Robert M. Morse

Mortality Following Inpatient Addictions Treatment: Role of Tobacco Use in a Community-Based Cohort

OBJECTIVE To determine the impact of tobacco- and alcohol-related deaths on overall mortality following inpatient treatment for alcoholism and other nonnicotine drugs of dependence. DESIGN Population-based retrospective cohort study. SETTING Olmsted County, Minnesota (the Rochester Epidemiology Project), and the Inpatient Addiction Program (IAP) at Mayo Clinic, Rochester. PATIENTS All 845 Olmsted County residents admitted to an inpatient addiction program for treatment of alcoholism and other nonnicotine drugs of dependence during the period 1972 through 1983. METHODS Patients were followed up through the medical record linkage system of the Rochester Epidemiology Project through December 1994 to obtain vital status, and death certificates were obtained for those who died. The underlying cause of death was classified as alcohol related, tobacco related, both, or neither based on the classification from the Centers for Disease Control and Prevention. The observed number of deaths by underlying cause were compared with the expected number using cause-specific 1987 death rates for the white population of the United States. All-cause mortality was also compared with that expected for persons in the West North Central Region of the United States of like age, sex, and year of birth. Univariate and multivariate assessments were made to identify predictors of all-cause mortality from baseline demographic information. RESULTS At admission, the mean (SD) age of the 845 patients was 41.4 (14.5) years, and 35% were women. Altogether, 78% had alcohol as their only nonnicotine drug of dependence and 18% had alcohol and other nonnicotine drugs of dependence, while 4% were classified as having a nonalcohol, nonnicotine drug dependence alone. At admission, 75% were current and 8% former cigarette smokers, 3% were current cigar or pipe smokers, and 2% were current users of smokeless tobacco. Follow-up after the index IAP admission totaled 8913 person-years (mean [SD] of 10.5 [5.6] years per patient). Death certificates were obtained for 96% (214) of the 222 patients who died. Of these 214 deaths, 50.9% (109) had a tobacco-related and 34.1% (73) had an alcohol-related underlying cause (P<.001). The cumulative mortality significantly exceeded that expected (P<.001); at 20 years, the observed mortality was 48.1% vs an expected 18.5%. Multivariate predictors of mortality, even after adjusting for expected mortality, were older age at admission (P<.001) and male sex (P<.001). CONCLUSIONS Patients previously treated for alcoholism and/or other nonnicotine drug dependence had an increased cumulative mortality that was due more to tobacco-related than to alcohol-related causes. Nicotine dependence treatment is imperative in such high-risk patients.

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.

Substance dependence and chronic pain: Experience with treatment and follow-up results

&NA; Fifty patients with chronic pain and substance dependence were admitted to the hospital for treatment of substance dependence. Sixteen patients left treatment prematurely and were noted to have been less flexible in seeking treatment options for relief of pain. Most patients experienced an improved sense of well‐being with abstinence, but this was not reflected in pain rating scales. At 1 and 3–4 years follow‐up, the group that completed treatment was more outstanding in its commitment to a course of abstinence from drugs and alcohol than the group that had not completed treatment and seemed to experience a greater improvement in overall functioning.

Substance dependence and chronic pain: Profile of 50 patients treated in an alcohol and drug dependence unit

&NA; Fifty adult patients with chronic pain and substance dependence were admitted to an inpatient unit for treatment of addiction without primary emphasis on treatment of pain. As a group they had received considerable medical attention for their pain, but relatively little for their addictions. When compared with a group of general medical patients, the study population showed MMPI evidence of considerably more psychopathologic characteristics. MMPI data and family histories of substance dependence did not differentiate the study group from a comparable group in a Pain Management Center.

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.

Learning and memory impairment in older, detoxified, benzodiazepine- dependent patients

The effects of benzodiazepine dependence on the ability to learn and remember new material (determined with the Auditory-Verbal Learning Test) were studied in 20 detoxified, benzodiazepine-dependent patients who were 55 years of age or older and in a drug-dependence rehabilitation program. The patients were matched approximately for age, sex, and IQ with 20 detoxified, alcohol-dependent patients in the same rehabilitation program and 22 control subjects from a community sample. Neuropsychologic testing was performed a mean of 6 to 10 days after the patients had been completely detoxified from the addicting substance. The benzodiazepine-dependent patients had more difficulty with tests of learning and short-term and delayed recall than did the alcohol-dependent or control group. The difference between the benzodiazepine-dependent patients and the control group was statistically significant. The results suggest that benzodiazepine dependence in older people can cause memory impairment that persists into the early drug-free period.

Alcoholism in physicians

The Self-Administered Alcoholism Screening Test was completed by physicians attending an annual continuing medical education meeting. Of the responding physicians, 12% were identified as abstainers, 81% were classified as not alcohol-dependent drinkers, 5% were classified as possibly alcoholic, and 2% were classified as probably alcoholic. These results were similar to those obtained in a nonphysician general medical patient population previously given the same questionnaire. The data show that the prevalence of alcoholism among a group of physicians is not substantially different from that in a general medical population.

Carisoprodol dependence: a case report.

Although known to have central nervous system effects comparable to those of meprobamate, carisoprodol has not previously been reported to be a dependence-producing drug. This case report is of a woman, previously addicted to other drugs, who became dependent on carisoprodol.

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.