Biomedical subjects

E Labouvie

Publications and source records attributed to E Labouvie.

At least 19 recordsLinked to original sources

PubMed2001

Drinking and driving: pre-driving attitudes and perceptions among Brazilian youth.

The aim of this study was to investigate driving under the influence of alcohol (DUI) risk profiles and predictors in a sample of pre-driving Brazilian youth, in the context of Brazil's new Traffic Code. Data were obtained in the Traffic Department in São Paulo from a sample of 2166 individuals. Subjects displayed a low level of knowledge about the laws and few believed the penalties would actually be enforced for those engaging in DUI. Findings suggest that changes in DUI laws in Brazil and elsewhere should be accompanied by enforcement and education in order to enhance levels of knowledge and credibility of the sanctions.

Accidents, Traffic↗

PubMed2001

Changes in alcoholic patients' coping responses predict 12-month treatment outcomes.

Patient subtypes (Types A and B alcoholism), determinants, and outcomes associated with changes in coping responses of 133 alcoholic patients in the year following admission to treatment were examined. In general, patients' use of avoidance coping declined and use of approach coping increased. Type B patients used more avoidance coping than did Type A patients, but the subtypes did not differ in rate of change in coping. As a determinant of coping, cognitive appraisal of threat showed a trend toward predicting avoidance coping at 6- and 12-month follow-ups. Decreased cognitive avoidance coping (e.g., daydreaming) predicted fewer alcohol, psychological, and interpersonal problems. Increased behavioral approach coping (e.g.. taking action) predicted lower severity of alcohol problems. Further study of changes in the cognitive aspects of coping (i.e., appraisals and cognitive avoidance coping) is needed to determine mechanisms underlying cognitive processes associated with treatment outcomes.

Adaptation, Psychological↗

PubMed2001

Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: within treatment and posttreatment findings.

This study evaluated the short-term effectiveness of cognitive-behavioral treatment (CBT) for substance abuse delivered in a community setting. At entry into outpatient community substance abuse treatment, participants (N = 252) were randomly assigned to 3 conditions: high-standardization CBT, low-standardization CBT, and treatment as usual. Treatment consisted of 12 weekly individual therapy sessions. There was a significant decrease in substance use from baseline, with participants reporting being abstinent on 90% of within-treatment days and 85% of days during the 6 months posttreatment. However, there were no significant differences in outcomes across conditions. Findings do not support the hypothesis that disseminating CBT to community settings will improve outcomes and suggest that standard substance abuse counseling may be more effective than previously thought.

Adult↗

PubMed2001

Clinical features of pathological gambling in an addictions treatment cohort.

This study examined the prevalence and descriptive psychopathology of pathological gambling in a heterogeneous treatment sample of 372 substance users. About 14% of male participants and 10% of female participants were identified as presumptive pathological gamblers (PGs) on the South Oaks Gambling Screen (SOGS). The authors contrasted 49 PGs with 323 participants who were not pathological gamblers (NPGs) on a host of variables measuring premorbid risk, pathological patterns of substance use, consequences of use, and psychiatric comorbidity. PGs showed more disturbance than NPGs on some measures of premorbid risk, pathological substance use, social consequences of use, and psychiatric comorbidity. Gambling status may be an important comorbid condition in addictions treatment settings and a significant covariate in research.

Adult↗

PubMed2001

Substance use and driving: the coexistence of risky and safe behaviors.

AIMS: Two risky behaviors (driving after drinking/getting drunk, riding with drinking drivers) and two safe behaviors (deciding not to drive under the influence of alcohol (DUI), preventing someone else from DUI) were examined in relation to use frequency and friends' DUI to determine whether individuals tend to engage in both types of behaviors. DESIGN: Self-report questionnaires were administered to a random sample of 1233 young adults in New Jersey (USA) on two occasions (mean age 21 and mean age 28). Structural equation modeling was used to assess the goodness of fit of a hypothesized model of cross-sectional and longitudinal relationships. FINDINGS: Relationships between the four behaviors were strongly positive for men and women at both occasions and were substantially accounted for by use frequency and friends' DUI. At the later age, however, it was necessary to add non-recursive pathways to the model, which were different for men and women. CONCLUSIONS: Findings suggest that (1) riding with drinking drivers plays an important role in the maintenance of the other behaviors and (2) most individuals vacillate between risky and safe behaviors indicating that drinking contexts are best viewed as risky decision-making situations requiring individuals to choose between riskier and safer courses of action.

Adolescent↗

PubMed2000

Guided and unguided self-help for binge eating.

