Journal of Psychopathology and Behavioral Assessment, VoL 19, No. 2, 1997

Abstracts

The following are abstracts of Poster Presentations at the Annual Conference on Behavior, Neurobiology, Substance Abuse, and Culture held in 1996 in Los Angeles.

Mental Impairment Evaluations in Disability Hearings: Actuary Analysis of Forensic Parameters

Terry Tang, Fremont, California A sample of 54 applications for disability insurance benefits was randomly selected from a pool of applications obtained from Offices of Hearings and Appeals, Social Security Administration, in California 1994-1996. All but six of the claimants had attorney representation. Confidentiality to all is maintained. Claimant age ranged from 4 to 64 years. Research on disability determinations for mental disorders has studied Social Security Administration versus independent judgments (1994), consistency of using Social Security Administration guidelines (1991), demographic data and DSM diagnoses (1986), and profiles of clients referred for psychiatric evaluation for disability and/or supplemental security income (1985). The focus of this research is on the nature of forensic exhibits presented to Office of Hearings and Appeals for Administrative Law Judge considerations and whether or not the findings will support a Probabilistic Dynamic Psychobiosocial Event Model (1985). Demographics (ethnicity, gender, age, etc.) and forensic parameters such as psychiatric evaluation/consultation, psychological tests administered, Mental Status Examination variables, psychotropic medication usage, treatment progress notes, and onset, duration, and cause of alleged disability were studied with statistical, actuary, and decision-tree analyses. Results did not support the probabilistic dynamic model (1985) proposed for disability compensation apportionments but, instead, emphasized the importance of and need for (1) more frequent and more comprehensive Mental Status Examinations; (2) identifying the purpose for prescribing each psychotropic medication used and its expected outcome within a designated time frame; (3).appropriate use and strengths and limitations of psychological tests and inferences made; and (4) better monitoring of the treatment process, including giving rationale for continuing 175 0882-2689/97/0600-0175512.50/0 © 1997 Plenum Publishing Corporation

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treatment when documentation shows absence of improvement. Questions such as "Is the claimant always helped by having his/her mental impairments brought out and displayed?.... Is the goal to help the patient or to win the case?" and "To what extent can malingering or exaggerating be attributed to a personality disorder of some sort?" were also raised.

Correlates Between Developmental Neurology, Heredity, and the Development of the Antisocial Personality Disorder

Anthony Louis Najamy, Columbia University Studies correlating neurological dysfunctions to the emergence of the antisocial personality disorder (APD) have produced weak correlations, if any. Low dopamine-l]-hydroxylase (DBH) activity in infants has shown the strongest relationship to APD development thus far. Research indicates that early abuse and disruption in infant-parent relations, linked to low socioeconomic status and substance abuse, can lead to low DBH activity in infants. During the critical period in infancy (age, <36 months), the effects of abuse and neglect have been found to be most severe. Additional studies have yielded correlations to complications in pregnancy and birth, in which possible brain damage can affect neurological functioning. Frontal lobe dysfunctions, as well as hemispheric connections, have produced interesting albeit weak correlations to APD development. Further neurological research is necessary for more conclusive results.

Group Psychotherapy for Asian and Pacific Islander Men with HIV Disease: Clinical Considerations

Ezer Kang, Fuller Theological Seminary Since 1981, the acquired immune deficiency syndrome (AIDS) has evolved into a serious public health problem with unprecedented medical, psychological, and social implications. AIDS, however, remains an underreported and therefore invisible epidemic within the Asian and Pacific Islander (API) community. Due to the small number of reported AIDS cases in the API community, comprehensive interventions that specifically address the needs of APIs living with HIV/AIDS are scarce. Moreover, few studies have systematically explored the adaptive challenges faced by APIs living with HIV/AIDS. Given the distinctive impact of AIDS on aspects of psychosocial functioning, an emerging body of studies have recently investigated the

