Screening for Alcohol Problems

Screening for Alcohol Problems in Primary Care; A Systematic Review.

Background; Primary care physicians can play a unique role in recognizing and treating patients with alcohol problems.

Objective; To evaluate the accuracy of screening methods for alcohol problems in primary care.

Methods; We performed a search of MEDLINE for years 1966 through 1998. We included studies that were in English, were performed in primary care, and reported the performance characteristics of screening methods for alcohol problems against a criterion standard. Two reviewers appraised all articles for methodological content and results.

Results; Thirty-eight studies were identified. Eleven screened for at-risk, hazardous, or harmful drinking; 27 screened for alcohol abuse and dependence. A variety of screening methods were evaluated.

The Alcohol Use Disorders Identification Test (AUDIT) was most effective in identifying subjects with at-risk, hazardous, or harmful drinking (sensitivity, 51%-97%; specificity, 78%-96%),

while the CAGE questions proved superior for detecting alcohol abuse and dependence (sensitivity, 43%-94%; specificity, 70%-97%).

These 2 formal screening instruments consistently performed better than other methods, including quantity-frequency questions. The studies inconsistently adhered to methodological standards for diagnostic test research: 3 (8%) provided a full description of patient spectrum (demographics and comorbidity), 30 (79%) avoided workup bias, 12 (of 34 studies [35%]) avoided review bias, and 21 (55%) performed an analysis in pertinent clinical subgroups.

Conclusions; Despite methodological limitations, the literature supports the use of formal screening instruments over other clinical measures to increase the recognition of alcohol problems in primary care. Future research in this field will benefit from increased adherence to methodological standards for diagnostic tests.

Research report; David A. Fiellin; M. Carrington Reid, MD; Patrick G. O’Connor. Screening for Alcohol Problems in Primary Care; A Systematic Review. Arch Intern Med. 2000;160.

Brief-TSF uses the CAGE and the AUDIT to identify alcohol use disorders.

Prevention of relapse in the recovery of Arizona health care providers

This project gathered survey information from physicians, physician assistants, dentists and pharmacists in Arizona who, while enrolled or following a completion of a monitored aftercare program, had relapsed back to active chemical dependency.

In general, survey respondents were male, averaged 52 years of age, had relapsed several times and started abusing illicit drugs and alcohol in high school or college.

The findings suggest several subjective factors that contributed to the subjects’ relapse included;

dishonesty to self,
not working a 12 step program, and
denial of the problem.

Factors reported to be helpful for future relapse prevention were

abstinence from substance use,
working a 12 step program, and
having spiritual beliefs.

By identifying the specific causes of relapse, future studies may attempt to decrease the percentage of health care providers who relapse by recognizing signs of problematic behavior before they occur.

Long MW, Cassidy BA, Sucher M, Stoehr JD. Prevention of relapse in the recovery of Arizona health care providers. J Addict Dis. 2006;25(1):65-72.

A Sponsorship Guide for 12-Step Programs
by M. T.

Alcoholics Anonymous and church involvement

Alcoholics Anonymous and church involvement as predictors of sobriety among three ethnic treatment populations

This study examines the impact of spirituality and religiousness, and involvement in Alcoholics Anonymous (AA) on sobriety among three ethnic groups, African Americans, Caucasians, and Hispanics.

Participants (African Americans: n = 253; Hispanics: n = 60, and Caucasians: n = 538) completed survey questionnaires upon entry into public, private, and health maintenance treatment programs.

Results indicated that among the three groups, African Americans, who described themselves as more religious, were less likely to substitute church attendance for participation in Alcoholics Anonymous.

African Americans reporting high AA attendance at the end of one year, in addition to church attendance, were more likely to report sobriety over the past 30 days than were those African Americans reporting only high church attendance.

Among Caucasians and Hispanics, participants reporting primarily high AA attendance were more likely to report past 30 day sobriety.

Research report; Roland, E.J.; Kaskutas, L.A. Alcoholics anonymous and church involvement as predictors of sobriety among three ethnic treatment populations. Alcoholism Treatment Quarterly, 20(1):61-77, 2002.

Drinking and Harm Continuum in Britain

Patterns of Alcohol Consumption and Related Behaviour in Great Britain:

A Latent Class Analysis of the Alcohol Use Disorder Identification Test (AUDIT).

AIMS: Attempts have been made to develop typologies to classify different types of alcoholism. However, limited research has focused on classifications to describe general patterns of alcohol use in general population samples.

METHODS: Latent class analysis was used to create empirically derived behaviour clusters of alcohol consumption and related problems from the Alcohol Use Disorder Identification Test (AUDIT) based on data from a large stratified multi-stage random sample of the population of Great Britain. Multinomial logistic regression was performed to describe these resultant classes using both demographic variables and mental health outcomes.

RESULTS: Six classes best described responses in the sample data.

Three were heavy consumption groups,

one with multiple negative consequences,
one experiencing alcohol-related injury and social pressures to cut down and
an additional class with memory loss.

