Substance Abuse in Older Adults: Review and Recommendations for Education and Practice in Medical Settings

Waldo DR , Sonnefeld ST , McKusick DR and Amett RH III . 1989. Health expenditures by age group: 1977 and 1987. Health Care Financ Rev, 10 (4): 111–120.

Schneider EL and Guralnik J . 1990. The aging of America: impact on health care costs. JAMA, 263: 2335–2340.

Fuchs V . 1999. Health care for the elderly: How much? Who will pay for it?. Health Aff (Millwood), 18: 11–21.

Krop JS , Powe NR , Weller WE , Shaffer TJ , Saudek CD and Anderson GF . 1998. Patterns of expenditures and use of services among older adults with diabetes: implications for the transition to capitated managed care. Diabetes Care, 21 (5): 747–752.

Barry K . 1997. “Alcohol and drug abuse”. In Fundamentals of Clinical Practice: A Textbook on the Patient, Doctor, and Society, Edited by: Mengle M and Hollman W . New York: Plenum Medical Book Company.

Gambert SR and Katsoyannis KK . 1995. “Alcohol–related medical disorders of older heavy drinkers”. In Alcohol and Aging, Edited by: Beresford T and Gomberg ESL . 70–81. New York: Oxford University Press.

Liberto JG , Oslin DW and Ruskin PE . 1992. Alcoholism in older persons: a review of the literature. Hosp Community Psychiatry, 43: 975–984.

Finch J and Barry KL . 1992. “Substance use in older adults”. In Addictive Disorders, Edited by: Fleming M and Barry K . 270–286. St. Louis, Mo.: Mosby Yearbook Medical Publishers.

Wetle T . 1997. Living longer, aging better: aging research comes of zge. JAMA, 278 (16): 1376–1377.

Brower KJ , Blow FC and Beresford TP . 1989. Treatment implications of chemical dependency models: an integrative approach. J Subst Abuse Treat, 6: 147–157.

Sessel T . 1988. Beyond the Supreme Court ruling on alcoholism as willful misconduct: it is up to Congress to act. JAMA, 260 (2): 248

Fleming MF , Manwell LB , Barry KL , Adams W and Stauffacher EA . 1999. Brief physician advice for alcohol problems in older adults: a randomized community–based trial. J Fam Pract, 48 (5): 378–384.

Baird M . 1992. “Care of family members and other affected persons”. In Addictive Disorders, Edited by: Fleming M and Barry K . 195–210. St. Louis, Mo.: Mosby Yearbook Medical Publishers.

Schuckit M . 1982. A clinical review of alcohol, alcoholism, and the elderly patient. J Clin Psychiatry, 43 (10): 396–399.

Beigel A and Ghertner S . 1977. “Toward a social model: an assessment of social factors which influence problem drinking and its treatment”. In The Biology of Alcoholism. Treatment and Rehabilitation of the Chronic Alcoholic, Edited by: Kissin B and Begleiter H . 197–233. New York: Plenum.

Khantzian E . 1985. The self–medication hypothesis of addiction disorders for heroin and cocaine dependence. Am J Psychiatry, 142 (11): 1259–1264.

American Medical Association. 1999. Master File of the American Medical Association. 1999, Chicago, Ill.: AMA.

Bureau of Labor Statistics. 2000. Annual Average Tables. January 2000 Issue of Employment and Earnings, Washington, DC: Office of Employment and Unemployment Statistics.

American Association of Colleges of Nursing. February 17 2000. “Nursing school enrollments decline as demand for RNs continues to climb”. February 17, accessed May 23, 2000. Web page. Available at: http://www.aacn.org.

American Academy of Physician Assistants: Data and Statistics. Accessed May 25, 2000. Web page. Available at: http://www.aapa.org. (http://www.aapa.org.)

Lennon T . 1999. Statistics of Social Work Education: 1998, Alexandria, Va.: Council on Social Work Education.

American Association of Colleges of Pharmacy. 2000. “Pharmacy Education: Facts and Figures”. Available at: http://www.aacp.org. Accessed May 23, 2000

American Geriatrics Society. About the AGS. Available at: http://www.americangeriatrics.org. Accessed May 23, 2000. (http://www.americangeriatrics.org. Accessed May 23, 2000.)

