National Institute Of Alcohol Abuse And Alcoholism Research Articles

Relationship of negative emotionality, NIAAA recovery, and 3- and 6-month drinking outcomes among adults in treatment for alcohol use disorder

BackgroundThe National Institute of Alcohol Abuse and Alcoholism (NIAAA) recently released a new definition of recovery from alcohol use disorder (AUD). A patient is considered recovered if they are remitted from DSM-5 AUD and report cessation of heavy drinking. The NIAAA has also recently proposed the Addictions Neuroclinical Assessment (ANA) to guide treatment research. Negative emotionality is one of three domains of the ANA and theory proposes that AUD is maintained by negative reinforcement via the relief of negative affect. The purpose of the current study was to examine: (1) the relationship of end-of-treatment negative emotionality and NIAAA recovery, and (2) the ability of NIAAA recovery at the end of treatment to predict three- and six-month drinking outcomes. MethodAt baseline and end-of-treatment, women and men (n = 181) in treatment for AUD completed measures of negative emotionality, drinking, and were assessed for DSM-5 AUD diagnostic criteria. At three- and six-months post-treatment, drinking was re-assessed. Results22.5% (n = 24) of participants met full criteria for NIAAA recovery at end-of-treatment. Lower levels of end of treatment negative emotionality were associated with increased odds of achieving NIAAA recovery. Meeting NIAAA recovery predicted greater percent days abstinent (PDA) and lower percent heavy drinking days (PHDD) at 3-months, but not at 6-months post-treatment. ConclusionsThis study is among the first to report a relationship between the negative emotionality domain of the ANA and NIAAA recovery. Results underscore the importance of addressing negative emotionality in treatment. Findings also suggest that NIAAA recovery predicts positive short term drinking outcomes.

Moderate Alcohol Consumption and Lipoprotein Subfractions: A Systematic Review of Intervention and Observational Studies

<h3>Lead Author's Financial Disclosures</h3> T.W. has received a Ph.D. scholarship partly sponsored by Carlsberg Foundation Semper Ardens grant Remaining Ph.D. scholarship sponsored by National Institute of Alcohol Abuse and Alcoholism (NIAAA). <h3>Study Funding</h3> Ph.D. scholarship sponsored in part by a Carlsberg Foundation Semper Ardens grant on biomarkers to L.O.D., and in part by National Institute of Alcohol Abuse and Alcoholism [grant number U10AA025286 to L.O.D.]. <h3>Background/Synopsis</h3> Moderate alcohol consumption is associated with decreased risk of cardiovascular disease and improvement in cardiovascular risk markers, including lipoproteins1, 2, and lipoprotein subfractions. Changes in lipoprotein subclasses could mediate the potential beneficial effects of moderate drinking on cardiovascular health. <h3>Objective/Purpose</h3> This study aimed to systematically review the relationship between moderate alcohol intake, lipoprotein subfractions, and related mechanisms. Secondarily, to investigate whether results differed by study design and subject health status. <h3>Methods</h3> The review followed the PRISMA guidelines. Studies with alcohol intake at doses up to 60 g/d were included from nine scientific databases. Lipoprotein subfractions and related mechanisms were examined. Eligible studies were human and ex vivo studies in all kinds of study designs, populations, and publication years. The last search was performed in March 2021, and clinicaltrials.gov was screened for unpublished literature. Risk of bias was assessed with The Cochrane Collaboration tool for assessing the risk of bias, The Risk of Bias Assessment tool for non-randomized Studies, and The JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. <h3>Results</h3> We included 37 intervention trials and 77 observational studies with a total of 20,510 and 104,773 participants, respectively. Most intervention studies provided an alcohol dose between 20 to 40 g per day. Alcohol intake was positively related to all HDL subfractions measured, independent of study design. Studies on the effects of alcohol on LDL and VLDL subfractions were limited, especially intervention studies. However, some studies of varying design found lower levels of small LDL particles, increased LDL particle size, and complex, non-linear relationships to apoB-containing particles. Hypothesis generating results on the associations of alcohol with lipoprotein subfractions defined by the content of the pro-atherogenic apoC-III were also identified. As for the mechanisms investigated, cholesterol efflux capacity and paraoxonase activity were consistently increased. Most studies included healthy subjects or populations of mixed health status. Several studies were graded to have unclear or high risk of bias, and heterogeneous laboratory methods restricted comparability between studies. <h3>Conclusions</h3> Alcohol intake in doses up to 60 g/day can cause changes in lipoprotein subfractions, such as increased HDL subfractions and decreased smaller LDL particles, which may relate to cardiovascular health. Future studies should investigate effects on apoB-containing lipoproteins and novel biomarkers such as HDL subfractions defined by apolipoproteins like apoC-III. This review is registered at http://www.crd.york.ac.uk/prospero/, no.: 98955.

