<p>Since the anecdotal assumption is that GPs do not effectively diagnose and manage problem drinking amongst their patients, this study investigated the role of GPs in addressing problem drinking in Cape Town as well as the prevalence of problem drinking amongst their patients.</p>

The purpose of the study was to evaluate the construct validity of the Substance Abuse Subtle Screening Inventory (SASSI) as a screening test for alcoholism. The study sample consisted of 238 participants. These included 50 alcoholics, 50 normals, 50 psychiatric outpatients, 50 co-dependent family members and 38 drug addicts, so classified by clinician diagnosis.All participants were administered the SASSI and also the Michigan Alcoholism Screening Test (MAST) and the MacAndrew Alcoholism-Screening Scale (AMAC). Correct classification rates for all three tests were determined using both a five-group criterion of classifying as an alcoholic, normal, psychiatric outpatient, co-dependent or drug addict, and a simpler two-group criterion of classifying as a substance abuser or non-abuser. Five null hypotheses were tested using Chi-square (alpha = .01) tests for equal proportions of classification accuracy. A sixth null hypothesis was tested using linear discriminant function analyses.Results Five-group criterion:1. The three tests differed in correctly classifying alcoholics, with the MAST statistically significantly superior to the AMAC and the SASSI.2. The three tests differed in correctly classifying normals, with the MAST and the AMAC statistically significantly superior to the SASSI.3. The three tests differed in correctly classifying psychiatric outpatients, with the AMAC statistically significantly superior to the SASSI.4. The three tests differed in correctly classifying drug addicts, with the AMAC and the SASSI statistically significantly superior to the MAST.5. The three tests did not differ to a statistically significant degree in classifying codependents.Two-group criterion (abuser/non-abuser):1. The three tests differed in correctly classifying alcoholics, with the MAST statitically significantly superior to the AMAC and the SASSI.2. The three tests differed in correctly classifying normals, with the SASSI statistically significantly superior to the AMAC and the MAST.3. The three tests differed in correctly classifying psychiatric outpatients, with the SASSI and the AMAC statistically significantly superior to the MAST.4. The three tests differed in correctly classifying drug addicts, with the MAST statistically significantly superior to the AMAC and the SASSI.5. The three tests differed in correctly classifying co-dependents, with the SASSI statistically significantly superior to the AMAC and the MAST.Employing the two-group criterion, all tests vastly improved their performance with the SASSI significantly superior to the MAST and the AMAC at author-recommended cutting scores. Increasing the cutting score for the MAST improved classification accuracy even further. Employing the linear discriminant function, the three tests differed significantly, with the MAST statistically significantly superior to all other scales.ConclusionsNone of the three scales performed adequately with the five-group criterion. The simpler two-group criterion produced an 87% classification accuracy rate for the SASSI with the study sample at author-recommended cutting scores, which was statistically significantly superior to the MAST and the AMAC. The highest classification accuracy rates of 90.3% and 91.2% respectively were produced by the MAST at elevated cutting scores of 10 and 12 in the two-group criterion. These parallelled linear discriminant function results for the MAST. / Department of Counseling Psychology and Guidance Services

<p>Since the anecdotal assumption is that GPs do not effectively diagnose and manage problem drinking amongst their patients, this study investigated the role of GPs in addressing problem drinking in Cape Town as well as the prevalence of problem drinking amongst their patients.</p>

Resumo: Visto que 80-95% dos estilistas são também tabagistas, é desejável que modelos experimentais de estudo dos efeitos deletérios do consumo crônico do álcool incluam grupos com a associação de etilismo e tabagismo, permitindo desta forma, mimetizar, de maneira mais precisa, os efeitos do abuso crônico do álcool em humanos. Objetivo: Investigar os efeitos da exposição crônica à fumaça do cigarro e ao álcool no estresse oxidativo, nas alterações morfo-funcionais e distúrbios imunohistoquímicos provocados por estas agressões no aparelho respiratório de ratos. Método: cento e vinte ratos machos Wistar foram divididos em oito subgrupos de quinze animais (controle, tabagista, alcoolista e alcoolista + tabagista) em dois tempos experimentais (180 e 260 dias). Os biomarcadores de estresse oxidativo (superóxido dismutase, concentração da proteína tiol, glutationa perodixase e substâncias reativas ao ácido tiobarbitúrico) foram pesquisados em hemáceas lavadas. As alterações morfo-funcionais pulmonares (presença de reação inflamatória e estimativa de enfisema) foram avaliadas através do estudo histológico em microscopia óptica e estudo do pulmão isolado (complacência e complacência específica). O estudo imunohistoquímico foi realizado através da pesquisa da expressão de survivina, proteína P53, antígeno nuclear de proliferação celular e do índice apoptótico, pela técnica de TUNEL, no parênquima pulmonar e na traquéia. Resultados: o peso corpóreo dos três grupos experimentais foi menor que o grupo controle, sendo os menores valores os dos grupos alcoolista + tabagista, sendo a estimativa de enfisema pulmonar também maior nestes animais. Os animais dos grupos tabagistas e tabagistas + alcoolista apresentaram: menor complacência, maior incidência de bronquiolite, maior expressão para a survivina nas traqueias e maior índice apoptótico... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Since 80-95% of alcoholic are also smokers, it is desirable that study's experimental models of deleterious effects of chronic alcohol consumption includes groups with association of alcohol and tobacco, thus allowing, mimic, more accurately, the effects of chronic alcohol abuse in humans. Objective: To investigate the effects of chronic exposure to cigarette smoke and alcohol on oxidative stress, on morpho-functional alterations and immunohistochemical disorders caused by these attacks to respiratory system of rats. Method: one hundred and twenty Wistar rats were divided into eight subgroups of fifteen animals (control, smoking, alcohol and alcohol + smoking) in two experimental times (180 and 260 days). Biomarkers of oxidative stress (superoxide dismutase, tiol protein concentration, glutathione perodixase and thiobarbituric acid reactive substances) were determined in washed red cells. The morpho-functional lung's alterations (presence of inflammatory reaction and estimate of emphysema) were evaluated by histological examination with optical microscopy and study of the isolated lung (compliance and specific compliance). The immunohistochemistry study was performed by investigating the expression of survivin, P53 protein, nuclear antigen of cell proliferation and apoptotic index by TUNEL technique, at pulmonary parenchyma and trachea. Results: The weight of the three experimental groups was lower than the control group, with the lowest values at the alcoholism + smoking groups, and the estimated pulmonary emphysema was higher also in these animals. The smokers and smokers+alcoholic groups's animals showed: lower compliance, higher incidence of bronchiolitis, larger survivin expression to trachea and higher bronchiolar apoptotic index. Animals exposed only to smoking showed elevated levels of thiobarbituric acid reactive substances and lower specific compliance. The three... (Complete abstract click electronic access below) / Orientador: Antonio José Maria Cataneo / Coorientador: Daniele Cristina Cataneo / Banca: Débora Damasceno / Banca: Maria Aparecida Custódio Domingues / Banca: Vera Luzia Capelozzi / Doutor

