Familial aggregation in specific language impairment.

A case-control family study design, in which the current language-related abilities of all biological, primary relatives (mother, father, siblings) of probands with specific language impairment (SLI) and matched controls were assessed, was used to investigate familial aggregation for language disorders. Current test data from each family member showed the rate of language impairment for mothers, fathers, sisters, and brothers of the SLI probands to be significantly higher than for members of control families. Impairment rates for fathers and mothers were approximately equal, whereas rates for brothers were significantly higher than for sisters. In SLI proband families, Language Impairment (LI) occurred in 13.0% of offspring (excluding proband) with neither parent affected, 40% of offspring with one parent affected, and 71.4% of offspring in families in which both parents were language impaired. Rates of impairment as determined in current testing were compared directly to impairment rates estimated from family-history questionnaires collected from the same families. Group data showed impairment rates estimated from the family-history questionnaires to be similar to the rates based on actual testing. Furthermore, both appeared in line with rates based primarily on questionnaire data as reported previously in the literature. However, case-by-case analyses showed poor intrasubject agreement on classification as language impaired on the basis of current testing as compared to history information.

Therapeutic alliance and the retention of couples in conjoint alcoholism treatment.

Differences were investigated in the degree to which less versus more experienced therapists formed a therapeutic alliance with their clients and how these differences were related to retaining couples in treatment. Two raters, using the Vanderbilt Therapeutic Alliance Scale (VTAS) and the Vanderbilt Negative Indicators Scale (VNIS), coded 15-minute audiotaped segments of the first treatment session for 66 couples participating in a randomized clinical trial of three types of couple therapy for alcoholism. Ten therapists, whose experience ranged from 15 years of postdoctoral practice to a 1 year predoctoral practicum, administered the treatment. Results indicated that the more experienced therapists scored significantly higher on the VTAS and lower on the VNIS than did the less experienced therapists. Therapists' scores on these scales were significantly related to number of treatment sessions attended and number of couples completing treatment, but not to treatment outcomes.

Maintaining change after conjoint behavioral alcohol treatment for men: outcomes at 6 months.

AIM: To compare the effectiveness of standard behavioral couples therapy for alcohol problems to two maintenance enhanced therapies. DESIGN: Randomized clinical trial. SETTING: Outpatient substance abuse treatment clinic. PARTICIPANTS: Ninety males with alcohol abuse or dependence and their female partners. INTERVENTIONS: Weekly, outpatient therapy in one of three randomly assigned conditions: Alcohol Behavioral Couples Therapy (ABCT), Alcoholics Anonymous plus ABCT (AA/ABCT) or Relapse Prevention plus ABCT (RP/ABCT). FINDINGS: The men significantly reduced the frequency of drinking and heavy drinking during treatment. During the first 6 months post-treatment, 65.7% of male subjects were classified as improved on a composite measure of drinking and drinking-related consequences. Compared to baseline levels, the percentage of abstinent days increased and heavy drinking days decreased, but the three conditions did not differ. Two outcome variables favored the purely behavioral treatment conditions (ABCT and RP/ABCT) over the AA/ABCT condition: time to the first heavy drinking day was longer for subjects in the ABCT condition than subjects in the AA/ABCT condition, and subjects in the RP/ABCT condition tended to have shorter drinking episodes than subjects in the AA/ABCT condition. Subjects who complied with post-treatment maintenance plans were more likely to be abstinent than subjects who did not. CONCLUSIONS: Results favored the two behavioral conditions and did not suggest additional benefit from combining AA with behavioral couples therapy, but those who did attend AA showed a positive impact.

Marital functioning in early versus late-onset alcoholic couples.

Current knowledge about alcohol and marital functioning is limited by restrictive sample selection, inattention to the literature on individual-based alcoholic subtypes, and lack of research linking individual differences among alcoholics to marital functioning. The present study was designed to study marital functioning of alcoholics in light of current alcohol typologies. Subjects were part of a larger study on conjoint treatment of alcoholic males and their female partners. Four typologies-including Type 1/2, In-Home/Out-of-home, Steady/Episodic, and Early/Late Onset-were tested for replicability and discriminant validity before linking them to marital functioning. Discriminant validity was found only for the Early (59%)-versus Late (41%)-Onset typology;thus, further analyses linked only this typology with marital functioning. At baseline, Early-Onset couples reported more marital instability, and the females in these couples were more distressed. During treatment, Early-Onset couples reported higher daily marital satisfaction than Late-Onset couples. Regardless of age of onset, males reported higher marital satisfaction than their spouses during treatment, but their satisfaction did not increase during treatment. Female partners' marital satisfaction increased during treatment. Female partners of Late-Onset males reported particularly low marital satisfaction during treatment. Parsing the sample according to the early-/late-onset typology yielded different predictors of marital satisfaction for males and females within each subtype. For female partners of Early-Onset alcoholics, psychological distress unrelated to her partner's drinking severity was most associated with her own marital satisfaction, whereas marital adjustment of female partners of Late-Onset alcoholics was most associated with the male's level of perceptual accuracy regarding her needs. This pattern was reversed for the males; marital adjustment of Early-Onset alcoholics was most associated with his partner's perceptual accuracy of his needs, whereas marital functioning of Late-Onset alcoholics was best accounted for by his own psychological distress.

Sources of motivation in a couples outpatient alcoholism treatment program.

