Predictors of suicide attempters

Predictors of suicide attempters in substance-dependent patients: a six-year prospective follow-up.

Background; This is a six-year prospective follow-up of a former cross sectional study of suicide attempters in a sample of treatment-seeking substance-dependent patients.

The aims were to explore the frequency of patients with new suicide attempts (SA) during the six-year observation period, and to explore the predictive value of lifetime Axis I and II disorders, measured at index admission, on SA in the observation period, when age, gender and substance-use variables, measured both at admission and at follow-up, were controlled for.

Methods; A consecutive sample of 156 alcohol-dependent and 131 poly-substance dependent inpatients and outpatients in two Norwegian counties were assessed at index admission (T1) with the Composite International Diagnostic Interview (Axis I disorders), Millonâ€™s Clinical Multiaxial Inventory (Axis II disorders) and Hopkins Symptom Checklist-25 (mental distress).

At follow-up six years later (T2), 56% (160/287 subjects, 29% women) were assessed using the HSCL-25 and measures of harmful substance use (Alcohol Use Disorders Identification Test and Drug Use Disorders Identification Test).

Results; The prevalence of patients with SA between T1 and T2 was 19% (30/160), with no difference between sexes or between patient type (alcohol-dependent versus poly substance-dependent).

Sober patients also attempted suicide.

At the index admission, lifetime eating disorders, agoraphobia with and without panic disorder, and major depression were significantly and independently associated with SA.

Prospectively, only lifetime Dysthymia increased the risk of SA during the following six years, whereas lifetime generalized anxiety disorder reduced the risk of SA.

Individually, neither the numbers of Axis I and Axis II disorders nor the sum of these disorders were independently related to SA in the observation period.

Substance use measured at T1 did not predict SA in the follow-up period, nor did harmful use of substances at follow-up or in the preceding year.

Conclusions; A high prevalence of SA was found six years later, both in patients still abusing substances and in sober patients.

To prevent SA, treatment of both affective disorders and substance abuse is important.

Research; Kjell Bakken, Per Vaglum. Predictors of suicide attempters in substance-dependent patients: a six-year prospective follow-up. Clinical Practice and Epidemiology in Mental Health 2007, 3:20

The Practical Art of Suicide Assessment: A Guide for Mental Health Professionals and Substance Abuse Counselors
by Shawn Christopher Shea

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ALCOHOLISM MYTHS

FIVE MAJOR ALCOHOLISM MYTHS

Myth 1: An alcoholic is the falling-down drunk on skid row.

Answer: Only three percent of alcoholics are on skid row. Those alcoholics on skid row are undoubtedly in the last stages of the illness. Most people with alcoholism are in the early and middle stages. They have families, they hold regular jobs, they may not appear to be any different from anyone else. The person with alcoholism may be an automobile mechanic, an officer of a large corporation, an actor, a salesman, a press operator, a stock clerk, a secretary, a housewife.

Clearly the disease of alcoholism is no respecter of persons.

About 80% Americans use alcohol and enjoy the relaxation it brings them. Unfortunately about one in fifteen of theses develops the disease of alcoholism. This disease eventually causes premature death or insanity unless it is treated. But it is a slow progressive illness and often requires five to twenty years before its victim becomes unemployable or incapable of being a responsible employee or housewife.

Myth II: Alcoholics are hopeless drunks.

Answer: Nothing could be farther from the truth. While there is no known cure, alcoholism can be arrested with proper treatment. Fifty to seventy percent of employed alcoholics who receive treatment recover and lead normal lives. For example, the businessman and the doctor who founded Alcoholics Anonymous were once considered by their friends to be "hopeless drunks". Instead, they demonstrated that alcoholics are anything but hopeless. And the fellowship of Alcoholics Anonymous, through which hundreds of thousands have received help, offers dramatic proof that people with alcoholism can recover.

Myth III: Alcohol is the cause of alcoholism.

Answer: The exact causes are still not known despite continuing research. However, it is known that alcohol by itself is not the only cause. If it were, then there would be about 80 million alcoholics in the United States — the same number of people who use alcohol.

We can draw parallels with another disease whose cause we do not know– cancer. Some people develop cancer, others do not. Similarly, some drinkers develop alcoholism, others do not. Like cancer. in another way, alcoholism can be treated and the chance of recovery is better in the early stages.

Myth IV: Alcoholics could recover if they had enough will power.

Answer: Recovery from any serious illness requires a strong will to live. This is not what we mean when we talk about will power. People do not recover from illnesses by simply resolving that they will stop being sick! They can resolve to go to the doctor. That can help. They can resolve to follow the doctor’s advice. That can help. They can resolve to follow through with any kind of treatment that is necessary. All theses things can help in their recovery from the illness.

