Rick Tivis | Idaho State University (original) (raw)

Papers by Rick Tivis

Research paper thumbnail of Soy protein may alleviate osteoarthritis symptoms

Phytomedicine, 2004

Alternative and complementary therapeutic approaches, such as the use of a wide array of herbal, ... more Alternative and complementary therapeutic approaches, such as the use of a wide array of herbal, nutritional, and physical manipulations, are becoming popular for relieving symptoms of osteoarthritis (OA). The present study evaluated the efficacy of soy protein (SP) supplementation in relieving the pain and discomfort associated with OA. One hundred and thirty-five free-living individuals (64 men and 71 women) with diagnosed OA or with self-reported chronic knee joint pain not attributed to injury or rheumatoid arthritis were recruited for this double-blind, placebo-controlled, parallel design study. Study participants were assigned randomly to consume 40 g of either supplemental SP or milk-based protein (MP) daily for 3 months. Pain, knee range of motion, and overall physical activity were evaluated prior to the start of treatment and monthly thereafter. Serum levels of glycoprotein 39 (YKL-40), a marker of cartilage degradation, and insulin-like growth factor-I (IGF-I), a growth factor associated with cartilage synthesis, were assessed at baseline and at the end of the study. Overall, SP improved OA-associated symptoms such as range of motion and several factors associated with pain and quality of life in comparison to MP. However, these beneficial effects were mainly due to the effect of SP in men rather than women. Biochemical markers of cartilage metabolism further support the efficacy of SP in men as indicated by a significant increase in serum level of IGF-I and a significant decrease in serum level of YKL-40 compared to MP. This study is the first to provide evidence of possible beneficial effects of SP in the management of OA. Examining and verifying the long-term effects of SP on improving symptoms of OA, particularly in men, is warranted.

Research paper thumbnail of Distance Learning and Simulation Technologies to Support Bioterrorism Preparedness Education

The primary objective of the Idaho Bioterrorism Awareness and Preparedness Program (IBAPP) is to ... more The primary objective of the Idaho Bioterrorism Awareness and Preparedness Program (IBAPP) is to administer and deliver continuing-education classes relevant to bioterrorism preparedness to healthcare professionals in rural Idaho. This program will address the gaps and ...

Research paper thumbnail of A Multisite, Multistakeholder Validation of the Accreditation Council for Graduate Medical Education Competencies

Academic Medicine, 2013

The Accreditation Council for Graduate Medical Education&... more The Accreditation Council for Graduate Medical Education's (ACGME's) six-competency framework has not been validated across multiple stakeholders and sites. The objective of this study was to perform a multisite validation with five stakeholder groups. This was a cross-sectional, observational study carried out from October to December, 2011, in the internal medicine residency continuity clinics of eight internal medicine residency programs in the Pacific Northwest, including a VA, two academic medical centers, a military medical center, and four private hospitals. The authors performed a cultural consensus analysis (CCA) and a convergent-discriminant analysis using previously developed statements based on internal medicine milestones related to the six competencies. Ten participants were included from each of five stakeholder groups: patients, nurses, residents, faculty members, and administrators from each training site (total: 400 participants). Moderate to high agreement and coherence for all groups were observed (CCA eigenvalue ratios ranging from 2.16 to 3.20); however, high differences in ranking order were seen between groups in four of the CCA statements, which may suggest between-group tension in these areas. Analyses revealed excellent construct validity (Zcontrast score of 5.323, P < .0001) for the six-competency framework. Average Spearman correlation between same-node statements was 0.012, and between different-node statements it was -0.096. The ACGME's six-competency framework has reasonable face and construct validity across multiple stakeholders and sites. Stakeholders appear to share a single mental model of competence in this learning environment. Data patterns suggest possible improvements to the competency-milestone framework.

Research paper thumbnail of Trends in United States Physician Work Hours and Career Satisfaction

The American Journal of Medicine, 2014

Research paper thumbnail of Semantic processing in alcoholics with and without antisocial symptomatology

Research paper thumbnail of Strength Modeling: The Role of Data in Defining Needs and Response for American Indian Substance Users

Substance Use & Misuse, 2007

Essential to clarifying the nature of health disparities and ultimately to developing appropriate... more Essential to clarifying the nature of health disparities and ultimately to developing appropriate responses is the access and availability of accurate, relevant data. This need is particularly obvious at the level of public health policy and practice. Unfortunately, current data sources are frequently restricted by a variety of factors, including jurisdictory limitations that restrict exchange of information between health delivery systems. This study was conducted to review conclusions drawn from disparate, yet functionally interdependent, data sources regarding alcohol-related medical outcomes among American Indians; specifically, non-reservation-residing Indian people. Data were collected from 1998 to 1999. The comparison revealed critical inconsistencies between data sources, reinforcing the call for enhanced data exchange and caution in interpreting data from singular sources.

