Students with a dense family history of alcoholism are most at risk of alcohol-use disorders

This study looks at first-, second- and third-degree relatives instead of just one parent, usually paternal

Not all university students will “mature out” of their heavy-drinking habits.

A new study examines the density of college students’ family history of alcoholism.

This type of measure – looking at first-, second- and third-degree relatives – identified a significant number of at-risk individuals who would have been missed using regular family-history measures.

While many university students tend to “mature out” of heavy-drinking behavior by the time they become young adults, some go on to develop alcohol-use disorders (AUDs). Most genetic research on an individual’s family history of alcoholism (FHA) has looked at the parents’ – usually paternal – alcohol use. New findings indicate that looking at the density of FHA – including first-, second- and third-degree relatives – is much more telling.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research.

“Using a density measure of FHA can identify a greater number of individuals who may be at risk for developing an alcohol problem,” said Christy Capone. “The greater number of affected relatives … the greater the potential risk of developing an AUD. Ours is the first published study to examine this measure among college students.”

“Family density appears to be a promising method to identify a higher percentage of at-risk individuals,” agreed John Hustad, research associate at Brown University. “For example, in this study, approximately 44 percent of the at-risk participants would have been missed if a typical family-history measure had been used instead of the family-history density approach.”

The study population for this research consisted of 408 undergraduate students (293 females, 115 males) from a northeastern U.S. university who were asked to complete an anonymous survey for course credit during the 2005-2006 academic year.

“Our use of a density measure identified a large proportion of students, about 29 percent, who are at potentially greater risk for development of AUDs based on their report of alcoholism among first- and second-degree relatives,” said Capone. “Our other key finding was the relationship between FHA and other potential risk factors – behavioral undercontrol, age of onset of drinking (AOD), and cigarette use.”

All of these risks factors are inter-related, added Hustad. “First, family-history density was related to AOD, behavioral undercontrol, and current cigarette use which, in turn, are related to alcohol use and/or alcohol-related problems in this sample of college students. Second, behavioral undercontrol was associated with alcohol problems but not the degree of alcohol consumption; this suggests that individuals with a family-history density of AUDs and behavioral undercontrol are more likely to behave irresponsibly when drinking.”

“The importance of identifying these risk factors is the idea that they can be useful markers of at-risk status and can help us to develop appropriate intervention strategies,” said Capone. “Although, given the fact that many students come to college already having experience with alcohol, I believe that preventive interventions should begin early in the high-school years or during the transition from middle school to high school.”

Hustad agreed. “Due to the relationship between earlier AOD and more alcohol-related problems during college, it is clear that education and prevention efforts should begin well before the college years,” he said. “Until that happens, the risk factors identified in this research can be easily implemented in any screening and brief intervention for incoming college students. For example, these results suggest that effective interventions addressing tobacco use may have a positive influence on both smoking and alcohol-related consequences.”

“It is important to remember that not everyone with density of familial alcoholism will go on to develop a long-term problem with alcohol themselves,” said Capone. “Alcohol dependence is a very complex disorder and FHA is but one influence on its development. However, college students who are heavy drinkers and have a greater density of familial alcoholism are certainly at higher risk of continuing to drink in a problematic fashion after the college years.”

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• AA Offers Recovery Not Religion
• Twelve Step Facilitation
• Subscribe to BriefTSF by e-Mail

Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism by AA Services Read more about this title…

Predictors of 4 year outcome of community residential treatment for patients with substance use disorders.

Aims This study examined systematically how predictors of substance use disorder (SUD) treatment outcome worked together over time and identified mediators and moderators of outcome.

Design The MacArthur model was applied in this naturalistic study to identify how baseline, discharge and 1-year follow-up factors worked together to predict 4-year improvement in substance-related problems.

Setting Eighty-eight community residential facilities were selected based on geographic representativeness, number of patient referrals and type of treatment orientation.

Participants Of 2796 male patients who completed intake assessments, 2324 were assessed at the 1-year follow-up and 2023 at the 4-year follow-up.

Measurements Self-report measures of

• symptom severity,
• functioning,
• social resources and coping,
• treatment and
• involvement in Alcoholics Anonymous (AA) were collected at baseline and at 1- and 4-year follow-ups.

Provider-rated treatment participation measures were obtained at discharge.

Findings

• Greater substance use severity,
• more psychiatric symptoms,
• more prior arrests and
• stronger belief in AA-related philosophy at treatment entry

predicted improvement significantly in substance-related problems 4 years later.

At the 1-year follow-up,

• being employed and
• greater use of AA-related coping
• predicted outcome significantly.

AA-related coping at 1 year mediated the relationship partially between belief in AA philosophy at treatment entry and 4-year outcome.

Conclusions

The findings highlight the unique and positive impact of AA involvement on long-term SUD treatment outcome and extend understanding of why AA is beneficial for patients.

Research report; Predictors of 4 year outcome of community residential treatment for patients with substance use disorders. Addiction. 2008 Apr;103(4):671-80. Laffaye C, McKellar JD, Ilgen MA, Moos RH.

