Objective-Most individuals with alcohol or other substance use disorders do not seek help for these problems. This study examined the factors associated with perceptions of need for help and receipt of help among individuals with alcohol or other substance dependence disorders in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Methods-The 2001-2002NESARC surveyed a representative sample of the noninstitutionalized population in the United States. Individuals with a past-year substance dependence diagnosis (N=1,602) were classified into one of three groups: received help in the past year (14.7%), perceived a need for help but did not receive it (8.5%), or perceived no need and received no help (76.8%). Multinomial logistic regression with population weights was used to examine the influence of predisposing, enabling, and need-related factors on help seeking in the past year.Results-Factors that increased the receipt of help included older age, drug dependence (versus alcohol dependence only), longer time since the onset of dependence, co-occurring mood disorder, and more problems associated with substance use. Nonwhites were about twice as likely as whites (odds ratio=2.2) to perceive a need for help but not receive it. Similarly, more problems associated with substance use increased the odds of both receiving help and perceiving a need for help but not receiving it. None of the enabling characteristics were associated with help seeking or perceived need, after analyses controlled for predisposing and need-related factors.Conclusions-Increasing the recognition of problems associated with substance dependence, particularly alcohol, may facilitate help seeking, although barriers persist in regard to age and raceethnicity.Most individuals with alcohol or drug use disorders do not seek help or receive treatment for these problems. National surveys suggest that fewer than half of those with past-year psychiatric disorders (including substance use disorders) receive any treatment (1,2). Research from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) indicated that 24% of individuals with alcohol dependence during their lifetime ever received treatment and that only 12% of individuals with past-year alcohol dependence received treatment in that year (3). Although treatment is generally higher among individuals with drug dependence, it is still far from comprehensive; current estimates suggest that 38% of those with Correspondence to: Christine E. Grella, grella@ucla.edu. The authors report no competing interests. lifetime drug dependence and 31% of those with the disorder in the past year receive treatment within those time frames (4). NIH Public AccessHealth services research has identified several factors associated with treatment. Treatment utilization is higher among individuals who have multiple types of substance use problems as well as co-occurring mental disorders (5-7). In addition to the nature and severity of disorders, the perception of need an...

Objective-To determine whether spectral analysis of unprocessed radiofrequency (RF) signal oVers advantages over standard videodensitometric analysis in identifying the morphology of coronary atherosclerotic plaques. Methods-97 regions of interest (ROI) were imaged at 30 MHz from postmortem, pressure perfused (80 mm Hg) coronary arteries in saline baths. RF data were digitised at 250 MHz. Two diVerent sizes of ROI were identified from scan converted images, and relative amplitudes of diVerent frequency components were analysed from raw data. Normalised spectra was used to calculate spectral slope (dB/MHz), y-axis intercept (dB), mean power (dB), and maximum power (dB) over a given bandwidth (17-42 MHz). RF images were constructed and compared with comparative histology derived from microscopy and radiological techniques in three dimensions. Results-Mean power was similar from dense fibrotic tissue and heavy calcium, but spectral slope was steeper in heavy calcium (−0.45 (0.1)) than in dense fibrotic tissue (−0.31 (0.1)), and maximum power was higher for heavy calcium (−7.7 (2.0)) than for dense fibrotic tissue (−10.2 (3.9)). Maximum power was significantly higher in heavy calcium (−7.7 (2.0) dB) and dense fibrotic tissue (−10.2 (3.9) dB) than in microcalcification (−13.9 (3.8) dB). Y-axis intercept was higher in microcalcification (−5.8 (1.1) dB) than in moderately fibrotic tissue (−11.9 (2.0) dB). Moderate and dense fibrotic tissue were discriminated with mean power: moderate −20.2 (1.1) dB, dense −14.7 (3.7) dB; and y-axis intercept: moderate −11.9 (2.0) dB, dense −5.5 (5.4) dB. DiVerent densities of fibrosis, loose, moderate, and dense, were discriminated with both y-axis intercept, spectral slope, and mean power. Lipid could be diVerentiated from other types of plaque tissue on the basis of spectral slope, lipid −0.17 (0.08). Also y-axis intercept from lipid (−17.6 (3.9)) diVered significantly from moderately fibrotic tissue, dense fibrotic tissue, microcalcification, and heavy calcium. No significant diVerences in any of the measured parameters were seen between the results obtained from small and large ROIs. Conclusion-Frequency based spectral analysis of unprocessed ultrasound signal may lead to accurate identification of atherosclerotic plaque morphology. (Heart 1998;79:459-467) Keywords: tissue characterisation; intravascular ultrasound; spectral analysis; radiofrequency data Previous intravascular ultrasound (IVUS) studies have shown that the presence of target lesion calcium aVects both the acute and long term results of coronary interventions. After percutaneous transluminal coronary angioplasty (PTCA), a chronic reduction in total vessel area is the main operative mechanism of lumen reduction and is more prevalent in lesions with mixed or calcific composition.

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Longstanding disparities in substance use disorders and treatment access exist among American Indian/Alaska Natives (AI/AN). Computerized, web-delivered interventions have potential to increase access to quality treatment and improve patient outcomes. Prior research supports the efficacy of a web-based version (Therapeutic Education System [TES]) of the Community Reinforcement Approach to improve outcomes among outpatients in substance abuse treatment; however, TES has not been tested among AI/AN. The results from this mixed method acceptability study among a diverse sample of urban AI/AN (N=40) show that TES was acceptable across seven indices (range=7.8 to 9.4 on 0 to 10 scales with 10 indicating highest acceptability). Qualitative interviews suggest adaptation specific to AI/AN culture could improve adoption. Additional efforts to adapt TES and conduct a larger effectiveness study are warranted.

Single-dose inhalation of vaporized cannabis had no clinically meaningful positive or negative effect on airway function, exertional breathlessness, and exercise endurance in adults with advanced COPD. Clinical trial registered with www.clinicaltrials.gov (NCT03060993).