Arthur R. Tarbox

Achieving and maintaining gains among problem drinkers: Process and outcome results

Treatments focused on drinking moderation have had much success in reducing alcohol consumption among problem drinkers not physically dependent on alcohol, but little is known about the variables pertinent to the achievement and maintenance of these behavior changes. The influences of aftercare and the posttreatment use of drinking reduction strategies were studied in this investigation. Male and female problem drinkers first participated in an 8-week drinking reduction program and then were assigned randomly to six months of group afterace, telephone aftercare, or no aftercare. Also studied was a separately recruited no-treatment comparison group comprised of drinkers concerned about their alcohol consumption who were not seeking treatment and participated only in a data collection session and follow-up. Treated subjects significantly reduced their monthly heavy drinking days (64% reduction from pretreatment to the 12-month follow-up point), regardless of aftercare condition. Similar reductions were found for the no-treatment subjects who were only followed over time. Reductions in heavy drinking among the treated subjects were associated with the posttreatment utilization of drinking reduction techniques.

Cognitive Deficits as a Function of Years of Alcohol Abuse

The present study relates duration of alcohol abuse and degree of cognitive impairment among a population of alcohol dependent subjects (DSM-III). Data on 175 consecutively admitted patients were first examined to empirically establish operational definitions of short-term and long-term alcohol abuse for this population. Five or more consecutive years of alcohol abuse was thus defined by a median split as long-term alcoholism. The next 125 consecutive admissions were subsequently identified as either Short-Term or Long-Term alcoholics according to this criterion. Data gathered from these 125 subjects represented a wide range of neuropsychological measures. Analyses showed that Long-Term alcoholics demonstrated significantly greater cognitive deficits on tasks of psychomotor speed, recent memory, and overall alertness relative to less chronic alcoholics. This pattern occurred independent of age and education. These findings are interpreted in terms of a cognitive typology of alcoholism, and implications for treatment, including aftercare and cognitive remediation techniques, are discussed.

Macroenvironmental Factors as Determinants of Substance Use and Abuse

There is little doubt that the use and abuse of alcohol and drugs is a process that is multidetermined, and there exists a variety of factors that can significantly affect substance use. The purpose of this chapter is to outline and discuss the role of one class of factors—macroenvironmental variables—on the use of alcohol and drugs.

A Cognitive Typology of Alcoholism: Implications for Treatment Outcome

The present study related patterns of alcohol-related cognitive deficits to the adjustment of the alcoholic at 2-year posttreatment follow-up. Patterns of cognitive control, based on the extent to which the individual utilized information concerning contemplated action (i.e., internal scanning), were studied within a sample of 42 male alcoholics shortly after the beginning of treatment. Adjustment scores at 2-year follow-up were determined by the subjects level of functioning in a variety of life-functioning domains (based on phone interviews with subjects and collateral sources). More effective internal scanning proved to be predictive of better adjustment 2 years following the assessment. In addition, alcoholics less aware of internal cues, defined as narrow internal scanners, more often reported drinking to reduce tension than did broad scanning alcoholics. The narrow internal scanning alcoholics also were slower learners at an electromyographic biofeedback training task than were the broad internal scanning alcoholics. These findings are interpreted in the context of a cognitive typology of alcoholism based on relative skills/deficits in internal cue processing. Factors relating to differential responsivity to treatment are discussed, and concomitant implications for treatment are noted.

Abuse of the elderly-the hidden agenda. II. Future research and remediation.

ABSTRACT: A schema for future research and efforts to remediate abuse of the elderly is presented. In the community at large, increased exposure of and education pertaining to the elderly are needed in order to intensify the public/community presence and reduce prejudices. In the medical community, improvements are needed in the extent of geriatric training, the ethics of pronouncement of death, the reliability of clinical documents, and the reporting of suspected cases of abuse. In the legal community, there is need for laws prohibiting abuse and neglect, and providing opportunity for recovery of minimum damages, with covering of attorneys fees and court costs. It is proposed that the administrative process be altered so as to provide either a financial penalty for abuse and neglect, or a reward for providing superior care.