Predictors of changes in alcohol-related self-efficacy over 16 years

Self-efficacy is a robust predictor of short- and long-term remission after alcohol treatment. This study examined the predictors of self-efficacy in the year after treatment and 15 years later.

A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years.

Predictors of self-efficacy at 1 year included

• improvement from baseline to 1 year in heavy drinking,
• alcohol-related problems,
• depression,
• impulsivity,
• avoidance coping,
• social support from friends, and
• longer duration of participation in mutual-help Alcoholics Anonymous (AA).

Female gender, more education, less change in substance use problems, and impulsivity during the first year predicted improvement in self-efficacy over 16 years.

Clinicians should focus on

• keeping patients engaged in self-help of AA,
• addressing depressive symptoms,
• improving patient’s coping, and
• enhancing social support

during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.

Research; Predictors of changes in alcohol-related self-efficacy over 16 years. John McKellar Ph.D, Mark Ilgen Ph.D., Bernice S. Moos B.A. and Rudolf Moos Ph.D. J Subst Abuse Treat. 2007 Nov 23.

See also;

• AA and Treatment Work Better Together
• Brief-TSF can assist patients cease alcohol consumption.
• AA Offers Recovery Not Religion

Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment by Marc A. Schuckit Read more about this title…

TSF for Dual Diagnosis

The role of 12-step programs and 12-step-oriented treatments for dually diagnosed individuals (DDI) remains unclear. Here are presented the results of a pilot study in a target population of 10 seriously mentally ill patients received an adjunctive modified 12-step facilitation (TSF) therapy emphasizing engagement of DDI in a specialized 12-step program for DDI.

Participants significantly increased their 12-step attendance and decreased their substance use during the 12 weeks of treatment.

Larger and longer-term studies are needed to assess the efficacy of modified TSF for DDI relative to other treatments, and to determine what forms of TSF are most effective in this population.

Research; Bogenschutz MP. Tucker NE Specialized 12-step programs and 12-step facilitation for the dually diagnosed. Community Ment Health J. 2005 Feb;41(1):7-20.

Brief-TSF can be adapted to serve these people.

Six-month changes in spirituality, religiousness, and heavy drinking in a treatment-seeking sample.

OBJECTIVE: This descriptive and exploratory study investigated change in alcoholics’ spirituality and/or religiousness (S/R) from treatment entry to 6 months later and whether those changes were associated with drinking outcomes.

METHOD: Longitudinal survey data were collected from 123 outpatients with alcohol use disorders (66% male; mean age = 39; 83% white) on 10 measures of S/R, covering behaviors, beliefs, and experiences, including the Daily Spiritual Experiences and Purpose in Life scales. Drinking behaviors were assessed with the Timeline Followback interview. Alcoholics Anonymous (AA) participation and attendance were also measured.

RESULTS: Over 6 months, there were statistically significant increases in half of the S/R measures, specifically the Daily Spiritual Experiences scale, the Purpose in Life scale, S/R practices scale, Forgiveness scale, and the Positive Religious Coping scale.

There were also clinically and statistically significant decreases in alcohol use.

• Multiple logistic regression analyses showed that increases in Daily Spiritual Experiences and in Purpose in Life scores were associated with increased odds of no heavy drinking at 6 months, even after controlling for AA involvement and gender.

CONCLUSIONS: In the first 6 months of recovery, many dimensions of S/R increased, particularly those associated with behaviors and experiences. Values, beliefs, self-assessed religiousness, perceptions of a Higher Power, and the use of negative religious coping did not change.

Increases in day-to-day experiences of spirituality and sense of purpose/meaning in life were associated with absence of heavy drinking at 6 months, regardless of gender and AA involvement.

The results of this descriptive study support the perspective of many clinicians and recovering individuals that changes in alcoholics’ S/R occur in recovery and that such changes are important to sobriety.

Robinson EA, Cranford JA, Webb JR, Brower KJ. Six month changes in spirituality religiousness and heavy drinking in a treatment-seeking sample. J Stud Alcohol Drugs. 2007 Mar;68(2):282-90.

