Raymond M. Costello

Alcoholism Treatment and Evaluation: In Search of Methods

This study collated 23 articles reporting outcome of alcoholism treatment efforts over a 2-year follow-up period. Broad conclusions reached by Costello (1975) in a similar collation of studies reporting on a 1-year follow-up interval found general support. Similar consistencies were noted across studies within groups described as having good outcome profiles as was noted by the previous collation. Good outcome results from matching relatively better prognostic cases wtih programs with broad treatment resources. Multiple baselines were offered as guidelines for program evaluation. Baselines were generated in the process of collation by hierachal grouping of outcome profiles. Different baseline to measure effectiveness of performance should prove appropriate for different measuring tasks. No one baseline is appropriate for all measuring tasks.

P-A-I-N: a four-cluster MMPI typology for chronic pain.

&NA; A 4‐cluster empirically derived MMPI typology for chronic pain sufferers has been demonstrated by combining the results of 10 investigative teams. These MMPI ‘types’ have been labeled P‐A‐I‐N and appear to have important clinical and demographic correlates. Type P is the most ‘psychopathological’ looking as nearly all scales are usually elevated. Type P patients are extreme in their claims of physical illness, psychological distress and social maladaptation. Demographic correlates include poor education, high rates of unemployment, and limited household income. Type A is defined by a ‘conversion V’ on the ‘neurotic’ triad scales. It has no unique correlates. Type I has elevations on all of the neurotic triad scales and on no others. Type I patients appear to be the most physically infirm with multiple surgeries and hospitalizations. They may not improve physical status with treatment, but appear to benefit psychologically. Type N profiles are ‘normal’ in that no scale, except perhaps scale K, is often elevated. Type N patients are moderate in their claims of ill health, often are better educated and employed, and appear to respond well to treatment. Classification rules have been proposed to allow patient‐typing without a computer. Use of these rules should allow programmatic research into treatment/ type interactions even in the ordinary clinical setting. The typology appears well enough established to allow for prospective studies to test theoretical hypotheses drawn from the literature base.

Alcoholism treatment and evaluation: in search of methods. II. Collation of two-year follow-up studies.

This study collated 23 articles reporting outcome of alcoholism treatment efforts over a 2-year follow-up period. Broad conclusions reached by Costello (1975) in a similar collation of studies reporting on a 1-year follow-up interval found general support. Similar consistencies were noted across studies within groups described as having good outcome profiles as was noted by the previous collation. Good outcome results from matching relatively better prognostic cases with programs with broad treatment resources. Multiple baselines were offered as guidelines for program evaluation. Baselines were generated in the process of collation by hierachal grouping of outcome profiles. Different baseline to measure effectiveness of performance should prove appropriate for different measuring tasks. No one baseline is appropriate for all measuring tasks.

Cognitive Impairment in Lacunar Strokes: The SPS3 Trial

Lacunar strokes are a leading cause of cognitive impairment and vascular dementia. However, adequate characterization of cognitive impairment is lacking. The aim of this study was to estimate the prevalence and characterize the neuropsychological impairment in lacunar stroke patients.

Depression in Opioid Users Varies with Substance Use Status

The relation of substance use status to depressed mood during careers of 173 opioid users was estimated using the Zung Self-Rating Depression Scale. The data suggested a progression in severity of depression from those abstinent or using occasionally, who were least depressed, through intermediate substance use states, to those dependent on illicit opioids, who were most depressed. One hundred five subjects completed the Scale in two interviews separated by a mean of 4.5 years. Change in substance use status from not dependent at first interview to dependent at second interview was associated with increased depression.

Validation of a preemployment MMPI index correlated with disciplinary suspension days of police officers

Abstract Following the judicial principles of good faith and rationality, an MMPI index (F + Pd + Ma) was selected for attempted validation in a law enforcement job context. Disciplinary suspension days after three year careers provided a criterion of job misperformance for 107 officers hired consecutively into a police department. Preemployment MMPIs were scored for the index, which has previously been proposed in a clinical psychology context as a measure of aggression. Each component of the index had been found to be related to some aspect of job misperformance in other studies. A statistically significant correlation of .223 was found. Analysis with a Receiver Operator Characteristic procedure located an optimal cutoff score of 192. A statistically significant Wilcoxon Statistic of .654 describes the effectiveness of the cutoff in differentiating the most extreme 10% of the officers from the remaining pool. Sensitivity of the index at 192 is .455; specificity is .854. Further construct validation is n...

Police applicant screening: An analogue study

Police department supervisors rated subordinates (N = 424) as either a credit or discredit to the department. A derived empirical MMPI index called the Goldberg Index (L + PA + SC − HY − PT) was used to differentiate three groups of officers: Acceptables, Intermediates, and Unacceptables. Acceptables could be differentiated from Unacceptables with the Goldberg Index at a high level of confidence. Validational shrinkage was observed when Intermediates were added to the pool. Conclusions drawn were that (1) police officers are a heterogeneous population and that numerous predictive indices will be required to screen adequately a pool of applicants; (2) the Goldberg Index with a cutting score of 60 may detect as many as 25% of a target population; (3) indices such as that of Goldberg are useful as phase I screens to generate high-density samples of a target phenomenon; (4) further work is necessary to determine what the Goldberg Index is measuring in a nonpsychiatric population.

Mortality in an Alcoholic Cohort

This investigation explored various aspects of the phenomenon of mortality in an alcoholic cohort. A retrospective, longitudinal cohort study of 400 new admissions to an alcohol rehabilitation center demonstrated: (1) a high case fatality rate (.0459) in the cohort with 95 deaths tabulated for 2,069 person-years of observation; (2) that the case fatality rate varied over time, peaking in years soon after first identification of the cohort (i.e., years 1 and 2) and in middle range follow-up years (i.e., years 5 and 6); (3) that cardiovascular diseases and violent causes accounted for the greatest numbers of deaths in the cohort; (4) that deaths from violent causes, acute intoxication, and cirrhosis were excessively over-represented; (5) that cause-specific mortality and age at death were significantly statistically associated, with deaths from violent causes and acute intoxication occurring at younger ages and deaths from cerebral lesions carcinomas, cirrhosis, and cardiovascular diseases occurring at olde...

Therapeutic Community Treatment for Alcohol Abusers: A one-year Multivariate Outcome Evaluation

This article describes the development of an alcohol treatment unit in a Veterans Hospital. The focus is on therapeutic philosophy, staffing patterns, and a critical evaluation and examination of issues related to program evaluation. About March of 1975 the administrative staff of the Audie Murphy Veterans Administration Hospital began tooling up for a new psychiatric unit to deal exclusively with the problem of alcohol abuse. The unit was officially opened in June of 1975. This article provides a short descriptive overview of the development of the program, with a focus on its staffing pattern and the operationalization of its treatment philosophy. It presents an evaluation of the program, describing the methodology of evaluation preferred for this type of operation as developed from previous experience of the senior author.

Alcoholic Mortality: A 12-Year Follow-up

This is a study of alcoholic mortality in which time, cause, and age at death were variables of critical interest. Five cohorts of 100 members each were followed 12, 11, 9, 6, and 4 years. A total of 133 cases were located as deceased. The overall case fatality rate (CFR) was .0371. Higher CFRs were observed in years 1 to 6. Cardiovascular disease, violence (homicide, suicide, accidental), cirrhosis, carcionomas, and acute intoxication were the leading causes of death. Violent deaths were more prevalent in younger admission age groups. The cardiovascular/other ratio increased in older admission age groups.