Alcoholics Anonymous and long term matching effects.
AIMS: (1) To examine the matching hypothesis that Twelve Step Facilitation Therapy (TSF) is more effective than Motivational Enhancement Therapy (MET) for alcohol-dependent clients with networks highly supportive of drinking 3 years following treatment; (2) to test a causal chain providing the rationale for this effect. DESIGN: Outpatients were re-interviewed 3 years following treatment. ANCOVAs tested the matching hypothesis. SETTING: Outpatients from five clinical research units distributed across the United States. Participants: Eight hundred and six alcohol-dependent clients. INTERVENTION: Clients were randomly assigned to one of three 12-week, manually-guided, individual treatments: TSF, MET or Cognitive Behavioral Coping Skills Therapy (CBT). MEASUREMENTS: Network support for drinking prior to treatment, Alcoholics Anonymous (AA) involvement during and following treatment, percentage of days abstinent and drinks per drinking day during months 37-39.
FINDINGS:
The a priori matching hypothesis that TSF is more effective than MET for clients with networks supportive of drinking was supported at the 3 year follow-up;
AA involvement was a partial mediator of this effect; clients with networks supportive of drinking assigned to TSF were more likely to be involved in AA;
AA involvement was associated with better 3-year drinking outcomes for such clients.
CONCLUSIONS:
in the long-term TSF may be the treatment of choice for alcohol-dependent clients with networks supportive of drinking;
involvement in AA should be given special consideration for clients with networks supportive of drinking, irrespective of the therapy they will receive.
Research; Longabaugh R, Wirtz PW, Zweben A, Stout RL. Network support for drinking, Alcoholics Anonymous and long-term matching effects.Addiction. 1998 Sep;93(9):1313-33.
The author of this report notes that AA self-help groups are the most commonly accessed component of treatment for alcoholism and alcohol-related problems. Additionally, the concepts and approaches of AA have significantly influenced other twelve-step programs in professional treatment.
Research has indicated that participation in AA or other 12-step programs results in reductions in substance abuse and also in psychiatric problems, reducing health care costs over time.
Section headings in this book chapter include:
nature and prevalence of AA;
nature and prevalence of 12-step treatment programs;
evaluations of community-based AA groups;
evaluation research on 12-step oriented professional treatment programs
potential future research directions.
Research report; Humphreys, K. Alcoholics Anonymous and 12-step alcoholism treatment programs. In: M. Galanter, Ed., Recent Developments in Alcoholism: Volume 16. Research on Alcoholism Treatment, New York, NY: Kluwer Academic/Plenum Publishers, 2003. (pp. 149-164)
We evaluates the gender matching hypothesis in Project MATCH, which states that women will benefit more from Cognitive-Behavioral Coping Skills Therapy (CBT) than from Twelve Step Facilitation (TSF).
CBT was expected to address the ancillary problems (e.g., external stressors, negative mood) that are more prevalent among female alcoholics; at the same time, TSF, which would encourage women to attend Alcoholics Anonymous (AA) meetings, was expected to increase guilt and undermine self-esteem and assertion.
Tests of the matching contrasts failed to provide support for the hypothesis in either arm of the trial.
Gender did produce significant prognostic effects in analyses of the aftercare arm, with women reporting a higher proportion of abstinent days and fewer drinks per occasion than men did.
Causal chain analyses produced mixed results. Male and female clients were shown to differ in terms of their initial treatment needs, and follow-up status with respect to these needs was related to drinking outcomes.
Contrary to prediction, however, CBT sessions for women, as compared to those for men, were not appreciably more likely to teach general problem-solving or mood-management skills.
Further, women did not avoid AA meetings.
Attendance at self-help meetings was comparable for the sexes in the outpatient arm;
in the aftercare study, women attended significantly more meetings and reported a higher degree of AA involvement.
Gender matching hypothesis 28. Del Boca, F.K.; Mattson, M.E. Gender matching hypothesis. In R. Longabaugh and P.W. Wirtz, Eds., Project MATCH Hypotheses: Results and Causal Chain Analysis, Bethesda, MD:NIAAA, 2001. 330p. (pp. 186-203)
As Bill Sees It: The A. A. Way of Life …Selected Writings of the A. A.’s Co-Founder by Alcoholics Anonymous World Service, Bill W
Biomarkers in Alcohol Misuse: Their Role in the Prevention and Detection of Thiamine Deficiency
In Western countries alcohol misuse is the most frequent cause of thiamine (vitamin B1) deficiency (TD) and consequent neuro-impairment.
