Co-occurrence Of Alcoholism Research Articles

Prevalence and Co-occurrence of Alcohol, Nicotine, and Other Substance Use Disorder Diagnoses Among US Transgender and Cisgender Adults

Substance use disorders are a major source of morbidity and mortality in the United States. National data comparing the prevalence of substance use disorder diagnoses (SUDDs) among transgender and cisgender individuals are lacking in the United States. To investigate the prevalence of SUDDs among transgender and cisgender adults and to identify within-group and between-group differences by age, gender, and geographic location. This cross-sectional study used the OptumLabs Data Warehouse to analyze deidentified claims from approximately 74 million adults aged 18 years or older enrolled in commercial or Medicare Advantage insurance plans in 2017. A total of 15 637 transgender adults were identified based on a previously developed algorithm using a combination of International Classification of Diseases, Tenth Revision (ICD-10) transgender-related diagnosis and procedure codes and sex-discordant hormone prescriptions. A cohort of 46 911 cisgender adults was matched to the transgender cohort in a 3:1 ratio based on age and geographic location. SUDDs, based on ICD-10 codes, were assessed overall and compared between transgender and cisgender cohorts and by geographic region (ie, Northeast, Midwest, South, and West); age groups (eg, 18-25, 26-30, 31-35 years), and gender (ie, transfeminine [TF; assigned male sex at birth, identify along feminine gender spectrum], transmasculine [TM; assigned female sex at birth, identify along masculine gender spectrum], male, and female). In this study of 15 637 transgender adults (4955 [31.7%] TM) and 46 911 cisgender adults (23 247 [50.4%] men), most (8627 transgender adults [55.2%]; 51 762 cisgender adults [55.2%]) were aged between 18 and 40 years, and 6482 transgender adults (41.5%) and 19 446 cisgender adults (41.5%) lived in the South. Comparing transgender to cisgender groups, significant differences were found in the prevalence of a nicotine (2594 [16.6%] vs 2551 [5.4%]; P < .001), alcohol (401 [2.6%] vs 438 [0.9%]; P < .001), and drug (678 [4.3%] vs 549 [1.2%]; P < .001) SUDDs. Among transgender adults, cannabis was the most prevalent drug SUDD (321 [2.1%]), followed by opioid SUDD (205 [1.3%]) and cocaine SUDD (81 [0.5%]), whereas among cisgender adults, cannabis and opioid SUDDs were equally prevalent (cannabis, 186 [0.4%]; opioid, 207 [0.4%]), followed by cocaine SUDD (59 [0.1%]). In this study, the prevalence of SUDDs was significantly elevated among transgender adults relative to their cisgender peers. These findings underscore the need for culturally tailored clinical interventions to treat substance use disorder in transgender populations.

Influence of catechol-O-methyltransferase enzyme gene polymorphism on alcohol and tobacco consumption in North Indian treatment seeking population

Background:The co-occurrence of alcohol and tobacco dependence is frequently witnessed in treatment settings. It is a challenge for clinicians to treat such patients due to their powerful biological association.Aim:The study is aimed to assess the relationship of Catechol-O-methyltransferase (COMT) Val158Met polymorphism with substance intake among individuals who are dependent on both alcohol and tobacco.Materials and Methods:A cross-sectional study involving patients coming to the outpatient department was planned. Brief information on their sociodemographic and substance use profile was recorded. Genotyping of COMT Val158Met was carried out using established polymerase chain reaction-restriction fragment length polymorphism method. The COMT genotyping was classified based on the presence or absence of Met allele using the dominant model. Descriptive statistics, Chi-square test, Mann–Whitney test, and Binary logistic regression analysis were performed to analyze the data.Results:The study included 104 alcohol and nicotine co-dependent subjects. More than eighty percent of the participants were educated above secondary level, married, and employed. The allele frequencies of met and Val were found to be 0.23 and 0.77, respectively. Forty percent of the participants reported tobacco-related health problems. The odds of consuming alcohol and nicotine were four times high among Met allele carriers. While the Fagerström test for nicotine dependence and heaviness of smoking index scores were up to four and eight times higher among met allele (odds ratio 4.3 and 8.9, respectively).Conclusion:Patients carrying Met allele are reported to consume higher amounts of alcohol and tobacco and were likely to score high among measures of nicotine dependence. Thus met allele carriers needs additional attention for a successful treatment outcome.

