Search PubMed⌕ Search

Biomedical subjects

F C Blow

Publications and source records attributed to F C Blow.

At least 55 records · Page 3Linked to original sources
PubMed1996

The relationship between alcohol symptoms and consumption among older drinkers.

The present study assessed the relationship between current alcohol symptoms and consumption levels in a heterogeneous sample of older adults. The sample consisted of 443 participants over age 55 who reported drinking within the past year, including social drinkers, alcoholics in treatment, and alcoholics not in treatment. Symptoms for the past year were assessed using the Diagnostic interview Schedule (DIS-III-R) alcohol section, and subjects were subsequently assigned to two groups (symptom-free and symptomatic), depending on whether they experienced any DSM-III-R alcohol symptoms in the last year. For both men and women, average daily consumption and the frequency of heavy drinking contributed to whether participants had experienced any alcohol symptoms. The results indicate that the consumption levels of men and women differed only for symptomatic drinkers. The findings support recommendations that consumption limits for older adults should be lower than those recommended in the literature for younger adults. Furthermore, the results suggest that, in addition to limiting average daily consumption to no more than one drink per day, eliminating episodes of heavy drinking (consuming five or more drinks) could further reduce the risk of alcohol-related symptoms for older adults.

Age Factors↗
PubMed1995

Women, alcohol, and driving.

Alcohol-related crashes and fatalities have shown a dramatic decrease over the last decade. While males continue to account for most alcohol-related crashes, females are an increasing proportion of alcohol-involved drivers in both fatal and nonfatal crashes. Although most research has not addressed the possibility of gender differences in the effects of alcohol on driving performance, available evidence suggests that such differences may exist. Alcohol appears to have greater effects on females in terms of biomedical damage and impaired performance, although these effects have not been systematically investigated in relation to driving. Effective prevention programs for women require more focused research to understand gender-related factors in the effects of alcohol on driving.

Accidents, Traffic↗
PubMed1995

The effects of travel barriers and age on the utilization of alcoholism treatment aftercare.

OBJECTIVE: The objective of this research was to ascertain whether geographical accessibility (in conjunction with other patient characteristics) reduced the probability of participating in alcoholism aftercare treatment. METHODS: A sample of 4,621 United States male veterans discharged with an outpatient appointment from one of 33 Department of Veterans Affairs inpatient Alcohol Dependency Treatment Programs was identified. The outpatient records of each patient were obtained to determine whether aftercare services were utilized following discharge. Binary choice analysis was used to model the decision to enter aftercare treatment as a function of travel distance, age, marital status, ethnicity, severity of illness, and urbanization. RESULTS: Travel barriers significantly reduced aftercare participation, especially for elderly and rural veterans. Both younger and older veterans were less likely to keep their aftercare appointment than middle-aged veterans. Married patients were more likely to utilize outpatient services than unmarried patients. Ethnic status, severity of illness, and urban size all negatively affected the likelihood of appointment attendance. CONCLUSIONS: The results obtained from this analysis can be effectively used to identify which patients are not likely to enter aftercare alcoholism treatment. The discharge plans of patients at risk for appointment noncompliance should be given special attention since aftercare has been shown to improve treatment outcome. Moreover, because alcoholism treatment reduces the utilization of other medical services, promoting continuity of care should help lower the overall costs of providing health care to alcoholic patients.

Adult↗
PubMed1994

Injury type, injury severity, and repeat occurrence of alcohol-related trauma in adolescents.

Injury associated with alcohol use is a significant problem among adolescents; however, routine evaluation of alcohol use in this population is not conducted. The purpose of this study was to compare injured adolescents presenting to an emergency room with a positive serum alcohol concentration (SAC+) with those injured adolescents with a negative serum alcohol concentration (SAC-). Data were collected retrospectively on 176 injured patients, between the ages of 13 and 18, consecutively admitted to a university hospital from January 1, 1989-December 31, 1990. Information collected included mechanism and severity of injury, outcome, SAC, length of stay, psychiatric history, prior or subsequent admission for injury, and hospital charges. Of those tested with an SAC, more than one-third had a positive SAC. Patients with positive SACs had a greater probability of having a psychiatric history and more frequently had a prior or subsequent injury. Furthermore, only 34% of SAC+ patients were referred for counseling. The results indicate that a SAC should be obtained on all adolescents admitted for trauma, that adolescents presenting with injuries and a positive SAC should be referred for alcohol and psychiatric assessment, and that injured adolescents may be at increased risk for repeat injuries in the future.