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function of group psychotherapy as a treatment modality for persons living with AIDS (PLA). This paper will sent a review of two areas of literature. The first deals with literature on the cultural distinctives of the API community, and the second deals with considerations for treating persons living with AIDS in group psychotherapy. Clinical examples will also be drawn from a psychotherapy group for API men living with HIV/AIDS, to identify three core cultural values in the API community, and discuss how they affect Yalom's (1975) therapeutic factors in group psychotherapy. First, the senses of self and family are strongly intertwined. The paramount fear of being identified as HIV infected and the subsequent risk of being rejected from significant others and family members underlie a significant number of stressors faced by many PLAs in the API community. Second, sexuality is solely perceived within the framework of perpetuating the kinship line. The reticence surrounding sexuality becomes particularly evident when the issue of homosexuality is raised, because it threatens the most critical expression of filial piety-marriage and the continuation of the man's family line. Third, mental health services are underutilized, resulting in an unfamiliarity with psychotherapeutic practices (e.g., diagnostic interviewing, appointment system, process of self-disclosure). Intrafamilial help and support from family elders are often sought over psychotherapeutic services because of the sense of family shame and obligation. This paper proposed that an understanding of the cultural values held by APIs living with HIV/AIDS will help the clinician consider the clients' experience, behavior, and feelings within proper context. Furthermore, the unique benefits of psychotherapeutic groups for PLAs in the API community rest on the ability to recreate the functions of family within the group. This process occurs by cultivating an environment where the group members witness and validate each other's experiences of bearing the stigma attached to the illness.

Dimensions of Perfectionism and Depression in Adult Children of Alcoholics

Sheryl B. Herson and C. Douglas Saddler, California Lutheran University Much recent interest has been shown in the adult children of alcoholics (ACOA) population. This group has been characterized, among other things, as being more depressed and anxious, as having strong approval and control needs, and as intensely fearing failure. Concurrent research on perfectionism has found it to have both interpersonal and intrapersonal dimensions. These dimensions have been related to numerous problematic outcomes and behavioral traits, many of which are believed to characterize

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ACOAs. No study has yet investigated perfectionism as a multidimensional construct in this group. The purpose of this study was to examine the interrelationships among the dimensions of perfectionism and depression in an ACOA nonclinical sample. One hundred sixty-eight undergraduate students attending a community college and a small private university in southern California served as participants. Students were administered an assessment battery consisting of the Multidimensional Perfectionism Scale (MPS), the Beck Depression Inventory (BDI), the Zung Depression Scale (ZDS), and the Adult Children of Alcoholics Index (ACOA1). Demographic data were also collected after students signed an informed consent form. Data were subjected to correlational analyses and analyses of variance. Results showed that students classified as ACOA were more depressed than those who were not so classified. Furthermore, the ACOA group scored higher on both interpersonal and intrapersonal dimensions of perfectionism than the non-ACOA group. These results are discussed as they apply to our understanding of ACOAs as well as to implications for psychological treatment for this group.

Prevalence of Depressive Disorders in Hispanic Family Caregivers of Alzheimer's Disease Patients

Dylan G. Harwood, Warren W. Barker, Marina Bravo, and Ranjan Duara, Wien Center, Mount Sinai Medical Center, Miami, Florida This study investigated the prevalence of depression in White Hispanic (WH) versus White non-Hispanic (WNH) first-degree relative caregivers of patients with Alzheimer's disease (A.D). Virtually all studies have confirmed the association between caring for a demented family member and substantial burden and psychological distress. However, relatively little is known regarding the prevalence of depressive symptomatology among caregivers from different ethnic groups. CES-D scores were assessed for 607 primary caregivers of noninstitutionalized family members diagnosed with possible or probable AD who presented at our memory disorder clinic. Of the total caregiver sample, 152 (25%) were classified as WH. We compared risk for depression in WH caregivers by level of cognitive impairment in the patient (Folstein Mini Mental Status Exam), patient gender, patient psychiatric features (geropsychiatry diagnoses of major depression or psychosis), caregiver gender, and relation to the patient utilizing an analysis of variance. The CES-D scale ranges from 0 to 60, with scores greater than or equal to 16 indicating risk for clinical depression. Of the 152 WH caregivers, 68 (45%) evidenced CES-D scores >16. Levels of depression

