Roger Dale Walker

• MD
• Professor Emeritus at Oregon Health & Science University

The present study examined costs of two residential substance abuse treatment programs designed for urban American Indians and Alaska Natives (AI/ANs). Costs for one agency were well within national norms, while costs at the other program were less than expected from nationwide data. Economies of scale accounted for much of the difference between o...

Although residential substance abuse treatment is utilized extensively by urban American Indians and Alaska Natives (AI/ANs), there are few detailed descriptions of this care. This study delineated services provided by and interviewed staff working at residential programs designed for chemically dependent urban AI/ANs. Study agencies were compared...

Like its three predecessors, the fourth edition of this book present current, informed reviews of research on treatments that work for a wide range of mental disorders. The 28 chapters cover pharmacological, psychosocial, and combined treatments for attention-deficit/hyperactivity disorder (ADHD), conduct disorder, disruptive behavior disorders, sc...

This study examines predictors of alcohol use disorders (AUDs) among an urban American Indian cohort who were followed from approximately age 11 to age 20. Approximately 27% of the sample had a lifetime diagnosis of alcohol abuse or dependence. The results indicated that externalizing, but not internalizing, behaviors, family conflict, and school l...

There are currently 4.1 million people in the United States that self-identify as being an American Indian (AI) or Alaskan Native (AN) that area also another race; while 2.5 million that are only AI/AN [1]. There are 560 tribes recognized by the United States, with Cherokee being the largest followed by Navajo as the second largest tribes in the na...

Background: Most American Indians and Alaska Natives live in metropolitan areas but there are few data about substance abuse treatment for this population. Methods: The present study recruited and followed for 12 months 186 Native clients (46% female, 91% ages 21 through 49) from 69 tribes who entered two residential substance abuse treatment pro...

Over the last 20 years governmental mandates for preferentially funding evidence-based "model" practices and programs has become doctrine in some legislative bodies, federal agencies, and state agencies. It was assumed that what works in small sample, controlled settings would work in all community settings, substantially improving safety, effectiv...

In 2007 the federal Department of Health and Human Services, Office for Minority Health, collaborating with other federal agencies, sponsored the Indian Country Methamphetamine Initiative (ICMI). ICMI was undertaken to create community-driven, culture-based best practices in methamphetamine prevention and treatment which could then be disseminated...

This study investigated the role of parental diagnosis of alcohol abuse/dependence and perceived family norms for adolescent drinking on alcohol use and alcohol-related problems among urban American Indian youth. A total of 251 urban, American Indian youth and their parents/caregivers were followed from ages 13 to 18. Perceived family norms against...

The objective was to assess the effect of early onset intoxication on subsequent alcohol involvement among urban American Indian youth. The data come from the American Indian Research (AIR) project, a panel study of urban Indian youth residing in King County, Washington. Data were collected annually from the adolescent and his/her primary caregiver...

This study uses data collected over 8 time periods to examine time-varying and time-invariant predictors of alcohol initiation among urban American Indian youth, an understudied population. Similar socialization risk and protective factors were found to be related to initiation as other American youth. However, a nuclear family was not found to be...

Although most American Indians and Alaska Natives live in metropolitan areas, there are few if any recent data about substance abuse treatment for this population. The present study recruited and is following quarterly for 12 months adult Native clients (57 female, 88 male, 92% between ages 21 and 49) entering long term residential substance abuse...

Douglas M. Ziedonis co-authored this practice guideline as a member of the Work Group on Substance Abuse Disorders. See article for complete list of authors.

Although American Indians and Alaska Natives have high rates of substance abuse, few data about treatment services for this population are available. We used national data from 1997-2002 to describe recent trends in organizational and financial arrangements. Using data from the Indian Health Service (IHS), the Substance Abuse and Mental Health Serv...

This study explored the changing relations among self-worth, peer deviance, and alcohol-related problems in a sample of 224 urban-dwelling, American Indian adolescents. Data were collected annually at 7 time points to test a proposed mediational model. As expected, peer deviance mediated the relation between low self-worth and alcohol-related probl...

