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Biomedical subjects

T F Babor

Publications and source records attributed to T F Babor.

At least 73 records · Page 4Linked to original sources
PubMed1988

The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures.

The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions from the Diagnostic Interview Schedule with questions designed to elicit Present State Examination items. It is fully structured to allow administration by lay interviewers and scoring of diagnoses by computer. A special Substance Abuse Module covers tobacco, alcohol, and other drug abuse in considerable detail, allowing the assessment of the quality and severity of dependence and its course. This article describes the design and development of the CIDI and the current field testing of a slightly reduced "core" version. The field test is being conducted in 19 centers around the world to assess the interviews' reliability and its acceptability to clinicians and the general populace in different cultures and to provide data on which to base revisions that may be found necessary. In addition, questions to assess International Classification of Diseases, ninth revision, and the revised DSM-III diagnoses are being written. If all goes well, the CIDI will allow investigators reliably to assess mental disorders according to the most widely accepted nomenclatures in many different populations and cultures.

Cross-Cultural Comparison↗
PubMed1988

Unitary versus multidimensional models of alcoholism treatment outcome: an empirical study.

This study examined two issues related to the distinction between unitary and multidimensional models of alcoholism treatment outcome. First, does treatment outcome vary along a variety of relatively independent dimensions? Second, how important is abstinence to improved health and psychosocial adjustment? A sample of 266 alcoholics were evaluated at intake and 1 year following inpatient treatment using an extensive battery of assessments. Correlational analysis and factor analysis provided limited support for both the unidimensional and multidimensional approaches. A synthetic measure of posttreatment drinking showed a clear linear relationship between level of consumption and lack of improvement in medical status, biological function, life stress and psychopathology. The findings are discussed in terms of the methodological difficulties in treatment evaluation and the need for more systematic research on the effect of posttreatment drinking on multiple dimensions of outcome status.

Adult↗
PubMed1988

Alcoholics, aggression and antisocial personality.

This study investigated relationships among antisocial personality (ASP) disorder, a childhood history of aggressive behavior and violent behavior in a sample of 77 hospitalized alcoholics. Patients classified according to childhood aggression (high, low) and ASP (present, absent) were compared using self-report measures of anger, aggression, depression, well-being and sociability. Items measuring these variables were rated in terms of the patients' typical behavior while drinking and while sober. Alcoholics reported more anger and aggression when drinking than when sober and this effect was greatest among individuals with a history of childhood aggression. ASP accounted for negligible amounts of the variance when the effects of childhood aggression were considered independently. Results indicate that both alcohol consumption and childhood antecedents contribute to the manifestation of violent behavior by alcoholics.

Adult↗
PubMed1987

Psychopathology as a predictor of treatment outcome in alcoholics.

We performed a one-year follow-up study of 266 alcoholics who had received extensive psychiatric assessment, including diagnosis with the National Institute of Mental Health Diagnostic Interview Schedule and DSM-III criteria, during their index treatment episode. The aims were to evaluate the relationship between additional DSM-III diagnoses in alcoholics and outcome at follow-up, assess the relative prognostic power of different ways of measuring psychopathology by comparing categorical DSM-III diagnoses and a global symptom severity measure, and assess whether ratings of psychopathology add to the prognostic power of an alcohol-dependence measure. While coexistent psychiatric diagnoses generally predicted poorer treatment outcome, there were significant interactions in the relationship between diagnoses and treatment outcome for men and women. For men, having an additional diagnosis of major depression, antisocial personality, or drug abuse was associated with poorer outcome. For women, having major depression was associated with a better outcome in drinking-related measures, while antisocial personality and drug abuse were associated with poorer prognosis. The value of determining psychiatric diagnosis was supported by covariance analyses that suggested that prognostic significance of specific disorders was not accounted for by general psychopathology or general dependence dimensions.

Adult↗
PubMed1987

Social drinking as a health and psychosocial risk factor. Anstie's limit revisited.

This chapter reviews empirical evidence dealing with the risk of using beverage alcohol in quantities generally considered to be within the range of moderate or social drinking. It begins with a discussion of terms and concepts typically employed to define the limits of moderate and social drinking. The historical debate over moderate drinking is considered next, using Francis Anstie's daily limit of 1.5 oz of absolute ethanol as an example of an influential and enduring approach to this issue. The scientific evidence relevant to the association between moderate drinking and damage is reviewed in sections dealing with the risks of acute ingestion of alcohol and the hazards of chronic drinking. In a final section, a multidimensional model of risk is developed to serve as a basis for early intervention and prevention planning. It is concluded that both social and moderate drinking entail risk of health hazards and psychosocial consequences. These risks are not always a direct function of the amount of ethanol consumed but rather reflect complex interactions among a host of antecedent and mediating variables. When these are taken into account, a better estimate of the relative risk of different consequences of drinking can be made.

