A healthy dentist is one of the most important ingredients in a successful dental practice. An ingredient not to be taken for granted. Professionals, dentists included, can and do experience illnesses and problems that can disrupt or impair a practice.

In addition to the vulnerabilities of the human condition–addictive disorders, psychiatric illnesses, infectious disease, family and relationship problems, or the many varieties of human misery–dentists have undergone a powerful process of socialization into their professional role that makes it difficult to seek help for themselves.

Stigma about addictive and psychiatric illnesses continues to be a problem despite significant advances in scientific understanding of these disorders.

Many people, especially those in positions of community visibility as dentists are, still struggle with shame when they associate problems with personal failure.

Dental societies are in an ideal position to provide resources and support, should they choose to take this opportunity, and the ADA has the information and expertise to help them do this.

PRACTICE IMPLICATIONS: Dentists can become more aware of their own vulnerabilities and enhance their personal and professional effectiveness, as well as evaluate ways they may support their staff and colleagues.

Research; J Am Dent Assoc. 2004 Jan;135(1):84-9. Safeguarding the health of dental professionals. Lavine SR, Drumm JW, Keating LK.

See also;

• Brief-TSF can assist people cease alcohol consumption.
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Subscribe to Twelve Step Facilitation by e-Mail

Natural Health, Natural Medicine: The Complete Guide to Wellness and Self-Care for Optimum Health by Andrew Weil Read more about this title…

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AA Utilization After Introduction in Outpatient Treatment.

Abstract; Treatment for alcohol dependence is often provided in outpatient settings, and often includes introduction to the 12-Step fellowship Alcoholics Anonymous (AA).

Relatively little is known about subsequent AA utilization.

Analyses of survey data collected from 72 clients of an outpatient treatment center introduced to AA revealed that, 6 months following intake, a large portion of the responding sample of 55 were still attending AA meetings.

Principal components analysis of self-reports of the frequencies of 12 AA-related behaviors found three dimensions of AA utilization:

• fellowship or social involvement,
• meeting attendance and participation, and
• involvement in bureaucratic functioning and meeting production.

Results suggest it is important to consider these dimensions of utilization for those wishing to understand AA involvement.

Research; Lisa Thomassen. AA Utilization After Introduction in Outpatient Treatment. Substance Use & Misuse, Volume 37, Issue 2 February 2002 , pages 239 – 253

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Brief Intervention as a Bridge to AA

Brief Intervention Is Insufficient for Medical Inpatients With Unhealthy Drinking

Data show that brief intervention reduces consumption and consequences among outpatients with unhealthy, but not dependent, alcohol use. To assess whether brief interventions work among medical inpatients with unhealthy drinking,* researchers randomized 341 of such patients to a 30-minute session of motivational counseling in the hospital or to usual care.

Most subjects had alcohol dependence, were unemployed during the previous 3 months, used other drugs, and had substantial psychiatric symptoms. Almost half were hospitalized for an alcohol-related medical diagnosis.

At 3 months among subjects with alcohol dependence, similar proportions of the intervention and control groups received alcohol assistance (e.g., specialty treatment) (49% and 44%, respectively).

At 12 months among all subjects, decreases in alcohol consumption did not significantly differ between the groups (e.g., adjusted mean decreases in drinks per day, 1.5 for intervention subjects and 3.1 for usual care subjects).

Comments:

Unlike most brief intervention studies in outpatients, this study enrolled a predominantly alcohol-dependent sample with major comorbidities—a group reflective of the treatment-resistant population identified when screening occurs in inpatient settings. The study suggests that screening, assessment, and brief counseling are necessary but not sufficient to change alcohol consumption in this population. Although the findings are disappointing, this study underscores that alcoholism—like cancer, atherosclerosis and other complex diseases—will not succumb to simple solutions.

References: Saitz R, Palfai TP, Cheng DM, et al. Brief intervention for medical inpatients with unhealthy alcohol use: a randomized controlled trial. Ann Intern Med. 2007;146(3):167–176.

• Brief-TSF extends brief intervention to lifelong recovery.

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Primary Care Clinicians Lack Comfort, Skills in Discussing Alcohol Use

Often, primary care clinicians inadequately address alcohol use with their patients.

To describe alcohol-related discussions in primary care, investigators audiotaped and performed qualitative analysis of outpatient visits involving 14 primary care clinicians (physicians and nurse practitioners) and 29 of their patients.

