Samuel Ball, PhD
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Research Summary
My major research interests involve the evaluation of personality dimensions and disorders as important constructs for subtyping addicted individuals for the purpose of predicting treatment outcome and developing interventions. My diagnostic and assessment research has included the validation of a multidimensional substance abuse typology that defines subtypes of substance abusers based on multiple risk factors that may have prevention and treatment relevance. I have developed and evaluated the first manual-guided psychotherapy for the full range of personality disorders co-occurring with substance abuse. I also have been an investigator on various projects evaluating the effectiveness of cognitive-behavioral therapies and brief interventions to improve retention and symptom reduction in substance abuse patients.
Specialized Terms: Personality; Personality Disorders; Psychotherapy; Substance Abuse; Addiction Treatment; Psychodiagnosis; Homelessness; Treatment Dropout
Extensive Research Description
My research investigates the most prevalent and yet commonly overlooked type of psychiatric comorbidity – substance abuse and personality disorders. I have conducted a systematic series of studies that have: evaluated the personality dimensions common to both of these psychiatric disorders; identified personality-related subtypes of substance abuse with greater symptom severity and worse prognosis, and; developed and tested the first psychotherapeutic model for the full range of personality disorders found in substance abusers. Personality traits appear to be risk factors for substance use, as well as risk factors for personality disorders that have substance abuse as an important behavioral expression. Maladaptive personality traits and related personality disorders are not simply consequences of addiction. Previous, ongoing, and planned studies focus on two major areas related to personality and substance use disorders: 1) assessment and diagnosis; 2) psychotherapy efficacy.
1) Assessment and Diagnosis
Over half of treated substance abusers meet diagnostic criteria for a personality disorder. The separation of addiction symptoms from personality traits and disorders through careful assessment is critically important for improving diagnostic reliability and validity and predicting treatment response. Personality disorders influence symptom severity, persist and interfere with psychosocial functioning once abstinence is achieved, create significant ongoing risk for relapse, and may require additional specialized treatment.
Over the past 20 years, my research has focused on evaluating extreme, maladaptive personality traits and the prevalence and treatment implications of personality disorders in substance abusers. I have mapped personality dimensions from five factor and seven factor models onto personality disorder diagnoses and compared the reliability of personality disorder and trait dimensions. A constellation of maladaptive personality traits is related to substance dependence severity, polydrug use, earlier age of onset, chronic/heavy use, conduct and antisocial personality disorders, violence, arrests, HIV risk behaviors, psychiatric symptoms, mood disorders, suicide attempts, and early treatment drop-out. My work has emphasized the importance of utilizing dimensional models of personality disorders which incorporate symptom severity measures of diagnostic interview categories as well as self-report measures of maladaptive personality traits and problems.
Consistent with the increased appreciation of the heterogeneity of addicted persons, my research has emphasized that personality factors can be viewed as etiologically or prognostically linked to some, but not necessarily all, subtypes of substance abusers. I have evaluated an empirical framework for understanding the relation between personality dimensions, substance abuse, and personality disorders through a typological system which organizes diverse variables into broader constructs which are associated with different etiologies, patterns, and courses of the disorder. This work included the first extension of a multidimensional alcoholism typology to the drug abuse field. One type (variously called Type I or Type A) is characterized by later age of onset, lower heritability, fewer childhood risk factors, and less severe dependence. The second type (Type II or B) is characterized by earlier onset, higher heritability, more childhood risk factors, more severe dependence, greater psychosocial impairment, antisocial behavior, and psychiatric comorbidity. In a series of studies, I validated this Type A/B and established its connection to certain personality traits and disorders.
Although antisocial and borderline are the most common personality disorders in addiction treatment settings, other disorders (avoidant, paranoid, dependent, narcissistic) affect a significant minority of substance abuse patients, but have not been the focus of diagnostic or treatment research. Other personality disorders, referred to as Cluster A or psychotic spectrum (schizoid, schizotypal, paranoid), are the most common form of diagnostic comorbidity in a group of substance abusers who have had limited or ineffective interactions with the addiction and mental health treatment system (i.e., homeless persons). The development of an effective therapy for the diverse groups of treatment refractory, personality disordered substance abusers has been the focus of my second major area of research and contribution to the field.
