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.

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/

Alcoholics Anonymous and Narcotics Anonymous benefit adolescents who attend

While Alcoholics Anonymous (AA) has existed for more than 70 years, and is the most commonly sought source of help for alcohol-related problems in the United States, there is little “hard scientific evidence” showing that AA and Narcotics Anonymous (NA) can improve substance-use outcomes. This study examined how helpful AA and NA may be for adolescents, finding long-term benefits even though many youth discontinue attendance after time.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research.

“It is difficult to evaluate the efficacy of mutual-help organizations like AA through randomized controlled experiments because the AA ‘intervention,’ being a community organization based on anonymity, cannot be directly under the control of the researcher in the usual way,” explained John F. Kelly.

Yet their popularity and cost-effectiveness cannot be denied, added Kelly.

“AA and NA are explicitly focused on abstinence and addiction recovery, they are widely available across most communities, they provide entry to a social network of recovery-specific support and sober events that can be accessed ‘on demand’ – particularly at times of high-relapse risk such as evenings and weekends, the services are free, and AA/NA can be attended as intensively, and for as long, as individuals desire,” he said.

However, he added, despite growing evidence that adults benefit from AA and NA, little is known about how these abstinence-focused organizations help youth, and what is known lacks scientific rigor.

“This knowledge gap is particularly noteworthy given that adolescents and young adults face more barriers to AA and NA than older adults and yet appear to be referred there just as frequently by treatment providers,” said Kelly. “Youth tend to have less severe addiction problems, on average, and consequently do not feel a strong need to stop using alcohol and/or drugs. ‘Why should they bother to go to abstinence-oriented organizations like AA and NA, and would they benefit even if they did go?’” These are the questions Kelly and his colleagues wanted to address.

The researchers recruited 160 adolescent inpatients (96 males, 64 females), with an average age of 16 years, who were enrolled at two treatment centers in California having a focus on abstinence and based on a 12-step model. The study participants’ length of stay ranged from four to six weeks, after which they were re-assessed on a number of clinical variables at six months, and one, two, four, six, and eight years.

“We found that most of the youth attended at least some AA/NA meetings post-treatment,” said Kelly. “Those patients with severe addiction problems and those who believed they could not use alcohol/drugs in moderation attended the most.

The NA and AA focus on abstinence/recovery probably resonates better with these more severely dependent individuals who also typically need ongoing support.”

Even though many of the youth discontinued AA/NA after time, they nonetheless appeared to benefit from attendance.

“We found that patients who attended more AA and/or NA meetings in the first six months post-treatment had better longer term outcomes, but this early participation effect did not last forever – it weakened over time,” said Kelly. “The best outcomes achieved into young adulthood were for those patients who continued to go to AA and/or NA. In terms of a real-world recovery metric, we found that for each AA/NA meeting that a youth attended they gained a subsequent two days of abstinence, independent of all other factors that were also associated with a better outcome.”

A little can go a long way, he added. “During the first six months post-treatment,” said Kelly, “even small amounts of AA/NA participation – such as once per week – was associated with improved outcome, and three meetings per week was associated with complete abstinence. This suggests youth may not need to attend as frequently as every day, sometimes recommended clinically, to achieve very good outcomes.”

Kelly believes that part of the reason for the success of AA/NA among adolescents who attend meetings is related to their developmental needs.

“Given the need for social affiliation and peer-group acceptance outside of the family at this stage of life, peers can exert strong influence on the behavior of young people,” he noted. “When you couple this fact with the reality that most adolescents and young adults are experimenting with, or heavily using, alcohol and other drugs, it may be hard to find suitable peer contexts that can facilitate recovery. In fact, we know that most youth relapses are connected with social contexts where alcohol/drugs are present; unlike adults, youth rarely relapse alone. So, organizations such as AA/NA may provide support, and encourage and provide alternatively rewarding sober social activities.”