To assess the prevalence of inhalant use among urban American Indian youth and to examine differences between inhalant users and non-users. Baseline (T1) self-report questionnaires completed in 5th-6th grade and at seven annual follow-up assessments (T2-T8). Seattle metropolitan area. Two hundred and twenty-four Indian youth. Youth-completed measur...

The public psychiatry training program at Oregon Health Sciences University, established in 1973, educates psychiatric residents to work in community mental health centers and state hospitals. The authors present a brief history of this program, which spans three decades, and describe recent developments in its operation, with special attention to...

The objective of this study was to test whether an intensive case management intervention would be effective with a group of homeless chronic public inebriate clients. The primary goals of the case management were to improve the financial and residential stability of the clients and to reduce their use of alcohol. Subjects (N = 298, 81% male) were...

To assess the effects of a smoking cessation program for recovering alcoholics on use of alcohol, tobacco and illicit drugs after discharge from residential treatment. A randomized community intervention trial design was employed in which 12 residential drug treatment centers in Iowa, Kansas and Nebraska were matched and then randomly assigned to t...

An open trial of transdermal nicotine replacement for smoking cessation was conducted. Over a 7-month period, all patients admitted to the inpatient alcohol and drug treatment unit of the Seattle Veterans Affairs Medical Center, (n = 207) were offered the opportunity to participate in an open trial of transdermal nicotine replacement for smoking ce...

To evaluate studies that applied Cloninger's tridimensional theory of personality to substance abusers. Medline and PsychInfo data bases were searched for studies published between 1986 and mid-1995 that used the Tridimensional Personality Questionnaire (TPQ). A supplemental manual search was conducted to identify additional evaluations of the trid...

Identifies and critiques studies regarding chemical dependency training within schools of nursing. The few research efforts in this area possessed methodological shortcomings, and schools of nursing generally provided minimal exposure to important concepts in addictions research. Neither the scope nor intensity of clinical instruction was sufficien...

Reported here are findings from a randomized community intervention trial that followed 90 recovering alcoholic smokers for 6 months. Because the brief (10-min) study intervention had no effect on tobacco use, intervention and control participants were pooled to identify predictors of attempts to quit smoking that may inform clinical practice. Duri...

Findings of the World Health Organization (WHO)-World Bank Global Burden of Disease (GBD) study (C. J. L. Murray and A. D. Lopez, Policy Forum, [1 Nov., p. 740][1]) accord well with those of less ambitious investigations and underscore the central importance of neuropsychiatric disorders to the

Native American (NA) veterans have rarely been the focus of investigational efforts. We review studies relevant to an assessment of NA substance-use disorders, and discuss findings of the Drug Abuse Treatment Services Evaluation Project pertaining specifically to NA veterans. A larger proportion of NA veterans discharged from VA inpatient care in F...

Alcohol (ethanol) use disorders are prevalent in many countries and are associated with significant social and health costs. Little is known, however, about the comparative cost effectiveness of treatments for alcoholism. Pharmacoeconomic evaluations are largely (if not wholly) absent from the alcoholism treatment outcome database. We discuss pharm...

Empirical studies of American Indian health and mental health have focused primarily on reservation samples or small cross-sectional school-based or treatment samples. Few studies have addressed these issues among urban American Indian populations. This paper introduces an ongoing ten-year prospective longitudinal study of alcohol abuse, drug abuse...

Demographic, diagnostic, and service utilization characteristics of veterans diagnosed with suicide attempt, substance dependence, both, or neither at discharge from Department of Veterans Affairs (DVA) hospitals in fiscal year 1994 (FY94) were compared using the DVA's discharge abstract database. Four groups of veterans were studied: (1) substance...

Methodological characteristics and substantive findings of investigations of essential and reactive alcoholics were reviewed. The data base was comprised of approximately 12 studies published between 1951–1992, most of which employed small samples of hospitalized male alcoholics. Psychometric properties of the Essential-Reactive Alcoholism Question...

