Norman G. Hoffmann

Prevalence of Abuse and Dependency in Chronic Pain Patients

A series of 414 chronic pain patients referred to Are Hospital, Are, Sweden, for evaluation and rehabilitation were administered a structured diagnostic interview to detect alcohol and drug misuse and dependence according to DSM-III-R criteria. A total of 97 (23.4%) met criteria for active alcohol, analgesic, or sedative misuse or dependency; an additional 39 (9.4%) met criteria for a remission diagnosis. Current dependency was most common for analgesics (12.6%) followed by alcohol (9.7%) and sedatives (7.0%).

Adolescent Cocaine Abuse Addictive Potential, Behavioral and Psychiatric Effects

Four hundred seventy-nine drug abusing adolescent patients enrolled in seven Straight, Inc. Adolescent Drug-Abuse Treatment Programs in five geographic regions across the United States were studied to determine the severity and patterns of cocaine abuse. Of these, 341 admitted to cocaine use and became part of this survey. Cocaine use was categorized as heavy, intermediate, or light. Areas examined were the addictive spectrum, psychosocial dysfunction, and psychiatric symptoms. Intermediate and heavy users of cocaine abused significantly less marijuana and inhalants than light cocaine abusers. Heavy and intermediate users were more likely to use cocaine intravenously and to use crack. They developed tachyphylaxis more frequently, progressed to weekly use in less than 3 months more frequently, and became preoccupied with obtaining and using cocaine significantly more frequently. They used more sedative hypnotics to calm themselves and engaged in more criminal behavior, such as stealing from parents and stores and passing bad checks. They had more arrests for possession of drugs, stole more cars, sold more drugs, and were more likely to trade sexual favors to obtain the drug. Heavy and intermediate users were significantly more psychiatrically disturbed than light users, becoming more suspicious, nervous, aggressive, and demonstrating increased symptoms of fatigue, sleeplessness, decreased appetite, and increasing cocaine dysphoria. All of these symptoms could be mistaken for psychiatric disorders. This study suggests that cocaine is as addictive in adolescents as in adults; possibly more so. It also causes psychosocial dysfunction and psychiatric symptoms. Further research into cocaine addiction among adolescents is indicated.

Differential drug use patterns among sexually abused adolescent girls in treatment for chemical dependency.

A sample of 444 girls admitted to adolescent chemical dependency treatment was divided into four groups based on sexual abuse experiences. Girls who reported intrafamilial abuse, extrafamilial abuse, or both, were compared with nonvictims in terms of alcohol and drug use histories. Prevalence and frequency of alcohol, marijuana, and cocaine did not differ significantly among the groups. However, all sexual abuse victims were significantly more likely to regularly use stimulants, sedatives, tranquilizers, and hallucinogens. Sexual abuse victims also reported earlier onset of alcohol and drug use, more self-medication, and more use to escape family problems.

Prevalence of Co-Occurring Disorders Among Juveniles Committed to Detention Centers

The Practical Adolescent Diagnostic Interview (PADDI), a structured diagnostic interview designed to gather basic information about substance use disorders, mental health conditions, and related experiences, was used in routine evaluation of all adolescents committed to two juvenile detention centers. Anonymous data from 252 consecutively admitted adolescents were analyzed to assess the prevalence and severity of problem areas and to provide a preliminary exploration of interrelationships among those problems. Results demonstrated that a majority of adolescents manifested multiple problems. Whereas prevalence rates were high across gender, females displayed significantly greater mental health problems and maltreatment histories.

Alcoholics Anonymous after Treatment: Attendance and Abstinence

Follow-up data on 900 inpatients at eight hospital-based chemical dependency treatment centers demonstrate a high correlation between total abstinence 6 months after discharge and weekly attendance at Alcoholics Anonymous during this period. Almost three-fourths (73%) of the regular attendees remained chemically free, compared with one-third (33%) of the nonattendees. These data suggest that Alcoholics Anonymous is an appropriate and beneficial aftercare for the majority of treatment inpatients.

