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Archive for the 'Stages of Change' Category


Spirituality Enables Adaptive Coping

Posted by Lakeside on 30th June 2008

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)


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Predictors of Alcoholics Changing

Posted by Lakeside on 24th June 2008

Predictors of changes in alcohol-related self-efficacy over 16 years.

Self-efficacy is a robust predictor of short and long term remission after treatment.

This study examined the predictors of self-efficacy in the year after treatment and 15 years later.

A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years.

Predictors of self-efficacy at 1 year included

  • improvement from baseline to 1 year in heavy drinking,
  • alcohol-related problems,
  • depression,
  • impulsivity,
  • avoidance coping,
  • social support from friends, and
  • longer duration of participation in Alcoholics Anonymous (AA).
  • Female gender,
  • more education,
  • less change in substance use problems, and
  • impulsivity during the first year predicted improvement in self-efficacy over 16 years.
  • Clinicians should focus on keeping patients engaged in AA,
  • addressing depressive symptoms,
  • improving patient’s coping, and
  • enhancing social support during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.

Predictors of changes in alcohol- efficacy- over 16 years. J Subst Abuse Treat. 2007 Nov 23. McKellar J, Ilgen M, Moos BS, Moos R.

 

          Understanding And Counseling Persons With Alcohol, Drug, And Behavioral Addictions
by Howard Clinebell

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Alcoholism and Suicide

Posted by Lakeside on 20th June 2008

Alcohol-dependent patients attempting and not attempting suicide: a comparison.

Background:

Alcohol dependence is a psychiatric disorder associated with an increased risk of suicidal behaviour. This is also associated with an increased number of suicide risk factors.

Objective:

The current study examined the sociodemographic and clinical characteristics of a number of alcohol-dependent patients who attempted suicide.

Methods:

We studied a consecutive series of 377 alcohol-dependent patients in our in-patient clinics. Their alcohol-use histories were assessed through semi-structured interviews. The Suicidal Behaviors Questionnaire, the Childhood Trauma Questionnaire, the Michigan Alcoholism Screening Test and the Hamilton Depression Rating Scale were administered to all patients. Serum total cholesterol levels, mean corpuscular volume, the liver enzymes gamma glutamyl transferase, aspartate aminotransferase and alanine aminotransferase were routinely measured. In the statistical analyses, Student’s t-test and chi-squared tests were applied.

Results:

  • Of the 377 alcohol-dependent patients, 89 (23.6%) had histories of attempted suicide.
  • Thirty-four (42.5%) of the 80 female alcohol-dependent patients and
  • 55 (18.5%) of the 297 male alcohol-dependent patients had attempted suicide;
  • this gender difference was statistically significant (khgr2 = 27.7, P < 0.001).
  • A greater proportion of the suicide attempters than of the non-attempters met the Diagnostic Statistical Manual IV criteria for another psychiatric disorder (60.6%, n = 54, vs. 40.6%, n = 117; khgr2 = 14.8; df = 6; P < 0.05).
  • The difference of total cholesterol levels between female (mean = 144.0, SD = 58.3; mean = 158.0, SD = 83.9; t = 4.5; P < 0.05) and male (mean = 133.7, SD = 50.5; mean = 163.6, SD = 69.7; t = 11.7; P < 0.01) attempters and non-attempters was statistically significant.

Conclusion: These results suggest that suicide attempts in alcohol-dependent patients are associated with more profound biopsychosocial pathology and decreased serum cholesterol levels.

Research; Pektas O; Mirsal H; Kalyoncu A; Ünsalan N; Beyazyürek M. Alcohol-dependent patients attempting and not attempting suicide: a comparison. Acta Neuropsychiatrica, August 2004, vol. 16, no. 4, pp. 204-211(8). Alcohol-dependent patients attempting and not attempting suicide: a comparison.

Abnormal Psychology (5th Edition)


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WILLINGNESS TO CHANGE

Posted by Lakeside on 9th June 2008

DEVELOPING A WILLINGNESS TO CHANGE: TREATMENT-SEEKING PROCESSES FOR PEOPLE WITH ALCOHOL PROBLEMS.

The study explores treatment-seeking processes in men and women with alcohol problems, focusing on promoting and hindering factors.

Open interviews were held with five women and seven men within a month of their first voluntary treatment for alcohol problems. The interview protocols were analysed consecutively in accordance with grounded theory methodology.

