Violent behavior as related to use of marijuana and other drugs.

UNLABELLED: The relationship of the degree of use of each of ten types of illicit drugs with each of eight types of violent criminal offenses, is reported for an African-American, inner-city, low SES, young adult study sample (N = 612). Prospective data from the time of birth was available for the statistical analyses, to provide 51 control variables on factors other than substance use which might predict to later violent behavior FINDINGS: Greater frequency of use of marijuana was found unexpectedly to be associated with greater likelihood to commit weapons offenses; and this association was not found for any of the other drugs, except for alcohol. Marijuana use was also found associated with commission of Attempted Homicide/Reckless Endangerment offenses. Cocaine/crack and marijuana were the only two types of drugs the frequency of use of which was found, for this sample, to be significantly related to the frequency of being involved in the selling of drugs. These findings may not apply to a middle-class African-American sample.

Family risk factors versus peer risk factors for drug abuse. A longitudinal study of an African American urban community sample.

This study compared the influence of family problems with influence of deviant and delinquent social behavior and peer relationships up to the time of the 16th birthday as risk factors for substance use, for lifetime up to age 26. Control variables for the analysis were available from the National Collaborative project's longitudinal data file, collected from time of birth, on the African American community study sample (N = 380). A key finding was that the social behavior and peer relationship problems accounted for 18.8% of the additional variance in later degree of substance use, whereas the family problems accounted for only 5.1% of the additional variance in later degree of substance use.

Positive findings on bone scan in multiple myeloma.

We report a case of multiple myeloma in which the bone lesions showed high uptake of technetium Tc 99m methylene diphosphonate on a bone scan. A review of the literature comparing the usefulness of conventional skeletal radiography and bone scans in diagnosing the osteolytic lesions of myeloma shows that bone scintigraphy, considered by many to have no role in the detection of osteolytic lesions of myeloma, is in fact more sensitive than radiography in detecting lesions in the ribs, scapula, and spine.

Childhood predictors of violent behavior.

In this study, prospective childhood data from birth to 7 years of age were used to determine predictors of subsequent violent behavior. The childhood predictors found for the girls accounted for more variance in the reported later violent offenses: 24.9% compared to 3.8% for the boys. This large difference may be due partly to the fact that violent behavior is more unusual among girls; thus, those girls who are violent are more readily differentiated from the others. The only two early childhood variables that were found to predict for both genders were: (a) less normal behavior and (b) presence of deviant or stereotyped behavior. Thus, abnormal behavior in childhood can be considered to be a fairly reliable predictor to greater likelihood of later violent behavior.

Validation of the criteria for DSM diagnosis of cocaine abuse and cocaine dependence.

The concurrent external validity of the diagnosis of cocaine abuse, based on the DSM criteria, is shown to be established to an unexpectedly high degree, based on a method of determining the association between a summary score derived by quantifying the DSM criteria and another summary score derived from weighting several measures of frequency of use of cocaine and a measure of its mode of use. The degree of validity was cross-validated by performing the same analysis on two study samples: one of inpatients (N = 179) and one of urban-community African-Americans (N = 204).

Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group.