See also;

• AA and Treatment Work Better Together
• Brief-TSF is designed to address these issues.
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Subscribe to Twelve Step Facilitation by e-Mail

• Al-Anon Offers New Life
• AA’s 12-Step Recovery Program
• Alcoholic Defence Mechanisms
• Attendance at Narcotics Anonymous and Alcoholics Anonymous Meetings
• Binge Drinking & Brain Damage
• Brief-TSF Description
• Characteristics of Children of Alcoholics
• Counseling and the 12 Steps of AA
• Counselor Characteristics
• Craving Reduction
• Effects of Gambling Addiction
• How do alcoholics get to AA?
• Phases of Recovery
• PTSD and Alcohol Addiction
• Research Evidence for TSF
• Slogans for everyday life in AA
• Symptoms of Alcoholism
• The Personality Traits of Alcoholics
• TSF Description
• What about Partners of Alcoholics?
• Subscribe to Twelve Step Facilitation by e-Mail

Couple Therapy for Alcoholism: A Cognitive-Behavioral Treatment Manual by Phylis J. Wakefield, Rebecca E. Williams, Elizabeth B. Yost, Kathleen M. Patterson Read more about this title…

Motivational Enhancement Therapy (MET) is a systematic intervention approach for evoking change in problem drinkers.

It is based on principles of motivational psychology and is designed to produce rapid, internally motivated change. This treatment employs motivational strategies to mobilize the client’s own change resources.

MET consists of four carefully planned and individualized treatment sessions.

The first two focus on structured feedback from the initial assessment, future plans, and motivation for change,

The final two sessions at the midpoint and end of treatment provide opportunities for the therapist to reinforce progress, encourage reassessment, and provide an objective perspective on the process of change.

The counselor seeks to develop a discrepancy in the client’s perceptions between current behavior and significant personal goal; emphasis is placed on eliciting from clients self-motivational statements of desire for and commitment to change.

The working assumption is that intrinsic motivation is a necessary and often sufficient factor in instigating change.

See also;

• Address the drinking problem directly
• Alcohol & Medication Interactions
• Alcoholic Family Roles
• Brief-TSF is designed to as adjunctive therapy for anti-craving medication.

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

On completion of BriefTSF, you will be able to use Brief-TSF as adjunctive therapy and;

Understand and use questionnaires for assessing alcohol use.

• Separate the differences between alcoholics and problem drinkers
• Guide alcoholics to self-assessment and acceptance of their condition
• Gauge suitability of alcoholics for Alcoholics Anonymous

Understand the barriers to alcoholics acceptance of their condition

• Understand alcoholism as an illness
• Help an alcoholic to work through denial, and self defeating thinking and emotions
• Understand the stages of change in recovery from alcoholism
• Understand the impaired thinking and behaviour of alcoholics
• Foster rational and spiritual responses to dangerous drinking reminders and situations
• Help the alcoholic understand the key remedies to craving and compulsive thinking.

Understand the self help methods of Alcoholics Anonymous, Alateen and Al-anon

• Be able to work with recovering members of self help groups such as AA, Al Anon and Alateen.
• Help and support prospective members in contacting an AA or Al-anon Peer Sponsor

Understand the ‘tools of recovery’ and practices of the AA program and culture.

• Support prospective and new members of AA in their quest for sobriety using AA meetings, slogans and AA members.
• Detect the barriers to ‘doing the program’ in AA
• Discuss remedies for dangerous actions and thinking with the alcoholic
• Promote relapse prevention and better responses to relapse
• Support an alcoholic in using the tools of relapse prevention
• Help alcoholics gain new motivation, hope and action after a relapse

Partners of Alcoholics

• Understand the thinking and actions of partners, children and parents of alcoholics
• Help with understanding of alcoholic family forces and the enabling of alcoholism
• recognise symptoms of child, youth and adult abuse within alcoholic families
• Recognize impaired and healthy caring actions of significant others
• Guide partners of alcoholics to self assessment and acceptance of their condition
• Judge suitability of partners and children of alcoholics for self help groups such as Al-anon or Alateen

Subscribe to free news feed for Twelve Step Facilitation.

