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A large proportion of patients entering substance abuse treatment carry psychiatric diagnoses, and some studies have found that those with psychopathology are more likely to withdraw before treatment is completed. We performed a prospective study of patients entering an inpatient substance abuse detoxification program to determine if the degree of anxiety and/or depression correlated with higher dropout rates. On entry to the unit, all patients were administered the Hamilton Rating Scales for Depression and Anxiety. Of the 148 patients studied, 97 (65.5%) completed treatment and 51 (34.5%) withdrew prematurely. There were no significant differences in Hamilton Depression and Anxiety Rating Scale scores between completers and withdrawers. This was true for the total study population, as well as for subgroups of patients based on primary drug abused (heroin or cocaine). Although anxiety and depression are common in substance abusers, we were unable to detect differences on validated anxiety and depression rating scales between those completing and those withdrawing from substance abuse detoxification.
J Subst Abuse Treat
PMID:The effect of anxiety and depression on completion/withdrawal status in patients admitted to substance abuse detoxification program. 869 44

The recurrence of depression following smoking cessation has been documented among smokers with a history of depression. This report examines the development of major depression following smoking cessation among three women without notable histories of depression. Shortly after smoking cessation, these women developed significant depressive symptoms requiring psychiatric intervention. These cases seem to support the hypothesis that some smokers may self-treat negative affect with nicotine and underscore the importance of monitoring depressive symptoms in patients undergoing smoking-cessation treatment.
J Subst Abuse 1996
PMID:Depression following smoking cessation in women. 874 74

Data concerning alcohol and drug abuse and dependence, depression, and antisocial behaviors, among both subjects and their parents, were obtained from a community sample of 1,201 young adults. Although 35% of the sample exhibited alcohol abuse or dependence, 14% marijuana or cocaine abuse or dependence, and 22% reported a parent positive for alcoholism, evidence of comorbidity with depression or antisocial personality was generally rare among both parents and subjects. Over one third of the subjects were negative both for family history and any disorder of their own and 20% reported a problem in both themselves and in one or both parents. These findings lend only partial support for Winokur's depression spectrum disease hypothesis, in that diagnosed children of depressed-only families have a 30% chance of exhibiting substance abuse or dependence alone, whereas diagnosed children of alcoholic-only families have only a 7% chance of exhibiting depression alone.
J Subst Abuse 1995
PMID:The relationship between parent and offspring comorbid disorders. 874 87

There has been little attention to the problem of violent stressors leading to post-traumatic stress disorder (PTSD) among opioid-dependent patients. In a sample of methadone maintenance patients, the prevalence of lifetime PTSD was determined to be 20% for women and 11% for men. The most common stressors reported were rape for women and seeing someone hurt or killed for men. Further research with methadone patients focused on PTSD should also ascertain current rates of PTSD and determine whether special treatments for PTSD and related problems of depression and suicidal ideation are necessary.
J Subst Abuse Treat
PMID:Post-traumatic stress disorder among inner city methadone maintenance patients. 883 Jan 52

Recent research emphasizes the importance of identifying older problem drinkers. However, very little is known about the longitudinal course and predictors of late-life problem drinking. This prospective study of late-life problem drinkers (N = 581) focused on predictors of alcohol consumption, drinking problems, depression, and treatment seeking over a 4-year interval. Heavier baseline alcohol use and being male independently predicted more alcohol consumption 4 years later; more baseline drinking problems and early-onset status independently predicted more drinking problems at follow-up. Independent of other factors, more initial depressive symptoms and chronic health stressors portended more depressive symptoms at follow-up. Individuals who initially sought more treatment, and who had more chronic health and spouse stressors at baseline, were more likely to seek help 4 years later. Heavier reliance on avoidance coping strategies heightened the risk that stressors and friends' approval of drinking would lead to more drinking problems at follow-up. However, for individuals who had more drinking problems at baseline, such environmental risk factors as negative health events and friend stressors predicted fewer subsequent drinking problems.
J Subst Abuse 1996
PMID:Late-life problem drinking: personal and environmental risk factors for 4-year functioning outcomes and treatment seeking. 888 Jun 58

Interview data from 7,359 adults 18 years of age and over who met the DSM-IV criteria for alcohol abuse or dependence at some point during their lives revealed that 23.0% of the men and 15.1% of the women ever received treatment for alcohol problems. The median interval from onset of disorder to first treatment was between 2 and 3 years longer for men than women. This difference did not result from women being more likely than men to initiate treatment shortly after onset of an alcohol use disorder, but rather from men being more likely than women to initiate treatment in the period well after onset. Excluding treatment initiated prior to the clinical onset of the disorders or after cessation of drinking, men's and women's cumulative conditional probabilities of having initiated treatment by 30 years after onset of alcohol abuse or dependence were .424 and .356, respectively. Within the first 8 years after onset of abuse or dependence, men's and women's probabilities of initiating treatment were about the same, but men were 13% to 20% more likely to initiate treatment in the period from 8 to 25 years after onset. Use of proportional hazards models to adjust for factors including sociodemographic characteristics, prior consumption, severity of disorder, and comorbid drug use and depression revealed that men's and women's likelihoods of ever having received treatment did not differ for the most severely affected, those with 20 or more symptoms of abuse or dependence. Among those less severely affected, the male-to-female ratio in the likelihood of treatment declined with severity from 1.75 (1 symptom) to 1.24 (15 symptoms).
J Subst Abuse 1996
PMID:Gender differences in the probability of alcohol treatment. 888 Jun 61

