A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS.

Since the 1970s, much of the public treatment system in California has been based on a social model orientation to recovery for alcoholics, but there has been minimal research on program outcomes. This article reports on follow-up interviews conducted with a representative sample of 722 people who had entered treatment about a year earlier in public and private programs, including publicly-funded social model detoxification and residential programs, and clinical model programs in hospitals and HMO clinics.

higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems

• Social model clients came to treatment with more severe legal and employment problems, whereas those seeking treatment at clinical programs reported more severe family problems.
• At follow-up, clients at both types of programs reported attending a similar number of Alcoholics Anonymous (AA) meetings, but social model clients reported going to more Narcotics Anonymous (NA) meetings and being involved in more AA activities.
• Social model clients were less likely than clinical model clients to report problems with alcohol or drugs at follow-up, but the odds of reporting other problems (e.g., medical, psychological, legal, family/social) were similar.

The program effect for better alcohol outcomes at the social model programs was partially explained by their clients’ higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems.

• Social networks supportive of abstinence also were predictive of reporting no alcohol problems at follow-up.

In contrast, subsequent detoxification treatment events between baseline and follow-up were associated with a higher odds of reporting alcohol, drug, psychiatric and family/social problems at follow-up.

These findings are consistent with the growing body of literature reporting higher rates of abstinence among those who are able to construct more positive social networks, and who attend and become involved in 12-step programs during and following treatment.

It is important that these results be replicated, as they suggest that social model programs are successful in engaging their clients in AA activities and in NA meeting attendance, and could represent for some an effective alternative to clinical model treatment programs.

Research; LEE ANN KASKUTAS, LYNDSAY AMMON, CONSTANCE WEISNER. A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS. International Journal of Self Help and Self Care; Volume 2, Number 2 / 2003-2004, 111 - 133

RSS feed keeps you up to date with all research on TSF.

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.

Subscribe to updates with your RSS feed reader.

Care is poor, despite the existence of proven therapies.

Evidence-based practice guidelines clearly state that patients at risk for alcohol withdrawal should be monitored and treated with benzodiazepines if their risk is high enough or symptoms are substantial. In a retrospective record review, researchers evaluated whether a protocol for such an approach — symptom-triggered therapy — was followed appropriately at two large general hospitals that offer more than 40 specialty services. The protocol — the Revised Clinical Institute for Withdrawal Assessment for Alcohol (CIWA-Ar) — employs a symptom assessment that required patients to be able to communicate.

Of 124 inpatients who received symptom-triggered therapy, more than half (52%) were treated inappropriately: 35 had no recent heavy alcohol use and therefore were not at risk for withdrawal, 9 could not communicate well, and 20 had no recent heavy drinking and were unable to communicate. Overall, 11 patients had adverse outcomes (i.e., seizure, delirium, death); 7 of them had received inappropriate treatment.

Comment: People who have not been drinking heavily recently cannot, and should not, be treated for alcohol withdrawal. People who cannot communicate can, and sometimes should, receive withdrawal treatment but not if the decision is based on a symptom scale that requires verbal communication. We should take notice when only half the people with a potentially fatal condition receive appropriate treatment. Known effective treatments exist for alcohol withdrawal, and they are quite straightforward. If the hospitals in this report represent U.S. hospitals generally (as is likely), we have a large challenge to implement appropriate care for this common condition.

Research report; Hecksel KA et al. Inappropriate use of symptom-triggered therapy for alcohol withdrawal in the general hospital. Mayo Clin Proc 2008 Mar; 83:274.

See also;

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

Alcohol and drug dependence approach

Synopsis - diagnosis and management

An empathetic and non-judgemental attitude to the patient is required when managing drug dependence problems.

Careful assessment to establish the nature and extent of drug use must precede any attempts at management (more than one consultation is likely to be necessary).

The active cooperation of the patient in any management plan is essential, as the patient’s readiness for change will be a powerful influence on the success of any intervention.

Goals for stopping or reducing drug use must be agreed with the patient and must be attainable. Abstinence from drugs will not be every patient’s goal; harm reduction (through education to avoid collateral risks or efforts to cut down on drug consumption) is a worthwhile objective.

Detoxification is only part of the process. Many lifestyle adjustments are required to maintain a drug-free existence, and these changes may require social support and/or psychological therapies.

Relapse is common but can be used as a learning experience. Patients who relapse into drug use should be encouraged to try again.

With empathy and positive management, many drug dependent people can be liberated from their addictions.

Research extract from; Tobie L Sacks and Nicholas A Keks. Alcohol and drug dependence: diagnosis and management. Medical Journal of Australia Practice Essentials #14.