Faculty Bibliography

A 3-year follow-up of longtime engaged members of the Unification Church revealed remarkable compliance with the sect's unusual marital commitments. Of 305 subjects, 95% were still active in the church and 85% had been married in the interim to mates designated by their religious leader. Their scores on a measure of psychological well-being remained below those of the general population, and members who deviated from the sect's expectations showed even greater distress. Furthermore, analysis revealed that affiliative ties with the sect apparently counteracted the distress produced by the unusual marital experience and help to explain compliance with the sect's unusual behavioral norms

High levels of serum cortisol or abnormal dexamethasone suppression tests may be helpful in diagnosing major depressive disorder. However, a controversy exists as to whether abnormal liver function associated with alcohol abuse may negate the diagnostic value of the dexamethasone suppression test in alcoholics. We investigated the value of the dexamethasone suppression test in alcoholics by analyzing the liver function, cortisol levels, and psychiatric status of inpatients from an alcohol detoxification treatment center. The subjects met the DSM III criteria for alcohol dependence but took no chronic medication and had negative screening for substance abuse. They had routine blood screening to evaluate liver function, the afternoon cortisol test and dexamethasone suppression test to study glucocorticoid activity, and a structured evaluation to determine psychiatric diagnoses. The blood chemistry findings demonstrated a lack of significant liver synthetic dysfunction in this group, although 43% of the subjects had some elevation of their liver enzymes. We did not find differences in the liver function between patients with normal and abnormal cortisol levels. However, subjects with endogenous depression did have significantly elevated afternoon cortisol levels, and they tended to have more normal liver tests. These results indicate that modest liver dysfunction does not contaminate the validity of the plasma cortisol tests or the dexamethasone suppression test as diagnostic tools for assessing depression in this group of detoxified alcoholics. In addition, they demonstrate an association between depression and plasma cortisol levels and suggest a correlation between depression and better liver function in alcoholics who seek detoxification

The article describes an approach to the treatment of cocaine dependent patients in which the patient's social network is used to bolster his attempts to achieve stable abstinence. The network is drawn from persons close to the patient, typically members of his immediate family or close friends, and is used for social support in assuring compliance with the treatment regimen and in undercutting denial. The function of the regimen is explained to the patient and network members: It is conducted to assure the patient's abstinence from the outset of treatment, to mitigate against the occurrence of slips, and to support reintegration into treatment should relapses to alcohol or drug use occur