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Nine Elements of Effective Alcohol Treatment for Adolescents

In evaluating a broad spectrum of treatment programs and approaches, researchers have identified common themes among the treatments that are most effective in helping teens. Drug Strategies, a Washington-based nonprofit research institute that promotes more effective approaches to the nation’s drug problems, found these key elements in an extensive review.

http://www.ensuringsolutions.org/resources/resources_show.htm?doc_id=336617&cat_id=989

Publisher

• Ensuring Solutions to Alcohol Problems
• George Washington University Medical Center
• Website: http://www.ensuringsolutions.org/

Compatibility With Other Treatments

Brief-TSF may be utilised in combination with supportive pharmacotherapy; for example, craving reduction medications.

While recognising the existence of multiple problems of adjustment in most problem drinkers (e.g., marital conflict, family dysfunction), Brief-TSF advocates pursuing the goal of early recovery as primary, delaying most other therapies if necessary, until the client has achieved approximately 6 months of sobriety.

The primary exceptions to this recommendation would be emergency or incapacitating medical treatment, debilitating depression or other major affective disorder, or a psychotic disorder, which would take precedence over Brief-TSF.

Brief-TSF is not compatible with treatments based on notions of controlled use.

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One-Year Outcomes among Members of a Dual-Recovery Self-Help Program.

Research Objective: Self-help is gaining increased acceptance among treatment professionals as empirical support for of its effectiveness is growing and the advent of managed care warrants the use of cost-effective modalities. Traditional “one disease-one recovery” self-help programs cannot serve adequately the needs of the dually-diagnosed.

This paper presents one-year outcome data from a longitudinal study of the effectiveness of self-help for the dually-diagnosed.

Subjects are members of Double Trouble in Recovery (DTR), a 12-step self-help program designed to meet the special needs of those diagnosed with both a mental health disorder and a chemical addiction.Study.

Design: The study uses a 12-month prospective longitudinal design with follow-ups at 12 and 24 months after baseline. Subjects (N = 310) were recruited at 25 DTR meeting sites throughout New York City. Semi-structured instruments assess history and current status of mental health and substance abuse, treatment in both areas, and self help participation (DTR as well as traditional 12-step groups such as AA and NA).

Population Studied: Community-based individuals dually-diagnosed with a mental health disorder and substance abuse.

Principal Findings: S’s are mostly members of underserved minority groups with long histories of substance abuse and mental health disorders.

Most S’s attend outpatient treatment (for drug use, mental health or dual-diagnosis - 77%) and take psychotropic medications (87%).

At the 12 months follow-up,

• 76% were still attending DTR;
• 68% were also attending AA or NA.

Mean number of symptoms S’s. experienced in the past year decreased significantly;

• two-thirds (69%) of S’s reported that their mental health was “better” in the past month than it was at baseline.
• One-third (29%) reported substance use in the past year, compared to 42% at baseline (p = .002).

Substance use (less) was significantly associated with DTR attendance:

• Total time abstinent was related to lifetime length of DTR attendance (r = .25, p = .002) and
• past year substance use was related to number of months of DTR attendance in the past year (r = -.17, p = .02).

Conclusions: For dually-diagnosed individuals, continued participation in dual recovery self-help groups plays a significant role in the recovery process, particularly in the area of substance use.

Implications for Policy, Delivery or Practice: Participation in dual-recovery self-help groups, both during and after formal treatment, should be encouraged as part of an integrated lifelong recovery plan for dually-diagnosed individuals.

Research; One-Year Outcomes among Members of a Dual-Recovery Self-Help Program. Laudet A, Magura S, Vogel H, Knight E, Staines G; Abstr Acad Health Serv Res Health Policy Meet. 2000; 17.

More at; Double Trouble in Recovery

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• Subscribe to Twelve Step Facilitation by e-Mail

Dual Diagnosis; Counseling the Mentally Ill Substance Abuser by Katie Evans, J. Michael Sullivan Read more about this title…

Brief-TSF Treatment Setting

Brief-TSF can be used with both individuals who have never sought treatment and those who had previous treatment and aftercare clients. The model is flexible enough to accommodate all of these client groups.