All patients were male veterans who screened positive for unhealthy alcohol use.*

Three themes emerged:

• Patients often disclosed that they consumed large amounts of alcohol and/or experienced negative health consequences from drinking.
• Clinicians commonly responded by changing the subject, minimizing the significance of their patients’ drinking, or pursuing a nonalcohol-related issue.
• Hesitation, stuttering, inappropriate laughter, and ambiguous statements were apparent when clinicians discussed alcohol but not other topics.
  Advice about drinking was tentative and vague while advice about smoking was more common, decisive, and specific.

Brief alcohol counseling — an evidence-based practice — has been poorly disseminated into primary care practice. This exploratory study suggests that clinicians’ discomfort and limited skills in assessing and advising patients with unhealthy alcohol use are partly to blame.

Although training alone is not sufficient to increase alcohol counseling, these findings indicate that educational initiatives to improve primary care clinicians’ comfort levels and skills are necessary, nonetheless.

Reprinted with permission from Alcohol and Health: Current Evidence.

Reference: McCormick KA, Cochran NE, Back AL, et al. (2006) How primary care providers talk to patients about alcohol: a qualitative study. J Gen Intern Med., 21(9): 966-972.

From Join Together Online

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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 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. Such as Brief-TSF.

Interventions that lead to initial increases in spirituality appear to lead to sustained AA affiliation, which, in turn, produces sustained recovery over time.

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

See also;

• What About This Spiritual Awakening Thing?
• 12-Step Treatment More Effective than Alternative
• Bill W.Biography
• 12 Steps and Post Traumatic Stress
• Psychology Books

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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%

1. low risk drinking = never exceed 4 drinks per day(male) or 3 drinks per day (female)
2. 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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Substance abuse among the elderly: A growing problem

In her early years, Eva would probably have been called a "teetotaler." Except for an infrequent sip of wine on special occasions, she never drank alcoholic beverages. But after her children moved away and her husband and many of her close friends died, Eva turned to the bottle for escape and companionship. Now in her late 70s, Eva is an alcoholic.

Harry has had problems with substance abuse since his late teens. Although drinking binges were often followed by periods of sobriety, he inevitably returned to his addictive ways. At 75, he is on several prescription medications, some of which should not be taken with alcohol. His children, long ago burned out from trying to persuade him to get help, have come to believe that you really can’t "teach an old dog new tricks."

These two composite situations illustrate what has been called one of the fastest growing health problems in this country–substance abuse among the elderly. More people are living longer and more of them are abusing drugs and alcohol in their later years.

Recent census data estimates that nearly 35 million people in the United States are 65 years or older. Substance abuse among those 60 years and older (including misuse of prescription drugs) currently affects about 17 percent of this population. By 2020, the number of older adults with substance abuse problems is expected to double.

As demographics change, attitudes about and use of alcohol and drugs change as well. "In January 2006, the leading edge of the baby-boom generation (those born during the population swell of 1946-1964) will turn 60," said Frederic Blow, professor in the Department of Psychiatry at the University of Michigan and a Huss Research Chair on Older Adults and Alcohol/Drug Problems at Hazelden’s Butler Center for Research. "These individuals have had more exposure to alcohol and illegal drugs, and there is more acceptance among them about using substances to ‘cure’ things. We expect to see an increase in drug and alcohol use; and more use means more problems."

Blow said there has also been an attitude shift regarding addiction and treatment, and that gives him hope that older substance abusers will get the help they need. "There is less shame and guilt associated with substance abuse now and more acceptance of treatment as a way to make things better," he said.

According to Blow and other experts, when people age, their sensitivity to alcohol increases as their tolerance decreases. Also, the percent of their body weight composed of water decreases, and alcohol–which is water-soluble–affects them more quickly and to a greater degree. Alcohol takes longer to metabolize in older persons, accumulating in their bodies and leading to intoxication if consumption is not controlled. Because of their physical make-up, older women are more vulnerable to the negative effects of alcohol.

As a whole, more older men have substance abuse problems than do older women, but women are more likely than men to start drinking heavily later in life. Substance abuse is more prevalent among persons who suffer a number of losses, including death of loved ones, retirement, and loss of health. The fact that women are more likely to be widowed or divorced, to have experienced depression, and to have been prescribed psychoactive medications that increase the negative effects of alcohol help explain these gender differences.

Unfortunately, health care providers often overlook substance abuse among older adults because they don’t know what to look for or they mistakenly assume that older adults cannot be successfully treated. Loved ones, too, may excuse an older relative’s substance abuse as a result of grief or loss or a reaction to boredom. Or family members may not want to confront an elder, fearing they will offend or anger them or get "written out of the will," said Blow.

