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Biomedical subjects

William R Miller

Publications and source records attributed to William R Miller.

52 records · Page 3Linked to original sources
PubMed2003

Spirituality, religion, and health. An emerging research field.

The investigation of spiritual/religious factors in health is clearly warranted and clinically relevant. This special section explores the persistent predictive relationship between religious variables and health, and its implications for future research and practice. The section reviews epidemiological evidence linking religiousness to morbidity and mortality, possible biological pathways linking spirituality/religiousness to health, and advances in the assessment of spiritual/religious variables in research and practice. This introduction provides an overview of this field of research and addresses 3 related methodological issues: definitions of terms, approaches to statistical control, and criteria used to judge the level of supporting evidence for specific hypotheses. The study of spirituality and health is a true frontier for psychology and one with high public interest.

Epidemiologic Studies↗
PubMed2003

Motivational interviewing in drug abuse services: a randomized trial.

Motivational interviewing (MI) is a directive, client-centered brief intervention to elicit behavior change by helping clients explore and resolve ambivalence. In this clinical trial, 152 outpatients and 56 inpatients entering public agencies for treatment of drug problems were randomly assigned to receive or not receive a single session of manual-guided MI. Drug use was assessed by self-report, urine toxicology, and collateral reports from significant others at baseline, 3, 6, 9, and 12 months. Contrary to prior reports, MI showed no effect on drug use outcomes when added to inpatient or outpatient treatment, although both groups showed substantial increases in abstinence from illicit drugs and alcohol.

Adult↗
PubMed2003

Client commitment language during motivational interviewing predicts drug use outcomes.

Client language from a motivational interview (MI) and drug use outcome were investigated. Interview videotapes of 84 drug abusers were coded for frequency and strength of utterances expressing commitment, desire, ability, need, readiness, and reasons to change or maintain their habit. Cluster analysis of proportion days abstinent (PDA) revealed 3 groups: high PDA at intake and follow-up (3, 6, 9, 12 months; maintainers); low intake PDA/high follow-up PDA (changers); and low intake PDA/low to moderate follow-up PDA (stragglers). Distinct group patterns emerged for commitment strength (CS) during MI. Clients dishonest in checklist self-report exhibited CS similar to stragglers. CS for client evaluation of a change plan predicted outcome PDA. CS was predicted by strength of desire, ability, need, and reasons, but more strongly predicted outcome PDA, suggesting CS is a pathway for their influence on behavior.

Adult↗
PubMed2003

Participation in alcoholics anonymous: intended and unintended change mechanisms.

This article is a compilation of the information presented at a symposium at the 2001 RSA Meeting in Montreal, Canada. The presentations were: (1) Maintaining change after conjoint behavioral alcohol treatment for men: the role of involvement with Alcoholics Anonymous, by Barbara S. McCrady and Elizabeth E. Epstein; (2) Changing AA practices and outcomes: Project MATCH 3-year follow-up, by J. Scott Tonigan; (3) Life events and patterns of recovery of AA-exposed adults and adolescents, by Patricia L. Owen and Valerie Slaymaker; (4) Social networks and AA involvement as mediators of change, by Lee Ann Kaskutas and Keith Humphreys; and (5) What do we know about Alcoholics Anonymous? by William R. Miller, discussant.

Alcoholics Anonymous↗
PubMed2003

The influence of Hispanic ethnicity on long-term outcome in three alcohol-treatment modalities.

