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Biomedical subjects

N Heather

Publications and source records attributed to N Heather.

At least 55 records · Page 3Linked to original sources
PubMed1994

The development of guidelines for drug and alcohol dependence treatment: affecting policy and practice.

The rationale and methodology behind the Australian Quality Assurance Project is described. The Project aimed to develop guidelines for treatment content based on three sources of information: research findings, current practice and expert opinion. The issue of the gap between research and practice is discussed, as well as the role of dissemination in altering clinician behaviour.

Journal Article↗
PubMed1994

Results of screening for excessive drinkers in four Sydney teaching hospitals.

In-patients from selected wards at four Sydney teaching hospitals were screened using a self-completed general health questionnaire. Screening was carried out between January 1990 and December 1991 as part of a larger study of brief interventions for excessive alcohol consumers detected in the general hospital setting. Comparison with other screening studies of excessive drinkers in hospitals is difficult, due to factors such as the different screening instruments used and the varying population targeted. However, similar trends among excessive drinkers were found, such as age and gender factors. The routine employment of simple screening instruments to detect excessive drinkers among hospital in-patients is once more urged.

Journal Article↗
PubMed1993

Alcohol cue exposure directed at a goal of moderate drinking.

A novel form of moderation-oriented cue exposure treatment for alcohol dependence is illustrated in a single case study. Formal clinic-based cue exposure following a priming dose of the client's preferred beverage is succeeded by supervised and then unsupervised in vivo practice at resisting continued drinking in tempting situations. Improvements on a range of outcome measures seen up to 12-month follow-up were supported by the results of an analogue measure of desire to drink. The potential place of this form of treatment in the range of services offered to problem drinkers is discussed.

Adult↗
PubMed1993

To drink or not to drink? Assessing conflicting desires in dependent drinkers in treatment.

Reactivity to Alcohol and Neutral Cues was compared in male, inpatient problem drinkers (N = 30). Subjects reported an overall desire not to drink alcohol which decreased in the presence of the Alcohol Cue. There were no cue-specific changes in heart rate, blood pressure and arousal level and a non-significant trend for increased stress in the Alcohol Cue condition. Subgroups of subjects reporting positive and negative desire for alcohol were identified. Subjects who reported negative desire for alcohol in the Alcohol Cue condition also reported greater self-efficacy to resist drinking in the future. These findings have implications for understanding the nature of self-reported desire for alcohol and its potential role in the treatment of alcohol dependence.

Adult↗
PubMed1993

Evaluation of a cognitive-behavioural intervention for HIV prevention among injecting drug users.

OBJECTIVE: To evaluate the effectiveness of relapse prevention (RP) and brief intervention (BI) in reducing HIV risk-taking behaviours among injecting drug users (IDU) enrolled in methadone programmes. The hypotheses tested were: (1) that a six-session RP programme would be more effective in reducing HIV risk-taking behaviours than a one-session BI and a non-intervention control condition (C); and (2) that BI would be more effective in reducing HIV risk-taking behaviours than C. DESIGN: Clients of methadone programmes were randomly assigned to either RP, BI, or C. Follow-up occurred 6 months after pre-intervention assessment and was conducted by independent research assistants who were not aware of subjects' group allocations. SETTING: Confidential assessment interviews and interventions generally took place at the methadone unit treating the subject. PARTICIPANTS: Ninety-five IDU enrolled in methadone programmes. Study entry criteria were: injection of any drug in the 6 months before the day of pre-intervention assessment; literacy in English; agreement to HIV-antibody testing for research purposes; and no known diagnosis of a serious mental illness. Eighty subjects were contacted successfully for a 6-month follow-up. INTERVENTIONS: The RP intervention was a six-session programme. Each 60-90 min session was conducted individually. The BI was a one-session motivational interview lasting 60-90 min, accompanied by a self-help booklet. MAIN OUTCOME MEASURES: All subjects were administered the Drug Use Scale and HIV Risk-Taking Behaviour Scale of the Opiate Treatment Index and consented to the collection of a capillary blood sample for HIV-antibody testing at pre-intervention assessment and follow-up. At follow-up, the Highest HIV Risk-Taking Behaviour Scale, collateral reports from subjects' sexual partners pertaining to the previous month and urinalysis results for the month before follow-up were collected. RESULTS: Compliance with interventions was good. Correspondence of self-reports with urinalysis and collateral reports was satisfactory. There were no significant differences between groups in risk-taking behaviours during the month before follow-up. However, there was evidence of a lower rate of needle-risk behaviour (sharing and cleaning) during the heaviest risk-taking month since pre-intervention assessment in the group given RP. There were no indications that BI was of greater benefit than the usual methadone treatment and neither intervention appeared to reduce sexual risk behaviour. CONCLUSIONS: The results are cautiously interpreted as showing that individual RP programmes decrease the level of needle-risk behaviour during relapse episodes, but further research is required to replicate this finding.

