Risk factors for drug abuse in Pakistan: a replication.

While a number of risk factors have been identified for drug abuse in the United States, little evidence is available about such factors in some other counties. Among these latter is Pakistan, a nation in which heroin addiction is a major problem. The present study was done to examine those psychosocial characteristics which differentiated 60 heroin addicts from 60 nondrug-using controls in Pakistan. Most of the drug-abuse factors identified earlier were significant in Pakistan as well. Applying cut-off scores previously established for each of 9 variables, the relationship between drug status and number of factors at risk was also examined. Over 98% of the addicts were at risk for five or more factors; only 15% of controls were at risk for 5 variables and none exceeded 5. Precursors for abuse appear to cut across cultural lines. The high-risk individual in Pakistan, as in the United States, is one with ready access to drugs and the social inducements to use them while lacking bonds with societal institutions or value systems which might mitigate against drug use. Because several of the risk factors represent deep and long-standing aspects of the addict's personality, both prevention and treatment confront formidable difficulties.

Risk factors for drug misuse in Pakistan.

While a number of risk factors have been identified for drug misuse in the United States, little evidence is available about such factors in other societies. This study attempted to identify risk factors in Pakistan. Ten of 11 sociodemographic variables which had previously been identified as predictors in the United States successfully differentiated groups of addicts and controls in Pakistan. About 97% of the 60 addicts studied were at risk on four or more factors; 100% of controls were at risk on four or fewer factors. It appears that the precursors for misuse cut across cultural lines.

Effects of life stress and dysphoria on complex judgments.

A sparse literature concerning the effects of stress on judgment and decision making has produced two tentative conclusions: (1) stress impairs judgment and (2) such impairment is often the result of the narrowing of a judge's focus of attention. While evidence supportive of these propositions exists, there have also been contradictory findings. This investigation attempted to address both of these issues. 98 undergraduate students completed a complex multiple-cue judgment task and were also assessed as to (a) their exposure to two potential sources of stress (life events and irrational thinking) and (b) the amount of personal dysphoria they were experiencing. Two indices of subjective distress, depression and state anxiety, were significantly related to poor judgmental performance. None of several indices of potential stressors confirmed a relationship, which suggests that possible external sources of stress do not negatively affect judgment unless they generate subjective distress at the time judgments are made. There was no support for the "narrowing" hypothesis.

Stress, anxiety, and cognitive buffering.

Cognitive theories of psychopathology and therapy maintain that attitudes and beliefs mediate one's affective responses to life events. Anxiety and depression are thus consequences, not of an individual's circumstances, but of the distorted, irrational perspective from which these are viewed. Similarly, although less often considered, adaptive cognitions should serve as buffers against stressful life events. This proposition has received little attention, and the single study that attempted to address it directly failed to do so. The present investigation sought to reassess the buffering hypothesis. Ninety-seven subjects were evaluated as to (1) the levels of stress they had experienced in the recent past; (2) their current feelings of anxiety and depression; and (3) the extent to which they endorsed illogical, unrealistic attitudes. Dysfunctional attitudes demonstrated strong direct relations with psychological distress. Two of the several indices of life stress, total and negative scores on the Life Experiences Survey, also correlated with distress. There was no significant interaction between the attitude and stress measures. Cognitions, at least on the functional-dysfunctional dimension, did not moderate the impact of life events. Rather, both attitudes and life stresses were strong independent variables that, in additive fashion, provided considerable power for predicting distress.

Cognitive mediation of responses to life stress.

Cognitive theories of psychopathology argue that thoughts play an active role between external events and subjective experience. These approaches suggest a "mediation hypothesis": adaptive thoughts should serve as buffers against life stresses. In the present study, we gathered data from 125 subjects regarding (1) the levels of stress they had experienced in the recent past; (2) their current feelings of anxiety and depression; and (3) the extent to which they endorsed illogical, unrealistic views of life. Contrary to the mediation hypothesis, no differential impact of environmental stress was found across levels of adaptive cognitions. Rather, adaptive cognitions emerged as a powerful independent variable, showing strong direct relations with measures of distress. It is argued that improved measures of environmental distress will be necessary to provide a more powerful test of the mediation hypothesis.

A cross-national study of drug treatment decisions in psychiatry.

