Exploring patterns of remission from alcohol dependence with and without Alcoholics Anonymous in a population sample.
Narratives provided by former heavy drinkers have indicated that respondents who attended the self-help fellowship Alcoholics Anonymous (AA) experienced more abrupt resolutions than respondents who never attended AA.
This study explored the extent to which this difference in resolution pattern exists in a representative sample of individuals remitted from a lifetime diagnosis of alcohol dependence.
The study used the 1990-1991 Mental Health Supplement to the Ontario Health Survey, a household survey that assessed the prevalence of psychiatric disorders, including alcohol dependence, among 9,953 respondents in Ontario.
Bivariate analyses were conducted comparing the characteristics for the 268 remitted alcohol-dependent respondents who had;
never attended AA (n = 189),
attended but not in the last year (n = 46), or
attended in the past 12 months (n = 33).
There appeared to be a difference in the abruptness of resolution among those respondents who had remitted from alcohol dependence.
That is, respondents who had attended AA were more likely to have ended their heaviest drinking period and to have experience their last symptom at roughly the same age, as compared with those who did not attend AA.
The latter group displayed greater differences in the ages at which they experienced these two markers of remission, perhaps indicating a more gradual “drift” out of alcohol problems.
Research; Cunningham, J.A.; Breslin, F.C. Exploring patterns of remission from alcohol dependence with and without Alcoholics Anonymous in a population sample. Contemporary Drug Problems, 28(4):559-566, 2001. (166942)
Dying to Drink: Confronting Binge Drinking on College Campuses by Henry Wechsler, Bernice Wuethrich
Benefits of Alcoholics Anonymous attendance: Replication of findings between clinical research sites in Project MATCH.
We compared findings on the benefits associated with 12-Step group Alcoholics Anonymous (AA) attendance across eleven clinical sites in Project MATCH. 1,726 clients were recruited for the study.
Results found that the largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences.
The magnitude of these benefits did not differ between sites.
A positive association was also found between AA attendance and increased purpose in life, but the size of this relationship was very small and was statistically significant only after controlling for measurement error.
Several explanations are offered to reconcile findings in this study with earlier work concluding that: (1) treatment setting moderated subsequent AA benefit, and (2) AA attendance was associated with psychosocial improvement.
Research; Tonigan , J. Scott. (2001) Benefits of Alcoholics Anonymous attendance: Replication of findings between clinical research sites in Project MATCH. Alcoholism Treatment Quarterly. Vol 19(1), 2001, 67-77.
Patients with a liver transplant for alcoholic liver disease are advised to abstain permanently from alcohol. To measure the recurrence of alcohol use after liver transplantation, researchers assessed 167 liver recipients every 3 months during the first year after the transplant and then every 6 months for 4 years thereafter. At routine appointments, patients received recommendations for complete abstinence from alcohol and additional counseling if they had returned to drinking. The majority of patients had alcohol dependence (alcoholism), and were sober for an average of 40 months before transplantation.
During the first year after transplantation, 22% of subjects had at least 1 drink. Ten percent had at least 1 heavy drinking episode (6 drinks a day for men and 4 drinks a day for women). And 5% returned to frequent drinking (4 drinking days per week).
By the fifth year after the transplant, 42% had at least 1 drink, 26% had at least 1 heavy drinking episode, and 20% returned to frequent drinking.
Longer sobriety before the transplant delayed the time to first drink and heavy drinking.
Alcoholism and depression predicted significantly higher alcohol use after the transplant.
Conclusion: This study shows that although the majority of liver recipients do not drink heavily, a substantial proportion returns to some alcohol use after transplantation for alcoholic liver disease. The findings highlight the need for supportive strategies, particularly those that increase the length of sobriety before the transplant, to minimize alcohol use after the transplant.
Therapy should include attendance at Alcoholics Anonymous for alcoholism which is known to increase alcohol abstinence.