Adams WL , Barry KL and Fleming MF . 1996. Screening for problem drinking in older primary care patients. JAMA, 276: 1964–1967.

Blow FC , Cook CA , Booth BM , Falcon SP and Friedman MJ . 1992. Age–related psychiatric comorbidities and level of functioning in alcoholic veterans seeking outpatient treatment. Hosp Community Psychiatry, 43: 990–995.

Blow FC , Brower KJ , Schulenberg JE , Demo–Dananberg LM , Young JP and Beresford TP . 1992. The Michigan Alcoholism Screening Test—Geriatric Version (MAST–G): a new elderly–specific screening instrument. Alcohol CM Exp Res, 16: 372

Robins LN , Helzer JE , Weissman MM , Orvascel H , Gruenberg E , Burke JD Jr. and Reigler DA . 1984. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Med, 41 (10): 949–958.

Blow FC , Gillespie BW , Barry KL , Mudd SA and Hill EM . 1998. Brief screening for alcohol problems in an elderly population using the Short Michigan Alcoholism Screening Test–Geriatric Version (SMAST–G). Proc R Soc Addiction, : 20–25.

Gurland BJ and Cross PS . 1982. Epidemiology of psychopathology in old age: some implications for clinical services. Psychiatr Clin North Am, 5 (1): 11–26.

Schuckit MA and Pastor PA Jr. 1978. The elderly as a unique population. Alcohol Clin Exp Res, 2: 31–38.

Beresford T . 1979. Alcoholism consultation and general hospital psychiatry. Gen Hosp Psychiatry, 1: 293–300.

Institute of Medicine, Division of Mental Health and Behavioral Medicine. 1990. “Who provides treatment?”. In Broadening the Base of Treatment for Alcoholism, 98–141. Washington, DC: National Academy Press.

Coulehan JL , Zettler–Segal M , Block M , McClelland M and Schulberg HC . 1987. Recognition of alcoholism and substance abuse in primary care patients. Arch Intern Med, 147: 349–352.

Blow F . 1998. Substance Abuse Among Older Adults, Treatment Improvement Protocol (TIP) Series. No. 26Rockville, Md.: Substance Abuse and Mental Health Services Administration.

Dufour MC and Fuller RK . 1995. Alcohol in the elderly. Annu Rev Med, 46: 123–132.

Chermack ST , Blow FC , Hill EM and Mudd SA . 1996. The relationship between alcohol symptoms and consumption among older drinkers. Alcohol Clin Exp Res, 20(1): 153–1158.

Doll R , Peto R , Hall E , Wheatley K and Gray R . 1994. Mortality in relation to consumption of alcohol: 13 years’ observation on male British doctors. Br Med J, 309: 911–918.

Klatsky AL , Armstrong MA and Friedman GD . 1997. Red wine, white wine, liquor, beer, and risk for coronary artery disease hospitalization. Am J Cardiol, 80 (4): 416–420.

Poikolainen K . 1997. Epidemiologic assessment of population risks and benefits of alcohol use. Alcohol Alcohol, : 27–34.

Atkinson R . 1990. Aging and alcohol use disorders: diagnostic issues in the elderly. Int Psychogeriatr, 2(1): J.–55–72.

American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Washington DC: American Psychiatric Association.

Barry KL and Blow FC . “Screening and assessment of alcohol problems in older adults”. In Handbook of Assessment in Clinical Gerontology, Edited by: Lichtenberg P . New York: Wiley. In press

Barry K . 1999. Brief Interventions and Brief Therapies for Substance Abuse, Rockville, Md.: Substance Abuse and Mental Health Services Administration.

Atkinson R . 1995. “Treatment programs for aging alcoholics”. In Alcohol and Aging, Edited by: Beresford TP and Gomberg ESL . 186–210. New York: Oxford University Press.

Hansagi H , Romelsjo A , Gerhardsson De Verdier M , Andreasson S and Leifman A . 1995. Alcohol consumption and stroke mortality: 20–year follow–up of 15,077 men and women. Stroke, 26: 1768–1773.

Kivela SL , Nissinen A and Ketola A . 1989. Alcohol consumption and mortality in aging or aged Finnish men. J Clin Epidemiol, 42: 61–68.