Research paper thumbnail of Cognitive efficiency in alcoholics and polysubstance abusers: Family history revisited

Psychology of Addictive Behaviors, 1999

The primary aim of this study was to evaluate the role of family history (FH) on cognitive effici... more The primary aim of this study was to evaluate the role of family history (FH) on cognitive efficiency by means of 4 different FH classification schemes. Sixty alcoholics, 64 polysubstance abusers, and 67 controls participated. No effects of FH were found for any of the 4 FH classification strategies. However, main effects of group were found, providing evidence that the clinical samples were representative of those from previous studies. These data support those of other investigators and suggest that having an FH of alcoholism cannot account for cognitive impairment among chronic alcoholics.

Research paper thumbnail of Television Exposure in Children after a Terrorist Incident

Psychiatry: Interpersonal and Biological Processes, 2001

This study examined the influence of bomb-related television viewing in the context of physical a... more This study examined the influence of bomb-related television viewing in the context of physical and emotional exposure on posttraumatic stress symptoms--intrusion, avoidance, and arousal--in middle school students following the 1995 Oklahoma City bombing. Over 2,000 middle school students in Oklahoma City were surveyed 7 weeks after the incident. The primary outcome measures were the total posttraumatic stress symptom score and symptom cluster scores at the time of assessment. Bomb-related television viewing in the aftermath of the disaster was extensive. Both emotional and television exposure were associated with posttraumatic stress at 7 weeks. Among children with no physical or emotional exposure, the degree of television exposure was directly related to posttraumatic stress symptomatology. These findings suggest that television viewing in the aftermath of a disaster may make a small contribution to subsequent posttraumatic stress symptomatology in children or that increased television viewing may be a sign of current distress and that it should be monitored. Future research should examine further whether early symptoms predict increased television viewing and/or whether television viewing predicts subsequent symptoms.

Research paper thumbnail of Neurocognitive function in alcoholic, schizophrenic, and dually diagnosed patients

Psychiatry Research, 1996

functions were compared in alcoholic, schizophrenic, and dually diagnosed (schizophrenic and alco... more functions were compared in alcoholic, schizophrenic, and dually diagnosed (schizophrenic and alcoholic) patients and community control volunteers. Participants (N = 52, n = 13 in each group) completed a brief battery including two measures of neuropsychological function and two affective measures. The neuropsychological tests included the Trail-Making Test Forms A and B and a face-recognition test. The affective measures included assessment of anxiety and depression. The major objective was to compare the patterns of neurocognitive performance among the four groups. The groups did not differ in mean age (35.37) or years of education (12.46). Compared with the community control and alcoholic groups, the schizophrenic groups reported higher mean depression (12.92 vs. 5.54) and mean state anxiety scores (60.73 vs. 46.04). Control subjects were generally, although not always significantly, superior to the other groups. Contrary to expectations, alcoholic patients were not consistently better than the schizophrenic groups, and dually diagnosed participants were not more impaired than schizophrenic patients without substance abuse histories. Thus, the interaction of schizophrenia and substance abuse did not have an additive effect on neurocognitive performance assessed in this study. More research using this complete four-group design and a larger neurocognitive batteq is needed.

Research paper thumbnail of An empirical assessment of post-treatment alcohol consumption

Psychiatry Research, 2003

Substance abuse treatment programs have long contended that any post-treatment alcohol use is ind... more Substance abuse treatment programs have long contended that any post-treatment alcohol use is indicative of relapse. Recent studies, however, suggest more inclusive definitions. Cisler (1996, 1999) consider both the drinking quantity and negative drinking consequences. Their proposed cutoffs integrate the 1995 NIAAA guidelines for sensible and high risk drinking levels with the objective assessment of drinking-related consequences into the definition of relapse. Our study applied this model to a group of detoxified alcoholics in a post-treatment followup project. We asked if: (1) Zweben and Cisler's drinking categories could be found in our sample; (2) whether subgroups defined by post-treatment drinking patterns differed with respect to their pre-treatment alcohol consumption levels, years of alcoholic drinking and drinking related problems; and (3) whether post-treatment drinking patterns were associated with differential psychosocial functioning at followup. Thirteen percent of the total sample (Ns61) was found to meet Zweben and Cisler's moderate drinking category; 34% were abstinent, 27% heavy drinkers and 13 participants (26%) were unclassifiable. At treatment completion (T1), those who became moderate drinkers reported higher levels of self-confidence, but were otherwise similar to both abstainers and heavy drinkers. At followup (T2), approximately 1 year after initial testing (T1), groups differed on measures of emotional discharge, avoidance and logical coping skills and information seeking, suggesting a possible association between post-treatment drinking patterns and psychosocial functioning. ᮊ

