Seeking Help Could Quadruple the Likelihood of Abstinence

To quantify the effect of help seeking on recovery from alcoholism, researchers in the United States analyzed data from 4,422 adults who had participated in a nationally representative survey and developed alcohol dependence at least 1 year before their participation.

• Only 26 percent of subjects had ever sought help for their alcohol problems;
• 3 percent participated in a 12-step program only,
• 6 percent in formal treatment only, and
• 17 percent in both. 

Help seekers drank more and had higher lifetime prevalences of other drug use, mood disorders, and personality disorders than did subjects who had not sought help.

In analyses adjusted for potential confounders, help seeking significantly increased the likelihood of any recovery (odds ratio [OR] 2.4) and of abstinence (OR 4.0). Any recovery was defined as, in the past year, having no symptoms of alcohol abuse or dependence and either drinking low-risk amounts* or abstaining.

The odds of recovery were greater for those who had participated in 12-step programs with or without formal treatment than for those who had participated in formal treatment only.

Comments by Peter Friedmann, MD, MPH:

Even though they had more comorbidity and therefore were at risk for worse outcomes, seekers of formal and informal treatment had better odds of recovery from alcohol dependence. This study could not separate the motivation inherent in seeking help from the therapeutic effects of help received. However, help seeking—regardless of the patient’s level of readiness—should be encouraged. 

Research Reference: Dawson DA, Grant BF, Stinson FS, et al. Estimating the effect of help-seeking on achieving recovery from alcohol dependence. Addiction. 2006;101(6):824–834.

Brief-TSF can assist patients cease alcohol consumption.

The interplay between help seeking and alcohol related outcomes: divergent processes for professional treatment and self-help groups.

Summary:
This study examined the influence of self-selection on the duration of professional treatment and participation in Alcoholics Anonymous (AA) and the influence of social causation on alcohol-related outcomes.

A sample of alcoholics was surveyed at baseline and 1, 3, and 8 years later. Participants completed an inventory at each survey that assessed participation in treatment and AA since the last assessment and alcohol-related functioning.

There were divergent processes of self-selection and social causation with respect to the duration of participation in professional treatment and AA.

Individuals with more severe alcohol-related problems obtained longer episodes of professional treatment, but this self-selection process was much less evident for AA.

Longer participation in professional treatment in the first year predicted better alcohol-related outcomes, but the duration of subsequent treatment was not associated with better subsequent outcomes.

In contrast, longer participation in AA consistently predicted better subsequent alcohol-related outcomes.

The findings are consistent with a need-based model of professional treatment, in which more treatment is selected by and allocated to individuals with more severe problems, and an egalitarian model of self-help, in which needs play little or no role in continued participation.

Rudolf H. Moos and Bernice S. Moos. The interplay between help-seeking and alcohol-related outcomes: divergent processes for professional treatment and self-help groups. Drug and Alcohol Dependence 75(2):155-164, August 2004.

12 Step Programs Offer Broad Benefits, Study Says

A study of Alcoholics Anonymous and other 12-step oriented self-help programs finds that they can help most people recover from alcoholism, even those who are not religious or have mental-health problems.

The Pacific Institute on Research and Education (PIRE) reported that researchers tracked a group of 227 alcoholics over three years and found that those who had attended AA or other self-help programs after treatment had higher rates of abstinence, and drank less if they did relapse.

The results cut across gender and religious lines and held regardless of psychiatric history or whether the patient had previously attended AA or other similar programs.

"Here’s a widespread, chronic disorder that seems to respond well to an inexpensive resource — mutual-help groups such as AA," said study co-author Robert Stout, Ph.D., director of the Decision Sciences Institute at PIRE. "Not only do we need to get more addicts engaged in these groups, but we also need to gather evidence on this issue and make sure that the public, policy-makers and practitioners know about it."

Added co-author John F. Kelly: "There is a clear dose-response relationship: If you don’t go to any meetings, you have the worst outcomes. If you go to a few, you have a little bit better outcome, and if you go to a lot, you have an even better outcome." Kelly is the associate director of the Massachusetts General Hospital/Harvard Addiction Research Program.

The study was published in the August 2006 issue of Alcoholism: Clinical and Experimental Research.

Brief-TSF intervention training; how best to get alcoholics to AA.

The aim of this study was to test the validity of the CAGE questions as a measure of severe drinking in subjects at drop-in centers for the homeless, using biological markers of acute liver reaction to alcohol as the “gold standard.”

A sample of homeless men and women in Copenhagen were invited to participate in a study of health problems. Subjects were interviewed and blood samples were taken and screened for indicators of

• liver dysfunction (gamma-glutamyltransferase [ GT],
• mean corpuscular volume [MCV],
• alanine aminotransferase [ALAT], and
• alkaline phosphatase [Alpase]), and
• hepatitis C [HCV].

Scores on CAGE correlated strongly with years of heavy drinking (rho = 0.43, p < 0.001), and while years of drinking did not correlate with biomarkers after controlling for multiple hypothesis testing, CAGE correlated with GT, Alpase and ALAT, but not MCV.

The correlations held even among those without HCV, but subjects with HCV + and CAGE > 1 had quite extreme values on liver markers.

Findings suggested that the CAGE was able to identify homeless drinkers whose drinking was significantly associated with increases in biomarkers associated with heavy drinking.

The CAGE as a Measure of Hazardous Drinking in the Homeless. Morten Hesse; Henrik Thiesen. American Journal on Addictions, Volume 16, Issue 6 November 2007 , pages 475 - 478

Brief-TSF can assist patients cease alcohol consumption.

Alcoholics Anonymous and Nursing; Lessons in Holism and Spiritual Care.

