Abuse Admissions Research Articles

The disadvantage of being advantaged?–on a social gradient in excess mortality among alcohol abusers

Do alcohol abusers from upper social classes have a more elevated excess mortality than alcohol abusers from lower social classes? This question was empirically assessed by analyses on data from a 40-year prospective study of more than 40,000 Norwegian conscripts on whom data on social class (i.e. educational level), alcohol abuse (admission to treatment) and cause specific mortality before the age of 60 years were available. The results demonstrated a social gradient in excess mortality: relative risk of premature death was 2.7 among those with the lowest educational level (primary school only) increasing to 6.2 among those with the highest educational level at conscription (grammar school). Among the alcohol abusers the risk of premature death, was slightly, but not significantly higher among those highly educated as compared to those with less education. Thus, alcohol abuse was not only found to elevate the individual's risk of premature death, but it also appeared to outweigh the advantages of those more socially privileged with respect to health and mortality. The question as to whether social class differences in selection to treatment could account for the observed social gradient in excess mortality is focused in the discussion.

SEVERITY OF ALCOHOL DEPENDENCE IN THE EAST END OF GLASGOW

A survey of 100 consecutive admissions for alcohol abuse in 1990 highlights the severity of alcohol dependence in the East End of Glasgow. The survey identifies a specific sub-group of heavy drinkers who consume strong lager, usually in open spaces, referred to locally as 'garden parties'. In the total population, males outnumbered females 3:1 with a mean consumption of 268 and 230 units of alcohol per week, respectively. The severity of alcohol abuse was reflected in their social, physical and central nervous system complications. Two-thirds of the population had a family history of alcohol abuse. Over three-quarters of the population showed self neglect with nearly half the males ascribing their marital breakdown or family neglect directly to their drinking problem. Both sexes showed a high prevalence of history of paraesthesiae, while half the male population had clear signs of peripheral neuropathy on admission. A history of delirium tremens in over 50% of the population with a history of seizures in 21% of males and 35% of females indicates central nervous system involvement. Three sub-groups were identified: history of delirium tremens, history of persecutory ideation and history of serious criminality. All three sub-groups had a shorter length of drinking with higher consumption and increased frequency of 'garden parties' than the group as a whole. This survey reinforces the need for appropriate in-patient detoxification and rehabilitation facilities for patients with severe alcohol dependence, to reduce their impact on other health, social work and criminal justice services.

EPIDEMIC FREE-BASE COCAINE ABUSE: Case Study from the Bahamas

Beginning in 1983, a sharp increase was noted in the number of new admissions for cocaine abuse to the only psychiatric hospital and to the primary outpatient psychiatric clinic in the Bahamas. For the two facilities combined, new admissions for cocaine abuse increased from none in 1982 to 69 in 1983 and to 523 in 1984. Although there was some evidence for a rise in cocaine use during this time, as the drug became cheaper and more available, a primary cause of this medical epidemic seemed to be a switch by pushers from selling cocaine hydrochloride, which has a low addictive potential, to almost exclusive selling of cocaine free base, which has a very high addictive potential and causes medical and psychological problems. Although the use of free cocaine base is rising around the world, this is the first report of a nationwide medical epidemic due almost exclusively to this form of the drug, although similar problems are reported with smoking coca paste in South America.

Estimating genetic correlations among discontinuous phenotypes: an analysis of criminal convictions and psychiatric-hospital diagnoses in Danish adoptees.

A biometrical model-fitting approach was applied to data from a full adoption design to study phenotypic variation and covariation among multiple discontinuous traits. Using statistical methods available for factor analyses of dichotomous-item data, generalized least-squares estimates were obtained for parameters of additive polygenic and environmental influences on criminal convictions and psychiatric-hospital diagnoses in 2532 Danish male adoptees and their family members. The procedure also provided estimates of genetic correlations, environmental correlations, and genotype-environment correlations among the measures while taking into account the effects of selective placement, assortative mating, and cultural transmission from parental phenotypes to off-spring environments. Significant heritable influences were found for property crime and for a composite psychiatric variable pertaining to hospital admissions for alcohol abuse, drug abuse, and personality disorders. Both correlated environmental factors and correlated genetic factors important to the different variables accounted for the observed phenotypic relationship between property crime and these antisocial disorders. No cultural transmission was present for the adoptees' antisocial disorders, although significant paternal cultural transmission was found for property crimes. Patterns of assortative mating differed for the biological versus adoptive parents, and selective placement was found to be negligible.

University infirmary admissions for drug abuse, 1968--1970 and 1973--1975.

University overnight infirmary admissions for drug abuse were reviewed over the 2-year periods 1968--1970 and 1973--1975. Hallucinogen abuse diminished over the years studied while alcohol abuse increased. Marijuana abuse was essentially unchanged. Diazepam overdosage generally replaced barbiturate overdosage, while aspirin remained the most common drug in overdose situations.

Indian child welfare: A community team approach to protective services

The purpose of this study is threefold: first, to describe the characteristics of child abuse and neglect on a major Indian reservation; second, to examine the impact of a community team approach to child abuse and neglect as measured by the incidence of reported abuse and neglect and admissions for emergency foster care; and third, to make recommendations for actions to close the gaps in child welfare services to Indian children living on reservations.

Battered Child Syndrome: Review of 130 Patients With Controls

The medical and social service records of the 130 battered children under 10 years of age admitted to San Francisco General Hospital during a six-year period, July 1, 1965, to June 30, 1971, were reviewed. Only children with physical injuries were included. A control group was selected from concurrent admissions. The findings showed a steadily rising number of admissions for child abuse. Many of the children suffered from emotional, physical and medical neglect as well as intentional trauma and 44% had been abused previously. Six children died. Sixty-three percent of the battered children were less than 2 years old. Their parents were significantly younger than parents of controls and also much more transient. White children rather than nonwhite children were battered more often than expected when compared to the ethnic distribution of the control group.

Some descriptive measures on 100 consecutive VA hospital drug abuse admissions.

The study concerned 100 consecutive admissions to the Houston VA Hospital Drug Abuse program. Drug history and various demographic and personality factors were investigated both in regards to the population as a whole and three subgroups; (1) opiate users, (2) active duty personnel and (3) drug users involved with drugs other than opiates. The subgroups did differ on economic and criminality measures as well as presenting different clinical pictures based on personality and symptomatic factors.