Blood alcohol level among emergency room patients: a multivariate analysis

This article examines the distribution of positive blood alcohol levels (BALs) among emergency room patients and the relationship between intoxication and other variables. Approximately one-quarter of the 640 subjects had positive blood alcohol levels and 16.3% had BAL readings above 0.10%, the legal limit for operating a motor vehicle in most states. Chi-square tests and logistic regression analysis indicated a significant relationship between employment status, gender, educational attainment, age and BAL. There were no significant racial differences. Analysis of the role of the presenting problem with BAL revealed that being involved in an accident was significantly predictive of a high BAL in a multivariate context. However, patients presenting with psychiatric problems had overall higher levels of intoxication than other patients. These findings have major implications for public policy formulation vis-à-vis public health delivery.     

HIV and AIDS risk behaviors among female jail detainees: implications for public health policy

OBJECTIVES: We examined the sexual and injection drug use HIV and AIDS risk behaviors of female jail detainees. METHODS: The sample (n = 948) was stratified by charge type (felony vs misdemeanor) and race/ethnicity (African American, non-Hispanic White, Hispanic, other). RESULTS: Non-Hispanic White women, women arrested for less serious charges, women who had prior arrests, women arrested on drug charges, and women with severe mental disorders were at especially high risk for sexual and injection drug transmission of HIV and AIDS. CONCLUSIONS: Many women at risk for HIV and AIDS--women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorders--eventually will cycle through jail. Because most jail detainees return to their communities within days, providing HIV and AIDS education in jail must become a public health priority.     

Police-referred psychiatric emergencies: advantages of community treatment

Police traditionally have brought persons they define to be in need of psychiatric intervention to state hospitals. However, as large state facilities decline, community mental health centers must be prepared to receive these individuals. The present study defines the client population that police bring to a large, urban community mental health center. In addition, a two-year follow-up compares the dispositions of those persons brought by police to the community mental health center with the outcomes for patients treated at a state facility. Treatment benefits inherent in such a community-based program are discussed.     

Crime victimization in adults with severe mental illness: comparison with the National Crime Victimization Survey

CONTEXT: Since deinstitutionalization, most persons with severe mental illness (SMI) now live in the community, where they are at great risk for crime victimization. OBJECTIVES: To determine the prevalence and incidence of crime victimization among persons with SMI by sex, race/ethnicity, and age, and to compare rates with general population data (the National Crime Victimization Survey), controlling for income and demographic differences between the samples. DESIGN: Epidemiologic study of persons in treatment. Independent master's-level clinical research interviewers administered the National Crime Victimization Survey to randomly selected patients sampled from 16 randomly selected mental health agencies. SETTING: Sixteen agencies providing outpatient, day, and residential treatment to persons with SMI in Chicago, Ill. PARTICIPANTS: Randomly selected, stratified sample of 936 patients aged 18 or older (483 men, 453 women) who were African American (n = 329), non-Hispanic white (n = 321), Hispanic (n = 270), or other race/ethnicity (n = 22). The comparison group comprised 32 449 participants in the National Crime Victimization Survey. MAIN OUTCOME MEASURE: National Crime Victimization Survey, developed by the Bureau of Justice Statistics. RESULTS: More than one quarter of persons with SMI had been victims of a violent crime in the past year, a rate more than 11 times higher than the general population rates even after controlling for demographic differences between the 2 samples (P<.001). The annual incidence of violent crime in the SMI sample (168.2 incidents per 1000 persons) is more than 4 times higher than the general population rates (39.9 incidents per 1000 persons) (P<.001). Depending on the type of violent crime (rape/sexual assault, robbery, assault, and their subcategories), prevalence was 6 to 23 times greater among persons with SMI than among the general population. CONCLUSIONS: Crime victimization is a major public health problem among persons with SMI who are treated in the community. We recommend directions for future research, propose modifications in public policy, and suggest how the mental health system can respond to reduce victimization and its consequences.     

