Feb

Screening for Alcohol Problems

Sparrow on February 9th, 2010

Screening for Alcohol Problems in Primary Care;

A Systematic Review

Background; Primary care physicians can play a unique role in recognizing and treating patients with alcohol problems.

Objective; To evaluate the accuracy of screening methods for alcohol problems in primary care.

Methods; We performed a search of MEDLINE for years 1966 through 1998. We included studies that were in English, were performed in primary care, and reported the performance characteristics of screening methods for alcohol problems against a criterion standard. Two reviewers appraised all articles for methodological content and results.

Results; Thirty-eight studies were identified. Eleven screened for at-risk, hazardous, or harmful drinking; 27 screened for alcohol abuse and dependence. A variety of screening methods were evaluated.

The Alcohol Use Disorders Identification Test (AUDIT) was most effective in identifying subjects with at-risk, hazardous, or harmful drinking (sensitivity, 51%-97%; specificity, 78%-96%).

The CAGE questions proved superior for detecting alcohol abuse and dependence (sensitivity, 43%-94%; specificity, 70%-97%).

These 2 formal screening instruments consistently performed better than other methods, including quantity-frequency questions.

The studies inconsistently adhered to methodological standards for diagnostic test research: 3 provided a full description of patient spectrum (demographics and comorbidity), 30 avoided workup bias, 12 avoided review bias, and 21 performed an analysis in pertinent clinical subgroups.

Conclusions; Despite methodological limitations, the literature supports the use of formal screening instruments over other clinical measures to increase the recognition of alcohol problems in primary care.

Research; David A. Fiellin, M. Carrington Reid, Patrick G. O’Connor. Screening for Alcohol Problems in Primary Care; A Systematic Review. Arch Intern Med. 2000;160:1977-1989.

Brief-TSF includes both the AUDIT and CAGE questionnaires.

ACTIVE INGREDIENTS OF EFFECTIVE ALCOHOL TREATMENT

Sparrow on February 8th, 2010

Early detection, including screening and brief interventions (for nondependent problem drinkers)
Comprehensive assessment and individualized treatment plan
Care management
Individually delivered, proven professional interventions
Contracting with patients
Social skills training
Medications
Specialized services for medical, psychiatric, employment or family problems
Continuing care
Strong bond with therapist or counselor
Longer duration (for alcohol dependent persons)
Participation in support groups
Strong patient motivation

Research Sources: McLellan, T.A. 2002; Miller,W.R. 2002; National Institute on Drug Abuse. 1999; Project MATCH Research Group. 1997.

Active participation in a support group can contribute to long-term recovery.

Project MATCH and other studies in the 1990s definitively proved that AA can be an active ingredient of treatment both during a professional intervention and afterward, depending on the patientâ€™s type of therapy.

Patients who joined the AA fellowship or who had an AA sponsor after receiving twelve step facilitation therapy had better abstinence records than those who received an intervention but did not continue their AA participation upon completion.

Other research indicates AA participation may be less effective for patients who receive cognitive behavior therapy because the programs have different goals that may confuse patients.

What researchers still donâ€™t understand, however, are the precise mechanisms of AA participation.

While AA affiliation is associated with self-efficacy, motivation and coping efforts, all significant predictors of good outcome following a professional intervention, some studies have shown that patients who adopt more of the fellowshipâ€™s basic tenets â€“ such as acknowledging that alcoholism is a disease, admission of their powerlessness over alcohol and working the twelve steps of the program â€“ relapse at the same rates as patients who adopt very few.

This suggests that the active ingredient may be less about AA per se than continuing participation in support groups that promote a lifestyle inconsistent with the problematic use of alcohol and other drugs.

From; www.ensuringsolutions.org

Brief-TSF is designed to support active participation in Alcoholics Anonymous.

Abstinence rates in AA

Sparrow on February 7th, 2010

If you continue to attend AA and not drop out you have nearly double chance of remaining abstinent.

Estimated Alcoholics Anonymous Membership 1991-1992

New members during past year – 0.9 million
On-going members – 1.5 million
Total membership – 2.4 million

Continuation Rate in Alcoholics Anonymous

In 1991-1992 4.8 million respondents reported ever attending an Alcoholics Anonymous (AA) meeting, for reasons related to their drinking, prior to the last 12 months and 31% reported continued AA attendance during the last 12 months.