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were significantly elevated in the WH sample (45%) versus the WNH sample (36%). Significantly higher mean CES-D scores were observed in the WH versus the WNH caregivers. The following associations were observed in the WH sample. Elevated CES-D scores in the caregivers were significantly associated with greater cognitive impairment in the patient. Caring for male patients, regardless of caregiver gender, was significantly linked to caregiver depression. Relationship to the patient was a significant determinant for risk of depression. There was a trend for elevated CES-D scores in those caring for a family member with psychosis. Depression in the patient was not related to caregiver depression. Chi-square analyses indicated that compared to WNHs, WH caregivers were more often children and less often spouses. The results suggest ethnically bound differences in the prevalence of depression among family members caring for AD patients. WH caregivers reported increased levels of depressive symptomatology in comparison to a similar population of WNH caregivers in our sample. Overall, the results are congruent with prior research reporting heightened psychological distress in persons caring for a family member suffering from a dementing illness. Of paramount interest is our finding of depression in nearly half (45%) of the WH caregivers. Several factors were associated with WH caregiver depression, namely, increased cognitive impairment in the family member, caring for a male patient, and relationship to the patient. Of further interest is the finding that although the role of caregiver was most often assumed by the daughters in WH families, wives were at the greatest risk for adepressive disorder. These results highlight the need to continue to explore the role of ethnicity in the mental health of AD caregivers as our country ages and becomes increasingly diverse.

The Impact of Psychosocial Variables on Immune System Functioning in a Sample of HIV-Positive Males

Gary K. Richey and *Wilfred G. Gorp, Plymouth State College and *West Los Angeles VAMC The current study employed a longitudinal, quasi-experimental design to assess the relationship between various psychological independent variables (including the Millon Behavioral Health Inventory) and immune system functioning, operationalized as CD4 levels, in a cohort of AIDS patients over a 24-month time period. The study analyzed the effect of coping style, stress, and somatic symptoms (as measured by the Millon Behavioral Health Inventory), as well as the effects of baseline depression, on immune system functioning over the 2-year period. Preliminary analyses comparing

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HIV-seropositive to HIV-seronegative subjects showed differences on four of eight coping style scales, as well as on all of the psychogenic attitudes scales reflecting stress levels. There were no effects of eight coping styles on immune system functioning for the seropositives. However, there were significant relationships among four of six psychogenic attitudes scales and immune system functioning for the seropositives. There were also significant effects of three scales measuring psychosomatic symptoms for the seropositives. However, there was no effect of level of depression on immune system functioning. Implications for therapy are discussed.

HIV/AIDs Risk Behaviors of Hispanic Males Seeking Cocaine Treatment in a Downtown Los Angeles Clinic Marianna S. Balquiedra Walter Ling, Steve Shoptaw, David Gudeman, and David Yeats, Pizarro Treatment Center The purpose of this study was to describe HIV/AIDS risk behaviors of Hispanic males seeking cocaine treatment and to determine the relationship of cocaine use with their sexual behaviors. The data used for this paper are part of a larger data set currently being gathered for the ongoing rapid evaluation on cocaine pharmacotherapies. Data are gathered through questionnaires and face-to-face, one-on-one interviews with the patients seeking treatment. Standard data measures used are the Addiction Severity Index (McLeUan et al., 1992), which estimates the severity of patient's addiction problems; HIV/AIDS Risk Assessment (DATAR), which evaluates patient's HIV/AIDS risk behavior; and the Cocaine Treatment Admission form (Rawson et al., 1985), which provides initial data from patients. As the research study is ongoing, the number of individuals included in this descriptive study is relatively small. The final report will include data from all patients treated prior to the conference. However, these patients (i.e., males of Hispanic origin) form the largest portion among individuals seeking treatment for cocaine use in the clinic (25.8%. A total of eight Hispanic males, so far, have sought treatment for their cocaine use from February 1996 to the present. Except for one, all males successfully completed screening. The average age is 33.57 years (range: 25-43 years), and the average number of years of cocaine use is 12.14 years (range: 6-20 years). Four of eight are currently employed, earning an average net income of $1,263.00 per month. Four have been separated or divorced and three are married. Since none of the participants used injection routes for cocaine use, there appears to be minimal HIV risks with drug use behaviors. All claim to be heterosexuals. For the 6 months prior to their initial interview,

