Introduction to the special section on empirical underpinnings of the ethics of alcohol administration in research settings.

This article introduces the special section of Psychology of Addictive Behaviors that focuses on the ethics of administering alcohol to human research participants, particularly those with a history of alcohol abuse or dependence. It is argued that many assumptions underlying ethical decision making can be put to an empirical test. These assumptions involve the degree to which participants can understand and give informed consent as well as the types and magnitude of possible risks associated with consuming alcohol in a research setting. The research literature relevant to these assumptions is reviewed in this series.

Environmental tobacco smoke: a risk factor for pediatric laryngospasm.

Adult patients who smoke are known to have airway complications during general anesthesia. The objective of this study was to explore the relationship between environmental tobacco smoke (ETS) exposure in the home and laryngospasm during general anesthesia in pediatric patients. A retrospective, cohort study was performed on pediatric ambulatory patients in the day surgery center and main operating room of a university hospital. We studied 310 consecutive pediatric patients (all ASA physical status I) who underwent an outpatient elective ear, nose, and throat or urologic surgical procedure in the spring and summer of 1994, and received inhalation induction by mask with halothane. Laryngospasm was identified from quality management and anesthetic records, and included only those patients whose records indicated that succinylcholine was given because of oxygen desaturation and inability to ventilate. Patients' families were questioned within 1 wk after surgery as to the number of smokers in each child's household. Of 96 children with ETS exposure, 9 (9.4%) developed laryngospasm. Of the 214 patients without domestic ETS exposure, 2 (0.9%) developed laryngospasm. The relative risk for developing laryngospasm was 10 times higher in the ETS-exposed patients compared with the non-ETS-exposed group (95% confidence interval = 2.2-45.6; P < 0.001). We conclude that ETS exposure is a strong risk factor for laryngospasm in infants and children during general anesthesia.

A test of Tiffany's cognitive model of drug urges and drug-use behavior.

Tiffany's (1990) cognitive model proposes that drug urges and drug use result from distinct (i.e., controlled versus automatic) cognitive processes. This study tested Tiffany's cognitive model utilizing innovative methods derived from the Multiple Resource Theory of cognitive psychology. Forty-two male and 42 female heavy drinking college students were assigned to 1 of 6 groups in two separate 1 (task) x 3 (treatment) factorial experiments in which half the subjects performed a math task while the other half performed a tracking task. Subjects received 1 of 3 treatments: Urge generation, "Drug" (Placebo) Consumption, or a Water control. The predictions were that urges would interfere with performance on the math task, and "drug" consumption would interfere with performance on the tracking task. The main dependent variables were measures of task performance. The results of this study do not clearly support the model; however, several suggestions for future tests of the cognitive model are discussed. Our findings highlight both the difficulty in testing the model, as well as opportunities for further integration of cognitive psychology and behavioral approaches to addictions.

Intraoperative reinfusion of whole blood using a new autoinfusion device.

Aortic aneurysm resection is frequently associated with considerable blood loss and requires transfusion. To minimize complications and cost many institutions use a "cell saving" method that allows reinfusion of the washed red cell fraction of blood suctioned from the operative field. The disadvantages of this technique are that homologous transfusion is regularly required to replace platelets and coagulation factors. Red cell transfusion may also be required when there is rapid major blood loss as the wash cycle may be too long to subject a patient, in a high-risk group for coronary artery disease, to anaemia. A new autoinfusion device anticoagulates blood as it is suctioned from the operative field then filters, defoams, and returns it whole to the patient without a processing time lapse. We successfully used the device in a patient for aortic aneurysm resection to reinfuse two-thirds of his blood volume shed over 80 min. Neither banked red cells nor plasma were used. His haematocrit and coagulation profile remained stable throughout surgery and recovery. The potential complications and cost of homologous transfusion were avoided.

Effects of alcohol consumption on the prevention and alleviation of stress-reactions.

Alcohol's Stress-Response-Dampening (SRD) effect has been the subject of much research, but little has been done to examine the effects of drinking alcohol after experiencing a stressor (Stress-Response-Recovery; SRR). In this study, 65 male and 65 female moderate or heavy drinking undergraduates were randomly assigned (with equal numbers of each sex per group) to 1 of 13 groups. Six experimental conditions were used to compare alcohol's SRD and SRR effects with two doses (moderate: .75 ml/kg; low: .33 ml/kg) and a placebo, and seven control conditions were used to measure the effects of the stressor (uncontrollable aversive noise) and the alcohol doses alone on the dependent measures. The major dependent variable was escape learning in a human shuttle box. In the SRD conditions, subjects who drank a moderate dose of alcohol learned to escape faster than those drinking the low dose or placebo. However, in the SRR conditions, subjects in the placebo group did not show escape learning deficits, in contrast to the impaired performance of subjects in the two alcohol groups. These results suggest a complex alcohol-stress relationship in which timing, dose, and expectations about alcohol lead to differential SRD and SRR effects.