This study compared the relative short- and longer-term efficacy of therapist-guided and unguided use of a cognitive behavioral self-help manual for binge eating [Fairburn, C. G. (1995). Overcome binge eating. New York: The Guilford Press.] Forty women (82.5% with binge eating disorder) were randomized to one of the two treatment levels. Results indicate that both conditions represent viable means of treating binge eating. Overall, patients improved their eating behavior, eliminated any inappropriate compensatory behaviors, reduced their shape concern, weight concern, and other symptoms of eating-related psychopathology, and improved their general psychological functioning. The guided self-help condition was notably superior in reducing the occurrence of binge eating and its associated symptomatology, as well as lowering interpersonal sensitivity. A high degree of general psychopathology was a negative prognostic indicator. The implications for a stepped-care approach to treating binge eating are discussed.

Adult↗

PubMed2000

Effective long-term treatment of obesity: a continuing care model.

BACKGROUND: Despite the well-documented success of behavioral techniques in producing temporary weight loss, treatment is typically followed by weight regain. The maintenance of treatment effects may therefore be the greatest challenge in the long-term management of obesity, and continuous care may be necessary to achieve it. OBJECTIVE: To describe the design and evaluate the effectiveness of the Trevose Behavior Modification Program, a potentially widely replicable self-help weight loss program offering continuous care. DESIGN: A description of the course of all subjects (n=171) who entered the Trevose program during 1992 and 1993. SUBJECTS: One hundred and forty-six women aged 44.1+/-11.7 y with a body mass index (BMI, kg/m2) of 33.2+/-4.4, and 25 men aged 49. 0+/-19.6 with a BMI of 35.1+/-5.2 enrolled in the Trevose program during 1992-1993. RESULTS: Mean duration of treatment was 27.1 months, with 47.4% of members still in treatment at 2 y and 21.6% at 5 y. Mean intent-to-treat weight loss was 13.7+/-0.5% of initial weight, or 12.8+/-0.5 kg. As long as they remained in treatment, almost all participants lost at least 5% of their initial weight and at least 83% lost more than 10%. Members completing 2 y of treatment lost an average of 19.3% of their initial body weight (17.9 kg); at 5 y the loss was still 17.3% (15.7 kg). After leaving the program, subjects regained weight but remained 4.7% (4.5 kg) below their pretreatment weight. CONCLUSION: A low-cost program offering treatment of indefinite duration produced large long-term weight losses and may be suitable for widespread replication.

Adult↗

PubMed2000

Toward the DSM-V: the Withdrawal-Gate Model versus the DSM-IV in the diagnosis of alcohol abuse and dependence.

The Diagtnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) classifies as dependent many cases of mild alcohol problems. DSM-IV diagnoses have modest relationships with predictive and some concurrent validators and often improperly sequence the onset of abuse versus dependence, perhaps due to insufficient emphasis on physiological features. Testing reliability, syndrome prevalence, syndrome sequencing, and concurrent and predictive validity, this study contrasted the DSM-IV with the Withdrawal-Gate Model (WGM), in which alcohol withdrawal is necessary and sufficient for the dependence diagnosis. Clinical samples of adults (baseline n = 318) and adolescents (baseline n = 214) meeting abuse or dependence were assessed for DSM-IV alcohol symptoms and external measures of problem severity and reinterviewed at 6 (adults) and 12 months (adults and adolescents). Among DSM-IV dependent cases, the WGM shifted 32% of adults and 80% of adolescents to the abuse category, making both categories more symptomatically severe, but had a negligible effect on the prevalence of total alcohol diagnoses. The WGM was more reliable than the DSM-IV and temporally sequenced abuse before dependence in a greater number of cases. The WGM was superior to the DSM-IV in concurrent and predictive validity on most measures. Future diagnostic systems may be more reliable and valid if they require evidence of withdrawal for substance dependence.

Adolescent↗

PubMed1999

Psychological versus pharmacological treatments of bulimia nervosa: predictors and processes of change.

This article extends the acute outcome findings from a study comparing psychological and pharmacological interventions for bulimia nervosa (B.T. Walsh et al., 1997) by examining 3 additional domains: predictive factors, therapeutic alliance, and time course of change. One hundred twenty women were randomized to cognitive-behavioral therapy (CBT), supportive psychotherapy (SPT) plus antidepressant medication or a placebo, or a medication-alone condition. Results indicate that high baseline frequencies of binge eating and vomiting, as well as a positive history of substance abuse or dependence, are negative prognostic indicators. Although a greater overall therapeutic alliance may increase the likelihood of remission, symptom change over the course of treatment may have as much of an impact on patient ratings of alliance as the reverse. CBT was significantly more rapid than SPT in reducing binge eating and vomiting frequencies.