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six claim to have had only one sexual partner and reported their spouses or their current partner as their sexual partners. For the other two patients, one had two sexual partners and one did not have any sexual partner at all. The average frequency of reported penetrative sexual activities among the patients for the last 6 months was once per week. Among penetrative sexual practices, insertive vaginal intercourse was most commonly reported. Oral sex was practiced by three patients. The patient who reported having two sexual partners also admitted practicing penetrative anal intercourse. Only three patients claimed to use cocaine before or during sex. None of the patients reported that they engaged in sexual intercourse with an injecting drug user nor a sex worker. What is significant among their reported sexual practices was the nonuse of condoms. All patients reported no condom use at all. Contrary to their high-risk sexual behaviors, most did not think about being exposed to HIV and more than half have never thought of getting infected with HIV. Maintaining a monogamous sexual relationship for the past 6 months also reinforces their beliefs that they cannot get HIV from someone and they cannot give HIV infection to others. Ironically, most patients have thought of ways to avoid HIV infection, but the data show that the decision to use condoms consistently was not a popular option.

Relationships of Psychopathology, Substance Use, and Various Cultural Demographic Variables in an HIV-Seropositive Population Kevin J. McCarthy, *Penelope W. Dralle, *Paul M. Balson, and *Kar/Cambre, Hunt Correctional Center and *Louisiana State University Medical School. HIV-related prevention and treatment interventions need to address relevant client risks and characteristics. Effective treatment strategies integrate a multifaceted approach in the delivery of health-care services. To identify the interrelationships among level of substance use, presence of psychopathology, and various demographic variables in an HIV-seropositive population, 108 Southern males completed a clinical psychiatric interview and a comprehensive psychosocial history. Subjects meeting criteria for Axis I diagnoses using DSM-III were classified into one of three groups: (1) HIVrelated psychopathology (N = 27), (2) non-IV-related psychopathology (N = 34), and (3) no psychopathology (N = 47). In addition, 11 subjects were classified as having personality disorders. Twenty-seven subjects met criteria for classification as substance abusers, and 20 were classified as substance dependent. In addition, data indicating drugs used by subjects during their lifetimes and current drugs used were analyzed. Demographic

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variables and clinical treatment variables were coded from the psychosocial histories. Chi-square analyses were used to examine intercorrelations among variables. Although the populations from which participants came is largely non-White, the majority of participants in this study were Caucasian (N = 87). There were no significant correlations based on race; however, there was a tendency for non-White males to more frequently report risk behaviors other than homosexuality, such as having multiple partners and bisexual behaviors. Age was significantly correlated with use of AZT; the 34--41 year olds had the highest rate of AZT treatment and none of those 25 years or younger were on AZT treatment. Age was also related to education level; older subjects were more likely to have post high school education. Current alcohol use was lower in the group of 34-41 year olds, although there were no differences in their histories of past use. Race was differentially related to alcohol and marijuana use and substance abuse diagnoses. Psychopathology group was related to HIV-disease progression and substance abuse and to the use of amphetamines and cocaine. Prevention and treatment programs should address differences in patterns of substance use and risk behaviors. The extent and type of psychopathology also need to be taken into account in developing effective HIV-related programs.

Avoidance Behavior in t ~ S D and Comorbid Substance Abuse: Implications for Symptomatology, Assessment, and Treatment

Andre P. Bessette, Erin G. Holker, Danielle R. Miller, and *Francis R. Abueg, Pacific Graduate School of Psychology and *National Center for PTSD, Palo Alto VAMC Three hundred Vietnam theater veterans dually diagnosed with posttraumatic stress disorder (PTSD) and substance-related disorders were studied using a multimethod assessment approach. The purpose was to determine how the frequency and intensity of elated to elevations on psychometric assessment measures. In particular, researchers were interested in traumarelated avoidance because of the challenges it may pose for treatment intervention. A multiple regression correlation was applied to CAPS-1 (Clinician-Administration PTSD Scale) avoidance frequency and intensity scores to predict elevations on the MMPI-2 (Clinical, Content, and Supplementary scales), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Investigators found correlations between the frequency of trauma-related avoidance behaviors and MMPI-2 Clinical scale 2, Content scales DEP and ASP, and Supplementary scales PK and MAC-

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R, as well as high scores on the BDI and BAI. Correlations were also found between the intensity of such avoidance behaviors and MMPI-2 Clinical scales 2, 8, and 9, Content scales DEP, ASP, and TRT, and Supplementary scales PK and R, in addition to elevations in BDI and BAI scores. These data suggest that the evaluation and treatment of trauma-related avoidance behaviors in PTSD may be best understood by considering both frequency and intensity of such behaviors. Avoiding trauma-related stimuli may prolong subjects' experience of distress and thus pose unique challenges to treatment.

