Self-help for substance-use disorders: history, effectiveness, knowledge gaps, and research opportunities

Scientific evidence suggests substance-use disorder (SUD)-focused self-help group involvement is a helpful adjunct to SUD treatment, yet significant knowledge gaps remain.

The principal aim of this review is to highlight areas of knowledge deficit and their implications for research and practice. To accomplish this, evidence regarding whether self-help group involvement is effective, for whom, and why, is reviewed.

The appropriateness of self-help groups for certain subpopulations is considered with respect to

• psychiatric comorbidity,
• religious orientation,
• gender, and
• age.

Results;

• An increasingly rigorous body of evidence suggests consistent benefits of self-help group involvement.
• Regarding subpopulations, current evidence suggests non- or less-religious individuals benefit as much from self-help groups as more religious individuals and
• women become as involved and benefit as much as men.
• However, participation in, and effects from, traditional self-help groups for dually diagnosed patients may be moderated by type of psychiatric comorbidity.
• Some youth appear to benefit, but remain largely unstudied.
• Dropout and nonattendance rates are high, despite clinical recommendations to attend.

Clinicians can significantly influence the effectiveness of self-help, but optimal methods and duration of facilitation efforts need testing.

Greater understanding of the reasons why many do not attend or drop out would benefit facilitation efforts.

Self-help for substance-use disorders: history, effectiveness, knowledge gaps, and research opportunities. Clinical Psychology Review, Volume 23, Issue 5, October 2003, Pages 639-663. John F. Kelly

See also;

• Brief-TSF is designed to address these issues.
• What About This Spiritual Awakening Thing?

The Twelve-Step Facilitation Handbook: A Systematic Approach to Early Recovery from Alcoholism and Addiction by Joseph Nowinski, Stuart Baker Read more about this title…

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Under diagnosis of alcohol misuse in the older adult population

Alcohol abuse in older adults is common, yet it is often under detected and misdiagnosed, and as a result associated with considerable morbidity.

There is growing concern that as the population ages, there will be a substantial increase in the number of older adults needing treatment for alcohol misuse and currently, little is done to identify and address this situation.

Factors contributing to under diagnosis include, but are not limited to,

• depression,
• dementia,
• physical changes associated with age,
• life events,
• late onset of alcoholism and
• lack of screening.

A case report is presented and existing research findings are discussed in the article cited below.

• The importance of assessment,
• the use of screening tools,
• treatment issues and
• identification of other comorbidities are presented.

The focus on increased awareness among clinicians as well as their role in identifying and addressing alcohol abuse issues in the older adult population is explored.

Loukissa D. Under diagnosis of alcohol misuse in the older adult population Br J Nurs. 2007 Nov 8-21;16(20):1254-8.

Brief-TSF can assist patients cease alcohol consumption.

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Research Summary; Women and men appear to have different genetic and environmental risk factors for alcoholism, Reuters reported Jan. 24/2006.

A quartet of new family studies on alcoholism show, for example, that while both sexes are more likely to develop alcoholism if they have a history of aggressive behavior in childhood, women who experienced severe physical punishment in childhood were also at elevated risk, while men were not.

“Clearly, there are some common antecedents (to alcoholism), such as conduct disorder or symptoms, but there are also predictors unique to each gender,” said researcher Aruna Gogineni of the Johns Hopkins University School of Medicine. “These are the kinds of findings that call out for many more studies on women in order to determine how the mechanisms of alcoholic parental risk may differ in men and women.”

Researchers affirmed that children of alcoholics were generally more likely to have alcohol problems themselves, but said that genetic makeup may be more important for men, while environmental factors may have more of an impact on women. For example, one study comparing children of biological and adopted parents with alcoholism found that male children of alcoholics related by blood were more likely to be alcoholics themselves.

The research appears in the February 2006 issue of the journal Alcoholism: Clinical & Experimental Research.

From; Join Together Online

See also;

• 12-Step Treatment More Effective than Alternative
• Twelve Step Facilitation
• Brief-TSF can assist patients cease alcohol consumption.
• Subscribe to BriefTSF by e-Mail

Understanding and Counseling: Persons With Alcohol, Drug, and Behavioral Addictions : Counseling for Recovery and Prevention Using Psychology and Religion by Howard Clinebell Read more about this title…

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Impact of parental history of substance use disorders on the clinical course of anxiety disorders.

Abstract; Background Among the psychological difficulties seen in children of parents with substance use problems, the anxiety disorders are among the most chronic conditions.

Although children of alcoholic parents often struggle with the effects of parental substance use problems long into adulthood, empirical investigations of the influence of parental substance use disorders on the course of anxiety disorders in adult offspring are rare.

The purpose of this study was to examine prospectively the relationship between parental substance use disorders and the course of anxiety disorders in adulthood over the course of 12 years.

