Status report.

Description based on: FY94-FY95; title from cover.

Surveillance of infants born with a positive toxicity for controlled substances /

Mode of access: Internet.

Surveillance of Illinois infants prenatally exposed to controlled substances, 1991-1999.

"November 2001."

Training resource catalog.

Description based on: 1991/1992 edition.

Virtual case manager : tactical implementation plan.

"During the 1996 spring session, the General Assembly passed and the Governor signed landmark legislation creating a Department of Human Services (DHS) effective July 1, 1997. The new department consolidates three human services departments in their entirety : Department of Alcoholism and Substance Abuse (DASA) - Department of Rehabilitation Services (DORS) - Department of Mental Health and Developmental Disabilities (DMH/DD)."

Helping your students say no to alcohol /

Mode of access: Internet.

Mental health : culture, race, and ethnicity : executive summary : a supplement to Mental health : a report of the Surgeon General.

Includes bibliographical references (p. 21).

Hemochromatosis and alcoholic liver disease

The close association of excessive alcohol consumption and clinical expression of hemochromatosis has been of widespread interest for many years. In most populations of northern European extraction, more than 90% of patients with overt hemochromatosis are homozygous for the C282Y mutation in the HFE gene. Nevertheless, the strong association of heavy alcohol intake with the clinical expression of hemochromatosis remains. We (individually or in association with colleagues from our laboratories) have performed three relevant studies in which this association was explored. In the first, performed in 1975 before the cloning of the HFE gene, the frequency of clinical symptoms and signs was compared in patients with classical hemochromatosis who consumed 100 g or more of alcohol per day versus in nondrinkers or moderate drinkers who consumed less than 100 g of alcohol per day. The results showed no difference between the two groups except for features of complications of alcoholism in the first group, especially jaundice, peripheral neuritis, and hepatic failure. Twenty-five percent of those with heavy alcohol consumption showed histologic features of alcoholic liver disease (including cirrhosis) together with heavy iron overload. It was concluded that these patients had the genetic disease complicated by alcoholic liver disease. In the second study (2002), 206 subjects with classical HFE-associated hemochromatosis in whom liver biopsy had been performed were evaluated to quantify the contribution of excess alcohol consumption to the development of cirrhosis in hemochromatosis. Cirrhosis was approximately nine times more likely to develop in subjects with hemochromatosis who consumed more than 60 g of alcohol per day than in those who drank less than this amount. In the third study (2002), 371 C282Y-homozygous relatives of patients with HFE-associated hemochromatosis were assessed. Eleven subjects had cirrhosis on liver biopsy and four of these drank 60 g or more of alcohol per day. The reason why heavy alcohol consumption accentuates the clinical expression of hemochromatosis is unclear. Increased dietary iron or increased iron absorption is unlikely. The most likely explanation would seem to be the added co-factor effect of iron and alcohol, both of which cause oxidative stress, hepatic stellate cell activation, and hepatic fibrogenesis. In addition, the cumulative effects of other forms of liver injury may result when iron and alcohol are present concurrently. Clearly, the addition of dietary iron in subjects homozygous for hemochromatosis would be unwise. (C) 2003 Elsevier Inc. All rights reserved.

Acceptability of various brief intervention approaches for hazardous drinking among university students

Aims: To determine the acceptability to university students of practitioner-delivered screening and brief intervention (SBI) versus a novel approach-web-based SBI (e-SBI). Methods: A random sample of 1910 university students was invited to indicate their preferences for various brief intervention approaches in an internet survey. Results: e-SBI was the most popular intervention. It was favoured by 81% of all students and 82% of hazardous drinkers. Conclusions: e-SBI is a promising approach for the reduction of hazardous drinking among young people.

Attitudes and management of alcohol problems in general practice: Descriptive analysis based on findings of a world health organization international collaborative survey

Aims: To determine if general practitioners' (GPs) experience of education on alcohol, support in their working environment for intervening with alcohol problems, and their attitudes have an impact on the number of patients they manage with alcohol problems. Methods: 1300 GPs from nine countries were surveyed with a postal questionnaire as part of a World Health Organization (WHO) collaborative study. Results: GPs who received more education on alcohol (OR = 1.5; 95% CI, 1.3-1.7), who perceived that they were working in a supportive environment (OR = 1.6; 95% CI, 1.4-1.9), who expressed higher role security in working with alcohol problems (OR = 2.0; 95% CI, 1.5-2.5) and who reported greater therapeutic commitment to working with alcohol problems (OR = 1.4: 95% CI, 1.1-1.7) were more likely to manage patients with alcohol-related harm. Conclusion: Both education and support in the working environment need to be provided to enhance the involvement of GPs in the management of alcohol problems.