Researchers responsible for"Alcohol Abuse in Urban Indian Adolescents and Women: A Longitudinal Study for Assessment and Risk Evaluation" respond to critiques of the research project. Clarifies project goals, discusses issues related to longitudinal research, and addresses concerns related to research utilization and data publication. (LP)

The study examined the prevalence of substance use, psychiatric, and medical disorders in female veterans discharged from VA hospitals. The VA discharge abstract database was used to identify women discharged in fiscal year 1991 who received a diagnosis of substance abuse or dependence or substance-induced psychosis (N = 1,698). They were compared...

Consensually established principles of clinical conduct, known variously as practice guidelines, standards, protocols, or algorithms, have proliferated throughout medicine over the past decade. Institutional and disciplinary efforts to develop and promulgate guidelines for the treatment of additive disorders have recently been initiated. We review...

Prescriptive standards of clinical conduct--practice guidelines--have proliferated throughout medicine over the past decade. Practicing physicians are confronted with a plethora of guidelines developed for different purposes by a diverse body of public and private organizations. We review factors contributing to the growth of guidelines, their desi...

The authors examined patterns of substance use disorders and psychiatric and medical comorbidity in all male veterans treated in Veterans Affairs (VA) medical centers during a one-year period. A national discharge abstract data base was used to derive point prevalence rates of psychiatric and medical disorders for 539,557 inpatients treated in VA m...

Demographic, clinical, and treatment episode characteristics of 3,087 American Indian veterans discharged from Department of Veterans Affairs hospitals in fiscal year 1991 were examined. Substance use disorders were diagnosed in 46.3 percent of discharged American Indians, compared with 23.4 percent of discharged veterans overall. More than 97 perc...

Examined patterns of substance use disorders and psychiatric and medical comorbidity in all male veterans treated in VA medical centers over 1 yr. For 539,557 inpatients, nearly one-quarter had a substance-related diagnosis. The most prevalent substance use disorders were alcohol dependence (87.7%) and cocaine dependence (17.5%), and the most frequ...

The Department of Veterans Affairs is the largest provider of drug dependence treatment services in the United States. However, a national evaluation of primarily drug-dependent veterans has never been reported. Findings from the Drug Abuse Treatment Services Evaluation Project, a three-year investigation of drug dependence treatment within the Dep...

The diagnosis and management of patients with combined psychiatric and substance use disorders is an important aspect of modern psychiatry, and psychiatrists should be strongly encouraged to become involved in this area. These efforts should be supported by training and educational programs involving a wide range of institutions, including local tr...

Alcohol exerts several of its actions via the chloride channel associated with the central GABA-benzodiazepine receptor complex. To explore a possible role for this receptor complex in risk for alcoholism, and to determine whether risk for alcoholism is associated with risk for benzodiazepine abuse, the authors administered intravenous diazepam to...

No single treatment approach is effective for all persons with alcohol problems. A more promising strategy involves assigning patients to alternative treatments based on specific needs and characteristics of patients. Project MATCH is a multisite clinical trial designed to test a series of a priori hypotheses on how patient-treatment interactions r...

This paper discusses treatment implications of comorbid psychopathology in the context of American Indian and Alaska Native culture and in the context of the Indian Health Service's Mental Health and Alcohol and Substance Abuse Program Branches. Treatment of comorbidity in this population is a particularly difficult problem due to numerous barriers...

Preclinical alcoholic cardiomyopathy, myocardial damage in the absence of overt congestive heart failure in chronic alcoholics, is well characterized at necropsy, but attempts to identify such a clinical entity before death have produced conflicting results. Studying subjects only at rest, the inclusion of older alcoholics and limitations of noninv...

Manifestations of anxiety, including panic disorder, are more common in the alcoholic population than in the general population. Alcoholics frequently abuse other drugs. The authors hypothesized that alcoholic subjects with panic attacks would abuse anxiolytic drugs more and panic-inducing drugs less frequently than nonanxious alcoholic subjects, a...

Assesses the present state of knowledge about American Indian and Alaskan native (AI/AN) adolescent suicide, evaluates progress (or lack thereof) during the 1980s in understanding and dealing with the issue, and suggests directions for addressing the phenomenon in the 1990s. A selective literature review is conducted on the epidemiology, causality,...