Adolescent↗

PubMed1999

Domestically violent and nonviolent male inmates' responses to their partners' requests for condom use: testing a social-information processing model.

This study used a model derived from social-information processing theory to investigate how men with a history of domestic violence would react to a condom request. The study used path analysis to examine men's attributional and evaluative responses as potential predictors of coercion and condom use compliance. Men responded to a hypothetical situation in which their main partner requested that they use a condom. Among 100 county jail inmates, men who used severe forms of domestic violence differed from moderately violent and nonviolent men in their tendency to react negatively to condom requests. Condom-specific attributions were significant predictors of condom use and coercive actions but were not consistently different across abuse groups. Attributions that increased the likelihood of negative responding were infidelity, selfishness, competition for dominance, or suspicion of the man's fidelity.

Adult↗

PubMed1998

Effects of an HIV risk reduction project on sexual risk behavior of low-income STD patients.

A 10-hour small-group informational and skill-building intervention was tested among patients (N = 472) attending publicly funded sexually transmitted disease clinics in Maryland, Georgia, and New Jersey. After completing a 90-minute interview concerning HIV risk behaviors, condom use self-efficacy and condom outcome expectancies, participants were randomized to either an intervention or a control condition. Participants in both conditions displayed significant reductions in unprotected encounters and number of partners and increases in condom use. No differences between treatment conditions were observed, indicating that the motivational effects of the interview may have been stronger than the effects of the intervention in this population.

Adolescent↗

PubMed1997

Selective processing of eating disorder relevant stimuli: does the Stroop Test provide an objective measure of bulimia nervosa?

OBJECTIVE: To evaluate the specificity of the modified Stroop test as an objective measure of bulimia nervosa. METHOD: A modified Stroop Test was administered to patients with bulimia nervosa and two non-clinical control groups of restrained and unrestrained eaters. RESULTS: The data failed to show any specificity in the Stroop effect. Nor did the test provide a useful measure of treatment response. DISCUSSION: Taken in conjunction with previous inconsistent findings, the results of this study call into question the utility of the modified Stroop effect as a specific measure of bulimia nervosa.

Adult↗

PubMed1997

The comorbidity of alcoholism and personality disorders in a clinical population: prevalence rates and relation to alcohol typology variables.

This study assessed prevalence rates and overlap among Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; DSM-III-R; American Psychiatric Association, 1987) personality disorders in a multisite sample of 366 substance abusers in treatment. In addition, the relation of antisocial personality disorder (APD), borderline personality disorder (BPD), and paranoid personality disorder (PPD) to alcohol typology variables was examined. Structured diagnostic interviews and other measures were administered to participants at least 14 days after entry into treatment. Results indicated high prevalence rates for APD and non-APD disorders. There was extensive overlap between Axis I disorders and personality disorders, and among personality disorders themselves. APD, BPD, and PPD were linked to more severe symptomatology of alcoholism and other clinical problems. However, only APD and BPD satisfied subtyping criteria, after controlling for other comorbidity. Implications for classifying alcoholics by comorbid disorders are discussed.

Adult↗

PubMed1997

Affiliation with Alcoholics Anonymous after treatment: a study of its therapeutic effects and mechanisms of action.

Relatively little is known about how substance abuse treatment facilitates positive outcomes. This study examined the therapeutic effects and mechanisms of action of affiliation with Alcoholics Anonymous (AA) after treatment. Patients (N = 100) in intensive 12-step substance abuse treatment were assessed during treatment and at 1- and 6-month follow-ups. Results indicated that increased affiliation with AA predicted better outcomes. The effects of AA affiliation were mediated by a set of common change factors. Affiliation with AA after treatment was related to maintenance of self-efficacy and motivation, as well as to increased active coping efforts. These processes, in turn, were significant predictors of outcome. Findings help to illustrate the value of embedding a test of explanatory models in an evaluation study.

Adaptation, Psychological↗

PubMed1997

Physiological alcohol dependence as a "specifier" of risk for medical problems and relapse liability in DSM-IV.

