Robert C. McMahon

An examination of depressed vs. nondepressed alcoholics in inpatient treatment

This study was designed to: (1) identify subgroups of depressed and nondepressed alcoholics who were entering inpatient treatment; (2) compare the groups on the basis of various demographic, social, occupational, educational, health and drinking related variables; and (c) determine whether the groups can be differentiated on the basis of personality and clinical symptoms as measured by clinical diagnostic instruments (N = 243). In comparison with the nondepressed alcoholics, depressed alcoholics in this study were found to have longer histories of problem drinking, more previous treatments for alcohol misuse, more difficulty controlling alcohol consumption, more marital problems, and more physical symptoms related to alcohol abuse. In addition, results of the discriminant analysis suggest that the depressed alcoholics may be distinguished from their nondepressed counterparts on the basis of having a detached interpersonal style, distracted cognition, alienated self-image, and mixed depressed-anxious emotionality.

A Comparative Study of Cocaine-Treatment Completers and Dropouts☆

This study compared matched groups of completers and dropouts from residential treatment for cocaine abuse on a range of outcome measures, including cocaine and alcohol use, stress, coping, and social support characteristics. The most striking finding of this study was that treatment dropouts differed from treatment completers on only 2 of 14 dependent measures reflecting substance use, stress, coping, and social support characteristics during two 3-month follow-up periods. Both dropouts and completers demonstrated large decreases in cocaine and alcohol use from pretreatment to the first follow-up period. Completers and dropouts did not differ in level of substance use during either follow-up period.

The Personality and Symptoms Scales of the Millon Clinical Multiaxial Inventory: Sensitivity to Posttreatment Outcomes.

This study examined patterns of consistency and change on the basic personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) in a sample of VA inpatient alcoholics (N = 96), who were administered the MCMI at intake and at 1 month into treatment, and in a sample of drug abusers (N = 33), who received MCMI administrations at intake into treatment and after 1 and 3 months of treatment. Both alcohol and drug abuser samples in this study showed significant changes on most personality and symptom scales between intake and 1 month into treatment. The drug abusers showed small, but significant changes on three personality scales between 1 and 3 months of treatment. No such changes on symptom scales were apparent in this analysis.

Effects of a Culturally Adapted HIV Prevention Intervention in Haitian Youth

&NA; This study assessed the impact of an 8‐week community‐based translation of Becoming a Responsible Teen (BART), an HIV intervention that has been shown to be effective in other at‐risk adolescent populations. A sample of Haitian adolescents living in the Miami area was randomized to a general health education control group (n = 101) or the BART intervention (n = 145), which was based on the information‐motivation‐behavior (IMB) model. Improvement in various IMB components (i.e., attitudinal, knowledge, and behavioral skills variables) related to condom use was assessed 1 month after the intervention. Longitudinal structural equation models using a mixture of latent and measured multi‐item variables indicated that the intervention significantly and positively impacted all IMB variables tested in the model. These BART intervention‐linked changes reflected greater knowledge, greater intentions to use condoms in the future, higher safer sex self‐efficacy, an improved attitude about condom use, and an enhanced ability to use condoms after the 8‐week intervention.

A description of the maternal addiction program of the University of Miami/Jackson Memorial Medical Center

The MAP of the University of Miami/Jackson Memorial Medical Center/Highland Park Pavilion is a comprehensive inpatient and outpatient chemical dependency rehabilitation program that serves mostly lower socioeconomic, African-American perinatal substance-abusing women. The multidisciplinary treatment team incorporates a broad spectrum of group and individual therapeutic modalities, including 12-step, psychoeducational, and RP components. Within MAP programs, significant attention is given to issues and experiences that are unique to this population and that must be addressed if rehabilitation is to be successful. These topics include, but are not limited to, physical, emotional and sexual abuse, empowerment, family and parenting concerns, and HIV prevention and coping skills for HIV-seropositive women.

Transient versus enduring depression among alcoholics in inpatient treatment

The purposes of this study are (1) to determine the incidence of significant clinical depression among alcoholics at treatment intake at a Veterans Medical Center, (2) to subdivide alcoholics who show significant clinical depression into enduring and transient depressive subgroups, and (3) to identify demographic and psychometric variables useful in discriminating between these two subgroups. Results indicate that of the 60% of VA inpatient alcoholics who showed evidence of significant clinical depression at intake, approximately equal numbers met criteria for inclusion in transient and enduring depressive subgroups. Patients with enduring and transient depression, as defined in this study, were differentiated on the basis of age, drinking pattern, and selected scales from two psychometric instruments which measure depression, confused and disorganized thinking, and an avoidant personality style. These findings may be useful in assisting clinicians in differentiating between alcoholic patients with transitory depression associated with alcohol consumption and/or withdrawal and alcoholic patients with more serious and enduring depression, which may require additional pharmacologic and/or psychotherapeutic intervention.