The relationship between pre-, during-, post-treatment factors, and adolescent substance abuse behaviors

This study examines the relationship between pre-, during-, post-treatment variables, and treatment outcome by using a secondary data analysis of the 6- and 12-months posttreatment follow-up data from 2,317 adolescent subjects. Pre-treatment variables included in this study are psychosocial, family-related, substance abuse, and special event variables. During-treatment variables are length of stay and parental participation in treatment. Post-treatment variables cover the attendance of subsequent treatment/continuing care, such as AA/NA and CD aftercare, and parental attendance of subsequent treatment. Results from discriminant function analyses indicated that during- and post-treatment variables could differentiate the abstinence status at 6- and 12-month follow-ups. It was also shown that the post-treatment variable group exhibited the best classification accuracy among the three variable groups across both follow-up periods. Limitations in applying research findings and their implications for adolescent substance abuse treatment are also discussed.

Sexual abuse correlates: Similarities between male and female adolescents in chemical dependency treatment.

A history of sexual abuse was examined for its relationship to signs ofpsychosocial dysfunction among an aggregated adolescent chemical dependency treatment sample. Chemical Abuse Treatment Outcome Registries (CATOR) collected and analyzed data on adolescents admitted to nine private treatment centers from 1984 to 1986; 210 self-reported female victims were compared with 234 nonvictims, 81 male victims with 890 nonvictims. Both male and female victims used a wider variety of drugs than did nonvictims and more used alcohol and drugs to self-medicate. More victims were troubled by nervousness, sleep problems, sexual problems, and suicidal thoughts. Twice as many victims as nonvictims had attempted suicide during the previous year. More victims were arrested at a young age, and more had suffered serious legal consequences. These findings have important implications for the evaluation and treatment of adolescents in clinical and correctional settings, as well as for rethinking priorities and strategies for prevention of substance abuse among the young.

UNCOPE: A Brief Substance Dependence Screen for Use with Arrestees

A national multi-site monitoring system for determining prevalence of alcohol and drug involvement in arrestees sought to refine the screening for substance dependence among persons arrested and incarcerated in local jails. Fifteen items were selected from the content of existing alcohol and drug abuse screens. These items were evaluated against a detailed diagnostic interview covering criteria of the DSM-IV. A total of 310 prisoners incarcerated within the previous 48 hours were recruited as subjects. Almost 65% of the subjects had a positive diagnosis of dependence for one or more substances. A six-item screen identified by the acronym UNCOPE emerged as the best set of screening items for identifying dependence on alcohol and/or drugs. The UNCOPE had sensitivity of 88% and specificity of 83% for the sample as a whole. It performed similarly irrespective of gender or ethnicity and appears to have potential utility in a wide range of populations.

Integration of treatment and posttreatment variables in predicting results of abstinence-based outpatient treatment after one year.

A multi-site, longitudinal study of patients undergoing outpatient alcohol and drug dependence treatment was conducted in private outpatient facilities, consisting of 2,029 subjects from 33 independent programs enrolled in a national addiction treatment outcomes registry. Pretreatment demographic and substance variables, treatment utilization variables, and post-treatment continuum of care variables were examined simultaneously in a multivariate prediction context for association with outcome. Upon admission patients provided history information to treatment staff trained in the collection of data for the evaluation efforts. Trained interviewers conducted consecutive structured interviews prospectively for treatment outcome at six- and 12-month follow-up periods. Multivariate analysis with stepwise multiple regression indicated that, relatively speaking, the most powerful predictors of treatment outcome were posttreatment variables: namely, support group attendance and involvement in a continuing care program. Pretreatment and treatment variables contributed proportionately little to the prediction of outcome. Additional sequential-stage analysis showed that the incremental contribution to prediction by posttreatment attendance at Alcoholics Anonymous and involvement in a treatment program following discharge far exceeded the initial predictive validity of the 14 pretreatment and treatment variables examined. Participation in posttreatment continuing care correlated with statistically significant reductions in job absenteeism, inpatient hospitalizations, and arrest rates. Posttreatment more than pretreatment factors may be decisive in influencing risk for relapse.

Occurrence of depression in the postpartum state

Using multiple variables of illness, comparisons were made between 17 postpartum depressives with recurrent affective disorder and 37 women with children and recurrent affective disorder but no postpartum depressions. An earlier age of onset in patients with postpartum depression was the only variable that was significantly different between groups. The occurrence of depression for the 17 subjects was significantly greater in the postpartum period than in the non-postpartum period. The postpartum depression rate for pregnancies subsequent to the initial postpartum episode was 75%.