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Biomedical subjects

T D Nirenberg

Publications and source records attributed to T D Nirenberg.

At least 19 recordsLinked to original sources
PubMed1997

Analysis of alcohol use clusters among subcritically injured emergency department patients.

OBJECTIVES: 1) To cluster patients according to self-reported drinking patterns using cluster analysis; 2) to externally validate clustered groups on variables related to drinking but not used in the cluster analysis; and 3) to use the clustered patients' responses to alcohol consumption questions to develop a brief screening tool emergency physicians can use to identify patients in need of referral or intervention related to potentially hazardous alcohol consumption. METHODS: A self-report battery was administered to 95 subcritically injured patients. Patients also were saliva alcohol-tested upon arrival to the ED. Using the patients' self-reported quantity, frequency of alcohol consumption, and frequency of having > or = 6 drinks on a drinking occasion, patients were categorized into 3 groups using cluster analysis. The 3 clusters were externally validated using injury-related variables, alcohol-related consequences, and the patients' reported readiness to change drinking. A screening tool was developed using cutoff values reported by the patients' answers to drinking pattern questions. RESULTS: Fifty-nine patients were alcohol-negative, and 36 tested alcohol-positive (i.e., > 4 mmol/L [> 20 mg/dL]) or had elevated scores on an alcohol problem screening instrument. Three distinct drinking pattern clusters were found. Clusters were validated using discriminant function analysis and multivariate analyses of variance to confirm cluster classifications. Steady and high-intensity drinkers reported more alcohol-related negative consequences, and high-intensity drinkers indicated they would consider changing their drinking. The screening tool correctly classified 97% of the patient sample into their respective clusters. CONCLUSIONS: Using the drinking pattern questions in the clustering procedure was effective for grouping injured patients into clusters that could be differentiated on other drinking-related variables. The resulting screening tool can be used in the ED setting to screen patients for further assessment and intervention. The readiness-to-change results support the assertion that the injury event provides a "teachable moment" for subcritically injured patients whose injury may be related to their alcohol consumption.

Alcohol Drinking↗
PubMed1996

Identification of hazardous/harmful drinking among subcritically injured patients.

OBJECTIVES: To examine the relationship between a saliva alcohol test (SAT) and hazardous/harmful drinking, as measured by the Alcohol Use Disorders Identification Test (AUDIT), among a sample of subcritically injured patients. METHODS: Patients (n = 78) seeking treatment for a subcritical injury were saliva-tested for alcohol and interviewed regarding their drinking behaviors and related difficulties. Associations of SAT values with AUDIT results were determined. RESULTS: SAT results and hazardous/harmful drinking were not independent events (p < 0.001). Estimates of sensitivity and specificity (using a dichotomous SAT result [> or = 4 mmol/L] to identify positive AUDIT patients) were 65.2% and 83.6%, respectively. SAT-positive people had significantly higher AUDIT scores than did SAT-negative individuals (p < 0.0001). Patients experiencing assault-type injuries were much more likely to be SAT-positive than were patients incurring other types of injury. Discriminant function analysis suggests that AUDIT scores can successfully identify SAT-positive and SAT-negative patients; the analysis accounted for 42.5% of the variance and correctly classified 84.6% of the sample. CONCLUSIONS: The use of an easy-to-administer, noninvasive, routine SAT, among patients presenting for a subcritical injury in a hospital ED, provides a mechanism for the identification of individuals with a history of hazardous/harmful drinking. However, since discrimination of hazardous/harmful drinking is imperfect, some caution is warranted when conducting such screening activities.

Accident Proneness↗
PubMed1995

Alcohol use among subcritically injured emergency department patients.

OBJECTIVES: To determine the incidence of alcohol use in subcritically injured patients presenting to the ED, by using a saliva alcohol test (SAT) at ED triage during the ED initial assessment; to compare the incidence of alcohol use revealed by the SAT with documentation of alcohol use by ED nurses and emergency physicians (EPs) blinded to the SAT results; and to describe the demographics of the SAT-positive, subcritically injured population. METHODS: A blinded, prospective, observational evaluation of ED patients presenting with subcritical injuries was performed. The patients were tested for alcohol use with an SAT, and a subsequent record review was conducted for extraction of demographic data and evidence of documentation of alcohol use by ED nurses and EPs blinded to the SAT results. RESULTS: During the study, 791 subcritically injured patients had SATs performed. Twenty-one percent of these patients were found to be alcohol-positive by SAT. Either the ED nurse or the EP documented a clinical impression of alcohol use for 52% of the SAT-positive patients. There were higher SAT-positive rates among men (24%), victims of assault (47%), and patients arriving at night (41%). CONCLUSIONS: While the SAT identified 21% of the subcritically injured patient population as alcohol-positive, ED nurse and EP documentation did not identify half of these alcohol-positive patients. Many of these patients may be at risk for additional injuries related to their drinking behavior.