Adams W . 1995. Interactions between alcohol and other drugs. Int J Addict, 30: 1903–1923.

Fraser A . 1997. Pharmacokinetic interactions between alcohol and other drugs. Clin Pharmacokinet, 33: 79–90.

Hylek EM , Heiman H , Skatess J , Sheehan MA and Singer DE . 1998. Acetaminophen and other risk factors for excessive warfarin anti–coagulation. JAMA, 279 (9): 657–662.

Willett WC , Stampfer MJ , Colditz GA , Rosner BA , Hennekens CH and Speizer FE . 1987. Moderate alcohol consumption and the risk of breast cancer. N Engl J Med, 316 (19): 1174–1189.

Ensrud KE , Nevitt MC , Yunis C , Cauley JA , Seeley DG , Fox KM and Cummings SR . 1994. Correlates of impaired function in older. women. J Am Geriatr Soc, 42: 481–489.

LaCroix AZ , Guralnik JM , Berkman LF , Wallace RB and Satterfield S . 1993. Maintaining mobility in late life. II. Smoking, alcohol consumption, physical activity, and body mass index. Am J Epidemiol, 137: 858–869.

Nelson DE , Sattin RW , Langlois JA , DeVito CA and Stevens JA . 1992. Alcohol as a risk factor for fall injury events among elderly persons living in the community. J Am Geriatr Soc, 40: 658–661.

Nelson HD , Nevitt MC , Scott JC , Stone KL and Cummings SR . 1994. Smoking, alcohol, and neuromuscular and physical function of older women. JAMA, 272: 1825–1831.

O'Loughlin JL , Dartigues JF , Lafont S , Letenneur L , Commenges D , Salamone R , Renaud S and Breteler MB . 1993. Incidence of and risk factors to falls and injurious falls among the community–dwelling elderly. Am J Epidemiol, 137: 342–354.

Scherr PA , LaCroix AZ , Wallace RB , Berkman L , Curb JD , Coroni–Huntley J and Evans DA . 1992. Light to moderate alcohol consumption and mortality in the elderly. J Am Geriatr Soc, 40: 651–657.

Joseph CL , Atkinson RM and Ganzini L . 1995. Problem drinking among residents of a VA nursing home. Int J Geriatr Psych, 10: 243–248.

Oslin DW , Streim JE , Parmelee P , Boyce AA and Katz IR . 1997. Alcohol abuse: a source of reversible functional disability among residents. Int J Geriatr Psych, 12 (8): 825–832.

Finlayson RE , Hurt RD , Davis LJ Jr and Morse RM . 1988. Alcoholism in elderly persons: a study of the psychiatric and psychosocial features of 216 inpatients. Mayo Clin Proc, 63: 761–768.

Blazer D and Williams CD . 1980. Epidemiology of dysphoria and depression in an elderly population. Am J Psychiatry, 137: 439–444.

Saunders PA , Copeland JR , Dewey ME , Davidson AI , McWilliam C , Sharma V and Sullivan C . 1991. Heavy drinking as a risk factor for depression and dementia in elderly men. Br J Psychiatry, 159: 213–216.

Conwell Y . 1994. “Suicide in elderly patients”. In Diagnosis and Treatment of Depression in Late Life, Edited by: Schneider LS , Reynolds CF III , Lebowitz BD and Friedhoff AJ . 397–418. Washington, DC: American Psychiatric Press.

Cook BL , Winkokur G , Garvey MJ and Beach V . 1991. Depression and previous alcoholism in the elderly. Br J Psychiatry, 158: 72–75.

George LK , Landerman R , Blazer DG and Anthony DC . 1991. “Cognitive impairment”. In Psychiatric Disorders in America: The Epidemiologic Catchment Area Study, Edited by: Robins LN and Reiger DA . 291–327. New York: Free Press.

Rains V and Ditzler T . 1993. Alcohol use disorders in cognitively impaired patients referred for geriatric assessment. J Addict Dis, 12: 55–64.

Wagman AM , Allen RP and Upright D . 1997. Effects of alcohol consumption upon parameters of ultradian sleep rhythms in alcoholics. Adv Exp Med Biol, 85A: 601–616.