Rate of continued AA attendance was associated with years since first AA meeting

1-4 years since first AA meeting – 36% remained
5-9 years since first AA meeting – 30% remained
10-19 years since first AA meeting – 29% remained
20 years or more since first AA meeting – 32% remained

Comparison of Past Year Drinking Status – Dropouts and Continuing AA Members

Dropouts:

Abstinent 33%
Low risk drinking 14%
High risk drinking 53%

Continued AA attendance:

Abstinent 62%
Low risk drinking 9%
High risk drinking 29%

low risk drinking = never exceed 4 drinks per day(male) or 3 drinks per day (female)
high risk drinking = exceeds 4 drinks per day (male) or 3 drinks per day (female)

Research Source: NIAAA 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). Data Brief – National Longitudinal Alcohol Epidemiologic Survey (NLAES) Findings on Alcoholics Anonymous Membership by Loran Archer.

Thus, 36% remain attending A.A. at the end of one year and 32% are still attending at the end of 20 years.

AA Attendance and Abstinence

Sparrow on February 6th, 2010

While Alcoholics Anonymous (AA) is a preferred form of aftercare for patients “completing” formal treatment programs, little is known about AA involvement and its effects on abstinence over time. In this study, researchers assessed participation in AA, abstinence, and other alcohol outcomes over 5 years among 349 patients who entered treatment at baseline and attended AA at least once during follow-up.

Four patterns of AA attendance emerged:

low (mainly during the year following treatment entry);
medium (about 60 meetings per year with a slight increase by year 5);
high (over 200 meetings per year with a slight decrease by year 5); and
declining (almost 200 meetings the year following treatment entry and about 6 meetings in year 5).

Abstinence (past 30 days) in year 5 significantly differed across groups:

79 percent of patients with high attendance reported abstinence, followed by
73 percent with medium attendance,
61 percent with declining attendance, and
43 percent with low attendance.

Patients with medium or high attendance had the largest social networks of people who supported patient abstinence or decreased alcohol use.

Patients across the groups had similar numbers of dependence symptoms and social consequences of drinking.

Patients who attend AA after treatment can be characterized as those who never connect, those who connect briefly, and those who maintain stable (and sometimes quite high) attendance. Even those who connect for a short while appear to benefit years later, though higher attendance was associated with a greater likelihood of long-term abstinence. Providers should reinforce AA attendance as part of a comprehensive effort to improve long-term abstinence.

Research Reference: Kaskutas LA, Ammon L, Delucchi K, et al. Alcoholics Anonymous careers: patterns of AA involvement five years after treatment entry. Alcohol Clin Exp Res. 2005:29(11);1983â€“1990.

Reprinted with permission from Alcohol and Health: Current Evidence.

From Jointogether

Abstinence Solves Thinking Problems

Sparrow on February 5th, 2010

Abstinence Resolves Most Brain Cognitive Problems Caused by Drinking

A study of alcoholics who have abstained from drinking for between six months and 13 years concludes that sobriety can counteract most of the brain and thinking damage caused by heavy drinking, News Today reported Aug. 29.

Researchers looked at a wide range of problem areas for alcoholics, including abstraction/cognitive flexibility, attention, auditory working memory, immediate memory, delayed memory, psychomotor function, reaction time, spatial processing, and verbal skills.

They found that all but spatial processing recovered with sustained sobriety, noting that even alcoholics in long-term recovery may have lingering problems with tasks like map-reading or assembling things.

“Alcoholics may have periods of abstinence, during which time they give their nervous system time for repair,” according to researcher Edith Sullivan of the Stanford University School of Medicine. “Thus, longitudinal studies of alcoholics are critical for identifying functional areas that are targeted by alcoholism, those that are relatively spared, and those that can recover with sobriety.”

The research was published in the September 2006 issue of Alcoholism: Clinical & Experimental Research.

Reference: Fein, G. et al. (September 2006). Cognitive Performance in Long-Term Abstinent Alcoholic Individuals. Alcoholism: Clinical & Experimental Research, 30,: 1538.

From; Join Together Online

Alcoholics Anonymous has the most consistent and well known global recovery record.

Phases of Recovery

Sparrow on February 4th, 2010

Phases of Alcoholism Recovery

The recovery process in Alcoholics Anonymous includes several general phases that people may pass through. These are not time related but are usually dependent on the persons particular circumstances.