Profile patterns, consistency, and change in the millon clinical multiaxial inventory‐II in cocaine abusers

This study examined the MCMI-II in samples of cocaine-dependent subjects who were receiving treatment in three separate residential facilities. Profile characteristics, patterns of scale stability, and change are reported. MCMI-II elevations are found in all three samples on the Antisocial, Aggressive/Sadistic, Narcissistic, Passive-Aggressive, Borderline, Drug Dependence, and Alcohol Dependence scales at both intake into treatment and discharge. Moderate stability coefficients are found on Basic Personality, Pathological Personality, and Symptom scales. Although some statistically significant mean scale changes between intake and discharge are noted in each sample, few involve change from clinically elevated to below clinical levels.

Concurrent validity of the clinical symptom syndrome scales of the millon clinical multiaxial inventory

This study examined relationships between the clinical symptom syndrome scales of the Millon Clinical Multiaxial Inventory (MCMI) and the various clinically meaningful mood or symptom states measured by the six Profile of Mood States (POMS) scales (N = 243). The MCMI symptom scale--POMS symptom/mood scale relationships found in this study were compared with MCMI symptom scale--MMPI and SCL-90 symptom/mood scale relationships reported in the MCMI manual (Millon, 1983). Results of the present investigation, when combined with results of the previous analyses reported in the MCMI manual, reveal a number of consistent associations of moderate strength between MCMI symptom scales and selected mood or symptom scales from the MMPI and Symptom Checklist-90 as well as from the POMS. Although most relationships between the MCMI symptom scales and the symptom/mood scales of the POMS, MMPI and SCL-90 were consistent with expectation, the Anxiety, Dysthymia and Psychotic Depression scales of the MCMI show limited ability to discriminate appropriately between anxiety and depression in several of the concurrent validity analyses considered herein.

Substance Abuse Problems, Psychiatric Symptoms, and Post-Treatment Status in MCMI Psychopathology Subgroups of Cocaine Dependent Males

This study involved cluster analysis of Millon Clinical Multiaxial Inventory-II (MCMI-II) records of 304 cocaine dependent males and examined differences among personality-based clusters in medical, legal, employment, drug, alcohol, family, and psychiatric problem severity at treatment intake and in outcome status during the 12 months after completion of residential drug treatment. A hierarchical cluster analysis (Wards method) was used to identify 4 cluster subgroups: antisocial, subclinical, neurotic, and high psychopathology. MANOVA revealed that membership in Neurotic and High Psychopathology Cluster subgroups was linked with more severe family and psychiatric problems at treatment intake than found in the Subclinical Cluster Subgroup (all ps <. 05). The High Psychopathology Cluster Subgroup also had more severe drug problems at intake than did the Subclinical Subgroup (p <. 05). Logistic regression analysis revealed that membership in the High Psychopathology Subgroup predicted relapse/loss to follow-up status after controlling for age, education, ethnicity, treatment program attended, and pretreatment cocaine use frequency (X2 = 21.25, df = 3, p <. 001).

Personality, Stress, and Social Support in HIV Risk Prediction

This study evaluated whether baseline levels of avoidant, antisocial, and dependent personality features and perceived stress and social support predict 12 month follow-up levels of unprotected sex in 141 male veterans undergoing alcohol and other drug (AOD) abuse treatment that included an HIV transmission risk reduction (HIV-TRR) component. Because our focus is on psychosocial predictors of level of unprotected sex after completion of AOD/HIV-TRR treatment, we first controlled for potential confounds including (a) intake level of unprotected sex and (b) both intake and follow-up AOD abuse values. Further, because associations between both stress and social support and level of risk behavior may be attributable to underlying pathological personality factors, we controlled for these factors in analyses of stress and support effects. Sequential regression was employed to determine if personality and then stress and social support characteristics improved prediction of unprotected sex after entering covariates. Pretreatment levels of unprotected sex and dependent personality significantly predicted unprotected sex during follow-up. Avoidant personality was associated with reduced risk linked with lower levels of sexual involvement. Perceived stress and social support did not significantly predict level of unprotected sex during follow-up. We found significant decreases in levels of alcohol, marijuana, and cocaine and in the number reporting IDU. Implications for developing personality-sensitive HIV prevention interventions are discussed.