2) Psychotherapy Efficacy
Although personality disorders are the most common form of psychiatric comorbidity in drug abusers and convey a negative prognosis, treatments have been adapted or tested for only two specific diagnoses (antisocial and borderline personality disorders). I am the originator of Dual Focus Schema Therapy (DFST) which is the only psychotherapy manual developed and tested for the full range of personality disorders encountered in substance abusers. The problem targets for this treatment are early maladaptive schemas and the associated coping styles related to addictive behaviors. The development of a personality disorder is conceptualized as an interaction between biologically-based personality or temperament traits and highly dysfunctional early caretaking environments which contribute to the development of enduring, unconditional, negative beliefs about oneself, others, and the world and coping behaviors that are inappropriate, rigid, and difficult to change.
DFST is an integrative, cognitive-behavioral therapy that targets these maladaptive personality processes (cognitive, behavioral, interpersonal, emotional) that heighten risk for relapse and adversely impacts treatment engagement, retention, and outcome and the social supports necessary for long-term recovery. It is a manual-guided individual therapy based on a detailed, multi-level assessment and conceptualization of personality traits, problems, and disorders. Cognitive, behavioral, relational, and experiential techniques are selected that focus on reducing addiction and psychiatric symptoms, the intensity of affective and behavioral reactions to schema activation, and maladaptive methods of coping with high risk situations. The choice and staging of interventions is guided by a detailed case formulation of personality functioning and an open, ongoing, collaborative dialogue between the therapist and patient about personality problems, addictive behaviors, and the identification of specific target problems for intervention. This therapeutic partnership fosters the type of strong working alliance that psychotherapy research has found associated with positive outcomes and seems especially important with challenging, refractory patients.
I have completed two smaller and one larger randomized clinical trials comparing DFST to standard addiction counseling approaches. All treatment studies involve very complex, traumatized, multi-problem patients. I have established the feasibility, safety, acceptability, and preliminary efficacy of DFST and developed a: detailed session-by-session treatment manual with prescribed and proscribed techniques; comprehensive, effective training and supervisory procedure for therapists, and; adherence/competence rating system to measure treatment discriminability and fidelity. In the first study in outpatient methadone maintained personality disordered patients, DFST was superior to 12 Step Facilitation Therapy on the primary substance use outcome and secondary therapeutic alliance measure. In the second study in homeless substance abusers with personality disorders, DFST promoted better therapy utilization than a Drug Counseling group. However, homeless clients with more severe forms of certain personality disorders exhibited better Drug Counseling group utilization. The third study of patients in long-term residential treatment found that DFST promoted significant psychiatric, interpersonal, and negative affect symptom reduction over the duration of therapy. However, patients with certain personality disorders had better psychiatric symptom reduction in Individual Drug Counseling than DFST.
The randomized clinical trial of DFST conducted in a homeless drop-in center unexpectedly found rates of Cluster A (paranoid, schizotypal, schizoid) and Cluster C (especially obsessive-compulsive) personality disorders that were 5 – 15 times (i.e., 40 – 75% prevalence rates) more common than typically found in mental health and addiction treatment programs. This was a new finding for the field as previous diagnostic research on the homeless had focused extensively on severe Axis I diagnoses (schizophrenic, mood, and substance use disorders) and ignored the Axis II diagnoses other than antisocial personality disorder. My team completed three additional diagnostic studies, all of which confirm the very high prevalence of these psychotic-spectrum personality disorders among the homeless. This has been the first research to conduct structured diagnostic interviews of the full range of personality disorders among homeless persons while controlling for the effects of other psychiatric disorders. This diagnostic work has established the independence of these very common severe personality disorders from their related, but less prevalent, mood, schizophrenic, anxiety, and substance use disorders. These severely traumatized, psychosocially challenged individuals have been insufficiently served by traditional treatment systems. Other recent research evaluates the relation between maladaptive personality dimensions and addiction symptom severity, psychosocial functioning, relapse risk, treatment motivation and response through a longitudinal evaluation of predictors of outpatient treatment engagement and attrition.
- Adaptive Brief Interventions for Drop-Out Re-Engagement
Prospective assessment of risk factors for early attrition from substance abuse treatment and evaluation of manual-guided adaptive intervention designed to improve re-engagement in treatment.
- Psychotic-Spectrum Personality Disorders in Homeless Persons
Evaluates prevalence and correlates of Axis I and II disorders in homeless persons.
