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 Read more about this title…

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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.

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A qualitative study of Alcoholics Anonymous members and South Asian men.

The spiritual aspect of recovery for people with drinking problems was explored in a comparative analysis of South Asian men recovering from drink problems and white members of Alcoholics Anonymous (AA).

In-depth semi-structured interviews were carried out with participants to explore significant factors that assisted recovery. Interviews were analyzed using grounded theory. Ten participants in total were interviewed; 5 were South Asian men receiving individual and/or group counseling with South Asian therapists either in an NHS or non-statutory specialist alcohol treatment service, and 5 were white members of AA.

Models of recovery for the two groups were developed and are presented.

Spirituality and religion played an important role in the experiences of recovery described by AA and South Asian participants respectively.

For AA participants their experiences reflected those described in AA’s Big Book although concepts such as that of a Higher Power were complex and multilayered, with spirituality just one, albeit significant, aspect.

South Asian participants generally underwent a re-affirmation of existing beliefs rather than the conversion type of experience described by AA participants.

The findings are discussed in relation to implications for service delivery and development and directions for future research.

Morjaria, A.; Orford, J. Role of religion and spirituality in recovery from drink problems: A qualitative study of alcoholics anonymous members and South Asian men. Addiction Research and Theory, 10(3):225-256, 2002.

The Spirituality of Imperfection: Storytelling and the Search for Meaning by Ernest Kurtz, Katherine Ketcham Read more about this title…

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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

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Brief-TSF Treatment Setting

Brief-TSF can be used with both individuals who have never sought treatment and those who had previous treatment and aftercare clients. The model is flexible enough to accommodate all of these client groups.

However, since Brief-TSF relies heavily on client involvement in community-based 12 step fellowship and meetings, it would be less ideally implemented in a long-term inpatient setting.

Many Twelve Step Fellowship members are willing to visit ‘Newcomers’ in hospital. Brief-TSF can easily be integrated into a general mental health outpatient clinic setting.

BriefTSF is designed to be used in the context of short-term individual adjunct therapy by general healthcare and other helping profession workers. BriefTSF is specifically intended to be implemented by nurses, doctors, psychologists, social workers, counselors etc while addressing other current issues (ie, medical treatment, relationship counselling, legal issues).

Brief-TSF is not time limited. After assessment support can last as long as the healthcare worker is seeing the client. It is intended to be implemented within a scheduled session often with another focus. The initial assessment session can last up to one hour, and regular support can be incorporated into other sessions.

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A 3-year study of addiction mutual-help group participation following intensive outpatient treatment

BACKGROUND: Addiction-focused mutual-help group participation is associated with better substance use disorder (SUD) treatment outcomes. However, little has been documented regarding which types of mutual-help organizations patients attend, what levels of participation may be beneficial, and which patients, in particular, are more or less likely to participate.

Furthermore, much of the evidence supporting the use of these organizations comes from studies examining participation and outcomes concurrently, raising doubts about cause-effect connections, and little is known about influences that may moderate the degree of any general benefit.

METHOD: Alcohol-dependent outpatients (N=227; 27% female; Mean age=42) enrolled in a randomized-controlled telephone case monitoring trial were assessed at treatment intake and at 1, 2, and 3 years post discharge.

Lagged-panel, hierarchical linear models tested whether mutual-help group participation in the first and second year following treatment predicted subsequent outcomes and whether these effects were moderated by gender, concurrent axis I diagnosis, religious preference, and prior mutual-help experience.

Robust regression curve analysis was used to examine dose-response relationships between mutual-help and outcomes.

RESULTS: Mutual-help participation was associated with both greater abstinence and fewer drinks per drinking day and this relationship was not found to be influenced by gender, Axis I diagnosis, religious preference, or prior mutual-help participation.

Mutual-help participants attended predominantly Alcoholics Anonymous and tended to be Caucasian, be more educated, have prior mutual-help experience, and have more severe alcohol involvement.

Dose-response curve analyses suggested that even small amounts of participation may be helpful in increasing abstinence, whereas higher doses may be needed to reduce relapse intensity.

CONCLUSIONS: Use of mutual-help groups following intensive outpatient SUD treatment appears to be beneficial for many different types of patients and even modest levels of participation may be helpful.

Future emphasis should be placed on ways to engage individuals with these cost-effective resources over time and to gather and disseminate evidence regarding additional mutual-help organizations.