Studies have demonstrated that between 30 and 80% of alcoholics are thiamine deficient, and this puts them at risk of developing the Wernicke–Korsakoff (WK) syndrome.
The relative roles of alcohol and TD in causing brain damage remain controversial and it is important to try to determine the role played by each factor.
Animal studies support an additive effect of alcohol exposure and TD, and indicate the potential for interaction between alcohol and TD in human alcohol-related brain damage.
Early diagnosis of alcohol-related TD is therefore an important aspect of effective intervention and treatment.
Alcohol biomarkers provide a direct and indirect way of estimating the amount of alcohol being consumed, the duration of ingestion and the harmful effects that long-term alcohol use has on body functions.
Appropriate use of these markers is very helpful when considering a diagnosis of alcohol-related TD.
Research report; Rosanna Mancinelli, and Mauro Ceccanti. Biomarkers in Alcohol Misuse: Their Role in the Prevention and Detection of Thiamine Deficiency. Alcohol and Alcoholism 2009 44(2):177-182;
The Alcohol Use Disorders Identification Test (AUDIT) as screening instrument for adolescents.
BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) is an international screening instrument extensively employed in adult target groups. However, there is scarce information on screening with the AUDIT in adolescent populations.
The purpose of this study was to determine the cut-off point for hazardous, harmful, and dependent alcohol use through the validation of the AUDIT in a Chilean adolescent sample.
METHODS: The original English version of the AUDIT was translated into Spanish, using the procedure recommended by the World Health Organization. The text was then back-translated and sent to one of the original authors (Thomas Babor), who approved the translation. Students attending public schools in Santiago, Chile, self-administered the AUDIT, and those older than 15 years completed the
Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM), which served as a gold standard. Between 1 and 4 weeks after the CIDI-SAM, participants answered a second AUDIT.
RESULTS:
A total of 42 female and 53 male adolescents (mean age: 15.9 [SD=1.2]) completed the AUDIT, with a mean score of 4.3.
Reliability according to Cronbach’s alpha was 0.83.
Test-retest correlation was also satisfactory (intra-class correlation 0.81 [95% CI 0.73-0.87]).
Analysis of the receiver operating characteristic (ROC) curve yielded cut-off points for hazardous, harmful, and dependent alcohol use of 3, 5, and 7 points, respectively.
CONCLUSIONS: The Chilean version of the AUDIT is a valid and reliable tool for identifying adolescents with hazardous, harmful, and dependent alcohol use. The suggested cut-off points make screening with the AUDIT more accurate for adolescent populations.
Research; Drug Alcohol Depend. 2009 Aug 1;103(3):155-8. Epub 2009 May 6. The Alcohol Use Disorders Identification Test (AUDIT) as a screening instrument for adolescents. Santis R, Garmendia ML, Acuña G, Alvarado ME, Arteaga O.
Aims; The helper therapy principle suggests that, within mutual-help groups, those who help others help themselves. The current study examines whether clients in treatment for alcohol and drug problems benefit from helping others, and how helping relates to 12-step involvement. Design Longitudinal treatment outcome.
Participants; An ethnically diverse community sample of 279 alcohol- and/or drug-dependent individuals (162 males, 117 females) was recruited through advertisement and treatment referral from Northern California Bay Area communities. Participants were treated at one of four day-treatment programs.
Measurements; A helping checklist measured the amount of time participants spent, during treatment, helping others by sharing experiences, explaining how to get help and giving advice on housing and employment. Measures of 12-step involvement and substance use outcomes were administered at baseline and a 6 month follow-up.
Findings; Helping and 12-step involvement emerged as important and related predictors of treatment outcomes. In the general sample, total abstinence at follow-up was strongly and positively predicted by 12-step involvement at followup, but not by helping during treatment; still, helping positively predicted subsequent 12-step involvement. Among individuals still drinking at follow-up, helping during treatment predicted a lower probability of binge drinking, whereas effects for 12-step involvement proved inconsistent.
Conclusions; Findings support the helper therapy principle and clarify the process of 12-step affiliation.
Research report; Sarah E. Zemore, Lee Ann Kaskutas & Lyndsay N. Ammon, In 12-step groups, helping helps the helper. Addiction; March 2004
Episodes of intimate partner violence are associated with alcohol consumption. To explore this relationship further, researchers interviewed a random sample of heterosexual couples at baseline and 5 years later. They assessed alcohol use and related problems, and the incidence (new cases) and recurrence (cases at both follow-up and baseline) of male-to-female partner violence and female-to-male partner violence. Analyses included 1136 couples who were cohabitating and/or married at both baseline and follow-up. Partner violence was defined as a range of violent behaviors, such as slapping, kicking, forcing sex, and threatening with a gun or knife.