The Critical Lack of Data on Alcohol and Marijuana Use by Adolescents on the Autism Spectrum.

Why is this topic important?: Alcohol is the most commonly used substance among adolescents, and marijuana is the most commonly used illicit drug. Previous studies suggest that at least some autistic individuals may be at increased risk of substance use disorder compared with allistic counterparts, potentially to control social anxiety or facilitate social interaction. However, to the best of our knowledge, estimates of substance use by autistic youth in the United States are limited.What is the purpose of this article?: This study was performed to highlight the lack of data sets that collect information about alcohol and/or marijuana use by autistic youth in the United States. We systematically reviewed U.S. data sources on child and/or adolescent health, disability, and/or substance use to identify sources that could generate estimates of the prevalence of substance use among autistic adolescents in the United States, even if those estimates may not be stable due to small sample sizes or other methodological weaknesses.What is the perspective of the authors?: The authors are a team of allistic researchers. M.B.-M. and S.B.-F. are pediatricians. E.F.R. and A.A. are public health researchers. S.B.-F. has an extensive background in providing clinical health care services to children with autism and is an autism researcher. R.A.N.P. and A.C.S.-R. are master's level public health research assistants. E.F.R., A.A., and M.B.-M. are adolescent health research experts. E.F.R. has an adolescent daughter on the autism spectrum. Our collective positionality is that we identify as people who are not autistic and who select to focus on research that we hope will benefit autistic people and society in general.What did the authors find?: Based on our four-step investigation, we identified 19 U.S. data sources that had the potential to generate estimates of the prevalence of alcohol and/or marijuana use in autistic youth. Only one included information about both autism and substance use.What do the authors recommend?: The National Institutes of Health (NIH), and the National Institute of Alcohol Abuse and Alcoholism (NIAAA) and National Institute of Drug Abuse (NIDA), specifically, should prioritize funding data collection from autistic youth and adults on alcohol and marijuana use, misuse, hazardous use, dependence, and use disorders. In addition, it is critical that nationally representative surveys and data sources include robust questions on autism and substance abuse. This includes assessing autism status in multiple ways (e.g., self-report, diagnosis by a clinician, neuropsychology reports). Substance use questions should include age of first drink or use, frequency of use, quantity of use per day or within a certain number of hours, expectancies, consequences of use, and indicators of alcohol use disorder.How will these recommendations help autistic individuals?: These findings highlight a critical gap in the literature on substance use among autistic youth. Substance use is recognized as a pressing adolescent health problem, and autistic youth deserve evidence-based substance use prevention strategies. Without an estimate of substance use by autistic youth, it is difficult to justify to funding entities the expenditure of resources on the development of evidence-based substance use prevention strategies to benefit them.

Screening for Adolescent Alcohol Use in the Emergency Department: What Does It Tell Us About Cannabis, Tobacco, and Other Drug Use?

Background: The pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse. Objective: A multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs. Methods: Participants included 12–17-year olds (n = 4834) treated in one of 16 participating PEDs. An assessment battery, including the NIAAA two-question screen and other measures of alcohol, tobacco and drug use, was self-administered on a tablet computer. Results: A diagnosis of CUD, lifetime tobacco use or lifetime drug use was predicted by any self-reported alcohol use in the past year, which indicates a classification of moderate risk for middle school ages and low risk for high school ages on the NIAAA two-question screen. Drinking was most strongly predictive of a CUD, somewhat weaker for lifetime tobacco use, and weakest for lifetime drug use. This same pattern held for high school and middle school students and was stronger for high school students over middle school students for all three categories. This association was also found across gender, ethnicity and race. The association was strongest for CUD for high school students, sensitivity 81.7% (95% CI, 77.0, 86.5) and specificity 70.4% (95% CI, 68.6, 72.1). Conclusions/Importance: A single question about past year alcohol use can provide valuable information about other substance use, particularly marijuana.