The relationship between alcohol and cannabis use with nonsuicidal self-injury among adolescent inpatients: Examining the 90 days prior to psychiatric hospitalization

BackgroundThis study examined the trajectories of alcohol use, cannabis use, suicide planning (SP), and nonsuicidal self-injury (NSSI) prior to hospitalization and examined the role of alcohol and cannabis use, independently and jointly, in predicting NSSI on a daily level and over time. MethodsParticipants included 71 adolescents hospitalized for suicide risk (75% female; 25% male; Mage = 15.79). All participants drank alcohol at least once in the prior 90-days. We conducted mixed effect models to assess the trajectories of alcohol use, cannabis use, and NSSI over the 90-days prior hospitalization. To test the effect of SP, alcohol use, and cannabis use on NSSI, we conducted logistic random effect models, while controlling for demographics. ResultsSP (OR = 4.47, p < 0.001) and suicide ideation (SI) (OR = 10.09, p < 0.001) significantly increased the odds of engaging in NSSI. Neither cannabis nor alcohol use independently predicted the odds of engaging in NSSI, however, the co-occurrence of alcohol and cannabis use increased the odds of engaging in NSSI on a given day (OR = 30.5, p < 0.05). ConclusionsStudy findings extend current knowledge about the longitudinal and day-to-day relationships between alcohol and cannabis use and NSSI. Results underscore the importance of developing interventions that address polysubstance use among suicidal adolescents engaging in NSSI.

Adolescents’ Sex-Related Alcohol Expectancies and Alcohol Advertisements in Magazines: The Role of Wishful Identification, Realism, and Beliefs about Women’s Enjoyment of Sexualization

In the United States, approximately one in five sexually active teens report alcohol or drug use before their last sexual encounter. The co-occurrence of alcohol with sex increases risky behaviors, such as having unprotected sex. Magazines that target adolescents often feature alcohol advertisements with sexual innuendo and female objectification. Such advertisements may inform adolescents’ expectancies that alcohol can facilitate sex. With an experimental design and path analysis, we examined 874 adolescents’ (ages 15–17, M = 16.05) exposure to objectifying alcohol ads, their perceptions of the ads, and their attitudes about women’s sexualization in relation to sex-related alcohol expectancies. For female adolescents we assessed their enjoyment of sexualization, and for male adolescents, we assessed their perceived enjoyment of sexualization among women. Teens’ perceptions that alcohol ads promote the co-occurrence of alcohol with sex mediated the effect of ad exposure and perceived realism of the ads on sex-related alcohol expectancies. The enjoyment of sexualization construct mediated the effect of wishful identification and perceived realism on sex-related alcohol expectancies. Wishful identification also directly related to sex-related alcohol expectancies. Results challenge the alcohol industry’s compliance with advertisement regulations and suggest media literacy as a strategy to promote healthy sex-related alcohol expectancies among adolescents.

Frequency and Predictors of Alcohol-Related Outcomes Following Alcohol Residential Rehabilitation Programs: A 12-Month Follow-Up Study.

Excessive use of alcohol has been identified as a major risk factor for diseases, injury conditions and increased mortality. The aims of this study were to estimate the frequency of success (abstinence and no alcohol related hospitalization) at 6- and 12-month follow-up after hospital discharge, and to identify the predictors of success. In 2009, a total of 1040 patients at their first admission in one of the 12 Residential Alcohol Abuse Rehabilitation Units (RAARUs) participating in the CORRAL (COordinamento of Residenzialità Riabilitative ALcologiche) project were included in the study. Several socio-demographic and clinical variables, and the number of treatments’ strategies during the rehabilitation were collected. Information on alcohol abstinence and no alcohol related hospitalization was assessed through a phone interview using a health worker-administered structured questionnaire at six and 12 months after discharge. An inverse probability weighted, repeated measures Poisson regression model with robust variance was applied to estimate the association between patients’ characteristics and the study’s outcomes, accounting for non-responders status. The frequencies of abstinence and non-alcohol related hospitalization were 68.38% and 90.73% at six months, respectively, and 68.65% and 87.6% at 12 months, respectively. Patients that were already abstainers in the month before RAARUs’ admission have an increased probability of being abstainers after discharge (relative risk: RR 1.20, 95% confidence interval: 95%CI 1.08–1.33) and of having an alcohol related hospitalization at 12 months. Subjects undergoing more than four treatment strategies (RR 1.19; 95% CI 1.01–1.40) had a higher abstinence probability and lower probability of no alcohol related hospitalizations after 12 months. Finally, patients with dual diagnosis (co-occurrence of alcohol abuse/dependence and psychiatric disorders) have a decreased probability of not being hospitalized for alcohol-related problems (RR 0.95; 95% CI 0.91–0.99). The results of this study suggest that specific attention should be paid to the intensity of treatment, with particular regard to a multidisciplinary rehabilitation in order to respond to the complexity of alcohol dependent patients.