At follow-up, the incidence of both female-to-male and male-to-female partner violence was only 6 percent. However, recurrence was more common (female-to-male violence 44 percent, male-to-female violence 39 percent).
In unadjusted analyses, incidence and/or recurrence of partner violence was significantly associated with greater mean consumption by male perpetrators; heavy drinking (at least 5 drinks on an occasion in the past year) by male and female perpetrators; and/or alcohol problems among male and female perpetrators.
Among these alcohol indicators, only mean consumption (among both female perpetrators and male victims) remained significantly associated with new or recurrent cases of female-to-male partner violence when analyses were adjusted for potential confounders.
Comments by Joseph Conigliaro, MD, MPH: Female-to-male partner violence was as common as male-to-female partner violence in this population-based sample, whereas male perpetration of partner violence is often the norm in clinical samples. Nevertheless, heavy episodic drinking, alcohol problems, and higher average alcohol consumption should be considered risk factors for partner violence and addressed in prevention efforts.
Reference: Caetano R, McGrath C, Ramisetty-Mikler S, et al. Drinking, alcohol problems and the five-year recurrence and incidence of male to female and female to male partner violence. Alcohol Clin Exp Res. 2005;29(1):98-106.
Reprinted with permission from “Alcohol and Health: Current Evidence”.
Healing the Trauma of Domestic Violence: A Workbook for Women (New Harbinger Self-Help Workbook) by Edward S., Ph.D. Kubany, Mari A. McCaig, Janet R. Laconsay
Bipolar Patients with Comorbid Substance Use Disorders; Diagnostic and Treatment Considerations:
Comorbidity of bipolar disorder (BD) and alcoholism and substance use disorders (SUDs) represents a serious public health problem and a major challenge to treatment systems.
Bipolar disorder is among the top causes of disabilities worldwide, and reportedly the fourth leading mental illness as a source of disease burden in established market economies. Large epidemiologic surveys in the United States have consistently confirmed a high association between bipolar disorder and SUDs. The Epidemiological Catchments Area Study reported bipolar I and bipolar II disorders as having the highest association with SUDs when compared with any other major psychiatric disorder.
The prevalence of lifetime alcohol abuse or dependence in persons with bipolar I disorder and bipolar II disorders were found to be 46%, and 39.2% respectively.
Similarly, the National Comorbidity Survey reported respondents with mania to be 8 to 9 times more likely to have an additional lifetime disorder of drug or alcohol dependence compared with the general population. The most recent and largest epidemiologic survey of more than 42,000 respondents in the United States, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), reported that mania and hypomania were associated with very high rates of SUDs. Those with mania were 6 times more likely to have alcohol dependence and 14 times more likely to have drug dependence over the past 12 months.
Research from; Psychiatric Annals, Volume 38 · Number 11, NOVEMBER 2008
There is a long-recognized association between alcohol consumption and aggressive behavior. But does aggression and hostility continue into sobriety?
This study was designed to examine aggression in a group of socially well-adapted recovered alcoholics.
The question addressed was whether the treatment, together with long-term abstinence from alcohol, could reduce aggression and hostility in recovered alcoholics.
Sixty four male stable alcoholics with at least 3 years sobriety were compared with 69 non-alcoholics. Neither group had any other psychological problems.
Both groups were given a questionnaire on general characteristics as well as aggressive and hostility traits.
After a 3-year abstinence, men from the recovering alcoholics group displayed greater signs of hostility and covert aggression. They were different from non-alcoholics on measures for indirect aggression, irritability, negativism, suspicion, resentment, and guilt.
Research report; Ziherl S, Cebasek Travnik Z, Kores Plesnicar B, Tomori M, Zalar B. Trait aggression and hostility in recovered alcoholics. Eur Addict Res 2007; 13(2): 89-93.
While the war on drugs continues to attract world attention, it is often overlooked that alcoholism remains a major worldwide health concern. No matter what your expertise, the Handbook of Alcoholism can help you acquire the necessary skills to treat problem drinkers and alcohol-dependent patients. In three sections;
Patient Care,
Research, and
Useful Data and Definitions
this comprehensive handbook not only addresses the underlying psychological problems of alcoholism, but helps you to better diagnose and treat the non-psychiatric medical disorders caused by the disease.
I’ll Quit Tomorrow: A Practical Guide to Alcoholism Treatment
Bipolar Patients with Comorbid Substance Use Disorders; Diagnostic and Treatment Considerations:
