Archive for the 'Stages of Change' Category
Posted by Sparrow on 23rd July 2008
Detoxification from alcohol abuse.
The alcohol withdrawal syndrome (AWS) is a common management problem in hospital practice for neurologists, psychiatrists and general physicians alike.
Although some patients have mild symptoms and may even be managed in the outpatient setting, others have more severe symptoms or a history of adverse outcomes that requires close inpatient supervision and benzodiazepine therapy.
Many patients with AWS have multiple management issues;
- withdrawal symptoms,
- delirium tremens (DT’s),
- the Wernicke–Korsakoff syndrome,
- seizures,
- depression,
- polysubstance abuse,
- electrolyte disturbances and
- liver disease,
These require a coordinated, multidisciplinary approach. Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients.
The alcohol withdrawal syndrome; Journal of Neurology, Neurosurgery, and Psychiatry 2008;79:854-862, A McKeon, M A Frye, Norman Delanty.
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Posted in Addiction, Alcohol, Alcoholism, Assessment, Detoxification, Disease of addiction, Drugs, Medication, Stages of Change, Symptoms of addiction | No Comments »
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.
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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 June 2008
If you continue to attend AA and not drop out you have nearly double chance of remaining abstinent.
Estimated Alcoholics Anonymous Membership 1991-1992
- New members during past year - 0.9 million
- On-going members - 1.5 million
- Total membership - 2.4 million
Continuation Rate in Alcoholics Anonymous
In 1991-1992 4.8 million respondents reported ever attending an Alcoholics Anonymous (AA) meeting, for reasons related to their drinking, prior to the last 12 months and 31% reported continued AA attendance during the last 12 months.
Rate of continued AA attendance was associated with years since first AA meeting
- 1-4 years since first AA meeting - 36% remained
- 5-9 years since first AA meeting - 30% remained
- 10-19 years since first AA meeting - 29% remained
- 20 years or more since first AA meeting - 32% remained
Comparison of Past Year Drinking Status - Dropouts and Continuing AA Members
Dropouts:
- Abstinent 33%
- Low risk drinking 14%
- High risk drinking 53%
Continued AA attendance:
- Abstinent 62%
- Low risk drinking 9%
- High risk drinking 29%
- low risk drinking = never exceed 4 drinks per day(male) or 3 drinks per day (female)
- high risk drinking = exceeds 4 drinks per day (male) or 3 drinks per day (female)
Research Source: NIAAA 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). Data Brief - National Longitudinal Alcohol Epidemiologic Survey (NLAES) Findings on Alcoholics Anonymous Membership by Loran Archer.
Thus, 36% remain attending A.A. at the end of one year and 32% are still attending at the end of 20 years.
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Posted by Sparrow on 18th June 2008
Drug commonly used for alcoholism craving curbs urges of pathological gamblers
A drug commonly used to treat alcohol addiction has a similar effect on pathological gamblers – it curbs the urge to gamble and participate in gambling-related behavior, according to a new research at the University of Minnesota.
Seventy-seven people participated in the double-blind, placebo controlled study. Fifty-eight men and women took 50, 100, or 150 milligrams of naltrexone every day for 18 weeks.
- Forty percent of the 49 participants who took the drug and completed the study, quit gambling for at least one month.
- Their urge to gamble also significantly dropped in intensity and frequency.
The other 19 participants took a placebo. But, only 10.5 percent of those who took the placebo were able to abstain from gambling.
Study participants were aged 18 to 75 and reported gambling for 6 to 32 hours each week.
Dosage did not have an impact on the results, naltrexone was generally well tolerated, and men and women reported similar results.
“This is good news for people who have a gambling problem,” said Jon Grant, M.D., J.D., M.P.H., a University of Minnesota associate professor of psychiatry and principal investigator of the study. “This is the first time people have a proven medication that can help them get their behavior under control.”
The research is published in the June 2008 issue of the Journal of Clinical Psychiatry.
Compulsive gamblers are unable to control their behavior, and the habit often becomes a detriment in their lives, Grant said. He estimates between 1 to 3 percent of the population has a gambling problem.
While the drug is not a cure for gambling, Grant said it offers hope to many who are suffering from addiction. He also said the drug would most likely work best in combination with individual therapy.
“Medication can be helpful, but people with gambling addiction often have multiple other issues that should be addressed through therapy,” he said.