Accidents, Traffic↗
PubMed1994

Family history of alcoholism and childhood adversity: joint effects on alcohol consumption and dependence.

Empirical studies provide substantial evidence that having a family history of alcoholism increases the risk of developing alcohol dependence; however, some of this effect may be caused by nonspecific childhood socioeconomic adversity common in families with an alcohol-dependent parent. In this study, we examine joint effects of family history and childhood adversity within a sample of 509 men and 217 women over age 40. The measures analyzed were included in routine screening assessments for participants in various studies at the University of Michigan Alcohol Research Center. About 60% of the men and 45% of the women were alcohol-dependent. About 30% reported an alcoholic parent. Degree of family history affected drinking behavior for both men and women. There were also environmental effects on the same measures for both men and women. Childhood socioeconomic adversity was reported more frequently by participants with an alcoholic parent, but adversity effects were also shown for those with a negative family history. The risk of alcohol dependence was additively increased by a positive family history and childhood socioeconomic adversity. The environmental effects identified in this study are promising evidence for nonspecific factors that moderate family history risk for development of alcohol problems.

Adult↗
PubMed1994

Severity and treatment of alcohol withdrawal in elderly versus younger patients.

We conducted a retrospective chart review of older (n = 48; mean age = 69) and younger (n = 36; mean age = 30) patients who were admitted to residential/inpatient treatment for alcohol withdrawal and dependence. Although the two age groups did not differ in terms of recent drinking history, the elderly group had significantly more withdrawal symptoms for a longer duration than the younger group. The elderly group also had more symptoms of cognitive impairment, daytime sleepiness, weakness, and high blood pressure. Finally, no significant differences were found between age groups in either the dosage or number of days of detoxification medication, although a trend was found for more days of medication in the elderly. We conclude that alcohol withdrawal may be more severe in elderly than in younger persons. Accordingly, treatment may take longer and should target the specific profile of symptoms that characterize alcohol withdrawal in the elderly.

Adult↗
PubMed1994

Treatment outcome of alcoholics with and without cocaine disorders.

The treatment outcome literature suggests that alcoholics with coexisting drug dependence have worse prognoses. We compared three groups of inpatients treated on the same hospital unit for disorders of alcohol only (n = 51), cocaine only (n = 27), or both disorders (dual group, n = 27). At follow-up, we contacted 105 (81%) of 129 patients at a mean of 13.4 +/- 4.1 months after discharge. The three groups significantly and equivalently decreased their consumption of substances at follow-up, and they also had equivalent improvements in employment and in medical and psychiatric well-being. A nonsignificant trend existed for greater abstinence in the alcohol group (53%) than in the dual group (35%), and with regression analysis diagnostic group and stable residence predicted abstinence in the past 30 days. Elapsed time before using alcohol was equivalent for the two alcohol groups, and relapse to alcohol preceded relapse to cocaine by 1 month on average. In sum, outcomes were more similar than different for the three groups. Although specific treatments to enhance abstinence for cocaine users are indicated, clinicians should approach cocaine-using alcoholics with equal optimism for improvement as with other alcoholics.

Adult↗
PubMed1994

The relationship between mortality and intensity of inpatient alcoholism treatment.

OBJECTIVES: Previous studies have examined mortality in alcoholics receiving extended inpatient alcoholism treatment, but few have investigated less intense treatment. This study examined mortality within 3 years after discharge from varying intensities of inpatient alcoholism treatment. METHODS: Using the computerized database of the Department of Veterans Affairs, we identified men participating in varying intensities of inpatient alcoholism treatment and followed them for 3 years after discharge. Adjusted mortality rates were computed and survival analysis was performed to assess the risk of death, adjusting for factors that may be related to mortality. RESULTS: The death rate was lower for men who completed extended formal inpatient treatment than for those who began, but did not complete, inpatient treatment or those who underwent short detoxification. Differences among the treatment groups remained after age, race, marital status, and disease severity were controlled. CONCLUSIONS: These results suggest that extended formal inpatient alcoholism treatment is associated with a lower risk of death than less intense forms of inpatient treatment.

Adult↗
PubMed1993

The kindling hypothesis: further evidence from a U.S. national study of alcoholic men.

