Dennis Moore

Alcohol and drug abuse among persons with multiple sclerosis

Objective: To examine the one-month prevalence and impact of substance abuse in a large community sample of persons with multiple sclerosis (MS). Method: Members of the Multiple Sclerosis Society of King C ounty were surveyed by mail. This multifaceted health survey included questions pertaining to substance abuse. Seven hundred and thirty-nine out of 1374 potential participants (54%) returned the survey, while 708 reported a medically confirmed diagnosis of MS and provided sufficient data. Results: Fourteen per cent of the sample screened positive for possible alcohol abuse or dependence, and 7.4% reported misusing illicit drugs or prescription medicatio ns within the previous month. Possible alcohol abuse and drug misuse were associated with younger age, less severe MS related disability and being employed, as well as greater self-reported depressive symptomatology. Most persons with alcohol problems indicated interest in learning more about ways to stop or cut down. Conclusions: Substance abuse may be present in up to 19% of this sample and contribute to high rates of depression. There may be greater risk of harm due to substance abuse in people with MS because of the potential magnification of motor and cognitive impairments. C omprehensive MS care should include substance abuse screening and advice to cut down or abstain.

Colostrum Avoidance, Prelacteal Feeding and Late Breast-Feeding Initiation in Rural Northern Ethiopia

OBJECTIVE To identify specific cultural and behavioural factors that might be influenced to increase colostrum feeding in a rural village in Northern Ethiopia to improve infant health. DESIGN Background interviews were conducted with six community health workers and two traditional birth attendants. A semi-structured tape-recorded interview was conducted with twenty mothers, most with children under the age of 5 years. Variables were: parental age and education; mothers ethnicity; number of live births and childrens age; breast-feeding from birth through to weaning; availability and use of formula; and descriptions of colostrum v. other stages of breast milk. Participant interviews were conducted in Amharic and translated into English. SETTING Kossoye, a rural Amhara village with high prevalence rates of stunting: inappropriate neonatal feeding is thought to be a factor. SUBJECTS Women (20-60 years of age) reporting at least one live birth (range: 1-8, mean: ∼4). RESULTS Colostrum (inger) and breast milk (yetut wotet) were seen as different substances. Colostrum was said to cause abdominal problems, but discarding a portion was sufficient to mitigate this effect. Almost all (nineteen of twenty) women breast-fed and twelve (63 %) reported ritual prelacteal feeding. A majority (fifteen of nineteen, 79 %) reported discarding colostrum and breast-feeding within 24 h of birth. Prelacteal feeding emerged as an additional factor to be targeted through educational intervention. CONCLUSIONS To maximize neonatal health and growth, we recommend culturally tailored education delivered by community health advocates and traditional health practitioners that promotes immediate colostrum feeding and discourages prelacteal feeding.

Relationship of Substance Use by Students with Disabilities to Long-Term Educational, Employment, and Social Outcomes

The study is based on data from the National Education Longitudinal Study of 1988–2000 (NELS: 88). The results indicate that adolescents with disabilities who used either cigarettes or marijuana or who engaged in binge drinking had significantly higher dropout rates, lower high school graduation status, lower college attendance, and lower high school grade point averages, and fewer earned core credit units in English, science, and mathematics than nonusers. In addition, adolescents with disabilities who used either cigarettes, alcohol, or drugs were significantly more likely to engage in sexual activity at a younger age. The findings support the need for improved substance use prevention programming targeting the needs of youth with disabilities.

Increasing Substance Abuse Treatment Compliance for Persons With Traumatic Brain Injury.

This study compared 3 methods of increasing participation in substance abuse treatment for clients with traumatic brain injury. Participants (N = 195) were randomly assigned to 4 conditions: (a) motivational interview, (b) reduction of logistical barriers to attendance, (c) financial incentive, and (d) attention control. Four interviewers conducted structured, brief telephone interventions targeting the timeliness of signing an individualized service plan. Participants assigned to the barrier reduction (74%) and financial incentive (83%) groups were more likely to sign within 30 days compared with the motivational interview (45%) and attention control (45%) groups. Similar results were observed for time to signing, perfect attendance at appointments, and premature termination during the following 6 months. Extent of psychiatric symptoms was the only significant covariate.

Symptom Prevalence of ADHD in a Community Residential Substance Abuse Treatment Program

Objective: ADHD is a common comorbid condition with substance use disorder. This study seeks to examine the discrepancy in the prevalence rate between those previously diagnosed with ADHD and those diagnosed while in treatment. It is hypothesized that clients with ADHD would have earlier unsuccessful terminations from treatment than non-ADHD clients and that the ADHD Self-Report Scale (ASRS Version 1.1) would be a reliable predictor. Method: Participants (N = 87) are admitted to a publicly funded 28-day residential treatment program. All participants are screened with the ASRS and participate in a clinical assessment evaluation. Results: A significant difference is found between the clinical record rate of 3.44% and the 43.68% rate found during treatment. The ASRS significantly predicts ADHD. Conclusions: The use of the ASRS is recommended and should be incorporated into standard intake assessment protocols. Careful diagnostic interviews are urged to determine if clients in residential treatment have ADHD.