The authors studied the response to sodium lactate infusion of 12 alcoholics with a history of panic attacks, 10 alcoholics without a history of panic attacks, and 16 nonalcoholic patients with panic disorder. The rate of lactate-induced panic was significantly higher in alcoholics with panic attacks than in alcoholics without panic attacks. Alcoho...

Alcoholism has been associated with a high prevalence of anxiety and phobic disorders. The authors ascertained the current prevalence of panic disorder and the lifetime prevalence of infrequent panic attacks in 154 male alcoholics in an inpatient alcohol treatment program. Thirteen percent (N = 20) gave a lifetime history of panic attacks and 45% (...

Although promising, the available data concerning drinking-related locus of control have been almost entirely limited to treatment samples of white men. The major purpose of this study was to extend our understanding by comparing the drinking-related expectancies of three groups of Native Americans: problem drinkers, nonproblem drinkers and recover...

Contends that research on the prevention of substance abuse among American Indian and Alaska Native youth offers challenges and demands careful methods. Such challenges are described in terms of philosophical, political, and cultural issues surrounding substance abuse prevention research with American Indian and Alaska Native people. Suggestions ar...

It is widely recognized that the cultural uniqueness of American Indians and Alaska Natives must be reflected in the methods of diagnosing and treating their mental health problems, but empirical validation of specific diagnostic instruments and treatment has been slow in coming. The authors' literature review indicates that many standardized self-...

We report data from a study of smokeless tobacco use among Native American adolescents (135 females and 119 males; mean age, 13.8 years) randomly selected from three reservations and one medium-sized city in Washington State. The data showed that 43.7 percent of the adolescents reported having used smokeless tobacco from 1 to 25 times. More than 25...

Research in the area of subtype development within alcoholic populations has undergone a number of changes over the recent years. First, there has been a shift from subtype derivation based on a priori comparative approaches toward a more recent use of a posteriori correlational approaches such as cluster analysis. Second, there has been an increas...

Fifty urban American Indians were interviewed during admission to a free-standing medical detoxification unit. From the year before the interview through 2 years of follow-up, this sample averaged 44.6 detoxification admissions and 64.1 days in other inpatient treatment and had no significant change in the number of annual detoxification admissions...

Contemporary American Indians face many health and social problems with established roots in North American history. Current programs designed to address the unique health needs of American Indians have undergone many difficulties, including an apparent lack of culturally relevant therapeutic approaches, a severe shortage of funding and personnel,...

Scores from 13 cognitive-neuropsychological tests administered to 245 men alcoholics were subjected to an average linkage cluster analysis. Six subtypes were derived but three were eliminated from further analyses because they had samples of less than 10. The remaining clusters appeared to reflect differing levels and patterns of neuropsychological...

The purpose of the present study was to investigate a number of factors that may influence the relationship between neuropsychological impairment and treatment outcome among alcoholics. Cognitive deficit upon admission to treatment was significantly related to the individual's age but independent of the years of problem drinking and the recency of...

This paper presents a critical discussion of the definitions, conceptual models, and methodological issues that researchers should consider in studies of sociocultural influences on drinking practices and problems. In particular, these concerns are related to studies of American Indian and Alaskan Native people. In an effort to avoid overgeneralize...

One hundred thirty-nine male veterans receiving treatment for alcoholism were administered the Cornell Medical Index (CMI), neuropsychological tests comprising the Brain Age Quotient (BAQ) and the Group Embedded Figures Test (GEFT). Patients endorsing items on scale J (frequency of illness) of the CMI comprised a frequently ill group (27%) with the...

Hypothesized that 245 alcohol-abusing male veterans, grouped according to levels of neuropsychological functioning, would have differential outcome following random assignment to 2- or 7-wk hospitalization in a milieu-oriented treatment program. Over the 9 mo of posthospitalization follow-up, there was significant improvement for the sample as a wh...

Pretreatment scores from the drinking-related locus of control scale (DRIE) and reasons for drinking were investigated as predictors of drinking relapse over a nine-month follow-up in a sample of 232 male alcoholics. A significant relationship was found between reasons for drinking and the probability of relapse, with the lowest relapse rates occur...

