Assessment-related anxiety among older adults: development of a measure.

Older adults are the largest population seeking neuropsychological assessment services. Anxiety has been shown to impact test scores, yet no anxiety measure currently exists specific to older adult neuropsychological assessment. This study piloted and validated the Feelings About Neuropsychological Testing measure (FANT), a measure of neuropsychological assessment anxiety developed to measure the cognitive, affective, and physiological aspects of test and state anxiety. The measure was validated on 105 community based older adults aged 55 and older. All participants were administered the FANT, the Generalized Anxiety Disorder- seven item (GAD-7), Test Anxiety Inventory- Short Form (TAI-SF), Patient Health Questionnaire- nine item (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), Dementia Worry Scale (DWS), and PROMIS Cognitive Function Short Form- 6a (CFSF). The measure proved feasible to administer, both the State and Test-specific dimensions demonstrated good internal consistency (state: α =.832; test: α =.894), discriminant validity, and external validity (compared to GAD-7, TAI-SF, PHQ-9, DWS, and CFSF). FANT scores may reveal patients for whom anxiety disrupts attention and attentional control, and therefore has promise as a measure that may inform assessment findings and guide possible intervention to maximize performance during testing sessions and to inform data interpretation.

Readiness to change drinking among heavy-drinking college students.

OBJECTIVE: The purpose of this study was to examine motivation to reduce alcohol consumption among heavy-drinking college students. Specific goals were to test the factor structure of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES); present normative SOCRATES data for collegiate heavy drinkers; present a heuristic, using SOCRATES scales to determine stage of readiness to change heavy-drinking; and compare students at different stages of change on demographic and drinking variables. METHOD: Participants were 278 (187 female) undergraduates who reported at least one episode of heavy drinking within the past 3 months. Students completed the SOCRATES and other questionnaires that assessed current and past drinking and demographics. RESULTS: Confirmatory factor analysis provided modest support for the SOCRATES factor structure. Students were classified according to the transtheoretical model of change (67% Precontemplation, 20% Contemplation and 13% Action). Contemplators drank more often, consumed more alcohol, reported more heavy drinking episodes and experienced more alcohol consequences than the other groups. CONCLUSIONS: Two thirds of the heavy-drinking college students did not recognize a need to reduce their alcohol consumption, despite evidence of tolerance and negative drinking consequences.

Detecting college binge drinkers using an extended time frame.

Collegiate binge-drinking is estimated at 44% nationwide, yet epidemiological studies typically limit estimates of binge drinking to episodes during the prior 2 weeks. This study hypothesized that a group of students will have binged on alcohol during the past 3 months but not within the past 2 weeks, and therefore would not be detected using the standard 2-week time frame. Forty males and 72 females who reported drinking alcohol within the past 3 months were included in this study. Fifty-four of the student drinkers (48.2%) were classified as binge drinkers using the prior 2-weeks time criterion, whereas 88 (78.6%) were identified as bingers using the prior 3 months as the criterion. Over one third (38.6%) of the students who binged during the past 3 months would not have been identified as bingers using a 2-week detection period. Furthermore, age, church attendance, alcohol-related consequences, and age of first intoxication were the same regardless of whether bingers had binged in the past 2 weeks or the past 3 months. In contrast, recent binge drinkers reported more frequent alcohol consumption than the 3-month bingers.

Progression of consequences among heavy-drinking college students.

Among a sample of 180 male and 226 female undergraduates, 84.2% reported a heavy drinking episode (5+ drinks for men, 4+ for women) within the previous 90 days. Principal-components analysis revealed 3 alcohol-related problem factors among the heavy drinkers (Careless Behavior, Risky/Reckless Behavior, and Authority Problems). Nearly all heavy drinkers experienced a careless behavior that was due to drinking (92.7%), and many reported a risky/reckless behavior (60.2%), yet only one third (33.9%) experienced an authority problem. Guttman scaling procedures revealed a progression from Careless Behavior to Reckless/Risky Behavior to an Authority Problem. Heavy drinkers with an authority problem drank more frequently, consumed more when drinking, endorsed more alcohol expectancies, and reported earlier ages of initial and regular drinking than other groups.