Validation of a Substance Use Disorder Screening Instrument for Use in Vocational Rehabilitation Settings

Objective: The study objectives were to develop and validate a substance use disorder screening instrument for vocational rehabilitation customers. Beginning with the Substance Abuse Subtle Screening Inventory–3 (SASSI-3), the authors developed items pertaining to prescription medication misuse and modified other items. Research Method/Design: Data were collected for the cross-sectional cohort study through interviews with a random subsample reinterviewed 14 days later. Complete data sets were collected from 948 customers recruited in Ohio, Illinois, and West Virginia; 128 completed a second interview. Women composed 52% of the sample and 58% were African American; the mean age was 40 years (12 years). Customers completed a preliminary version of the new instrument, called the Substance Abuse in Vocational Rehabilitation Screener (SAVR-S), and the Diagnostic Interview Schedule. The authors used Rasch analyses to reduce the instrument to 43 items then divided the sample into a development subsample (used to formulate a scoring routine) and a validation subsample. Results: Sensitivity in detecting substance use disorders was 82% and specificity was 85% in the validation subsample. Conclusions/Implications: The SAVR-S appears to be a valid instrument and minimizes respondent burden while maximizing sensitivity and specificity to substance use disorders. It can assist vocational rehabilitation staff in identifying customers who need professional assessment and help support efforts toward self-sufficiency.

An Ecological Approach to Addressing HIV/AIDS in the African American Community

The disproportionate impact of HIV/AIDS on African Americans is a significant public health challenge. The complex constellation of individual, social, and environmental factors influencing transmission, require ecological solutions that recognize these multiple levels of influence and actively involve communities. This article describes the formation of a community-based coalition and highlights three initiatives it has undertaken in the areas of mobile HIV testing, HIV education, and faith-based work to improve HIV services for African Americans.

Intention to Quit Tobacco Use among Clients in Substance Use Disorder Treatment Settings

The purpose of this study was to investigate the influence of age, gender, tobacco-related knowledge, treatment modality, and changes in smoking patterns on intention to quit tobacco use among individuals participating in substance use disorder (SUD) treatment in Ohio. Of the 791 SUD program attendees, 91.7% currently used tobacco, with cigarette smoking being the most prevalent form of use. Among tobacco users, 67% reported intention to quit tobacco use. Four of the five hypothesized predictor variables had a significant relationship with intention to quit tobacco: gender, age, treatment modality, and smoking pattern, with age and gender demonstrating the strongest relationships to intention to quit smoking.

Validation of the substance abuse screener in American Sign Language (SAS--ASL).

OBJECTIVE The study objectives were to adapt and validate a substance use disorder (SUD) screening instrument in American Sign Language (ASL) to be used to identify those deaf individuals who have a high probability of having an SUD. The goal was to develop an accurate screening instrument that balanced sensitivity and specificity while imposing minimal response burden on respondents. METHOD A sample of 198 deaf participants in behavioral health, family social service, and educational programs that provide specialized services for deaf individuals was interviewed to obtain clinical diagnoses for current (past 12 months) SUD according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and completed a 42-item version of the Substance Abuse Screener in American Sign Language (SAS-ASL). We used Rasch and discriminant function analyses to reduce the instrument to 28 items, then divided the sample into a development subsample, used to formulate a scoring routine, and a validation subsample to assess correspondence with clinical diagnoses. To provide validation data on the shortened SAS-ASL, an independent sample of 62 respondents was diagnosed and completed the screener. RESULTS The SAS-ASL instrument demonstrated good person reliability (.85), sensitivity (.90), and specificity (.84) in the primary validation sample, and 100% screening accuracy with 62 respondents in the second validation sample. CONCLUSION The SAS-ASL provides a standardized SUD screening for the deaf population. The adaptability of the instrument to electronic administration lends itself to a continuum of technologically supported services for a high-risk population that is disenfranchised for most community-based behavioral health services.

The PALS Prevention Program and Its Long-Term Impact on Student Intentions to Use Alcohol, Tobacco, and Marijuana

A unique Alcohol, Tobacco, and Other Drug (ATOD) prevention program called PALS (Prevention through Alternative Learning Styles) was implemented with middle school students with the goal of enhancing student knowledge of the harmful effects of ATOD, promoting the use of refusal skills and reducing intentions to use ATOD in the future. Intentions to use were measured at four points: pre-PALS, post-PALS, and at 1-year and 2-year follow-ups. Student survey responses were then matched and compared across the four time periods. This article reports on the long-term effectiveness of PALS on student intentions to use ATOD in high school. When follow-up surveys of PALS students were compared to students not exposed to PALS (comparison group), the PALS students had significantly lower intentions to use alcohol and tobacco, providing evidence that the PALS intervention did have a long-term impact on intentions to use these substances.