Adolescent↗
PubMed1993

Predictive validity of the Readiness to Change Questionnaire.

Following the development of the Readiness to Change Questionnaire described by Rollnick et al., this article reports on the predictive validity of the questionnaire among a sample of 174 male excessive drinkers identified by screening on wards of general hospitals. Relationships between patients' "stage of change" derived from questionnaires administered prior to discharge from hospital and changes in drinking behaviour at 8 weeks and 6 months follow-up are analysed. Allocated stage of change provided statistically significant relationships with drinking outcome. Multiple regression analysis showed that stage of change remained a significant predictor of changes in alcohol consumption when other possible predictors were taken into account. Two methods for allocating stage of change on the basis of questionnaire responses for use in different circumstances, a "quick" and a "refined" method, are described.

Adolescent↗
PubMed1993

Reactivity to alcohol-related cues in heavy and light drinkers.

Physiological responses and self-reported desire for alcohol were compared in heavy (n = 21) and light (n = 29) drinkers under each of two cue conditions. The cues were presented in a counterbalanced order and consisted of the sight, smell and taste of the subject's preferred alcoholic beverage (alcohol cue) and of a nonalcoholic lemon-flavored drink (neutral cue). Heavy drinkers showed a significant linear increase in reported desire for alcohol over time in the presence of the alcohol cue. This persistent increase in desire for alcohol seen in heavy drinkers contrasted with the initial increase shown by light drinkers which dissipated over time. Neither group showed any significant change in desire for alcohol when presented with the neutral cue. Heavy drinkers showed lower levels of skin conductance than light drinkers and all subjects showed changes in heart rate during exposure to both cues. Heart rate was affected differentially in the two groups of drinkers but only when the alcohol cue was presented first. Neither blood pressure nor stress and arousal levels changed significantly from pre- to post-cue presentations. The findings of this study have implications for understanding the nature and time course of cue-elicited desire for alcohol and its potential role in the development and treatment of alcohol dependence.

Adolescent↗
PubMed1993

Development of a scale for measuring impaired control over alcohol consumption: a preliminary report.

Impaired control over drinking has occupied a central place in explanations of alcohol dependence since the late 18th century. Despite this key theoretical role, no instrument has been developed to directly assess the construct. This article describes the development of a three-part Impaired Control Scale (ICS), in which Part 1 measures the degree to which a subject has attempted to exercise control over drinking in the past 6 months; Part 2 measures the degree of success in controlling drinking over the past 6 months; and Part 3 measures the subject's belief in his or her ability to control drinking if it were attempted. Psychometric analysis showed that, despite difficulties reported in the literature, impaired control could be measured in a reliable fashion, with satisfactory discriminant and concurrent validity. Preliminary investigation of the relationship between the ICS and elements of the alcohol dependence syndrome suggests that the construct of impaired control is related to, but may be distinguished from, a general factor of alcohol dependence. While more research is needed to replicate these findings and to examine interrelationships among the various parts of the ICS, the scale may have both theoretical and practical value in research and treatment for alcohol dependence and its related problems.

Adult↗
PubMed1992

Why alcoholism is not a disease.

OBJECTIVE: To expound the argument that alcoholism (or "problem drinking") is not best regarded as a disease. SUMMARY: Excessive drinking can cause physical disease and involve physical dependence without therefore being a disease itself. The "disease concept" of alcoholism is not needed to justify medical intervention or a caring approach to those who are dependent on alcohol. There is a specific and a general version of the disease concept of alcoholism. The specific disease concept, associated mainly with the Fellowship of Alcoholics Anonymous, is contradicted by empirical evidence and unhelpful for preventive and treatment responses to problem drinking, especially for the effort to detect and modify problem drinking at an early stage. The more general disease concept shares these disadvantages and is also ineffective in engendering sympathetic attitudes towards problem drinkers among the general public. It is more useful to view problem drinking as the result of the interaction between the individual's personality and the social context in which he or she has learned how to drink. CONCLUSION: For an effective and compassionate societal response to problem drinking, the disease model of alcoholism should be replaced by a social learning perspective.