Dual disorders in individuals under treatment for both alcohol and cocaine: Madrid study on the prevalence of dual disorders

Introduction. Descriptive data about co-occurrence of alcohol and cocaine consumption is scarce, despite its important prevalence. Dual disordes shows high prevalence in clinical samples, and patients report worse evolution and need more health services. Objective. To compare psychopathology in patients in treatment with lifetime alcohol and cocaine (Alc + Coc) substance use disorder (SUD) with subjects with alcohol but not cocaine (Alc) lifetime SUD and cocaine but not alcohol (Coc) SUD. Method. The sample consisted of 837 outpatients from Madrid, Spain, under treatment in substance misuse or mental health units. Two analyses were made: we compared subjects in the Alc + Coc (n = 366) to the Alc group (n = 162), and then to the Coc group (n = 122). Socio-demographic variables were addressed by interview. The Mini International Neuropsychiatric Interview (MINI) was used to evaluate Axis I disorders and the Personality Disorder Questionnaire (PDQ) to evaluate Personality Disorders (PD). Results. Compared to Alc group, patients in the Alc + Coc group were younger, had different socio-demographic characteristics, had more proportion of cannabis and opioid SUD, had less proportion of major depressive disorder, obsessive and depressive PD, more proportion of antisocial PD and lower suicide risk. Compared to the Coc group, they had more cannabis SUD and lower opioid SUD, showed higher prevalence of bipolar disorder, general anxiety disorder, paranoid, histrionic and dependent PD. Discussion and conclusion. We present a cross-sectional study describing comorbidity of dual disordes on treatment-seeking concurrent alcohol and cocaine problematic users. This concurrence showed different dual disordes prevalence profile than single users in some specific mental disorders.

Effects of Smoking, Drinking and Drug use on the Adolescent&amp;#039;s Suicidal Ideation by using the Data of the Korea Youth Risk Behavior Web-based Survey through from 2008 to 2014

Purpose:This studyaims toinvestigatetheassociationbetweensuicidal thoughts and theco-occurrenceof alco- hol, tobacco, and drug use among adolescents. Methods: This study used the data of the Korea Youth Risk BehaviorWeb-basedSurveyfrom2008through2014. Thesubjects of this studywere 517,866students, intotal (Male266,500,Female251,366). Frequencyanalysiswasconductedonthedataaboutthesubjects'general char- acteristics and their experience of smoking, drinking, and drug use. The relationship between suicidal thoughts and the co-occurrence of alcohol, tobacco, and drug use was analyzed through x 2 -test and logistic regression. TheanalysesweredoneusingSAS9.4.Results:Accordingtothestudy,adolescentswhousedalcohol, cigarettes, and drugs at the same time engaged in suicidal ideation 3.69 times more than their peers who didn't use such substances(95%CI:3.40~4.00,p<.001). Also,adolescentswhoused onlytobacco, onlyalcohol,andonlydrugs engaged in suicidal ideation 1.49 times (95% CI: 1.43~1.56, p<.001), 1.28 times (95% CI: 1.26~1.31, p<.001) and2.34times(95%CI: 2.04~2.69, p<.001) morethanthe students whodidn't use anysubstances, respectively. Conclusion:Adolescents' suicidal ideationandtheco-occurrenceof alcohol, tobacco, anddruguse hadastatisti- cally significant relationship.

Co-Occurrence of Substance-Related and Other Mental Health Disorders Among Adolescent Cannabis Users.