Lorcaserin decreases the reinforcing effects of 3,4‐methylenedioxypyrovalerone (MDPV) and cocaine in Sprague‐Dawley rats

Lorcaserin is a serotonin (5‐HT) 2C receptor‐preferring agonist that is currently approved by the Food and Drug Administration to treat obesity; however, its behavioral effects are also mediated by 5‐HT 2A and 1A receptors. Agonists acting at 5‐HT2C receptors are known to dampen dopamine neurotransmission, an effect that could be beneficial for treating drug abuse. 3,4‐Methylenedioxypyrovalerone (MDPV) is a cocaine‐like monoamine reuptake inhibitor that is commonly found in abused bath salt preparations. Recent studies have demonstrated lorcaserin decreases the reinforcing effects of cocaine in rats and monkeys, and the present study aimed to: (1) determine whether lorcaserin was equally effective at decreasing the reinforcing effects of MDPV and cocaine; and (2) determine the receptor(s) responsible for the effects of lorcaserin on cocaine and MDPV self‐administration. Male Sprague‐Dawley rats (n=6) were injected with lorcaserin (0.1–5.6 mg/kg, IP) 25 minutes before the initiation of MDPV or cocaine self‐administration sessions. Lorcaserin was equipotent at suppressing responding for MDPV and cocaine; however, individual differences in sensitivity to lorcaserin were observed. To determine which receptor mediated the effects of lorcaserin, rats were administered 5‐HT1A (WAY100635, 0.178 mg/kg), 5‐HT2A (MDL100907, 0.1 mg/kg), or 5‐HT2C (SB242084, 0.1 mg/kg) receptor antagonists (IP) 15 minutes prior to lorcaserin treatment. Antagonism of 5‐HT2C (but not 5‐HT1A or 5‐HT2A) receptors reversed the effects of lorcaserin on MDPV and cocaine self‐administration. Taken together, these data indicate lorcaserin may be an effective pharmacotherapy against MDPV and cocaine abuse through its agonist actions at 5‐HT2C receptors.Support or Funding InformationThis research was supported by the National Institutes of Health (NIH) and the National Institute on Drug Abuse (NIDA) R01DA039146 (GTC) and T32DA031115 and the NIH Intramural Research Programs of the NIDA and the National Institute of Alcohol Abuse and Alcoholism (NIAAA) (KCR).

Reliability and Validity of a Two-Question Alcohol Screen in the Pediatric Emergency Department.

A multisite study was conducted to determine the psychometric properties of the National Institute of Alcohol Abuse and Alcoholism (NIAAA) 2-question alcohol screen within pediatric emergency departments (PEDs). Participants (N = 4838) included 12- to 17-year-old subjects treated in 1 of the 16 participating PEDs across the United States. A criterion assessment battery (including the NIAAA 2-question alcohol screen and other measures of alcohol, drug use, and risk behaviors) was self-administered on a tablet computer. A subsample (n = 186) was re-administered the NIAAA 2-question screen 1 week later to assess test-retest reliability. Moderate to good test-retest reliability was demonstrated. A classification of moderate risk or higher on the screen had the best combined sensitivity and specificity for determining a diagnosis of alcohol use disorder (AUD) for all students. Any past year drinking among middle school students increased the odds of a diagnosis of an AUD according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, whereas the optimal cutoff for high school ages was ≥3 drinking days in the past year. The optimal cutoff for drinking days determining a positive Alcohol Use Disorders Identification Test score among middle school subjects was ≥1 drinking day, whereas the optimal cutoff for high school subjects was ≥2 drinking days. The NIAAA 2-question screen is a brief, valid approach for alcohol screening in PEDs. A positive screen suggests that referral for further evaluation is indicated to determine if an adolescent has an AUD.