Methods; Data on 618 subjects were derived from the Harvard/Brown Anxiety Research Project (HARP), a longitudinal naturalistic investigation of the clinical course of multiple anxiety disorders. Kaplan-Meier survival estimates were used to calculate probabilities of time to anxiety disorder remission and relapse. Proportional hazards regressions were conducted to determine whether the likelihood of remission and relapse for specific anxiety disorders was lower for those who had a history of parental substance use disorders than for individuals without this parental history.

Results; Adults with a history of parental substance use disorders were significantly more likely to be divorced and to have a high school level of education.

History of parental substance use disorder was a significant predictor of relapse of social phobia and panic disorders.

Conclusions; These findings provide compelling evidence that adult children of parents with substance use disorders are more likely to have relapses of social phobia and panic disorders.

Clinicians who treat adults with anxiety disorders should assess parental substance use disorders and dependence histories. Such information may facilitate treatment planning with regards to their patients’ level of vulnerability to perceive scrutiny by others in social situations, and ability to maintain a long-term panic-free state.

Research; Impact of parental history of substance use disorders on the clinical course of anxiety disorders. Maria E. Pagano, Richard Rende, Benjamin F. Rodriguez, Eric L. Hargraves, Amanda T. Moskowitz, & Martin B. Keller. Substance Abuse Treatment, Prevention, and Policy 2007, 2:13

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A cohort study of male subjects attending an Alcoholics Anonymous program in India: One-year follow-up for sobriety.

A cohort of subjects in India who completed detoxification treatment and a de-addiction program based on the Alcoholics Anonymous (AA) model were followed-up at 1 year to investigate the factors associated with complete abstinence.

Patients (N = 187 men) who were admitted consecutively to an addiction facility and fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for alcohol dependence were recruited for the study.

Patients with major psychopathology were excluded. The final outcome at 1 year was determined by visiting the patients and talking to the families and members of the local AA group.

Of the 187 men initially recruited, 5 were excluded because of major psychopathology, 1 committed suicide, and 7 could not be traced.

Of the 174 patients available for follow-up, 58 (33.3%) remained sober (complete abstinence for the past year) at 1 year.

Patients coming from distant places and those with follow-up workers in their localities fared better than those from the local area and those from towns where there was no one to motivate them to continue with AA meetings.

These variables were significantly associated with sobriety even after adjustment for other confounders using multivariate techniques. A third of the cohort remained sober at 1-year follow-up.

The patients’ initial motivation and continued support once they returned to their communities were associated with sobriety at follow-up.

Research report; Kuruvilla PK; Vijayakumar N; Jacob KS. A cohort study of male subjects attending an Alcoholics Anonymous program in India: One-year follow-up for sobriety. Journal of Studies on Alcohol 65(4):546-549, July 2004.

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Adolescents’ participation in Alcoholics Anonymous and Narcotics Anonymous: review, implications and future directions.

Youth treatment programs frequently employ 12-Step concepts and encourage participation in Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).

Since AA/NA groups are easily accessible at no charge and provide flexible support at times of high relapse risk they hold promise as a treatment adjunct in an increasingly cost-constricting economic climate.

Yet, due to concerns related to adolescents’ developmental status, skepticism exists regarding the utility of AA/NA for youth.

This review evaluates the empirical evidence in this regard, identifies and discusses knowledge gaps, and recommends areas for future research.

Findings suggest youth may benefit from AA/NA participation following treatment, but conclusions are limited by four important factors:

• a small number of studies;
• no studies with outpatients;
• existing evidence is solely observational; and
• only partial measurement of the 12-Step construct.

While surveys of adolescent SUD treatment programs indicate widespread clinical interest and application of adult-derived 12-Step approaches this level of enthusiasm has not been reflected in the research community.

Qualitative research is needed to improve our understanding of youth-specific AA/NA barriers, and efficacy, comparative effectiveness, and process studies are still needed to inform clinical practice guidelines for youth providers.

Research; Kelly JF, Myers MG. Adolescents’ participation in Alcoholics Anonymous and Narcotics Anonymous: review, implications and future directions. J Psychoactive Drugs. 2007 Sep;39(3):259-69.

See also;

• Brief-TSF is designed to address these issues.
• Twelve Step Facilitation

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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 comorbidities—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 alcoholism—like cancer, atherosclerosis and other complex diseases—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):167–176.

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Female drinkers lose brain volume more quickly than men, according to researchers at the University of Heidelberg in Germany.

The BBC reported May 15 that researchers took CT scans of 150 women — about half of them alcoholics — and found that the heavy drinkers have smaller brains.

Female alcoholics were found to lose the same brain volume as male alcoholics, but suffered atrophy much more quickly.