The Relationship Between Socialization and Problematic Substance Use

Michael Campos, Peter Arnett, and Molly Jordan, Washington State University Prior research has indicated that, like psychopaths, college students identified as low socialized (Low-So) on Gough's Socialization Scale (1960) show an increased prevalence of substance use and increased antisocial behaviors relative to controls (Kosson et al., 1994); they also show passive avoidance learning deficits on laboratory tasks (Arnett, 1966; Nathan, 1980). The current research was designed with two goals in-mind: (1) to replicate the findings of increased substance use in Low-So subjects reported by Kosson et aL (1994) and (2) to evaluate real-world evidence of difficulty avoiding negative consequences for substance use (poor passive avoidance) in Low-So subjects. It is predicted that, compared to High-So subjects, Low-So subjects will report increased substance use and significantly more problems as a consequence of substance use. Subjects were 106 undergraduates who scored in the top and bottom thirds of a larger sample of undergraduate males on the Socialization Scale (top third cutoff = 37.00; bottom third cutoff = 31.00). Consistent with our hypotheses, chisquare analyses indicated that, compared to High-So subjects, the Low-So undergraduates were more likely ever to have used psychedelics (p < .001) or stimulants (p, .001). Also consistent with our predictions, they were more likely to have used marijuana (p < .05) or alcohol (p < .05) in the last 4 weeks and were more likely to have experienced school Co < .001), family/friend (p < .001), or legal problems (p < .01) due to substance use. Our fi.ndings of greater substance use in Low-So relative to High-So college students replicates the findings of Kosson et al. (1994). The greater occurrence of negative events as a result of use reported by Low-So subjects is consistent with the laboratory findings of passive avoidance learning deficits in this group. Low-So students may have difficulties regulating substance use in response to negative consequences.

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Chemical Dependency and Brain Injury Rehabilitation: A Model of Early Intervention

Roberta Kaye, Roger K~ Light, Larry Ross, and Dinat, qlla, Daniel Freeman Hospital There exists a strong relationship between brain injury and substance abuse. This includes a high percentage of emergency-room admissions positive for blood alcohol, as well as more severe brain injuries and poorer outcomes from rehabilitation programs in those with the dual diagnosis of brain injury/chemical dependency (Kreutzer et aL, 1990). Traditionally, these dualdiagnosis patients receive neurological rehabilitation initially, and only later are chemical dependency (CD) issues addressed. In this era of shrinking inpatient rehabilitation stays, this failure to address CD issues during this phase of treatment often leads to premature termination of rehabilitation and poor outcomes. In a 1-year survey of admissions to the Daniel Freeman Hospital Inpatient Neurological Rehabilitation Program, 24% of admissions had significant substance abuse histories prior to their injuries or were impaired at the time of their injury. The effects of brain injury can also put the patient at risk for additional substance abuse that can lead to additional injury. In addition, due to cognitive problems, these patients are frequently less able to benefit from traditional CD rehabilitation programs [e.g., 12-step meetings (Blackerby & Baumgarten, 1990)]. Despite this relationship between CD and brain injury, the majority of intervention models in the literature focus u p o n the outpatient and postacute phases of treatment. A relative paucity of interventions has been established at the acute inpatient level of rehabilitation. This presentation will describe the assessment and intervention program developed at Daniel Freeman Hospital for treating the dual-diagnosis patient earlier in the recovery process. The program emphasizes comprehensive assessment (including details of injury, past usage, family history, etc.) and education (tailored to the needs of the patient and family through a variety of channels and in language of maximal benefit). Exposure to CD recovery materials in cognitive rehabilitation interventions is also included as well as referrals and outings to community based CD programs (including dual-diagnosis 12-step meetings). Follow-up and aftercare in outpatient treatment modalities are also pursued. The entire rehabilitation team participates in this process, with intervention woven into all therapy disciplines. Given the denial associated with both brain injury and CD problems, staff also provides environmental management to facilitate the patient's insight and development of appropriate coping strategies. Finally, preliminary results and plans for further development and application will be presented. While the program is not

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a traditional CD program as practiced in a CD recovery hospital, preliminary results indicate that the integration of both issues earlier in treatment for brain injury survivors is helpful in maximizing rehabilitation outcomes and improving the quality of life for dual-diagnosis patients and their families.