Screening for at-risk drinking behavior in trauma patients.

A blood alcohol level above 0 g/dL is found in up to 50% of patients presenting with traumatic injuries. The presence of alcohol in the blood not only increases the risk of traumatic injury, but it is also associated with worse outcomes and trauma recidivism. In light of these risks, the American College of Surgeons Committee on Trauma advocates screening for at-risk drinking. Although many institutions use blood alcohol levels to determine at-risk drinking in trauma patients, the Alcohol Use Disorders Identification Test (AUDIT) offers a cheap and easy alternative. Few direct comparisons have been made between these 2 tests in trauma patients. To compare the utility of blood alcohol level and AUDIT score as indicators of at-risk drinking in trauma patients. Records for all trauma patients aged 18 years or older who were admitted to a level I trauma center from May 2013 through June 2014 were reviewed in this retrospective cohort study. Inclusion criteria required patients to have undergone both blood alcohol level testing and AUDIT on admission. A blood alcohol level greater than 0 g/dL and an AUDIT score equal to or above 8 were considered positive for at-risk drinking. Performance of both tests was indexed against the National Institute of Alcohol Abuse and Alcoholism (NIAAA) criteria for at-risk drinking. Of 750 patients admitted for trauma, 222 records (30%) contained data on both blood alcohol level and AUDIT score. The patients were predominantly male (178 [80%]) and had a mean (SD) age of 40.1 (16.7) years. Most patients (178 [80%]) had sustained blunt trauma. Ninety-seven patients (44%) had a positive blood alcohol level, 70 (35%) had a positive AUDIT score, and 54 (24%) met NIAAA criteria for at-risk drinking. The sensitivity and specificity of having a positive blood alcohol level identify at-risk drinking were 61% and 62%, respectively. The sensitivity and specificity of having a positive AUDIT score identify at-risk drinking were 83% and 81%, respectively. As a stand-alone indicator of at-risk drinking behavior in trauma patients, the AUDIT score was shown to be superior to blood alcohol level. The utility of obtaining routine blood alcohol levels in trauma patients as a screening tool for at-risk drinking should be reexamined.

122. Transitions to Parenthood: Maternal Adjustment Sexually Transmitted Infection Risk Among Young African American Mothers

Purpose: Studies show high rates of sexually transmitted infections (STIs) among adolescent mothers. Although the transition to parenthood may be particularly difficult for adolescents, few studies have examined maternal adjustment in relation to STI risk among young mothers. The purpose of this study was to examine associations between parenting self-efficacy and parenting satisfaction and STI risk among young African American mothers. Methods: The analytic sample included 140 mothers participating in an HIV/STI prevention trial for young African American women (18-24 years) who use alcohol. Prior to randomization, participants provided baseline data via audio computer-assisted self-interviews and vaginal swab specimens assayed for Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae using DNA amplification. Parenting self-efficacy was measured using a 7-item scale, with higher scores indicating greater self-efficacy. Parenting satisfaction was measured using a 6-item scale, with higher scores indicating greater satisfaction. Unadjusted and adjusted logistic models examined associations between parenting self-efficacy and parenting satisfaction and sexual risk behavior in the past 3months (had multiple sexual partners; traded sex drugs, money, food, or a place to stay; drank alcohol prior to sex) and STI prevalence. Adjusted models controlled for mother’s age at first child’s birth ( 17 years, 18-19 years, 20-24 years), age of her youngest child (years), and depressive symptomology, as measured by the 8-item Center for Epidemiologic Studies Depression Scale (CES-D). Results: Themajority of the sample, 55% (n1⁄477), reported drinking alcohol 2-4 timespermonth or less. Age atfirst child’s birthwas<18 for 32% (n1⁄445) and 18-19 for 39% (n1⁄455). Age of the youngest child was<1 year for 31% (n1⁄444) and 1-2 years for 40% (n1⁄457). Each unit increase in parenting satisfaction score was associated with a significantly decreased likelihood of being infectedwith T. vaginalis (AOR: 0.94, 95% CI:0.88, 1.00, p1⁄40.041). No other measures of maternal adjustment were significantly associated with the outcomes examined. Conclusions: Greater parenting satisfaction was associated with reduced T. vaginalis prevalence among young African American mothers. Additional research on factors associated with parenting satisfaction and the nature of relationships between parenting satisfaction and STI risk among adolescent and young adult mothers may be useful for improving the health of young mothers and their families. Sources of Support: This work was supported by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) grant number 5R01AA018096 to the senior author. Andrea Swartzendruber was supported by NIAAA grant number F32 AA022058. Jessica M. Sales was supported by the National Institute of Mental Health grant number K01 MH085506.