Alcohol Drinking↗
PubMed1992

Drug use and HIV risk-taking behaviour among clients in methadone maintenance treatment.

Current drug use and HIV risk-taking behaviour of a sample of 95 methadone maintenance clients was investigated. Subjects had been on their current programme for an average of 70.9 weeks with a mean daily dose of methadone of 65.6 mg. Two-thirds had injected heroin, and 82% had injected a street drug in the month prior to interview. Over 20% of subjects had shared a needle in the month before interview, all with only one other person. Subjects who had injected cocaine in the month before interview had significantly higher levels of injecting risk-taking behaviour than those subjects who had injected but not used cocaine. Condom use among subjects was low, particularly in regular relationships. While knowledge concerning HIV was high among subjects, there was no relation between level of knowledge and actual behaviour. It is concluded that knowledge alone is not sufficient to ensure behaviour change.

Adolescent↗
PubMed1992

Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: the Opiate Treatment Index.

This article presents a new instrument with which to assess the effects of opiate treatment. The Opiate Treatment Index (OTI) is multi-dimensional in structure, with scales measuring six independently measured outcome domains: drug use; HIV risk-taking behaviour; social functioning; criminality; health; and psychological adjustment. Psychometric properties of the Index are excellent, suggesting that the OTI is a relatively quick, efficient means of obtaining reliable and valid data on opiate users undergoing treatment over a range of relevant outcome domains.

Adolescent↗
PubMed1992

Development of a short 'readiness to change' questionnaire for use in brief, opportunistic interventions among excessive drinkers.

Excessive drinkers (141) identified in medical settings who were not seeking help for an alcohol problem completed a questionnaire based on Prochaska and DiClemente's stages of change model. Principal components analysis revealed a clear factor structure corresponding to the 'precontemplation', 'contemplation' and 'action' stages of change. On this basis, a 12-item 'Readiness to change' questionnaire was developed with satisfactory psychometric properties. As predicted, scale scores on adjacent stages of change showed significantly higher inter-correlations than scores on non-adjacent stages. Concurrent validation by comparison with subjects' choices of cartoons depicting each of the stages of change and with screening questions regarding aspects of drinking behaviour was moderate to very good. The questionnaire provides a short and convenient measure of readiness to change which may be used in conjunction with brief, opportunistic interventions with excessive drinkers.

Adult↗
PubMed1992

Depressed affect as a predictor of increased desire for alcohol in current drinkers of alcohol.

Male drinkers (n = 45) were asked to rate their desire for a drink of alcohol when presented with the sight, smell and taste of their preferred alcoholic beverage and of a lemon cordial drink. The subjects' level of depressed affect on that day and their average daily consumption of alcohol over the last 30 days were measured prior to exposure to these cues. Both level of depressed affect and log of mean daily alcohol consumption predicted increased desire for alcohol when alcohol cues were present, accounting for 40% of the variance in desire. When presented with the lemon cordial cues only 14% of the variance in desire for alcohol was explained by these variables. Also, Spearman's rank order correlations were calculated between heavy drinkers' (n = 19) ratings of self-efficacy to resist drinking and desire for alcohol in the presence of the alcohol cues. There were significant negative correlations between desire for alcohol and self-efficacy ratings on the 'urges and temptations' and 'positive social situations' subscales of the Situational Confidence Questionnaire-39. Several alternative accounts of these findings are discussed.

Adolescent↗
PubMed1991

Problem drinking.

Explore the source record for details and available documents.

Alcoholism↗
PubMed1991

Importance of substance cues in relapse among heroin users: comparison of two methods of investigation.

Ninety-three heroin users in treatment rated the importance to their last relapse to heroin use of the 13 categories and subcategories of reasons for relapse identified by Marlatt and Gordon (1985). These subject ratings were compared with the consensual categorizations of two independent judges who coded subjects' descriptions of the same relapse episodes. The results showed that, when judges categorized subjects' open-ended responses to questions about their last relapse, temptations or urges in the presence of substance cues were accorded no importance as a reason for relapse, and these categorizations were similar in this respect to previously reported findings. In contrast, when subjects themselves directly quantified the importance of the various relapse categories in precipitating their last relapse, substance-related temptations or urges obtained the highest mean rating of all categories.

Adaptation, Psychological↗