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N el-Guebaly

Publications and source records attributed to N el-Guebaly.

At least 19 recordsLinked to original sources
PubMed1995

Prospective and retrospective reports of mood states before relapse to substance use.

In a prospective design, it was predicted that the role of negative mood in precipitating relapses and crises among alcohol-dependent participants would be greater when assessed with retrospective mood ratings than when assessed by prospective mood ratings because of participants' attributional biases. This hypothesis was not supported. Support was found, however, for a relationship between negative bias and the amount of negative mood assessed at the time the retrospective report was given. As has been previously found, the most frequent precipitant of relapses and crises in this study was negative emotional states. Female participants were more likely to report interpersonal and less likely to report intrapersonal determinants than male participants. Minor relapses were more likely to be precipitated by social pressure and less likely to be related to negative emotions than major relapses.

Adolescent↗
PubMed1995

Alcohol and polysubstance abuse among women.

A review of the literature in this relatively new field highlights the legitimacy of gender-specific research on substance abuse in women. Consistent findings compared to men include a higher physical vulnerability to alcohol, a higher risk of assortative mating, the reported association of traumatic events with the onset of substance abuse, a higher psychiatric comorbidity and a shorter interval between first problem and first treatment episode. Intravenous drug use remains the major source of growth of HIV infection among women. Family assessment and treatment as well as the involvement of female role models are critical to the recovery process. Gender-specific services may be recruiting women who might not otherwise have sought treatment for their substance abuse. Further investigation is required in order to distinguish the relative significance of the genetic versus environmental vulnerability of women, the impact of rapidly changing social mores on the onset, pattern and course of substance abuse, possible gender-specific alcohol typologies, the validity of the recall of traumatic events as well as the program variables required in reaching out and engaging women on the path to recovery.

Adult↗
PubMed1992

More data on the Addiction Severity Index. Reliability and validity with the mentally ill substance abuser.

The Addiction Severity Index (ASI) is a semistructured interview that collects data from substance abusers in seven problem areas: medical, employment, legal, alcohol, other drug use, family-social functioning, and psychological status. In each area, the clients provide an estimate of the seriousness of the problem and their need for treatment. It has been demonstrated in a number of studies to be reliable, valid, and useful in monitoring treatment changes and in matching substance-abusing clients to treatments. This study investigates the usefulness of the ASI with male and female substance abusers who suffer a concurrent major psychiatric disorder (N = 152). Data on the independence of the problem scales, their internal consistency, interrater reliability, and concurrent validity are presented. It is concluded that: a) the problem areas are independent from each other, underscoring the need for multidimensional assessment; b) interviewer severity ratings provide information in addition to that provided by clients; c) the reliability of the composite scores is generally adequate, with the exception of the legal and family-social scales; and d) further examination of the employment scores is required.

Adult↗
PubMed1992

Adult children of alcoholics in treatment programs for anxiety disorders and substance abuse.

Studies of the first-degree relatives of patients with alcoholism and anxiety disorders have identified a significant overlap of these disorders. Forty percent of the patients in an outpatient anxiety disorder program were adult children of alcoholics (ACOA), a proportion similar to that found in the substance abuse program. The ACOAs in both programs were younger, had higher co-dependency scores and were younger when they had their first psychiatric contact than the controls. The adult children of alcoholics who had anxiety disorders were more likely to be female and their alcoholic parents were less likely to have had psychiatric antecedents to alcoholism. Aside from substance abuse, similarities in sociodemographic variables and the impact of the parents' alcoholism were noted, reinforcing the hypothesis that vulnerabilities to anxiety disorders and alcoholism overlap.

Adult↗
PubMed1992

Schizophrenia and substance abuse: prevalence issues.

A review of studies of the prevalence of substance abuse among schizophrenics suggest that both demographic and environmental factors are strong determinants of the extent of substance abuse in this population as well as the type of substances used. In a mid-sized Canadian city, a sample of schizophrenic patients referred to a dual diagnoses clinic were administered the Addiction Severity Index. With age and gender included as a factor, no significant differences were found in the choice or length of use of most drugs between diagnostic groups, contrary to some other reports from large urban centres. Compared with a population of a similar age, there were fewer regular and more former drinkers among the schizophrenic patients. The choice of other substances by the sample reflected the pattern of use in the population at large. This approach to prevalence provides a more balanced perspective of the substance abuse by schizophrenics. The major targets for prevention remain the alcohol, caffeine and tobacco consumption.

