ALCOHOLISM: A TWO-YEAR FOLLOW-UP STUDY OF PATIENTS ADMITTED TO THE PSYCHIATRIC DEPARTMENT OF A GENERAL HOSPITAL

Ageing and recovery from alcoholism

Fifty-five dependent (DSM-III) male alcoholics, chosen for good social adjustment, were personally followed up about 20 years after their first admission to hospital. The conditions of all the alcoholics were evaluated with a multidimensional diagnostic schedule when first admitted. At the follow-up, 11 were abstainers, 11 reported a change to social drinking via abstinence, and 10 reported a change to social drinking by gradual stages. Improvement after the age of 45 was mainly due to gradual change to social drinking. This type of improvement was in half of the cases attributed to a decreased tolerance for alcohol. In the present sample, there were no indications of any relationship between premature ageing and gradual change to social drinking. It is hypothesised that physiological processes of normal ageing with concomitant changes in reactions to alcohol may be of importance for remission from alcoholism in middle-aged and older alcoholics. The relationships of personality, social factors and the degree of alcohol-dependence to patterns of successful long-term adjustment are discussed.

Prediction of readmission in a cohort of alcoholics: a 2-year follow-up

A cohort of 1,192 first admissions to metropolitan public alcohol treatment programs was examined after 2 years. With the sample sub-divided by number of readmissions, discriminant analysis based on demographic data, social history, and current drinking behavior provided only modest prediction of group membership (k = .46), but may be sufficient to provide an alerting function for recidivism.

The development and use of standardized assessment of abnormal personality

A standardized assessment of personality (SAP) based on interview with an informant has been developed to classify a patient's premorbid personality in clinical terms for use for research purposes in or out of a hospital setting. Three preliminary investigations of its use are reported. These indicate that an informant's account of personality can be rated reliably by psychiatrists and is consistent over time. The addition of two extra descriptive types to the schema of ICD Section 301, the anxious and the self-conscious personalities, is found to contribute usefully to a taxonomy of personality in two series of patients investigated with the SAP. Further investigations are indicated to determine the accuracy of an informant's account before epidemiological studies with this instrument can be considered.

A Closeness to Divorce Scale for wives of alcoholics

A 15-item Guttman scale, Closeness to Divorce, was developed to describe and quantify how close an alcoholic's wife is to divorce at a given point in time. A detailed precoded interview schedule guided extensive interviews with 60 women, varying in marital status, who were current or former wives of men treated of alcoholism in Veterans Administration Hospitals. The interview contained 24 items on various aspects of marital stability gathered from the literature and from pilot interviews. These items were factor analysed and 15 items, loading 0.40 or better on the first principal component, were chosen for further analysis. A Guttman scale computer program was used to arrange the 15 items to form a Closeness to Divorce Scale, i.e. a unidimensional, cumulative scale with divorce at the endpoint and sequential psychological, interpersonal, geographic and legal steps toward divorce as the other items. Preliminary evidence of construct validity, potential clinical and research uses for scale, its limitations, and suggestions for future studies are described.

Mood change following left hemispheric brain injury

Eighteen patients with left hemispheric strokes were compared to 11 patients with traumatic brain injury for frequency and severity of depression, using several mood scales. More than 60% of the stroke patients had clinically significant depressions as compared with about 20% of the trauma patients, even though the two groups had comparable impairments in their activities of daily living and global cognitive functions. Analyses of brain CT scans revealed that the two groups had similar-sized lesions, but the areas of ischemic injury were more anterior than the traumatic lesions. When the results were controlled for lesion location, there were no significant differences in mood between the two groups. The severity of depression was directly correlated with the closeness of the lesion to the frontal pole. These results suggest that depression following left hemispheric brain injury may not be a nonspecific neurological or psychological response, but rather may be a symptom of injury to specific pathways, such as the catecholamine-containing ones, as they pass through the frontal cortex.

Prognostic indicators of alcoholism treatment outcome

This literature review is a systematic attempt to isolate the personal characteristics of alcoholics generally associated with their prognosis. Forty-five studies which met certain standards for inclusion are summarized here. The description of each study and its corresponding list of characteristics of alcoholics investigated for prognostic value are reported in tables. The tables do not reveal stable predictors across the studies, though some personal characteristics are more generally of predictive value than are others. A number of reasons for the absence of predictor stability are discussed--among them the possibility that certain treatments may work best with certain alcoholic patients.

Alcoholism treatment and evaluation: in search of methods. II. Collation of two-year follow-up studies

This study collated 23 articles reporting outcome of alcoholism treatment efforts over a 2-year follow-up period. Broad conclusions reached by Costello (1975) in a similar collation of studies reporting on a 1-year follow-up interval found general support. Similar consistencies were noted across studies within groups described as having good outcome profiles as was noted by the previous collation. Good outcome results from matching relatively better prognostic cases wtih programs with broad treatment resources. Multiple baselines were offered as guidelines for program evaluation. Baselines were generated in the process of collation by hierachal grouping of outcome profiles. Different baseline to measure effectiveness of performance should prove appropriate for different measuring tasks. No one baseline is appropriate for all measuring tasks.

A categorization for the assessment of prognosis and outcome in the treatment of alcoholism

For the study reported in the accompanying paper (Willemset al., 1973), a number of variables, thought to be of prognostic relevance in alcoholism, were selected and categorized in a rank order. These can be regarded asordinalscales, since in every case (a) each category differs from the others, and (b) each is related to the others. In each case there can be said to be an underlying continuum and in all cases a higher number indicates, in our opinion, a less ‘desirable’ state.

Alcoholism in North-East Scotland: its treatment and outcome

Concern has been expressed in many quarters about the size of the problem of alcoholism in Great Britain, although there are no figures available from a direct count in the general population. Morrison (1964) has adduced evidence that the size of the problem doubled between 1956 and 1961 and that alcoholism is perhaps four or five times more prevalent in Scotland than in England and Wales. Existing treatment facilities have been criticized and the establishment of special units for the treatment of alcoholics has been advocated (Ministry of Health, 1962). One such unit was opened in Edinburgh in 1963 (Waltonet al., 1966), and the opening of further units in Scotland is being considered (Scottish Home and Health Department, 1965).

The prognosis of alcohol addicts treated by a specialized unit

The need for increased services for the treatment of alcoholism has been officially accepted and indeed emphasized in recent years (15, 20). The following evaluation of an Alcoholic Unit is based on the response to treatment over the course of one year shown by a cohort of 100 patients, half of whom were admitted to the Unit while the remainder were out-patients. The study aimed at describing the patients referred to the unit and at ascertaining what attributes of the patient and his treatment appeared to influence the prognosis.