Actually, most people with alcoholism have a great deal of will power. For example, the person who has a responsible job and serious case of alcoholism. By sheer will power he gets to work in the morning on days when with any other illness he would stay home in bed. After a bender he gets up in the morning with butterflies in his stomach and suffers from "the shakes". Somehow he gets shaved without cutting himself too badly, has a shower, puts on his clothes, and takes a bit of the "hair of the dog that bit him" the night before. The nip of alcohol quiets his shaking nerves enough so that he can get a cup of coffee and a slice of toast to sit in his stomach. Then he goes off to work and somehow gets through the day even though he may feel terrible. This is not the picture of a man lacking will power.

Instead, it is a picture of a conscientious man who wishes to keep up appearances — a person who is suffering from an illness and does not know that he can get treatment for it. Like most people, he believes the myths about alcoholism being a moral problem.

Myth V: Alcoholism is a self-inflicted moral problem

Answer: Some people are ready to admit that alcoholism is a disease — but then maintain it is a "self-inflicted disease". This is a pretty silly idea if you look at it carefully in the light of what happens with other illnesses. Being overweight may help bring on a heart attack. Yet, we never say a fat person’s heart attack was self-inflicted. Most people have had the experience of mission sleep and fatiguing themselves, and then catching a cold. Again, no one says that the cold was "self-inflicted", even though, with sufficient rest, they might not have caught the cold. Thus if we say that alcoholism is "self-inflicted", we also must admit that many other illnesses are "self-inflicted". In addition, we do not speak of any disease itself as being a moral problem.

Spirituality in alcoholics during treatment

The purpose of this study was to measure;

spiritual well-being (SWB),
private religious practices (PRP),
positive religious coping,
abstinence self-efficacy (AASE),
affiliation with AA (AAA), and
their associations with alcoholics in treatment.

Seventy-four adults in a three-week outpatient addiction treatment program were assessed at admission and discharge.

Wilcoxon signed rank and t tests demonstrated significant increases in all variables. Spearman correlation coefficients detected significant associations between the spiritual variables, SWB and AASE, as well as PRP and AAA.

Findings suggest that spiritual variables can change during treatment and that there may be connections between spiritual variables and variables associated with longer-term recovery.

Research; Piderman KM, Schneekloth TD, Pankratz VS, Maloney SD, Altchuler SI. Spirituality in alcoholics during treatment. Am J Addict. 2007 May-Jun;16(3):232-7.

Role of religion and spirituality in recovery from drink problems

A qualitative study of Alcoholics Anonymous members and South Asian men.

The spiritual aspect of recovery for people with drinking problems was explored in a comparative analysis of South Asian men recovering from drink problems and white members of Alcoholics Anonymous (AA).

In-depth semi-structured interviews were carried out with participants to explore significant factors that assisted recovery. Interviews were analyzed using grounded theory. Ten participants in total were interviewed; 5 were South Asian men receiving individual and/or group counseling with South Asian therapists either in an NHS or non-statutory specialist alcohol treatment service, and 5 were white members of AA.

Models of recovery for the two groups were developed and are presented.

Spirituality and religion played an important role in the experiences of recovery described by AA and South Asian participants respectively.

For AA participants their experiences reflected those described in AA’s Big Book although concepts such as that of a Higher Power were complex and multilayered, with spirituality just one, albeit significant, aspect.

South Asian participants generally underwent a re-affirmation of existing beliefs rather than the conversion type of experience described by AA participants.

The findings are discussed in relation to implications for service delivery and development and directions for future research.

Morjaria, A.; Orford, J. Role of religion and spirituality in recovery from drink problems: A qualitative study of alcoholics anonymous members and South Asian men. Addiction Research and Theory, 10(3):225-256, 2002.

The Spirituality of Imperfection: Storytelling and the Search for Meaning
by Ernest Kurtz, Katherine Ketcham

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Substance Abuse and Mental Disorders

The Co-Occurring Center for Excellence. Addressing mental disorders and alcoholism, addiction co-occurring.

The Co-Occurring Center for Excellence (COCE) was created by SAMHSA in 2003 to provide information and a range of services to mental health and substance abuse administrators and policymakers at state and local levels, their counterparts in tribal and Native populations, clinical providers, other providers, and all other agencies and systems through which clients may enter the treatment system.

COCE provides state-of-the-art and sustainable technical assistance, training, information and resources, and links to other resources that serve persons with co-occurring disorders.

http://www.coce.samhsa.gov/

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Stress Affects Relapse

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

Brief-TSF addresses relapse prevention as stress relief.

Methadone Patients Drink Heavily

Correlates of alcohol use among methadone-maintained adults

This prospective study (n = 190) examined correlates of alcohol use from baseline data of a longitudinal trial conducted among moderate and heavy alcohol users receiving methadone maintenance therapy (MMT).

The sample included MMT clients who were 18â€“55 years of age, and were receiving MMT from five large methadone maintenance clinics in the Los Angeles area.

Half of the sample was heavy drinkers and nearly half (46%) reported heroin use. Using a structured questionnaire, correlates of heavy alcohol use included White and Hispanic ethnicity, and fair or poor physical health combined with older age (?50 years). We also found that MMT clients who were younger than 50 years, regardless of health status, were more likely to be heavy drinkers.