Adult↗
PubMed1991

The optimal psychiatrist-to-population ratio: a Canadian perspective.

A systematic effort is underway to rationalize the planning of physician supply. This paper summarizes the current methodologies available and focuses on the attempts to determine the optimal psychiatrist-to-population ratio in Canada. The impact of several variables influencing this ratio is discussed. An outline of the correlation between target physician supply and requirements of future trainees is presented. While the relevant methodology is rapidly evolving, an improved process of data collection is urgently required. A number of challenges for our profession lay ahead, such as the need for sensitive and reliable measures of the adequacy of psychiatrist and subspecialist supply and public issues arising from the poor geographic distribution of psychiatric manpower.

Canada↗
PubMed1991

The adult children of alcoholics in a psychiatric population.

The issues confronting adult children of alcoholics (ACOA) are well publicized but their empirical basis remains limited. The screening of 250 consecutive psychiatric admissions to a general hospital revealed a significant prevalence of ACOAs across diagnoses. Compared to the other patients, the ACOA group was younger but with no other socioeconomic difference. The diagnoses of substance abuse and phobic disorders were more frequent. The group was psychiatrically hospitalized at an earlier age. The impact of an ACOA status varied with the parental biological relation and gender, and with the premorbid antecedents of parental alcoholism.

Adult↗
PubMed1991

Psychometric evaluation of the Children of Alcoholics Screening Test (CAST) in a psychiatric sample.

The Children of Alcoholics Screening Test (CAST) is a 30-item screening instrument developed to identify children who are either living with or have lived with alcoholic parents. In a sample of 250 psychiatric patients, the CAST exhibited substantial item-total scale correlations and a high level of internal consistency reliability. Total CAST scores discriminated self-identified children of problem drinkers from control subjects and were significantly correlated with the severity of parental psychological and social complications due to alcohol misuse. Factor analysis indicated a unidimensional scale structure. CAST cut-off scores produced a low false positive and false negative rate. The psychometric properties of the CAST suggest that it is a useful screening instrument for identifying the offspring of problem drinkers and alcoholics.

Adult↗
PubMed1990

Psychometric properties of the Drug Abuse Screening Test in a psychiatric patient population.

The Drug Abuse Screening Test (DAST) is a 28-item screening instrument developed by Skinner for clinical screening and treatment evaluation research in the substance abuse field. In a sample of 250 psychiatric patients drawn from four treatment programs, the DAST evidenced high internal consistency reliability and good item-total score correlations. A factor analysis of the DAST item correlation matrix revealed a predominantly unidimensional scale with the possibility of rotating five additional factors reflecting a continuum of drug abuse. The five factors were interpreted as (a) self-recognition of a drug problem, (b) serious social consequences of drug use, (c) help-seeking for drug abuse, (d) illegal drug-related activities, and (e) inability to control drug use. The diagnostic validity of the DAST in discriminating patients according to DSM-III Substance Abuse diagnostic criteria was high and a range of valid clinical DAST cutoff scores from 5/6 through 10/11 was identified. The DAST appears to be a valid measure of drug involvement and abuse in a psychiatric patient population, a finding of increasing clinical relevance.

Adult↗
PubMed1990

Substance abuse and mental disorders: the dual diagnoses concept.

The concept of "dual diagnoses" is reviewed along with its clinical implications. Prevalence studies report substance abuse in psychiatric populations as ranging between 20% and 75%, depending on reporting, demographic variables and the community availability of substances. On the other hand, 20% to 65% of alcoholics entering rehabilitation suffer from another major psychiatric disorder. The clinical impact of dual diagnoses involves the development and expression of psychiatric disorders depending on the choice of drugs, the severity of psychopathology and risk of assaultive behaviour, possible misdiagnosis such as the confusion between alcoholism and affective disorders, the increased use of psychiatric resources including emergency, an earlier onset of symptomatology and poorer prognosis. The evolutionary impact of the concept, reflected in successive psychiatric diagnostic classifications, is discussed along with its bridging influence between the fields of mental health and addictionology. Appropriate assessment tools along with treatment strategies are suggested. Effective features of a group process include a nonconfrontational approach with emphasis on education, an expectation of abstinence as a goal, a discussion of diagnoses and medication and lastly particular attention to vocational rehabilitation and constructive use of leisure time.