Reference: DiMartini A, Day N, Dew MA, et al. Alcohol consumption patterns and predictors of use following liver transplantation for alcoholic liver disease. Liver Transplant. 2006;12(5):813–820.
Brief-TSF will assist breakdown of denial and sustained recovery.
Alcohol & Other Drug Recovery by Belleruth Naparstek
This course is designed for Substance Abuse Counselors and Professionals in the Social Service field with an overview of domestic violence and substance abuse.
This education course will cover various forms of domestic violence, identification of risk factors and causes, intervention and treatment approaches.
Primary care doctors’ perception of treatment demand and need for training in drug addiction issues.
Aim: To learn the opinion of primary care physicians (PCPs) on healthcare provision for the drug addict population and to determine their knowledge and needs as regards to continuing training and their attitudes towards drug addiction.
Methods: We conducted a cross-sectional survey of 301 PCPs in Castilla-La Mancha, Spain using a questionnaire designed to elicit physician’s opinions about drug addiction.
Results: The response rate was 85.0% (256 cases). 84.2% of the doctors considered that 10% of patient visits to primary care centres were related to drug addiction.
The doctors frequently experienced difficulty in:
the diagnosis and treatment of organic diseases associated with addiction (18.4%),
the assessment of the situation and level of dependence (36.7%),
support to treatment of some aspects of drug addiction (51.3%) and,
above all, the treatment of these addictions (62.9%).
Of all respondents, 53.8% reported they had received some form of postgraduate training in drug addiction issues.
Only 28.5% considered they had received sufficient information on specialised drug addiction services.
Conclusions: As regards to PCPs’ attitudes to drug addiction, we observed a positive attitude regarding the needs of those who abuse drugs, and the development of intervention programmes.
PCPs believe that addicts deserve treatment, that there should be more treatment programmes and that primary healthcare centres should establish links with specialised services.
A popular aid is the Just for Today card that AA and Al-anon members carry in their pocket or purse and refer to when thinking of a drink or they are disturbed by a life event.
Just for today I will try to live through this day only, and not tackle all my problems at once. I can do something for twelve hours that would appall me if I felt that I had to keep it up for a lifetime.
Just for today I will be happy. This assumes to be true what AbrahamLincoln said, that most folks are as happy as they make up their minds to be.
Just for today I will adjust myself to what is, and not try to adjust everything to my own desires. I will take my luck as it comes, and fit myself to it.
Just for today I will try to strengthen my mind. I will study. I will learn something useful. I will not be a mental loafer. I will read something that requires effort, thought and concentration.
Just for today I will exercise my soul in three ways: I will do somebody a good turn, and not get found out; if anybody knows of it, it will not count. I will do at least two things I don’t want to do just for exercise. I will not show anyone that my feelings are hurt; they may be hurt, but today I will not show it.
Just for today I will be agreeable. I will look as well as I can, dress becomingly, keep my voice low, be courteous, criticize not one bit. I won’t find fault with anything, nor try to improve or regulate anybody but myself.
Just for today I will have a program. I may not follow it exactly, but I will have it. I will save myself from two pests: hurry and indecision.
Just for today I will have a quiet half hour all by myself and relax. During this half hour, sometime, I will try to get a better perspective of my life.
Just for today I will be unafraid. Especially I will not be afraid to enjoy what is beautiful and to believe that as I give to the world, so the world will give to me.
A pocket sized version of this is available at most 12-Step meetings such as Alcoholics Anonymous or Al-Anon
Download a PDF copy to printout and give to your patients.
Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: a prospective randomised controlled trial.
AIMS: To assess the impact of two methods of brief nurse-delivered brief interventions in reducing drinking variables in hazardous drinkers with alcohol-related facial injuries.
METHODS: A randomised controlled trial of two brief interventions involving hazardous drinkers with facial trauma in three Oral and Maxillofacial Surgery outpatient clinics in the West of Scotland; 194 patients were recruited and randomised to have either a nurse-led brief motivational intervention (intervention group) or a leaflet about alcohol misuse (control group). Patients were followed up at 3 and 12 months after the intervention and drinking variables reassessed.