Alcohol use disorders are common and make a significant contribution to the burden of disease throughout the world. This is especially true among the younger age groups. Although these disorders are common, evidence suggests that those affected do not seek help for their disorders. In order to understand this, reviews of the treatment literature and the epidemiological data on prevalence and correlates of alcohol use disorders and treatment seeking are presented. These reviews confirm that effective treatments exist and that screening in primary care can be efficacious. The reviews also highlight deficits such as the need for more epidemiological evidence on the validity of DSM definitions of alcohol use disorders and for more Australian data on the prevalence and correlates of the disorders and related treatment seeking. This thesis sets out to address these deficits applying sophisticated statistical techniques to data from a large nationally representative Australian sample. A confirmatory factor analysis of the eleven criteria that specify alcohol dependence and abuse examined the validity of DSM-IV definitions of alcohol use disorders and the best solution was found to be a single factor, not two as currently defined. These findings question the bi-axial nature of alcohol use disorders that has underpinned their definition since the publication of DSM-III-R in 1987. Data from this national sample also confirm that, in line with research from other western countries, Australians have high levels of alcohol use disorders, especially amongst males and younger people. Also no association was found between alcohol dependence and treatment seeking, and young people were least likely to seek treatment. However, a relatively large proportion of young people who drink had been in contact with their GPs in the past year; demonstrating that there is ample opportunity for screening and referral for treatment for alcohol use disorders in this vulnerable group. This research has found that although alcohol disorders are not necessarily associated with disability, there are those who can benefit from treatment. It suggests that outcomes for such individuals may be improved by better specification of disorders as well as improved access to best treatments.

Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1990. / Includes bibliographical references (leaves 138-151) / Microfiche. / ix, 151 leaves, bound 29 cm

BACKGROUND: Accurate clinical prediction supports the effective treatment of alcohol use disorder (AUD) and other psychiatric disorders. Traditional statistical techniques have identified patient characteristics associated with treatment outcomes. However, less work has focused on systematically leveraging these associations to create optimal predictive models. The current study demonstrates how machine learning can be used to predict clinical outcomes in people completing outpatient AUD treatment. METHOD: We used data from the COMBINE multisite clinical trial (n = 1383) to develop and test predictive models. We identified three priority prediction targets, including (1) heavy drinking during the first month of treatment, (2) heavy drinking during the last month of treatment, and (3) heavy drinking between weekly/bi-weekly sessions. Models were generated using the random forest algorithm. We used "leave sites out" partitioning to externally validate the models in trial sites that were not included in the model training. Stratified model development was used to test for sex differences in the relative importance of predictive features. RESULTS: Models predicting heavy alcohol use during the first and last months of treatment showed internal cross-validation area under the curve (AUC) scores ranging from 0.67 to 0.74. AUC was comparable in the external validation using data from held-out sites (AUC range = 0.69 to 0.72). The model predicting between-session heavy drinking showed strong classification accuracy in internal cross-validation (AUC = 0.89) and external test samples (AUC range = 0.80 to 0.87). Stratified analyses showed substantial sex differences in optimal feature sets. CONCLUSION: Machine learning techniques can predict alcohol treatment outcomes using routinely collected clinical data. This technique has the potential to greatly improve clinical prediction accuracy without requiring expensive or invasive assessment methods. More research is needed to understand how best to deploy these models.

Using both qualitative and quantitative research designs, this study focused on the knowledge of Children Protective Services (CPS) social workers for identifying Alcohol and Other Drugs (AOD) risk factors in their clients, and the impact that these AOD issues have on the child welfare system in San Bernardino County, California.