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1998 March

Relationship of Reported Assault History to Substance Abuse Consequences and Treatment Charges among Dually Diagnosed Adults

Katherine A. Comtois, PhD
Acting Assistant Professor

Psychiatry & Behavioral Sciences

Description: The proposed study will seek to determine whether childhood sexual assault and physical assault and adult sexual and physical assault are associated with more substance abuse consequences and greater mental health and/or dual diagnosis treatment charges among dually diagnosed individuals. Two hundred and fifty dual diagnosis clients will be randomly selected from all clients enrolled in the Harborview Recovery and Rehabilitation Program (HaRRP), a large outpatient treatment program integrating mental health and substance abuse treatment. Assuming 67 % of recruited subjects consent to participate, the final sample size will be 165. Subjects will be given an assessment battery including the FISC, CQ, DRUG, Trauma Assessment for Adults, and the Post-Traumatic Symptom Scale-Self Report. Recruitment letters will be sent to selected subjects and followed by a personal or telephone introduction to the study. Consenting subjects will be administered the battery and paid a $20 gift certificate.

Multiple regression will be used to predict four outcome variables: number of lifetime consequences of substance abuse and charges for three psychiatric services: outpatient treatment, inpatient treatment, and psychiatric medication. Assault history will be entered last following important covariates (i.e. age, gender, psychiatric diagnosis, GAF, and length of enrollment in HaRRP) and Post-traumatic Stress Disorder (PTSD) symptoms.

Cerebrovascular Effects of Moderate Prenatal Alcohol Exposure in Preterm Fetal Sheep

Christine A. Gleason, MD
Professor and Head

Division of Neonatology, Pediatrics

Description: Fetal brain damage resulting from maternal alcohol abuse is one of the leading causes of mental retardation in the United States and yet the mechanisms by which in utero alcohol exposure adversely affects fetal brain development and function are largely unknown. Previous studies from the P.I.'s laboratory have demonstrated abnormal cerebrovascular reactivity to hypoxia in newborn sheep exposed to moderate maternal alcohol intoxication in the first trimester of pregnancy. Based on these findings as well as supportive data from other investigations, we have developed the hypothesis that in utero alcohol exposure affects the development and function of cerebral blood vessels and consequently, vascular responsivity.

The objective of this study is to determine whether chronic maternal alcohol intoxication early in pregnancy alters fetal cerebral responses to hypoxia. We will test the hypothesis that fetal alcohol exposure early in pregnancy attenuates fetal hy poxic cerebral vasodilation and impairs cerebral oxygen delivery. Results from these studies will provide important new information regarding mechanisms of alcohol-induced fetal brain injury and may lead to the development of more effective perinatal preventive and/or therapeutic strategies for pregnant women who use or abuse alcohol.

Corporate Alcohol Abuse Prevention Project

Mary E. Larimer, PhD
Research Assistant Professor

Psychology

Description: An estimated 20% of the adult workforce can be classified as problem drinkers, individuals who regularly or occasionally consume excessive amounts of alcohol and experience related negative consequences. In addition to interpersonal, emotional, health, and legal consequences related to their drinking, problem drinkers are often implicated in work-related consequences such as absenteeism, accidents, lowered productivity, and increased corporate health care costs.

The workplace may be an important context for understanding and preventing adult alcohol abuse and dependency. The culture of the workplace, expectations surrounding alcohol use at work-related events, and the financial and legal consequences of alcohol abuse for the company all contribute to its potentially significant role in prevention efforts. Unfortunately, while companies are increasingly sponsoring Employee Assistance Programs that include alcohol dependency treatments, these interventions often do not address the more widespread problem of problem drinking occurring in the absence of physical dependency.

The proposed study seeks to survey corporate interest in and determine potential barriers to implementing a worksite alcohol abuse prevention program. We further aim to test the efficacy of a brief, individualized alcohol-abuse prevention program designed to address issues of problem drinking within the corporate environment. In the present study, businesses will be targeted for recruitment and surveyed based on size, estimated turnover rates, and location (N=94). From those companies expressing interest in further participation, one company will be randomly chosen and up to 260 randomly selected employees of that company will participate in a 6-month controlled worksite prevention trial. The goals of this project are threefold: first, to decrease the overall number of negative alcohol-related consequences experienced by employees; secondly, to reduce the quantity and frequency of alcohol consumption by employees; and finally, to demonstrate the utility of the workplace as a platform for prevention efforts regarding alcohol use and abuse.