Impact of Coexisting Substance-Related Disorders on Clinical Outcomes and Service Delivery at an Emergency Housing Program Serving the Homeless Mentally Ill

Karen C. O. Batia, Roosevelt University This study examined treatment service profiles at an Emergency Housing Program (EHP) and offsite facilities for 161 homeless mentally ill individuals. Two-thirds of the sample were diagnosed with cooccurring substance disorders. Differences in service utilization profiles for the homeless dually diagnosed and homeless mentally ill only were presented. The homeless dually diagnosed had worse clinical outcomes from the EHP as determined by planned discharges from the program. Treatment services provided did not determine successful completion at EHP. Length of stay was a predictor of positive clinical outcome. Implications for treatment programming for the homeless mentally ill population were discussed.

Comparison of Personality and Neuropsychological Functioning in Alcoholics With and Without Childhood Hyperactivity

L. Randolph Waid, Diane E. Johnson, Raymond F. Anton, and *Harvey Richman, Medical University of South Carolina and *Georgia Southwest College Research has demonstrated cognitive impairments in postwithdrawal alcoholics, though significant variability exists in the manifestation of such impairments. In the search for possible determinants of this variability, historical variables such as childhood behavior disorders have been investigated. One such variable is hyperkinesis/minimal brain dysfunction (HK/MBD), now known as attention-deficit hyperactivity disorder (ADHD), which has a high rate of comorbidity with substance abuse disorders. The purpose of the present study was to identify personality and neuropsychotogical characteristics .associated with HK/MBD in mild to moderate alcohol-dependent subjects. Subjects (n = 102) participating in an outpatient treatment program were administered Tarter's (1977)

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HK/MBD Childhood Symptom Checklist and a battery of personality and neurocognitive measures. Subjects scoring in the upper and lower third on Tarter's Scale were classified as HK/MBD positive (HK/MBD+; n = 35) versus HK/MBD negative (HK/MBD-; n = 33). Exclusion criteria included current major psychiatric diagnoses, other substance or medication use, and previous detoxification. Analysis failed to reveal significant differences between groups with regard to age, years of education, gender, and recent alcohol consumption (Time-line Follow-back). HK/MBD+, subjects scored significantly higher on the Alcohol Dependency Scale (ADS), indicating more severe dependent symptoms during the past year. On Cloninger's (1987) Tridimensional Personality Questionnaire (TPQ), HK/MBD+ subjects scored significantly higher on the Novelty Seeking and Harm Avoidance scales, reflective of greater sensation seeking and anxious symptomatology. Groups did not differ on the Beck Depression Inventory or Reward Dependence scale of the TPQ. Analysis of neuropsychological functioning revealed HK/MBD+ subjects to perform significantly poorer on tests of vocabulary, abstract reasoning, verbal fluency, and information processing speed, with estimated IQ being lower (99 vs. 106). The findings are consistent with the postulated "executive dysfunction" in adult ADHD subjects and were not attributable to differences in IQ. To isolate the measures that were most effective in discriminating groups, all personality, behavioral, and neuropsychological variables were entered into exploratory correlational and forward, backward, and stepwise discriminant analyses. A five-variable model correctly identified 80% of HK/MBD+ subjects and 84% of ~ B D subjects. This model, incorporating the ADS, Full Scale IQ, Controlled Oral Word Association Test (verbal fluency), Novelty Seeking scale of the TPQ, and Wisconsin Card Sorting Test, presents the best compromise between parsimony and discriminatory ability. The current study objectified personality and neurocognitive differences associated with childhood hyperactivity, which has implications for differential diagnosis and treatment matching.

