Archive for September, 2009

Predictors of a suicide attempt after treatment

Predictors of a suicide attempt one year after entry into substance use disorder treatment.

Background: The present study examined the patient intake and treatment-related risk factors associated with a suicide attempt in the 30 days before a 1-year post-treatment assessment.

Methods: A national sample of 8,807 patients presenting for treatment of substance use disorders (SUD’s) in the US Department of Veterans Affairs healthcare system were assessed at treatment intake and follow-up.

Using the MacArthur Model, the risk and protective factors for suicide attempt were identified at baseline and during treatment.

Results: At follow-up, 4% (314/8,807) of the patients reported a suicide attempt within the past 30 days.

Baseline predictors of a suicide attempt before follow-up included

elevated suicidal/psychiatric symptoms,
more recent problematic alcohol use, and
longer duration of cocaine use.

Contact with the criminal justice system was a protective factor that reduced the likelihood of a future suicide attempt.

Greater engagement in SUD treatment was also associated with a reduction in suicide risk.

Conclusions: More involvement in SUD treatment reduced the likelihood of a future suicide attempt in high-risk patients.

Substance use disorder treatment providers interested in reducing future suicidal behavior may want to concentrate their efforts on identifying at-risk individuals and actively engaging these patients in longer treatment episodes.

Research report; Predictors of a suicide attempt one year after entry into substance use disorder treatment. Ilgen MA, Harris AH, Moos RH, Tiet QQ. Alcohol Clin Exp Res 2007; 31(4): 635-42.

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12-Step Recovery Theory and Application

The concepts, principles, practices, and suggested 12 steps to recovery of the 12-step recovery approach to treating addictive disorders are examined.

Twelve-step recovery approaches are complex, multidimensional, biopsychosocial, and spiritual programs widely available in the United States and some other countries to people with addictive disorders, their family members, and significant others.

it has not been widely recognized that these programs are complex programs for living and address many issues other than alcohol and drug consumption.

Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Al-Anon, Alateen, and other 12-step recovery groups have flourished for the better part of the twentieth century, whereas many other treatment approaches have been tried and abandoned.

Although much discussion has centered on their spiritual emphasis, 12-step recovery approaches are clearly psychosocial recovery programs in which many important features entirely consistent with

behavior modification,
recent cognitive therapies,
modern social learning theories,
social psychology, and
sociology are very much in evidence.

Although many people are aware that 12-step recovery approaches are designed to deal specifically with drinking and drug misuse, it has not been widely recognized that these programs are complex programs for living and address many issues other than alcohol and drug consumption.

By JACK Wallace. In: P.J. Ott, R.E. Tarter, and R.T. Ammerman (Eds.), Sourcebook On Substance Abuse: Etiology Epidemiology, Assessment, and treatment. Allyn & Bacon 1999.

Sourcebook on Substance Abuse: Etiology, Epidemiology, Assessment, and Treatment
by Peggy J. Ott, Ralph E. Tarter, Robert T. Ammerman

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Teen Brain Wired to Seek Easy Rewards

Researchers say that the reward center in an adolescent’s brain isn’t as fully developed or responsive as an adult’s, which could explain why teens tend to engage in risky behaviors such as consuming alcohol, using drugs, or having unsafe sex, Health Day News reported Feb. 26.

Using magnetic resonance imaging (MRI), researchers scanned the brains of 12 teens aged 12 to 17 and 12 young adults aged 22 to 28. During the scan, participants played a game that involved monetary risk and reward.

In comparing the scans, the researchers found that the ventral stratium, the section of the brain known as the reward center, showed increased activity as the reward increased for both groups. However, the right ventral stratium, which is responsible for motivation, showed more activation in adult participants than in the teens.

“That region of the brain controls how much an organism is willing to work to get a reward,” Bjork said. “The data show that adolescents are just as happy and excited at the prospect of winning as adults, but they differed in the expenditure of effort for that reward.”

The researchers concluded that adolescents are more likely to engage in risky behaviors, such as alcohol and other drug use, because they involve little effort but provide a greater reward in return.

The research also may explain why teens sometimes seem unmotivated to adults. “Adults have readily active motivation in the brain,” said study co-author James Bjork, a research fellow in the Laboratory of Clinical Studies at the National Institute on Alcohol Abuse and Alcoholism. “But it may take exceptionally strong incentives to get kids jazzed up.”

The study’s findings are published in the Feb. 25 issue of the Journal of Neuroscience.

Creative Interventions for Troubled Children & Youth
by Liana Lowenstein

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Lesbians, Alcoholism & Depression

The Co-Occurrence of Depression and Alcohol Dependence Symptoms in a Community Sample of Lesbians

Numerous studies have found an association between depression and alcohol use disorders in women.