Multiple substance use disorders in juvenile detainees

OBJECTIVE: To estimate the 6-month prevalence of multiple substance use disorders (SUDs) among juvenile detainees by demographic subgroups (sex, race/ethnicity, age). METHOD: Participants were a randomly selected sample of 1,829 African American, non-Hispanic white, and Hispanic detainees (1,172 males, 657 females, aged 10 to 18). Patterns and prevalence of DSM-III-R multiple SUDs were assessed using the Diagnostic Interview Schedule for Children Version 2.3. The authors used two-tailed F and t tests with an alpha of .05 to examine combinations of SUDs by sex, race/ethnicity, and age. RESULTS: Nearly half of the detainees had one or more SUDs; more than 21% had two or more SUDs. The most prevalent combination of SUDs was alcohol and marijuana use disorders (17.25% females, 19.42% males). Among detainees with any SUD, almost half had multiple SUDs. Among detainees with alcohol use disorder, more than 80% also had one or more drug use disorders. Among detainees with a drug use disorder, approximately 50% also had an alcohol use disorder. CONCLUSIONS: Among detained youths with any SUD, multiple SUDs are the rule, not the exception. Substance abuse treatments need to target detainees with multiple SUDs who, upon release, return to communities where services are often unavailable. Clinicians can help ensure continuity of care by working with juvenile courts and detention centers.     

Screening for alcohol use patterns among methadone maintenance patients

Alcohol use among Methadone Maintenance Treatment (MMT) patients poses a major health risk, exacerbates psychopathology, and increases the risk of death by accidental overdose. Despite these factors, screening for alcohol use remains underutilized in the methadone community. Utilizing a self-report screening measure - the Michigan Alcohol Screening Test (MAST) - and consistent with the literature, we found high rates of alcohol problems among MMT patients. Benefits and limitations of using the MAST to screen for alcohol use patterns are discussed.     

Suicidal ideation and behaviors among youths in juvenile detention

OBJECTIVE: To examine suicidal ideation, suicide attempts, lethality of suicide attempts, and the relationship between psychiatric disorder and recent attempts in newly detained juveniles. METHOD: The sample included 1,829 juveniles, ages 10 to 18 years, sampled after intake to a detention center in Chicago. Interviewers administered the Diagnostic Interview Schedule for Children to assess for thoughts of death, suicidal ideation, suicide plans, lifetime suicide attempts, number of attempts, age at first attempt, attempts within the past 6 months, method of suicide attempts, and psychiatric disorder. RESULTS: More than one third of juvenile detainees and nearly half of females had felt hopeless or thought about death in the 6 months before detention. Approximately 1 in 10 (10.3%, 95% confidence interval: 7.7%-12.8%) juvenile detainees had thought about committing suicide in the past 6 months, and 1 in 10 (11.0%, 95% confidence interval: 8.3%-13.7%) had ever attempted suicide. Recent suicide attempts were most prevalent in females and youths with major depression and generalized anxiety disorder. CONCLUSIONS: Fewer than half of detainees with recent thoughts of suicide had told anyone about their ideation. Identifying youths at risk for suicide, especially those suffering from depressive and anxiety disorders, is a crucial step in preventing suicide.     

Psychiatric and substance abuse disorders among male urban jail detainees.

This paper presents prevalence rates by race/ethnicity and age for nine psychiatric and substance use disorders found in a random sample of 728 male jail detainees. Two thirds of the sample detainees had had a disorder other than antisocial personality during their lifetimes; half of these had had an episode within 2 weeks of the interview. More than 30% currently had either a severe mental disorder or a substance use disorder. Detainees with severe mental disorders or substance use disorders were most often in jail because they had committed nonviolent crimes. Policy implications of the results are discussed.     

Tampering by office-based methadone maintenance patients with methadone take home privileges: a pilot study

Methadone Maintenance Treatment (MMT) is among the most widely studied treatments for opiate dependence with proven benefits for patients and society. When misused, however, methadone can also be lethal. The issue of methadone diversion is a major concern for all MMT programs. A potential source for such diversion is from those MMT patients who receive daily take home methadone doses. Using a reverse phase high performance liquid chromatography method, seven of the nine patients who were randomly selected to have all of their remaining methadone take home doses (within a 24 hour period) analyzed, returned lower than expected quantities of methadone. This finding suggests the possibility that such patients may have tampered with their daily take home doses. Larger prospective observational studies are clearly needed to test the supposition of this pilot study.