Coauthors
Research Interests
Behavior and Behavior Mechanisms; Mental Disorders; Ill-Housed Persons; Personality; Personality Disorders; Psychiatry; Psychotherapy; Substance Abuse Detection; Treatment Outcome; Psychiatry and Psychology
Selected Publications
- Computer-based training for cognitive behavioral therapy for Spanish-speaking substance users: adaptation and satisfaction.Silva M, Añez L, Carroll K, Jaramillo Y, Kiluk B, Frankforter T, Ball S, Gordon M, Paris M. Computer-based training for cognitive behavioral therapy for Spanish-speaking substance users: adaptation and satisfaction. Journal Of Ethnicity In Substance Abuse 2022, 1-21. PMID: 35714996, DOI: 10.1080/15332640.2022.2086194.
- Verslaving en persoonlijkheidspathologieVerheul R, van den Bosch W, Ball S. Verslaving en persoonlijkheidspathologie 2017, 483-501. DOI: 10.1007/978-90-368-0931-3_24.
- Introduction and SignificanceJacobs S, Ball S, Davidson L, Díaz E, DeSanto Iennaco J, McMahon T, Rohrbaugh R, Steiner J, Styron T, Sernyak M, Zonana H. Introduction and Significance 2016, 1-12. DOI: 10.1093/med/9780190214678.003.0001.
- Conclusion and Future ChallengesJacobs S, Ball S, Davidson L, Díaz E, DeSanto Iennaco J, McMahon T, Rohrbaugh R, Steiner J, Styron T, Sernyak M, Zonana H. Conclusion and Future Challenges 2016, 273-286. DOI: 10.1093/med/9780190214678.003.0019.
- The Factor Structure and Concurrent Validity of the Early Maladaptive Schema Questionnaire: Research VersionSamuel D, Ball S. The Factor Structure and Concurrent Validity of the Early Maladaptive Schema Questionnaire: Research Version Cognitive Therapy And Research 2012, 37: 150-159. DOI: 10.1007/s10608-012-9439-6.
- Temporal stability of personality traits and disorders within substance dependent patientsSamuel D, Ball S. Temporal stability of personality traits and disorders within substance dependent patients Personality And Mental Health 2010, 4: 246-256. DOI: 10.1002/pmh.141.
- Correction to Ball et al. (2007)Ball S, Martino S, Nich C, Frankforter T, Van Horn D, Crits-Christoph P, Woody G, Obert J, Farentinos C, Carroll K. Correction to Ball et al. (2007) Journal Of Consulting And Clinical Psychology 2009, 77: 336-336. DOI: 10.1037/a0015304.
- 24 Verslaving en persoonlijkheidspathologieVerheul R, van den Bosch W, Ball S. 24 Verslaving en persoonlijkheidspathologie 2009, 417-432. DOI: 10.1007/978-90-313-6821-1_24.
- A Step Forward in Teaching Addiction Counselors How to Supervise Motivational Interviewing Using a Clinical Trials Training ApproachMartino S, Gallon S, Ball S, Carroll K. A Step Forward in Teaching Addiction Counselors How to Supervise Motivational Interviewing Using a Clinical Trials Training Approach Substance Abuse 2008, 6: 39-67. DOI: 10.1080/15332700802127946.
- Concurrent and Predictive Validity of Drug Use and Psychiatric Diagnosis Among First-Time DWI OffendersPalmer R, Ball S, Rounsaville B, O'Malley S. Concurrent and Predictive Validity of Drug Use and Psychiatric Diagnosis Among First-Time DWI Offenders Alcoholism Clinical And Experimental Research 2007, 0: 070227012339003-???. DOI: 10.1111/j.1530-0277.2007.00346.x.
- Verslaving en persoonlijkheidspathologieVerheul R, van den Bosch W, Ball S. Verslaving en persoonlijkheidspathologie 2007, 387-402. DOI: 10.1007/978-90-313-6404-6_22.
- Cognitive-Behavioral and Schema-Based Models for the Treatment of Substance Use Disorders.Ball S. Cognitive-Behavioral and Schema-Based Models for the Treatment of Substance Use Disorders. 2007, 111-138. DOI: 10.1037/11561-006.
- Personality traits, problems, and disorders: Clinical applications to substance use disordersBall S. Personality traits, problems, and disorders: Clinical applications to substance use disorders Journal Of Research In Personality 2005, 39: 84-102. DOI: 10.1016/j.jrp.2004.09.008.