Research paper thumbnail of Neurophysiological efficiency in male and female alcoholics

Chronic alcoholics often exhibit impairment in behavioral indicators of cognitive efficiency. How... more Chronic alcoholics often exhibit impairment in behavioral indicators of cognitive efficiency. However, potential neurophysiological correlates of this deficit are understudied. To examine this function, semantic expectancy was measured by recording the N400 component of the event-related potential (ERP), which is elicited by incongruent semantic information. Abstinent alcoholics, 21 -45 days sober (n = 26; 12 males, 14 females), as well as age and education equated community controls (n = 26; 12 males, 14 females), were instructed to read silently 218 sentences ending with either congruent, related/incongruent, or unrelated/incongruent terminal words. Difference waveforms to the terminal word were derived, and amplitude and latency measures of the most negative peak between 300 and 600 ms were obtained. Electrode sites included the midline sites, Fz, Cz, and Pz; the temporal sites T3 and T4; and parietal sites P3 and P4. Significant group effects in amplitude were observed for the difference waveform under the unrelated/incongruent condition at T3, T4, and P4 ( P .05). Measures at P3, Pz, Fz, and Cz approached significance ( P .15). Although the overall pattern did not change when regression techniques were used to control for age, only the T4 site retained significance ( P .05). Across all electrode sites, alcoholics produced reduced N400 amplitudes relative to community controls. Latency was unaffected. There were no group effects for amplitude or latency measures in the related/incongruent condition. These data are consistent with the hypothesis that alcoholics suffer from a subtle deficiency in neurophysiologically based cognitive efficiency which renders them less likely to respond appropriately to irrelevant information. D

Research paper thumbnail of Substance abuse-related P300 differences in response to an implicit memory task

Research paper thumbnail of Visual–spatial attention in alcoholics and illicit stimulant abusers: effects of nicotine replacement

Reports of alcohol or illicit drug-related cognitive impairments have frequently disregarded the ... more Reports of alcohol or illicit drug-related cognitive impairments have frequently disregarded the potentially confounding effects of smoking status and nicotine withdrawal on these measures. This study addressed this issue by measuring visual-spatial attention via an adaptation of the Posner paradigm in three groups of tobacco smokers: controls without a history of alcoholism or illicit drug use (n=27; 20 male), chronic alcoholics (n=22; 18 male), and illicit stimulant abusers (n=36; 21 male). Throughout testing, nicotine levels were stabilized by the double-blind administration of a high (14 or 21 mg) or low (7 mg) dose transdermal nicotine patch. A significant effect of group was observed for number of correct responses to restriction trials ( F=5.48, 2/79 df; p=.006). Performance was normalized in the illicit stimulant group, and alcoholic participants exhibited superior performance relative to both illicit stimulant abusers ( p=.002) and controls ( p=.01). These findings support the hypothesis that nicotine may have a compensatory or normalizing effect on attentional functions in substance abusers. Whether these results reflect the central nervous system-activating effects of nicotine or merely alleviation of nicotine withdrawal is a topic of ongoing research. D

Research paper thumbnail of Posttraumatic Stress Responses in Bereaved Children After the Oklahoma City Bombing

Journal of the American Academy of Child & Adolescent Psychiatry, 1999

To investigate the responses of middle and high school students exposed to the 1995 Oklahoma City... more To investigate the responses of middle and high school students exposed to the 1995 Oklahoma City bombing across a spectrum of loss. A questionnaire measuring exposure, personal consequences, initial response, and current posttraumatic stress and other symptoms was administered to 3,218 students 7 weeks after the explosion. More than one third of the sample knew someone killed in the explosion. Bereaved youths were more likely than nonbereaved peers to report immediate symptoms of arousal and fear, changes in their home and school environment, and posttraumatic stress symptoms. Retrospective measures of initial arousal and fear predicted posttraumatic stress symptoms at 7 weeks. The results support the literature addressing the role of initial response in posttraumatic stress symptom development. The study raises concern about the impact of television, and traumatized youths' reactivity to it, in the aftermath of disaster.

Research paper thumbnail of Transdermal Nicotine Administration and the Electroencephalographic Activity of Substance Abusers in Treatment

Objectives-It is widely recognized that individuals with alcohol or illicit substance abuse disor... more Objectives-It is widely recognized that individuals with alcohol or illicit substance abuse disorders often smoke cigarettes. However, few studies have examined the direct effects of nicotine among substance abuse subgroups. The current study examined patterns of electroencephalographic (EEG) activity in alcohol-dependent (AD), stimulant-dependent (StimD), alcohol-and stimulantdependent (ASD) participants, as well as community controls (CC). All participants were regular smokers.

