Correlates of violence history among injured patients in an urban emergency department: gender, substance use, and depression.

This study surveyed consecutive injured patients (n = 320) in an urban emergency department (ED) regarding past year violence, substance use, and depression. Victimization and aggression variables (none = N, partner only = P, non-partner only = NP, and generalized/both partner and non-partner = G) were compared on gender, depression, and substance use/consequences. Findings were similar for victimization and aggression variables. Depression was significantly related to violence for women but not for men; women in the P group reported the most depression. Substance variables were significantly related to violence by gender groups. Men in NP and G groups reported the most binge drinking; men in the G group reported the most consequences and drug use. Women in P and G groups reported the most binge drinking and consequences; women in the P group reported the most drug use. Screening urban ED patients for violence is warranted, with interventions addressing both partner and non-partner violence.

Brief detection and co-occurrence of violence, depression and alcohol risk in prenatal care settings.

The purpose of the study was to examine the rates and inter-relationships among violence receipt, alcohol use problems, and depression in women seeking prenatal care. While waiting for their prenatal care appointment, women (n = 1054) completed measures of past year partner and non-partner violence receipt, alcohol misuse (TWEAK and quantity and frequency of alcohol use in past year), and depression (Center for Epidemiological Studies Depression Scale - CESD and prior history of depression). Over 30% of women reported either violence receipt, alcohol use problems or depression risk. Significant inter-relationships among all measured risk variables were found. Although violence receipt was significantly related to alcohol misuse, cigarette use, less education, and scoring above the cutoff on the CESD (>/= 16) was most strongly associated with violence. Practitioners should be well-equipped to provide assessment, interventions, or referrals as needed to the high numbers of women encountered in prenatal care settings experiencing psychosocial and behavioral problems that may affect their pregnancy.

Correlates of expressed and received violence across relationship types among men and women substance abusers.

This study examined expressed and received violence among men and women in substance abuse treatment. Rates of past-year partner violence (PV) did not differ by gender, although men reported markedly higher rates of nonpartner violence (NPV). Compared with PV, NPV was associated with more demographic and background factors (e.g., childhood aggression and conduct problems, family history of violence). The most consistent correlates of violence across relationship types were age, minority status, drug-related consequences, psychiatric distress, and frequency of childhood aggression. Only a few gender-specific correlates were identified; most notably, witnessing father-to-mother violence was related to received PV only for women. Identification of correlates of expressed and received violence in partner and nonpartner relationships is essential for the assessment and treatment of individuals in substance abuse treatment settings.

Older adult treatment outcome following elder-specific inpatient alcoholism treatment.

This study examined multidimensional 6-month outcomes of elder-specific inpatient alcoholism treatment for 90 participants over the age of 55. At baseline, physical health functioning was similar to that reported by seriously medically ill inpatients in other studies while psychosocial functioning was worse, and nearly one third of the sample had comorbid psychiatric disorders. Based on 6-month outcomes, participants were classified into the following groups: Abstainers, Non-Binge Drinkers, and Binge Drinkers. The groups did not differ on any baseline measures (demographics, drinking history, alcohol symptoms and age of onset, comorbidity, or length of treatment). General health improved between baseline and follow-up for all groups. Psychological distress decreased for Abstainers and Non-Binge Drinkers, but did not change for Binge Drinkers. Results suggest that a large percentage of older adults who receive elder-specific treatment attain positive outcomes across a range of outcome measures.

Comparison of patient self-reports and urinalysis results obtained under naturalistic methadone treatment conditions.

This study examined under naturalistic assessment conditions the validity of self-reported opiate and cocaine use among 175 veterans enrolled in methadone treatment, and factors related to self-report validity, such as stage in treatment and drug of abuse. Veterans were interviewed by clinical staff about past 30-day drug use with the addiction severity index (ASI), and urinalysis results were obtained for the same 30-day interval assessed with the ASI. Analysis revealed that urinalysis generally produced higher rates of substance use than patient self-report, and with the exception of reported opiate use among new patients presenting for treatment, validity of patient self-reported drug use generally was poor with patients under-reporting both opiate and cocaine use. The findings are in marked contrast to those obtained in other studies in which participants are ensured confidentiality regarding their self-reports. Further, the results raise questions about the utility of self-report measures of substance use to assess patient progress or methadone program performance.

Stability in the drinking habits of older problem-drinkers recruited from nontreatment settings.