OBJECTIVE: To determine the incidence, predictors, and cost of atrial fibrillation and flutter (AFIB) following coronary artery bypass graft (CABG) surgery. DESIGN: Prospective observational study (MultiCenter Study of Perioperative Ischemia). SETTING: Twenty-four university-affiliated hospitals in the United States from 1991 to 1993. SUBJECTS: A total of 2417 patients undergoing CABG with or without concurrent valvular surgery selected using a systematic sampling interval. MEASUREMENTS: Detailed preoperative, intraoperative, and postoperative data collected on standardized reporting forms. RESULTS: The overall incidence of postoperative AFIB was 27 percent. Independent predictors of postoperative AFIB included advanced age (odds ratio [OR], 1.24 per 5-year increase; 95 percent confidence interval [CI], 1.18-1.31); male sex (OR, 1.41; 95 percent CI, 1.09-1.81); a history of AFIB (OR, 2.28; 95 percent CI, 1.74-3.00); a history of congestive heart failure (OR, 1.31; 95 percent CI, 1.04-1.64); and a precardiopulmonary bypass heart rate of more than 100 beats per minute (OR, 1.59; 95 percent CI, 1.00-2.55). Surgical practices such as pulmonary vein venting (OR, 1.44; 95 percent CI, 1.13-1.83); bicaval venous cannulation (OR, 1.40; 95 percent CI, 1.04-1.89); postoperative atrial pacing (OR, 1.27; 95 percent CI, 1.00-1.62); and longer cross-clamp times (OR, 1.06 per 15 minutes; 95 percent CI, 1.00-1.11) also were identified as independent predictors of postoperative AFIB. Patients with postoperative AFIB remained an average of 13 hours longer in the intensive care unit and 2.0 days longer in the ward when compared with patients without AFIB. CONCLUSION: Postoperative AFIB is common after CABG surgery and has a significant effect on both intensive care unit and overall hospital length of stay. In addition to expected demographic factors, certain surgical practices increase the risk of postoperative AFIB. Randomized controlled trials are necessary to determine if modification of these surgical practices, especially in patients at high risk, would decrease the incidence of postoperative AFIB.

The consequences of drug use/abuse for vocational career: a longitudinal study of a male urban African-American sample.

This report is from a longitudinal study of a community sample of African-American males (N = 197) on the relationship of the degree of earlier substance use/abuse up to average age 24, to vocational performance (employment and occupational level) 2 1/2 years later (at average age 26 1/2). The statistical analyses included numerous control variables developed from prospective data of the National Collaborative Perinatal Project, on the subjects and on their families from the subjects' birth to age 7, and from their school behavior and academic performance up to age 16, which may have influenced their vocational-occupational behavior during early adulthood. It was found that greater earlier marijuana use and greater earlier alcohol use predicted, to a significant degree, poorer occupational performance.

The relationships of substance abuse to illegal and violent behavior, in a community sample of young adult African American men and women (gender differences).

In a longitudinal study of an African American young adult community sample (N = 380), prospective data on lifetime substance use/abuse from childhood up to age 24 were used as control variables in analyses to predict illegal and violent behavior during the ensuing 2 1/2-year period. Frequent earlier use of drugs predicted subsequent violent behavior for both men and women. Frequency of earlier use of alcohol predicted subsequent violent behavior for men but not for women. A weaker relationship was found between degree of psychopathology and degree of engaging in either illegal or violent behavior than between degree of psychopathology and degree of substance use/abuse. Comorbidity (the combination of earlier use/abuse of drugs with earlier psychopathology) was a stronger predictor, for women than for men, of later illegal and violent behavior.

Recurrence of systemic lupus erythematosus in a hemodialysis patient presenting as a unilateral abducens nerve palsy.

A 45-year-old hemodialysis patient presenting with recurrence of SLE which manifested predominantly as a unilateral left abducens (VIth) nerve palsy is described. The signs and symptoms of the cranial nerve palsy resolved within two weeks of initiating corticosteroid therapy. This is the first reported case of an abducens nerve palsy occurring in a maintenance hemodialysis patient associated with recurrence of SLE.

Gender differences in early life risk factors for substance use/abuse: a study of an African-American sample.

Gender differences in risk and protective factors for substance use/abuse in early adulthood were studied. Comprehensive systematic data on African-American males (N = 318) and females (N = 322), from birth to 7 years of age, were available from the National Collaborative Perinatal Study. These subjects were retrieved for assessment at average age 24. There are more differences between males and females than there are similarities in regard to the early childhood variables that predict substance use in early adulthood. However, high activity and intensity of response during infancy (measured at 8 months of age) was found to predict later substance use for both males and females. This type of behavior is considered by use to be a trait of temperament and to suggest the possibility of a genetic predisposition. More risk factors were found for female than for males. The risk factors for females were primarily of two types: 1) Related to experiences with mother and with the family environment; and 2) Poor levels of intellectual functioning and academic performance, and abnormal mental status.

Family and client characteristics as predictors of outpatient treatment outcome for adolescent drug abusers.