A sample of 6818 alcoholic men participating in a short in-patient detoxification episode was studied to examine the kindling effect of repeated prior alcohol withdrawals on occurrence of seizures or severe withdrawal problems observed during the hospitalization. Subjects studied were hospitalized in one of 172 U.S. Department of Veterans Affairs medical centers. Patients with seizures and withdrawal problems had more prior detoxifications and other alcohol-specific hospitalizations. They were also more likely to be later readmitted for an alcoholism diagnosis. Patients with withdrawal problems during the detoxification episode studied were more likely to have such problems again as well as seizures during the readmission; those with seizures during the index detoxification were more likely to have repeated seizures during the readmission. These results confirm the kindling effect in a large, multi-site patient sample and suggest that alcohol detoxification programs may need to consider anticonvulsant therapy in patients with many prior detoxifications or withdrawals.

Adult↗
PubMed1993

Recent advances in addictive disorders. Special populations. Women, ethnic minorities, and the elderly.

The term special populations in the field of substance abuse refers to groups of patients who have unique treatment needs or who are underserved. This article reviews recent advances in substance abuse among three special population groups: women, ethnic minorities, and the elderly. The prevalence, problems with identification, issues in treatment, and treatment outcomes of substance abuse are discussed separately for each group. Finally, the heterogeneity of characteristics within each special population group is emphasized.

Age Factors↗
PubMed1992

Utilization of outpatient mental health services after inpatient alcoholism treatment.

It is generally agreed that use of aftercare services following discharge from alcoholism treatment is optimum for patients to achieve long-term recovery. However, the quantity and duration of utilization of such services in non-experimental settings are generally unknown. Using secondary data sources, we studied 5,635 alcoholics completing formal extended inpatient treatment and 1,860 alcoholics discharged from brief inpatient hospitalizations in Department of Veterans Affairs medical centers. Weekly use of outpatient mental health services (OPMH) prior to hospital admission was equally low for both patient groups (approximately 2-3% of patients) until four weeks prior to admission, at which time OPMH use increased, particularly for the extended treatment group. In the four weeks after discharge, use of OPMH services was substantially higher for patients with extended treatment compared to those with brief hospitalizations (40% vs. 18%), with 22% of patients completing treatment utilizing such services in the first week after discharge. Utilization steadily decreased until only 8% and 4% of both groups, respectively, were using OPMH services at the end of six months after discharge. Study results suggest the need to examine barriers to outpatient mental health utilization after discharge as well as interventions to increase compliance with long-term aftercare.

Adult↗
PubMed1992

Alcoholism treatment, severity of alcohol-related medical complications, and health services utilization.

In efforts to contain costs and efficiently allocate resources, evaluation studies in alcoholism have increasingly assessed the effect of treatment on the use of health services through comparisons of treated and untreated alcoholics. The success of this approach requires that evaluators identify and adjust for differences between these two groups, thereby decreasing the likelihood that health utilization outcomes are attributed to the effects of treatment when in fact they may be related more to unidentified group differences. Using a sample of 63,873 hospitalized alcoholics, this study focused on one critical group difference, the severity of alcohol-related medical complications. Comparisons between treated alcoholics who either completed alcoholism treatment or detoxification only and untreated alcoholics with either primary medical/surgical or psychiatric diagnoses demonstrated the following: (a) untreated alcoholics with medical/surgical diagnoses were more likely to have severe alcohol-related medical complications than the other groups; (b) a positive linear relationship between health services utilization in the previous year and the severity of medical complications existed for all groups, except untreated alcoholics with psychiatric diagnoses; and (c) untreated alcoholics with psychiatric diagnoses with the most severe complications used fewer health services than any of the other three groups. Differences between treated and untreated alcoholics in both severity of medical complications and previous health utilization patterns demonstrate the need to identify and adjust for these factors in evaluation studies that examine the outcomes of alcoholism treatment.

Adult↗
PubMed1992

Selection for and outcome of liver transplantation in alcoholic liver disease.