Cannabis is the most commonly used illicit substance in the United States and is increasingly being legalized throughout the United States. Many believe that cannabis is relatively harmless, and some believe that cannabis is not addictive. We wondered what the rates of cannabis abuse and dependence might be among adolescents referred for substance use evaluations and also about the incidence of co-occurring psychiatric illnesses and substance use disorders among those individuals. Herein, we analyze intake data from 483 adolescents referred for evaluation at an adolescent substance abuse clinic, with information gleaned from the adolescents and their parents or caregivers. Forty-seven percent of our sample met the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) criteria for cannabis dependence and another 32% for cannabis abuse. Among adolescents with cannabis use disorders, the co-occurrence of alcohol and opioid abuse or dependence was high. These individuals also suffered from significant psychiatric comorbidities otherwise. Our results show that cannabis use carries the risk of dependence and also carries with it significant risk of comorbidities, both with respect to other substance use disorders and other psychiatric illness. Given the growing body of research linking cannabis use with addiction and other psychiatric illness, public health efforts ought to center on the potential dangers of cannabis use.

Co-occurrence of alcohol, drug use, DSM-5 alcohol use disorder, and symptoms of drug use disorder on both sides of the U.S.-Mexico border.

The U.S.-Mexico border displays elevated rates of hazardous alcohol and drug use. Whether the co-occurrence of alcohol and drug use and disorders is also high in the border area is unknown. Data are from the U.S.-Mexico Study on Alcohol and Related Conditions, a cross-sectional survey of randomly selected respondents interviewed from 2011 to 2013. Participants included 1,690 Mexican Americans from Texas (572 in an off-border city and 1,118 from 3 border cities) and 1,293 Mexicans from Nuevo Leon and Tamaulipas (415 in an off-border city and 878 from 3 Mexican cities bordering Texas) who reported drinking in the last 12months. Participants were interviewed regarding the prevalence of and risk factors for: (i) co-occurring hazardous alcohol use (5+/4+ at least monthly) and drug use (medical and illicit) and (ii) co-occurring presence of a DSM-5 alcohol use disorder (AUD) and 2 symptoms (hazardous use and quit/control) of drug use disorder (DUD symptoms). Co-occurring hazardous alcohol and drug use was more common in the U.S. border cities (14.7%) than off-border (7.2%), but similar for Mexican border (1.2%) and off-border (1.4%) cities. Co-occurrence of AUD and DUD symptoms was likewise more common at the U.S. border (6.8%) than off-border (3.3%), as well as at the Mexican border (1.3%), compared to off-border (0.6%), but not statistically significant for Mexico. In models adjusting for demographics, mobility factors and exposure to the U.S. culture, border residence in both countries related to a nearly twofold increase in prevalence ratios (PRs) of co-occurring AUD and DUD symptoms (PR=1.97, 95% CI=1.36 to 2.85). Increased rates of co-occurring AUDs and DUDs suggest an added negative impact on already difficult conditions of the border population.

Decline in Genetic Influence on the Co-Occurrence of Alcohol, Marijuana, and Nicotine Dependence Symptoms From Age 14 to 29

Cross-sectional studies have demonstrated high rates of comorbidity among substance use disorders. However, few studies have examined the developmental course of incident comorbidity and how it changes from adolescence to adulthood. The authors examine patterns of comorbidity among substance use disorders to gain insight into the effect of shared versus specific etiological influences on measures of substance abuse and dependence. The authors evaluated the pattern of correlations among nicotine, alcohol, and marijuana abuse and dependence symptom counts as well as their underlying genetic and environmental influences in a community-representative twin sample (N=3,762). Symptoms were assessed at ages 11, 14, 17, 20, 24, and 29 years. A single common factor was used to model the correlations among symptom counts at each age. The authors examined age-related changes in the influence of this general factor by testing for differences in the mean factor loading across time. Mean levels of abuse or dependence symptoms increased throughout adolescence, peaked around age 20, and declined from age 24 to age 29. The influence of the general factor was highest at ages 14 and 17, but decreased from age 17 to age 24. Genetic influences of the general factor declined considerably with age alongside an increase in nonshared environmental influences. Adolescent substance abuse or dependence is largely a function of shared etiology. As young people age, their symptoms are increasingly influenced by substance-specific etiological factors. Heritability analyses revealed that the generalized risk is primarily influenced by genetic factors in adolescence, but nonshared environmental influences increase in importance as substance dependence becomes more specialized in adulthood.