Moeller FG , Gillin JC , Irwin M , Golshan S , Kripke DF and Shuckit M . 1993. A comparison of sleep EEGs in patients with primary major depression and major depression secondary to alcoholism. J Affect Disord, 27: 39–42.

Oslin D . 1996. “Alcohol”. In Geriatric Secrets, Philadelphia: Hanley and Belfus.

Thun MJ , Peto R , Lopez AD , Monaco JH , Henley SJ , Health CW Jr and Doll R . 1997. Alcohol consumption and mortality among middle–aged and elderly US adults. N Engl J Med, 337 (24): 1705–1714.

Dufour MC , Archer L and Gordis E . 1992. Alcohol and the elderly. Clin Geriatr Med, 8: 127–141.

Graham K and Schmidt G . 1999. Alcohol use and psychosocial well–being among older adults. J Stud Alcohol, 60: 345–351.

Boffetta P and Garflnkel L . 1990. Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study. Epidemiology, 1: 342–348.

Broe GA , Creasey H , Jorm AF , Bennett HP , Casey B , Waite LM , Grayson DA and Cullen J . 1998. Health habits and risk of cognitive impairment and dementia. AustNZJPublic Health, 22: 621–623.

DeLabry LO , Glynn RJ , Levenson MR , Hermos JA , Lacastro JS and Vokonas PS . 1992. Alcohol consumption and mortality in an American male population: recovering the U–shaped curve—findings from a normative aging study. J Stud Alcohol, 53: 25–32.

Klatsky AL , Armstrong MA and Friedman GD . 1990. Risk of cardiovascular mortality in alcohol drinkers and nondrinkers. Am J Cardiol, 66: 1237–1242.

Orgogozo JM , Streim JE , Parmelee P , Boyce AA and Katz IR . 1997. Wine consumption and dementia in the elderly: a prospective community study in the Bordeaux area. Rev Neurol (Paris), 153 (3): 185–192.

Rimm EB , Giovannucci EL , Willett WC , Colditz GA , Ascherio A , Rosner B and Stampfer MJ . 1991. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet, 338: 464–468.

Shaper A . 1990. Alcohol and mortality: a review of prospective studies. Br J Addiction, 85: 837–847.

Stampfer MJ , Willett WC , Colditz GA , Speizer FE and Hennekens CH . 1988. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N Engl J Med, 319 (5): 267–273.

Conigliaro J , Lofgren RP and Hanusa BH . 1998. Screening for problem drinking: impact on physician behavior and patient drinking habits. J Gen Intern Med, 13: 251–256.

US Department of Health and Human Services. January 2000. Healthy People 2010, Conference Edition, 2–vol, January, Washington, DC: Department of Health and Human Services.

Greist JH , Klein MH , Erdman HP and Bires JK . 1987. Comparison of computer– and interviewer–administered versions of the Diagnostic Interview Schedule. Hosp Community Psychiatry, 38 (12): 1304–1311.

Barry KL and Fleming MF . 1990. Computerized administration of alcoholism screening tests in a primary care setting. J Am Board Fam Pract, 3: 93–98.

Flynn HA , Blow FC , Walton MA and Barry KL .in press. Changes in older adult drinking after screening. Subst Use Misuse,

Mayfield D , McLeod G and Hall P . 1974. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry, 131 (10): 1121–1123.

Fleming MF and Barry KL . 1991. A three–sample test of a masked alcohol screening questionnaire. Alcohol Alcohol, 26: 81–91.

Bush B , Shaw S , Cleary P , Delbanco TL and Aronson MD . 1987. Screening for alcohol abuse using the CAGE questionnaire. Am J Med, 82: 231–235.

Beresford TP , Blow FC , Hill E , Singer K and Lucey MR . 1990. Comparison of CAGE questionnaire and computer–assisted laboratory profiles in screening for covert alcoholism. Lancet, 336: 482–485.

Babor TF , Kranzler HR and Lauerman RJ . 1989. Early detection of harmful alcohol consumption: comparison of clinical, laboratory, and self–report screening procedures. Addict Behav, 14 (2): 139–157.

Fleming MF , Barry KL and MacDonald R . 1991. The Alcohol Use Disorders Identification Test (AUDIT) in a college sample. Int J Addict, 2b: 1173–1185.

