Faculty Bibliography

The alcohol withdrawal syndrome is common in elderly individuals who are alcohol dependent and who decrease or stop their alcohol intake. While there have been few clinical studies to directly support or refute the hypothesis that withdrawal symptom severity, delirium and seizures increase with advancing age, several observational studies suggest that adverse functional and cognitive complications during alcohol withdrawal do occur more frequently in elderly patients. Most elderly patients with alcohol withdrawal symptoms should be considered for admission to an inpatient setting for supportive care and management. However, elderly patients with adequate social support and without significant withdrawal symptoms at presentation, comorbid illness or past history of complicated withdrawal may be suitable for outpatient management. Although over 100 drugs have been described for alcohol withdrawal treatment, there have been no studies assessing the efficacy of these drugs specifically in elderly patients. Studies in younger patients support benzodiazepines as the most efficacious therapy for reducing withdrawal symptoms and the incidence of delirium and seizure. While short-acting benzodiazepines, such as oxazepam and lorazepam, may be appropriate for elderly patients given the risk for excessive sedation from long-acting benzodiazepines, they may be less effective in preventing seizures and more prone to produce discontinuation symptoms if not tapered properly. To ensure appropriate benzodiazepine treatment, dose and frequency should be individualised with frequent monitoring, and based on validated alcohol withdrawal severity measures. Selected patients who have a history of severe or complicated withdrawal symptoms may benefit from a fixed schedule of benzodiazepine provided that medication is held for sedation. beta-Blockers, clonidine, carbamazepine and haloperidol may be used as adjunctive agents to treat symptoms not controlled by benzodiazepines. Lastly, the age of the patient should not deter clinicians from helping the patient achieve successful alcohol treatment and rehabilitation.

Motivation or readiness to change has been studied intensively in recent years in research on the use of brief interventions to change alcohol problems in the primary care setting. The purpose of this study was to investigate the factor structure and concurrent and predictive evidence for validity of the short Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), a 19-item self-report instrument developed to measure readiness to change alcohol problems in individuals presenting for specialized alcohol treatment. The participants were 210 men and 91 women who were identified as "at-risk" drinkers in 13 community primary care clinics. These individuals completed the SOCRATES and a number of other assessments as part of a preintervention evaluation. A principal components analysis of the SOCRATES data revealed a two-factor structure: a confirmatory factor analysis showed that this structure was a better fit to the data than the three-factor structure that Miller and Tonigan (1996) identified for the SOCRATES. The two factors (9 and 6 items, respectively), seemed to measure perceived degree of severity of an existing alcohol problem (called "Amrec" because it consisted of Miller and Tonigan's ambivalence and recognition items) and taking action to change or to maintain changes in one that exists (called "Taking Steps"). Predictions of significant and nonsignificant correlations between the two derived factors and other baseline variables (alcohol consumption, related problems and symptoms, and demographic factors) generally were confirmed. In addition, baseline Amrec scores were related in predicted directions to 6-month alcohol consumption and related problems data, but the magnitude of these relationships were reduced when other variables that correlated with Amrec or when the 6-month data were taken into account. In general, Taking Steps showed little or no relationship to the 6-month data. The results are compared to previous work with the SOCRATES and suggestions for future research are discussed.

David M. Oshinsky reviews the book "Why the American Century?" by Olivier Zunz

I AM no expert in the field of history CD-ROM's. In truth, I have consciously shied away from them, seeing digital tools as a frivolous assault on scholarly standards. After spending a week playing with The Library of Congress: Eyes of the Nation, a new CD-ROM exploring the American experience through documents selected from the world's largest archive, I've been partly converted, much like the wayward Puritan of the 1650's who made a ''halfway covenant'' with his faith. Used in conjunction with more traditional methods, the CD-ROM may well revolutionize the way we teach history. The Eyes of the Nation CD-ROM is divided into five parts. All provide a glimpse of the treasures to be found in the Library of Congress's fabulous special collections. (The DVD-ROM version has 19 additional exhibits, more than 1,000 additional images and three hours of full-screen video.) Part One introduces the viewer to the world of rare books, maps, prints and photographs, including the first known slave narrative published on American soil (1760), a detailed sketch of the Gettysburg battlefield by a Confederate topographer (1863) and a poignant photo of two black women on their knees, decorating the grave of a black soldier in the segregated Arlington National Cemetery (1943)

I am no expert on history CD-ROMs. In truth, I have consciously shied away from them, seeing digital tools as a frivolous assault on scholarly standards. After spending a week playing with The Library of Congress: Eyes of the Nation, a new CD-ROM exploring the American experience through documents selected from the world's largest archive, I've been partly converted. Used in conjunction with more traditional methods, the CD-ROM may well revolutionize the way we teach history

Oshinsky reviews "Freedom From Fear: The American People in Depression and War, 1929-1945" by David M. Kennedy

David Oshinsky reviews the book "A Nearly Normal Life: A Memoir" by Charles L. Mee