Amitifadine, a triple monoamine uptake inhibitor, reduces binge drinking and negative affect in an animal model of co-occurring alcoholism and depression symptomatology

The co-occurrence of alcoholism and depression is highly prevalent and difficult to treat. In an animal model of binge drinking that exhibits abstinence-induced behaviors reminiscent of negative affective states, the triple monoamine uptake inhibitor, amitifadine, produced a selective, dose dependent attenuation of binge drinking. Amitifadine also reversed abstinence-induced increases in the intracranial self-stimulation threshold, a model of anhedonia, and immobility in the forced swim test, reflecting behavioral despair. In view of the safety profile of amitifadine in humans, including low risk for weight gain, lack of sexual side effects, and low potential for abuse, we hypothesize that amitifadine will be effective in treating co-occurring alcoholism and depression.

The impact of co-morbid alcohol use disorder in bipolar patients

Alcohol use is highly prevalent in patients with bipolar disorder (BD) and is associated with significant mortality and morbidity. The detrimental effects of each condition are compounded by the presence of the other. The objective of this study was to examine the impact of alcohol abuse and of alcohol dependence in BD in a Brazilian sample, as indicated by clinical severity, functional impairment, and quality of life (QOL). A cross-sectional survey of 186 bipolar outpatients were interviewed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders—4th Edition. The primary outcome measures were functioning, as indicated by the Global Assessment of Functioning Scale scores and QOL, as indicated by the World Health Organization Quality of Life Instrument. Secondary outcomes were clinical severity features. Alcohol abuse and dependence were associated with male gender, lower education, earlier age of onset, psychosis within first episode, depressive symptoms, and worse functioning. In addition, the presence of alcohol abuse or dependence was associated with remarkably high rates of suicide attempt. Our findings suggest that the co-occurrence of alcohol abuse/dependence with BD increases the risk for suicide attempt, which may reflect in part the greater severity of symptoms and impaired functioning. This subgroup of bipolar patients requires a treatment tailored to address both conditions.

The Genetic Components of Alcohol and Nicotine Co-Addiction: From Genes to Behavior

Co-occurrence of alcohol and nicotine addiction in humans is well documented and there is good evidence that common genes may contribute to both disorders. Although genetic factors contributing to tobacco and alcohol problem use have been well established through adoption, twin and family studies, specific genes remain to be identified and their mode of action elucidated. Recent work from human genetics studies has provided evidence that neuronal nicotinic acetylcholine receptors (nAChR) genes may have a role in mediating early behaviors that are risk factors for alcohol and nicotine dependence, such as age of initiation and early subjective responses to the drugs. Converging evidence suggests that the dopaminergic system is likely to be important in mediating the pleasurable feelings of reward when activated by nicotine and/or alcohol consumption. The nAChRs are important components of the dopaminergic reward system because some of the receptors have been shown to activate the release of dopamine, and mice lacking genes for specific nAChR gene subunits show altered behavioral responses to nicotine and alcohol. Furthermore, complex interactions between other neurotransmitter circuits including GABA, glutamate and serotonin may be modulated by nAChRs, leading researchers to study genes involved in neurobiology shared by different drugs. Future studies aimed at understanding the variation among these genes, and their corresponding functional implications, will help elucidate how natural variants in nicotinic receptor genes contribute to these common co-morbid disorders.

The role of conduct disorder in explaining the comorbidity between alcohol and illicit drug dependence in adolescence

Background Conduct disorder (CD), alcohol dependence (AD), and illicit drug dependence (IDD) frequently co-occur. This paper describes the result of an investigation of the extent to which comorbid alcohol and illicit drug dependence in adolescents are explained by etiological factors in common with conduct disorder. Methods Participants were 645 MZ twin pairs, 702 DZ twin pairs, 429 biological sibling pairs, and 96 adoptive sibling pairs, aged 12–18 years, from a community based sample. Conduct disorder was measured using the Diagnostic Interview Schedule for Children-IV. Alcohol and illicit drug dependence were assessed using the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). For each outcome, subjects were categorized into those with no symptoms, those with one or more symptoms but no diagnosis, and those with a diagnosis. Results The heritability estimates for CD, AD, and IDD were 58, 66, and 36%, respectively. The genetic correlation between AD and IDD was partially explained by the genetic risk they both share with conduct disorder. Conclusions We conclude that conduct disorder in adolescents explains, in part, the co-occurrence of alcohol and illicit drug dependence. Specifically, the genetic contribution to their covariation is explained partially by the genetic contribution in common with conduct disorder.

Co-occurrence of alcohol and cigarette use among adolescents.