See also;

• Brief-TSF is designed to as adjunctive therapy for anti-craving medication.
• Twelve Step Facilitation

This study analyzed the Alcoholics Anonymous (AA) participation of 55 patients during the 3 months after their discharge from structured treatment, when dropout is high.

Three levels of meeting attendance were discerned:

• low,
• mid-level, and
• “90 meetings in 90 days.”

Of greatest interest, the mid-level group showed mixed interest in AA practices despite substantial meeting attendance, that is,

• they admitted powerlessness over alcohol, but had less enthusiasm for the higher power concept, and relapsed significantly;
• they were likely to have a sponsor, but were less involved with other AA members; and
• they reported working the 12 Steps, but were less interested in the AA literature.

Findings suggest that individuals who are attending AA but having difficulty embracing key aspects of the program need professional assistance that focuses more on AA practices and tenets and meeting attendance.

Barriers to affiliation can also serve as opportunities for furthering both counselling goals and affiliation.

Research; Paul Elliott Caldwell and Henry S.G. Cutter. Journal of Substance Abuse Treatment. Volume 15, Issue 3, May-June 1998, Pages 221-228

• See also:
• Twelve Step Facilitation
• Brief-TSF Description
• AA and Treatment Work Better Together
• Alcohol Related Brain Injury
• THE TWELVE REWARDS OF RECOVERY

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.

See also;

• Twelve Step Facilitation is designed to support people returning to their community
• Brief-TSF professional training is complimentary to all these courses.

Due to their high prevalence in the general population, alcohol use and abuse can be associated with hepatitis B and C virus infections and it has been demonstrated that alcohol plays a role as a co-morbid factor in the development of liver disease.

There is evidence that alcohol abuse accelerates the progression of liver fibrosis and affects the survival of patients with chronic hepatitis C. The mechanism by which alcohol worsens hepatitis C virus-related liver disease has not been fully clarified, but enhanced viral replication, increased oxidative stress, cytotoxicity and impairment of immune response could play a relevant role.

Alcohol abuse also seems to reduce both sensitivity to interferon and adherence to treatment.

It sounds reasonable to presume that the mechanisms enhancing liver damage in patients affected by hepatitis B are similar to those involved in hepatitis C virus infection.

However, more studies are warranted to improve our knowledge about the interaction between alcohol intake and hepatitis B virus infection.

In conclusion alcohol abuse is associated with an accelerated progression of liver injury, leading to an earlier development of cirrhosis, higher incidence of hepatocellular carcinoma, and higher mortality.

Abstinence from alcohol could reverse some of these deleterious effects.

Research report; Gitto S, Micco L, Conti F, Andreone P, Bernardi M. Alcohol and viral hepatitis: a mini-review. Dig Liver Dis. 2009 Jan;41(1):67-70. Epub 2008 Jul 3.

See also;

• Helping an Alcoholic is Possible in Right Circumstances
• Hep C Factsheet
• Hepatitis B
• If you have healthcare training this manual may help.

The Alcoholic

• 12-Step Recovery Theory And Application
• AA And Al-Anon
• AA And The Disease Concept Of Alcoholism
• Adolescent Children Of Alcoholics
• Al-Anon Offers New Life
• Alcohol Consumption In Patients Pancreatitis
• Alcohol Metabolization
• Alcohol Related Brain Injury
• Alcoholic Brain Damage And Thiamine
• Alcoholic Jealousy
• Alcoholics Anonymous
• Alcoholics Can Benefit From Al-Anon
• Alcoholism And Personality Disorders
• Alcoholism Is Also Genetic
• Alcoholism Myths
• Anti-Craving Naltrexone Injection Reduce
• Benefits Of Alcoholics Anonymous
• Beyond Codependency
• Brief-TSF Description
• Children With Alcohol Dependent Fathers
• Counselor Characteristics
• Craving Reduction
• Effective Professional Interventions
• Effects Of Gambling Addiction
• Free Inhalant Abuse Education
• Just For Today Card
• Mindfulness Can Help Recovery
• Prescription Drug Overdose Becomes Big Killer
• Process Of Recovery For Alcoholic Women
• Research Evidence For TSF  .
• Return To Drinking After Liver Transplantation For Alcoholic Liver Disease
• Role Of Significant Others
• Screening Can Decrease Teen Risk Behaviour
• Sleep Problems Affect Alcoholism Recover
• Spirituality And Helping In Alcoholics Anonymous
• Strategies For Dealing With Common Problems
• Strategies For Dealing With Denial
• Sweet Tooth And Alcoholism
• Symptoms Of Alcoholism
• Teen Drinking Leads To Risk Of Alcoholism And Social Exclusion
• The Aging Alcoholic
• The Classification Of Alcoholics
• The Dry Drunk
• Thyroid Function In Depression And Alcohol Abuse
• TSF Description
• Twelve Step Recovery Is Spiritual
• Twelve Steps To Recovery From Burnout
• What About Partners Of Alcoholics?

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An empowerment process: successful recovery from alcohol dependence.

Aims. The purpose of this study was to explore the concepts and processes for successful abstinence from alcohol for Taiwanese Alcoholics Anonymous members.