Research paper thumbnail of Alcohol and Health Disparities in Nonreservation American Indian Communities

Alcoholism: Clinical & Experimental Research, 2003

Research paper thumbnail of Patterns of Cognitive Impairment among Alcoholics: Are There Subtypes?

Alcoholism: Clinical and Experimental Research, 1995

The mild generalized dysfunction hypothesis of alcohol abuse's deleterious effects on cognitive p... more The mild generalized dysfunction hypothesis of alcohol abuse's deleterious effects on cognitive processes has gained support from a number of studies in which detoxified alcoholics have a lower mean performance level than peer controls on a variety of neuropsychological tests. This approach might obscure consistent but different patterns of preserved and impaired cognitive performance among subgroups of alcoholics, suggestive of alternative hypotheses. To test this possibility, neuropsychological test data from two large, independent samples of alcoholics (sample 1, n = 143; sample 2, n = 130) and controls (sample 1, n = 97; sample 2, n = 83) were subjected to separate centroid hierarchical cluster analyses. For both samples, the majority of alcoholics (94% and 94%) exhibited a pattern of impaired verbal and nonverbal performance and deficits in memory and perceptual motor skill, with normal motor skill. The alcoholics who did not fit this pattern showed more severe or wide-ranging impairments. These findings indicate that empirical support for the mild generalized dysfunction hypothesis of alcoholics' cognitive deficits is not an artifact of averaging.

Research paper thumbnail of Behavioral Dysfunction and Cognitive Efficiency in Male and Female Alcoholics

Alcoholism: Clinical and Experimental Research, 1995

This study was conducted to examine the role of childhood behavioral disorders (CBDs) and residua... more This study was conducted to examine the role of childhood behavioral disorders (CBDs) and residual attention deficit disorder (AD-DRT) in alcohol-related cognitive dysfunction in male and female subjects. Alcoholic (n = 44 females, 56 males) and control (n = 40 females, 40 males) subjects completed assessments that included measures of CBDs, ADDRT, and cognitive and psychosocial functioning. Cognitive tests were specifically designed to assess efficiency in function. As expected, alcoholics were inferior to controls in their cognitive efficiency [F(1,171) = 10.43, p = 0.0015]. Alcoholics reported more CBDs [F(1,161) = 12.02,~ = O.O007], regardless of sex. They also reported more ADDRT [F(1,173) = 44.12, p = O.OOOl] than did controls. There were also sex [F(l,173) = 13.31, p = 0.0004] and group by sex effects [F(1,173) = 3.93, p = 0.051. Female alcoholics

Research paper thumbnail of Interpersonal Problem-Solving in Male and Female Alcoholics

Alcoholism: Clinical and Experimental Research, 1992

This study compared the performance of alcoholics (18 male, 16 female) with community controls (1... more This study compared the performance of alcoholics (18 male, 16 female) with community controls (15 male, 12 female) on the Adaptive Skills Battery (ASB), a test of interpersonal problem-solving. The ASB consists of 30 situations. Fifteen situations require subjects' typical responses and 15, their optimal responses. Male and female alcoholics were inferior to controls in their typical responses [F(1,57) = 45.22, p = 0.0001], but did not differ on the optimal responses (F less than 1). Further analyses indicated that decreased feelings of self-efficacy could not account for the alcoholic deficit. Females were superior to males in the optimal response condition [(F(1,56) = 9.90, p = 0.003]. No significant group x sex interactions were obtained. Performance on the ASB was not correlated with performance on traditional measures of problem-solving. Post-hoc correlational analyses revealed differential patterns between depression scores and performance for alcoholics and controls. These data suggest that (1) female and male alcoholics exhibit similar interpersonal problem-solving deficits, (2) alcoholic self-efficacy expectancies cannot account for the impairment, (3) the ASB appears to assess aspects of problem-solving not typically examined, and (4) the role of depression in alcoholic performance deserves continued empirical evaluation.

Research paper thumbnail of Cognitive Efficiency in Stimulant Abusers With and Without Alcohol Dependence

Alcoholism: Clinical & Experimental Research, 2003

Background: Although previous studies have found stimulant (i.e., cocaine, methamphetamine) abuse... more Background: Although previous studies have found stimulant (i.e., cocaine, methamphetamine) abusers and alcoholics to have neuropsychological deficits, research examining which cognitive abilities are most affected by concurrent exposure to these substances is lacking. To address this issue, detoxified men and women who met criteria for dependence of (a) alcohol only (ALC) (n ϭ 15); (b) stimulants only (STIM) (n ϭ 15); and (c) both alcohol and stimulants (A/STIM) (n ϭ 15) were compared with age-and educationmatched community controls (n ϭ 15).