1998 October

Adolescent Offender Comorbidity Project

Mary E. Larimer, PhD
Research Assistant Professor

Psychology

Aaron P. Turner, PhD (Dissertation research)

Description: It is estimated that nearly 100% of juvenile delinquents experiment with some form of alcohol or other drug use and that a substantial number qualify for formal diagnoses of abuse or dependence. Additionally, close to 100% of these youth also suffer from co-occurring depression, anxiety, or conduct-disordered behavior. Symptoms of psychopathology are particularly important to an understanding of substance abuse because they have been realted to more severe forms of alcohol and drug use in other adolescent populations.

The proposed study seeks to test a model of substance use derived from social learning theory in which anxiety, depression, and the frequency of conduct-disordered behavior represent significant risk factors for alcohol and other drug use problems in juvenile delinquents. It hypothesizes that these symptoms of psychopathology interact with expectations about the mood-enhancing effects of alcohol or drugs and their perceived risks to produce higher rates of substance use and consequences. The social learning theory model will also be used to predict documented criminal offenses. Finally, diagnostic efficiency statistics (sensitivity, specificity, positive predictive power, and negative predictive power) of a current experimental mental health and substance use screening tool will be evaluated.

Study participants will be recruited from two Washington State Juvenile Rehabilitation Administration detention facilities. A cross-sectional sample (N=500) of the total population of both facilities will be administered a one hour questionnaire battery. Additional information on the documented criminal histories of each participant will also be obtained from existing criminal database records.

The goal of this project is to identify potential antecedents of drug and alcohol use in a sample of juvenile offenders with co-occurring symptoms of psychopathology. Study results will be used to determine the relative contributions of expectancies, risk perception, and coping to the prediction of substance abuse. Results will also inform the development of cognitive and behavioral clinical interventions aimed at reducing the rates and consequences of alcohol and drug use in this vulnerable and understudied population.

Resulting articles & projects:

  • Turner AP, Larimer ME, Sarason IG, Trupin EW. Identifying a negative mood subtype in incarcerated adolescents: Relationship to substance use. Addictive Behaviors 2005;30:1442-1448. Pubmed abstract
  • Eftekhari A, Turner AP, Larimer ME. Anger expression, coping, and substance use in adolescent offenders. Addictive Behaviors 2004;29:1001-1008. Pubmed abstract

Regional Metabolic Changes in Brain Function Associated with Acute Alcohol Intoxication: A Functional Neuroimaging Study

Kenneth Maravilla, MD
Professor

Radiology

Description: Although the behavioral effects of acute alcohol intoxication are well documented, there are relatively few in vivo neuroimaging studies of transient brain changes associated with such impairments. The proposed study will use an alcohol challenge procedure in conjunction with functional magnetic resonance imaging (fMRI) to explore the effects of acute alcohol intoxication on changes in brain function. Ten subjects who are healthy social drinkers will receive an oral dose of ethyl alcohol sufficient to induce impaired cognitive and motor function. Following a sufficient delay period to allow attainment of peak blood alcohol concentration, subjects will undergo a brain scan while performing two tasks known to be disturbed by alcohol intoxication: verbal working memory and complex finger sequencing. The study will use a dual task experimental paradigm, in which the two tasks are performed singly, and then concurrently, in order to maximally challenge targeted brain systems. On a separate occasion the same subjects will undergo a non-challenge fMRI scanning session using the same methods, but with administration of a placebo drink rather than alcohol (baseline condition). The order of placebo vs. alcohol-challenge scans will be counterbalanced across subjects to avoid learning effects. It is hypothesized that, relative to baseline, the alcohol challenge scan will result in decreased task-related brain activity both in extent and magnitude of activation. Results gained from this study will provide greater understanding of the acute effects of alcohol consumption on brain activity. Once a detailed fMRI challenge protocol has been developed, validated and documented, it will be made available for use in future studies of brain dysfunction or behavioral compromise associated with alcohol or other substances of abuse.

