TARGET POPULATIONS

Clients Best Suited for This Approach

Twelve Step Facilitation has been utilized in controlled outcome studies with alcohol abusers and alcoholics and with persons who have concurrent alcohol-cocaine abuse and dependency. It has been used with clients of diverse socioeconomic, educational, and cultural backgrounds and a range of maladjustment.

Clients Poorly Suited for This Approach

Individuals who have severe symptoms of addiction to cocaine or opiates. That is not to say that alternative treatments have proven effective with that group of individuals.

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Exhaustive Review of the Literature Reveals Even Moderate Alcohol Intake Increases Risk of Cancer

The Cancer Institute of New South Wales, Australia, has released a comprehensive analysis of current evidence for the association between alcohol consumption and risk of cancer. Limited to systematic reviews and meta-analyses of the highest methodological quality, the 194-page monograph, entitled Alcohol as a Cause of Cancer, revealed that even moderate alcohol consumption is associated with an often dramatic increase in the risk of several types of cancer.

Key findings are as follows:

Alcohol intake of approximately 2 drinks per day increases the risk of

• cancer of the oral cavity and pharynx by 75 percent,
• the risk of esophageal cancer by 50 percent, and
• the risk of laryngeal cancer by 40 percent.

Moderate intake also significantly increases the risk of colorectal cancer, liver cancer, and stomach cancer.

• Intake of approximately 4 drinks per day increases the risk of any cancer by 22 percent, while
• 8 drinks per day increases the risk by 90 percent.

The risk of breast cancer is 11 to 22 percent higher in women who drink alcohol than in women who do not.

Comments: The authors were unable to identify levels of consumption associated with no risk of cancer. Although the World Health Organization lists alcohol as a Group-1 carcinogen, as noted in the introduction to this study, few people are aware that even moderate consumption can cause cancer. These findings may be limited by possible underreporting of alcohol use or misclassification of exposure (e.g., light or ex-drinkers classified as nondrinkers).

Nonetheless, information about the association between alcohol and cancer needs to be more widely available so that the public can make informed choices about their behavior.

Richard Saitz, MD, MPH. Research Reference; Lewis S, Campbell S, Proudfoot E, et al. Alcohol as a Cause of Cancer. Sydney, Cancer Institute NSW, May 2008.

See also;

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

Counselling for Alcohol Problems (Counselling in Practice series) by Richard D B Velleman Read more about this title…

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…

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.

See also;

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

Aims; To describe alcohol use, and the prevalence and predictors of hazardous drinking, among hospital doctors.

Methods. Data were collected by anonymous mail survey in 2006, from a representative national sample of 1917 (58% response rate) hospital doctors in Germany. Alcohol use was measured using the AUDIT-C, scores of 5 or more for males and females indicating “hazardous drinking.”

Results. There were;

• 9.5% abstainers,
• 70.7% moderate drinkers, and
• 19.8% hazardous drinkers.
• The majority of doctors (90.5%) used alcohol—mainly at a sensible level, e.g., 2–4 times a month (32%) or 2–3 times a week (29%), and 1–2 glasses on one occasion (83%).
• Binge drinking was common (53%), but for most occurred less than once in a month (39%).
• When hazardous drinking was controlled for certain confounders, being male (OR 4.7; 95% CI 3.4–6.5) and having a surgical specialty (OR 1.4; 1.1–1.8) were significantly correlated to hazardous drinking.
• Age had no influence on this model.
• By contrast, the age group 40 years and younger (OR 2.1; 1.4–3.0) was a significant predictor of abstinence.

Conclusions. There is a higher rate of abstainers and a lower rate of binge drinkers among hospital doctors in Germany than in the general population. However, some hospital doctors drink hazardously, the risk being greater among males and among surgeons, which should be paid due attention in the interest of their health and their function as doctors.

Alcohol and Alcoholism 2008 43(2):198-203.Hazardous alcohol use among hospital doctors in Germany, Judith Rosta

See also;

• 12-Step Treatment More Effective than Alternative
• Twelve Step Facilitation
• Subscribe to BriefTSF by e-Mail

Spirituality and Alcoholics Anonymous.

What can be confidently said about AA in general and about the role of spirituality in AA in particular?

