Faculty Bibliography

In order to ascertain the relative impact of coercion by a welfare program on retention in an ambulatory alcoholism program, records of 178 consecutive admissions to an inner-city alcoholism clinic were reviewed. Patients who came to the clinic via coerced referral from a public assistance agency were as likely to remain in treatment for at least nine sessions as self-referred patients

Basal plasma levels of cortisol and its suppression by dexamethasone were measured in 60 inpatient alcoholics 12-13 days after detoxification. Both hypothalamic-pituitary adrenal system parameters were essentially within normal limits in most patients--those who did not meet criteria for major depressive disorder (n = 43) as well as those who met criteria for MDD per their episode (n-17). Basal levels of cortisol below 7 micrograms/dl distinguished alcoholics without MDD from those who met criteria for MDD per current episodes

Alcohol abuse, alcohol withdrawal, and deterioration of hepatic function have been associated with abnormal dexamethasone suppression test (DST) results. Chronic alcohol abuse may also directly alter the pharmacokinetic disposition of dexamethasone. Plasma dexamethasone concentrations following a DST were determined in 53 detoxified alcoholics. Those with abnormal liver function had higher 4 p.m. plasma dexamethasone concentrations and lower DST cortisol concentrations. Those with normal liver function had lower plasma dexamethasone and higher DST cortisol concentrations consistent with induction of hepatic metabolic enzymes from chronic use of alcohol. The data indicate that liver function is one of the variables influencing dexamethasone disposition and DST cortisol suppression

The authors conducted a survey of psychiatric education in alcoholism and drug abuse in the United States. Ninety-seven percent of 106 undergraduate training programs and 91% of 169 residency programs offered curriculum units in this field. Most of these programs also provided supervised clinical care. Areas of reported faculty dissatisfaction included problems with attitude and interest of psychiatric faculty and with the amount of curriculum time allotted. The authors conclude that although the amount of curriculum time devoted to training in alcoholism and drug abuse is growing, further investment in developing faculty and fellowships is warranted to increase the quality of teaching commitment

Thirty-two dually diagnosed inpatients described drug-induced changes in their psychiatric symptoms. All heroin addicts and most alcoholics reported drug-induced improvement of their primary psychiatric symptoms; all cocaine addicts reported symptom worsening. These findings suggest that chronic cocaine abuse may not necessarily be related to attempts at self-medication of psychiatric symptoms