Little is known, however, about the relationship between depression and alcohol use among lesbians.

We examined the prevalence of depression and alcohol dependence symptoms as well as the co-occurrence of these two health problems in a large community-based sample of women who self-identified as lesbian.

Past year alcohol dependence symptoms were significantly associated with both past year and lifetime depression.

Lifetime depression was higher among White and Latina lesbians than among African American lesbians.

Younger women and those not currently in a committed relationship more commonly reported past year depression.

Younger age was the strongest predictor of the co-occurrence of depression and alcohol dependence symptoms.

Research report; Wendy B Bostwick, Tonda L. Hughes & Timothy Johnson. The Co-Occurrence of Depression and Alcohol Dependence Symptoms in a Community Sample of Lesbians. Journal of Lesbian Studies, Volume: 9 Issue: 3, 2005

New Zealandâ€™s spiritual aspects in 12-Step treatment

The Spiritual Characteristics of New Zealanders Entering Treatment for Alcohol/Other Drug Dependence

This study describes the spiritual experiences, beliefs, and practices of New Zealanders entering intensive treatment for alcohol/ other drug dependence, and seeks to determine factors that influence spirituality in a clinical population. Ninety clients entering three residential treatment programs for alcohol and/or cannabis dependence were interviewed about their spiritual beliefs, behaviors, and experiences, using a broad selection of accepted measures.

A number of associations between aspects of spirituality and gender, ethnicity, age, employment, severity of dependence, and depression were found.

In particular, the more religiously active participants were less severely alcohol/other drug dependent, and depression was negatively associated with beliefs and activity related to 12-step participation.

Research; Michael P. Baker, J. Douglas Sellman, & Jacqueline Horn. The Spiritual Characteristics of New Zealanders Entering Treatment for Alcohol/Other Drug Dependence. Alcoholism Treatment Quarterly, Volume: 24 Issue: 4, 2006 Pages: 137 – 155

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Screening Can Decrease Teen Risk Behaviors

Simple Screening Can Help Decrease Teen Risk Behaviors

Research shows that adolescents who engage in one form of risky behavior, like drug or alcohol use, are likely to engage in other risky behaviors like self-harm, or having unprotected sex, but often times these behaviors are not discussed during a medical or mental health exam. Now, a new study shows that a simple and brief screening measure called the adolescent risk inventory (ARI) can quickly identify the broad range of risk behaviors found among adolescents.

â€œThis constellation of behavior problems is really the thing we are trying to avoid. So, identifying early that a teen is engaging in a risky behavior may prevent that behavior from being the gateway to further risky behaviors,â€ says lead author Celia Lescano, PhD with the Bradley Hasbro Children’s Research Center and The Warren Alpert Medical School of Brown University.

This research study appeared in the April 2007 issue of the journal Child Psychiatry and Human Development.

Prior research indicates that teenagers who engage in one risky behavior are more likely to be involved in others and that this has an additive effect. The authors note that risk behaviors among teens are prevalent and can lead to increased morbidity, mortality, and health care costs, so identifying and dealing with problematic issues as they arise can help teens be safer and healthier.

Researchers studied 134 youth ages 12 to 19 with psychiatric disorders. Each study participant was given the adolescent risk inventory (ARI) (a paper and pencil measure). The ARI included questions about sexual history (have you ever been pregnant or been a dad?), self-harm (have you ever attempted suicide?), and attitudes towards acting out (do you break rules for no reason?).

â€œWe found that the ARI is reliable and comprehensive and can be useful in quickly identifying a wide range of teen risk behaviors,â€ says Lescano.

This is important, the authors say, because when teens are seen for medical and/or mental health care, risk behavior issues are often neglected. Time and relevance are often seen as barriers that prevent providers from obtaining this important information.

â€œGiven that the ARI is brief and broad in it assessment of behaviors, these barriers can be overcome and allow pediatricians, family doctors and mental health professionals to make referrals based on the information they get from the teen,â€ explains Lescano.

The analyses also provided intriguing data on the relationship between sex risk, psychopathology, and behavior in that abuse or self-harm behaviors were highly predictive of sex risk. This is important because while many clinicians are aware of the sexual risks that aggressive youths take, many are unaware of the association between risky sexual behavior and emotional distress, abuse and self-harm. Behaviors like self-cutting thoughts, suicidal thoughts or attempts, or a history of sexual abuse should alert clinicians to the potential for significant sexual risk, the authors say.

Oftentimes, research programs that target the identified risk behavior can be found in nearby communities or even through the medical or mental health offices in which the teens are being seen.

â€œReferral to these programs, as well as to mental health professionals to help treat the negative emotions that can precipitate risk behaviors may be useful avenues to decreasing risky behaviors in teens,â€ says Lescano.