RESULTS: A brief motivational intervention for alcohol provided by a nurse was more effective than a leaflet in helping some patients with facial trauma to reduce their alcohol consumption 12 months after the intervention (p<0.05).
CONCLUSIONS: Facial trauma in the West of Scotland is strongly associated with alcohol misuse and is a recurrent disease, particularly among those who drink heavily. A nurse-delivered brief motivational intervention is effective in helping patients with high scores in the Alcohol Use Disorders Identification Test (AUDIT) to reduce their drinking, and this effect was apparent 12 months after the intervention.
Goodall CA, Ayoub AF, Crawford A, Smith I, Bowman A, Koppel D, Gilchrist G. Br J Oral Maxillofac Surg. 2008 Mar;46(2):96-101. Epub 2007 Dec 21. Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: a prospective randomised controlled trial
Alcoholics can be distinguished from controls in terms of cyclothymic traits
Ninety-four consecutive responders to treatment alcoholics, 39 with and 55 without psychiatric comorbidity, were compared, regarding affective temperaments, according to the formulation of Akiskal and Mallya, with 50 healthy volunteers displaying the same social characteristics and belonging to the same environment.
No differences were observed between alcoholics and controls on the hyperthymic scale.
Significant discrepancies were measured on the depressive, cyclothymic, and irritable scales, where alcoholics scored higher, regardless of the presence or absence of dual diagnosis.
In a multivariate discriminant analysis, mainly cyclothymic, but also depressive traits to a lesser degree, make it possible to distinguish between alcoholics and controls, but not between alcoholics with and without a dual diagnosis.
The present study shows the main ways in which alcoholics can be distinguished from controls in terms of cyclothymic traits, with a depressive component, and why these characteristics are unrelated to the presence of dual diagnosis.
Research report; Pacini M, Maremmani I, Vitali M, Santini P, Romeo M, Ceccanti M. Affective temperaments in alcoholic patients. Alcohol. 2009 Aug;43(5):397-404.
Brief Twelve Step Facilitation (Brief-TSF) is a new synthesis of experience and research covering the last 65 years. Varied forms of TSF have been devised and utilised by a variety of helpers since Twelve Step Fellowships originated by Alcoholics Anonymous (AA). These range from simple advice to ‘Go to AA’ through various forms of counseling, mandated attendance and coercion to long-term residential treatment.
Brief-TSF, unlike full TSF, is for use by generalist healthcare workers as an adjunctive intervention to their normal practice. It is brief in that Brief-TSF only requires one dedicated session.
Brief-TSF can be used as;
a discrete structured assertive intervention,
in an opportunistic supportive mode or,
simply as a knowledge base for healthcare workers who wish to respect a clients/patients choice of recovery through a twelve step fellowship.
Brief-TSF is intended to be utilised in ‘mainstream’ healthcare as an earlier intervention to prevent harms such as family breakdown, legal sanctions, medical complications, anti-social behaviour, employment interruption & etc.
Brief-TSF consists of a brief and structured approach to facilitating early recovery from alcoholism. It is intended to be implemented on an individual basis and is based in behavioural, spiritual, and cognitive principles that form the core of 12 step fellowships such as Alcoholics Anonymous (AA). It is suitable for those who are alcohol dependent.
![Stages of change in anxiety: psychometric properties of the University of Rhode Island Change Assessment (URICA) scale [An article from: Behaviour Research and Therapy]](http://ecx.images-amazon.com/images/I/51VYTX084TL._SL75_.jpg "Stages of change in anxiety: psychometric properties of the University of Rhode Island Change Assessment (URICA) scale [An article from: Behaviour Research and Therapy]")
![images[5]](http://brieftsf.com/wp-content/uploads/2008/03/images5.jpg)