This study examines sources of motivation to seek treatment. Participants were 105 male alcoholics and their non-alcoholic female partners who participated in a study of three different approaches to the conjoint treatment of alcoholism. Participants' sources of motivation were coded from responses to questions at the initial clinical screening interview. Sources of motivation were classified as "internal" or "external." More participants had internal sources of motivation (74%) than external sources. Participants with internal sources of motivation scored higher on the Michigan Alcoholism Screening Test than participants with external sources of motivation, but did not differ on other measures of pretreatment severity of alcohol problems. About half of the participants (53%) cited their partner as a primary source of motivation to seek treatment. Other sources of motivation cited were: increasing problems with alcohol, mental health problems, and physical health problems. There was greater variability among internal sources of motivation than among external sources of motivation. Participants' partners but not the male participants themselves, experienced an increase in marital satisfaction from pre- to within-treatment when the participant was motivated to come to treatment by his partner.

The Drinking-Related Locus of Control Scale: the factor structure with treatment-seeking outpatients.

OBJECTIVE: The psychometric properties of the Drinking-Related Locus of Control Scale (DRIE) were investigated when the distribution of DRIE scores taken from a sample of outpatient men was found to be skewed toward an internal locus of control, and numerous items on the scale showed little or no variability. METHOD: The DRIE was administered to 93 treatment-seeking, male alcoholics meeting DSM-II-R criteria for alcohol abuse or dependence who attended a clinical screen and baseline assessment for a larger study designed to examine the efficacy of conjoint marital therapy in the treatment of alcoholism. Subjects were recruited through newspaper, radio and television announcements, letters to physicians, employee assistance programs, outpatient treatment programs and detoxification centers. Subjects were either married or in a cohabitating relationship with a nonalcoholic, female partner. RESULTS: A factor analysis with a Procrustes rotation failed to replicate the three factor structure identified by previous researchers and consequently the reliability coefficients of the corresponding subscales were found to be low. Several items were endorsed as internal by more than 95% of the sample, showing little or no variability among subjects. An independent factor analysis, which excluded the items endorsed predominantly as internal, identified a single factor structure comprised of first person statements about helplessness and an inability to abstain from drinking. CONCLUSIONS: One possible explanation for the difference in the factor structure is that the current investigation employed outpatient subjects rather than inpatient subjects, who have been the focus of most research on the control orientation of alcoholics to date. A second possible explanation may be found in the sociodemographic makeup of the current sample which is younger, better educated and has less severe drinkers than the sample of veterans in the study that established the original factor structure of the DRIE.

Issues in the implementation of a randomized clinical trial that includes Alcoholics Anonymous: studying AA-related behaviors during treatment.

OBJECTIVE: The purpose of this study is to examine implementation of a randomized clinical trial and within treatment behavior when AA is included as an element of treatment. Special attention is given to the measurement of compliance, use of treatment skills, and the nature and extent of involvement with AA during the active phase of treatment. METHOD: Subjects, 90 male alcoholics and their female partners seeking conjoint, outpatient behavioral alcoholism treatment, were randomly assigned to one of three treatments: alcohol-focused behavioral marital therapy (ABMT), ABMT plus AA/Alanon (AA/ABMT), or ABMT plus relapse prevention (RP/ABMT). Within treatment data are reported for the 68 couples who completed at least five treatment sessions. Measures included: treatment attrition, number of treatment sessions, attendance at AA and Alanon, use of AA and Alanon skills, compliance with homework assignments and drinking during treatment. RESULTS: Several aspects of within treatment behavior were examined: (1) Attrition: There was no differential attrition across treatment conditions, with 24.4% of couples discontinuing treatment prior to the fifth session. (2) AA and Alanon attendance: Subjects in the AA/ABMT treatment were more likely to attend AA (91.7% attended at least one AA meeting; 58.3% attended at least one Alanon meeting) than were subjects in the other treatment conditions (18% attended at least one AA meeting and 14% at least one Alanon meeting). Subjects in the AA/ABMT condition attended significantly more AA and Alanon meetings than did subjects in the other treatment conditions. (3) Homework compliance: Subjects generally showed no differences in compliance with homework assignments, but spouses in the AA/ABMT condition completed less condition-specific homework (37.2%, versus 67.8% for the RP/ABMT spouses) because of low utilization of Alanon. (4) Use of AA-related skills: Subjects reported using AA-related skills more frequently in the AA/ABMT condition than in the other treatment conditions. (5) Patterns of attendance: Analyses of AA attendance during treatment revealed three patterns: positive attendance, characterized by regular AA attendance or increasing use of AA across treatment; negative attendance, characterized by decreased AA attendance over time; and nonattendance, characterized by none or infrequent and erratic attendance. CONCLUSIONS: Randomized clinical trials can be used to study AA. Use of multiple measures of treatment compliance and examination of patterns of AA utilization use over time provide more complex views of the patterns of involvement with AA than do simple descriptive reports of attendance.

Comparison of Directigen Group A Strep Test with a traditional culture technique for detection of group A beta-hemolytic streptococci.

The Directigen Group A Strep Test (DGAST), a new rapid method of detecting group A beta-hemolytic streptococci directly from throat swabs, was compared with a traditional culture technique for the detection of group A beta-hemolytic streptococci. Five hundred oropharyngeal swabs from pediatric and adult patients were cultured and then processed by using the DGAST. Of the 144 specimens positive by culture, 131 were DGAST positive (sensitivity, 90.9%). Of the 356 specimens negative by culture, 353 were DGAST negative (specificity, 99.2%). Twelve of the 13 false-negative DGAST results were from pediatric patients. One hundred isolates of non-group A beta-hemolytic streptococci were recovered, primarily groups C, F, and G. The DGAST is easy to perform, rapid, sensitive, and very specific for detection of group A beta-hemolytic streptococci directly from swabs. Supplementing the DGAST with a culture on a 5% sheep blood agar plate would enhance detection of group A beta-hemolytic streptococci, especially in pediatric patients.