Gerard J. Connors

Addictive behaviors among hospitalized psychiatric patients

A survey was conducted to assess the extent of alcohol abuse, drug abuse, obesity, and smoking among patients hospitalized on other than substance abuse treatment wards of a large psychiatric hospital. The results revealed extensive addictive behavior problems in the sample with nearly 90% of the patients having at least one of the problems. Prevalence rates for smoking and alcohol abuse substantially exceeded, and for obesity was equivalent to, the prevalence of these behaviors in the general population. Drug abuse was the least frequent problem and comparisons to the general population could not be made. Another major finding was that a relatively small proportion of patients was receiving any treatment for their addictive problems that was likely to be effective. For the most part, it seemed that patients receiving treatment were cases in which the addictive problem caused a serious immediate danger to the patient or others on the ward or seriously disrupted the ward routine.

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.

School adjustment of children of alcoholic fathers: Comparison to normal controls

The present study used objective indices of academic performance to test the hypothesis that children of alcoholic fathers (COAs) have poorer school adjustment than children of nonalcoholic parents (non-COAs). Subjects were 39 children of male alcoholics treated for alcoholism in a VA program and 33 control children whose nonalcoholic parents (matched on demographic indices) reported low marital conflict. The results showed that daughters of alcoholics, but not the sons, showed more variability than controls in their school attendance. There was suggestive evidence that they also missed more school days than controls, with a reversed pattern for the sons of alcoholics. Generally, however, the COA group was not compromised academically and did not show more conduct problems compared to controls. Within the COA group, long-term paternal drinking adjustment (years of problem drinking and total number of hospitalizations for drinking) appeared to be related to poorer GPA, while short-term adjustment (alcohol-related days in jail and number of days drinking in year previous to treatment) were more related to poorer attendance. The results are discussed in terms of the mechanism of the effect of paternal drinking on childrens school adjustment and the difficulty in making generalizations about the consequences of being the child of an alcoholic.

Percutaneous revascularization of long femoral artery lesions for claudication: patency over 2.5 years and impact of systematic surveillance.

Background: Angioplasty and stenting are preferred treatments for revascularizing femoral artery lesions up to 100 mm, but surgical bypass is recommended for longer lesions. We assessed long‐term patency after percutaneous revascularization of long femoral artery lesions for claudication with intensive out‐patient surveillance. Methods: We followed a cohort of 111 consecutive patients receiving angioplasty or stenting in 142 limbs in two institutions. Patients were followed for 2.5 years, and event curves and multivariable survival analysis used to compare outcomes in three groups according to lesion length (< 100 mm, 100–200 mm, and greater than 200 mm). Failed patency was defined as recurrence of symptoms with a decline in ankle brachial index, or stenosis identified by duplex ultrasound, or reintervention. Results: Compared to lesions less than 100 mm, longer lesions had higher failed primary patency (100–200 mm: HR = 2.0, P = 0.16, >200 mm: HR = 2.6, P = 0.03). Failed secondary patency was similar for short and intermediate lesions (< 5% incidence), but trended higher for lesions >200 mm (HR = 4.2, P = 0.06). An initial procedure residual stenosis greater than 20% was the only significant multivariable factor related to poorer long‐term patency (HR = 15.8, P = 0.003). Compared to short lesions, the gain in long‐term patency with out‐patient surveillance and reintervention was higher for longer lesions and significantly so for intermediate lesions (100–200 mm = 23% versus <100 mm = 8%, P = 0.041). Conclusion: Percutaneous treatment of long femoral artery lesions can provide acceptable long‐term patency for patients with claudication when out‐patient surveillance is used to identify patients who require repeat interventions. Future long‐term studies should consider overall patency encompassing more than one percutaneous reintervention.

Behavioral Treatment of Drunk-driving Recidivists: Short-term and Long-term Effects

This study was designed to investigate the relative effects of two behavioral group treatments on short-term (knowledge and attitude change) and long-term (recidivism) variables among persons with multiple arrests for driving under the influence of alcohol (DUI). Subjects were randomly assigned to a behavioral treatment that was highly-individualized and focused on principles of self-control or to a general behavioral treatment (which focused on alcohol education, relaxation training, and guided reevaluation of situations typically associated with DUI arrests). Results showed that subjects in both groups reported, over treatment, a more frequent use of portable breath test devices for assessing blood alcohol levels and perceived an increased probability of being arrested if they drank and drove. In addition, subjects in the individualized behavioral groups reported that they subsequently spent more time thinking about avoiding DUI. However, the two treatment groups did not differ in their rates of DUI arrest recidivism (which averaged 11.7% per year over the three-year follow-up period). One third of the subjects were rearrested for DUI during the 36-month follow-up period, although there were indications that rearrests may have been delayed as a function of the treatment interventions. Taken together, the data suggest that these drunk-driving recidivists may be responsive to the treatment interventions described herein. Additional research is needed to specify the relative impact of the behavioral techniques utilized in the treatment programs and to identify strategies for maintaining treatment gains over longer periods of time.