OBJECTIVE: Prior research has suggested that treatment-seeking Hispanic clients are not likely to affiliate with Alcoholics Anonymous (AA). It was hypothesized that AA 12-step facilitation therapy (TSF) would therefore be less effective than cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET) for Hispanics, particularly for those with low acculturation. METHOD: Outcomes for non-Hispanic white (n = 105; 70% male) and Hispanic (n = 100; 80% male) clients at the New Mexico site within Project MATCH were analyzed for evidence of differential treatment response. A pretreatment measure of acculturation to non-Hispanic white culture was available for 80 of the Hispanic clients. RESULTS: Self-identified ethnicity mediated treatment response at distal follow-up, as measured by frequency and intensity of alcohol consumption (p < .02). Hispanics drank with more intensity than did non-Hispanic whites when assigned to TSF; non-Hispanic whites in TSF drank with less frequency than those in the combined CBT and MET conditions. The modest outcome advantage for TSF observed in Project MATCH appears to have been limited to non-Hispanic clients. Contrary to prediction, level of acculturation did not mediate treatment response at proximal (Months 1-6 after treatment) or distal follow-up (Months 7-12). CONCLUSIONS: Ethnic self-identification may interact with treatment outcomes in complex ways that are not directly associated with the factors tapped by commonly used measures of acculturation.

Adult↗
PubMed2002

Concomitance between childhood sexual and physical abuse and substance use problems. A review.

This review focuses on the apparent connection between childhood sexual or physical abuse (CSA, CPA) and later substance use problems (SUPs) among adolescents and adults. The rates of CSA among females with SUPs were found to be, on average, nearly two times higher than those found in the general population, and the rates of SUPs among women with CSA histories were found to be similarly elevated. The rates of CSA were not found to be elevated among males with SUPs, but men with histories of CSA were found to be at greater risk for SUPs than men in the general population. Women, girls, and boys with SUPs were found to have elevated rates of CPA relative to the general population, while adult males with SUPs were not found to have elevated rates of CPA. Concomitance rates were not found to vary systematically with regard to either the methodological quality of the studies included nor the year of study publication. Additional descriptive examination of selected studies indicates that among women, childhood abuse is likely to be a factor in the development of SUPs, but that the relationship is mediated by other psychiatric conditions, such as anxiety and depressive disorders.

Adolescent↗
PubMed2002

Magdalena Pilot Project: motivational outreach to substance abusing women street sex workers.

The Magdalena Pilot Project provided outreach to Albuquerque women sex workers who were also using illicit drugs, primarily cocaine and heroin. This initial uncontrolled trial evaluated the feasibility and potential impact of motivational interviewing (MI) on change in drug use and HIV risk behaviors. Twenty-seven women were enrolled and interviewed about their substance use, health risk behaviors, and plans for change, using the client-centered, directive method of MI. Four months later, 25 women (93%) were interviewed again to assess their drug use and health risk behaviors. Large reductions were reported in frequency (days) of drug use and sex work, with a corresponding increase in days of lawful employment. In identifying problems that most needed to be addressed in order to help them live healthier lives, the women prioritized (1) basic needs including decent housing, (2) mental health care, and (3) treatment for substance use disorders.

Adult↗
PubMed2002

Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders.

AIM: A 3-year update with 59 new controlled trials is provided for the ongoing Mesa Grande project reviewing clinical trials of treatments for alcohol use disorders. The project summarizes the current evidence for various treatment approaches, weighting findings differentially according to the methodological strength of each study. DESIGN: The review includes 361 controlled studies that (1) evaluated at least one treatment for alcohol use disorders, (2) compared it with an alternative condition (such as a control group, a placebo, a brief intervention or an alternative treatment), (3) used a procedure designed to create equivalent groups before treatment and (4) reported at least one outcome measure of drinking or alcohol-related consequences. Studies were rated by two reviewers on 12 methodological criteria, and outcome logic was analyzed for the specific treatment modalities tested. FINDINGS: Methodological quality of studies was significantly but modestly correlated with the reporting of a specific effect of treatment. Among psychosocial treatments, strongest evidence of efficacy was found for brief interventions, social skills training, the community reinforcement approach, behavior contracting, behavioral marital therapy and case management. For the first time, two pharmacotherapies also appeared among the most strongly supported approaches: opiate antagonists (naltrexone, nalmefene) and acamprosate. Least supported were methods designed to educate, confront, shock or foster insight regarding the nature and causes of alcoholism. CONCLUSIONS: Treatment methods differ substantially in apparent efficacy. It would be sensible to consider these differences in designing and funding treatment programs.