Yet Blow said there is "good evidence" that older adults do as well as young people when it comes to treating substance abuse and that they may even do somewhat better. "Older adults can recognize all kinds of benefit from treatment," stressed Blow. "There are often direct health benefits, improved cognition, more independent living, more and better social connectedness, and new hobbies. The benefits are enormous."

The U.S. Substance Abuse and Mental Health Services Administration (http://www.samhsa.gov/) offers a wide range of information and resources to help identify, treat, and prevent substance abuse among older adults.

The pamphlet " How to Talk to an Older Person Who Has a Problem With Alcohol or Medications" is available on the Hazelden Web site.

Related Reading:

Helping other alcoholics in Alcoholics Anonymous and drinking outcomes: findings from project MATCH.

OBJECTIVE: Although Alcoholics Anonymous (AA) is the largest mutual-help organization for alcoholics in the world, its specific mechanisms that mobilize and sustain behavior change are poorly understood. The purpose of this study is to examine prospectively the relationship between helping other alcoholics and relapse in the year following treatment for alcohol use disorders.

METHOD: Data were derived from Project MATCH, a longitudinal prospective investigation of the efficacy of three behavioral treatments for alcohol abuse and dependence. Kaplan-Meier survival estimates were used to calculate probabilities of time to alcohol relapse. To identify the unique value of helping other alcoholics when controlling for the number of AA meetings attended, proportional hazards regressions were conducted to determine whether the likelihood of relapse was lower for those who were helping other alcoholics.

RESULTS: There were no demographic differences that distinguished participants in regard to involvement in helping other alcoholics, with the exception of age; those who were helping other alcoholics were, on average, 3 years older than those who were not helping alcoholics.

Those who were helping were significantly less likely to relapse in the year following treatment, independent of the number of AA meetings attended.

CONCLUSIONS: These findings provide compelling evidence that recovering alcoholics who help other alcoholics maintain long-term sobriety following formal treatment are themselves better able to maintain their own sobriety. Clinicians who treat persons with substance abuse disorders should encourage their clients to help other recovering alcoholics to stay sober.

Research; Pagano ME, Friend KB, Tonigan JS, Stout RL. Helping other alcoholics in alcoholics anonymous and drinking outcomes: findings from project MATCH. J Stud Alcohol. 2004 Nov;65(6):766-73.

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About a quarter of individuals screened for alcohol misuse in hospital emergency rooms reported unsafe drinking levels, according to a study concluding that hospital-based brief interventions for alcohol problems are effective.

This target population has previously been thought to be unresponsive to intervention.

Medical News Today reported Dec. 26 that the study sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that screened patients who received brief counseling during ER visits reported lower levels of risky drinking three months later than those who only received written advice about controlling their drinking.

The research was conducted at 14 university-based emergency health centers in the U.S. A total of 7,751 patients received a brief questionnaire about their alcohol use, and more than 1,100 who reported excessive alcohol use — defined as more than 14 drinks per week for men and more than 7 per week for women — took part in the study. The intervention tool used by ER staff was the Brief Negotiated Interview (BNI).

“This study demonstrates that a broad group of emergency practitioners can learn how to perform the intervention and that it is effective across multiple practice sites,” said study co-author Gail D’Onofrio, M.D., professor and chief of emergency medicine at Yale University. “The emergency department visit is often the only access to care for many patients and thus is an ideal opportunity to begin the conversation regarding unhealthy alcohol use.”

The study appeared in the December 2007 issue of the Annals of Emergency Medicine.

Brief-TSF can assist patients cease alcohol consumption.

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Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals,

Abstract

This study was a part of a larger qualitative descriptive study designed to explore chronic sorrow as a relapse trigger among female victims of child abuse who were currently enrolled in substance abuse treatment for relapse.

The purpose of this study was to identify coping strategies and other factors these women perceived as helpful to their recovery. A purposive sample of twelve women participated in interviews using a semistructured interview schedule.

The advice the participants offered to women in similar situations reflected interpersonal, cognitive and action-focused positive coping strategies.

They encouraged clinicians in primary care facilities to approach persons suspected of substance abuse in a nonjudgmental manner. Healthcare professionals should be more assertive in recommending resources for substance abuse treatment.

Research; Cheryl Slaughter Smith. Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals, Journal of Addictions Nursing, Volume 18, Issue 2 April 2007 , pages 75 – 80

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