Research paper thumbnail of Soy protein may alleviate osteoarthritis symptoms

Phytomedicine, 2004

Alternative and complementary therapeutic approaches, such as the use of a wide array of herbal, ... more Alternative and complementary therapeutic approaches, such as the use of a wide array of herbal, nutritional, and physical manipulations, are becoming popular for relieving symptoms of osteoarthritis (OA). The present study evaluated the efficacy of soy protein (SP) supplementation in relieving the pain and discomfort associated with OA. One hundred and thirty-five free-living individuals (64 men and 71 women) with diagnosed OA or with self-reported chronic knee joint pain not attributed to injury or rheumatoid arthritis were recruited for this double-blind, placebo-controlled, parallel design study. Study participants were assigned randomly to consume 40 g of either supplemental SP or milk-based protein (MP) daily for 3 months. Pain, knee range of motion, and overall physical activity were evaluated prior to the start of treatment and monthly thereafter. Serum levels of glycoprotein 39 (YKL-40), a marker of cartilage degradation, and insulin-like growth factor-I (IGF-I), a growth factor associated with cartilage synthesis, were assessed at baseline and at the end of the study. Overall, SP improved OA-associated symptoms such as range of motion and several factors associated with pain and quality of life in comparison to MP. However, these beneficial effects were mainly due to the effect of SP in men rather than women. Biochemical markers of cartilage metabolism further support the efficacy of SP in men as indicated by a significant increase in serum level of IGF-I and a significant decrease in serum level of YKL-40 compared to MP. This study is the first to provide evidence of possible beneficial effects of SP in the management of OA. Examining and verifying the long-term effects of SP on improving symptoms of OA, particularly in men, is warranted.

Research paper thumbnail of Distance Learning and Simulation Technologies to Support Bioterrorism Preparedness Education

The primary objective of the Idaho Bioterrorism Awareness and Preparedness Program (IBAPP) is to ... more The primary objective of the Idaho Bioterrorism Awareness and Preparedness Program (IBAPP) is to administer and deliver continuing-education classes relevant to bioterrorism preparedness to healthcare professionals in rural Idaho. This program will address the gaps and ...

Research paper thumbnail of A Multisite, Multistakeholder Validation of the Accreditation Council for Graduate Medical Education Competencies

Academic Medicine, 2013

The Accreditation Council for Graduate Medical Education&... more The Accreditation Council for Graduate Medical Education's (ACGME's) six-competency framework has not been validated across multiple stakeholders and sites. The objective of this study was to perform a multisite validation with five stakeholder groups. This was a cross-sectional, observational study carried out from October to December, 2011, in the internal medicine residency continuity clinics of eight internal medicine residency programs in the Pacific Northwest, including a VA, two academic medical centers, a military medical center, and four private hospitals. The authors performed a cultural consensus analysis (CCA) and a convergent-discriminant analysis using previously developed statements based on internal medicine milestones related to the six competencies. Ten participants were included from each of five stakeholder groups: patients, nurses, residents, faculty members, and administrators from each training site (total: 400 participants). Moderate to high agreement and coherence for all groups were observed (CCA eigenvalue ratios ranging from 2.16 to 3.20); however, high differences in ranking order were seen between groups in four of the CCA statements, which may suggest between-group tension in these areas. Analyses revealed excellent construct validity (Zcontrast score of 5.323, P < .0001) for the six-competency framework. Average Spearman correlation between same-node statements was 0.012, and between different-node statements it was -0.096. The ACGME's six-competency framework has reasonable face and construct validity across multiple stakeholders and sites. Stakeholders appear to share a single mental model of competence in this learning environment. Data patterns suggest possible improvements to the competency-milestone framework.

Research paper thumbnail of Trends in United States Physician Work Hours and Career Satisfaction

The American Journal of Medicine, 2014

Research paper thumbnail of Semantic processing in alcoholics with and without antisocial symptomatology

Research paper thumbnail of Strength Modeling: The Role of Data in Defining Needs and Response for American Indian Substance Users

Substance Use & Misuse, 2007

Essential to clarifying the nature of health disparities and ultimately to developing appropriate... more Essential to clarifying the nature of health disparities and ultimately to developing appropriate responses is the access and availability of accurate, relevant data. This need is particularly obvious at the level of public health policy and practice. Unfortunately, current data sources are frequently restricted by a variety of factors, including jurisdictory limitations that restrict exchange of information between health delivery systems. This study was conducted to review conclusions drawn from disparate, yet functionally interdependent, data sources regarding alcohol-related medical outcomes among American Indians; specifically, non-reservation-residing Indian people. Data were collected from 1998 to 1999. The comparison revealed critical inconsistencies between data sources, reinforcing the call for enhanced data exchange and caution in interpreting data from singular sources.