There was one moderate class with few negative consequences.
There were two mild consumption groups,

one with alcohol-related injury and social pressure to cut down and
one with no associated problems.

CONCLUSIONS: Alcohol use in Great Britain can be hypothesized as reflecting six distinct classes, four of which follow a continuum of increased consumption leading to increased dependence and related problems and two that do not.

Differences between alcohol use classes are apparent with;

reduced risk of depressive episode in moderate classes and
an increased risk of anxiety disorders for the highest consumers of alcohol.

Research report; Alcohol Alcohol. 2008 May 22; Patterns of Alcohol Consumption and Related Behaviour in Great Britain: A Latent Class Analysis of the Alcohol Use Disorder Identification Test (AUDIT). Smith GW, Shevlin M.

Dual Disorders, Dual Diagnosis

Dual Disorders – Third Edition

Depression. Schizophrenia. Post-traumatic stress disorder. Bipolar disorder.

Millions of individuals diagnosed with psychiatric or emotional disorders must battle an equally menacing and powerful disease–chemical dependency–alcoholism, drug addiction, medication addiction.

First published in 1993, Dual Disorders is the leading text on the biological and psychological relationship between mental illness and addiction.

The third edition of this Hazelden best-seller has been updated to include the latest research, information about new medications, and an explanation of new diagnostic criteria.

Key features and benefits

outlines the relationship between chemical dependency and psychiatric disorders

contains important resources for chemically dependent individuals and their families

presents practical relapse prevention strategies

pharmacotherapy

Dual Disorders – Buy 3rd Ed today!

Lesbian Alcoholics were Unloved

Lesbian Alcoholics were Unloved, Unwanted and Alcoholic had Parents; Social Supports and Lesbian Alcoholics

The purpose of this study was to investigate the relationship between social support and alcoholism among lesbians.

Fifteen lesbian alcoholics and 15 lesbian non-alcoholics were administered a questionnaire covering their childhood and adolescent history, social support systems, history of drinking, and demographic information.

The findings suggested that the alcoholic lesbiansâ€™ current support systems were not as disrupted as had been anticipated.

However, the alcoholic lesbians more often reported;

having had a less supportive childhood and adolescence,
feeling unloved and unwanted,
experiencing conflict with adults in their families, and
having had a parent with a drinking problem.

Social Supports and Lesbian Alcoholics. Rebecca Schilit, W. Mark Clark, and Elizabeth Ann Shallenberger. Affilia 1988; 3; 27.

Alcohol intervention may help.

Spirituality Enables Adaptive Coping

Spirituality religiosity promotes acceptance based responding and 12-step involvement.

BACKGROUND: Previous investigations have observed that spirituality/religiosity (S/R) is associated with enhanced 12-step involvement. However, relatively few studies have attempted to examine the mechanisms for this effect. For the present investigation, we examined whether acceptance-based responding (ABR) – awareness or acknowledgement of internal experiences that allows one to consider and perform potentially adaptive responses – accounted for the effect of S/R on 12-step self-help group involvement 2 years after a treatment episode.

METHODS: Data were collected as part of a multi-site treatment outcome study with 3698 substance-dependent male veterans recruited at baseline. Assessments were conducted at baseline, discharge, 1-year follow-up, and 2-year follow-up. We utilized structural equation modeling to examine the relationships among latent variables of S/R, ABR, and 12-step involvement over time.

RESULTS: In the final model, S/R was not directly related to 12-step involvement at 2-year follow-up. However, S/R predicted enhanced ABR at 1-year follow-up after accounting for discharge levels of ABR. In turn, ABR at 1-year follow-up predicted increased 12-step involvement at 2-year follow-up after accounting for discharge levels of 12-step involvement.

CONCLUSIONS: S/R promotes the use of post-treatment self-regulation skills that, in turn, directly contribute to ongoing 12-step self-help group involvement.

Research report; Carrico AW, Gifford EV, Moos RH. Spirituality religiosity promotes acceptance based responding and 12-step involvement Drug Alcohol Depend. 2007 Jun 15;89(1):66-73.

Conversations with God : An Uncommon Dialogue (Book 1)

Mutual-help Helps

A 3-year study of addiction mutual-help group participation following intensive outpatient treatment

BACKGROUND: Addiction-focused mutual-help group participation is associated with better substance use disorder (SUD) treatment outcomes. However, little has been documented regarding which types of mutual-help organizations patients attend, what levels of participation may be beneficial, and which patients, in particular, are more or less likely to participate.

Furthermore, much of the evidence supporting the use of these organizations comes from studies examining participation and outcomes concurrently, raising doubts about cause-effect connections, and little is known about influences that may moderate the degree of any general benefit.

METHOD: Alcohol-dependent outpatients (N=227; 27% female; Mean age=42) enrolled in a randomized-controlled telephone case monitoring trial were assessed at treatment intake and at 1, 2, and 3 years post discharge.

Lagged-panel, hierarchical linear models tested whether mutual-help group participation in the first and second year following treatment predicted subsequent outcomes and whether these effects were moderated by gender, concurrent axis I diagnosis, religious preference, and prior mutual-help experience.