Background. Attempting to identify the psychological and social influences upon alcohol consumption remission outside of alcoholism treatment could help professionals to engage in a broad array of community interventions in an informed fashion. Methods. Grounded theory method was utilized in this study. The study chose nine participants who had succeeded in abstinence, using theoretical sampling and conducted in-depth interviews by an open-ended questionnaire.

Results. The results of this study indicated that the core of the process during which alcoholic individuals succeeded in abstaining from further alcohol consumption was an empowerment process for the involved individual.

Alcoholics felt that their

• family,
• interpersonal relationships,
• jobs and
• personal finances all had been at ‘rock-bottom’ level following a long period of alcohol dependence.

This feeling caused the individual to experience an emotion of a loss of control and provoked the arousal of an alcoholic’s inner consciousness levels, this then resulting in the generation of a driving force for abstinence from alcohol for these individuals.

Conclusions. The expansion of an individual’s internal awakening power helps the individual to obtain assistance and to resist the temptation of further alcohol consumption.

Therefore, the power derived by individuals form the

• stages of repositioning,
• releasing,
• active sharing,
• resistance and
• assistance are the maintenance factors for an individual’s empowerment process that help maintain the successful recovery from alcohol for the involved individual.

Relevance to clinical practice. A good comprehension of the recovery processes for alcoholics, we believe, will trigger clinical professionals to pay appropriate attention to the specific problems and needs of alcoholic individuals, to build an effective resource network for treatment and to help solve alcoholics’ physical and psychosocial problems.

Yeh MY, Che HL, Lee LW, Horng FF. An empowerment process: successful recovery from alcohol dependence. J Clin Nurs. 2008 Apr;17(7):921-9.

See also;

• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Brief-TSF ASSESSMENT

Predictors of relapse in 300 Brazilian alcoholic patients: a 6-month follow-up study.

Three hundred alcoholic patients were interviewed at hospitalisation and again 3 and 6 months thereafter in Porto Alegre, Brazil, from March 2002 to January 2004.

Assessment included the SCID-I to check for the presence of Axis I mental disorders, a questionnaire focusing on patient relationship with AA groups, and specific questions about participation in psychotherapy. A logistic regression analysis was performed to determine predictive variables for relapse or abstinence 6 months after discharge.

Previous treatment for alcohol dependence and being single proved to be associated with relapse,

Findings; adherence to AA, the presence of a comorbid depressive disorder, and probably adherence to psychotherapy could be associated with abstinence.

adherence to AA could be associated with abstinence

These findings reinforce the importance of psychotherapy and AA groups for alcoholics to remain abstinent for longer.

The greater adherence to treatment observed among depressive alcohol dependents can be explained by the fact that this is a comorbid condition that acts as a protective factor against relapse.

Predictors of relapse in 300 Brazilian alcoholic patients: a 6-month follow-up study. Subst Use Misuse. 2008;43(3):403-11. Terra MB, Barros HM, Stein AT, Figueira I, Athayde LD, Ott DR, De Azambuja Rde C, Da Silveira DX.

See also;

• Brief-TSF is designed to address these issues.
• 12-Step Treatment More Effective than Alternative
• Subscribe to BriefTSF by e-Mail

Alcoholics Anonymous after Treatment: Attendance and Abstinence

Follow-up data on 900 inpatients at eight hospital-based chemical dependency treatment centers demonstrate a high correlation between total abstinence 6 months after discharge and weekly attendance at Alcoholics Anonymous during this period.

Almost three-fourths (73%) of the regular attendees remained chemically free, compared with one-third (33%) of the nonattendees.

These data suggest that Alcoholics Anonymous is an appropriate and beneficial aftercare for the majority of treatment inpatients.

Alcoholics Anonymous after Treatment Substance Use & Misuse 1983, Vol. 18, No. 3, Pages 311-318. Norman G. Hoffmann , Patricia Ann Harrison and Carol A. Belille

Empathy Ability Is Impaired in Alcohol-Dependent Patients

Empathy is a complex form of psychological inference in which observation, memory, knowledge and reasoning are combined to yield insights into the thoughts and feelings of others.

The aim of this study was to evaluate the level of empathy in a sample of alcohol-dependent (alcoholic) patients in comparison to a control sample.

One hundred and fifty alcoholic subjects were consecutively recruited. All of the subjects successfully detoxified have been evaluated with the Empathy Quotient (EQ) and then compared with 107 control subjects.

1. The level of empathy was significantly lower in the group of alcoholic subjects than in the control sample (p <.001).
2. Differences with respect to gender and psychiatric comorbidity have also been observed.
3. A low level of empathy could be a psychological trait typically observed in pre-morbid alcoholic personalities.

Further, the lack of empathy could lead latent abusers to find in the alcohol misuse something enabling them to compensate for their intrinsic weakness

Research report; Empathy Ability Is Impaired in Alcohol-Dependent Patients. Giovanni Martinotti;  Marco Di Nicola;  Daniela Tedeschi;  Sante Cundari; Luigi Janiri. American Journal on Addictions, Volume 18, Issue 2 March 2009 , pages 157 – 161

See also;

• AA and Treatment Work Better Together
• AA Offers Recovery Not Religion
• BriefTSF is designed to help breakdown denial