HIV and other infectious disease prevention activities at mental health and substance abuse treatment agencies in Alaska.
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Alaska↗
Biomedical subjects
Mark E Johnson
Publications and source records attributed to Mark E Johnson.
A comparison of schizophrenic patients with or without coexisting substance use disorder.
Increasing numbers of research investigations have documented psychosocial, demographic, and treatment course differences between schizophrenic patients with and without additional substance use disorder. However, many of these studies have failed to control for additional psychiatric diagnoses. This study sought to elucidate differences between schizophrenic patients with versus without coexisting substance use disorder, while controlling for the possible confounding impact of additional Axis I or Axis II diagnoses. We explored the records of 308 psychiatric inpatients who were either solely diagnosed with schizophrenia or solely diagnosed with coexisting schizophrenia and substance use disorder. We compared these two groups on a variety of psychosocial, demographic, and clinical variables shown in prior research to differentiate these two types of patients. Findings revealed that substance use interacts with schizophrenia to increase psychiatric admissions and decrease lengths of stay upon admission. Findings also revealed that patients with coexisting substance use and schizophrenia have unique psychosocial and demographic presentations that reflect more challenging life circumstances. Differences were not revealed between groups in terms of legal and criminal involvement. Based on pure diagnostic groupings, findings indicate that an additional substance use disorder is associated with psychosocial, demographic, and treatment course differences among individuals with a schizophrenia diagnosis. When screening, developing treatment, and planning aftercare, it is crucial to not view individuals with schizophrenia diagnoses as a monolithic group, but rather to consider the presence of a substance abuse diagnosis; such consideration will increase the likelihood of appropriate treatment and successful outcomes.
Adult↗
Use of emergency room services by out-of-treatment drug users in Long Beach, California.
The purpose of this study was to investigate the use of emergency room services among out-of-treatment drug users in Long Beach, CA. Primary data collection occurred between 1991-1996. The study setting was a community-based location through which out-of-treatment drug users were recruited using a standard research protocol. The original study randomized 1,728 participants into a standard or enhanced HIV prevention protocol. Data were collected longitudinally at two points in time, with 1,201 returning for follow-up interview. Standardized instruments were used at baseline and follow-up. Logistic regression and test-retest reliability were performed using the SAS System. Factors associated with emergency room use included income from public assistance sources, ever using other opiates, income less than 500 dollars in the last month, reporting White race/ethnicity, and HIV positive serostatus. Having income from public assistance programs is highly predictive of emergency room use in out-of-treatment drug users.
Adult↗
Validity of injecting drug users' self report of hepatitis A, B, and C.
OBJECTIVE: To test the validity of drug users self-reports of diseases associated with drug use, in this case hepatitis A, B, and C. DESIGN: Injecting drug users (n = 653) were recruited and asked whether they had been diagnosed previously with hepatitis A, B, and/or C. These self-report data were compared to total hepatitis A antibody, hepatitis B core antibody, and hepatitis C antibody seromarkers as a means of determining the validity of the self-reported information. SETTING: Anchorage, Alaska. PARTICIPANTS: Criteria for inclusion included being at least 18-years old; testing positive on urinalysis for cocaine metabolites, amphetamine, or morphine; having visible signs of injection (track marks). INTERVENTION: Serological testing for hepatitis A, B, and C. MAIN OUTCOME: Findings indicate high specificity, low sensitivity, and low kappa coefficients for all three self-report measures. RESULTS: Subgroup analyses revealed significant differences in sensitivity associated with previous substance abuse treatment experience for hepatitis B self-report and with gender for hepatitis C self-report. CONCLUSION: Given the low sensitivity, the validity of drug users, self-reported information on hepatitis should be considered with caution.
Adolescent↗
Clients with substance abuse and mental health concerns: a guide for conducting intake interviews.
Although comorbidity (co-occurrence of a psychiatric and substance use disorder) is a common phenomenon at both mental health and substance abuse treatment agencies, rarely do such agencies thoroughly assess for both types of diagnoses during their standard intake interview. This article describes the development of an intake form designed to guide a comprehensive assessment of both mental health and substance abuse concerns. The form guides intake interviewers toward documenting administrative and demographic information, substance use and mental health concerns, and variables needed for compliance with grant funding sources. Use of the protocol and provide a clinical foundation for treatment planning and continuity of care for clients, while also providing error-free agency data that can be used for administrative, program planning, outcome assessment, and research purposes.
Clinical Protocols↗
Comorbidity training needs at a state psychiatric hospital.
This study explored training issues relevant to work with comorbid clients (those with both psychiatric and substance abuse diagnoses) among members of a psychiatric hospital clinical staff (N=147). Respondents reported that they had received limited training for working with comorbid or substance abusing clients; they perceived comorbid clients as presenting with particular concerns, especially regarding referral to treatment services and management of acting-out behaviors; and they attached great importance to the need for training in comorbidity. With high proportions of clients at psychiatric hospitals being comorbid, it is imperative that staff members receive training to deal with substance abuse and comorbidity. These results suggest that such training has not been available, but it is needed and wanted.
Alaska↗
Relationship among gender, depression, and needle sharing in a sample of injection drug users.