Nancy Kishlar Mello.

Nancy Kishlar Mello.

The Prevalence of Harmful and Hazardous Alcohol Consumption in Older U.S. Adults: Data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES)

Alcohol consumption and its interaction with disease, medication use, and functional status may result in serious health problems, but little information exists about the national prevalence of alcohol-related health risk in older adults. To estimate the prevalence of harmful and hazardous alcohol use and the prevalence of consumption in excess of National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommendations, in people aged 65 and older, and by sex and race/ethnicity sub-group. Cross-sectional, using data from the 2005-2008 National Health and Nutrition Examination Survey of the non-institutionalized U.S. population. One thousand and eighty-three respondents aged 65 and older who consume alcohol. Participants' alcohol consumption was classified as Harmful, Hazardous, or Healthwise, in the context of their specific health status, using the Alcohol-Related Problems Survey classification algorithm. Overall, 14.5 % of older drinkers (95 % CI: 12.1 %, 16.8 %) consumed alcohol above the NIAAA's recommended limits. However, when health status was taken into account, 37.4 % of older drinkers (95 % CI: 34.9 %, 40.0 %) had Harmful consumption and 53.3 % (95 % CI: 50.1 %, 56.6 %) had either Hazardous or Harmful consumption. Among light/moderate drinkers, the proportions were 17.7 % (95 % CI: 14.7 %, 20.7 %) and 28.0 % (95 % CI: 24.8 %, 31.1 %), respectively. Male drinkers had significantly greater odds of Hazardous/Harmful consumption than female drinkers (OR = 2.14 [95 % CI: 1.77, 2.6]). Black drinkers had worse health status and significantly greater odds of Hazardous/Harmful consumption than white drinkers (OR = 1.49; 95 % CI: 1.02, 2.17), despite having no greater prevalence of drinking in excess of NIAAA-recommended limits. Most older Americans who drink are light/moderate drinkers, yet substantial proportions of such drinkers drink in a manner that is either harmful or hazardous to their health. Older adults with risky alcohol consumption are unlikely to be identified by health care providers if clinicians rely solely on whether patient consumption exceeds the NIAAA-recommended limits.

The Impact of Screening, Brief Intervention and Referral for Treatment in Emergency Department Patients' Alcohol Use: A 3-, 6- and 12-month Follow-up

Aims: This study aims to determine the impact of Screening, Brief Intervention and Referral for Treatment (SBIRT) in reducing alcohol consumption in emergency department (ED) patients at 3, 6, and 12 months following exposure to the intervention. Methods: Patients drinking above the low-risk limits (at-risk to dependence), as defined by National Institute of Alcohol Abuse and Alcoholism (NIAAA), were recruited from 14 sites nationwide from April to August 2004. A quasi-experimental comparison group design included sequential recruitment of intervention and control patients at each site. Control patients received a written handout. The Intervention group received the handout and participated in a brief negotiated interview with direct referral for treatment if indi- cated. Follow-up surveys were conducted at 3, 6, and 12 months by telephone using an Interactive Voice Response (IVR) system. Results: Of the 1132 eligible patients consented and enrolled (581 control, 551 intervention), 699 (63%), 575 (52%) and 433 (38%) completed follow-up surveys via IVR at 3, 6, and 12 months, respectively. Regression analysis adjusting for the clustered sampling design and using multiple imputation procedures to account for subject attrition revealed that those receiving SBIRT reported roughly three drinks less per week than controls (B=�3.00, SE = 1.06, P< 0.05) and the level of maximum drinks per occasion was approximately three-fourths of a drink less than controls (B= -0.76, SE = 0.29, P< 0.05) at 3 months. At 6 and 12 months post-inter- vention, these effects had weakened considerably and were no longer statistically or substantively significant. Conclusion: SBIRT delivered by ED providers appears to have short-term effectiveness in reducing at-risk drinking, but multi-contact interventions or booster programs may be necessary to maintain long-term reductions in risky drinking.