• First, there is convincing evidence that alcoholism severity predicts later AA attendance.
• Second, atheists are less likely to attend AA, relative to individuals who already hold spiritual and/or religious beliefs. However, belief in God or a Higher Power before AA attendance does not offer any advantage in AA-related benefits, and atheists, once involved, are at no apparent disadvantage in deriving AA-related benefits.
• Third, the spiritually-based principles of AA appear to be endorsed in AA meetings regardless of the perceived social dynamics or climate of a particular meeting, eg, highly cohesive or aggressive.
• Fourth, significant increases in spiritual and religious beliefs and practices seem to occur among AA-exposed individuals.
• Fifth, in spite of much discussion to the contrary there is little evidence that spirituality directly accounts for later abstinence. We are finding, however, that spirituality has an important indirect effect in predicting later drinking reductions.

Specifically, in the past 20 years a number of effective methods have been developed to facilitate initial AA attendance (AA dropout is high, with some estimates ranging as high as 80%). Interventions that lead to initial increases in spirituality appear to lead to sustained AA affiliation, which, in turn, produces sustained recovery over time.

TSF and Brief-TSF are designed from studies such as this to facilitate AA attendance.

Research; Tonigan JS. Spirituality and alcoholics anonymous. South Med J. 2007 Apr;100(4):437-40.

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Difference in medical history classified by ICD-10 between male and female alcoholics.

The drinking history and current medical history of patients with alcohol dependence were surveyed in Japan and they were analyzed by demographics; gender, age and changes with time (2 stages).

The results showed that in the course of continued habitual drinking by patients with alcohol dependence, a wide range of physical complications occurred.

The main complications

• in men were gastrointestinal diseases and
• in women were mental and behavioral disorders, showing a gender difference in the medical history.

This result suggested that there is a high possibility that this will contribute to early discovery and early measures against alcohol related problems in women, which are difficult to bring out into the open.

Better alcohol education including mental health is important from an early age.

Nihon Arukoru Yakubutsu Igakkai Zasshi. 2008 Feb;43(1):25-34. Difference in medical history classified by ICD-10 between male and female alcoholics. Shinoda R, Mizukami Y, Nakagawa Y, Maruyama K.

See also;

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

Counseling the Culturally Diverse: Theory and Practice by Derald Wing Sue, David Sue Read more about this title…

Special populations in Alcoholics Anonymous.

The vast majority of Alcoholics Anonymous (AA) members in the United States are white, and only a few studies have investigated the program’s effectiveness for ethnic minorities. Other demographics need to be examined.

Project MATCH, a multisite research study aimed at developing guidelines for assigning alcoholics to appropriate treatment approaches, also assessed AA effectiveness for minority clients.

Some differences in AA attendance existed among white, African-American, and Hispanic Project MATCH participants who had received some inpatient treatment before entering the study, but not among participants who had not received inpatient treatment.

Further analyses of white and Hispanic Project MATCH participants demonstrated that although Hispanic clients attended AA less frequently than white clients, their involvement with and commitment to AA was higher than among white clients. For these target populations, both Hispanics and whites, AA involvement predicted increased abstinence.

Research; Tonigan JS, Connors GJ, Miller WR. Special populations in Alcoholics Anonymous. Alcohol Health Res World. 1998;22(4):281-5.

Alcoholics Anonymous and long term matching effects.

AIMS: (1) To examine the matching hypothesis that Twelve Step Facilitation Therapy (TSF) is more effective than Motivational Enhancement Therapy (MET) for alcohol-dependent clients with networks highly supportive of drinking 3 years following treatment; (2) to test a causal chain providing the rationale for this effect. DESIGN: Outpatients were re-interviewed 3 years following treatment. ANCOVAs tested the matching hypothesis. SETTING: Outpatients from five clinical research units distributed across the United States. Participants: Eight hundred and six alcohol-dependent clients. INTERVENTION: Clients were randomly assigned to one of three 12-week, manually-guided, individual treatments: TSF, MET or Cognitive Behavioral Coping Skills Therapy (CBT). MEASUREMENTS: Network support for drinking prior to treatment, Alcoholics Anonymous (AA) involvement during and following treatment, percentage of days abstinent and drinks per drinking day during months 37-39.

FINDINGS:

• The a priori matching hypothesis that TSF is more effective than MET for clients with networks supportive of drinking was supported at the 3 year follow-up;
• AA involvement was a partial mediator of this effect; clients with networks supportive of drinking assigned to TSF were more likely to be involved in AA;
• AA involvement was associated with better 3-year drinking outcomes for such clients.