Initial Sobriety

Surrenders to alcohol – accepts alcoholism
Begins humble search for self
Restoration of physical health begins
Restoration of memory begins
Restoration of mental functions begins
Begins to practice self-honesty
Is pre-occupied with sobriety
Growth of open-mindedness
Lessening of needless guilt
Freely discusses alcohol and its problems
Mild depression and anxiety lessens
Mental functions are more alert

Learning Sobriety

Accepts and owns their alcoholism
Loss of freedom acknowledged and accepted
Alibis replaced by sound reasons for sobriety
Social pressures to quit, lessen – threats replaced by encouragement
Grandiose behaviour begins to be replaced by the give and take of real personal relations
Aggressive behaviour begins to be replaced by willingness to learn
Persistent remorse disappears, peace initiated
Abstinence graduates into sobriety
Pattern of thinking begins to change
Regains friends
Job prospects improve
Sobriety-centred behaviour improves
Regains outside interests
Acceptance of friends
Sense of humour starts to replace self-pity
Acceptance of environment improves
Begins to regain family faith
Resentment of others begins to be replaced by acceptance of others
Loyalty and protection of family interests begins
Sex relations improve
Greater understanding of life partner
Learns to enjoy a good breakfast

Accepting Sobriety

Surrenders to life – accepts life on its terms
Loss of desire to drink becomes profane and lasting
Improved ethical and moral perception
Improved thinking
Improved feeling
Keeps company with people one can respect of help
Emotional â€˜dips’ become fewer and shallower
Emotions become easier to manage

Creative sobriety

Loss of desire to drink becomes deeper and almost permanent
Fears, anxieties and depressions are understood and managed in interpersonal relations
Appreciates deeply freedom from alcohol
Explores new freedom to use it in other activities without fear
Single-minded sobriety; defines assurances that there is no compromise with sobriety
Genuine spiritual desires centred on new way of life
Alibi system replaced by deepening quality of intelligent sobriety
Appreciates need for help, both for sobriety and as a guard against drinking in daily life

Pleasurable Sobriety

Self-unity, at peace with oneself, knows serenity
Socialises easily, at one with the world
Little or no emotional hang-overs
Rewards clearly exceed tough times
Feels well, enjoys sobriety
Anxiety, shyness, etc., disappear in genuine interpersonal relations

Adapted from Stewart DA. Thirst For Freedom. Hazeldene; Minnesota

Substance use among Dutch dental students.

Sparrow on February 3rd, 2010

The objectives of this research were to assess the prevalence of substance use among Dutch dental students and to determine their attitudes about substance use and its consequences.

METHODS: In association with a national study of drug use among US dental students, a questionnaire was translated from English into Dutch and administered to dental students at two dental schools in The Netherlands. Students received an anonymous 115-item questionnaire in the fall of 1996.

RESULTS: Alcohol was the students’ drug of choice for

lifetime (95%),
past year (94%) and
past month (88%) use.

No significant correlations were found between alcohol use and gender, schools, and years in dental education.

In the past month,

58% of students reported drinking on 5 or more days;
53% had 5 or more drinks on the same occasion,
20% had 5 or more drinks on the same occasion on 5 or more days; and
17% reported getting drunk at least monthly.

Prevalence rates for past month use of tobacco was 24% and marijuana, 4%.

Male students smoked twice as much as females, with significant differences found for all three periods of use (X2>19.00, P<0.01).

When asked whether their schools offered policies and education programs on alcohol and other drugs, 52% of students reported that these were not available.

CONCLUSIONS: Dental schools should develop effective programmes to educate students about responsible use of alcohol and other licit and illicit drugs. Schools should also inform students about their susceptibilities to substance abuse and dependency.

Community Dent Oral Epidemiol. 2001 Feb;29(1):48-54. Substance use among Dutch dental students. Plasschaert AJ, Hoogstraten J, van Emmerik BJ, Webster DB, Clayton RR.

Recovering Alcoholics Effective in Helping Others

Sparrow on February 2nd, 2010

A new report shows that people in recovery can help hospitalized alcoholics by encouraging them to quit drinking and enter counseling, Reuters reported June 11.

“A recovering alcoholic can help alcoholics who are still suffering from the disease, because the patients relate to them,” said Dr. Richard D. Blondell, an addiction-medicine specialist at the University of Louisville School of Medicine in Kentucky. “The patients credit the visitor as the main thing that motivated them.”