Preventing and Reducing Underage Drinking

In 2007, former Acting Surgeon General RADM Ken neth Moritsugu released The Surgeon Generals Call to Action to Prevent and Reduce Underage Drinking1 to let the American people know about the nature and extent of underage drinking and its consequences, defined in this article as alcohol consumption by people younger than the minimum legal drinking age of 21. Dr. Moritsugu also wanted to alert the public to recent scientific evi dence indicating that the developing adolescent brain might be particularly susceptible to long-term negative consequences from alcohol use. He also focused on emerging developmental research that explains why adolescents use alcohol differently from adults, why they react uniquely to it, and why alcohol can pose such a powerful attraction to them with unpredictable and potentially devastating outcomes. Following publication of the report, my office has worked closely with the spouses of governors who are members of the Leadership to Keep Children Alcohol Free, the National Institute of Alcohol Abuse and Alcoholism (NIAAA), and the Substance Abuse and Mental Health Services Administration (SAMHSA) to encourage states and communities across the country to work together to prevent and reduce underage drinking. As part of this effort, I have visited 13 states and helped to launch town hall meetings in more than 1,800 communities in all 50 states. My colleagues and I have undertaken this educational effort because under

Prevalence and predictors of research participant eligibility criteria in alcohol treatment outcome studies, 1970–98

To describe the eligibility criteria (i.e. study participant inclusion and exclusion rules) employed in alcohol treatment outcome research and to identify predictors of their use. The eligibility criteria of 683 alcohol treatment outcome studies conducted between 1970 and 1998 were coded reliably into 14 general categories. Predictors of the use of eligibility criteria were then examined. Patients were most often ruled ineligible for research studies because of their level of alcohol problems (39.1% of studies), comorbid psychiatric problems (37.8%), past or concurrent utilization of alcohol treatment (31.8%), co-occurring medical conditions (31.6%), and because they were deemed non-compliant and unmotivated (31.5%). The number of eligibility criteria employed in studies increased from the 1970s through the 1990s, and was positively associated with funding from the US National Institute of Alcohol Abuse and Alcoholism (NIAAA) and from the private sector, lack of an inpatient/residential treatment condition, presence of a pharmacotherapy, and use of a randomized, multiple-condition design. Principal investigators with doctoral degrees used more eligibility criteria than those with lower degrees. Participant eligibility criteria are extensively employed in alcohol treatment outcome research, and vary significantly across historical periods, funders and research designs. Researchers should report the details of subject eligibility criteria and excluded patients more fully, and, evaluate how eligibility criteria affect the cost, feasibility, and generalizability of treatment outcome research.

Research Examining Impacts of Attempts to Change Patterns of Alcohol Consumption and Related Behaviors

An issue of considerable concern in American society has been that of problems resulting from alcohol consumption. Our research during the past few years has focused on attempting to understand this phenomenon and how it relates to other behavior patterns. Specifically, we have been involved in research evaluating consequences of laws and programs designed to impact drinking behaviors. In addition to these practical policy concerns, we have also focused on testing implications of neutralization and deterrence theories as sociological explanations for the domain of alcohol use and abuse. Methodologically we have focused on self-administered questionnaire formats in longitudinal designs in order to be able to examine subjects and variables over time. We have also been interested in examining response differences among student-nonstudent populations, variations in drinking patterns among racial and ethnic groups, and response differences that might occur as a result of changes in item wording on questionnaires. During the early 1970s a trend developed in the U.S. to lower the minimum drinking age. In subsequent years, increases in accident rates among young drivers were reported, and some states then began to raise the minimum drinking age. Research seeking to understand the relationship between the drinking age and alcohol related behaviors, including accident rates, however, has produced inconsistent results (cf. Hanson, Engs, and Katter 1984; Rooney and Schwartz 1977; Williams, Rich, Zador, and Robertson 1975; Naor and Nashold, 1975). In September of 1983, the Oklahoma legislature joined those states changing the drinking age by passing a bill to raise the minimum drinking age for 3.2 beer from 18 to 21 (the minimum age for wine and distilled spirits was already 21). A three-year grant was obtained from The National Institute of Alcohol Abuse and Alcoholism (NIAAA) to examine alcohol consumption and related behavior patterns among Oklahoma State University students, both before and after implementation of the new law. The research focused on changes in drinking patterns that occurred both over time and in relation to baseline data collected in 1981. Questionnaires were completed by students in randomly selected Introductory Sociology classes at Oklahoma State University just prior to implementation of the legislation (September 1983); and the same methodology was repeated each semester through the spring of 1987. A total