Research paper thumbnail of Cognitive efficiency in alcoholics and polysubstance abusers: Family history revisited

Psychology of Addictive Behaviors, 1999

The primary aim of this study was to evaluate the role of family history (FH) on cognitive effici... more The primary aim of this study was to evaluate the role of family history (FH) on cognitive efficiency by means of 4 different FH classification schemes. Sixty alcoholics, 64 polysubstance abusers, and 67 controls participated. No effects of FH were found for any of the 4 FH classification strategies. However, main effects of group were found, providing evidence that the clinical samples were representative of those from previous studies. These data support those of other investigators and suggest that having an FH of alcoholism cannot account for cognitive impairment among chronic alcoholics.

Research paper thumbnail of Television Exposure in Children after a Terrorist Incident

Psychiatry: Interpersonal and Biological Processes, 2001

This study examined the influence of bomb-related television viewing in the context of physical a... more This study examined the influence of bomb-related television viewing in the context of physical and emotional exposure on posttraumatic stress symptoms--intrusion, avoidance, and arousal--in middle school students following the 1995 Oklahoma City bombing. Over 2,000 middle school students in Oklahoma City were surveyed 7 weeks after the incident. The primary outcome measures were the total posttraumatic stress symptom score and symptom cluster scores at the time of assessment. Bomb-related television viewing in the aftermath of the disaster was extensive. Both emotional and television exposure were associated with posttraumatic stress at 7 weeks. Among children with no physical or emotional exposure, the degree of television exposure was directly related to posttraumatic stress symptomatology. These findings suggest that television viewing in the aftermath of a disaster may make a small contribution to subsequent posttraumatic stress symptomatology in children or that increased television viewing may be a sign of current distress and that it should be monitored. Future research should examine further whether early symptoms predict increased television viewing and/or whether television viewing predicts subsequent symptoms.

Research paper thumbnail of Neurocognitive function in alcoholic, schizophrenic, and dually diagnosed patients

Psychiatry Research, 1996

functions were compared in alcoholic, schizophrenic, and dually diagnosed (schizophrenic and alco... more functions were compared in alcoholic, schizophrenic, and dually diagnosed (schizophrenic and alcoholic) patients and community control volunteers. Participants (N = 52, n = 13 in each group) completed a brief battery including two measures of neuropsychological function and two affective measures. The neuropsychological tests included the Trail-Making Test Forms A and B and a face-recognition test. The affective measures included assessment of anxiety and depression. The major objective was to compare the patterns of neurocognitive performance among the four groups. The groups did not differ in mean age (35.37) or years of education (12.46). Compared with the community control and alcoholic groups, the schizophrenic groups reported higher mean depression (12.92 vs. 5.54) and mean state anxiety scores (60.73 vs. 46.04). Control subjects were generally, although not always significantly, superior to the other groups. Contrary to expectations, alcoholic patients were not consistently better than the schizophrenic groups, and dually diagnosed participants were not more impaired than schizophrenic patients without substance abuse histories. Thus, the interaction of schizophrenia and substance abuse did not have an additive effect on neurocognitive performance assessed in this study. More research using this complete four-group design and a larger neurocognitive batteq is needed.

Research paper thumbnail of An empirical assessment of post-treatment alcohol consumption

Psychiatry Research, 2003

Substance abuse treatment programs have long contended that any post-treatment alcohol use is ind... more Substance abuse treatment programs have long contended that any post-treatment alcohol use is indicative of relapse. Recent studies, however, suggest more inclusive definitions. Cisler (1996, 1999) consider both the drinking quantity and negative drinking consequences. Their proposed cutoffs integrate the 1995 NIAAA guidelines for sensible and high risk drinking levels with the objective assessment of drinking-related consequences into the definition of relapse. Our study applied this model to a group of detoxified alcoholics in a post-treatment followup project. We asked if: (1) Zweben and Cisler's drinking categories could be found in our sample; (2) whether subgroups defined by post-treatment drinking patterns differed with respect to their pre-treatment alcohol consumption levels, years of alcoholic drinking and drinking related problems; and (3) whether post-treatment drinking patterns were associated with differential psychosocial functioning at followup. Thirteen percent of the total sample (Ns61) was found to meet Zweben and Cisler's moderate drinking category; 34% were abstinent, 27% heavy drinkers and 13 participants (26%) were unclassifiable. At treatment completion (T1), those who became moderate drinkers reported higher levels of self-confidence, but were otherwise similar to both abstainers and heavy drinkers. At followup (T2), approximately 1 year after initial testing (T1), groups differed on measures of emotional discharge, avoidance and logical coping skills and information seeking, suggesting a possible association between post-treatment drinking patterns and psychosocial functioning. ᮊ