Hypothesized that 245 alcohol-abusing male veterans, grouped according to levels of neuropsychological functioning, would have differential outcome following random assignment to 2- or 7-wk hospitalization in a milieu-oriented treatment program. Over the 9 mo of posthospitalization follow-up, there was significant improvement for the sample as a wh...

The current study investigated the role of family resources in successful outcome of alcoholism treatment. Fixty-six patients were administered the Family Environment Scale. The scores of completers and non-completers were compared. The current findings suggest that marital status alone is not predictive of outcome and that self-reports of the fami...

Male alcoholics in an inpatient rehabilitation program were selected to investigate differential characteristics of court-referred patients on measures of personality, drinking style, demograhics, and cognitive style. Seventy-eight males were separated into two groups based upon the demographic dimension of whether or not the patient was in treatme...

The Seattle Indian Alcoholism Program offers a a comprehensive Indian-oriented rehabilitation system. Anthropology is an integral part designed to document and evaluate the treatment program.

her complicated because of difficulty in defining the nature, or even the size, of the problem. Research literature concerning the definition, etiology, dynamics, assessment and treatment of alcoholism among American Indians is abundant but of unequal quaL ity and questionable usefulness. No single agency or organization collects or has access to i...

Orientation control is a personality construct referring to an individual's beliefs about the locus of control over his life events. The social learning model of behavior implies that people differ with respect to this orientation. The Drinking-related Internal Locus of Control Scale is viewed as a measure of specific expectancies dealing with a va...

Individual differences in neuropsychological status, drinking history, and depression as they relate to autonomic functioning in a sample of hospitalized alcoholics was investigated. Neuropsychological tests (Category Test, Trailmaking Test, Block Design, and Digit Symbol), the Alcohol Use Inventory, and the Beck Depression Inventory were administe...

The nature of implicit judgements clinicians form of their patients was investigated in relation to patient characteristics and length of clinical experience in an outpatient mental health facility. Professional and trainee staff rated patients on measures of interpersonal attractiveness following a screening interview. These ratings were compared...

Investigated the potential utility and validity of a measure of subjective helplessness, the H25. Helplessness is defined as the degree to which the individual perceives him/herself to be unable to influence or control the initiation and outcome of a variety of potentially reinforcing activities. Alcoholic subjects were classified into three levels...

The relationship of cognitive impairment to treatment outcome in a sample of male alcoholics (N = 30) was explored. The Brain-Age Quotient (BAQ), an index of problem solving and adaptive abilities based on a battery of neuropsychological tests, was used as the summary measure of cognitive impairment. High BAQ scores were found to be more highly rel...

The fact that alcoholism programs are biased in terms of the kind of patients admitted to treatment is well recognized. The authors examined the possible bias of preadmission screening procedures in an alcoholism treatment program and investigated some of the criteria used by staff clinicians in determining an applicant's acceptability for treatmen...

Locus of control is viewed as a measure of the degree of responsibility an individual perceives himself to have over meaningful life events. The drinking-related Internal-External locus of control scale represents the translation of generalized expectancies for locus of control into a measure of specific expectancies dealing with a variety of drink...

The present study investigated the interaction between cognitive style, imagery, and memory. The Tactual Performance Test Location Score from the Halstead-Reitan battery was used as a measure of incidental tactual memory and mental imagery. The Group Embedded Figures Test was used to assess cognitive style. Results for 38 Caucasian males of mean ag...

Investigated the utility of subtests from the Wechsler-Bellevue Intelligence Scale and the Halstead-Reitan Neuropsychological Test Battery to differentiate between alcoholics and nonalcoholics (N = 76). Analyses of variance indicated that the alcoholics were more impaired than nonalcoholics. It was found that the Wechsler-Bellevue Performance subte...

This study was sponsored by Grant PL—480 of the United States Public Health Service, in co-operation with the Association of American Medical Colleges, the Andrija Stampar School of Public Health in Zagreb, Croatia, and the Institute for the Study and Control of Alcoholism, Zagreb, Croatia.