Alcohol's Influence on Women's Cognitive Appraisals of Sexual Assault Risk and Subsequent Responses

Jeannette Norris, PhD
Research Scientist

Alcohol and Drug Abuse Institute

Tina Zawacki, PhD; Tatiana Masters, PhD, Susan Stoner

Description: Sexual assault by acquaintances is a serious problem for young women. Approximately 1 in 4 experience either rape or attempted rape, the overwhelming majority of which are committed by acquaintances. Alcohol consumption by the victim, assailant or both is involved in more than half. One key element of sexual assault prevention is early perception of risk, which enables women to respond effectively and extricate herself from the situation before it escalates. In assessing risk and responding to it, women make a series of primary and secondary cognitive appraisals. Primary appraisals are those directed specifically to acknowledging and assessing the level of risk in a particular situation. Secondary appraisals involve weighing the potential to respond effectively against psychological barriers preventing effective responding. Both women's own alcohol consumption and their perception of the assailant's consumption can affect this cognitive appraisal process. Theoretical models of cognitive appraisal and coping and response conflict related to alcohol consumption provide the foundation for the proposed work. One experiment will investigate alcohol's physiological effects on women's primary and secondary cognitive appraisals to a sexual assault scenario and subsequent responses. in addition to women's alcohol consumption, manipulated variables include the level of prior relationship between the woman and the assailant and the assailant's alcohol consumption. This work will provide important information about how women's alcohol consumption affects perception of risk and subsequent responding to it. Findings have implications for designing prevention interventions, especially related to alcohol's role as a risk factor for sexual assault.

Resulting articles & projects:

  • Demonstrating that the research method could reliably assess women's cognitions and hypothetical responses after alcohol consumption and that alcohol did indeed affect this cognitive mediation process provided the basis for a successful application to NIAAA a grant "Alcohol Effects on Cognitive & Affectivbe Mediation of Women's Decision Making," which as had continuous funding from 2003 through 2014. R01AA014512.
  • Zawacki T, Norris J, George WH, Abbey A, Martel, J, Stoner SA, Davis KD, Buck PO, Masters NT, McAuslan P, Beshears R, Parkhill MR, Clinton-­Sherrod AM. Explicating alcohol's role in acquaintance sexual assault: Complementary perspectives and convergent findings. Alcohol Clin Exper Res 2005;29:263-269.
  • Testa M, Fillmore MT, Norris J, Abbey A, Curtin JJ et al. Understanding alcohol expectancy effects: Revisiting the placebo condition. Alcohol Clin Exper Res 2006;30:339-348.
  • Norris J, George WH, Stoner SA, Masters NT, Zawacki T, Davis KC. Women's responses to sexual aggression: The effects of child trauma. alcohol and prior relationship. Exper Clin Psychopharmacol 2006;14:402­-411.
  • Macy RJ, Nurius PS, Norris J. Responding in their best interests: Contextualizing women's coping with acquaintance sexual aggression. Violence Against Women 2006;12(5):478-500.
  • Norris J, George WH, Stoner SA, Masters NT, Zawacki T. The Effect of Alcohol Consumption and Relationship Status on Acquaintance Sexual Assault Risk Perception. Presented at a meeting of the Research Society on Alcoholism, Fort Lauderdale, FL, June 2003.
  • Norris J, George WH, Stoner SA, Masters NT. Child abuse and adult revictimization: Alcohol's mediating influence. Presented at a meeting of the American Psychological Association, Chicago IL, August 22-25, 2002.
  • Norris J, George WH, Stoner SA, Masters NT. The effect of victimization history and alcohol consumption on hypothetical responses to sexual assault. Presented at a meeting of the International Society for Research on Aggression, Montreal, Quebec, July 2002.

Brain Morphometry in FAS/FAE and Normal Subjects

Paul D. Sampson, PhD
Research Professor

Statistics

Description: This research proposes to identify and measure a number of neuroanatomic structures in 3D MRI brain scans we have already obtained on 45 adult male subjects with FAS and FAE diagnoses and normal Controls. We will compute inter and intraobserver measures of reliability and variability in the manual identification of these structures. We will then assess the ability of an elastic energy-based "brain mapping" algorithm to reliably identify these neuroanatomic structures using a neuroanatomically-labeled template and target MRI scans with labeled point landmarks. The resulting volumetric measures of brain size and shape will help us to quantify the neuroanatomic abnormalities in people with brain damage caused by prenatal alcohol exposure. The geometric representations of these structures, combined with currently digitized point landmarks, will further enable more sophisticated morphometric analyses of the relationships between neuroanatomic structure and neuropsychologic function in subjects with intrauterine fetal alcohol exposure. This work will result in a new NIAAA grant application that would extend these new methods to analysis of additional data sets and the pressing clinical problem of identifying fetal alcohol affected individuals who lack the traditional facial configuration of FAS, but experience central nervous system dysfunction and subtle brain damage not now detected in clinical readings of MRI brain scans.