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Biomedical subjects

H W Clark

Publications and source records attributed to H W Clark.

50 records · Page 3Linked to original sources
PubMedDate not supplied

Neurocognitive impairment: the unrecognized component of dual diagnosis in substance abuse treatment.

Brief neuropsychological tests were administered to an inpatient substance abuse population to (1) evaluate the status of neurocognitive functioning at admission, (2) assess changes that may occur during the treatment program, and (3) compare various testing devices for clinical application in this setting. Patients entering a 14-day inpatient substance abuse unit were tested within a few days of admission with the Neurobehavioral Cognitive Status Examination (NCSE), the screening test for the Luria-Nebraska Neuropsychological Battery, and the Trail Making Test. Impaired neurocognitive performance was observed in approximately two-thirds of patients; the most frequently compromised areas of functioning involved attention and memory, calculation, abstraction, ability to follow complex commands, and visuospatial skills. Readministration of the NCSE prior to discharge detected a statistically significant improvement in attentional abilities, and a tendency toward improvement for verbal comprehension and abstraction. Discussion of these findings addresses several issues: (1) the frequency and degree of impairment in this population; (2) the observed variability of cognitive functioning; (3) the question of clinical improvement in neurocognitive functioning observed during a program of this length; and (4) a preference for the NCSE in this setting. The authors argue for the routine neuropsychological assessment of substance abusers, and discuss the above issues in terms of their implications for treatment at both the individual and programmatic level. Discussion of two cases illustrates the application of the NCSE, and the effect of finding organic impairment on staff attitudes and treatment issues.

Adult↗
PubMedDate not supplied

Legal vulnerabilities in the treatment of chemically dependent dual diagnosis patients.

Substance abusing patients with significant psychiatric disorders can present unique legal vulnerabilities for treatment professionals. The tendency within the chemical dependency community to treat patients uniformly can militate against the individualized treatment planning that satisfies legal obligations to act in the best interest of the patient. The failure to adequately consider both the psychiatric disorder and substance abuse problem may create legal vulnerabilities that issue from the failure to refer a patient in need of medication or the failure to prevent the suicide of a patient in a situation where suicide is preventable. Patients suffering harm from acts of commission or omission of a chemical dependency treatment specialist have recourse through laws regarding negligence. Variations in the backgrounds and training of care providers create problems for the harmed patient in establishing a standard of care for the treatment of chemical dependence. However, the psychological symptoms of the dual diagnosis patient make it easier to establish a standard of care that may be legally cognizable. The chemical dependency specialist--of whatever discipline--has a duty to patients that requires sound assessment and disposition.

Adult↗
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The medical review officer and workplace drug testing.

Rational drug-testing programs attempt to balance the need for accuracy of the process with the need to preserve the rights and dignity of the people being tested. U.S. Department of Transportation regulations prescribe the specifics of how urine specimens are to be collected, how to inform the specimen donor of the process to which he or she will be subjected, and certification of laboratories by the National Institute of Drug Abuse. These guidelines are an effort to assure that each collection site and each laboratory testing the urine of employees adheres to certain basic standards of quality control.

Environment↗
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Policy and medical-legal issues in the prescribing of controlled substances.

The physician who prescribes controlled substances is faced with an array of laws, regulatory policies, and professional attitudes about their use. Prescriptions for these scheduled drugs are furthermore monitored by the pharmacists who dispense them. Certain drugs, such as the opioids and the benzodiazepines, are considered so potentially abusive that special programs have been recommended to track the behavior of physician prescribers. Multiple copy programs have been implemented in some states. More recent proposals recommend electronic data transfer (EDT) of pharmacy information to centralized processing points so that misprescribing physicians and doctor-shopping patients can be identified. Regulators concerned about physician behavior and confronted by demands of nonphysicians to prescribe controlled substances may find EDT a good solution. Physicians should be concerned about being censured for misprescribing, because such actions may lead to inclusion in the National Practitioner Data Bank. With all of the regulatory concerns about controlled substances, those physicians who would employ long-term opioid therapy for their chronic pain patients must follow certain basic guidelines to be able to defend themselves against allegations of deviant professional behavior. Such procedures as conducting a history and physical examination, maintaining a written treatment plan, consulting with knowledgeable colleagues, and assessing for addictive behavior can provide the practitioner with safeguards.

Drug Prescriptions↗
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Traumatic experiences and substance abuse: mapping the territory.

This article examines the relationships between various types of traumatic experiences and addictive behavior, with an eye to formulating effective treatment strategies. Interventions in the posttraumatic stress disorder (PTSD) and related fields are reviewed in an effort to understand how best to integrate them into substance abuse treatment. The recovery-oriented therapy model is used as a framework to define treatment tasks at each stage of the recovery process: how one addresses painful issues depends on the objective, given the recovery stage at hand. These tasks include making a commitment to abstinence, stopping alcohol and other drug use, consolidating abstinence and changing lifestyles, and addressing short- and long-term psychosocial issues. The article focuses on the clinical features of PTSD in an effort to enhance the practitioner's ability to address this disorder within the context of substance abuse treatment. Finally, recommendations are offered for training practitioners at varying skill levels in the addiction treatment field.

Adolescent↗
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Anger management and temper control: critical components of posttraumatic stress disorder and substance abuse treatment.

Recent studies have shown associations among combat experience, PTSD, anger and hostility, and involvement in violence. Clinical observations of veterans enrolled in the Substance Use/Posttraumatic Stress Disorder Team (SUPT) program at the San Francisco Veterans Affairs Medical Center revealed relatively high levels of anger and aggressive behavior, including physical assaults and property damage. In response to this anger and aggressive behavior, an anger management treatment was added to the SUPT program's treatment of substance abuse and PTSD. Anger management consisted of a 12-week cognitive-behavioral group treatment. Session topics included identifying the physical, emotional, and situational cues to anger, developing individualized anger-control plans, recognizing and altering destructive self-talk, utilizing time-out, practicing conflict resolution techniques, and using the group to discuss and evaluate high-risk anger situations. Special attention was given to self-monitoring anger-escalating behavior (using an anger meter) and avoiding negative consequences. This article describes the components of the anger management treatment. A clinical vignette is also presented to illustrate the benefits of anger management treatment.

Anger↗
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Unrecognized substance misuse: clinical hazards and legal vulnerabilities.

This paper explores clinical psychologists' relative lack of attention to alcohol and other drug problems, and examines clinical consequences as well as legal vulnerabilities. The ease with which manifestations of substance abuse readily imitate every other entity seen in clinical practice allows both use and abuse to influence treatment in ways which remain often unrecognized. Borderline personality disorder is a common example. Failure to assess and appropriately treat or refer places the psychologist in an increasingly untenable position, especially as sophistication about alcohol and drug problems increases among other professionals and the lay public. The paper outlines sources of legal vulnerabilities, such as negligence and deviation from the standard of care, as they could be arise in substance abuse cases.

Accidents, Traffic↗
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Residential substance abuse treatment for pregnant and postpartum women and their children: treatment and policy implications.

In FY 1993 and FY 1995, the federal government awarded 27 five-year grants that supported 35 residential treatment projects for substance-abusing pregnant and postpartum women and their children. These projects provided comprehensive culturally and gender-specific treatment. Preliminary aggregated data collected in a national cross-site evaluation of 24 of these projects are encouraging with respect to infant mortality and morbidity, treatment retention and completion rates, and behavioral changes in the participating mothers at six months postdischarge. Local evaluations reflect other benefits of treatment. Cost data are expected to demonstrate the efficiencies and benefits of these projects compared to no treatment.

Adult↗