Robust regression curve analysis was used to examine dose-response relationships between mutual-help and outcomes.

RESULTS: Mutual-help participation was associated with both greater abstinence and fewer drinks per drinking day and this relationship was not found to be influenced by gender, Axis I diagnosis, religious preference, or prior mutual-help participation.

Mutual-help participants attended predominantly Alcoholics Anonymous and tended to be Caucasian, be more educated, have prior mutual-help experience, and have more severe alcohol involvement.

Dose-response curve analyses suggested that even small amounts of participation may be helpful in increasing abstinence, whereas higher doses may be needed to reduce relapse intensity.

CONCLUSIONS: Use of mutual-help groups following intensive outpatient SUD treatment appears to be beneficial for many different types of patients and even modest levels of participation may be helpful.

Future emphasis should be placed on ways to engage individuals with these cost-effective resources over time and to gather and disseminate evidence regarding additional mutual-help organizations.

Kelly JF, Stout R, Zywiak W, Schneider R. A 3-year study of addiction mutual-help group participation following intensive outpatient treatment. Alcohol Clin Exp Res. 2006 Aug;30(8):1381-92.

Brief-TSF is designed to engage alcoholics in supportive therapy while attending Alcoholics Anonymous.

Alcoholics Anonymous with Narcotics Anonymous success in England

Alcoholics Anonymous with Narcotics Anonymous success in England

AIMS: This study investigates the relationship between frequency of attendance at Narcotics Anonymous and Alcoholics Anonymous (NA/AA) meetings and substance use outcomes after residential treatment of drug dependence.

It was predicted that post-treatment NA/AA attendance would be related to improved substance use outcomes.

METHODS: Using a longitudinal, prospective cohort design, interviews were conducted with drug-dependent clients (n = 142) at intake to residential treatment, and at 1 year, 2 years and 4-5 years follow-up.

Data were collected by structured interviews. All follow-up interviews were carried out by independent professional interviewers.

FINDINGS: Abstinence from opiates was increased throughout the 5-year follow-up period compared to pre-treatment levels.

Clients who attended NA/AA after treatment were more likely to be abstinent from opiates at follow-up.

Abstinence from stimulants increased at follow-up but (except at 1-year follow-up) no additional benefit was found for NA/AA attendance.

There was no overall change in alcohol abstinence after treatment but clients who attended NA/AA were more likely to be abstinent from alcohol at all follow-up points.

More frequent NA/AA attenders were more likely to be abstinent from opiates and alcohol when compared both to non-attenders and to infrequent (less than weekly) attenders.

CONCLUSIONS: NA/AA can support and supplement residential addiction treatment as an aftercare resource.

In view of the generally poor alcohol use outcomes achieved by drug-dependent patients after treatment, the improved alcohol outcomes of NA/AA attenders suggests that the effectiveness of existing treatment services may be improved by initiatives that lead to increased involvement and engagement with such groups.

Gossop M, Stewart D, Marsden J. Addiction. 2008 Jan;103(1):119-25. Epub 2007 Nov 20. Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study.

Cognitive Functions and Social Disability in Alcoholics

Objective: The aim of this study was to evaluate the impact of chronic alcoholism on cognitive functions and social disability.

Method: Forty-one chronic alcoholic men and forty control subjects of comparable age and forty control subjects of comparable age and education level were evaluated. The patients received the neuropsychological tests and social disability scale after a 3 week period of abstinence. Each subject was given an extensive battery of neuropsychological tests assessing language skills, attention, memory and cognitive functions related to frontal regions of brain. Two groups were compared regarding the results of Wisconsin Card Sorting Test (WCST), Line Orientation Test (LOT), Visual Auditory Digit Span Test (VADST), Stroop Test, Mini Mental State Examination, and Hamilton Depression Scale. Social disability level was determined by the administration of the Short Form General Health Survey of Medical Outcome Study (SF-MOS). The symptoms and the symptom severity of alcohol dependent patients were evaluated by using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN), a semi-structured instrument for clinical interview and symptom rating.

Results: Alcoholic patients showed a significant impairment on auditory part of VADST. Similarly LOT results were significantly different between alcoholics and control group. The following WCST subscores were statistically different between the two groups: Total answer, total error, total perseverative responses, perseverative errors, percent of perseverative errors, nonperseverative errors, number of categories completed, and conceptual responses. Stroop Test results showed no statistical difference between the two groups. Social disability scores were significantly higher in alcoholic patients compared with the control group. 63.42% of the forty-one patients, had severe disability. Statistical analysis failed to show any significant correlation between the neuropsychological test results and disability scores.

Conclusion:

Alcohol dependent patients displayed significant neurocognitive impairment and high levels of social disability compared with healthy controls.

Social disability levels did not appear to be correlated with neurocognitive dysfunction.

Research report; Cognitive Functions and Social Disability in Alcohol Dependency. Dr. Sibel MERCAN, Dr. Berna ULU?, Dr. Ahmet GÃ–?Ãœ?. Turkish J of Psychiatry, 1999; 10(1): 3-12