The study included 140 patients who were hospitalized for alcohol-related incidents. One group received standard medical care, a second group received medical care plus a 15-minute intervention by a trained addiction specialist, and the third group received medical care, intervention, and an in-depth talk with a recovering alcoholic.

Researchers found that 59 percent of those who met with recovering alcoholics abstained from drinking for six months after the incident, compared to 44 percent of those who received addiction counseling alone, and one-third of those who only received medical care.

In addition, half the patients who met with recovering alcoholics had entered some form of treatment, compared with only 15 percent of those who received medical treatment and counseling by an addiction specialist.

The study is published in the May issue of the Journal of Family Practice.

From; Jointogether

Brief-TSF is based on these principles.

Persistent Pain Increases Risk of Relapse

Sparrow on February 1st, 2010

Persistent pain is prevalent among people with substance use disorders.

It is not known, however, whether such pain increases the risk of relapse following periods of abstinence.

Researchers assessed data on pain and substance use in 397 adults who, as part of a larger randomized trial, had been interviewed periodically in the 24 months after their discharge from an urban, residential alcohol and drug detoxification unit.

Pain was measured with the pain item on the SF-36 Health Survey. Analyses were adjusted for potential confounders (e.g., demographics, addiction severity, depressive symptoms).

Sixteen percent of subjects reported persistent pain (moderate-to-higher levels of pain at all available interviews) in the 24 months after detoxification.
Subjects reporting persistent pain were significantly more likely than those with mild or no pain to have used the following in the past 30 days at the 24-month follow-up:

heroin/opioids not prescribed for pain (odds ratio, 5.4);
heavy amounts of alcohol* (odds ratio, 2.2).

Comments: Persistent pain is common among alcohol and drug users who have undergone residential detoxification and increases the likelihood of relapse. This study suggests that clinicians must be careful to screen for pain symptoms in patients with substance dependence. When persistent pain is present, thoughtful management is required to minimize risks associated with undertreatment while not fostering opioid analgesic abuse.

Research References:Larson MJ, Paasche-Orlow M, Cheng DM, et al. Persistent pain is associated with substance use after detoxification: a prospective cohort analysis. Addiction. 2007.

The Mindbody Prescription: Healing the Body, Healing the Pain
by John E. Sarno

The Role of AA Sponsors

Sparrow on January 30th, 2010

A pilot study of the role of AA sponsors

An AA sponsor is a close 1-on-1 collaboration between an older sober member and a relative newcomer to sobriety. Its a two way helping relationship â€“ the sponsor affirms their own sobriety and the sponsee gains new insights.

AIMS: The aim of this study was to explore the roles of Alcoholics Anonymous (AA) sponsors and to describe the characteristics of a sample of sponsors.

METHODS: Twenty-eight AA sponsors, recruited using a purposive sampling method, were administered an unstructured qualitative interview and standardized questionnaires. The measurements included: a content analysis of sponsors’ responses; Severity of Alcohol Dependence Questionnaire-Community version (SADQ-C) and Alcoholics Anonymous Affiliation Scale (AAAS).

RESULTS: Sample characteristics were as follows:

the median length of AA attendance was 9.5 years (range 5-28);
the median length of sobriety was 11 years (range 4.5-28);
the median number of sponsees per sponsor was 1 but there was a wide range (0-17, interquartile range 3.75); and
the sponsors were highly affiliated to AA (median AAAS score 8.75, range 5.5-8.75, maximum possible score 9).

Past alcohol dependence scores were surprisingly low:

5 (18%) sponsors had mild,
14 (50%) moderate and
9 (32%) severe dependence according to the SADQ-C (median 26.5, range 11-56).

Sponsorship roles were as follows: 16 roles were identified through the initial content analysis. These were distilled into three super-ordinate roles through a thematic analysis:

encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity);
support (regular contact, emotional support and practical support); and
carrying the message of AA (sharing sponsor’s personal experience of recovery with sponsees).

CONCLUSIONS: The roles identified broadly corresponded with the AA literature delineating the duties of a sponsor. This non-random sample of sponsors was highly engaged in AA activity but only had a past history of moderate alcohol dependence.

Research; The role of AA sponsors: a pilot study. Whelan PJ, Marshall EJ, Ball DM, Humphreys K. Alcohol Alcohol. 2009 Jul-Aug;44(4):416-22. Epub 2009 Mar 18.