Study Examines Link Between Stress Relapse

A new animal study finds that a stress-related gene and brain chemical may play a role in addiction relapse, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Researchers from NIAAA and Camerino University in Italy found that rats that showed a preference for alcohol were more sensitive to stress. Those more prone to relapse under stress were examined for genetic patterns that might offer clues to this trait. Researchers found that these rats had higher expression levels of Crhr1, a gene that encodes the stress-related corticotropin-releasing hormone receptor 1 (CRH-R1).

“Our findings demonstrate that the Crhr1 genotype and its expression interact with environmental stress to reinstate alcohol-seeking behavior in this animal model of excessive drinking,” said study leader Anita Hansson, Ph.D., a fellow at NIAAA’s Laboratory of Clinical and Translational Studies.

“This finding helps untangle the complex interplay of genetic and environmental factors that influence relapse,” added NIAAA Director T-K Li, M.D. “It also points to potential approaches for treating individuals at risk for relapse.”

The research appears in the online edition of the Proceedings of the National Academy of Sciences. 

Research Reference: Hansson, A.C., et al. (2006) Variation at the rat Crhr1 locus and sensitivity to relapse into alcohol seeking induced by environmental stress. Proc. Natl. Acad. Sci.

From Join Together

Relaxation And Stress Reduction Workbook by Martha Davis Read more about this title…

12-Step Involvement Increases Sobriety and Reduces Costs

BACKGROUND: Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients’ health care costs in the first year after treatment, but such initially impressive effects may wane over time. This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.

METHODS: A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step-based (n=887 patients) or cognitive-behavioral (CB, n=887 patients) treatment programs. The 12-step-based programs placed substantially more emphasis on 12-step concepts, had more staff members "in recovery," had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs. The 2-year follow-up assessed patients’ substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.

RESULTS: As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) versus CB (37.0%) programs. Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs. In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p=0.01).

CONCLUSIONS: Promoting self-help group involvement appears to improve posttreatment outcomes while reducing the costs of continuing care. Even cost offsets that somewhat diminish over the long term can yield substantial savings. Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.

Humphreys K, Moos RH. Alcohol Clin Exp Res. 2007 Jan;31(1):64-8. Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes.

Brief-TSF Goals and Objectives

Brief-TSF seeks to facilitate three general goals in individuals with alcoholism:

1. acceptance (of the need for abstinence from alcohol),
2. surrender, or the willingness to participate actively in 12-Step fellowships as a means of sustaining sobriety, and
3. taking action to address the disease or malady.

These goals are in turn broken down into a series of cognitive, emotional, relationship, behavioural, social, and spiritual objectives.

Women Physicians and Addiction.

Doctors get addicted just like other people and female doctors have earlier addiction and develop worse medical conditions.

Researchers compared case histories of 969 male and female (13%) substance dependent doctors. Their conclusions; “These findings suggest different characteristics between male and female impaired physicians which may have implications for identification and treatment of this population.”

The comparison revealed that females;

• Were younger by 4 years (mean 40 years)

• Had 15% more medical problems (49%), and

• 13% more psychiatric issues (76%)

• More past suicidal ideation (52% v 30%), and

• Current suicidal ideation (11% v 5%)

• Had attempted more suicides (20% v 5%) while intoxicated, and

• Had attempted more suicides (14% v 2%) while clean or sober

• Mainly abused alcohol, but

• Were more likely to use hypnotics (11% v 6%)

• Employment and legal problems (65% and 18% respectively) were similar in both genders

Research report; Women Physicians and Addiction. Martha J. Wunsch, Janet S. Knisely, Karen L. Cropsey, Eleanor D. Campbell, Sidney H. Schnoll. Journal of Addictive Diseases, Volume: 26 Issue: 2

Bloggers comment; This research mainly parallels sex differences in the general population which shows that women suffer earlier addiction and greater medical problems.