Leo J. Davis

Alcoholism in elderly persons: a study of the psychiatric and psychosocial features of 216 inpatients.

The medical records of 216 elderly persons, admitted to the hospital for treatment of alcoholism, were reviewed. Concern of family and friends was the most common factor motivating patients for admission. Patients with late-onset alcoholism reported an association between a life event and problem drinking more frequently than did the early-onset alcoholics. The most common associated psychiatric disorders were tobacco dependence (67%), organic brain syndrome (25%), atypical or mixed organic brain syndrome (19%), and affective disorder (12%). Fourteen percent of patients also had a drug abuse or dependence problem, all using legally prescribed drugs. Psychiatric diagnoses and results of psychologic testing did not differ between early-onset and late-onset alcoholism groups. In a 60-patient cohort studied for correlation of outcome of treatment for alcoholism with major psychiatric diagnoses, no associations were found.

Alcoholism in Elderly Persons: Medical Aspects and Prognosis of 216 Inpatients

We describe 216 elderly patients (65 years of age or older) who were treated for alcoholism in an inpatient treatment program. Emphasis is placed on the demographics, medical characteristics, results of laboratory tests, outcome of treatment, and various comparisons of early- and late-onset alcoholism. The frequency of serious medical disorders among these patients was higher than would be expected for the overall population of a similar age. Elderly alcoholics have more abnormal results of commonly used laboratory tests than do younger alcoholics. Our data show that the elderly alcoholic can be successfully treated in a medically oriented inpatient treatment program. The concept of less-intensive treatment for the elderly alcoholic is generally not supported. More-intensive treatment may be necessary for some of these patients because of the high frequency of accompanying major medical and psychiatric problems. Early-onset alcoholism predominated, but we found no major differences between the two groups.

Point prevalence of alcoholism in hospitalized patients: Continuing challenges of detection, assessment, and diagnosis

OBJECTIVE To measure a 1-day point prevalence of alcohol dependence among hospitalized patients and to assess practices of detection, evaluation, and diagnosis of alcohol problems. PATIENTS AND METHODS On April 27, 1994, a total of 795 adult inpatients at 2 midwestern teaching hospitals were asked to complete a survey that included the Self-administered Alcoholism Screening Test (SAAST). The records of SAAST-positive patients were reviewed to determine the numbers of patients receiving laboratory screening for alcoholism, addiction consultative services, and a discharge diagnosis of alcoholism. RESULTS The survey response rate was 84% (667/795). Of the 569 patients who provided SAAST information, 42 (7.4%) had a positive SAAST score and thus were identified as alcohol dependent. Thirteen (31%) of the 42 alcoholic patients received addiction or psychiatric consultative services during their hospitalization. Serum gamma-glutamyltransferase was measured in 4 (11%) of the 38 actively drinking alcoholic patients. Three (7%) of 42 alcoholic patients received a discharge diagnosis of alcohol abuse or dependence. CONCLUSIONS The alcoholism prevalence rate was lower than those observed in several other US hospitals. Laboratory testing may be underutilized in identifying hospitalized patients who may be addicted to alcohol. Physician use of consultative services and diagnosis of alcohol dependence had not improved from similar observations more than 20 years earlier. These findings may indicate persistent problems in physician detection, assessment, and diagnosis of alcoholism.

Standard scores for Wechsler memory scale subtests

Equations are provided for the calculation of age-corrected standard scores with a mean of 10 and a standard deviation of 3 for the Mental Control, Logical Memory, Visual Reproduction, and Associate Learning subtests of the Wechsler Memory Scale. Use of the standard scores is expected to facilitate intersubtest comparisons.

Self-administered nicotine-dependence scale (SANDS): Item selection, reliability estimation, and initial validation

The Self-Administered Nicotine-Dependence Scale (SANDS) is a questionnaire to assist in the determination of the most appropriate intervention for the nicotine-dependent individual. Six content domains included are: (1) self-efficacy; (2) social skills deficit; (3) loss of control; (4) consequences of use; (5) social support for smoking; and (6) concern for healthy life-style. A preliminary set of 79 items was reduced to a 32-item scale, which, in turn, was divided into two non-overlapping subscales of 16 items each. Logistic regression analyses of an additional sample of subjects indicated that the SANDS added predictive power to knowledge of sex and transdermal-patch status for predictions of smoking status 6 months later.

The CAL: an MMPI alcoholism scale for general medical patients.

We developed a MMPI alcoholism scale based on adult medical patient samples. Our criterion group consisted of 736 inpatients (525 males; 211 females) diagnosed as having alcoholism according to DSM-III criteria. Three contrast samples that totaled 13,120 individuals were used for control purposes. MMPI items were chosen by means of logistic regression. The 33 items yielded by this procedure formed a provisional scale (CAL, for common alcoholism logistic) that worked equally well for males and females. With new cross-validation samples, with sensitivity (proportion of alcoholics correctly identified) set at 90%, the specificity (proportion of nonalcoholics correctly identified) ranged from 90% to 96% for selected contrast samples. We conclude that this scale shows promise as a screening device in similar populations.

Resurrecting the ICAS: A competitor for the MAC in screening medical patients for alcoholism?

Although the MacAndrew scale (MAC) is the most widely used of the MMPI alcoholism screening scales, evidence to support its continued use is equivocal, and recent data raise serious questions about its efficacy in the screening of medical patients. In comparison, the Institutionalized Chronic Alcoholic Scale (ICAS), an 8-item scale, has an equivalent correct classification rate among male alcoholics and is significantly better than the MAC scale at identifying female alcoholics. Furthermore, misclassification rates among medical patients and normal persons are substantially lower for the ICAS than for the MAC scale, although the ICAS overidentifies potential alcoholism among normal women and female medical patients. However, reliability coefficients across the criterion and contrast samples are disappointingly low, and the use of the ICAS cannot be defended on that basis.

Association between scores on the SAAST (a direct measure of alcohol misuse) and CAL scale (an indirect measure of alcohol misuse) among medical patients admitted for treatment of alcohol dependence.

Abstract Patients with medical or social problems related to alcohol abuse or alcohol dependence frequently are seen in the health care delivery system. Direct and indirect screening methods are available, but contemporary data describing their combined effectiveness have not been reported. We determined the sensitivity of (a) an empirically derived, item-weighted, relatively “indirect” screening measure for alcohol misuse (the Common, Alcohol, Logistic [CAL] scale for the MMPI), (b) a “direct” approach to screening for alcohol misuse (the Self-Administered Alcohol Screening Test [SAAST]), and (c) their combined application. We obtained the responses to both measures from an archival sample of 361 medical patients (89 women, 272 men) who had been diagnosed with alcohol dependence by DSM-III-R criteria. The CAL scale and the SAAST both demonstrated high sensitivity. However, results favored the simultaneous use of a directin this study, the SAASTand an indirectin this study, the CAL scalescreening procedure.