Search PubMed⌕ Search

Biomedical subjects

T F Babor

Publications and source records attributed to T F Babor.

At least 37 records · Page 2Linked to original sources
PubMed1997

Alcohol and drug abuse among Connecticut youth: implications for adolescent medicine and public health.

In 1995, a statewide survey of alcohol and other drug use was conducted in a random sample of approximately 4,000 7th to 12th graders in public schools in Connecticut. The survey, part of a statewide substance abuse treatment needs assessment, showed that use of tobacco, alcohol, and marijuana was widespread and increasing, particularly among younger students. Connecticut's students reported higher rates of substance use compared to their peers nationwide. Substance use differed according to age, gender, ethnic background, and community type. It was estimated that almost 1-in-10 senior high school students should receive a diagnostic evaluation for substance abuse, with half likely to need a treatment referral. Most of these adolescents had not received treatment for their substance abuse. Primary-care physicians can play a key role in reducing adolescent substance abuse through prevention messages, screening for drug use, brief interventions, and timely referrals to appropriate intervention services.

Adolescent↗
PubMed1997

Ethical, scientific and clinical issues in ethanol administration research involving alcoholics as human subjects.

Research involving the administration of ethanol to human subjects has been conducted with some regularity since the 1960s. The purpose of this paper is to provide a broader discussion of the ethical and clinical issues pertaining to the administration of ethanol to subjects with a history of alcohol dependence and to assess the potential benefits and risks of ethanol administration research. Three kinds of investigation are reviewed: (1) basic scientific research on alcohol dependence and related disabilities; (2) clinical research that involves ethanol administration as part of the treatment; and (3) studies that have evaluated the short- and long-term effects of ethanol administration on the health and wellbeing of alcoholic research participants. It is concluded that ethanol administration research has not only contributed to the fund of knowledge about basic mechanisms of alcohol dependence; it has also advanced the scientific understanding of treatment. Moreover there is no compelling evidence that participation in ethanol administration research per se has adverse effects on alcoholic research subjects. In the interests of developing a practical approach to the ethical dilemmas posed by ethanol administration research, an ethical review process is suggested that takes into account the principles of respect for people, beneficence, and justice by tailoring the risk/benefit analysis to four types of research subjects: alcoholics recruited directly from the community, subjects recruited from residential treatment settings, recovering alcoholics, and alcoholics in outpatient treatment.

Alcoholism↗
PubMed1996

Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in type B alcoholics.

OBJECTIVE: The aim of this study was to test the hypothesis that, because of abnormalities in serotonergic neurotransmission that may underlie craving and impulsive behavior, fluoxetine treatment differentially affects drinking among type B alcoholics, who are characterized by high levels of both premorbid vulnerability and alcohol-related problems. METHODS: Using a k-means clustering procedure, alcohol-dependent subjects from a placebo-controlled trial of fluoxetine were grouped into low-risk/severity (type A: n = 60) and high-risk/ severity (type B: n = 35) groups. Multivariate analysis of covariance (with pretreatment measures as covariates) evaluated the effects of Alcoholic Subtype, Medication Group, Treatment Completion, and their interactions on measures of drinking, both during the 12-week treatment period and a 6-month follow-up period. RESULTS: Although there were no main effects of Alcoholic Subtype or Medication Group, subjects who completed the treatment trial showed significantly better drinking-related outcomes. There was also an interaction of Alcoholic Subtype by Medication Group during treatment. Among type B subjects, fluoxetine treatment resulted in poorer drinking-related outcomes than placebo treatment. Among type A subjects, there was no effect of Medication Group. This interactive effect did not persist during the 6-month follow-up period. CONCLUSIONS: Alcoholic subtypes identified by cluster analysis seem to be differentially responsive to the effects of fluoxetine treatment on drinking-related outcomes. Serotonergic abnormalities previously identified among a subgroup of alcoholics who are also characterized by impulsivity and severity of alcohol dependence may help to explain the differential medication effect. Based on these findings, it is recommended that, in the absence of a comorbid mood or anxiety disorder, fluoxetine not be used to maintain abstinence or reduce drinking in high-risk/severity alcoholics.