Research paper thumbnail of Neurophysiological efficiency in male and female alcoholics

Chronic alcoholics often exhibit impairment in behavioral indicators of cognitive efficiency. How... more Chronic alcoholics often exhibit impairment in behavioral indicators of cognitive efficiency. However, potential neurophysiological correlates of this deficit are understudied. To examine this function, semantic expectancy was measured by recording the N400 component of the event-related potential (ERP), which is elicited by incongruent semantic information. Abstinent alcoholics, 21 -45 days sober (n = 26; 12 males, 14 females), as well as age and education equated community controls (n = 26; 12 males, 14 females), were instructed to read silently 218 sentences ending with either congruent, related/incongruent, or unrelated/incongruent terminal words. Difference waveforms to the terminal word were derived, and amplitude and latency measures of the most negative peak between 300 and 600 ms were obtained. Electrode sites included the midline sites, Fz, Cz, and Pz; the temporal sites T3 and T4; and parietal sites P3 and P4. Significant group effects in amplitude were observed for the difference waveform under the unrelated/incongruent condition at T3, T4, and P4 ( P .05). Measures at P3, Pz, Fz, and Cz approached significance ( P .15). Although the overall pattern did not change when regression techniques were used to control for age, only the T4 site retained significance ( P .05). Across all electrode sites, alcoholics produced reduced N400 amplitudes relative to community controls. Latency was unaffected. There were no group effects for amplitude or latency measures in the related/incongruent condition. These data are consistent with the hypothesis that alcoholics suffer from a subtle deficiency in neurophysiologically based cognitive efficiency which renders them less likely to respond appropriately to irrelevant information. D

Research paper thumbnail of Substance abuse-related P300 differences in response to an implicit memory task

Research paper thumbnail of Visual–spatial attention in alcoholics and illicit stimulant abusers: effects of nicotine replacement

Reports of alcohol or illicit drug-related cognitive impairments have frequently disregarded the ... more Reports of alcohol or illicit drug-related cognitive impairments have frequently disregarded the potentially confounding effects of smoking status and nicotine withdrawal on these measures. This study addressed this issue by measuring visual-spatial attention via an adaptation of the Posner paradigm in three groups of tobacco smokers: controls without a history of alcoholism or illicit drug use (n=27; 20 male), chronic alcoholics (n=22; 18 male), and illicit stimulant abusers (n=36; 21 male). Throughout testing, nicotine levels were stabilized by the double-blind administration of a high (14 or 21 mg) or low (7 mg) dose transdermal nicotine patch. A significant effect of group was observed for number of correct responses to restriction trials ( F=5.48, 2/79 df; p=.006). Performance was normalized in the illicit stimulant group, and alcoholic participants exhibited superior performance relative to both illicit stimulant abusers ( p=.002) and controls ( p=.01). These findings support the hypothesis that nicotine may have a compensatory or normalizing effect on attentional functions in substance abusers. Whether these results reflect the central nervous system-activating effects of nicotine or merely alleviation of nicotine withdrawal is a topic of ongoing research. D

Research paper thumbnail of Posttraumatic Stress Responses in Bereaved Children After the Oklahoma City Bombing

Journal of the American Academy of Child & Adolescent Psychiatry, 1999

To investigate the responses of middle and high school students exposed to the 1995 Oklahoma City... more To investigate the responses of middle and high school students exposed to the 1995 Oklahoma City bombing across a spectrum of loss. A questionnaire measuring exposure, personal consequences, initial response, and current posttraumatic stress and other symptoms was administered to 3,218 students 7 weeks after the explosion. More than one third of the sample knew someone killed in the explosion. Bereaved youths were more likely than nonbereaved peers to report immediate symptoms of arousal and fear, changes in their home and school environment, and posttraumatic stress symptoms. Retrospective measures of initial arousal and fear predicted posttraumatic stress symptoms at 7 weeks. The results support the literature addressing the role of initial response in posttraumatic stress symptom development. The study raises concern about the impact of television, and traumatized youths' reactivity to it, in the aftermath of disaster.

Research paper thumbnail of Transdermal Nicotine Administration and the Electroencephalographic Activity of Substance Abusers in Treatment

Objectives-It is widely recognized that individuals with alcohol or illicit substance abuse disor... more Objectives-It is widely recognized that individuals with alcohol or illicit substance abuse disorders often smoke cigarettes. However, few studies have examined the direct effects of nicotine among substance abuse subgroups. The current study examined patterns of electroencephalographic (EEG) activity in alcohol-dependent (AD), stimulant-dependent (StimD), alcohol-and stimulantdependent (ASD) participants, as well as community controls (CC). All participants were regular smokers.

