Anne Helene Skinstad

COMORBIDITY IN A CLINICAL SAMPLE OF SUBSTANCE ABUSERS

The sample consisted of 125 male inpatients admitted to one of two substance abuse treatment centers in Iowa. They were diagnosed by means of the Diagnostic Interview Schedule Screening Interview-Quick-DIS version, the Structural Interview for DSM-III-R Personality Disorder (PD), revised, and the Substance Abuse Reporting System. The most frequently diagnosed comorbid Axis I conditions were anxiety and mood disorders, while the most frequently observed Axis II disorders were in Cluster B, borderline PD, and antisocial PD followed by Cluster C, avoidant PD, passive-aggressive PD and obsessive-compulsive PD; and then Cluster A; schizoid PD. Subjects diagnosed with Borderline PD showed the highest rate of comorbid psychopathology, including Axis I disorders of generalized anxiety disorder, major depression, cocaine dependence, and inhalant dependence. The most likely comorbid diagnosis for antisocial PD subjects was bipolar disorder. The schizoid PD and the NoPD groups were less likely to meet criteria for other Axis I disorders. A high rate of comorbid Axis II pathology was also found. Polysubstance dependent subjects were more likely to be diagnosed with anxiety disorder or bipolar disorder than were those who were not polysubstance dependent or were dependent only on alcohol. Polysubstance dependent men were at highest risk for Axis II disorders: 56% of them met criteria for a Cluster B PD, with borderline PD and histrionic PD most frequent.

History of the Concept of Addiction

Our distant forebears wrestled with concepts of alcohol addiction not unlike those of today: Is addiction a sin or a disease? Is addiction caused by the gods, the substance, the individuals vulnerability, or psychological or social factors? Luther, Calvin, and Catholic Church leaders viewed moderate alcohol use as Gods gift; used intemperately, it was a moral transgression. The founders of modern scientific psychiatry rejected moral explanations for addiction in favor of an early biological model. The first two versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I and DSM-II) stigmatized addiction by listing it with other societally disapproved disorders stemming from personality disorder. DSM-III espoused atheoretical, descriptive diagnoses but required tolerance or withdrawal to diagnose dependence. Substance dependence in DSM-III-R included physiological and behavioral symptoms and reflected the substance dependence syndrome. DSM-IVs emphasis on biology in its concept of dependence was unchanged from its immediate predecessors. DSM-5 declared that all drugs taken in excess have in common the direct activation of the brain reward system. This article examines evolving concepts of alcohol addiction through 12,000 years of recorded human history, from the first mention of alcohol consumption in China more than 12,000 years ago to alcohol use and abuse in the DSM era, 1952 to the present.

Hospitalizations and hospital charges for co-occurring substance use and mental disorders

Most published studies have examined co-occurring disorders among mental health patients. Our objective was to compare the length of stay and hospital charges between hospitalized patients with alcohol- or substance-related disorders with and without co-occurring disorders. We analyzed nationally representative hospital discharge data (Nationwide Inpatient Sample, 2003-2007) and examined factors associated with length of stay and hospital charges. Forty-four percent of patients who were hospitalized with alcohol- or substance-related disorders were diagnosed with co-occurring mental disorders, representing 979,421 such disorders nationwide between 2003 and 2007. Females, those of White race, those who paid with insurance, and those who stayed in large, rural, nonteaching, and Midwest region hospitals had a high prevalence of co-occurring disorders. Co-occurring disorders were associated with longer hospital stays, but there were mixed results with hospital charges per discharge. An increase in co-occurring disorders among hospitalized patients with substance-related disorder may be due to the improvement in diagnosis and clinical attention.

Drug & alcohol intervention for older women: a pilot study

Pretest and posttest information was gathered from 26 older women attending educational programs related to alcohol and drug use. The goals of the study were to determine current knowledge about alcohol and drugs among older women and to gather some initial information about the potential for alcohol and drug interactions and misuse. The intervention included a 60-minute presentation on the metabolism of alcohol and drugs in the aging body, the potential for alcohol-drug interactions, and a discussion of healthy lifestyles (e.g., diet, exercise). Older women, especially those who were moderate to heavy drinkers, were found to have many misconceptions about alcohol and drug use, but their knowledge improved dramatically after the brief educational intervention. This finding may suggest that most of the women had knowledge deficits rather than deeply entrenched attitudes about alcohol and drug use or alcohol dependence. Therefore, simple educational interventions may be very effective with this subset of women.

Women with Alcohol and Drug Problems in Aftercare Treatment

Abstract The purpose of this study was to analyze changes if any in alcohol and drug abusing women from admission to discharge from an aftercare program. Sixty-nine women were admitted to three programs and 51 of them completed aftercare treatment. Of the women who did not complete aftercare treatment (n = 18), fourteen relapsed or did not successfully complete the program and were discharged, two were still in treatment, one was referred to treatment in another agency or could not be located, and one had an abusive partner who prevented her from continuing in the program. Symptoms of obsessive-compulsive disorder and sleep disturbance were reduced at discharge. Womens experiences of verbal, physical, and sexual abuse were significantly reduced at discharge and the number of women having custody of their children increased at discharge. Womens personal concerns about ability to raise their children, as well as those of others, were reduced at discharge.

CROSS-CULTURAL COMPARISON OF CLINICAL SAMPLES OF NORWEGIAN AND IOWAN WOMEN WITH SUBSTANCE-RELATED DISORDERS

The purpose of this study was to compare two clinical samples of women substance abusers, one from Iowa and one from Norway, along several dimensions: “substance abuse” history, current “abuse” pattern, parental and spouse drinking history, symptoms of psychological distress, and “vulnerability” to relapse. A higher percentage of women substance abusers from Iowa were divorced and lived alone, were “vulnerable” to relapse, and reported more life problems secondary to their substance use than women from Norway. The Iowa women had used more substances in addition to alcohol than had the Norwegian women. The Norwegian women reported greater intensity of emotional distress than the women from Iowa.