Factors affecting agreement between severely mentally ill alcohol abusers' and collaterals' reports of alcohol and other substance abuse.

This study examined subject-collateral reports of alcohol use among a sample of 167 dually diagnosed individuals seeking outpatient treatment at a community mental health clinic. All subjects met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for a schizophrenia-spectrum or bipolar disorder and for alcohol abuse or dependence. Subjects were recruited within 2 weeks of treatment entry and completed measures of cognitive functioning, alcohol dependence severity, psychiatric symptoms, and quantity and frequency of substance use over the previous 60 days using the Timeline Follow-Back interview (L. C. Sobell & M. B. Sobell, 1996). They also provided a urine sample, which was screened for recent drug use. Collateral interviews were conducted by phone and included an assessment of the subject's alcohol and drug use over the same 60-day period. Collaterals also reported their confidence in the accuracy of their reports. Overall, the results indicated generally poor subject-collateral agreement. However, subject-collateral agreement appeared better for those individuals (n = 97) with negative urine drug screens. The most consistent predictor of subject-collateral discrepancy scores was subjects' recent drug use. Recommendations for enhancing the validity of self-reports of substance use in a severely mentally ill population are discussed.     

The development and maturation of humanitarian psychology

Humanitarian psychological support as an organized field is relatively young. Pioneers in the field were involved primarily in providing psychological support to refugees and internally displaced persons in conflict and nonconflict situations. This article describes basic principles for the design of psychological support programs and interventions. The International Federation of Red Cross and Red Crescent Societies (IFRC) began a psychological support program in 1991. The IFRC chose psychological first aid as its model for implementation in developing countries. Psychological first aid fits all the principles for psychological support program design and is adapted to individual communities. The first generation of psychological support programs differed dramatically depending on the countries in which they were developed. A second generation of psychological support programs evolved in response to the earthquake/tsunami of December 26, 2004. The Inter-Agency Standing Committee international guidelines consolidated the advances of second-generation programs and provided a clear indication of the wide acceptance of the importance of psychological support. A glimpse is provided of the third generation of psychological support programs, and an admonition is made for a more empirical evaluation of the effectiveness of interventions.     

Evaluations of causal and conditional hypotheses

This study examined evaluations of causal and conditional hyptheses on the basis of individual exemplars. Subjects were presented scenes describing something that is malfunctioning and is taken to an expert. The expert makes a causal diagnosis and a prediction concerning an outcome following treatment. Four types of outcome evidence were provided: (1) treatment is provided and the problem is eliminated; (2) treatment is not provided and the problem is eliminated; (3) treatment is provided and the problem is not eliminated; and (4) treatment is not provided and the problem is not eliminated. Subjects were required to judge whether individual exemplars prove the diagnosis, disprove the diagnosis, or fail to test the diagnosis. A second form of problem presented the same scenes but required evaluation of the conditional prediction. A third form of problem did not present the causal scenes; the subject evaluated the conditional predication and no context. Three content domains were used: medical, mechanical, and arbitrary. There were three general results: (1) diagnoses were judged as less open to testing than predictive conditional hypotheses; (2) medical problems were judged differently from mechanical problems; and (3) problems lacking meaningful content or contexts led to more primitive response strategies.