Collins E. Lewis

Comparison between self-report and hair analysis of illicit drug use in a community sample of middle-aged men

Discrepancies between biological assays and self-report of illicit drug use could undermine epidemiological research findings. Two objectives of the present study are to examine the degree of agreement between self-reported illicit drug use and hair analysis in a community sample of middle-aged men, and to identify factors that may predict discrepancies between self-report and hair testing. Male participants followed since 1972 were interviewed about substance use, and hair samples were analyzed for marijuana, cocaine, opiates, phencyclidine (PCP) and methamphetamine using radioimmunoassay and gas chromatography-mass spectrometry (GC-MS) techniques. Self-report and hair testing generally met good, but not excellent, agreement. Apparent underreporting of recent cocaine use was associated with inpatient hospitalization for the participants most recent quit attempt, younger age, identifying as African American or other, and not having a diagnosis of antisocial personality disorder. The overestimate of marijuana use relative to hair test was associated with frequent use since 1972 and providing an inadequate hair sample. Additional research is needed to identify factors that differentially affect the validity of both hair drug testing and self-report.

Uses of Coercion in Addiction Treatment: Clinical Aspects

Coerced or involuntary treatment comprises an integral, often positive component of treatment for addictive disorders. By the same token, coercion in health care raises numerous ethical, clinical, legal, political, cultural, and philosophical issues. In order to apply coerced care effectively, health care professionals should appreciate the indications, methods, advantages, and liabilities associated with this important clinical modality. An expert panel, consisting of the Addiction Committee of the Group for the Advancement of Psychiatry, listed the issues to be considered by clinicians in considering coerced treatment. In undertaking this task, they searched the literature using Pubmed from 1985 to 2005 using the following search terms: addiction, alcohol, coercion, compulsory, involuntary, substance, and treatment. In addition, they utilized relevant literature from published reports. In the treatment of addictions, coercive techniques can be effective and may be warranted in some circumstances. Various dimensions of coercive treatment are reviewed, including interventions to initiate treatment; contingency contracting and urine testing in the context of psychotherapy; and pharmacological methods of coercion such as disulfiram, naltrexone, and the use of a cocaine vaccine. The philosophical, historical, and societal aspects of coerced treatment are considered.

The significance of secondary depression

Secondary depression is a depression in an individual who has one or more preexisting, nonaffective psychiatric disorders or an incapacitating or life-threatening medical illness which precedes and parallels the symptoms of depression. Secondary depression is commonly seen in patients presenting to psychiatric facilities. For every 5 patients who are seen with a diagnosis of depression, approximately 2 should be classified as secondary. A patient with secondary depression is more likely to be younger, male, and to have a family history of alcoholism. His first diagnosis is most likely to be alcoholism; however, the preceding diagnosis varies depending on the setting in which the patient is seen. Hysteria, sociopathy, drug abuse and anxiety neurosis are also common. The symptom picture of secondary depression is almost indistinguishable from primary depression. One important reason a patient enters psychiatric treatment is that he develops a coexistent depression.

Socially Sanctioned Coercion Mechanisms for Addiction Treatment

Coercion as a strategy for treatment of addiction is an effective but often negatively perceived approach. The authors review current policies for involuntary commitments and explore coercive dimensions of treating alcohol and drug dependence in the workplace, sports, and through professional licensure. Gender-specific issues in coercion are considered, including evidence for improved treatment retention among pregnant and parenting women coerced via the criminal justice system. Social security disability benefits represent an area where an opportunity for constructive coercion was missed in the treatment of primary or comorbid substance use disorders. The availability of third-party funding for the voluntary treatment of individuals with substance use disorders has decreased. This unmet need, coupled with the evidence for positive clinical outcomes, highlights the call for implementing socially sanctioned mechanisms of coercion.