Schmidt A , Barry KL and Fleming MF . 1995. Detection of problem drinkers: the Alcohol Use Disorders Identification Test (AUDIT). South Med J, 88 (1): 52–59.

Committee of the Institute of Medicine (Division of Mental Health and Behavioral Medicine). 1990. “Assessment”. In Broadening the Base of Treatment for Alcoholism, 242–278. Washington, DC: National Academy Press.

Spitzer RL , Williams JBW and Skodol AE . 1980. DSM III: the major achievements and an overview. Am J Psychiatry, 137 (2): 151–164.

Robins LN , Helzer JE , Croughan J and Ratcliff KS . 1981. National Institute of Mental Health Diagnostic Interview Schedule. Arch Gen Psychiatry, 38: 381–389.

Babor TF , Ritson EB and Hodgson RJ . 1986. Alcohol–related problems in the primary health care setting: a review of early intervention strategies. Br J Addiction, 8 (1): 23–46.

Babor TF and Grant M . 1992. Project on identification and management of alcohol–related problems, Report on Phase II: a randomized clinical trial of brief interventions in primary health careGeneva, Switzerland: World Health Organization.

Barry KL and Fleming MF . 1994. The family physician. Alcohol Health Res World, 18: 105–109.

Chick J , Lloyd G and Crombie E . 1985. Counseling problem drinkers in medical wards: a controlled study. Br Med J, 290: 965–967.

Fleming MF , Barry KL , Manwell LB , Johnson K and London R . 1997. Brief physician advice for problem drinkers: a randomized controlled trial in community–based primary care practices. Alcohol Alcohol, 27: 1039–1045.

Wallace P , Cutler S and Haines A . 1988. Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. Br Med J, 297 (6649): 663–668.

Harris KB and Miller WR . 1990. Behavioral self–control training for problem drinkers. Psychol Addict Behav, 4 (2): 82–90.

Gentilello LM , Rivara FP , Donovan DM , Jurkocich GJ , Daranciang E , Dunn CW , Villaveces A , Copass M and Ries RR . 1999. Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg, 230 (4): 473–480.

Tomson Y , Romelsjo A and Aberg H . 1998. Excessive drinking: brief intervention by a primary health care nurse—a randomized controlled trial. Scand J Prim Health Care, 16 (3): 188–192.

Richmond RL , C–Novak K , Kehoe L , Calfas G , Mendelsohn CP and Wodak A . 1998. Effect of training on general practitioners’ use of a brief intervention for excessive drinkers. Aust NZ J Public Health, 22 (2): 206–209.

Walsh R , Sanson–Rsher RW , Low A and Roche AM . 1999. Teaching medical students alcohol intervention skills: results of a controlled trial. Med Educ, 33 (8): 559–565.

National Institute on Alcohol Abuse and Alcoholism. April 1999. “Brief intervention for alcohol problems”. April, Available at http://silk.nih.gov/silk/niaaal/publication/aa43.htm. Accessed January 25, 2000.

Kristenson H , Ohlin H , Hulten–Nosslin MB , Trell E and Hood B . 1983. Identification and intervention of heavy drinking in middle–aged men: results and follow–up of 24–60 months of long–term study with randomized controls. Alcohol Clin Exp Res, 7 (2): 203–209.

Persson J and Magnusson P–H . 1989. Early intervention in patients with excessive consumption of alcohol: a controlled study. Alcohol, 6: 403–8.

Miller WR and Heather N . 1986. Treating Addictive Behaviors: Process of Change, New York: Plenum Press.

Miller WR and Munoz RF . 1976. How to Control Your Drinking, Englewood Cliffs, NJ: Prentice–Hall.

Miller WR and Rollnick S . 1991. Motivational Interviewing: Preparing People to Change Addictive Behavior, New York: Guilford Press.

Miller WR and Taylor CA . 1980. Relative effectiveness of bibliotherapy, individual and group self–control training in the treatment of problem drinkers. Addict Behav, 5: 13–24.

Blow F . 1998. “The spectrum of alcohol interventions for older adults”. In Alcohol Problems and Aging, Edited by: Gomberg ESL , Hegedus AM and Zucker RA . 373–396. Washington, DC: NIAAA.