- MET meets the real world: design issues and clinical strategies in the Clinical Trials NetworkNetwork F, Carroll K, Farentinos C, Ball S, Crits-Christoph P, Libby B, Morgenstern J, Obert J, Polcin D, Woody G. MET meets the real world: design issues and clinical strategies in the Clinical Trials Network Journal Of Substance Abuse Treatment 2002, 23: 73-80. PMID: 12220604, PMCID: PMC3651591, DOI: 10.1016/s0740-5472(02)00255-6.
- BABIES AND BATH WATER: PERSONALITY DISORDER RESEARCH EMERGES FROM A MURKY TOXONOMY. REFLECTIONS ON A HANDBOOK OF PERSONALITY DISORDERS.Ball S. BABIES AND BATH WATER: PERSONALITY DISORDER RESEARCH EMERGES FROM A MURKY TOXONOMY. REFLECTIONS ON A HANDBOOK OF PERSONALITY DISORDERS. The Journal Of Nervous And Mental Disease 2002, 190: 495-502. DOI: 10.1097/00005053-200208000-00001.
- Reliability of Personality Disorder Symptoms and Personality Traits in Substance-Dependent InpatientsBall S, Rounsaville B, Tennen H, Kranzler H. Reliability of Personality Disorder Symptoms and Personality Traits in Substance-Dependent Inpatients Journal Of Psychopathology And Clinical Science 2001, 110: 341-352. PMID: 11358028, DOI: 10.1037/0021-843x.110.2.341.
- Reconceptualizing Personality Disorder Categories Using Personality Trait Dimensions: Introduction to Special SectionBall S. Reconceptualizing Personality Disorder Categories Using Personality Trait Dimensions: Introduction to Special Section Journal Of Personality 2001, 69: 147-153. PMID: 11339793, DOI: 10.1111/1467-6494.00139.
- Addicted patients with personality disorders: traits, schemas, and presenting problems.Ball S, Cecero J. Addicted patients with personality disorders: traits, schemas, and presenting problems. Journal Of Personality Disorders 2001, 15: 72-83. PMID: 11236816, DOI: 10.1521/pedi.15.1.72.18642.
- One‐year follow‐up of disulfiram and psychotherapy for cocaine‐alcohol users: sustained effects of treatmentCarroll K, Nich C, Ball S, McCance E, Frankforter T, Rounsaville B. One‐year follow‐up of disulfiram and psychotherapy for cocaine‐alcohol users: sustained effects of treatment Addiction 2000, 95: 1335-1349. PMID: 11048353, DOI: 10.1046/j.1360-0443.2000.95913355.x.
- Comorbid Psychopathology in Binge Eating Disorder: Relation to Eating Disorder Severity at Baseline and Following TreatmentWilfley D, Friedman M, Dounchis J, Stein R, Welch R, Ball S. Comorbid Psychopathology in Binge Eating Disorder: Relation to Eating Disorder Severity at Baseline and Following Treatment Journal Of Consulting And Clinical Psychology 2000, 68: 641-649. PMID: 10965639, DOI: 10.1037/0022-006x.68.4.641.
- Dual Focus Schema Therapy for personality disorders and substance dependence: Case study resultsBall S, Young J. Dual Focus Schema Therapy for personality disorders and substance dependence: Case study results Cognitive And Behavioral Practice 2000, 7: 270-281. DOI: 10.1016/s1077-7229(00)80083-8.
- Multidimensional subtypes and treatment outcome in first-time dwi offendersBall S, Jaffe A, Crouse-Artus M, Rounsaville B, O'Malley S. Multidimensional subtypes and treatment outcome in first-time dwi offenders Addictive Behaviors 2000, 25: 167-181. PMID: 10795943, DOI: 10.1016/s0306-4603(99)00053-2.
- Co‐occurrence of Axis I and Axis II disorders in substance abusersVerheul R, Kranzler H, Poling J, Tennen H, Ball S, Rounsaville B. Co‐occurrence of Axis I and Axis II disorders in substance abusers Acta Psychiatrica Scandinavica 2000, 101: 110-118. PMID: 10706010, DOI: 10.1034/j.1600-0447.2000.90050.x.