Government publications in the medical sciences

Over the past twenty-five years an increasing understanding of the relationship of mental health to the development, course and outcome of physical illness and a heightened awareness of the extent of psychiatric disorder and emotional distress in the population has resulted in a growth in lay-public and professional interest in these areas. The federal government is responsible for publishing a variety of information resources in mental health. The National Mental Health Act of 1946 established the National Institute of Mental Health (NIMH) to provide a focus for research efforts in mental health and psychiatric illness. Although the NIMH is an obvious publisher in these areas, the interdisciplinary nature of mental health assures that materials of interest will be produced by a variety of government sources. Mental health may be broadly described as a multidisciplinary area in which the biomedical, behavioral and social sciences interface in the study of the development and maintenance of “normal” behavior and emotional well-being. Studies of the etiology, prevention, diagnosis, treatment and socio-legal implications of psychiatric disorder and the psychosocial aspects of medical illness are also considered under the umbrella term of mental health. The major government producers of mental health information are generally organized under the Department of Health and Human Services, the Department of Education and the Veterans Administration. They include the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA), the National Institute of Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Drug Abuse (NIDA), the National Institute of Child Health and Human Development (NICHD), the National Institute for Handicapped Research (NIHR), the National Institute of Education (NIE), the National Institute on Aging (NIA), the Children’s Bureau, the Head Start Bureau and the President’s Committee on Mental Retardation. However, other less obvious sources are widely scattered throughout the federal system, such as the military, the National Cancer Institute, the National Institute of Occupational Safety and Health and the Congress. The federal government’s publishing efforts reflect the broad subject scope of the mental health fields and span clinical, research, educational and administrative interests. In the last decade, materials have been produced on topics such as women’s issues, adoption, mental health service delivery, psychoanalysis, schizophrenia, child abuse, alcoholism, special education, stress, motivation and productivity, mental retardation, aging and forensic psychiatry. Monographs, pamphlets, statistics, proceedings, bibliographies, directories, reviews/ overviews and training manuals are designed to meet the information needs of researchers,

INDIAN ALCOHOLISM TREATMENT PROGRAMS AS FLAWED RITES OF PASSAGE

Treatment of American Indians has been given high priority by both the National Institute of Alcohol Abuse and Alcoholism (NIAAA) and the Indian Health Service (IHS). Numerous studies have assessed the success rates of the Indian alcoholism treatment programs developed in the last decade in response to this national health concern. The results range from mixed to disappointing (Albaugh 1973; Alday 1971; Bittker and Metzner 1973; Wolman 1970). Even though treatment personnel, the National Task Force on Alcohol Abuse among Native Americans, and most evaluative survey reports call for development of Indian alcoholism treatment programs sensitive to tribal, acculturational, age, and sex differences of their clienteles, Western medical model treatment perspectives predominate (Albaugh and Anderson 1974; Bouche 1979; Everett 1973; Stone 1980; Weibel and Weisner 1980a, 1980b). For the most part these treatment philosophies go unappreciated by Indian clients who are labeled alcoholic by their treatment counselors but who see themselves as neither diseased nor alcoholic. Definitional, motivational, and cultural differences between treatment personnel and clients create treatment contexts in which staff morale is low and client