Hypothesized simple factor structure for the Alcohol Expectancy Questionnaire: confirmatory factor analysis.

This study proposed and tested a theoretical factor structure for the Alcohol Expectancy Questionnaire (AEQ; S. A. Brown, M. S. Goldman, A. Inn, & L. R. Anderson, 1980). Factors were hypothesized to (a) reflect either positive or negative reinforcement, and (b) target either personal feelings or social contexts, resulting in 4 hypothesized factors (Social Enhancement, Social Coping, Personal Enhancement, Personal Coping). Participants were 180 male and 226 female undergraduates who completed the AEQ and additional self-report measures. Confirmatory factor analysis revealed that the hypothesized model fit the data. Post hoc adjustments further improved the model. Finally, a higher order factor model fit the data best. Factors correlated in hypothesized ways with other measures: (a) Only Personal Coping expectancies correlated with negative affect; (b) self-efficacy to resist drinking for emotional relief correlated highest with Personal Coping; and (c) self-efficacy to resist social pressure to drink correlated highest with Social Enhancement. Correlations with B. C. Leigh and A. W. Stacy's (1993) Drinking Expectancy Questionnaire indicated congruent and divergent validity.

Modeling of alcohol use mediates the effect of family history of alcoholism on adolescent alcohol expectancies.

The relative impact of biological family history of alcoholism and exposure to abusive parental drinking on alcohol effect expectancies of adolescent offspring were investigated in the present study. Exposure to familial models of alcohol abuse and biological family history were both predictive of positive alcohol effect expectancies of adolescent offspring. Degree of exposure to an alcohol-abusing family member mediated the relationship between biological family history of alcoholism and adolescent alcohol outcome expectancies. These results support prior findings of expectancy differences between youths with and without a family background of alcoholism and provide evidence supporting the significance of family modeling influences in the development of adolescents' alcohol expectancies.

Psychometric evaluation of the Customary Drinking and Drug Use Record (CDDR): a measure of adolescent alcohol and drug involvement.

OBJECTIVE: The present study was undertaken to assess the psychometric characteristics of the Customary Drinking and Drug Use Record (CDDR), an interviewer-administered questionnaire. The CDDR provides current (past 3 months) and lifetime measures of four alcohol- and other drug-related domains: level of involvement, withdrawal characteristics, psychological/behavioral dependence symptoms, and negative consequences. The present report describes the evaluation of the psychometric properties of the instrument with youth between the ages of 13 and 22 years who had markedly variable histories of involvement with alcohol and other psychoactive substances. METHOD: The sample assessed was composed of 166 adolescents recruited from two inpatient substance abuse treatment programs and 115 adolescents recruited from the community. Of the 281 subjects, 150 were male. Follow-up interviews with each adolescent and a resource person were conducted 6, 12, 24 and 48 months after the initial assessment. RESULTS: Reliability of the CDDR was assessed by examination of internal consistency, test-retest reliability and interrater reliability. Convergent, discriminant and construct validity were evaluated for each of the CDDR domains, and gender and ethnic differences on substance involvement were examined. The CDDR was found to be internally consistent and reliable over time and across interviewers for each major domain assessed. The findings supported the validity of the four domains of alcohol and other drug involvement assessed on the CDDR. CONCLUSIONS: The present results demonstrated convergent validity of the CDDR, ability to differentiate abusing from nonabusing youth and strong diagnostic specificity when compared to other standard instruments. The solid psychometric characteristics of the CDDR support its use for both research and clinical purposes.

Stress, vulnerability and adult alcohol relapse.