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Posted in Addiction, Alcohol, Alcoholism, Disease of addiction, Gamblers Anon, Gambling, Loss of control, Medication, Research, Stages of Change, Symptoms of addiction | No Comments »
Posted by Sparrow on 3rd June 2008
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.
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Posted in Addiction, Adjunctive therapy, Alcohol, Alcoholism, Disease of addiction, Recovery, Stages of Change, Symptoms of addiction | No Comments »
Posted by Sparrow on 1st June 2008
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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… |
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Posted in 12-Step Groups, Addiction, Adult Children of Addiction, Al-anon, Alcohol, Alcoholics Anon, Alcoholism, Blogroll, Brief-TSF, Disease of addiction, Drugs, Family, Gamblers Anon, Gambling, Medication, Narcotics Anon, Recovery, Relapse prevention, Research, Spirituality, Stages of Change, Symptoms of addiction, TSF, Women, Youth | No Comments »
Posted by Sparrow on 30th May 2008
Phases of Alcoholism Recovery
The recovery process in Alcoholics Anonymous includes several general phases that people may pass through. These are not time related but are usually dependent on the persons particular circumstances.
Initial Sobriety
- Surrenders to alcohol - accepts alcoholism
- Begins humble search for self
- Restoration of physical health begins
- Restoration of memory begins
- Restoration of mental functions begins
- Begins to practice self-honesty
- Is pre-occupied with sobriety
- Growth of open-mindedness
- Lessening of needless guilt
- Freely discusses alcohol and its problems
- Mild depression and anxiety lessens
- Mental functions are more alert
Learning Sobriety
- Accepts and owns their alcoholism
- Loss of freedom acknowledged and accepted
- Alibis replaced by sound reasons for sobriety
- Social pressures to quit, lessen - threats replaced by encouragement
- Grandiose behaviour begins to be replaced by the give and take of real personal relations
- Aggressive behaviour begins to be replaced by willingness to learn
- Persistent remorse disappears, peace initiated
- Abstinence graduates into sobriety
- Pattern of thinking begins to change
- Regains friends
- Job prospects improve
- Sobriety-centred behaviour improves
- Regains outside interests
- Acceptance of friends
- Sense of humour starts to replace self-pity
- Acceptance of environment improves
- Begins to regain family faith
- Resentment of others begins to be replaced by acceptance of others
- Loyalty and protection of family interests begins
- Sex relations improve
- Greater understanding of life partner
- Learns to enjoy a good breakfast
Accepting Sobriety
- Surrenders to life - accepts life on its terms
- Loss of desire to drink becomes profane and lasting
- Improved ethical and moral perception
- Improved thinking
- Improved feeling
- Keeps company with people one can respect of help
- Emotional ‘dips’ become fewer and shallower
- Emotions become easier to manage
Creative sobriety
- Loss of desire to drink becomes deeper and almost permanent
- Fears, anxieties and depressions are understood and managed in interpersonal relations
- Appreciates deeply freedom from alcohol
- Explores new freedom to use it in other activities without fear
- Single-minded sobriety; defines assurances that there is no compromise with sobriety
- Genuine spiritual desires centred on new way of life
- Alibi system replaced by deepening quality of intelligent sobriety
- Appreciates need for help, both for sobriety and as a guard against drinking in daily life
Pleasurable Sobriety
- Self-unity, at peace with oneself, knows serenity
- Socialises easily, at one with the world
- Little or no emotional hang-overs
- Rewards clearly exceed tough times
- Feels well, enjoys sobriety
- Anxiety, shyness, etc., disappear in genuine interpersonal relations
Adapted from Stewart DA. Thirst For Freedom. Hazeldene; Minnesota
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Posted by Sparrow on 30th May 2008
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.
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Posted in Alcohol, Alcoholism, Assessment, Brief-TSF, Contrast to other models, Disease of addiction, Loss of control, Relapse prevention, Stages of Change, Target populations | 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 Sparrow on 27th May 2008
Twelve Step Facilitation Therapy facilitates patients’ active participation in the fellowship of Alcoholics Anonymous.
TSF regards such active involvement as the primary factor responsible for sustained sobriety (recovery) and therefore as the desired outcome of participation in this treatment program.
This therapy is grounded in the concept of alcoholism as a spiritual and medical disease.
TSF consists of a brief, 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 behavioral, 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 is only used by specialist alcoholism therapists.
- BriefTSF is used by generalist healthcare workers.
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