Developing a willingness to change was found to be the basic psychosocial process that lead to treatment seeking.

Categories that constituted sub-processes and supported willingness to change were:

  • actuating inner forces;
  • dealing with conflicting feelings and thoughts; and
  • hoping to turn the situation around.

These processes were continuously assisted by demanding and caring support from partners, friends or professionals.

The processes that precede treatment-seeking were highly complex, and both internal and external factors promoted and hindered treatment entry.

The social significance of alcohol and the grief related to thoughts of abstaining were the most striking hindering factors.

Such feelings need to be considered when motivating people to seek treatment for alcohol problems.

Jakobsson A, Hensing G, Spak F. DEVELOPING A WILLINGNESS TO CHANGE: TREATMENT-SEEKING PROCESSES FOR PEOPLE WITH ALCOHOL PROBLEMS. Alcohol Alcohol. 2004 Dec 6;

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25 Top Posts at BriefTSF

Posted by Lakeside on 1st June 2008

Popular Blogging at BriefTSF

          Understanding and Counselling the Alcoholic
by Jr. Howard J. Clinebell

Amazon books; Read more about this title…


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Posted in Addiction, Adult Children of Alcoholics, Alcohol, Alcoholics Anonymous, Alcoholism, Blogroll, Brief-TSF, Drugs, Higher Power, Inhalants, Medication, PTSD, Pharmacotherapy, Recovery, Relapse prevention, Research, Spirituality, Stages of Change, Symptoms of addiction, TSF, Target populations, Training, Women | No Comments »

Drinking and Harm Continuum in Britain

Posted by Lakeside on 27th May 2008

Increased drinking can act like falling dominos, more means more harm 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;

          Understanding and Counselling the Alcoholic
by Howard J. Clinebell

Amazon books; Read more about this title…


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Getting active

Posted by Lakeside on 22nd May 2008

Getting active in Recovery in AA

This is an extract from the book ‘Living Sober’ by Alcoholics Anonymous.

(A more complete extract can be down loaded as a PDF file for printing to give to patients / clients and you can buy the complete book via Amazon)

It is very hard just to sit still trying not to do a certain thing, or not even to think about it. It’s much easier to get active and do something else-other than the act we’re trying to avoid.

So it is with drinking. Simply trying to avoid a drink (or not think of one), all by itself, doesn’t seem to be enough. The more we think about the drink we’re trying to keep away from, the more it occupies our mind, of course. And that’s no good. It’s better to get busy with something, almost anything, that will use our mind and channel our energy toward health.

Thousands of us wondered what we would do, once we stopped drinking, with all that time on our hands. Sure enough, when we did stop, all those hours we had once spent planning, getting our drinks, drinking, and recovering from its immediate effects, suddenly turned into big, empty holes of time that had to be filled somehow.

Most of us had jobs to do. But even so, there were some pretty long, vacant stretches of minutes and hours staring at us. We needed new habits of activity to fill those open spaces and utilize the nervous energy previously absorbed by our preoccupation, or our obsession, with drinking.

Anyone who has ever tried to break a habit knows that substituting a new and different activity is easier than just stopping the old activity and putting nothing in its place.

Recovered alcoholics often say, "Just stopping drinking is not enough." Just not drinking is a negative, sterile thing. That is clearly demonstrated by our experience. To stay stopped, we’ve found we need to put in place of the drinking a positive program of action. We’ve had to learn how to live sober.

Fear may have originally pushed some of us toward looking into the possibility that we might have a drinking problem. And over a short period, fear alone may help some of us stay away from a drink. But a fearful state is not a very happy or relaxed one to maintain for very long. So we try to develop a healthy respect for the power of alcohol, instead of a fear of it, just as people have a healthy respect for cyanide, iodine, or any other poison. Without going around in constant fear of those potions, most people respect what they can do to the body, and have enough sense not to imbibe them. We in A.A. now have the same knowledge of, and regard for, alcohol. But, of course, it is based on firsthand experience, not on seeing a skull and crossbones on a label.

We can’t rely on fear to get us through those empty hours without a drink, so what can we do?

We have found many kinds of activity useful and profitable, some more than others. Here are two kinds, in the order of their effectiveness as we experienced it.

A. Activity in and around A.A.

When experienced A.A. members say that they found "getting active" helpful in their recovery from alcoholism, they usually mean getting active in and around A.A.