- A general system for evaluating therapist adherence and competence in psychotherapy research in the addictionsCarroll K, Nich C, Sifry R, Nuro K, Frankforter T, Ball S, Fenton L, Rounsaville B. A general system for evaluating therapist adherence and competence in psychotherapy research in the addictions Drug And Alcohol Dependence 2000, 57: 225-238. PMID: 10661673, DOI: 10.1016/s0376-8716(99)00049-6.
- Axis I and Axis II disorders in alcoholics and drug addicts: fact or artifact?Verheul R, Kranzler H, Poling J, Tennen H, Ball S, Rounsaville B. Axis I and Axis II disorders in alcoholics and drug addicts: fact or artifact? Journal Of Studies On Alcohol And Drugs 2000, 61: 101-10. PMID: 10627103, DOI: 10.15288/jsa.2000.61.101.
- Factor Replicability and Validity of the Temperament and Character Inventory in Substance Dependent PatientsBall S, Tennen H, Kranzler H. Factor Replicability and Validity of the Temperament and Character Inventory in Substance Dependent Patients Psychological Assessment 1999, 11: 514-524. DOI: 10.1037/1040-3590.11.4.514.
- Rates of personality disorders in substance abusers: a comparison between DSM-III-R and DSM-IV.Poling J, Rounsaville B, Ball S, Tennen H, Kranzler H, Triffleman E. Rates of personality disorders in substance abusers: a comparison between DSM-III-R and DSM-IV. Journal Of Personality Disorders 1999, 13: 375-84. PMID: 10633317, DOI: 10.1521/pedi.1999.13.4.375.
- Concurrent and Predictive Validity of Antisocial Personality Disorder Subtyping among Substance AbusersCECERO J, BALL S, TENNEN H, KRANZLER H, ROUNSAVILLE B. Concurrent and Predictive Validity of Antisocial Personality Disorder Subtyping among Substance Abusers The Journal Of Nervous And Mental Disease 1999, 187: 478-486. PMID: 10463065, DOI: 10.1097/00005053-199908000-00004.
- Manualized treatment for substance abusers with personality disorders Dual focus schema therapyBall S. Manualized treatment for substance abusers with personality disorders Dual focus schema therapy Addictive Behaviors 1998, 23: 883-891. PMID: 9801723, DOI: 10.1016/s0306-4603(98)00067-7.
- Types of Abuse and Cocaine Use in Pregnant WomenJantzen K, Ball S, Leventhal J, Schottenfeld R. Types of Abuse and Cocaine Use in Pregnant Women Journal Of Substance Abuse Treatment 1998, 15: 319-323. PMID: 9650140, DOI: 10.1016/s0740-5472(97)00198-0.
- Personality disorder and dimension differences between type A and type B substance abusers.Ball S, Kranzler H, Tennen H, Poling J, Rounsaville B. Personality disorder and dimension differences between type A and type B substance abusers. Journal Of Personality Disorders 1998, 12: 1-12. PMID: 9573515, DOI: 10.1521/pedi.1998.12.1.1.
- Personality, Temperament, and Character Dimensions and the DSM–IV Personality Disorders in Substance AbusersBall S, Tennen H, Poling J, Kranzler H, Rounsaville B. Personality, Temperament, and Character Dimensions and the DSM–IV Personality Disorders in Substance Abusers Journal Of Psychopathology And Clinical Science 1997, 106: 545-553. PMID: 9358685, DOI: 10.1037/0021-843x.106.4.545.
- Maternal Attentiveness of Cocaine Abusers During Child—Based AssessmentsBall S, Mayes L, DeTeso J, Schottenfeld R. Maternal Attentiveness of Cocaine Abusers During Child—Based Assessments American Journal On Addictions 1997, 6: 135-143. PMID: 9134075, DOI: 10.1111/j.1521-0391.1997.tb00562.x.
- The impact of the Yale faculty development program: Clinical alcohol and drug research and education (cadre) on medical student teaching about substance abuseO'Connor P, Pearsall H, Ball S, Forsyth B, Faraclas W, Schottenfeld R. The impact of the Yale faculty development program: Clinical alcohol and drug research and education (cadre) on medical student teaching about substance abuse Substance Abuse 1997, 18: 33-40. DOI: 10.1080/08897079709511344.