It is generally believed that American psychiatrists prescribe higher doses of psychoactive drugs than do European psychiatrists. This belief is based on cross-national studies that compared different groups of psychiatrists treating different patients, thus confounding patient and physician variables. An experimental approach derived from cognitive psychology was used to present identical patient material to a group of American psychiatrists and to two groups of Swiss psychiatrists. Cross-national differences were confirmed--the Americans prescribed much higher doses than the Swiss. Considerable differences in doses prescribed were also found between the two Swiss groups. Neither group was very consistent in prescribing. Agreement about choice of drug among psychiatrists in all three groups was low; agreement among the Americans was not above chance.

Drug therapy decisions. A social judgment analysis.

Seventy psychiatric staff members at various Veterans Administration hospitals made decisions concerning appropriate medication for 40 hypothetical cases. A profile presented for each case described the patient's status on eight symptom dimensions. The physician-judges examined each profile and specified appropriate drugs and dose levels for the case. Analyses focused on agreement among judges and on prescriptive strategies, the manner in which symptoms were weighted in specific drug decisions. When base rates were taken into account in determining chance levels, the judges failed to agree with each other significantly more than would be expected by change; this was true for their prescriptions of general class of medications, specific drugs, and dose levels. Differences among physicians were traceable to inconsistency in the use of symptom information and individual variations in prescriptive strategies, cue (symptom) weighting strategies of judges being dissimilar and sometimes contradictory.

An analysis of drug decisions in a state psychiatric hospital.

Sixteen staff physicians at a state psychiatric hospital made decisions that concerned appropriate medication for 40 hypothetical cases. A profile presented for each case described the patient's status on eight symptom dimensions. The physician-judges examined each profile and specified appropriate drugs and dose levels for the case. Agreement among judges and their prescriptive policies were studied, as well as the manner in which symptoms were weighted in specific drug decisions. While agreement was above chance levels, it was generally very low. Differences in prescriptive choice were traceable to inconsistency in the use of symptom information and individual variations in prescriptive policies because cue (symptom) weighting strategies of judges were dissimilar and sometimes contradictory.

A comparative study of competitive and social reinforcement models of interview behavior.

While psychotherapy typically is conceptualized as a social reinforcement process, Haley suggests that most interview behavior is predicted better by a competitive model of social interaction. Davis (1971) compared the two models by having interviewers follow reinforcing or competitive response programs and comparing the frequencies with which interviewees initiated interactions under the contrasting conditions. His results suggested that the competitive model predicted interviewee behavior more accurately. This study attempted both to replicate Davis' work with a different S sample (N = 48) (psychiatric inpatients as opposed to college students) and to extend it by using both male and female interviewers. Few of Davis' findings were replicated. Message frequency requests were equal in the competitive and reinforcing conditions, both of which induced more requests than a mixed interviewer program. The interactions that Davis had found between interviewer programs and Ss' classification on the repression-sensitization dimension were not significant. It is suggested that Davis' results may be limited to his college student sample and apparently do not generalize to those individuals more likely to be involved in therapeutic interviews.

An experimental study of the effectiveness of attitude change techniques for enhancing self-esteem.

A frequent goal in psychotherapy is the modification of low self-esteem. While such modification is accomplished most often in an indirect manner, it is possible to apply attitude change techniques directly to this purpose. In this study, 36 college students who had scored poorly on a standardized measure of self-esteem were exposed to a videotaped counter-attitudinal message under conditions of either high or low credibility; controls did not view the videotape. Results were consistent across several esteem measures and demonstrated significant positive changes in esteem for Ss exposed to the high credibility communication. The possibilities of adapting attitude change techniques to psychotherapy are considered.

A study of pretherapy role induction as an influence process.

It is not clear whether the effectiveness of role induction procedures derives from the fact that they (a) provide clients with information about therapy; or (b) serve as a vehicle for influencing attitudes and beliefs about treatment. In this study 17 clients were assigned to one of two pretherapy interview conditions or to a control (no interview) group. In one condition, social influence aspects of the interview were maximized, while in the other they were minimized. Information given about therapy was the same in both circumstances. Results suggest that therapeutic gains were greatest for patients in the high influence condition. Implications are drawn for the conceptualization of role induction procedures.