Forty-two workers from a chemical plant producing inorganic mercury compounds were evaluated for neurologic, nephrotic, and ophthalmologic toxicity. Despite elevated blood and urinary mercury levels, routine clinical testing such as physical examination, blood chemistries, and urinalysis were generally normal. These findings from the routine examination are in contrast to the complaints of neuropsychological symptoms, elevated urinary n-acetyl B-D-glucosaminidase (NAG) levels, decreased motor nerve conduction velocities, and the presence of lenticular opacities on slit-lamp examination that were found, when organ systems known to be affected by mercury were targeted. More sensitive but objective indicators of toxicity need to be included in routine medical screening so as to help diagnose the etiology of neuropsychological symptoms and prevent long-term sequelae in workers exposed to mercury.

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This prospective study examines the causal relations among life events, chronic strain, and psychological distress. The influence of total number of life events; recent events; and undesirable, disruptive, and unanticipated events on marital strain and work/economic strain is assessed using latent variable structural equation modeling. It is hypothesized that chronic strain mediates the effects of life events on psychological distress. The data analyzed are from the first two waves of a prospective study on psychosocial factors and cancer mortality in a sample of skilled blue collar workers exposed to asbestos. A subsample of married and employed men within a relatively narrow age range was selected for this study to facilitate the investigation of the relations among life events, strain, and distress among individuals similarly situated in the life course. The results show that total number of events and recent, undesirable, disruptive, and unanticipated events increase work/economic strain and that, through this increase in strain, life events influence both contemporaneous levels of psychological distress and changes in distress. Life events do not have a direct effect on psychological distress when prior levels of events, work/economic strain, and distress are controlled. In contrast, life events do not have an impact on marital strain; rather, marital strain exerts a direct effect on distress. Undesirable, unanticipated, and disruptive events exert modest but significant direct effects on psychological distress in models including marital strain. These findings are discussed in terms of the place of the sample of workers in the life course, and implications for the design of preventive intervention programs are presented.

Painters in three shipyards, exposed to a wide variety of solvents, were examined. A short battery of performance tests, a detailed occupational history, and a special questionnaire to assess acute (prenarcotic, transitory) and chronic (persistent) neurologic symptoms was administered. The results of the neurobehavioral performance tests demonstrated decrements in central nervous system function in painters when compared with a control group matched for age, sex, race, and education. The prevalence of reported acute neurological symptoms among painters was increased significantly compared to other occupational groups in the same yards; for chronic, persistent symptoms the difference was not statistically significant. Performance test scores were significantly, negatively correlated with chronic symptoms but not with acute symptoms. No significant correlations between performance test scores and duration of solvent exposure or between symptoms and duration of solvent exposure were observed. The reversibility of such symptoms and of decrements in central nervous system function after cessation of exposure is still uncertain.

The association between lead absorption and objective psychological performance tests in five groups with different levels of lead absorption was studied in the following groups: (1) a control, non-lead-exposed group; (2) cable splicers, (3) cable manufactures, and (4) secondary lead smelter workers. The following performance tests were used: Block Design, Digit Symbol, and Embedded Figures. Age-corrected performance test scores and the average of three test scores (INDEX) were used throughout. A significant association between performance tests scores and increased lead absorption was found. Zinc protoporphyrin level was a more "powerful" (in the statistical sense) indicator of lead-induced CNS effects than blood lead levels. This study provides additional evidence that neurotoxic effects associated with occupational exposure to lead can be demonstrated by means of performance tests. It has been known and widely accepted that increased lead absorption is associated with "non-specific" subjective symptoms: tiredness, sleep disturbance, irritability, etc. Psychometric techniques (including an appropriate statistical analysis strategy) are highly sensitive for the early detection of CNS neurotoxicity, such as metal toxicity. Moreover, even in lead-exposed but asymptomatic individuals, a significant correlation (negative) between test scores and levels of lead absorption could be detected. It is concluded that workers exposed to lead at levels considered "safe" might be at risk of developing brain dysfunction with long term exposure.

The influence of event characteristics on recall was examined by directly comparing fall-off in reporting life events as a function of life change, desirability, and anticipation. We collected information from a sample of 1,669 blue-collar workers on stressful life events that occurred in a 1-year interval before the questionnaire was administered. The results indicated no fall-off in reporting events associated with marked life changes (ie, salient events). In contrast, significant fall-off was observed for events characterized by varying degrees of desirability and anticipation. Although ratings of desirability and saliency were not independent, saliency of life events emerged as the dimension most closely associated with accuracy of event reporting. Research on the reliability of measures of life events and the association between event characteristics and illness should consider the kinds of systematic reporting differences observed here.

This analysis of five recovery narratives from leaders of a peer-led, 12-Step-based self- help group in a methadone treatment program highlights the importance of spiritually-mediated role transformation in the recovery process. For these men and women in their forties and fifties, their progression to a leadership role helping others with their recovery validated the spiritual transformation they regarded as underlying their own recovery process. Assumption of this new leadership/helper role marked a tangible sign that their deepened spirituality allowed them to assume a new, higher function in a struggle with the addiction that had plagued their lives. For these peer leaders, methadone was at the core of the group experience and an aid to spiritual transformation.

This paper reviews the literature on ambulatory substance abuse treatment for adolescents, including brief intervention, Twelve-Step-based outpatient treatment, family-based treatment, cognitive behavioral therapy, and pharmacologic treatment. An overview of socially and culturally specific strategies is also included. The diversity of settings and approaches and combinations of approaches in the treatment of adolescents is emphasized as are adaptations of Twelve-Step and other group based interventions. Family-based and multisystem therapy, adapted for substance using adolescents, is highlighted as a promising future direction of effective treatment.