Adolescent drug abuse clients (N = 176) and their mothers, in six different outpatient drug-free programs, were assessed at admission and at follow-up, 15 months after initiation of treatment. Family therapy sessions were offered in all six programs programs in addition to individual and group counseling. The pretreatment assessment procedures, and thus also the variables analyzed for prediction of treatment outcome, emphasized family measures (including the Family Environment Scale, the Family Adaptability and Cohesion Scale, the Parent-Adolescent Communication Inventory, and other information about the family and the parents). Multiple regression analysis determined which of three demographic variables and 39 other independent pretreatment predictor variables had a significant relationship with each of the six outcome criteria (dependent variables). Four of these outcome criteria were based on client information, and two were based on information provided by the mother. The more positively the family's functioning and relationships were described by the client at pretreatment, the more client improvement was reported by either client or mother at follow-up. Eleven of the 12 predictor variables that were found to be significantly related to any of the treatment outcome criteria were measures, at pretreatment, either of the client's perceptions of family functioning, or of his or her relationship with parents, particularly with the mother. These findings show the power of the family factors as indicators of prognosis. The predictor variable that was found to have the largest number of significant relationships, predicting three of the six outcome criteria, was the "family independence" dimension of the FES (i.e., "The extent to which family members are encouraged to be assertive, self-sufficient"). It appears that the FES instrument may be quite effective for predicting improvements in the behavior of adolescent drug-abusing clients.

Early childhood and maternal antecedents to drug use.

In a longitudinal study, the substance use/abuse histories were obtained on a community sample of 640, (mean age of 24.9 years) randomly selected from the 8,000 Philadelphia black subjects who had been studied comprehensively from birth to seven years of age in the National Collaborative Perinatal Project (NCPP). Among other conclusions, it is postulated from some of the many significant associations found between early life variables and substance use/abuse in early adulthood, that an infant is at risk who has the following combination of characteristics and family situation: outgoing, responsive, assertive or impulsive, or willful, and who is in an unfavorable family environment, with a mother who is generally negative toward the infant, has a larger number of small children and has had more fetal deaths, in a generally poor social environment.

Outcome of a unique youth drug abuse program: a follow-up study of clients of Straight, Inc.

A unique feature of the 12-hour per day Straight, Inc., program is temporary placement of the client with the family of a client who has progressed further in the program. Eighty-five (85) percent of the clients reported that their drug use was less at follow-up than when they started in the program. Follow-up reports by parents indicated their impression of a statistically significant decrease in the proportion of clients who were still involved in substance use. Statistically significant improvement at follow-up was also reported by the clients on seven of eight other selected outcome criteria (e.g., suicidal thoughts, physical violence, number of arrests, etc.). The majority of the clients reported that they were "satisfied" with the program (70%), that the program "helped" them (74%), and, specifically, that the program helped them with their relationship with their parents (69%).

A method for diagnosing and planning the treatment of adolescent drug abusers (the Adolescent Drug Abuse Diagnosis [ADAD] instrument).

There is a need for a diagnostic method and an instrument appropriate for adolescent drug abuse clients, that permits the assignment of clients to the most appropriate treatment setting, provides the basis for individualized treatment planning, and facilitates comparability across research studies. The development of the Adolescent Drug Abuse Diagnosis (ADAD), a 150-item instrument with a structured interview format, modeled after the Addiction Severity Index (ASI) (which is for adults), is described. The ADAD produces a broad-spectrum comprehensive evaluation of the client, the interviewer's ten-point severity ratings, and composite scores for each of nine life problem areas that are often relevant to the treatment needs of adolescent drug abuse clients. A series of validity and reliability tests are described. The characteristics of the standardization sample (N = 1,042), and the comparison of the characteristics of the three subsamples (outpatient, residential or non-hospital, and inpatient) are also presented.

Residential program characteristics for completion of treatment by adolescent drug abusers.