Research report from; Lifespan

Process of Recovery for Alcoholic Women

Factors that Foster and Hinder the Process of Recovery for Alcoholic Women.

Alcoholism is a chronic, progressive, potentially fatal disease that crosses gender, race, ethnicity, age, and socioeconomic strata.

Much of what is known about the disease of alcoholism has been uncovered studying male alcoholics.

A phenomenological study was undertaken to identify those contextual factors that fostered and hindered the process of recovery for alcohol dependent women.

Criteria for participation in the study were: women self-identifying as recovering from alcoholism, aged 25 years and older, able to converse and write in English, and abstinent from alcohol use for a minimum of two years. Eleven women (6 Caucasian, 4 African-American, one Native American; 8 heterosexual and 3 lesbians) in recovery for alcohol dependency were recruited by networking and snowball sampling. The women ranged in age from 32 to 76 years of age and had been in recovery from 2 to 37 years. Data were collected through individual audio tape recorded interviews that lasted 45 minutes. Data were analyzed using the constant comparative method for content analysis.

The data revealed the factors that fostered recovery from alcoholism were:

working a program of recovery,
developing a support system,
making amends for past behaviors,
recognizing recovery as a life-long process, and
helping other alcohol dependent women struggling in recovery.

The identified factors that hindered the process of recovery were:

everyday stress,
feeling stigmatized for being alcoholic, and
dealing with painful childhood memories.

Research report; M. Kathleen Brewer. The Contextual Factors that Foster and Hinder the Process of Recovery for Alcohol Dependent Women. Journal of Addictions Nursing, Volume 17, Issue 3 September 2006 , pages 175 – 180

Brief-TSF addresses all these issues.

TSF more economical with greater success

Encouraging post-treatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes

Background: Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients’ health care costs in the first year after treatment, but such initially impressive effects may wane over time.

This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.

Methods: A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step-based (n = 887 patients) or cognitive-behavioral (CB, n = 887 patients) treatment programs.

The 12-step-based programs placed substantially more emphasis on 12-step concepts, had more staff members "in recovery," had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs.

The 2-year follow-up assessed patients’ substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.

substantially higher abstinence rate among patients treated in 12-step

Results: As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) in contrast to CB (37.0%) programs.

Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs.

30% lower costs in the 12-step treatment programs

In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p = 0.01).

Conclusions:

Promoting self-help group involvement appears to improve post-treatment outcomes while reducing the costs of continuing care.
Even cost offsets that somewhat diminish over the long term can yield substantial savings.
Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.

Research; Keith Humphreys, and Rudolf H. Moos Alcoholism: Clinical and Experimental Research 2007; 31(1):64-68) – 1 This computation is in 2006 dollars, to which we converted for comparative purposes our prior findings, which had been originally reported in 1999 dollars (Humphreys and Moos, 2001).

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TSF and other models

CONTRAST TO OTHER COUNSELING APPROACHES

Most Similar Counseling Approaches

TSF has its roots in the Minnesota Model first described by Daniel J. Anderson and as implemented in most AA-oriented treatment programs (e.g.,the Hazelden Foundation, the Betty Ford Foundation, the Sierra Tuscan Center, and others). These models assume addiction can be arrested but not cured, ascribe to the AA/NA philosophy as described in AA/NA literature that relies heavily on a combination of spirituality and pragmatism, and advocate peer support as the primary means for achieving sustained sobriety.

Most Dissimilar Counseling Approaches

Any approach that advocates controlled use of alcohol or other drugs (as compared with abstinence) is fundamentally dissimilar to TSF with respect to basic treatment goals. Cognitive-behavioural approaches that are based on the idea that problem drinking and other drug use stem primarily from inadequate stress management skills and that aim to enhance problem solving and coping skills differ from TSF with respect to the assumption of peer support as fundamental to recovery. TSF also assumes that alcoholism and other drug addiction are primary diagnoses and not symptoms of another diagnosis (e.g., depression, antisocial personality).

Benefits of ACOA Mutual-help Groups

ACOA Mutual help groups, perceived status benefits, and well-being: A test with adult children of alcoholics with personal substance abuse problems.

A field experiment was conducted to examine the potential effects of mutual help group participation on perceived status benefits, depression, and substance use among 82 adult children of alcoholics (ACOA’s; aged 22-60 yrs) with personal substance abuse problems.

Participants were randomly assigned to attend either ACOA-specific mutual help group meetings or substance abuse education classes during the initial month that they were enrolled in a residential treatment program for low-income substance abusers.

Analyses were based on assessments made at baseline, a 1-month posttest, and a 6-month follow-up.

Results indicate that participation in the mutual help group promoted perceived status benefits, which in turn led to reductions in depression and substance use.

These findings have clear implications for consumers of ACOA groups and can inform research on the social psychological underpinnings of different types of mutual help groups.