- Addiction Severity and MMPI‐Derived Typologies in Cocaine AbusersBall S, Carroll K, Robinson J, O'Malley S. Addiction Severity and MMPI‐Derived Typologies in Cocaine Abusers American Journal On Addictions 1997, 6: 83-86. PMID: 9097875, DOI: 10.1111/j.1521-0391.1997.tb00395.x.
- Maternal Attentiveness of Cocaine Abusers During Child-Based AssessmentsBall S, Mayes L, DeTeso J, Schottenfeld R. Maternal Attentiveness of Cocaine Abusers During Child-Based Assessments American Journal On Addictions 1997, 6: 135-143. DOI: 10.3109/10550499709137024.
- A Five-Factor Model of Personality and Addiction, Psychiatric, and AIDS Risk Severity in Pregnant and Postpartum Cocaine MisusersBall S, Schottenfeld R. A Five-Factor Model of Personality and Addiction, Psychiatric, and AIDS Risk Severity in Pregnant and Postpartum Cocaine Misusers Substance Use & Misuse 1997, 32: 25-41. PMID: 9044535, DOI: 10.3109/10826089709027295.
- Generalizability of the Type A/Type B Distinction Across Different Psychoactive SubstancesFeingold A, Ball S, Kranzler H, Rounsaville B. Generalizability of the Type A/Type B Distinction Across Different Psychoactive Substances The American Journal Of Drug And Alcohol Abuse 1996, 22: 449-462. PMID: 8841691, DOI: 10.3109/00952999609001671.
- Attachment Theory as a Working Model for the Therapist Transitioning from Early to Later Recovery Substance Abuse TreatmentBall S, Legow N. Attachment Theory as a Working Model for the Therapist Transitioning from Early to Later Recovery Substance Abuse Treatment The American Journal Of Drug And Alcohol Abuse 1996, 22: 533-547. PMID: 8911591, DOI: 10.3109/00952999609001679.
- The Validity of an Alternative Five-Factor Measure of Personality in Cocaine AbusersBall S. The Validity of an Alternative Five-Factor Measure of Personality in Cocaine Abusers Psychological Assessment 1995, 7: 148-154. DOI: 10.1037/1040-3590.7.2.148.
- Subtypes of Cocaine Abusers: Support for a Type A–Type B DistinctionBall S, Carroll K, Babor T, Rounsaville B. Subtypes of Cocaine Abusers: Support for a Type A–Type B Distinction Journal Of Consulting And Clinical Psychology 1995, 63: 115-124. PMID: 7896976, DOI: 10.1037/0022-006x.63.1.115.
- Sensation Seeking, Substance Abuse, and Psychopathology in Treatment-Seeking and Community Cocaine AbusersBall S, Carroll K, Rounsaville B. Sensation Seeking, Substance Abuse, and Psychopathology in Treatment-Seeking and Community Cocaine Abusers Journal Of Consulting And Clinical Psychology 1994, 62: 1053-1057. PMID: 7806714, DOI: 10.1037/0022-006x.62.5.1053.
- A Sibling Study of Sensation Seeking and Opiate AddictionKOSTEN T, BALL S, ROUNSAVILLE B. A Sibling Study of Sensation Seeking and Opiate Addiction The Journal Of Nervous And Mental Disease 1994, 182: 284-289. PMID: 10678310, DOI: 10.1097/00005053-199405000-00006.
- A Comparison of Alternate Systems for Diagnosing Antisocial Personality Disorder in Cocaine AbusersCARROLL K, BALL S, ROUNSAVILLE B. A Comparison of Alternate Systems for Diagnosing Antisocial Personality Disorder in Cocaine Abusers The Journal Of Nervous And Mental Disease 1993, 181: 436-443. PMID: 8320546, DOI: 10.1097/00005053-199307000-00006.
- Psychiatric Disorders Among Relatives of Cocaine‐Abusing IndividualsLuthar S, Ball S, Rounsaville B. Psychiatric Disorders Among Relatives of Cocaine‐Abusing Individuals American Journal On Addictions 1993, 2: 225-231. DOI: 10.1111/j.1521-0391.1993.tb00424.x.
- Psychiatric Disorders Among Relatives of Cocaine-Abusing Individuals: Assessments of Familial RiskLuthar S, Ball S, Rounsaville B. Psychiatric Disorders Among Relatives of Cocaine-Abusing Individuals: Assessments of Familial Risk American Journal On Addictions 1993, 2: 225-231. DOI: 10.3109/10550499309113943.