Concurrent use of alcohol and cigarettes among adolescents is a serious public health issue. Trends in concurrent use of alcohol and cigarettes were determined using data from three comparable large statewide samples of 7-12th-grade students in New York State, from surveys conducted in 1983, 1990, and 1994. The prevalence of use of alcohol and cigarettes decreased from 1983 (23%) to 1990 (19%), and increased by 1994 (22%). Logistic regression analysis showed that these trends are highly significant, and that the probability of use of alcohol and cigarettes is higher for females than males, increases with age, and is lower for most ethnic minorities than for Whites. In the 1990s, Blacks, Hispanics, and Asians increased in their probability of concurrent use more than did Whites. Users of both alcohol and cigarettes are at increased risk of personal and social problems, as well as increased risk of delinquency. Drinking and smoking show synergistic effects on illicit drug use and drug problems.

Alcohol and Eating Disorders: Implications for Alcohol Treatment and Health Services Research

This paper focuses on the co-occurrence of alcoholism and eating disorders and the clinical implications for treating this comorbidity in women with alcohol use disorders. There is substantial literature that supports higher than expected rates of co-occurrence of these two disorders. In addition, there is evidence that the co-occurrence of alcoholism and eating disorders is more likely to occur in the presence of other psychiatric disorders. A critical analysis of the studies on the comorbidity of these disorders is conducted along with a review of the possible etiologic association between the two disorders. Crucial questions related to pharmacological and behavioral treatments for this subgroup of alcoholic women with eating disorders are raised from a health services research perspective. There is substantial evidence that alcoholism and eating disorders co-occur at high rates. However, as this review points out, several important research questions remain regarding both the clinical manifestations of each problem in women who are comorbid for both disorders and the treatment implications.

Alcohol and Eating Disorders: Implications for Alcohol Treatment and Health Services Research

Background: This paper focuses on the co-occurrence of alcoholism and eating disorders and the clinical implications for treating this comorbidity in women with alcohol use disorders. There is substantial literature that supports higher than expected rates of co-occurrence of these two disorders. In addition, there is evidence that the co-occurrence of alcoholism and eating disorders is more likely to occur in the presence of other psychiatric disorders. A critical analysis of the studies on the comorbidity of these disorders is conducted along with a review of the possible etiologic association between the two disorders. Crucial questions related to pharmacological and behavioral treatments for this subgroup of alcoholic women with eating disorders are raised from a health services research perspective. Conclusions: There is substantial evidence that alcoholism and eating disorders co-occur at high rates. However, as this review points out, several important research questions remain regarding both the clinical manifestations of each problem in women who are comorbid for both disorders and the treatment implications.

Co-occurrence of alcohol, smokeless tobacco, cigarette, and illicit drug use by lower ranking military personnel

The Worldwide Survey of Health Related Behaviors is administered periodically to a probability sample of military personnel. Earlier reports of these surveys suggested that illicit drug use was highest among the lowest ranking personnel. This paper reports a secondary analysis of the 1992 and 1995 surveys of the lowest ranking personnel. The results suggested that in general illicit drug users tended also to use alcohol, smokeless tobacco, and cigarettes. Heavy drinkers were more likely than light drinkers to use illicit drugs. No such relationship was observed between illicit drug use and the level of use of cigarettes or smokeless tobacco. Moreover, among the heavy drinkers, illicit drug users were especially likely to use cigarettes and among males, smokeless tobacco. The relevance of these results to military policies toward illicit drug use is discussed.

Detecting alcohol use disorders in the severely mentally ill.

The frequent co-occurrence of alcoholism with serious mental illnesses ("dual diagnosis") necessitates that clinicians are able to recognize its presence in people with disabling mental illnesses. This study demonstrates that professionals often miss the diagnosis, but that their ability to detect alcoholism can be greatly enhanced by the use of a simple screening tool. Members of an urban psychosocial rehabilitation program who received psychiatric treatment in an affiliated outpatient clinic were interviewed after their clinic therapists and rehabilitation counselors had been asked questions pertaining to their general health and substance use. The members were interviewed with two screening tests, the CAGE and the SMAST, and a clinical DSM-III-R diagnosis of alcohol use disorder was established. Both the SMAST and CAGE had good sensitivity and the addition of a screener enhanced the clinicians' ability to detect alcohol use disorders.

A model of AA utilization by persons with a dual diagnosis (the co-occurrence of alcoholism and severe mental illness)

A model of AA utilization by persons with a dual diagnosis (the co-occurrence of alcoholism and severe mental illness)