Humans↗
PubMed1989

A call for primary prevention: reality or utopia.

The efficacy of primary prevention of mental disorders has been debated over the years. The debate is complicated by ideology, semantic confusion, methodological difficulties and a paucity of good evaluative studies. This paper reviews newer concepts of primary prevention and mental health promotion, methodological issues, model programs, and inherent ethical concerns. Further evaluative studies and an increased contribution of psychiatrists to the primary prevention debate are recommended as necessary steps in further evolution of the field.

Canada↗
PubMed1988

Peer review: empirical data base and practical implications.

Psychiatrists in the U.S. have raised a host of issues related to their experience with peer review including a concern for the patient's confidentiality, the need to correlate normative standards with local customary practice, the significance of the reviewer's theoretical orientation and training, the optimal documentation required and the impact of peer review on the reimbursement of claims for services rendered. The empirical and experimental evidence relevant to these issues is reviewed. The resulting implications for our clinical freedom and developing quality assurance network are discussed.

Canada↗
PubMed1987

Alcohol, alcoholism, and biological rhythms.

Chronobiological rhythms contribute to our understanding of the effect of alcohol and of several features of alcoholism. The observation of infradian periodicities suggests preventive seasonal strategies aimed at reducing the consumption of alcohol and its consequences. Circadian variations in blood alcohol levels and behavioral impairment indicate a complex temporal rhythmicity with both physiological and psychosocial determinants. Circadian differences are noted among possible mediators of susceptibility towards alcoholism. Ultradian patterns may be of prognostic value in assessing risks such as that of relapse during withdrawal from alcohol. Recommendations for future animal and human investigations are suggested.

Adult↗
PubMed1987

Chronobiological susceptibility to alcoholism: a hypothesis.

The search for carriers of a specific biologic risk for alcoholism is ongoing. In addition to seeking "the needle in the haystack," the need to monitor a broader phenotypic indicator such as chronobiological interaction is hypothesized. Certain potential mediators of genetic predisposition to alcoholism are subject to periodic rhythmicity in both animal and human investigations. These mediators include prolactin, cortisol, and MOPEG levels along with possible sleep characteristics. Suggestions for future animal and human investigations are outlined using adequate sampling criteria, appropriate rating and recording instruments, and controls predisposed to other psychiatric diagnoses.

Activity Cycles↗
PubMed1986

Risk research in affective disorders and alcoholism: epidemiological surveys and trait markers.

Traditional designs in risk research have been in the form of epidemiologic surveys aimed at assessing a genetic contribution or search for broader indicators of vulnerability, resulting from the interaction of both nature and nurture. Recently, an interest in biological markers has resulted in the search for possible trait markers identifying more specifically, individuals with a life-long risk for an illness that may be expressed or not. The contributions, limitations and evolution of these strategies are reviewed in the syndromes of affective disorders and alcoholism. Recommendations include the use of biotypes rather than phenomenotypes for the diagnosis of the index case. Current promising approaches include the study of pedigrees biased towards a particular variable, a discriminant analysis of the variation in expressivity of the syndrome and the genetic linkage studies. While there is so far no established trait marker, research strategies are emerging and withstanding the test of time. The present technological explosion will undoubtedly further our understanding of risk factors.

Adoption↗
PubMed1986

Change with time in patients' reactions to committal.

The influence of time on patients' reactions to involuntary committal is a variable seldom considered in reports. The reactions to committal of thirty-four subjects interviewed one week/one month/three months/six months post committal are reported. Generally committal was viewed neutrally. The major changes in attitudes related to knowledge of the fact of committal and of rights of appeal. The importance of these findings for the management of committed patients is stressed.

Adult↗