The authors explored the relationships among gender, needle sharing, and depression in a sample of 392 male and 121 female street drug users. Using the Risk Behavior Assessment (National Institute on Drug Abuse, 1991) and the Beck Depression Inventory-2 (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), the authors found that women reported higher levels of depression than men and that sharers endorsed higher levels of depression than nonsharers. Further, the authors found that female sharers reported the highest levels of depression of all groups, that is, as compared with male sharers, female nonsharers, and male nonsharers, who did not differ from one another. This suggests the presence of a special dynamic between gender and depression that is related to higher rates of needle sharing among women.
Adolescent↗
Recognizing comorbidity among drug users in treatment.
This study identified comorbidity (coexistence of substance abuse and mental health diagnoses) rates and characteristics among 104 clients in a substance abuse treatment setting. To identify commonly collected intake variables that can be used for early identification of drug users with coexisting mental health concerns, participants completed a demographics questionnaire, brief symptom inventory, behavior and symptom identification scale (BASIS-32), and a drug and alcohol assessment. Results revealed a comorbidity rate of 45% and significant relationships between comorbidity and the following variables: absence of prior treatment, greater rates of unemployment, poorer physical health, poorer functioning in a variety of areas, greater symptom severity regarding drug use, poorer mental health, and greater rates of homelessness. Of these, the first four variables were the most powerful predictors of comorbidity. It can be concluded that unemployment without looking for work, difficulties relating to self and others, not having received prior outpatient treatment, and having poorer physical health can signal the possible presence of coexisting mental health problems. Implications for early detection and subsequent treatment planning are discussed.
Adult↗
Contribution of Lactococcus lactis cell envelope proteinase specificity to peptide accumulation and bitterness in reduced-fat Cheddar cheese.
Bitterness is a flavor defect in Cheddar cheese that limits consumer acceptance, and specificity of the Lactococcus lactis extracellular proteinase (lactocepin) is widely believed to be a key factor in the development of bitter cheese. To better define the contribution of this enzyme to bitterness, we investigated peptide accumulation and bitterness in 50% reduced-fat Cheddar cheese manufactured with single isogenic strains of Lactococcus lactis as the only starter. Four isogens were developed for the study; one was lactocepin negative, and the others produced a lactocepin with group a, e, or h specificity. Analysis of cheese aqueous extracts by reversed-phase high-pressure liquid chromatography confirmed that accumulation of alpha(S1)-casein (f 1-23)-derived peptides f 1-9, f 1-13, f 1-16, and f 1-17 in cheese was directly influenced by lactocepin specificity. Trained sensory panelists demonstrated that Cheddar cheese made with isogenic starters that produced group a, e, or h lactocepin was significantly more bitter than cheese made with a proteinase-negative isogen and that propensity for bitterness was highest in cells that produced group h lactocepin. These results confirm the role of starter proteinase in bitterness and suggest that the propensity of some industrial strains for production of the bitter flavor defect in cheese could be altered by proteinase gene exchange or gene replacement.
Cheese↗
Rates and sequelae of the coexistence of substance use and other psychiatric disorders.
OBJECTIVES: Despite a growing body of investigations documenting the coexistence of substance use and other psychiatric disorders in a variety of patient populations, no data about comorbidity in the inpatient mental health system in Alaska have been published in scientific journals, and only limited data exist nationwide about coexistence rates in public psychiatric hospitals. METHODS: A retrospective population based study was performed on the entire population of psychiatric patients hospitalized at Alaska Psychiatric Institute (API) between 1993 and 2001. To explore rates of comorbidity, 5,862 patients (who accrued 10,656 visits) were classified according to their diagnostic status; to explore clinical and socio-demographic difference between patients with and without coexisting disorder, univariate analyses were calculated. RESULTS: The study revealed startlingly high rates of comorbidity that have been rising steadily since the early 1990's. In fact, comorbidity has become the rule, not the exception, among patients receiving services at API, with over 60% presenting with coexisting substance use symptoms. Complicating issues even further, these comorbid patients presented with more complex social and interpersonal circumstances, more complex clinical issues, different courses of treatment, and greater symptom complexity than psychiatric-only patients. CONCLUSIONS: 1.) Individual patient level--Providers for psychiatric inpatients must become more prepared to deal with coexisting substance abuse symptoms; policy makers must become more aware of the need for such patients to have smooth transitions from mental health to substance abuse treatment systems. 2.) Systemic-administrative level--Educators must better prepare providers to deal with this challenging clientele.
Adult↗
Preferences of Alaska and New Mexico psychiatrists regarding professionalism and ethics training.
OBJECTIVE: To identify the preferences of practicing licensed psychiatrists in two rural states regarding ethics training. METHOD: All licensed psychiatrists in Alaska and New Mexico were mailed a survey exploring differences in ethical and practice issues between rural and urban health care providers. Data were collected from 97 psychiatrists. RESULTS: Findings indicated a moderate level of interest in training related to a diverse set of ethics topics. Although women expressed greater interest in most topics than did men, ranking of topics was similar across genders. Level of interest in training was inversely related to number of years in practice. CONCLUSIONS: The psychiatrists in this study indicated some interest in professionalism and ethics training, but did not express the level of need or enthusiasm documented in many studies of physicians-in-training. Creating continuing medical education initiatives that are attuned to the distinct needs and preferences of psychiatrists in clinical practice thus poses many challenges. This may be particularly true for certain aspects of practice, such as ethics and professionalism, that have long been recognized as vital to clinical care, but now are viewed as core competency areas.
Alaska↗
Comorbidity in Alaska: evidence and implications for treatment and public policy.
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Alaska↗