OBJECTIVE: Alcoholics experiencing highly threatening or chronic psychosocial stress following treatment are more likely to relapse than abstaining individuals not experiencing such stress. Expanding upon this stress-relapse hypothesis, we predicted that individual risk and protective characteristics would contribute to vulnerability to relapse in alcoholic men confronted with significant life adversity. The present investigation examined the relationship between psychosocial vulnerability and return to drinking. METHOD: A group of abstinent male alcoholics (N = 67) who experienced marked life adversity that posed a severe and/or chronic threat participated in this study. Men completed a psychosocial assessment first as an inpatient in treatment for alcohol dependence, and again at 3 months and 1 year following discharge. RESULTS: Among alcoholic men exposed to severe psychosocial stressors, those with higher composite psychosocial vulnerability scores were more likely to subsequently relapse than those with lower vulnerability scores. Additionally, men who improved in psychosocial functioning following treatment had better outcomes than men whose vulnerability increased. In particular, coping, self-efficacy and social support most consistently predicted relapse among this sample of severely stressed abstaining alcoholics. CONCLUSIONS: These findings supported the stress-vulnerability model of relapse. Results indicated that improvement in psychosocial domains (e.g., coping skills, social networks, perceived ability to tolerate relapse-risk situations) enhanced the ability of these men to remain abstinent despite severe stress. This study highlights the importance of cognitive and behavioral interventions for increasing improvement in these psychosocial domains.

Severity of psychosocial stress and outcome of alcoholism treatment.

We examined the relation between stressful life events and drinking outcome among 129 male alcoholics who had completed an alcohol treatment program. Life events were assessed for the year prior to treatment and for the 3 months after treatment and were rated on the Psychiatric Epidemiology Research Interview and the Contextual Rating System. Approximately 40% of the pretreatment stressors were found to be directly or indirectly related to alcohol use. When stressors related to drinking were excluded from consideration, we found that men who returned to drinking after treatment experienced more severe or highly threatening stress before their relapse than men who remained abstinent during the follow-up period. These data suggest that although less severe stress may not increase risk for relapse, acute severe stressors and highly threatening chronic difficulties may be associated with elevated relapse risk.

Characteristics of relapse following adolescent substance abuse treatment.

Historically research has focused on the characteristics of adults who relapse following treatment for alcohol or drug dependence. The circumstances of adolescent relapse, however, have largely gone unattended. The present study investigated the relapse rates and characteristics of adolescent posttreatment drug relapse. Seventy-five teens and their parents were interviewed while participating in an adolescent chemical dependency treatment program and at three and six months following treatment. Results indicate that a number of characteristics of adolescent relapse, including rates, are comparable to those of adults. In contrast to adult relapse, adolescent relapses occur most commonly in the presence of social pressure to drink. Situational characteristics of initial relapse experiences were different for transient or minor relapses and adolescent relapses which lead to a return to abusive drinking and drug use patterns.

Education and self-care of patients with low back pain.

Two groups of patients with 'low back pain', comparable regarding sex, age and diagnosis, all hospitalized at the Hospital for Rheumatology, Kristiansand, for a period of 4-6 weeks, were treated as follows: Group I (209 (180) patients): Education program combined with practise of exercises and correct use of the back. Group II (190 (153) patients): Usual physiotherapeutic treatment methods (individual or group exercises in the charge of a physiotherapist). Further, both groups received similar swimming pool exercises and electrotherapy. Group I was studied on the basis of a questionnaire completed by patients before beginning the education program and both groups were studied on a similar basis after 12 months. Results are extracted from these questionnaires. In spite of various and extensive previous treatment (Table I), not many patients in group I had received information prior to the education program. Significantly more patients in group I than in group II stated that they had received tuition at our hospital (p less than 0.01) (Table II). Group I seemed to practise self-care more than group II and was statistically in less need of physiotherapy during the year after leaving the hospital (p less than 0.05). This seems to be beneficial for the patients and of economic importance for society at large. We conclude that education is important and has to be organized in the form of special lessons.