Research paper thumbnail of Alcohol and Health Disparities in Nonreservation American Indian Communities

Alcoholism: Clinical & Experimental Research, 2003

Research paper thumbnail of Patterns of Cognitive Impairment among Alcoholics: Are There Subtypes?

Alcoholism: Clinical and Experimental Research, 1995

The mild generalized dysfunction hypothesis of alcohol abuse's deleterious effects on cognitive p... more The mild generalized dysfunction hypothesis of alcohol abuse's deleterious effects on cognitive processes has gained support from a number of studies in which detoxified alcoholics have a lower mean performance level than peer controls on a variety of neuropsychological tests. This approach might obscure consistent but different patterns of preserved and impaired cognitive performance among subgroups of alcoholics, suggestive of alternative hypotheses. To test this possibility, neuropsychological test data from two large, independent samples of alcoholics (sample 1, n = 143; sample 2, n = 130) and controls (sample 1, n = 97; sample 2, n = 83) were subjected to separate centroid hierarchical cluster analyses. For both samples, the majority of alcoholics (94% and 94%) exhibited a pattern of impaired verbal and nonverbal performance and deficits in memory and perceptual motor skill, with normal motor skill. The alcoholics who did not fit this pattern showed more severe or wide-ranging impairments. These findings indicate that empirical support for the mild generalized dysfunction hypothesis of alcoholics' cognitive deficits is not an artifact of averaging.

Research paper thumbnail of Behavioral Dysfunction and Cognitive Efficiency in Male and Female Alcoholics

Alcoholism: Clinical and Experimental Research, 1995

This study was conducted to examine the role of childhood behavioral disorders (CBDs) and residua... more This study was conducted to examine the role of childhood behavioral disorders (CBDs) and residual attention deficit disorder (AD-DRT) in alcohol-related cognitive dysfunction in male and female subjects. Alcoholic (n = 44 females, 56 males) and control (n = 40 females, 40 males) subjects completed assessments that included measures of CBDs, ADDRT, and cognitive and psychosocial functioning. Cognitive tests were specifically designed to assess efficiency in function. As expected, alcoholics were inferior to controls in their cognitive efficiency [F(1,171) = 10.43, p = 0.0015]. Alcoholics reported more CBDs [F(1,161) = 12.02,~ = O.O007], regardless of sex. They also reported more ADDRT [F(1,173) = 44.12, p = O.OOOl] than did controls. There were also sex [F(l,173) = 13.31, p = 0.0004] and group by sex effects [F(1,173) = 3.93, p = 0.051. Female alcoholics

Research paper thumbnail of Interpersonal Problem-Solving in Male and Female Alcoholics

Alcoholism: Clinical and Experimental Research, 1992

This study compared the performance of alcoholics (18 male, 16 female) with community controls (1... more This study compared the performance of alcoholics (18 male, 16 female) with community controls (15 male, 12 female) on the Adaptive Skills Battery (ASB), a test of interpersonal problem-solving. The ASB consists of 30 situations. Fifteen situations require subjects' typical responses and 15, their optimal responses. Male and female alcoholics were inferior to controls in their typical responses [F(1,57) = 45.22, p = 0.0001], but did not differ on the optimal responses (F less than 1). Further analyses indicated that decreased feelings of self-efficacy could not account for the alcoholic deficit. Females were superior to males in the optimal response condition [(F(1,56) = 9.90, p = 0.003]. No significant group x sex interactions were obtained. Performance on the ASB was not correlated with performance on traditional measures of problem-solving. Post-hoc correlational analyses revealed differential patterns between depression scores and performance for alcoholics and controls. These data suggest that (1) female and male alcoholics exhibit similar interpersonal problem-solving deficits, (2) alcoholic self-efficacy expectancies cannot account for the impairment, (3) the ASB appears to assess aspects of problem-solving not typically examined, and (4) the role of depression in alcoholic performance deserves continued empirical evaluation.

Research paper thumbnail of Cognitive Efficiency in Stimulant Abusers With and Without Alcohol Dependence

Alcoholism: Clinical & Experimental Research, 2003

Background: Although previous studies have found stimulant (i.e., cocaine, methamphetamine) abuse... more Background: Although previous studies have found stimulant (i.e., cocaine, methamphetamine) abusers and alcoholics to have neuropsychological deficits, research examining which cognitive abilities are most affected by concurrent exposure to these substances is lacking. To address this issue, detoxified men and women who met criteria for dependence of (a) alcohol only (ALC) (n ϭ 15); (b) stimulants only (STIM) (n ϭ 15); and (c) both alcohol and stimulants (A/STIM) (n ϭ 15) were compared with age-and educationmatched community controls (n ϭ 15).