Adolescent↗
PubMed1995

Injury as a motivator to reduce drinking.

OBJECTIVES: To identify predictors of readiness to change drinking behavior by minor-injury patients who had positive saliva alcohol tests (SATs) in the ED. To develop and test a model intended to be prognostic of readiness to change, which included predispositional and injury-event-related variables. METHODS: An on-site survey was conducted of minor-injury ED patients sampled consecutively during predesignated periods. Patients were identified as SAT-positive during their screening evaluations. After giving their consent, they were administered a self-report battery that assessed predispositional and injury-event-related variables as well as readiness to change their drinking. Predictors of readiness to change drinking were tested with regression analyses. RESULTS: Twenty-four SAT-positive patients participated; there were 18 men and six women (average age 34 years). Preinjury predispositional variables were by themselves unrelated to the patient's readiness to change while in the ED. Aversiveness of the injury and perception of degree of alcohol involvement were injury-event-related variables predictive of readiness to change (p < 0.008). Negative consequences attributed to drinking prior to the injury event strengthened the association of injury aversiveness and alcohol involvement with readiness to change (p < 0.0075). CONCLUSION: Interventions to decrease drinking in this population should focus on increasing patient awareness of the association between drinking, injuries, and other alcohol-related negative consequences.

Adult↗
PubMed1993

Development of a behavior analytically derived alcohol-specific role-play assessment instrument.

Social learning theory postulates that chronic alcohol abusers may have deficits in ability to cope with stressful situations, and these deficits may be associated with relapse after treatment. Attempts to study the hypothesized deficits have been hampered by methodological problems. Therefore, a behavior analytic procedure was used to develop 10 categories of situations based on over 600 drinking situations elicited from alcoholics. Role plays were developed for each of these categories, and samples of alcoholics in treatment were asked to respond as if they were trying not to drink. Videotaped responses were behaviorally rated by trained judges for skill and anxiety, and subjects completed self-report ratings of urge to drink, anxiety, difficulty and skill after each role play. Good interrater reliabilities and internal consistency were found across three samples of alcoholics, with virtually no gender differences. Previous and current investigations show the validity and utility of this instrument. The Alcohol Specific Role Play Test therefore shows promise as a means of assessing alcoholics' reactions to high-risk situations.

Adaptation, Psychological↗
PubMed1991

Volunteer bias in a study of male alcoholics' sexual behavior.

Studies on sexual behavior frequently require that subject volunteers engage in intrusive/sensitive assessment procedures. While earlier investigators have found that these demands may result in volunteer bias (volunteers differing from nonvolunteers), these studies were limited to nonclinical samples. The present study involved 182 males admitted to an inpatient alcoholism rehabilitation program. Those patients who volunteered to participate in an intrusive study examining sexual functioning were dissimilar to nonvolunteers. Compared to nonvolunteers, volunteers reported a greater interest in sex, less satisfaction with sex, more concerns about sexual functioning, a greater incidence of premature ejaculation, and a greater incidence of negative sexual experience. Volunteers also had a higher MAST score, used outpatient substance-abuse counseling more often, and more frequently had a diagnosis of cocaine/amphetamine dependence and cannabis dependence. These differences between volunteers and nonvolunteers suggest a need to use caution when generalizing the results of similar studies to the overall population. Procedures that may help to minimize volunteer bias are offered.

Adult↗
PubMed1991

Patient-treatment matching for alcoholic men in communication skills versus cognitive-behavioral mood management training.