Few prospective studies have examined older problem-drinkers not currently in treatment to determine the stability in alcohol problems over time. Seventy-eight currently drinking, older adults meeting a diagnosis of alcohol abuse or dependence were recruited via advertising to complete a health interview; 48 were reinterviewed approximately 3 years later. Participants were categorized based on alcohol consumption (risk) and alcohol-related diagnostic symptoms (problem) at baseline and follow-up. At follow-up, few older adults (11.4%) were resolved using both risk and problem criteria. Alcohol risk/problem groups were not significantly stable between baseline and follow-up. Health problems was the most common reason for changing drinking habits. Average and maximum consumption at baseline and follow-up were significant markers of follow-up risk group and follow-up alcohol-related consequences, respectively, with maximum consumption being more robust. The course of alcohol problems among older adults fluctuates over time, and heavy drinking appears to be the best indicator of problem continuation.

Predictors of expressed partner and non-partner violence among patients in substance abuse treatment.

This study examined reports of expressed partner and non-partner violence among men (n = 126) and women (n = 126) in the 12 months prior to substance abuse treatment. Rates of violence were 57% for partner, 53% for non-partner, and 75% collapsing across partner and non-partner relationships. Factors associated with partner and non-partner violence severity differed substantially. Partner violence was predicted by age, marital status, and drug problem severity. Non-partner violence was predicted by gender, income, alcohol and drug problem severity. The results highlight that individuals in substance abuse treatment are at high risk for violence, and targeted screening and intervention approaches should be routine in addictions treatment.

Gender differences in the development of substance-related problems: the impact of family history of alcoholism, family history of violence and childhood conduct problems.

OBJECTIVE: This study examined gender differences regarding the relative influence of family history of alcoholism (FHA) and family history of violence (FHV) on reported childhood conduct problems (CCP) and adult problems with alcohol, drugs and violence. METHOD: The participants were 110 men and 103 women with alcohol-related problems recruited within 30 days of enrolling in treatment for substance abuse or dependence. Participants completed self-report measures of pretreatment violence, FHV, CCP, substance use and consequences, and demographics; a semi-structured interview was used to assess FHA. RESULTS: Structural equation modeling (SEM) analyses revealed gender differences with regard to the influence of FHA and FHV as important factors in the development of childhood and adult behavioral problems. For women, the influence of FHA on subsequent childhood conduct problems and adult problems with alcohol was accounted for by FHV. For men, FHA was not directly associated with CCP or adult problems with alcohol and violence, but was associated with adult drug problems. For both men and women, FHV was associated with CCP, and CCP were associated with adult problems with drugs and violence. CONCLUSIONS: Overall, the analyses illustrate the relative importance of FHV as a risk factor in the developmental course leading to problems with drugs and violence among individuals with alcohol-related problems enrolled in treatment for substance abuse or dependence. Further, there was evidence that women may be impacted more than men by family background variables (both FHA and FHV) in terms of the development of adult problems with alcohol, drugs and violence.

Screening for alcoholism among medical inpatients: how important is corroboration of patient self-report?

Little is known about the utility of collateral reports in substantiating self-report for individuals assessed in nonalcoholism treatment contexts. This study examined the concordance of 581 pairs of medical patient and collateral responses to a commonly used alcohol screening instrument, the CAGE Questions, as well as to reports of the patient's drinking consequences and alcohol consumption. Results demonstrated that patient/collateral concordance was marginal, but acceptable, on CAGE cut-off scores and, that similar to reports from alcoholism treatment settings, patients generally reported more drinking consequences than collaterals. Patient and collateral reports of the patient's alcohol consumption did not differ significantly. This pattern of patient and collateral reporting of alcohol consequences and consumption was found for both men and women, as well as for patients with a DSM-III-R diagnosis of alcohol dependence. The findings support the validity of patient self-report on alcoholism screening measures in medical settings. Furthermore, results demonstrated that the addition of collateral reports to information directly obtained from patients only modestly improved the identification of alcohol dependence. The overall findings indicate that alcohol screening can be done effectively and efficiently in medical settings.

The relation between alcohol and aggression: an integrated biopsychosocial conceptualization.

The relation between acute alcohol consumption and aggressive behavior is a complex phenomenon that has been studied from a variety of different disciplines. This article reviews findings from both survey and experimental research. The influence of both situational and individual difference variables on the alcohol-aggression relation is discussed and the strengths and weaknesses of various methodological approaches are highlighted. Current theoretical perspectives of the alcohol-aggression relation are reviewed. An integrated heuristic framework of the alcohol-aggression relation also is outlined. This conceptualization involves both distal and proximal risk factors for problems with alcohol and violence, which include biological, psychological, interpersonal, and contextual influences. Research and treatment implications of this framework are also discussed. It is recommended that researchers attempt to measure variables from a variety of domains in order to obtain a better understanding of this complex phenomenon. Furthermore, it is emphasized that there is a clear need to further implement and assess primary and secondary prevention efforts and to design integrated and flexible approaches for individuals with alcohol and violence problems.