The relationship to treatment outcome (as measured by the National Institute of Drug Abuse Client-Oriented Data Acquisition Process [NIDA-CODAP] Reasons for Discharge classification) of specific characteristics and elements of 22 drug-free residential programs for adolescents is reported. Admission and discharge data were obtained from NIDA-CODAP on 2,532 adolescents in the 22 programs. A partial cross-validation study was conducted by analyzing separately for two annual client subsamples. The program, not the individual client, was the unit of analysis. When three differences between programs in their client populations were "partialed out" the following characteristics of programs were found to predict positively to outcome (a lower treatment failure rate) to a statistically significant degree: the number of years that the counselors had worked in the programs; the number of volunteer staff in direct service (client contact); the proportion of clients receiving bodily and mental relaxation techniques: the counselors' perceptions that their programs accept or encourage relatively more spontaneous personal expressiveness, including expression of anger by clients, in staff-client relationships, but encourage less client "autonomy" (to be self-sufficient and independent with regard to making their own decisions); the counselors report that providing practical assistance in solving clients' real-life problems is useful. There was a high degree of replication of these findings across the two annual subsamples of clients. These findings for adolescents in residential programs are compared with findings reported in a parallel study of treatment outcome for adolescents in outpatient programs.

Effects of psychiatric symptomatology on treatment outcome for adolescent male drug abusers.

There is evidence that adult substance abusers tend to have high rates of psychiatric symptomatology and diagnosable psychiatric disorders and that those with more severe psychiatric problems show lower levels of improvement. This paper examines whether these same two findings also hold for adolescent substance abusers. The outcome of treatment, in a day treatment center in a private vocational high school setting, for 130 court-referred substance-abusing delinquent boys aged 14 to 18 years was studied in relation to their psychic symptomatology at admission, as measured by the Brief Symptom Inventory and the Emotional Reaction Inventory. The unexpected finding, although not conclusive, shows that there is a slight tendency among these young clients for those who report more psychiatric symptoms to improve more, rather than less, with treatment. For example, a greater score on the borderline psychotic subscale of the Emotional Reaction Scale predicted to more improvement as measured by reduction in drug use. A response set explanation was postulated for this finding: those clients who were more self-evaluative and more open and self-revealing about their disturbing inner thoughts and feelings might have been more trusting, more ready, and better motivated for counseling. The following are some possible explanations for the fact that the findings are different from those of some studies reported for adult substance abusers: adolescent drug abusers have, or are aware of having, or report, less psychiatric symptomatology, than adult abusers or addicts; our study sample included only court-referred delinquents; and there are differences in research methodology, specifically in the types of instruments and measures used.(ABSTRACT TRUNCATED AT 250 WORDS)

Families of adolescent drug abusers are "rigid": are these families either "disengaged" or "enmeshed," or both?

The FACES instrument, based on Olson's Circumplex Model of family functioning, was administered to 96 adolescent drug-abuse clients and their parents. The majority of these families categorized themselves as "disengaged" (rather than "enmeshed") on the cohesion dimension, and as "rigid" (rather than "chaotic") on the adaptability dimension. These findings were unexpected as they were substantially different from published findings on families with other types of problems. Family therapists, utilizing Olson's Clinical Rating Scale for the Circumplex Model, characterized significantly more of these same families as "enmeshed," rather than "disengaged." Possible explanations for the difference between the therapists' perceptions and the families' self-perceptions are discussed.

Program characteristics for successful treatment of adolescent drug abuse.

The relationship to treatment outcome, as measured by reduction in drug use, of specific characteristics and elements of 30 drug-free outpatient programs for adolescents is reported. Admission and discharge data were obtained from National Institute on Drug Abuse-Client Oriented Data Acquisition Process on 5789 adolescents in the 30 programs. A partial cross-validation study was conducted by analyzing separately for two annual client subsamples. The program, not the individual clients, was the unit of analysis. While controlling for differences between programs on their client populations, multiple regression analysis indicated that the following characteristics of programs were found to predict the outcome criterion variable, to a statistically significant degree: treat a large number of adolescent clients; have a special school for school dropouts; have a relatively large budget; employ counselors or therapists who have at least 2 years' experience in working with adolescent drug abusers; provide special services such as vocational counseling, recreational services, and birth control services; use such therapy methods as crisis intervention, gestalt therapy, music/art therapy, and group confrontation; and be perceived by the clients as allowing and encouraging free expression and spontaneous action by clients. There was a high degree of replication of these findings across the two annual subsamples of clients; and the amount of variance in the treatment outcome criterion variable accounted for by the above-listed program characteristics was quite impressive.