Compared with moderate alcohol consumers, a greater number of heavy alcohol users also experienced recent victimization.

To optimize MMT, alcohol screening should be part of routine assessment and alcohol treatment should be made available within MMT programs.

Moreover, special consideration should be provided to the most vulnerable clients, such as the younger user, those with a long-term and current history of heavy drug use, and those victimized and reporting fair or poor health. In addition, promoting attention to general physical and mental health problems within MMT programs may be beneficial in enhancing health outcomes of this population.

Research report; Adeline Nyamathi, Allan Cohen, Mary Marfisee, Steven Shoptaw, Barbara Greengold, Viviane de Castro, Daniel George and Barbara Leake. Drug and Alcohol Dependence. Volume 101, Issues 1-2, 1 April 2009, Pages 124-127. Correlates of alcohol use among methadone-maintained adults

Se also;

Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach

Harmful Drinking after Liver Transplantation

“I’ll never touch it again, doctor!” – harmful drinking after liver transplantation.

Alcohol relapse can negatively influence the outcome after liver transplantation (LT).

The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT.

A total of 387 consecutive patients (23.8% women) who underwent LT for alcoholic cirrhosis in Geneva, Switzerland, and Lyon, France, between 1989 and 2005 were evaluated.

Mean +/- SD age was 51.3 +/-7.5 years. Follow-up time was 61.2 +/- 47.5 months.

Alcohol consumption relapse and potential factors associated with it were studied.

The relapse rate of harmful alcohol consumption after LT was 11.9%.

In univariate analysis, alcohol relapse was significantly associated with

age greater than 50 years,
year of LT 1995 or earlier,
duration of abstinence less than 6 months,
presence of psychiatric comorbidities,
presence of a life partner, and
a high score on the High-Risk Alcoholism Relapse (HRAR) scale.

Multivariate logistic regression disclosed the following independent factors of relapse:

duration of abstinence of less than 6 months;
presence of psychiatric comorbidities; and
HRAR score higher than 3.

In patients with none of these factors, alcohol relapse was 5%, while the presence of 1, 2, or 3 factors was associated with relapse rates of 18%, 64%, and 100% of the patients, respectively.

In a large cohort of patients undergoing LT for alcoholic cirrhosis,

a duration of abstinence of less than 6 months before wait-listing for LT,
the presence of psychiatric comorbidities, or
an HRAR score higher than 3

was associated with relapse into harmful drinking.

The presence of more than 1 factor dramatically increased this risk over 50%.

In the pre-LT evaluation in this setting, these factors should be accurately determined.

Research; Haber PS, McCaughan GW. “I’ll never touch it again, doctor!” – harmful drinking after liver transplantation. Hepatology. 2007 Sep 25;46(4):1302-1304.

Liver Transplantation & the Alcoholic Patient: Medical, Surgical and Psychosocial Issues
by Michael R. Lucey, Robert M. Merion, Thomas P. Beresford

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The Long Term Hangover

via recoveryissexy.com

Health impacts of long term alcohol misuse
Long term abuse of alcohol creates medical risks to individuals and may contribute to many cases of illness and premature death.

Posted via web from Recovery Is Sexy’s posterous

Adolescent Children of Alcoholics

Adolescent Children of Alcoholics: Vulnerable or Resilient?

BACKGROUND: Children of alcoholics (COAs) have been described as both vulnerable and resilient. Although identified as at-risk for mental and physical health problems, chemical dependency, and child abuse and neglect, many go on to lead successful lives.

OBJECTIVE: The relationship between COA status and various adolescent risk behaviors, such as drug and alcohol abuse and sexual precocity, was assessed by addressing the following research question: Could parental alcoholism be a risk factor for teens engaging in problem behaviors?

STUDY DESIGN: A secondary analysis of a Wyoming high-risk youth data set was conducted (N _ 1632). Wernerâ€™s (1992) core resiliency factors provided the conceptual frame for the study.

RESULTS: Adolescent COAs scored significantly (p < .000) lower on all psychosocial factors of family/personal strengths and school bonding and significantly higher on all factors of at-risk temperament, feelings, thoughts, and behaviors than non-COAs.

CONCLUSIONS: Adolescent COAs are at risk for depression, suicide, eating disorders, chemical dependency, and teen pregnancy. It has been proposed that mental health professionals teach core resiliency factors to promote healthy behaviors for this vulnerable population.

Children of addicted parents are the highest risk group of children to become alcohol and drug abusers because of both genetic and family environment factors.

Twenty-two percent (n _ 352) of the combined sample identified themselves as a child of an alcoholic. This is consistent with current estimates of children of parental period alcoholics, which is calculated to be 22% (Eigen & Rowden, 2000). Rodney and Mupier (1997), in a recent study among 595 African American boys age 13 to 17 years, identified that 23% of the participating teens were COAs. The National Association of Children of Alcoholics (NACOA, n.d.) estimates that there are 11 million COAs under 18 years of age.

COAâ€™s scored lower on psychosocial factors;