CONCLUSIONS:

• in the long-term TSF may be the treatment of choice for alcohol-dependent clients with networks supportive of drinking;
• involvement in AA should be given special consideration for clients with networks supportive of drinking, irrespective of the therapy they will receive.

Research; Longabaugh R, Wirtz PW, Zweben A, Stout RL. Network support for drinking, Alcoholics Anonymous and long-term matching effects.Addiction. 1998 Sep;93(9):1313-33.

The patient who abuses alcohol often is in denial about his addiction and frequently becomes unruly and obstinate as necessary detox measures and treatments are carried out. When the patient is elderly, additional issues can come into play, such as dementia and a poorly functioning immune system caused by years of drinking.

Increasing Numbers

Unfortunately, caring for elderly alcoholics is not an uncommon challenge. Studies find an increasing prevalence of alcoholism among older adults in health care settings. In fact, surveys show 6% to 11% percent of elderly people admitted to hospitals have symptoms of alcoholism, as do 20% in psychiatric wards and 14% in emergency departments.

Alcohol-related admission rates to acute care hospitals also have been found to be similar to those for myocardial infarction, and evidence shows the prevalence of problem drinking in nursing homes is as high as 49%.

Alcoholism itself can be a major concern, but when combined with medical problems associated with aging, care and treatment issues often are compounded. For instance, alcohol consumption causes more falls involving hip fractures in the elderly than would otherwise occur, due to their decreased bone density compared to elderly nonalcoholics.

Elderly drivers who have consumed alcohol are at greater risk for accidents; with age it takes less alcohol to interfere with coordination, judgment and medications.

Increased medication use and age-related liver degeneration means that older adults’ bodies cannot break down the drugs and eliminate them as quickly; this puts them at more risk to suffer adverse reactions. The heart, gastrointestinal tract, immune system and cognitive and motor functions of the brain also are negatively affected by alcohol consumption, and it has been found to increase the risk for some cancers.

Subtle Symptoms

Regardless of age, caring for a patient with alcoholism is a challenge. Unless someone reports the ED patient is an alcoholic, staff often have to look for subtle symptoms, according to Catherine Wilson, RN, a psychiatric nurse clinician at Virginia Commonwealth University Hospital, Richmond. “Most patients are not going to come to you and say they drink every day,” she said.

When a patient shows up in the ED with a fractured hip, sky-high blood alcohol level and is taking out his hostilities on caregivers, the important thing is to keep him from going into withdrawal, Wilson said. Symptoms of this can be a rising temperature, tremors, nausea and vomiting.

With the elderly, these syptoms can mean the patient may be deteriorating rapidly. He can go into delirium tremens, including hallucinations, as well as develop other symptoms—seizures, coma and even death. “People do die from alcohol withdrawal,” Wilson emphasized.

Decision Time

In the ED, many elderly alcoholic patients require surgery after a fall. The attending physician must decide what should come first, the surgery or detoxification. The anesthesiologist, in fact, may make the call to detox first, based on lab results showing magnesium deficiency and/or other abnormal values.

“Obviously, the risks of postponing any surgical intervention must be weighed against the risks of undergoing surgery,” said William J. Lorman, PhD, MSN, PsyNP, chief clinical officer at Livengrin Foundation in Bensalem, Pa., a facility caring for those requiring intervention due to alcohol or drug abuse.

Detox Measures

Wilson stressed, “There is a very fine balance with the elderly, because they tend to react to benzodiazepines [e.g., lorazepam, a commonly used detox drug], more than younger adults. Sometimes phenobarbitol is used instead.”

ED staff also must look for comorbidities such as high blood pressure and other sequelae that tend to accompany prolonged alcohol use.

“If surgery is urgent, the use of benzodiazepines will prevent withdrawal for up to 14 days,” Lorman said.

“Interestingly,” he noted, “the complications reported postoperatively are not secondary to alcohol withdrawal itself, but instead are related to infection, bleeding and delayed wound healing as a result of chronic alcohol misuse.”

By Bette Mooney who is a freelance writer and retired editor at ADVANCE.

Handbook of Alcoholism Treatment Approaches (3rd Edition) by Reid K. Hester, William R. Miller, Hester, Miller Read more about this title…