Martha C. Beattie

Success and Failure Static Concepts in a Dynamic Society

Since program participants are inclined to view evaluators as a threat to themselves and their program, and since such a perception can restrict the flow of information about a program to the evaluators, the authors attempted to avoid such alienation by assuring members that they would make no judgments of success or failure. The case is the American Sociological Associations Project to Improve Undergraduate Teaching in Sociology. A conceptual framework for the analysis is borrowed from organizational theory. Such concepts as goal succession, goal displacement, and goal perspectives help illuminate the program as an ongoing organization. The data consist of participant- observation field notes and published reports by the projects themselves.

Determinants of neuropsychological impairment in antisocial substance abusers.

Persons displaying Antisocial Personality Disorder (ASP) may be at risk for neuropsychological impairment due to a number of developmental and later life experiences to which they are prone. Thirty substance abusers meeting research criteria for ASP were compared to a demographically matched non-ASP cohort on neuropsychological test performance. The ASP subjects were found to have a higher prevalence of neuropsychological deficit. The groups were then compared on factors which might lead to brain impairment. Presence of ASP was associated with earlier and heavier past drinking patterns, more negative health and behavioral effects of alcohol abuse, and greater abuse of other drugs in addition to alcohol. The ASP alcoholics also reported a high prevalence of serious head injury (58%), although they did not differ from non-ASP alcoholics in this regard. Implications for the neuropsychology of alcoholism and for treatment are discussed.

Smoking and treatment outcome for alcoholics: Effects on coping skills, urge to drink, and drinking rates

The interrelationship between alcohol and tobacco addiction is beginning to receive more attention because it has conceptual and practical significance for understanding and treating addictive disorders. This investigation focuses on the effects of smoking on risk for relapse after alcoholism treatment. The relationships between smoking and: (1) alcohol consumption rate and dependence at pretreatment, (2) reactions to coping with alcohol high-risk-for-relapse role plays, and (3) alcohol treatment outcome were investigated. These relationships were studied first in a sample of male VA alcoholics (n=45) and then replicated and extended in a different sample from a private hospital (n=53 females, 110 males). Smoking and drinking rate, and smoking and alcohol dependence, were significantly correlated at pretreatment. Smokers with greater dependence on cigarettes (i.e., higher Fagerstrom Tolerance Questionnaire scores; shorter latency to smoking first cigarette of the day) experienced significantly greater urge to drink, urge to smoke, difficulty, and anxiety in role plays of alcohol high-risk situations, independent of their pretreatment drinking rate or alcohol dependence. Smoking dependence did not predict mean number of drinks per day or frequency of drinking days during 6-month follow-up. In the private hospital sample, among alcoholics who drank at all during follow-up, the more dependent smokers drank more alcohol on drinking days than did the less dependent smokers. Implications for theory and treatment of addictive disorders are discussed.

Effectiveness of alcoholism treatment in partial versus inpatient settings: Twenty-four month outcomes☆

The authors examined the effectiveness of the partial hospital setting, in contrast to the inpatient setting, for the rehabilitation of alcohol abusers and alcoholics. Outcomes after 24 months in five life health areas indicated marked improvement from baseline for the entire follow-up period on almost all measures. There also was a strong relationship between drinking outcomes and outcomes in the other health areas. Although there were few between group differences on the clinical outcome measures, differences which were found favored the partial hospital setting. Furthermore, cost of treatment over two years clearly favored the partial hospital.

Differences between alcoholics and spouses in their perceptions of family functioning

The present study is an investigation of differences between alcoholics and significant others in their perceptions of the functioning of their families or households. A sample of 80 pairs of alcoholic patients (PTs) and their spouses or spouse equivalents (SOs) who were living together in the same household evaluated family functioning by completing the Family Assessment Device (FAD). Agreement between PTs and SOs was moderate on the Affective Responsiveness, Communication, Problem Solving, Roles, and General Functioning scales. However, there was little or no agreement on the Behavior Control and Affective Involvement scales. These results indicate that although PTs and SOs tended to agree about how well family members work together and share thoughts and feelings, they disagreed about how well boundary issues were dealt with in their families. Implications for treating alcoholic families are discussed.

Liver function tests and neuropsychologic impairment in substance abusers

The relationship between residual neuropsychologic dysfunction in alcoholics and subtle changes in liver function during acute phases of treatment was examined. Noncirrhotic alcoholics who exhibited extreme elevations in the liver enzyme gamma-glutamyl transferase (GGT) were found to have greater impairments in tasks of visuoperceptual and conceptual abilities when compared to alcoholics with normal or only mild elevations in GGT. The relationship between acute liver dysfunction and residual neuropsychologic impairment appeared to be independent of age and patterns of drinking. The implications of these findings in relation to treatment planning and prognosis of alcoholics are discussed.

An outcome monitoring system for psychiatric inpatient care.

As the national impetus for examining treatment outcomes increases, the demand for cost-effective systems for psychiatric outcome monitoring grows. This article describes one local effort to develop a monitoring system at Butler Hospital in Providence, Rhode Island. The system uses a combination of face-to-face and computer interviews of a random sample of recently admitted inpatients, with follow-up interviews one month postdischarge and one year following admission. The patient self-report data and interviewer assessment data generated by these interviews are used to quantify patient symptoms and social functioning. With a large enough sample, these findings can be used to identify areas where patient care may be improved. The article also discusses the process and problems involved in implementing the monitoring system and presents illustrative preliminary findings.