Psychiatric diagnostic predispositions to alcoholism

Abstract Various authors have described pre-alcoholic psychopathology in female problem drinkers; 1 however, actual studies of rigorously defined antecedent and concurrent psychiatric disorders have been few. More recently, several authors have reported that both affective disorder and antisocial personality are quite prevalent as primary diagnoses in hospitalized alcoholic women, 2,3,4 but the risk of subsequent alcoholism in women with these and other psychiatric syndromes needs to be clarified. In this study we investigate the prevalence of alcoholism in three populations of women with serious psychopathology. The first is a sample of psychiatrically hospitalized women with a history of depression at some time in their lives (hospitalized sample); second is a felon sample of women on probation and parole (felon sample); and third is a sample of female narcotics addicts admitted to the United States Public Health Service facility at Lexington, Kentucky for detoxification and treatment (Lexington sample). Our data set is unique in that despite being collected at different times and at different locations, uniform diagnostic criteria and uniform interview schedules were employed. 5,6

Is a history of alcohol problems or of psychiatric disorder associated with attrition at 11-year follow-up?

Although rarely available, detailed analyses of attrition in psychiatric surveys are important because surveys of this type might be more vulnerable to follow-up losses. In this report the demographic characteristics, as well as history of alcohol problems and psychiatric disorders of responders were compared to nonresponders in an 11-year follow-up study. Data revealed few differences between responders and nonresponders. Men, those less educated, and low users of medical care were more likely to be nonresponders, as were those reporting driving trouble when drinking or a history of barbiturate abuse or dependence. A history of other psychiatric disorders was not associated with nonresponse. Refusal conversion did not change the findings; those who were converted (25% of initial refusals) had demographic characteristics, symptoms of alcohol abuse, and psychiatric histories comparable to those who resisted conversion. These findings suggest that efforts to convert refusals to responders might not be necessary. The results also support community psychiatric research by providing evidence that those with a history of psychiatric disorder are not more difficult to recruit than their unaffected counterparts.

Association of alcoholism and antisocial personality in a narcotic-dependent population: The Lexington addicts

Men with antisocial personality have a higher prevalence of alcoholism than men without. This relationship was examined in a narcotic-dependent sample, and it was found that narcotic-dependent men with antisocial personality had a rate of alcoholism comparable to that of narcotic-dependent men without antisocial personality. The methodological and clinical explanations for this finding are discussed along with the neurophysiological implications.

Alcoholism, Antisocial Behavior, and Family History: A Synopsis

Investigators have long recognized the association between alcoholism and criminal behavior1 and with the recent advent of standardized psychiatric diagnostic criteria, many studies2 have reported that individuals with antisocial personality (ASP) have a higher prevalence of alcoholism than individuals without. A second robust correlate of alcoholism is a family history of problem drinking, and numerous investigations3 have demonstrated that individuals who have close biological relatives (parents, siblings, or children) with problem drinking are themselves at an increased risk for alcoholism.

Emotional, Clinical, and Familial Correlates of Antisocial Personality Disorder and Alcoholism in Men with Unipolar Major Depression

The assessment of the clinical and emotional correlates of alcoholism is important for understanding more about the disease process itself. Investigators have reported at least two factors which predispose to problem drinking; they are: a psychiatric diagnosis of antisocial personality (ASP) (Lewis, Cloninger, & Pais, 1983; Lewis, Rice, and Helzer, 1983b; Lewis, Robins, & Rice, 1985), and a family history of alcoholism (Cotton, 1979). Furthermore, half sibling (Schuckit, Goodwin, & Winokur, 1972) and adoption (Cloninger, Bohman, and Zigvardsson, 1981; Goodwin, Schulsinger, Hermansen, Guze, & Winokur, 1973) studies have demonstrated that this familial disposition may pass from one generation to another in the absence of being raised by alcoholic parents. Our studies (Lewis, et al., 1983b; 1985b) indicate that both a diagnosis of ASP and a positive family history make independent contributions to increase the risk of alcoholism.