Recent theory and research suggest that the process of changing addictive behaviors may be conceptualized as a stage phenomenon consisting of precontemplation, contemplation, preparation, action, and maintenance stages. Accurately assessing motivation or commitment to change seems to be a crucial step in matching patients to appropriate interventions. Using the University of Rhode Island Change Assessment Scale (URICA; McConnaughy, Prochaska, & Velicer, 1983), previous research has identified subtypes of outpatient alcoholics based on their attitude toward each of the stages of change. Profiles derived for each subtype roughly corresponded to one of the specific stages of change. The goals of this study were to determine if similar groups could be identified for patients receiving substance abuse treatment in a residential setting and to examine whether these groups would differ on other theoretically relevant variables. Stage of change scale scores for 141 patients entering an alcohol treatment program at a VA domiciliary were submitted to a hierarchical cluster analysis. A two-cluster solution appeared to fit the data best, with group means suggesting the existence of precontemplation and contemplation/action stage groups in this population. The two clusters did not differ on demographic variables, biochemical markers of alcohol consumption, or self-reported awareness of alcohol-related problems. However, participants in the precontemplation cluster reported being less worried about their use, less receptive to help, and having sought out help fewer times in the past. Participants in the contemplation/action cluster also reported greater symptoms of depression and anxiety. Preliminary treatment outcome data for each group are presented, as well as suggestions for treatment matching. Results suggest that the URICA can be used to identify clinically meaningful subtypes of treatment-seeking alcoholics.
J Subst Abuse 1996
PMID:Construct validity and predictive utility of the stages of change scale for alcoholics. 893 34

The capability of four contextual risk factors (social support, maternal psychological adjustment, maternal preparation for parenting, and child temperament) as well as maternal predisposition for aggression (stress perception and endorsement of punitive parenting) to predict child abuse potential in adolescent mothers was investigated in 75 mother-child dyads. These pairs were drawn from a larger, longitudinal study on adolescent parenting conducted in Indiana and South Carolina (US). Mothers averaged 17.3 years of age at delivery and were predominantly (64%) African-American. Data were collected prenatally, at 6 months, and at 12 months. Compared to the general teen population, mothers showed above-average levels of financial stress and internalizing psychological problems (e.g., depression); they were uncertain about their roles as parents and rated their infants as difficult. A higher score on the risk composite was significantly (p 0.01) associated with a higher score on the abuse potential index. Also significant (p 0.001) was an association between the risk composite and a predisposition for aggressive coping. However, separate analyses revealed that the four risk factors were not equally effective in predicting child abuse potential. Abuse potential was significantly related only to parenting preparation (p 0.001). Endorsement of punitive parenting was an influential mediator of the relationships between risk factors. These findings suggest a need for interventions aimed at educating teens about child development and realistic expectations, expanding their repertoire of parenting skills, and teaching them to control aggression.
 ...
PMID:Adolescent mothers and child abuse potential: an evaluation of risk factors. 895 54

Successful nonchemical drug treatment is a transformative experience: client change is the goal of treatment. Two domains in which programs intend to facilitate change are emotional well-being and the therapeutic relationship. Little previous research has addressed the question of what changes clients in drug treatment actually undergo while in treatment. This article presents results from a pilot longitudinal study of clients in two short-term drug treatment programs in Houston, TX. Results showed measurable increases in self-esteem and connection to counselor and decreases in anxiety and depression over the course of treatment for clients who completed treatment. Program graduates and early withdrawals showed distinctly different patterns of progress as measured by emotional and relationship scales.
J Subst Abuse Treat
PMID:The trajectory of client progress. A longitudinal pilot study. 901 63

A total of 84 adult inpatient dual-diagnosis (cocaine dependence and unipolar depressive disorder) patients' charts were reviewed. Patients were administered the BDI, SCL-90-R with Additional Items for Major Depressive Syndrome, and the DAST-20 within 5 days of admission as standard assessment practice in a hospital program. Depression scores for the BDI and the SCL-90-R were generally consistent, respectively, across each of the depressive disorder diagnostic groups with the exception of organic (cocaine-induced) mood disorder, which had lower mean scores on both instruments. BDI mean score differences were statistically significant regarding the depressive and organic (substance-induced) patients. DAST-20 mean scores were consistent across the diagnostic groups (substantial drug abuse range). Results suggest potential discriminating ability of the BDI in particular in distinguishing genuine unipolar depressive disorders from organically (cocaine) induced mood symptomology when assessments are done rapidly following cocaine cessation.
J Subst Abuse Treat
PMID:Acute dually diagnosed inpatients: the use of self-report symptom severity instruments in persons with depressive disorders and cocaine dependence. 921 38


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