B. Activity Not related to A.A.

It’s curious, but true, that some of us, when we first stop drinking, Seem to experience a sort of temporary failure of the imagination.

It’s curious, because during our drinking days, so many of us displayed almost unbelievably fertile powers of imagination. In less than a week, we could dream up instantly more reasons (excuses?) for drinking than most people use for all other purposes in a lifetime. (Incidentally, it’s a pretty good rule of thumb that normal drinkers-that is, nonalcoholics-never need or use any particular justification for either drinking or not drinking!)

When the need to give ourselves reasons for our drinking is no longer there, it often seems that our minds go on a sit own strike. Some of us find we can’t think up nondrinking things to do! Perhaps this is because we’re just out of the habit.

The following list is just a starter for use at that time. It isn’t very thrilling or adventurous, but it covers the kinds of activity many of us have used to fill our first vacant hours when we were not at our jobs or with other nondrinking people. We know they work. We did such things as:

  • Taking walks
  • Reading
  • Going to museums and art galleries.
  • Exercising swimming, golfing, jogging, yoga, or other forms of exercise your doctor advises.
  • Starting on long-neglected chores
  • Trying a new hobby
  • Revisiting an old pastime
  • Taking a course.
  • Volunteering
  • Doing something about your personal appearance.
  • Taking a fling at something frivolous! Not everything we do has to be an earnest effort at self-improvement, although any such effort is worthwhile and gives a lift to our self-esteem. Many of us find it important to balance serious periods with things we do for pure fun.
  • Fill this one in for yourself. Let’s hope the list above sparked an idea for you which is different from all of those listed. . . . It did? Good! Go to it.

One word of caution, though. Some of us find we have a tendency to go overboard, and try too many things at once. The best approach is called "Easy Does It."

Living Sober (#2150)

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Predictors of Relapse in Alcoholism

Posted by Lakeside on 3rd May 2008

Alcoholic relapse predictors 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;

  From Denial to Recovery: Counseling Problem Drinkers, Alcoholics, and Their Families (Jossey Bass Social and Behavioral Science Series)
by Lawrence Metzger

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Posted in 12-Step Groups, Alcohol, Alcoholics Anonymous, Alcoholism, Assessment, Recovery, Relapse prevention, Research, Stages of Change | No Comments »

Men and Women Alcoholics have Differing Medical History

Posted by Lakeside on 1st May 2008

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;

          Counseling the Culturally Diverse: Theory and Practice
by Derald Wing Sue, David Sue

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Posted in Alcohol, Alcoholism, Demographics, Disease of addiction, History, Men, Research, Stages of Change, Symptoms of addiction, Women | No Comments »

The Recovery from Alcoholism in AA

Posted by Lakeside on 30th April 2008

Alcoholics Anonymous, The recovery from alcoholism: Twelve steps of Alcoholics Anonymous.

AA is a self-help, volunteer organization begun in the mid-1930s that views alcoholism as a disease, not a defect of will.

Its founders, themselves alcoholics, maintained that persons with the disease should completely stop drinking, but they did not concern those who could handle alcohol.

This position contrasted with the premises of most temperance advocates, who saw drinking as a moral choice and opposed any alcohol use by anyone.

The Twelve Steps embody the wisdom of the founders of AA about pursuing ongoing recovery from alcoholism.

The procedure they describe has evolved into one of the most successful programs for helping alcoholics.

Many drug treatment programs also have based themselves on this twelve-step model.

The abbreviated Twelve Steps are:

  1. admission of powerlessness;
  2. belief in a greater Power;
  3. submission of one’s will to that Power;
  4. self-examination;
  5. admission of wrongs within self;
  6. readiness to have God remove these faults;
  7. humble prayer for removal of these short-comings;
  8. list persons whom one has offended;
  9. make restitution to those whom one has offended;
  10. continue to take personal inventory;
  11. seek through prayer and meditation to improve conscious contact with God; and
  12. having realized a spiritual awakening, try to carry this message to alcoholics and practice these principles in all affairs.
Alcoholics Anonymous (AA) The recovery from alcoholism: Twelve steps of Alcoholics Anonymous. In: D.F. Musto, Drugs in America: A Documentary History, New York, NY: New York University Press, 2002. 574 p. (pp. 158-159).
           Alcoholics Anonymous - Big Book 4th Edition
by AA Services

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