It has been proposed that evaluation of alcoholic patients for liver transplantation should comprise a multidisciplinary program including medical, surgical, and psychiatric assessment. This article presents the outcome in 99 alcoholic persons evaluated from 1985 through 1989. Alcoholism was defined as alcohol dependence or abuse according to the DSM-III-R. Forty-five patients (43%) were considered suitable candidates and underwent transplantation. Actuarial survival in this group was 78% and 73% at 12 and 24 months, respectively, and did not differ from that observed in nonalcoholic recipients. Return to alcohol use after transplantation has been documented in 5 persons, 2 of whom have had episodes of uncontrolled drinking. Of 54 patients not selected for transplantation, 17 were considered too well and suitable for alternative therapy. Actuarial survival was 93% at 12 and 18 months but declined to 59% at 24 months. Nineteen patients were medically unsuitable and had very poor survival; survival was 35% at 3 months and 0% at 12 months. Seventeen patients were not selected on psychiatric grounds. Actuarial survival in this group (65% at 12 months, 43% at 18 months) was significantly less than that in alcoholics with transplants (P less than 0.05). There were no differences in age, sex ratio, degree of hepatic dysfunction, or duration of abstinence between alcoholics with transplants and those considered psychiatrically unsuitable. It was concluded that liver transplantation is successful in selected patients with alcoholic cirrhosis, that patients who are not selected because they are "too well" need continuing surveillance as a significant decline in survival can occur 18-24 months after initial evaluation and, finally, that patients not selected on psychiatric grounds have a significantly worse survival rate than those with transplants.

Adolescent↗
PubMed1992

Young-adult children of alcoholic parents: protective effects of positive family functioning.

The occurrence of alcoholism is clustered within families, but the detrimental effect of a positive family history may vary with the degree of family impairment involved. In this study we assessed the effects of family history and family environment on alcohol misuse. From ongoing studies we recruited parents who had a child aged 18-30, 20 with a DSM-III-R alcohol dependence diagnosis, 20 without. The child then completed a multidimensional assessment. The young-adult participants included 20 men and 20 women (mean age = 24.8). Differences by family history were restricted to substance abuse behaviors. While a high level of alcohol problems occurred in both groups, those with an alcohol-dependent parent were more likely to be heavy drinkers and showed more symptoms of alcohol dependence. Overall psychological adjustment did not differ between the groups, however. Alcohol misuse measures did correlate moderately with symptoms of poor emotional health. The most important correlates of alcohol misuse measures in this study were exposure to parental alcoholism, abusive punishment, and psychological symptoms, with some separation of effects in the two subgroups. Psychological symptoms had a stronger relationship with misuse in subjects with social-drinking parents, while abuse was more associated in the group with an alcohol-dependent parent. These results confirm the importance of environmental interactions with familial risk. A biological vulnerability from an alcohol-dependent parent was not sufficient or necessary for the participants in this study to develop alcohol dependence as a young adult, although there was an increased risk. There appear to be strong protective effects of positive family relationships on the potential negative effects of a family history of alcoholism.

Adaptation, Psychological↗
PubMed1992

Age and ethnicity among hospitalized alcoholics: a nationwide study.

Little is known about the broad-scale demographic characteristics of low income or indigent alcoholics in public hospital systems. The purpose of the study was to examine issues relative to age, race/ethnicity, and marital status for a large group (n = 62,829) of alcoholic men receiving inpatient care in Department of Veterans Affairs (VA) medical centers nationally. Subjects were VA inpatients completing alcoholism treatment (n = 27,562), in brief alcohol detoxification or short intervention (n = 9,322), or hospitalized for primary diagnoses other than alcoholism but with a secondary diagnosis of alcohol dependence syndrome (n = 25,945). Minority alcoholics were significantly younger than Caucasian alcoholics. Hispanic and African-American men, as well as older alcoholics, were significantly less likely to complete treatment or attend detoxification and more likely to be hospitalized for other primary diagnoses. Native Americans, however, were most likely to complete alcoholism treatment. Results suggest that members of some minority groups and elderly alcoholics seek inpatient care for diagnoses other than alcoholism and that, as a result, such individuals may need targeted interventions to encourage them to seek alcohol-specific care.

Adult↗
PubMed1992

Age-related psychiatric comorbidities and level of functioning in alcoholic veterans seeking outpatient treatment.

The relationship of age and of level of adaptive functioning to comorbidity of mental disorders among alcoholics was studied in a survey of all alcoholics seeking outpatient mental health treatment in the Veterans Affairs mental health care system during a one-month period in 1986 (N = 22,463). More than half of the alcoholic outpatients had one or more comorbid psychiatric diagnoses. Rates for comorbid substance abuse disorders, posttraumatic stress disorder, schizophrenia, and personality disorders peaked in younger alcoholics and then decreased with age. Age-related increases were observed for major depression, anxiety disorders, and organic brain syndrome or dementia. DSM-III axis V ratings of poor to grossly impaired functioning were consistent across age groups. More than half of alcoholics with a comorbid psychiatric disorder were rated as severely impaired, compared with less than a third of those with no comorbid mental disorder.

Activities of Daily Living↗