Alcohol Drinking↗
PubMed1987

Substance-use disorders in DSM-III-R. Evidence for the dependence syndrome across different psychoactive substances.

Using the newly revised DSM-III-R criteria for substance-abuse diagnoses, we examined dependence syndrome elements among 83 psychiatric patients. The sample included 14 with no history of substance abuse. The remainder abused alcohol (52), sedatives (31), hallucinogens (12), stimulants (33), cannabis (44), cocaine (52), or opiates (47). Many patients (52) had abused more than one type of drug. Ten items assessing the proposed dependence symptoms for each type of drug were factor-analysed. The dependence syndrome items formed a single factor for opiates, cocaine, and alcohol, but not for other drugs. When the items were combined into cumulative scales, they had excellent internal consistency. Furthermore, they formed good approximations of unidimensional Guttman scales on which higher scores indicated greater syndrome severity. The items associated with higher scores differed across drugs, with opiates having the most striking differences from the other substances. Medical-psychosocial consequences were relatively independent of the dependence syndrome, although alcohol and cocaine dependence had some association with other problem areas. These findings support the utility of a common dependence syndrome concept for drugs of abuse as well as alcohol, and provide empirical support for the current revision of the DSM-III diagnostic criteria.

Adult↗
PubMed1987

Verbal report methods in clinical research on alcoholism: response bias and its minimization.

Verbal report procedures, such as interviews, tests and questionnaires, have become the dominant method to obtain clinical data on alcohol abuse and its modification through treatment. The extent to which this method provides reliable and valid information for research purposes, and how its accuracy and usefulness can be enhanced, is examined. A review of methodological studies in the alcohol literature shows that although the information obtained from alcoholics and heavy drinkers tends to be reliable and valid, there can be considerable variability in accuracy, depending on the sensitivity of the information sought, the specificity of the validation criteria, the personal characteristics of the respondents and the demand characteristics of the task. It is suggested that the question of whether verbal report procedures are valid or invalid is less important than the issue of how they can be improved to the point that confidence can be placed in their findings. To facilitate this process, methodological techniques likely to enhance validity are reviewed.

Alcoholism↗
PubMed1986

Classification and forms of inebriety. Historical antecedents of alcoholic typologies.

This chapter reviews 39 typological classifications of alcoholics published in the world alcohol literature between 1850 and 1941. After a brief discussion of the concept of typology within the Western intellectual tradition, the typologies are described in terms of classification criteria, cultural context, and historical trends. Four countries (France, Germany, England, and the United States) accounted for all but one of the typologies. Within countries, typological theories tended to be concentrated during specific historical periods, often reflecting prevailing trends in medicine, psychiatry, and clinical practice. Despite a number of common themes, there was little indication of the progressive development of typology theory in a predictable direction. Like their counterparts in contemporary times, these typologies failed to gain widespread acceptance as the basis for theoretical explanations or clinical practice. Rather, their function was more likely to serve as justifications for the disciplinary or policy orientations held by the typologists. It is concluded that unless typologies are formulated on the basis of careful research, sound theory, and clinical relevance, they are likely to be relegated to a similar status as historical artifacts.

Alcoholism↗
PubMed1986

Issues in the definition and diagnosis of alcoholism: implications for a reformulation.

This paper examines definitions of alcoholism from theoretical and historical points of view. It begins with a review of definitions of alcoholism from the 19th century to the present, giving particular attention to medical approaches, psychiatric formulations, behavioral concepts, and definitions proposed by the American Psychiatric Association and the World Health Organization. It is concluded that current definitions differ widely in scope, the meanings attached to words like disease and disorder, the criteria for including signs and symptoms as essential characteristics, and the potential uses of the definitions. Based on these considerations, the practical issues of developing and applying clinically useful diagnostic procedures are discussed. The paper concludes with a discussion of diagnostic issues that should be considered in any effort to improve clinical identification, treatment planning and international communication.

Alcoholism↗
PubMed1986

Alcoholism and prevalence of medical and psychiatric disorders.

Prevalence of medical disorders was determined for 10,758 consecutive admissions for inpatient alcoholism treatment to 13 hospitals located in eight states of the United States. The majority of patients (approximately 70% of the men and 73% of the women) had a significant medical problem other than alcoholism. The most prevalent disorders were diseases of the liver, gallbladder and pancreas; bronchitis; emphysema; and asthma. Hypertensive disease was found in 15% of the men and 7% of the women. Psychiatric disorders associated with alcoholism were neuroses, personality disorders and other nonpsychotic states. Less than 10% of all patients were referred by physicians; more than 90% had not been previously diagnosed or treated for medical or psychiatric disorders associated with alcoholism. The high prevalence of medical disorders indicates that inpatient treatment of alcoholism should be undertaken in facilities that have expertise and resources for concurrent treatment of serious medical illness.

Adolescent↗