Stricter Sobriety Standards for California Health Professionals November 30, 2009

Nurses, doctors, dentists and other health professionals in California who are in treatment for alcohol and other drug problems will now be subject to stricter oversight and could be immediately removed from practice should they relapse, the Los Angeles Times reported.

Health workers will now be required to take more than 100 drug tests during their first year in treatment. One positive drug test result will be enough to have a health professional be temporarily suspended from practice.

All restrictions to licenses will be posted online for public access.

The new standards were created by the state legislature last year to address the way recovery programs for doctors were being handled. The Medical Board of California ended its diversion program in 2008 after several audits found that doctors were not monitored properly and those who relapsed were not being fired.

The new standards will apply to the seven boards that oversee diversion programs, which allow licensed health professionals with addiction problems to undergo drug tests and group therapy to address their illness.

Licensed health professionals who are on probation for abusing substances will also be subject to the new rules.

Critics of the new standards include Ellen Brickman, president of the National Organization of Alternative Programs, which advocates for treatment rather than punishment for impaired healthcare professionals. “I’m listening to this and I’m cringing,” said Brickman. “I’m not optimistic that this is going to work the way they want it to. It won’t keep people from abusing substances. It will keep them out of the system, where they’ll be sicker before anybody can do anything about it.”

Listening to a peer helper

This study compares peer helping and 12-step involvement among participants receiving chemical dependency treatment at day hospital (N = 503) and residential (N = 230) programs, and examines relationships between both variables and outcomes.

Findings show that residential (vs. day hospital) participants reported significantly more peer helping and 12-step involvement during treatment, and marginally more 12-step involvement at 6 months.

Both peer helping and 12-step involvement predicted higher odds of sobriety across follow-ups; helping showed an indirect effect on sobriety via 12-step involvement.

Results contribute to the 12-step facilitation literature (TSF); confirm prior results regarding benefits of mutual aid; and highlight methodological issues in helping research.

Research report; 12 Step Involvement and Peer Helping in Day Hospital and Residential Programs, Sarah E. Zemore; Lee Ann Kaskutas; Substance Use & Misuse, Volume 43, Issue 12 & 13 October 2008 , pages 1882 – 1903

• Twelve Step Facilitation is designed to support people returning to their community

Mechanisms of action in integrated cognitive-behavioral treatment versus twelve-step facilitation for substance-dependent adults with comorbid major depression.

OBJECTIVE: In a population of veterans with co-occurring substance use disorders and concomitant major depressive disorder, the current study compared mechanisms of change and therapeutic effects relevant to both disorders between integrated, dual disorder-specific cognitive behavioral therapy (ICBT) and twelve-step facilitation (TSF).

METHOD: Veterans (N = 148) were given standard pharmacotherapy for depression and were randomly assigned to receive 24 weeks of either TSF or ICBT. Process measures were selected to quantify (1) changes in self-efficacy in ICBT, (2) changes in ability to terminate negative affect in ICBT, (3) twelve-step affiliation (TSA) in TSF, and (4) changes in social support in both conditions. Measures of depression and substance use were administered to all participants before treatment, during treatment, and at the end of treatment.

RESULTS: Self-efficacy increased among both TSF and ICBT participants during treatment, whereas self-reported ability to regulate negative affect did not change.

Consistent with predictions, TSF participants increased community TSA during treatment, whereas those receiving ICBT reduced TSA.

Changes in self-efficacy and TSA were associated with improvement in substance use outcomes at the end of treatment.

Hypothesized changes in social support were not supported.

CONCLUSIONS: Both ICBT and TSF produce improvements in self-efficacy, and these changes are related to substance use outcomes for depressed substance abusers.

In TSF, intervention-specific changes in TSA occur during the course of treatment and are related to substance use outcomes.

Research; J Stud Alcohol Drugs. 2007 Sep;68(5):663-72. Mechanisms of action in integrated cognitive-behavioral treatment versus twelve-step facilitation for substance-dependent adults with comorbid major depression. Glasner-Edwards S, Tate SR, McQuaid JR, Cummins K, Granholm E, Brown SA.

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;

• AA and Treatment Work Better Together
• Brief-TSF can assist patients cease alcohol consumption.
• AA Offers Recovery Not Religion

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

Are Brief Alcohol Interventions Likely to be Effective in Routine Primary Care Practice?

A number of meta-analyses have demonstrated the modest efficacy of brief interventions (BI) for nondependent unhealthy alcohol use in primary care settings.

Whether this level of efficacy can be expected when BIs are delivered outside of research studies in not known.

This systematic review identified 22 randomized trials including over 5800 patients. Investigators classified the trials on a spectrum from tightly controlled (efficacy design) to real world (effectiveness design) studies.

The scale considered whether patients presented to health care with a range of conditions, whether practices delivered a full range of medical services, whether practitioners routinely worked in the service rather than being funded by the trial, and whether the intervention could be delivered within standard visit times.

• Participants who received BI drank approximately 3 standard drinks per week less than those who did not.
• Longer duration of intervention was not significantly associated with a larger effect.
• The effect of BI on drinking was similar in studies regardless of whether they were tightly controlled or had more real world characteristics.

Comments by Michael Levy, PhD

This meta-analytic study showed the benefit of BI in reducing alcohol consumption in both controlled and real world primary care settings.

It seems logical to assume similar results could be achieved in community treatment programs.

Since BI in the studies reviewed was designed to achieve a reduction in alcohol consumption, treatment programs could consider implementing BI for patients who are not interested in achieving abstinence but who want to reduce their intake.