Fleming MF , Manwell LB , Barry KL , Adams W and Stauffacher EA . 1999. Brief physician advice for alcohol problems in older adults: a randomized community–based trial. J Fam Pract, 48 (5): 378–384.

Babor TF , Longabaugh R , Zweben A , Fuller RK , Stout RL and Randall CL . 1994. Issues in the definition and measurement of drinking outcomes in alcoholism treatment research. J Stud Alcohol, 12 (suppl): 101–111.

Prochaska JO and DiClemente CC . 1986. “Toward a comprehensive model of change”. In Treating Addictive Behaviors: Process of Change, Edited by: Miller WR and Heather N . 3–27. New York: Plenum Press.

DiClemente CC , Prochaska IO , Fairhurst SK , Velicer WF , Velasquez MM and Rossi JS . 1991. The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol, 59: 295–304.

Velicer WF , Prochaska JO , Rossi JS and Snow MG . 1992. Assessing outcome in smoking cessation studies. Psychol Bull, 111 (1): 23–41.

National Institute on Alcohol Abuse and Alcoholism. 1995. Diagnostic criteria for alcohol abuse. Alcohol Alert, 30: 1–6. (PH 359)

Brower KJ , Mudd S , Blow FC , Young JP and Hill EM . 1994. Severity and treatment of alcohol withdrawal in elderly versus younger patients. Alcohol Clin Exp Res, 18: 196–201.

Foy A , March S and Drinkwater V . 1988. Use of an objective clinical scale in the assessment and management of alcohol withdrawal in a large general hospital. Alcohol Clin Exp Res, 12: 360–364.

Sullivan JT , Sykora K , Schneiderman J , Naranjo CA and Sellers EM . 1989. Assessment of alcohol withdrawal: the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA–Ar). Br J Addict, 84 (11): 1353–1357.

AMA Council on Scientific Affairs. 1996. Alcoholism in the elderly. JAMA, 275: 797–801.

Kofoed LL , Tolson RL , Atkinson RM , Toth RL and Turner JA . 1987. Treatment compliance of older alcoholics: an elder–specific approach is superior to <mainstreaming>. J Stud Alcohol, 48: 47–51.

Wiens AN , Menustik CE , Miller SI and Schmitz RE . 1982–1983. Medical–behavioral treatment of the older alcoholic patient. Am J Drug Alcohol Abuse, 9 (4): 461–475.

Atkinson RM , Tolson RL and Turner JA . 1993. Factors affecting outpatient treatment compliance of older male problem drinkers. J Stud Alcohol, 54 (1): 102–106.

Schonfeld L and Dupree LW . 1991. Antecedents of drinking for early–and late–onset elderly alcohol abusers. J Stud Alcohol, 52 (6): 587–592.

Atkinson RM , Tolson RL and Turner JA . 1990. Late versus early onset problem drinking in older men. Alcohol Clin Exp Res, 14 (4): 574–579.

Rice C , Longabaugh R , Beattie M and Noel N . 1993. Age group differences in response to treatment for problematic alcohol use. Addiction, 88: 1369–1375.

Kashner TM , Rodell DE , Ogden SR , Guggenheim FG and Karson CN . 1992. Outcomes and costs of two VA inpatient treatment programs for older alcoholic patients. Hosp Community Psychiatry, 43 (10): 985–989.

Anda RF , Williamson DF and Remington PL . 1988. Alcohol and fatal injuries among US adults: findings from the NHANES I Epidemiologic Follow–up Study. JAMA, 260 (17): 2529–2532.

Kranzler HR , Babor TF and Lauerman RJ . 1990. Problems associated with average alcohol consumption and frequency of intoxication in a medical population. Alcohol Clin Exp Res, 14 (1): 119–126.

Heather N and Tebutt J . 1989. Definitions of non–abstinent and abstinent categories in alcoholism treatment outcome classifications: a review and proposal. Drug Alcohol Depend, 24 (2): 83–93.

American Society of Addiction Medicine. 1996. Patient Placement Criteria for the Treatment of Substance–Related Disorders, 2nd ed., Washington, DC: American Society of Addiction Medicine.

Fleming M and Barry K . 1992. Addictive Disorders, St. Louis, Mo.: Mosby Yearbook Medical Publishers.