to-high reliability and validity in assessing AUDs among adolescents.

Adolescent↗
PubMed1997

Screening for drug abuse among adolescents in clinical and correctional settings using the Problem-Oriented Screening Instrument for Teenagers.

Recent research has indicated high rates of substance abuse among adolescents with emotional and behavioral disorders. Moreover, adolescents in clinical and correctional settings found to have comorbid disorders involving substance abuse experience higher morbidity and mortality rates when compared to adolescents having one or no condition. The present study examines the ability of the Problem-Oriented Screening Instrument for Teenagers (POSIT) to identify DSM-III-R-defined psychoactive substance use disorders among 342 adolescents aged 12-19 years. Participants were sampled from school, clinical, and correctional settings. Optimal-scale cut scores for drug abuse diagnosis classification were derived by a minimum loss function method that minimized false classifications. When using the optimal cut score of two for the total sample, the standard POSIT substance use/abuse scale obtained a drug abuse diagnosis classification accuracy of 84% with sensitivity and specificity ratios of 95% and 79%, respectively. The internal validity of the standard 17-item substance use/abuse scale was subsequently examined by principle component analysis, item analysis, and coefficient alpha. The internal validity analyses were conducted to determine if a shortened scale could be developed and yet retain acceptable classification accuracy. When using the optimal cut score of two for the total sample, the revised 11-item scale obtained a drug abuse diagnosis classification accuracy of 85% with sensitivity and specificity ratios of 91% and 82%, respectively. The results suggest that the POSIT can serve as a useful first-gate instrument to identify adolescents in need of further drug abuse assessment.

Affective Symptoms↗
PubMed1997

Measuring change in adolescent drug misuse with the Personal Experience Inventory (PEI).

The purpose of this study was to examine the utility of the Personal Experience Inventory (PEI) as a measure of change in adolescent drug misuse. One year test-retest reliability of the PEI Problem Severity Scales was measured in a sample of drug-misusing adolescents who did not receive treatment during the 1-year test-retest interval (n = 37). The five PEI Problem Severity Scales demonstrated satisfactory 1 year temporal stability coefficients, ranging from .86 to .89. The utility of the PEI as a measure of change was demonstrated by using the 1-year test-retest reliability data to measure both statistically significant and clinically significant change between admission and 1-year follow-up in a sample of drug-misusing adolescents who received treatment (n = 45). The PEI was useful in identifying which treatment clients exhibited statistically significant improvement, statistically significant deterioration, and no reliable change.

Adolescent↗
PubMed1993

Further validation of new scales measuring adolescent alcohol and other drug abuse.

The Personal Experience Inventory (PEI) is a recently developed self-report inventory that measures problem severity and psychosocial risk factors associated with adolescent alcohol and other drug involvement. Although previous studies have provided initial support for the psychometric properties of the PEI, this validity evidence was based on uncontrolled studies. The present study examined the concurrent validity of the PEI on a new sample using more controlled research procedures. Results indicated that the PEI Basic Problem Severity scales were significantly related to groups defined by DSM-III-R criteria for substance use disorders and by treatment referral recommendations. Also, the main PEI Problem Severity scale, the Personal Involvement scale, correctly classified a significantly greater proportion of participants into referral subgroups than would be expected given the base rates for the sample. This evidence provides additional support for the validity of the PEI as a problem severity measure of adolescent alcohol and other drug use.

Adolescent↗
PubMed1989

Development of psychosocial scales for the assessment of adolescents involved with alcohol and drugs.

There are differences among adolescents who use alcohol and other drugs not only in the extent and pattern of their use, but also with respect to the factors that may have contributed to or accompany their involvement with drugs. The Personal Experience Scales (PES) is a new self-report inventory developed to assess psychosocial factors that may: (1) predispose or perpetuate adolescent chemical involvement, (2) complicate chemical abuse treatment, or (3) require treatment in their own right. This paper provides an overview of the development of the PES. Scale construction procedures, scale characteristics, and evidence of scale validity are reported.

Adaptation, Psychological↗
PubMed1988

Development of problem severity scales for the assessment of adolescent alcohol and drug abuse.

The Chemical Dependency Adolescent Assessment Project was established to develop a standardized assessment battery to provide a multidimensional description of problems associated with alcohol and drug use by adolescents that can assist in the identification, referral, and treatment of adolescent alcohol and drug abuse. This paper provides an overview of the development of the portion of the assessment battery that addresses problem severity of alcohol and drug abuse. Scale construction procedures, scale characteristics, and relationships of scales with external variables are discussed.

Adolescent↗