Posted by Sparrow on 22nd July 2008
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;
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Posted in 12-Step Groups, Adjunctive therapy, Alcoholics Anon, Alcoholism, Men, Mutual-help, Research, Self-help, Stages of Change, TSF, Women | No Comments »
Posted by Sparrow on 28th May 2008
Alcoholism in women: is it different in onset and outcome compared to men?
Abstract; Onset and course of alcohol dependence show gender related differences suggesting that women are more vulnerable to chronic alcohol consumption. Known as the telescoping effect where women have greater and faster alcohol related effect.
This raises the question whether the differences are associated with a different treatment outcome as well.
We hypothesized, that alcohol dependent women with a telescoping course show a less favourable treatment outcome compared to men.
We investigated 212 alcohol dependent patients; matching 106 consecutively admitted women with 106 men drawn from a total sample of 343 male patients.
The treatment program consisted of a 6 week inpatient treatment and 12 months of outpatient aftercare. We assessed milestone variables in development and course of alcoholism and carried out standardized diagnostic tests, physical and blood examinations to evaluate the course of the disease and treatment outcome.
Overall, we confirm the telescoping effect, a faster progression in the course of alcoholism (developmental events and adverse consequences) in women compared to men (“telescoping effect”).
However, despite the telescoping effect treatment outcome was similar in women and men. During the inpatient treatment program no alcohol relapse occurred.
Throughout the 12 months outpatient treatment we found no significant differences in the survival analysis between women and men.
At the end of the 12 months both groups had an abstinence rate of approximately 50% and a drop-out rate of 33%.
Alexander Diehl, Bernhard Croissant, Anil Batra, Götz Mundle, Helmut Nakovics and Karl Mann. Alcoholism in women: is it different in onset and outcome compared to men? European Archives of Psychiatry and Clinical Neuroscience, July 2007.
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Posted in Adjunctive therapy, Alcohol, Alcoholism, Demographics, Men, Research, Stages of Change, Women | 1 Comment »
Posted by Willhunger on 19th April 2008
Twelve Step Facilitation (TSF)
Twelve-Step Facilitation (TSF) consists of a structured, and manual-driven approach to facilitating early recovery from alcohol abuse/alcoholism and other drug abuse/addiction. It is intended to be implemented on an individual basis in 12 to 15 sessions and is based in behavioural, spiritual, and cognitive principles that form the core of 12-step fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). It is suitable for problem drinkers and other drug users and for those who are alcohol or other drug dependent.
TSF seeks to facilitate two general goals in individuals with alcohol or other drug problems: acceptance (of the need for abstinence from alcohol or other drug use) and surrender, or the willingness to participate actively in 12-step fellowships as a means of sustaining sobriety. These goals are in turn broken down into a series of cognitive, emotional, relationship, behavioural, social, and spiritual objectives.
The theoretical rationale is based in the 12 steps and 12 traditions of AA and includes the need to accept that willpower alone is not sufficient to achieve sustained sobriety, that self-contredanses must be replaced by surrender to the group conscience, and that long-term recovery consists of a process of spiritual renewal. The primary mechanism action is active participation and a willingness to accept a higher power as the locus of change in one’s life.
The facilitator in the TSF treatment model is more truly a facilitator of change than an agent of change. The true agent of change (i.e., sustained sobriety) lies in active participation in 12-step fellowships like AA and NA along with the principles set forth in the 12 steps and 12 traditions that guide these fellowships.
Alcoholism and other drug addiction are considered illnesses that affect individuals both mentally and physically in such a way that they are unable to control their use of alcohol or other drugs. Viewed from this perspective, the concept of controlled use of alcohol or other drugs amounts to denial of the primary problem, that is, loss of control. Specific causative factors are of less relevance in recovery than is acceptance of both the loss of control and the need for abstinence and a willingness to follow the pathway laid out in the 12 Steps.
After Nowinski J. NIDA, 2000.
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Posted by Willhunger on 19th April 2008
TSF TARGET POPULATIONS
Clients Best Suited for This Counseling Approach
TSF has been utilized in controlled outcome studies with alcohol abusers and alcoholics and with persons who have concurrent alcohol-cocaine abuse and dependency. It has been used with clients of diverse socioeconomic, educational, and cultural backgrounds and a range of maladjustment.
Clients Poorly Suited for This Counseling Approach
Individuals who have severe symptoms of addiction to cocaine or opiates, who are unemployed, and who also have no source of spousal or other family support appear to have the poorest prognosis. That is not to say that alternative treatments have proven effective with that group of individuals. When treating addiction to cocaine, it is recommended that sessions be scheduled twice a week for the first 3 weeks.
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Posted by Sparrow on 16th April 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.
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Posted in Adjunctive therapy, Alcohol, Alcoholism, Assessment, Disease of addiction, Men, Relapse prevention, Research, Stages of Change, Symptoms of addiction | No Comments »
Posted by Sparrow on 29th January 2008
Risk indicators to identify intimate partner violence
Intimate partner violence against women is prevalent and is associated with poor health outcomes.
Understanding indicators of exposure to intimate partner violence can assist health care professionals to identify and respond to abused women. This study was undertaken to determine the strength of association between selected evidence-based risk indicators and exposure to intimate partner violence.
In this cross-sectional study of 768 women aged 18-64 years who presented to 2 emergency departments in Ontario, Canada, participants answered questions about risk indicators and completed the Composite Abuse Scale to determine their exposure to intimate partner violence in the past year.
Results: Intimate partner violence was significantly associated with
- being separated,
- in a common-law relationship or
- single
- depression
- somatic symptoms
- having a male partner who was employed less than part time, or
- having a partner with an alcohol or
- drug problem
Each unit increase in the number of indicators corresponded to a four-fold increase in the risk of intimate partner violence; women with 3 or more indicators had a greater than 50% probability of a positive score on the Composite Abuse Scale.
Intimate partner violence was not associated with pregnancy status.
Specific characteristics of male partners, relationships and women’s mental health are significantly related to exposure to intimate partner violence in the past year. Identification of these indicators has implications for the clinical care of women who present to health care settings. (Source: Open Medicine
Respond to Intimate Partner Violence - 10 Action Steps You Can Take to Help Your Patients and Your Practice
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