However, since Brief-TSF relies heavily on client involvement in community-based 12 step fellowship and meetings, it would be less ideally implemented in a long-term inpatient setting.

Many Twelve Step Fellowship members are willing to visit ‘Newcomers’ in hospital. Brief-TSF can easily be integrated into a general mental health outpatient clinic setting.

BriefTSF is designed to be used in the context of short-term individual adjunct therapy by general healthcare and other helping profession workers. BriefTSF is specifically intended to be implemented by nurses, doctors, psychologists, social workers, counselors etc while addressing other current issues (ie, medical treatment, relationship counselling, legal issues).

Brief-TSF is not time limited. After assessment support can last as long as the healthcare worker is seeing the client. It is intended to be implemented within a scheduled session often with another focus. The initial assessment session can last up to one hour, and regular support can be incorporated into other sessions.

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Role of Self Help Programs in Brief-TSF

Participation in self-help groups is central to Brief-TSF and is regarded as the primary agent of change.

Specific objectives within Brief-TSF include attending regular AA meetings, getting and using members’ phone numbers, getting a peer sponsor, and assuming responsibilities within a meeting.

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Cognitive Behavioral Social Skills Therapy is an intervention that improves the patient’s cognitive and behavioral skills for changing his/her problematic drinking behavior.

CBT is based on the principles of social learning theory and views drinking behavior as functionally related to major problems in a person’s life.

It posits that addressing this broad spectrum of problems will prove more effective than focusing on drinking alone.

Emphasis is placed on overcoming skill deficits and increasing the person’s ability to cope with high-risk situations that commonly precipitate relapse, including both interpersonal difficulties and intrapersonal discomfort such as anger or depression.

See also;

• What is alcoholism?
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Brief-TSF can assist people cease alcohol consumption.
• Subscribe to Twelve Step Facilitation by e-Mail

Rational Emotive Behavior Therapy: A Therapist’s Guide by Albert Ellis, Catharine MacLaren Read more about this title…

Alcoholics Anonymous careers

BACKGROUND: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of adjunctive aftercare, but we know very little about treatment seekers’ patterns of AA involvement over time and how these relate to abstinence.

METHOD: This paper applies latent class growth curve modeling to longitudinal data from 349 dependent drinkers recruited when they were entering treatment and were re-interviewed at one or more follow-up interviews one, three and five years later, and who reported having attended AA at least once.

RESULTS: Four classes of AA "careers" of meeting attendance emerged:

The low AA group mainly just attended AA during the 12 months following treatment entry.

The medium and high AA groups were characterized by stable attendance at the second and third follow-ups-at about 60 meetings a year for the medium group and over 200 meetings per year for the high group, followed by slight increases for the medium group and slight decreases for the high group by year five.

The declining AA group doubled its meeting attendance post baseline, to almost 200 meetings during the year following treatment entry, but by year five they were only attending about six meetings on average.

Decreases in AA meetings did not necessarily signal disengagement from AA; at the five-year follow-up, a third of the low AA group and over half of the declining AA group said they felt like a member of AA. Activities other than meeting attendance, such as having a sponsor, otherwise paralleled the meeting careers, but social networks were similar by year five.

Rates of abstinence by year five (for the past 30 days) were

• 43% for the low AA group,
• 73% for the medium group,
• 79% for the high group and
• 61% for the declining group.

Rates of dependence symptoms and social consequences of drinking did not differ between the groups at year five.

CONCLUSIONS: The prototypical AA careers derived empirically are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable (and sometimes quite high) rates of AA attendance. However, contrary to AA lore, many who connect only for a while do well afterwards.

Research; Kaskutas LA, Ammon L, Delucchi K, Room R, Bond J, Weisner C. Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry. Alcohol Clin Exp Res. 2005 Nov;29(11):1983-90.

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