OBJECTIVE: This study tested the ability of DSM-IV physiological alcohol dependence to predict multiple indices of medical problems and relapse behavior. It also tested the ability of three additional variables--DSM-IV nonphysiological dependence, an alternative dichotomous criterion for coding physiological dependence and a dimensional measure of physiological dependence--to predict medical problems and relapse behavior in alcoholism. METHOD: A heterogeneous group of 365 patients was recruited from eight addictions treatment programs in the northeastern United States. A multidimensional assessment battery able to diagnose the presence of physiological dependence according to each of three systems--the criteria of DSM-IV, alternative dichotomous criteria and a dimensional scale-- was administered about 2 weeks after admission, and 241 subjects were reinterviewed 6 months later. The three systems were compared for their ability to predict a variety of external measures of medical complications and relapse liability. RESULTS: Physiological alcohol dependence as diagnosed by DSM-IV bore no relationship to either risk for medical problems or relapse behavior. Further analyses showed that this failure was due to operational problems of physiological dependence in DSM-IV, rather than to a lack of conceptual merit for physiological dependence per se as a course specifier. Use of alternative criteria for coding physiological dependence which are difficult and less internally consistent, and use of a dimensional measure, found improved relationships with the external validators. CONCLUSIONS: Contrary to early reports, physiological dependence can serve as a course specifier for alcohol problems, but must be more sensitively scaled than it was in DSM-IV. Tests of alternative options suggest that a multistage criterion to replace DSM-IV's dichotomous criterion is the best remedy.

Adolescent↗

PubMed1997

Age of first use: its reliability and predictive utility.

OBJECTIVE: The purpose of this study was: (1) to assess the utility of age of first licit use and age of first illicit use as predictors of alcohol and drug use at ages 20 and 30; and (2) to examine the reliability of retrospectively recalled ages of onset of use. METHOD: Subjects (N = 839) from the Rutgers Health and Human Development Project provided four waves of longitudinal data spanning the age range from 15 to 31. RESULTS: Retrospective recall of age of onset revealed a fair degree of relative agreement but a lack of absolute agreement because of an upward shift in recalled ages as individuals became older. Repeated measures ANOVAS revealed normative declines in alcohol and drug use from 20 to 30 even though individual differences in use remained quite stable across time. Regression analyses indicated that: (1) age of first licit use as recalled at age 18 did not predict alcohol or drug use at age 20; (2) age of first illicit use was a weak predictor of alcohol use at 20 but a fairly strong predictor of drug use at 20; and (3) neither age predicted use or use consequences at age 30. CONCLUSIONS: In the general population, illicit drug use and heavier alcohol use are, regardless of age of onset, adolescence-limited phenomena for most individuals. Findings suggest that intervention efforts need to be aimed simultaneously at delaying the onset of illicit use and reducing use levels among young adult users.

Adolescent↗

PubMed1996

Modeling therapeutic response to 12-step treatment: optimal responders, nonresponders, and partial responders.

Findings from alcohol treatment studies have had limited impact on clinical practice, in part because they have failed to accurately model treatment factors. This study attempted to model initial response to 12-step substance abuse treatment using a treatment theory-guided evaluation paradigm. A theory-guided measure of 12-step behaviors was constructed. Participants (N = 103) from two traditional substance abuse treatment programs were assessed at intake, discharge, and 1 month after discharge from intensive treatment. Results indicated that the measure of 12-step behaviors had adequate psychometric properties, and a one-factor solution best fit the data. Participants demonstrated substantial variability in their initial response to treatment. A cluster analysis of 12-step behaviors yielded three distinct groups of responders: optimal responders, partial responders, and nonresponders. Descriptive features and differences in relapse rates for groups are reported. Implications for matching patients to 12-step treatment and for clarifying the specific effects of this widely used treatment model are discussed.

Adult↗

PubMed1996

On criterion weighting in the DSM-IV.

Differential weighting of illness signs and symptoms has surfaced recurrently in psychiatric nosology. Six alternately weighted algorithms for diagnosing alcohol dependence in accordance with the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), based on statistical, unit, rational and random criterion weighting systems, were used to predict an array of concurrent validators and 6-month drinking outcomes in a regional clinical sample of 365 participants. Comparable predictive efficiency across all algorithms, including the randomly weighted versus statistical best-fit model, was observed. Further analyses and geometric modeling suggested that this was due to the extremely high internal consistency of the DSM-IV criteria. An alternative strategy that favors factorially complex, less homogeneous criteria was used to develop an experimental DSM-IV algorithm from an array of 39 candidate criteria. This algorithm had extremely low internal consistency, high difficulty, and complex factor loadings. Differential weighting of its criteria produced a good range of efficiencies, predictive power for rational models exceeding the random weight model, and a best-fit algorithm with substantial surplus predictive power. These results illustrate an emerging conflict in nosology between 2 opposing trends: a press for the promulgation of criterion arrays with high internal consistency and a clear desire to assign some criteria extra weight for prognosis or decision making. Both cannot be had in the same algorithm. An alternative approach emphasizing diagnostic criteria with complex structures can satisfy the multiple demands of brevity, validity, and weighting performance.

Adult↗