Adult↗
PubMed1996

Validity of the SCID in substance abuse patients.

Structured or semi-structured interviews, including the Structured Clinical Interview for DSM-III-R (SCID), are used widely to maximize the reliability and validity of psychiatric diagnoses. Although the reliability of such interviews appears adequate, there has been little effort to evaluate their validity. In a sample of 100 substance abuse patients, we evaluated the concurrent, discriminant and predictive validity of SCID substance use diagnoses, as well as co-morbid disorders that occur commonly among these patients. The validity of current and life-time substance use diagnoses obtained by a research technician using the SCID was good; it was moderate for antisocial personality disorder and major depression and poor for anxiety disorders. Although accurate diagnosis of substance use disorders in substance abuse patients can be accomplished by a research technician, the diagnosis of co-morbid psychiatric disorders requires either additional expertise or the use of a diagnostic instrument specially designed for that purpose.

Adult↗
PubMed1995

Subtypes of cocaine abusers: support for a type A-type B distinction.

The replicability and generalizability of a multidimensional alcoholism typological system was systematically assessed in 399 inpatient, outpatient, and non-treatment-seeking cocaine abusers. Two different cluster-analytic procedures supported the construct, concurrent, and predictive validity of the Type A-Type B distinction in cocaine abusers. Participants classified as Type B (33%) cocaine abusers exhibited higher rates of premorbid risk factors (family history, childhood behavior problems, personality, age of onset), more severe drug and alcohol abuse, more addiction-related psychosocial impairment, more antisocial behavior, and more comorbid psychiatric problems than Type A participants (67%). Multidimensional typological systems have had a major impact on the alcoholism field and may be equally important for the assessment, prevention, treatment, and theoretical understanding of other substance use disorders.

Adult↗
PubMed1995

The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings.

OBJECTIVE: The concurrent, construct, and discriminant validity of the Alcohol Use Disorders Identification Test (AUDIT) were evaluated. AUDIT consists of a 10-item Core questionnaire and an 8-item Clinical procedure. AUDIT was designed to identify hazardous drinkers (whose drinking increases their risk of alcohol-related problems, though alcohol-associated harm has not yet occurred); harmful drinkers (who have had recent physical or mental harm from their drinking, but who are not alcohol-dependent); and people with alcohol dependence. METHOD: Known alcoholics (n = 65) and general medical patients (n = 187) completed self-report questionnaires and underwent a diagnostic interview, physical examination and laboratory testing. RESULTS: AUDIT scores correlated significantly with scores on the MAST and MacAndrew alcoholism screening tests, and with ALAT, ASAT, GGT and MCV levels, which reflect recent heavy drinking. AUDIT scores were correlated with measures of alcoholism vulnerability (e.g., familial alcoholism and sociopathy), and with somatic and affective consequences of drinking. Receiver operating characteristic and discriminant function analyses indicated that the AUDIT Core and Clinical Instruments were sensitive and specific in discriminating alcoholics from medical patients, most of whom were nonalcoholics. The AUDIT Core was superior to the MAST and the AUDIT Clinical in discriminating hazardous drinkers from nonhazardous drinkers. It was also superior to the AUDIT Clinical in discriminating harmful from nonharmful drinkers. CONCLUSIONS: The AUDIT Core Instrument is useful for early detection of hazardous or harmful drinking, while the AUDIT Clinical Instrument is better applied to identification and/or confirmation of cases of alcohol dependence.

Adolescent↗
PubMed1994

The type A/type B distinction. Subtyping alcoholics according to indicators of vulnerability and severity.