It would be helpful to be able to predict which alcoholics will be more likely to benefit from specific forms of treatment in order to optimize treatment resources. Certain hypothesized patient-treatment matching predictions were investigated with 52 alcoholics who received either communication skills training or cognitive behavioral mood management training in addition to a standard Veterans Administration inpatient alcoholism treatment program. Significant interaction effects showed that alcoholics had worse treatment outcomes in mood management training if they had higher initial anxiety or urge to drink in high-risk role plays or lower had higher initial anxiety or urge to drink in high-risk role plays or lower education. No significant interaction of treatment with irrational beliefs or marital status was found. Communication skills training seemed to be equally effective for alcoholics at any educational level, irrespective of initial coping skill, anxiety, urge to drink, alcohol dependence, or marital status. Thus, although mood management training seems to be as effective as communication skills training for alcoholics with higher education, less anxiety, and less urge to drink, communication skills training benefits a broader spectrum of patients, regardless of initial level of education, alcohol dependence, skill, anxiety, or beliefs.

Adult↗
PubMed1991

Alcohol content variation in the assessment of alcohol consumption.

Most investigators have not adequately accounted for the alcohol content of different beverages when assessing alcohol consumption. Considerable research has assessed consumption in terms of the number of standard drinks. A problem with standard drink measures is that different distilled spirits, wines, and malt beverages vary considerably in alcohol content. State-to-state and brand-to-brand variations in the strength of different malt beverage brands are provided, as malt beverage alcohol contents are not contained on labels due to federal and state regulations. Ignoring alcohol content variation when estimating consumption can produce a large amount of error. Alcohol consumption should be assessed in terms of the number, size, and alcohol content of beverages.

Alcohol Drinking↗
PubMed1991

Alcohol abusers' and social drinkers' responses to alcohol-relevant and general situations.

Responses of alcohol abusers and social drinkers were compared on general and alcohol-specific problem situations using role-play methodology. Multiple responses were assessed including behavioral observational ratings, self-reports and psychophysiologic measures. There were few differences between groups in responses to the general situations. Alcohol abusers had higher urges to drink than did the social drinkers in both the general and the alcohol-specific situations. However, in response to the alcohol-specific situations, the alcohol abusers, compared to the social drinkers, were rated by judges as significantly less skillful, and they displayed more self-reported anxiety, had a higher frequency of occurrence of problem situations in the natural environment and reported greater perceived realism of the alcohol-specific situations. Psychophysiologic measures did not differentiate between the groups. Results are discussed with respect to the importance of situation specificity in understanding the precipitants of drinking and their treatment implications.

Adaptation, Psychological↗
PubMed1991

Young adults' knowledge of the strength of different alcoholic beverages.

Providing information about the strength of different alcoholic beverages is a common component of alcohol abuse prevention programs. However, little is known about drinkers' knowledge of the strength of different alcoholic beverages. In the present study, 113 young adult drinkers responded to a questionnaire concerning the alcohol content of different types of malt beverages (beers, malt liquors), wines, fortified wines (port, sherry), and distilled spirits. The results indicated rates of correct responses well below 50 percent for each type of alcoholic beverage, with a substantial proportion of subjects either overestimating or underestimating alcohol content. Not a single subject reported correct alcohol content values for all four beverage types. There was a trend towards less accurate estimates of the alcohol content of strength were less accurate than those of men. The results are discussed in terms of prevention of alcohol abuse.

Adult↗
PubMed1990

Detoxification of alcoholics: improving care by symptom-triggered sedation.

This study evaluated a staff training program on alcohol detoxification. Training consisted of didactic presentations on the pathophysiology of alcohol withdrawal syndrome and information on use of the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A). Treatment course was assessed on 100 patients admitted before or after the training. Whereas 73% of patients were given drug therapy before, only 13% of patients received drug therapy after. Significantly more benzodiazepine was administered before training (M = 108.48 mg) than after training (M = 42.97 mg). After excluding those who received no drug therapy, patients who received benzodiazepine after the training received significantly higher amounts of benzodiazepine (M = 252.50 mg) than those who received drug before (M = 144.64 mg). The average number of hours from the first benzodiazepine dose to the last was reduced from 13 to 5 hr. Clinical implications of matching patient symptomatology with appropriate drug therapy, thus preventing both over- and under-treatment for alcohol withdrawal symptoms, are discussed.

Alcoholism↗
PubMed1990

Communication skills training, communication skills training with family and cognitive behavioral mood management training for alcoholics.