“Women typically start drinking later in life, consume less … and one could reason that women are less affected by alcohol,” said lead study author Karl Mann. “But there is evidence for a faster progress of the events leading to dependence among female alcoholics and an earlier onset of adverse consequences of alcoholism. This suggests that women may be more vulnerable to chronic alcohol consumption.”

The findings were reported in the journal Alcoholism: Clinical and Epidemiological Research.

Mann, K., Ackermann, K., Croissant, B., Mundle, G., Nakovics, H., & Diehl, A. (2005) Neuroimaging of Gender Differences in Alcohol Dependence: Are Women More Vulnerable? Alcoholism: Clinical and Epidemiological Research, 29(5): 896-901.

From; Jointogether

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One cannabis joint is as bad as five cigarettes

RESEARCH CONFIRMS CANNABIS POSES SERIOUS HEALTH RISK TO LUNGS

The British Lung Foundation welcomes research published in the journal Thorax highlighting the dangers cannabis poses to the lungs.

“This research confirms that cannabis poses a serious health risk to the lungs and smoking a joint can be more harmful to the lungs than smoking a cigarette”, says Dr Keith Prowse, Chairman of the British Lung Foundation. “It’s important to remember, though, that tobacco continues to be more harmful overall because it is typically smoked in much higher quantities than cannabis.”

One of the reasons a cannabis joint can be more dangerous than a cigarette is that people tend to inhale the smoke more deeply as well as then holding it in for longer.

Reuters reported that smoking one cannabis joint is as harmful to a person’s lungs as having up to five cigarettes, according to research published on Tuesday.

Those who smoked cannabis damaged both the lungs’ small fine airways, used for transporting oxygen, and the large airways, which blocked air flow, the researchers said.

It meant cannabis smokers complained of wheezing, coughing, and chest tightness, the study by experts at the Medical Research Institute of New Zealand found.

The study found only those who smoked tobacco suffered from the crippling lung disease emphysema, but cannabis use stopped the lungs working properly.

"The extent of this damage was directly related to the number of joints smoked, with higher consumption linked to greater incapacity," said the authors of the report published in the medical journal Thorax.

"The effect on the lungs of each joint was equivalent to smoking between 2.5 and five cigarettes in one go."

“The danger cannabis poses to respiratory health is consistently being overlooked,” says Dame Helena Shovelton, Chief Executive of the British Lung Foundation. “Smoking a joint is more harmful to the lungs than smoking a cigarette and we have just banned people from doing that in public places because of the health risks.”

In a 2002 report, the British Lung Foundation estimated that three to four cannabis cigarettes a day were associated with the same amount of damage to the lungs as 20 or more tobacco cigarettes a day. The British Lung Foundation also called for more awareness of the issue.

The BLF are calling for:

• A public health campaign to make young people fully aware about the increased risk of lung infections and respiratory cancers
• Further research into potential links between cannabis smoking and Chronic Obstructive Pulmonary Disease (COPD) – an umbrella term for conditions including emphysema and chronic bronchitis.

Research; Sarah Aldington, Mathew Williams, Mike Nowitz, Mark Weatherall, Alison Pritchard, Amanda McNaughton, Geoffrey Robinson and Richard Beasley. THE EFFECTS OF CANNABIS ON PULMONARY STRUCTURE, FUNCTION AND SYMPTOMS. Thorax, July 2007.

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Gender, treatment and self-help in remission from alcohol use disorders.

OBJECTIVES: To examine gender differences in the influence of treatment, self-help groups and life context and coping factors on remission among initially untreated individuals with alcohol use disorders.

DESIGN: A naturalistic study in which individuals were assessed at baseline and 1, 8 and 16 years later.

SETTING: Participants initiated help-seeking with the alcoholism service system by contacting an information and referral service or detoxification program.

PARTICIPANTS: A total of 461 individuals with alcohol use disorders (50% women).

METHODS: Participants were assessed by mail surveys and telephone interviews on

• participation in professional treatment and
• Alcoholics Anonymous (AA),
• alcohol-related functioning and
• indices of life context and coping.

RESULTS: Compared to men, women were more likely to participate in treatment and AA, and to experience better alcohol-related and life context outcomes.

In general, women and men who participated in treatment and/or AA for a longer duration were more likely to achieve remission.

However, women benefited somewhat more than men from extended participation in AA.

Continuing depression and reliance on avoidance coping were more closely associated with lack of remission among men than among women.

CONCLUSION: Compared to men, women with alcohol use disorders were more likely to obtain help and achieve remission.

Women tended to benefit more from continued participation in AA and showed greater reductions in depression and avoidance coping than men did.

These findings identify specific targets for clinical interventions that appear to be especially beneficial for women and that may also enhance the likelihood of recovery among men.

Research; Moos RH, Moos BS, Timko C. Gender, treatment and self-help in remission from alcohol use disorders. Clin Med Res. 2006 Sep;4(3):163-74.

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