Multidimensional typologies of alcoholics are reviewed, including Cloninger's neurobiological learning model, Morey and Skinner's hybrid model, and Zucker's developmental model. The more recent Type A/Type B typology proposed by Babor and colleagues is reviewed in more depth, as is a previous replication and extension by Litt and colleagues. Both the original study and the replication indicate this typology is a useful tool in classifying alcoholic inpatients into two groups and in matching alcoholics to the most suitable treatment. The present study replicates the typology using outpatient samples of male alcoholics. The resulting two clusters are very similar to those identified by the two earlier studies. As expected, the relative proportion of Type A alcoholics is higher in the outpatient samples than in the previously studied inpatient samples. Preliminary analysis of the typology's clinical efficiency suggests that the variables used to classify subjects might be appreciably reduced, thus effecting a considerable time savings in assessment. A discriminant function analysis indicates that using only 5 of the original 16 clustering variables results in a correct classification rate of almost 95%. Future research directions are addressed.

Adult↗
PubMed1994

Buspirone treatment of anxious alcoholics. A placebo-controlled trial.

BACKGROUND: Symptoms of anxiety are common in alcoholics and may contribute to relapse following initiation of abstinence. Buspirone hydrochloride, a serotonin1A partial agonist, has a pharmacologic profile that may be particularly suited to the treatment of anxious alcoholics. METHODS: We conducted a randomized, 12-week, placebo-controlled trial of buspirone in 61 anxious alcoholics, all of whom also received weekly relapse prevention psychotherapy. Outcomes were measured at the end of treatment and at a 6-month follow-up evaluation. RESULTS: Buspirone therapy was associated with greater retention in the 12-week treatment trial, reduced anxiety, a slower return to heavy alcohol consumption, and fewer drinking days during the follow-up period. CONCLUSIONS: Buspirone appears to have a useful role in the treatment of anxious alcoholics. Further research is needed to clarify which patient characteristics and concomitant treatments result in optimal response to buspirone therapy.

Adult↗
PubMed1994

Avoiding the horrid and beastly sin of drunkenness: does dissuasion make a difference?

Nearly 3 centuries ago, an anonymous English author prepared an educational brochure to dissuade problem drinkers from the "horrid and beastly sin of drunkenness" (Anonymous, 1705). During the past 2 decades, more than 25 randomized trials have been conducted in 12 countries to evaluate 2 basic questions: (a) Does dissuasion make a difference, and (b) What kinds of dissuasion work best? In response to the first question, studies indicate that dissuasion does make a difference with heavy drinkers who have not developed severe alcohol dependence. In response to the second question, the evidence is more equivocal because of the practical and methodological problems encountered in the comparison of different interventions. It is concluded that changes sometimes attributed to specific behavioral and psychological interventions may be due to a combination of advice, individual motivation, and nonspecific social influence.

Alcohol Drinking↗
PubMed1994

Longitudinal, expert, all data procedure for psychiatric diagnosis in patients with psychoactive substance use disorders.

The Longitudinal, Expert, All Data (LEAD) procedure has been proposed as a criterion for the assessment of the procedural validity of diagnostic instruments. The authors evaluated the procedure's test-retest reliability and whether it enhanced diagnosis based on a single interview. Data were collected using interviews and questionnaires to assess current and lifetime substance use disorders and common comorbid disorders in 100 patients recruited from a substance abuse treatment program. An initial diagnostic interview was conducted by a primary expert who, at the end of treatment, formulated LEAD diagnoses for each patient, based on the results of the research assessment and all available clinical records. Secondary experts used a similar procedure in a subsample of 40 patients to provide a measure of test-retest reliability. Overall reliability of LEAD diagnoses was good, though it varied from excellent for substance use disorders to poor for some comorbid psychiatric disorders. As a consequence of the LEAD procedure, the total number of substance use diagnoses increased significantly, with no effect on diagnostic reliability. Based on these findings, we conclude that, while the overall reliability of the LEAD procedure is comparable to other diagnostic methods, there was considerable variability among groups of diagnoses. The additional cost of the procedure would appear to be justified only when diagnostic sensitivity is at a premium and principally for the diagnosis of psychoactive substance use disorders. Before it is widely used as a diagnostic criterion measure, the utility of the LEAD procedure should be evaluated in a variety of patient samples and under varying circumstances.

Adult↗