To evaluate three promising social learning approaches to the treatment of alcoholism, 69 male alcoholics in standard inpatient treatment participated in either a communication skills training group (CST), a communication skills training group with family participation (CSTF) or a cognitive behavioral mood management training group (CBMMT). Alcoholics who received CST or CSTF drank significantly less alcohol per drinking day during 6-month follow-up than those in CBMMT. The groups did not differ in abstinence rates or latency to relapse. All groups improved in skill and anxiety on the extensive battery of process measures, including role-play tests of general and alcohol-specific coping skills, but those in CST improved most in skill in alcohol-specific high-risk role plays and in ability to relax after the role plays. Alcoholics' skill, response latency, anxiety and urge to drink during alcohol-specific role plays were highly correlated with treatment outcome, demonstrating the importance of including comprehensive process measures in treatment outcome research. Implications for patient-treatment matching and future research are discussed.

Adaptation, Psychological↗
PubMed1990

The sexual relationship of male alcoholics and their female partners during periods of drinking and abstinence.

The quality of the sexual relationship between alcoholic male veterans admitted to an alcohol treatment program and their stable nonalcoholic female partners was assessed in relation to time intervals of abstinence and drinking. Repeated measures analyses performed on the LoPiccolo Sexual History Form provided information on sexual problems associated with the desire, arousal and orgasm phases of the sexual response cycle and other kinds of information relevant to sexual functioning. Results indicate that the sexual relationship varies in relation to drinking or abstinence. Sexual intimacy appears quite normal and satisfactory during abstinent periods; however, female partners present an internally consistent picture of neither desiring nor enjoying sex during drinking periods, though accepting sex reluctantly. For male alcoholics, satisfaction with sex while drinking continues to be reported despite awareness of their partner's negative emotional reactions during sex. Clinicians and researchers are cautioned to differentiate drinking and abstinent periods when assessing the sexual relationship of alcoholic couples.

Adult↗
PubMed1990

The relationship between assessment and alcohol treatment.

Recently considerable attention has been paid to the matching hypothesis as an explanation of the failure to find a treatment of alcoholism that is generally beneficial. Clinicians, however, have long claimed that they match treatments to their patients' characteristics. The purpose of this study was to obtain descriptive data on the practice of patient-treatment matching in alcohol treatment programs. A survey questionnaire was sent to the directors of VA inpatient alcohol treatment programs across the United States. The questionnaire concerned program characteristics, treatment content, and patient-treatment matching practice. The results suggest that matching commonly occurs in the sample treatment programs, despite their typically structured format. Questions about the practice of patient-treatment matching that the findings raised are addressed.

Alcoholism↗
PubMed1990

Family history of alcoholism in males: absence of distinguishing features for treatment matching.

One variable for subtyping the alcoholic population that could influence treatment-matching efforts is family history of alcoholism. This study compared two groups of male patients undergoing rehabilitation for alcohol dependence (39 family history positive [FHP] versus 36 family history negative [FHN]) on a number of salient dimensions for which specific targeted intervention components might be implemented. The FHP were similar to FHN subjects on all variables except that FHP had significantly fewer years of education than did FHN. Several possible explanations to account for these findings are discussed.

Adaptation, Psychological↗
PubMed1990

Behavioral treatment of alcohol and drug abuse. What do we know and where shall we go?

Over the last 20 years there has been a substantial increase in the use of alcohol and drugs in industrialized nations and a concomitant shift in the emphasis of treatment for alcohol and drugs. Rather than seeking treatment for alcohol alone or a single class of drug, many individuals are seeking treatment for alcohol and/or a number of drugs. While theoreticians have been exploring the similarities in the addictive behaviors, clinical researchers are only just beginning to do so. Unfortunately, most treatment research has focused almost exclusively on alcohol abusers or drug abusers, with little research conducted to date with alcohol and drug abusers. Behavioral interventions developed for alcohol abuse are now being tested with drug abusers, and vice versa. The purpose of this chapter is fourfold: (1) to briefly discuss the similarities in the assessment of alcohol and drug abuse; (2) to describe behavioral interventions that have been supported by research and briefly review this treatment outcome research; (3) to discuss the theoretical similarities in behavioral interventions for alcohol and drug abuse; and (4) to make recommendations for future advancements in treatment and research.

Alcoholism↗