AA as adjunctive therapy works

An Evaluation of the Therapeutic Programme Conducted by the Southern Regional Alcohol-Abuse Treatment Centre: Study on the Programme’s Results One Year after Discharge from Inpatient Care.

Given the clinical and social problems caused by the consumption of alcohol in most industrialised countries, there is a strong need to develop and evaluate the effectiveness of integrated care programmes.

In this study, the authors describe the results observed in 124 sequentially admitted subjects at various points throughout the course of the first year after their discharge from the Southern Regional Alcohol-Abuse Treatment Centre (CRAS) in Lisbon, Portugal.

An inpatient stay at this unit of CRAS lasts for between 5 and 7 weeks and implies that the patient must submit him/herself to a therapeutic model which has been adapted from the Minnesota model which includes attendance at 12 Step Alcoholics Anonymous meetings.

At the end of the year under study 44.3% of the patients were still abstinent, 40.3% were consuming alcohol and 15.4% did not reply.

51 patients (41.1% of the initial sample) were still in regular contact with CRAS for further treatment at that point.

The variable that was found to possess the most significant association with a favourable outcome was adherence to the therapeutic programme over the course of that year.

Domingos Neto, Miguel Xavier, Paula Lucena, Ana Vieira da Silva. An Evaluation of the Therapeutic Programme Conducted by the Southern Regional Alcohol-Abuse Treatment Centre: Study on the Programme’s Results One Year after Discharge from Inpatient Care. European Addiction Research 2001;7:61-68

How AA Members Get Sober in Taiwan

An ongoing process: A qualitative study of how the alcohol-dependent free themselves of addiction through progressive abstinence

Abstract (provisional)

Background Most people being treated for alcoholism are unable to successfully quit drinking within their treatment programs. …

Note: Cross posted from Twelve Step Facilitation.com.

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Twelve Step Facilitation (TSF) Reduces Substance Abuse

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.

As spirituality increases drinking decreases

Six-month changes in spirituality, religiousness, and heavy drinking in a treatment-seeking sample.

OBJECTIVE: This descriptive and exploratory study investigated change in alcoholics’ spirituality and/or religiousness (S/R) from treatment entry to 6 months later and whether those changes were associated with drinking outcomes.

METHOD: Longitudinal survey data were collected from 123 outpatients with alcohol use disorders (66% male; mean age = 39; 83% white) on 10 measures of S/R, covering behaviors, beliefs, and experiences, including the Daily Spiritual Experiences and Purpose in Life scales. Drinking behaviors were assessed with the Timeline Followback interview. Alcoholics Anonymous (AA) participation and attendance were also measured.

RESULTS: Over 6 months, there were statistically significant increases in half of the S/R measures, specifically the Daily Spiritual Experiences scale, the Purpose in Life scale, S/R practices scale, Forgiveness scale, and the Positive Religious Coping scale.

There were also clinically and statistically significant decreases in alcohol use.

Multiple logistic regression analyses showed that increases in Daily Spiritual Experiences and in Purpose in Life scores were associated with increased odds of no heavy drinking at 6 months, even after controlling for AA involvement and gender.

CONCLUSIONS: In the first 6 months of recovery, many dimensions of S/R increased, particularly those associated with behaviors and experiences. Values, beliefs, self-assessed religiousness, perceptions of a Higher Power, and the use of negative religious coping did not change.

Increases in day-to-day experiences of spirituality and sense of purpose/meaning in life were associated with absence of heavy drinking at 6 months, regardless of gender and AA involvement.

The results of this descriptive study support the perspective of many clinicians and recovering individuals that changes in alcoholics’ S/R occur in recovery and that such changes are important to sobriety.

Robinson EA, Cranford JA, Webb JR, Brower KJ. Six month changes in spirituality religiousness and heavy drinking in a treatment-seeking sample. J Stud Alcohol Drugs. 2007 Mar;68(2):282-90.

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Suicide and Alcohol Abuse

Characteristics of suicide attempts preceded by alcohol consumption.

Acute alcohol ingestion and alcohol dependence are known to increase the risk of impulsive suicide attempt even in non-depressed patients.

The relation between alcohol and suicide risk needs, however, to be clarified. We assessed for this purpose prevalence of recent alcohol intake among suicide attempters and compared suicide attempts preceded (“Alcohol + “) or not by alcohol intake.

We included 160 patients examined in the emergency service of a French general hospital after a suicide attempt. Psychiatric disorders were identified according to the DSM-IV criteria. Patients were rated for depression and alcohol use disorder (MAST).

Prevalence of alcohol consumption was 40%.
Patients from the “Alcohol + ” group were significantly older (40 versus 34.8 years, p = 0.03).
Alcohol abuse was more frequent among suicide attempters with prior alcohol ingestion (49% versus 12%,).
Alcohol dependence was also more frequent in the “Alcohol + ” group (43% versus 9%).
Patients from the “Alcohol + ” group
drank more alcohol each day (6.1 versus 1.3 drinks) and
more often during the week (3.6 days per week versus 1.4). They had a
higher number of alcohol intoxications each week (0.9 versus 0.3). They
drank more often alone (41% versus 12%, p < 0.005) and in the
morning (21% versus 3%).
They had higher scores on the Michigan Alcohol Screening test (14.8 versus 2.9).
Prevalence of drug dependence was higher in the “Alcohol + ” group (21% versus 3%, respectively).

Suicide attempts must be asked about their recent alcohol intake. This alcohol intake is often the symptom of an alcohol abuse or dependence disorder.