Definition and Quality of Depression and Anxiety in Chronic Cocaine Abusers

Christine H. Carrington, Tony L. Strickland, and *Keith Andre, Howard University and *Charles R. Drew University of Medicine & Science This study examined the nature and quality of depression in chronic cocaine abusers in the greater Los Angeles area. Participants were predominantly African-American males and females who were participants in a previously

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conducted large-scale study at Drew-Harbor UCLA, investigating the neurobehavioral functions among chronic abusers. The significance of the presentation of psychopathology in chronic substance-abusing populations has been debated in the substance abuse research literature. Studies that examine ethnic and gender variance in these populations have resulted in differential outcomes. Mood disorders have been found consistently in substance abusers, but a well-defined relationship between cocaine abuse and mood has not been systematically established among lower-socioeconomic status individuals who also have multiple challenges to their day-to-day well-being, making it difficult to differentiate the contributions of substance abuse to mood. While anxiety symptoms have been identified in population of cocaine users, no significant linkages have been established between anxiety disorders and cocaine use in lower socioeconomic-status individuals. Considerable attention has been given to the motivation of clinically depressed persons to use drugs, but whether the depression antedates the need to self-medicate or whether the chronic drug use produces changes in brain morphology resulting in changes in mood functioning has not been established through systematic research. Fifty African-American males and females were assessed using the following instruments: Hamilton Depression Scale, Spielberger Anxiety Scale (state and trait), Spielberger Anger Scale (state and trait), Dysthymia Evaluation Scale, and Trauma Symptom Inventory. Implications of findings for treatment and research programs are discussed.

Ethnic Differences Among Counselors Who Treat Substance Abusers with HIV

Dominick Frosch, Richard Rawson, Merredith Portnoff, *Steven Shoptaw, and *Walter Ling, Matrix Center, Los Angeles, and *Los Angeles Addiction Treatment Research Center This study was designed to examine the effects of ethnic differences among a sample of substance abuse counselors who treat clients afflicted with HIV in addition to having chemical dependency problems. Baseline data from an ongoing NIDA funded study, evaluating a Structured Treatment Manual for Substance Abusers with HIV, are presented. Detailed surveys, which include the Maslach Burnout Inventory, were completed by 134 counselors from 34 clinics nationwide. Participants were drawn from both methadone and drug-free outpatient clinics. In terms of results, African-American and Latino counselors were more confident than Caucasian counselors of their ability to work with clients whose ethnicity was different from theirs. Findings from the Maslach Burnout Inventory indicated that African-American

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and Latino counselors were less optimistic and had a lesser sense of personal accomplishment from their work than their Caucasian colleagues. African-American counselors rated their satisfaction with the clients they treat as lower than Latino and Caucasian counselors. In addition, African-American and Latino counselors were found to have significantly larger caseloads than Caucasian counselors and were less likely to have a college degree than Caucasian counselors. They were also less likely to have substance abuse-specific certification such as CADAC. Overall, HIV knowledge in the total sample was found to be low (M = 54.07% of questions on an HIV quiz answered correctly). In this sample, Caucasian counselors were found to have somewhat more accurate knowledge about HIV than their African-American and Latino counterparts. Findings are discussed in terms of the need for more training in substance abuse counseling and specific issues relevant to substance abusers with HIV. Possible interactions between lack of education and higher Maslach Burnout Inventory scores are explored. The possibility that lower HIV knowledge results from greater difficulty in addressing issues related to HIV in the respective communities is also examined.

Gender Differences in Vulnerability to Drug Use Among Latino Adolescents

Maria Fdlix-Ortiz and Michael D. Newcomb, University of Southern California Separate risk and protective factor indices were developed to examine gender differences in vulnerability to drug use among Latino high-school students. In our conceptualization of risk and protection, protection is not assumed to be equivalent to the absence of risk. Survey data were collected from 516 Latino ninth- and tenth-grade youths in the Los Angeles area. Frequency and quantity of use data were collected for a range of drugs including inhalants, cocaine, and other hard drugs. Seventeen variables were examined for inclusion in a risk (RFI) or protective factor index (PFI). Bivariate, multivariate, and structural equation models were employed in the analysis of data. Multiple regression analyses suggested that all of the variables except for one were uniquely risk-inducing for these Latino youth; however, as a group, the PFI predicted several types of drug use for boys and girls. In the structural equation models, vulnerability to drug use as indicated by the RFI and PFI was strongly associated with drug use for both boys and girls. Other specific effects of risk and protection were identified. The epidemiological model is useful in beginning to understand the effects of multiple factors on drug use among Latino youths.