The relationship between alcohol symptoms and consumption among older drinkers.

The present study assessed the relationship between current alcohol symptoms and consumption levels in a heterogeneous sample of older adults. The sample consisted of 443 participants over age 55 who reported drinking within the past year, including social drinkers, alcoholics in treatment, and alcoholics not in treatment. Symptoms for the past year were assessed using the Diagnostic interview Schedule (DIS-III-R) alcohol section, and subjects were subsequently assigned to two groups (symptom-free and symptomatic), depending on whether they experienced any DSM-III-R alcohol symptoms in the last year. For both men and women, average daily consumption and the frequency of heavy drinking contributed to whether participants had experienced any alcohol symptoms. The results indicate that the consumption levels of men and women differed only for symptomatic drinkers. The findings support recommendations that consumption limits for older adults should be lower than those recommended in the literature for younger adults. Furthermore, the results suggest that, in addition to limiting average daily consumption to no more than one drink per day, eliminating episodes of heavy drinking (consuming five or more drinks) could further reduce the risk of alcohol-related symptoms for older adults.

Older adult controlled drinkers and abstainers.

Little is known about the lifetime course of alcohol problems, especially during late adulthood. Many individuals with a history of alcohol problems achieve remission of their symptoms through abstinence or controlled drinking. This study examined 135 older adults with a prior history of alcohol diagnoses who were symptom free for at least the past year. Two groups were identified based on their alcohol consumption within the past year: abstinent individuals (n = 92) and controlled drinkers (n = 43). The groups did not differ in age, racial composition, education, income, or years since their last alcohol-related symptom, but they did differ in gender composition, indices of alcoholism severity, history of formal and informal treatment, as well as lifetime alcohol consumption patterns. Abstinent individuals had more severe alcohol problems, consumed higher amounts of alcohol on drinking days, had more years of heavy alcohol consumption, and were more likely to have attended alcohol treatment and Alcoholics Anonymous (AA). The controlled drinkers had a longer history of moderate social drinking, and their current consumption habits appeared to be similar to symptom-free older adult drinkers. The results suggest that gender, alcoholism severity, history of formal and informal treatment, and past consumption patterns are associated with whether older adults with histories of alcoholism attain successful outcomes through abstinence or controlled drinking.

Alcohol and human physical aggression: pharmacological versus expectancy effects.

OBJECTIVE: Research has demonstrated that there is a relationship between alcohol consumption and aggressive behavior. Two basic theoretical positions have been proposed to account for this relationship: the pharmacological perspective and the expectancy perspective. This study examined these two competing explanations of the alcohol-aggression relationship. METHOD: Subjects were 40 males selected from a pool of 233 potential subjects who were interviewed by telephone regarding their alcohol expectancies. Subjects who believed that alcohol increases their aggression and subjects who believed that alcohol decreases their aggression were selected to participate. These subjects were randomly assigned to one of two dose conditions: active-placebo or high dose of alcohol. Subjects were given the opportunity to behave in an aggressive manner within the context of a competitive reaction time task. Aggression was operationalized as the intensity of electric shock subjects set for their opponent during the task. RESULTS: It was found that the high dose of alcohol resulted in significantly higher levels of aggression than the active-placebo dose regardless of subjects' alcohol-aggression expectancies. For the intoxicated subjects, the expectancy that alcohol increases aggressiveness tended to facilitate intense levels of aggression during conditions of high provocation. CONCLUSIONS: The results suggest that the pharmacological effects of alcohol play a primary role in the relationship between alcohol ingestion and aggression.

Alcohol, drugs and human physical aggression.

Research on the relationship between alcohol, drugs and aggression is reviewed. The findings indicate that alcohol is a potent antecedent of aggressive behavior. Studies conducted in our laboratory demonstrate that aggressive behavior is related to the quantity of alcohol ingested, that the effect of social pressure to aggress and of intense provocation is enhanced by alcohol, that the instigating effect of alcohol depends upon the aggressive disposition of the alcohol consumer, that the aggressive behavior of the intoxicated person can be regulated by altering cues that affect cognitive processes and that other depressant increase aggressive responding. A hypothetical model is described that summarizes the experimental findings and provides a vehicle for discussing the major factors and psychological processes involved in alcohol-induced aggression.