Reference: Kaner EF, Dickinson HO, Beyer F, et al. The effectiveness of brief alcohol intervention in primary care settings: a systematic review. Drug Alcohol Rev. 2009;28(3):301–323.

From; Join Together Online

Brief-TSF manual; How to help an alcoholic find freedom from alcohol.

You will be automatically redirected to a download page once payment is confirmed.

US$9.95 – using Paypal, Visa or Mastercard

—————————————————-

Help set the ghosts of alcoholism free

Medical students’ knowledge about alcohol and drug problems: results of the medical council of Canada examination.

PURPOSE: To determine knowledge of a national sample of medical students about substance withdrawal, screening and early intervention, medical and psychiatric complications of addiction, and treatment options.

METHODS: Based on learning objectives developed by medical faculty, twenty-two questions on addictions were included in the 1998 Canadian licensing examination.

RESULTS: The exam was written by 858 medical students. The average score on the addiction questions was 64%.

• Students showed strong knowledge of the clinical features of medical complications.

Specific knowledge gaps were identified for

• withdrawal treatment protocols,
• low-risk drinking guidelines,
• taking an alcohol history,
• substance-induced psychiatric disorders, and
• Alcoholics Anonymous.

CONCLUSION: Medical students are knowledge-deficient around key learning objectives in addictions. The deficiencies were in areas of basic knowledge that could be learnt with little difficulty.

Research report; Kahan M, Midmer D, Wilson L, Borsoi D. Medical students’ knowledge about alcohol and drug problems: results of the medical council of Canada examination. Subst Abus. 2006 Dec;27(4):1-7.

Brief-TSF includes training, as well as other matters, in taking an alcohol inventory and knowledge of Alcoholics Anonymous.

Older Adults Often Exceed Alcohol Consumption Limits

Guidelines for “safe” alcohol use among older adults recommend daily limits no more than 2 drinks for men and 1 drink for women, weekly limits no more than 14 drinks for men and 7 drinks for women or a combination no more than 1 drink per day, 7 drinks per week, or 3 drinks per drinking session, regardless of sex.

The proportion of older adults who actually exceed each of these limits (i.e., engage in risky drinking) and experience associated alcohol-related problems is unknown.

To explore these issues, researchers surveyed 1291 non-abstinent, community-dwelling older adults at baseline and 10 years later.

The prevalence of risky drinking differed across guidelines, ranging from 23 percent to 50 percent among women and from 29 percent to 45 percent among men.

Both men and women who exceeded consumption limits were more likely to have alcohol-related problems (e.g., difficulties with relationships and functioning) both at study entry and follow-up. These problems were more prevalent in men.

In this community-based sample, risky drinking (defined by specific consumption levels) was prevalent among older adults, and guideline cut-offs were associated with alcohol-related problems.

Research Reference: Moos RH, Brennan PL, Schutte KK, et al. High-risk alcohol consumption and late-life alcohol use problems. Am J Public Health. 2004; 94(11):1985-1991. From Join Together

• See also;
• Elderly substance abuse

One-Year Outcomes among Members of a Dual-Recovery Self-Help Program.

Research Objective: Self-help is gaining increased acceptance among treatment professionals as empirical support for of its effectiveness is growing and the advent of managed care warrants the use of cost-effective modalities. Traditional “one disease-one recovery” self-help programs cannot serve adequately the needs of the dually-diagnosed.

This paper presents one-year outcome data from a longitudinal study of the effectiveness of self-help for the dually-diagnosed.

Subjects are members of Double Trouble in Recovery (DTR), a 12-step self-help program designed to meet the special needs of those diagnosed with both a mental health disorder and a chemical addiction.Study.

Design: The study uses a 12-month prospective longitudinal design with follow-ups at 12 and 24 months after baseline. Subjects (N = 310) were recruited at 25 DTR meeting sites throughout New York City. Semi-structured instruments assess history and current status of mental health and substance abuse, treatment in both areas, and self help participation (DTR as well as traditional 12-step groups such as AA and NA).

Population Studied: Community-based individuals dually-diagnosed with a mental health disorder and substance abuse.

Principal Findings: S’s are mostly members of underserved minority groups with long histories of substance abuse and mental health disorders.

Most S’s attend outpatient treatment (for drug use, mental health or dual-diagnosis – 77%) and take psychotropic medications (87%).

At the 12 months follow-up,

• 76% were still attending DTR;
• 68% were also attending AA or NA.

Mean number of symptoms S’s. experienced in the past year decreased significantly;

• two-thirds (69%) of S’s reported that their mental health was “better” in the past month than it was at baseline.
• One-third (29%) reported substance use in the past year, compared to 42% at baseline (p = .002).

Substance use (less) was significantly associated with DTR attendance:

• Total time abstinent was related to lifetime length of DTR attendance (r = .25, p = .002) and
• past year substance use was related to number of months of DTR attendance in the past year (r = -.17, p = .02).

Conclusions: For dually-diagnosed individuals, continued participation in dual recovery self-help groups plays a significant role in the recovery process, particularly in the area of substance use.

Implications for Policy, Delivery or Practice: Participation in dual-recovery self-help groups, both during and after formal treatment, should be encouraged as part of an integrated lifelong recovery plan for dually-diagnosed individuals.

Research; One-Year Outcomes among Members of a Dual-Recovery Self-Help Program. Laudet A, Magura S, Vogel H, Knight E, Staines G; Abstr Acad Health Serv Res Health Policy Meet. 2000; 17.

More at; Double Trouble in Recovery

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• Subscribe to Twelve Step Facilitation by e-Mail

Dual Diagnosis; Counseling the Mentally Ill Substance Abuser by Katie Evans, J. Michael Sullivan Read more about this title…