Research report; Lejoyeux M, Huet F, Claudon M, Fichelle A, Casalino E, Lequen V. Characteristics of suicide attempts preceded by alcohol consumption. Arch Suicide Res 2008; 12(1): 30-8.

Brief Intervention

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 comorbiditiesâ€”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 alcoholismâ€”like cancer, atherosclerosis and other complex diseasesâ€”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):167â€“176.

Brief-TSF extends brief intervention to lifelong recovery.

Urge To Drink

Does Urge To Drink Predict Relapse After Treatment?

By Damaris J. Rohsenow, Ph.D., and Peter M. Monti, Ph.D.

The urge to drink, also often referred to as craving, is an emotional state in which a person is motivated to seek and use alcohol. In abstinent alcoholics, this urge may contribute to the risk of relapse.

Researchers have developed several models-including the

conditioned withdrawal model,
conditioned appetitive motivational model,
social learning model, and
information-processing model-to describe the role of urges in relapse.

Several studies have evaluated the role of urges in predicting alcoholism treatment outcome and relapse.

Some findings indicate that the degree of urge an alcoholic experiences when confronted with a simulated high-risk situation at the end of alcoholism treatment can predict subsequent drinking. Other studies, however, show inconsistent results regarding the role of urges in predicting treatment outcome.

Overall, the study results suggest that urges do not necessarily increase the risk of relapse but may actually protect some drinkers against further drinking.

Alcohol Research & Health Vol. 23, No. 3, 1999

Treating Chronic Pain in the Shadow of Addiction

Balancing the treatment of chronic pain and the risks of developing or exacerbating an addictive disorder is a medical challenge.

At times, it is necessary to prescribe opioid analgesia in a chronic pain patient who is at risk of addiction, or with an active addictive disorder. After conducting a comprehensive assessment of the patient and the reported pain, a strategic stepwise therapeutic approach is needed for improving care and containing risk.

This monograph addresses these issues, as well as assists clinicians in identifying aberrant behaviors suggestive of substance abuse or addiction. Recommendations are provided for treating chronic pain patients who present with or develop a de novo addictive disorder.

Free PDF file available online for download at:
http://www.emergingsolutionsinpain.com/images/pdf/casestudyeval/ziegler/monograph.pdf

By: Penelope P. Ziegler, MD, FASAM; from Emerging Solutions in Pain, 2007.

THE DRY DRUNK

A Hazard to the Non-drinking Alcoholic

When an alcoholic stops drinking, it’s cause for rejoicing.

Unfortunately, sobriety is not guaranteed to last. It takes hard work and commitment and a keen eye for dangers.

One danger to the non-drinking alcoholic is the dry drunk, a set of habits and attitudes that take the joy out of life for the alcoholic and those around him or her. Those habits often precede a relapse into drinking, even if the alcoholic has been sober for years.

A dry drunk can be successfully treated. Here are some signs that will help you recognize the condition, and some suggestions on how to cope with it.

Warning Signs

During their drinking years, alcoholics develop many abnormal attitudes and behaviors, which come with them into sobriety, and are characteristic of the dry drunk. Often, family members don’t recognize the symptoms of a dry drunk as anything unusual, since they have become so used to the abnormal behavior of the alcoholic.

Some typical signs of a dry drunk are:

acting self-important, either by â€œhaving all the answers,â€ or playing â€œpoor me.â€
making harsh judgments of oneself and others.
being impatient or pursuing whims.
blaming others for shortcomings one suspects in oneself.
being dishonest, usually beginning with little things.
impulsive behavior which ignores what’s best for oneself and others.
inability to make decisions.
mood swings, trouble with expressing emotions, feeling unsatisfied.
detachment, self-absorption, boredom, distraction or disorganization.
nostalgia for the drinking life.
fantasizing, daydreaming and wishful thinking or euphoria.
less participation in a 12-step program or dropping out altogether.

Cure

Talk to your sponsor, go to meetings, meditation, trust your Higher Power and don’t drink.

Falling Back: The Dry Drunk Syndrome Discussion Guide

AA attendance was best predictor of abstinence

AA attendance was best predictor of abstinence in a 60-year follow-up of alcoholic men

A classic study of alcohol abuse and alcoholism

This prospective follow-up study examined two community cohorts of adolescent males from 1940 until 2001. Two hundred and sixty-eight undergraduates and 456 non-delinquent, socially disadvantaged adolescents participated. Since adolescence, these cohorts have been followed by repeated interview, questionnaires, and physical examination. The college cohort has been followed until age 80 and the younger core city cohort until age 70. DSM-III criteria were used to ascertain alcohol abuse and alcohol dependence.

At some point during their lives, 54 (20%) of the college men and
140 (31%) of the core city men met criteria for alcohol abuse.

Outcome categories were mortality, continued alcohol abuse and stable remission.

These socially divergent cohorts resembled each other in four respects.

First, by age 70 chronic alcohol dependence was rare; this was due both to death and to stable abstinence. By age 70, 54% of the 72 successfully followed alcohol-dependent core city men had died, 32% were abstinent, 1% were controlled drinkers and only 12% were known to be still abusing alcohol. By age 70, 58% of the 19 successfully followed college alcohol-dependent men had died, 21% were abstinent, 10.5% were controlled drinkers and only 10.5% were known to be still abusing alcohol.
Secondly, in both samples alcohol abuse could persist for decades without remission, death or progression to dependence.