Alcoholic Anonymous (AA) is a worldwide, 2 million-member organization that has assisted countless alcoholics to achieve sobriety through a spiritual program of recovery from alcoholism.

Based on spiritual principles known as the “Twelve Steps” and “Twelve Traditions,” AA has provided a model for other recovery programs such as

• Narcotics Anonymous (NA),
• Gamblers Anonymous (GA), and
• Sex and Love Addicts Anonymous (SLAA).
• Al-anon
• Adult Children of Alcoholics

Recovery in AA appears to involve a process of self-transcendence.

In recent years, nursing scholars have increasingly explored the concepts of self-transcendence and spirituality as they apply to nursing theory and practice.

This article explores the roots and spiritual dimensions of 12-step recovery programs. It further explores the ways in which theoretical and clinical knowledge about the delivery of spiritual care interventions may be gained from an understanding of AA’s spiritual approach to recovery.

Alcoholics Anonymous and Nursing; Lessons in Holism and Spiritual Care. Eileen M. McGee, J Holist Nurs 2000; 18; 11.

Brief-TSF can assist patients cease alcohol consumption.

Is emergency department based brief intervention worthwhile in adults presenting with alcohol related events?

BEST EVIDENCE TOPIC REPORTS

A short cut review was carried out to establish whether emergency department (ED) based brief intervention is worthwhile in adults presenting with alcohol related events.

A total of 590 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question.

The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are presented in table 1.

The clinical bottom line is that brief psychotherapeutic intervention is worthwhile in adults who attend the emergency department after an alcohol related event.

Emergency Medicine Journal 2007;24:785-788.

Spirituality and Alcoholics Anonymous.

What can be confidently said about AA in general and about the role of spirituality in AA in particular?

• First, there is convincing evidence that alcoholism severity predicts later AA attendance.
• Second, atheists are less likely to attend AA, relative to individuals who already hold spiritual and/or religious beliefs. However, belief in God or a Higher Power before AA attendance does not offer any advantage in AA-related benefits, and atheists, once involved, are at no apparent disadvantage in deriving AA-related benefits.
• Third, the spiritually-based principles of AA appear to be endorsed in AA meetings regardless of the perceived social dynamics or climate of a particular meeting, eg, highly cohesive or aggressive.
• Fourth, significant increases in spiritual and religious beliefs and practices seem to occur among AA-exposed individuals.
• Fifth, in spite of much discussion to the contrary there is little evidence that spirituality directly accounts for later abstinence. We are finding, however, that spirituality has an important indirect effect in predicting later drinking reductions.

Specifically, in the past 20 years a number of effective methods have been developed to facilitate initial AA attendance (AA dropout is high, with some estimates ranging as high as 80%). Interventions that lead to initial increases in spirituality appear to lead to sustained AA affiliation, which, in turn, produces sustained recovery over time.

TSF and Brief-TSF are designed from studies such as this to facilitate AA attendance.

Research; Tonigan JS. Spirituality and alcoholics anonymous. South Med J. 2007 Apr;100(4):437-40.

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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.

Rates and Correlates of Relapse Among Individuals in Remission From DSM-IV Alcohol Dependence: A 3-Year Follow-Up.

Background: There is little information on the stability of abstinent and nonabstinent remission from alcohol dependence in the general U.S. population. The aim of this study was to examine longitudinal changes in recovery status among individuals in remission from DSM-IV alcohol dependence, including rates and correlates of relapse, over a 3-year period.

Methods:This analysis is based on data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults aged 18 years and older originally interviewed in 2001 to 2002 and reinterviewed in 2004 to 2005. The Wave 1 NESARC identified 2,109 individuals who met the DSM-IV criteria for full remission from alcohol dependence. Of these, 1,772 were reinterviewed at Wave 2, comprising the analytic sample for this study. Recovery status at Wave 2 was examined as a function of type of remission at Wave 1, with a focus on rates of relapse, alternately defined as recurrence of any alcohol use disorder (AUD) symptoms and recurrence of DSM-IV alcohol dependence. Logistic regression models were used to estimate the odds of relapse among asymptomatic risk drinkers and low-risk drinkers relative to abstainers, adjusted for a wide range of potential confounders.

Results: By Wave 2,

• 51.0% of the Wave 1 asymptomatic risk drinkers had experienced the recurrence of AUD symptoms, compared with
• 27.2% of low-risk drinkers and
• 7.3% of abstainers.

Across all ages combined, the adjusted odds of recurrence of AUD symptoms relative to abstainers were

• 14.6 times as great for asymptomatic risk drinkers and
• 5.8 times as great for low-risk drinkers.

The proportions of individuals who had experienced the recurrence of dependence were

• 10.2%, for asymptomatic risk drinkers
• 4.0%, for low-risk drinkers and
• 2.9%,  for abstainers

The adjusted odds ratios relative to abstainers were

• 7.0 for asymptomatic risk drinkers and
• 3.0 for low-risk drinkers.

Age significantly modified the association between type of remission and relapse. Differences by type of remission were not significant for younger alcoholics, who had the highest rates of relapse.

Conclusions: Abstinence represents the most stable form of remission for most recovering alcoholics.

Study findings highlight the need for better approaches to maintaining recovery among young adults in remission from alcohol dependence, who are at particularly high risk of relapse.

Research; Deborah A. Dawson, Risë B. Goldstein, Bridget F. Grant. Rates and Correlates of Relapse Among Individuals in Remission From DSM-IV Alcohol Dependence: A 3-Year Follow-Up. Alcoholism: Clinical and Experimental Research (2007) 31 (12), 2036–2045.

Brief-TSF can assist patients cease alcohol consumption.

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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