Alcoholism↗
PubMed2002

Utilization of AA by Hispanic and non-Hispanic white clients receiving outpatient alcohol treatment.

OBJECTIVE: Research indicates that Hispanic clients are less likely than non-Hispanic white (NHW) clients to attend Alcoholics Anonymous (AA) after treatment. This study examined how, if at all, the nature of commitment to prescribed AA-related behaviors after treatment differed between Hispanic and non-Hispanic whites, and how such behaviors were associated with drinking reductions. METHOD: This retrospective study was conducted using Project MATCH data collected at the Albuquerque clinical research unit. Study aims were investigated using the Form 90, the Alcoholics Anonymous Inventory and the Religious Background and Behavior measures. A total of 100 Hispanic and 105 non-Hispanic clients were randomized to receive either Cognitive Behavioral Therapy (CBT), Motivational Enhancement Therapy (MET) or Twelve-Step Facilitation (TSF) therapy, and findings were divided according to whether clients were encouraged to attend AA (TSF) or not (CBT and MET). RESULTS: Six months after treatment, Hispanic clients assigned to TSF reported significantly less AA attendance relative to NHW clients in TS, and no differences in AA attendance rates were found between Hispanics encouraged and not encouraged to attend AA (TSF vs CBT and MET). Among TSF clients, however, no ethnic differences were found in rates of specific AA-related behaviors. Controlling for intake beliefs, "God Consciousness" after treatment was significantly higher for Hispanic relative to NHW clients, and a main effect of treatment was also obtained (TSF vs CBT and MET). Specific AA-related practices were not associated with increased abstinence, in general. CONCLUSIONS: Despite less frequent AA attendance, Hispanic clients showed increase in AA commitment comparable to that of NHW clients. It thus appears that differential commitment to AA does not explain why Hispanic clients report less frequent AA attendance but equal benefit, relative to NHW clients.

Adult↗
PubMed2002

Development and validation of a method for using breast core needle biopsies for gene expression microarray analyses.

PURPOSE: Gene expression microarray technologies have the potential to define molecular profiles that may identify specific phenotypes(diagnosis), establish a patient's expected clinical outcome (prognosis), and indicate the likelihood of a beneficial effect of a specific therapy (prediction). We wished to develop optimal tissue acquisition, processing, and analysis procedures for exploring the gene expression profiles of breast core needle biopsies representing cancer and noncancer tissues. EXPERIMENTAL DESIGN: Human breast cancer xenografts were used to evaluate several processing methods for prospectively collecting adequate amounts of high-quality RNA for gene expression microarray studies. Samples were assessed for the preservation of tissue architecture and the quality and quantity of RNA recovered. An optimized protocol was applied to a small study of core needle breast biopsies from patients, in which we compared the molecular profiles from cancer with those from noncancer biopsies. Gene expression data were obtained using Research Genetics, Inc. Named Genes cDNA microarrays. Data were visualized using simple hierarchical clustering and a novel principal component analysis-based multidimensional scaling. Data dimensionality was reduced by simple statistical approaches. Predictive neural networks were built using a multilayer perceptron and evaluated in an independent data set from snap-frozen mastectomy specimens. RESULTS: Processing tissue through RNALater preserves tissue architecture when biopsies are washed for 5 min on ice with ice-cold PBS before histopathological analysis. Cell margins are clear, tissue folding and fragmentation are not observed, and integrity of the cores is maintained, allowing optimal pathological interpretation and preservation of important diagnostic information. Adequate concentrations of high-quality RNA are recovered; 51 of 55 biopsies produced a median of 1.34 microg of total RNA (range, 100 ng to 12.60 microg). Snap-freezing or the use of RNALater does not affect RNA recovery or the molecular profiles obtained from biopsies. The neural network predictors accurately discriminate between predominantly cancer and noncancer breast biopsies. CONCLUSIONS: The approaches generated in these studies provide a simple, safe, and effective method for prospectively acquiring and processing breast core needle biopsies for gene expression studies. Gene expression data from these studies can be used to build accurate predictive models that separate different molecular profiles. The data establish the use and effectiveness of these approaches for future prospective studies.