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.

Femoral artery percutaneous revascularization for patients with critical limb ischemia: outcomes compared to patients with claudication over 2.5 years

Patients with critical limb ischemia have higher rates of death and amputation after revascularization compared to patients with intermittent claudication. However, the differences in patency after percutaneous revascularization of the superficial femoral artery are uncertain and impact the long-term risk of amputation and function in critical limb ischemia. We identified 171 limbs from 136 consecutive patients who had angioplasty and/or stenting for superficial femoral artery stenoses or occlusions from July 2003 through June 2007. Patients were followed for primary and secondary patency, death and amputation up to 2.5 years, and 111 claudicants were retrospectively compared to the 25 patients with critical limb ischemia. Successful percutaneous revascularization occurred in 128 of 142 limbs (90%) with claudication versus 25 of 29 limbs (86%) with critical limb ischemia (p = 0.51). Overall secondary patency at 2.5 years was 91% for claudication and 88% for critical limb ischemia. In Cox proportional hazards models, percutaneous revascularization for critical limb ischemia had similar long-term primary patency (adjusted hazard ratio = 1.1, 95% CI = 0.4, 2.6; p = 0.89) and secondary patency (adjusted hazard ratio = 1.1, 95% CI = 0.2, 6.0; p = 0.95) to revascularization for claudication. Patients with critical limb ischemia had higher mortality and death rates compared to claudicants, with prior statin use associated with less death (p = 0.034) and amputation (p = 0.010), and prior clopidogrel use associated with less amputation (p = 0.034). In conclusion, percutaneous superficial femoral artery revascularization is associated with similar long-term durability in both groups. Intensive treatment of atherosclerosis risk factors and surveillance for restenosis likely contribute to improving the long-term outcomes of both manifestations of peripheral artery disease.

Applying behavioral contracting to alcohol abuse in a spinal cord injured patient

While there have been studies of the use of contingency contracting with several populations of alcohol abusers, the application of alcohol-related contracting to non-psychiatric environments and patients without primary alcohol diagnoses has not been illustrated. A behavioral contract, which included the use of a time out detoxification room, scheduled communication sessions, and a drinking checklist was employed to reduce the inappropriate drinking, verbal and physical abuse of a spinal cord injured patient during a 12-month intervention/follow-up period. The contracts features and methods for improving its effectiveness are discussed.

IMPORTANCE OF OUT-PATIENT SURVEILLANCE FOR ACHIEVING LONG-TERM PATENCY AFTER PERCUTANEOUS REVASCULARIZATION OF LONG FEMORAL ARTERY DISEASE

Methods: A cohort of 134 consecutive patients receiving angioplasty or stenting in 171 limbs by Interventional Vascular Medicine specialists in two institutions were followed for up to 2.5 years. Event curves and survival analysis compared outcomes in three groups by lesion length (<100 mm, 100-200 mm, and >200 mm). Failed patency was defined as recurrence of symptoms, decline in ankle brachial index, stenosis by duplex ultrasound or need for re-intervention.

Behavioral Group Therapy with Drunk-Driving Offenders

Motor vehicle accidents have become the major cause of accidental mortality and morbidity in industrial nations (Havard, 1975), and alcohol consumption has been cited as the most significant contributor to such accidents (Seppala, Lin-noila, & Mattila, 1979). Of the approximately 50,000 traffic accident mortalities that occur yearly in the United States, it has been estimated that as many as 78% of these victims are drivers with some level of alcohol in their blood (Reed, 1982). Of course, a measurable blood alcohol level does not necessarily mean that a driver is “drunk” nor that there is a causal relationship between alcohol consumption and accident involvement. In fact, Zylman (1975) has suggested that perhaps only 30% of traffic deaths can be linked to alcohol consumption in some causal manner. Nevertheless, when all is taken into account, the impact of drinking drivers assuredlv remains immense.