Being stoned: A review of self-reported cannabis effects

Although there has been considerable research into the adverse effects of cannabis, less attention has been directed toward subjective effects that may be associated with ongoing cannabis use. Examination of self-reported cannabis effects is an important issue in understanding the widespread use of cannabis. While reviews have identified euphoria as a primary factor in maintaining cannabis use, relaxation is the effect reported most commonly in naturalistic studies of cannabis users, irrespective of the method used. Self-reported effects in 12 naturalistic and 18 laboratory studies were compared. Regardless of methodology there was considerable variation in the effects experienced. Variation has been reported in terms of opposite effects being experienced by different individuals, variation of effects by individuals within a single occasion and between occasions of use. Factors that might explain this variation are outlined. Limitations of the available literature and suggested directions for future research are discussed.

Psychometric properties of the drinking expectancy questionnaire: A review of the factor structure and a proposed new scoring method

Objective: Expectancies about the outcomes of alcohol consumption are widely accepted as important determinants of drinking. This construct is increasingly recognized as a significant element of psychological interventions for alcohol-related problems. Much effort has been invested in producing reliable and valid instruments to measure this construct for research and clinical purposes, but very few have had their factor structure subjected to adequate validation. Among them, the Drinking Expectancies Questionnaire (DEQ) was developed to address some theoretical and design issues with earlier expectancy scales. Exploratory factor analyses, in addition to validity and reliability analyses, were performed when the original questionnaire was developed. The object of this study was to undertake a confirmatory analysis of the factor structure of the DEQ. Method: Confirmatory factor analysis through LISREL 8 was performed using a randomly split sample of 679 drinkers. Results: Results suggested that a new 5-factor model, which differs slightly from the original 6-factor version, was a more robust measure of expectancies. A new method of scoring the DEQ consistent with this factor structure is presented. Conclusions: The present study shows more robust psychometric properties of the DEQ using the new factor structure.

The genetics of alcohol intake and of alcohol dependence

Background: Because alcohol has multiple dose-dependent consequences, it is important to understand the causes of individual variation in the amount of alcohol used. The aims of this study were to assess the long-term repeatability and genetic or environmental causes of variation in alcohol intake and to estimate the degree of overlap with causes of susceptibility to alcohol dependence. Methods: Data were used from three studies conducted between 1980 and 1995 on volunteer adult male and female Australian twin subjects. In each study, alcohol intake was reported both as quantity X frequency and as past-week data. Repeatability was calculated as correlations between occasions and between measures, and the effects of genes and environment were estimated by multivariate model fitting to the twin pair repeated measures of alcohol use. Relationships between mean alcohol use and the lifetime history of DSM-III-R alcohol dependence were tested by bivariate model fitting. Results: Repeatability of the alcohol intake measures was between 0.54 and 0.85, with the highest repeatability between measures within study and the lowest repeatability between the first and last studies. Reported alcohol consumption was mainly affected by genetic factors affecting all times of study and by nonshared environmental factors (including measurement error) unique to each time of study. Genes that affect alcohol intake do affect alcohol dependence, but genetic effects unique to dependence are also significant; environmental effects are largely unique to either intake and dependence. Conclusions: Nearly all the repeatable component of variation in alcohol intake is due to genetic effects. Genes affecting intake also affect dependence risk, but there are other genes that affect dependence alone. Studies aiming to identify genes that affect alcohol use disorders need to test loci and candidate genes against both phenotypes.

Effects of dopamine receptor D4 variation on alcohol and tobacco use and on novelty seeking: Multivariate linkage and association analysis

The dopamine D4 receptor gene contains a polymorphic sequence consisting of a variable number of 48-base-pair (bp) repeats, and there have been a number of reports that this polymorphism is associated with variation in novelty seeking or in substance abuse and addictive behaviors. In this study we have assessed the linkage and association of DRD4 genotype with novelty seeking, alcohol use, and smoking in a sample of 377 dizygotic twin pairs and 15 single twins recruited from the Australian Twin Registry (ATR). We found no evidence of linkage or association of the DRD4 locus with any of the phenotypes. We made use of repeated measures for some phenotypes to increase power by multivariate genetic analysis, but allelic effects were still non-significant. Specifically, it has been suggested that the DRD4 7-repeat allele is associated with increased novelty seeking in males but we found no evidence for this, despite considerable power to do so. We conclude that DRD4 variation does not have an effect on use of alcohol and the problems that arise from it, on smoking, or on novelty seeking behavior. (C) 2003 Wiley-Liss, Inc.

Occupational therapy and evidence-based practice in mental health

Evidence-based practice (EBP) represents a paradigm shift in health care. This review has two aims. The first is to consider the merits of EBP,especially in respect of its use in mental health settings. The second is both to identify psychosocial interventions that have an established evidence base for effectiveness and to provide an analysis of the quality of this evidence and its implications for occupational therapy. Supported employment, family psychoeducation, assertive case management and integrated substance use treatment are examined in detail. It is proposed that occupational therapists working in mental health give priority to psychosocial interventions that are based on evidence and incorporate these into their practice. It is further proposed that, in implementing EBP,practitioners take an active evaluating position in relation to published evidence, paying particular attention to the evidence of effectiveness in equivalent clinical environments.