Animals↗
PubMed2002

The inventory of drug use consequences (InDUC): test-retest stability and sensitivity to detect change.

The Inventory of Drug Use Consequences (InDUC) is a self-administered measure of consequences of drug use. Psychometric characteristics have been published for its alcohol-focused parent instrument (Drinker Inventory of Consequences; W. Miller, J. Tonigan, & R. Longabough, 1995). Two studies provided information about the test-retest reliability (lifetime) of InDUC scales (Study 1, N = 34) and the replicability of findings to the 5 InDUC scales (recent; Study 2, N = 208). Four scales had good to excellent test-retest reliability. Findings also indicate that reductions in drug use and problems after treatment are large and that the magnitude of change differs between drug use and consequences. Consequences of drug use should be measured directly rather than be inferred from measures of use.

Adult↗
PubMed2002

A randomized trial of two methods for engaging treatment-refusing drug users through concerned significant others.

In a randomized clinical trial, 90 concerned significant others (CSOs) of treatment-refusing illicit drug users were assigned to either (a) community reinforcement and family training (CRAFT), which teaches behavior change skills, (b) CRAFT with additional group aftercare sessions after the completion of the individual sessions; or (c) Al-Anon and Nar-Anon facilitation therapy (Al-Nar FT). All protocols received 12 hr of manual-guided individual treatment. Follow-up rates for the CSOs were consistently at least 96%. The CRAFT conditions were significantly more effective than Al-Nar FT in engaging initially unmotivated drug users into treatment. CRAFT alone engaged 58.6%, CRAFT + aftercare engaged 76.7%, and Al-Nar FT engaged 29.0%. No CSO engaged a treatment-refusing loved one once individual sessions had been completed.

Adult↗
PubMedDate not supplied

Endocrine and clinical endpoints of exemestane as neoadjuvant therapy.

A series of in vitro and in vivo studies have been performed to establish the endocrine and clinical endpoints of the type I anti-aromatase agent exemestane in neoadjuvant therapy. In vitro studies demonstrated a dose-related inhibition of aromatase activity with exemestane, even when activity was measured in a system in which the aromatase enzyme was induced in fibroblasts preincubated with exemestane but assayed in the absence of the drug. In contrast, type II anti-aromatase agents (eg, aminoglutethimide, anastrozole, and letrozole) often caused a paradoxical increase in aromatase activity when measured under similar conditions. In vivo and in situ studies were performed in 12 postmenopausal women with untreated large or locally advanced estrogen receptor-rich tumors. The effect of exemestane 25 mg daily for 3 months on aromatization peripherally and in breast cancer and surrounding normal tissue was determined. Immediately before starting therapy, patients received an 18-hour infusion of radioactively labeled androgen and estrogen, followed by a wedge biopsy. This procedure was repeated after 3 months of treatment with exemestane, and the data were used to calculate peripheral and local aromatization. Changes in tumor volume were based on clinical examination, ultrasound, and mammography. Exemestane treatment was associated with a marked reduction in aromatization peripherally and in nonmalignant breast tissue in every patient and in breast tumor in all but one patient. Median reduction in tumor volume was 85.5% for clinical examination, 82.5% for ultrasound, and 84% for mammography. Eight of 10 patients who would have required mastectomy before treatment were able to undergo breast-conserving surgery after treatment. Clinical benefits were accompanied by a marked reduction in cellular proliferation and progesterone receptor expression. These data support the use of exemestane in neoadjuvant therapy of breast cancer in postmenopausal women.

Aged↗