Development of a comprehensive operating room pharmacy.

The justification, implementation, and services of a comprehensive on-site operating room (OR) pharmacy are reviewed. Justification was accomplished through audits of controlled substance accountability, drug preparation, labeling and storage, and cost analyses of drug waste and potential savings. Implementation was achieved through the joint efforts of the Department of Anesthesia, Pharmacy, and Nursing. Services of the OR pharmacy are dynamic and include standardized drug preparation, case-by-case drug distribution and patient billing, controlled substance accountability, provision of drug information, and clinical research support. This pharmacy has proven cost effective and has become integral to the daily function of the OR.

Effects of infant cries on alcohol consumption in college males at risk for child abuse.

This analog study examines the effect of hearing a child's cries on alcohol consumption, comprising one link in a possible association between drinking and child abuse. Thirty-two male undergraduate volunteers were preselected by age, drinking practices, and abuse potential. Subjects were assigned to either a high or low abuse potential group and were then randomly assigned to hear either an infant cry or a smoke alarm. Blood pressure was measured during each of three stimulus presentations. Following each presentation, the subject was asked to rate the stimulus on a number of different dimensions (e.g., soothing-arousing). Additionally all subjects participated in a subsequent taste-rating task as an unobtrusive measure of alcohol consumption. The results indicate that, regardless of risk group, subjects who listened to the infant cry consumed significantly more alcohol (M = 206 ml, SD = 126.43) during the taste-rating task than did those who heard only the smoke alarm (Mr = 95.68 ml, SD = 62.94) which was also rated as aversive. There was no relationship between abuse potential and alcohol consumption. Although diastolic blood pressure did not differ between groups, analysis of the infant rating scales revealed that, regardless of risk group, subjects who heard the infant cry reported feeling more aversion, arousal, and distress, than did those who heard the smoke alarm. These results lend additional support to studies depicting the infant cry as a stressful and aversive event, capable of eliciting increased drinking. Implications for arousal reduction by alcohol and a model of alcohol-induced child abuse are discussed.

An analysis of alcohol portrayal on prime-time television.

A content and functional analysis of alcohol use was conducted on the 15 most popular prime-time television programs in late 1979. These shows were videotaped and then rated by two independent observers. Interrater agreement, averaged over all code categories, was 91%. Results indicated that alcohol use and verbalizations about alcohol are frequent occurrences on prime-time television. Antecedent conditions to alcohol ingestion were identified. However, no consistent behavioral consequences of alcohol use were observed.

Self-statement induction of mood: some variations and cautions on the Velten procedure.

Assessed the utility of the Velten mood induction procedure over two sessions and with a reduced number of self-statements. Ss (N = 72) read 25 or 50 statements that were elative, neutral (no change), or depressive and completed Multiple Affect Adjective Checklists on both days. On both days, statements were found to influence significantly mood ratings, although a slight reduction in change conditions was noted. Reading a full set of statements (50) was found to have the greatest impact on mood.

Alcohol enhancement of human memory: tests of consolidation and interference hypotheses.

Two hypotheses about the phenomenon of alcohol-enhanced human memory were investigated. Whereas a consolidation account of this phenomenon indicates that continued processing of a target memory is facilitated by alcohol, an interference account states that the alcohol main effect is to impair the acquisition of potentially interfering new memories. No support was found for the consolidation view in an experiment manipulating (1) the length of time items preceded drug administration, (2) the amount of postpresentation processing each item received, and (3) the type of memory test employed. In line with expectations derived from interference theory, retention was substantially improved only for recall and not for tests of recognition memory.

Coping with spinal cord injury: the family perspective.

Little attention has been paid in the literature to the special needs of family members in dealing with the sudden trauma of spinal cord injury and the long-term implications of rehabilitation. Families are often encouraged to participate in rehabilitation plans that do not take their own developmental needs into account. As a result, developmental stresses occur, often expressed as a medical crisis for the spinal cord injured patient. Requests for psychiatric consultation are a frequent initial response of the medical staff to such crisis. Two clinical cases are presented to illustrate this process. Emphasis is placed on family aspects of the cases. Data from family interviews and home visits are used to illustrate the central themes that emerged during consultations. In particular, the data illustrate how family efforts to cope with the needs of their spinal cord injured member have caused them to place inappropriate emphasis on short-term stability of family life, sacrificing, in the process, long-term growth. Recommendations are made regarding the role of the consultation-liaison psychiatrist in the use of this family developmental approach.

Attitudes of paraprofessionals toward alcoholism; setting effects.

Paraprofessionals working in a residential alcoholism treatment program had significantly more "custodial" attitudes and attitudes of "humanism" toward alcoholics and beliefs concerning a psychological etiology of alcoholism than did paraprofessionals at a sobering-up station.