Kelly JF, Stout R, Zywiak W, Schneider R. A 3-year study of addiction mutual-help group participation following intensive outpatient treatment. Alcohol Clin Exp Res. 2006 Aug;30(8):1381-92.

Brief-TSF is designed to engage alcoholics in supportive therapy while attending Alcoholics Anonymous.

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Screening for Alcohol Problems in Primary Care; A Systematic Review.

Background; Primary care physicians can play a unique role in recognizing and treating patients with alcohol problems.

Objective; To evaluate the accuracy of screening methods for alcohol problems in primary care.

Methods; We performed a search of MEDLINE for years 1966 through 1998. We included studies that were in English, were performed in primary care, and reported the performance characteristics of screening methods for alcohol problems against a criterion standard. Two reviewers appraised all articles for methodological content and results.

Results; Thirty-eight studies were identified. Eleven screened for at-risk, hazardous, or harmful drinking; 27 screened for alcohol abuse and dependence. A variety of screening methods were evaluated.

The Alcohol Use Disorders Identification Test (AUDIT) was most effective in identifying subjects with at-risk, hazardous, or harmful drinking (sensitivity, 51%-97%; specificity, 78%-96%),

while the CAGE questions proved superior for detecting alcohol abuse and dependence (sensitivity, 43%-94%; specificity, 70%-97%).

These 2 formal screening instruments consistently performed better than other methods, including quantity-frequency questions. The studies inconsistently adhered to methodological standards for diagnostic test research: 3 (8%) provided a full description of patient spectrum (demographics and comorbidity), 30 (79%) avoided workup bias, 12 (of 34 studies [35%]) avoided review bias, and 21 (55%) performed an analysis in pertinent clinical subgroups.

Conclusions; Despite methodological limitations, the literature supports the use of formal screening instruments over other clinical measures to increase the recognition of alcohol problems in primary care. Future research in this field will benefit from increased adherence to methodological standards for diagnostic tests.

Research report; David A. Fiellin; M. Carrington Reid, MD; Patrick G. O’Connor. Screening for Alcohol Problems in Primary Care; A Systematic Review. Arch Intern Med. 2000;160.

Brief-TSF uses the CAGE and the AUDIT to identify alcohol use disorders.

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TSF TARGET POPULATIONS

Clients Best Suited for This Counseling Approach

TSF 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 Counseling Approach

Individuals who have severe symptoms of addiction to cocaine or opiates, who are unemployed, and who also have no source of spousal or other family support appear to have the poorest prognosis. That is not to say that alternative treatments have proven effective with that group of individuals. When treating addiction to cocaine, it is recommended that sessions be scheduled twice a week for the first 3 weeks.

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Brain research shows why long-term drug users just can’t say no

Groundbreaking research from the University of Melbourne has shed new light on why long term drug users find it hard to say no, despite dire consequences to their health.

A study into the frontal cortex, the key region of the brain involved in decision making, has shown that drug users have to place much greater demand on the brain to control impulses.

The two year study was conducted by researchers Dr Murat Yücel and Dr Dan Lubman of the ORYGEN Research Centre and the Melbourne Neuropsychiatry Centre, based at the University of Melbourne and was recently published in the July edition of the prestigious international journal Molecular Psychiatry.

“Drugs can capture and hijack some parts of the brain,” said Dr Murat Yücel a lead researcher in the study.

“In this study we found the frontal cortex, an area that is essential for exercising control over thoughts and behaviours, was working inefficiently.”

“These findings may help explain why it takes addicted individuals enormous effort to exercise control over their drug-taking behaviour in the face of adverse consequences, and why they are vulnerable to relapse back into uncontrolled, compulsive patterns of use.”

The studies involved brain-imaging technology to probe the physiological and biochemical properties of a key region of the brain, the frontal cortex.

Participants were asked to complete a test of self-control in which they had to overcome an automatic response in favour of a more controlled alternative response, thus requiring them to control their impulsive tendencies.

They researchers discovered two important differences between the opiate-using group and a group who have never used heroin.

Firstly, the opiate-using group needed to activate more of their brain by placing greater physiological demand on it to avoid making an error on a test of self control.

At the same time, brain cells in the frontal region were revealed to be less healthy than the non opiate-using group.

“What people don’t tend to understand about long term drug users is that this is not a matter of choice. They have a reduced level of biological resources and find it hard to stop.”

Dr Dan Lubman, an addiction psychiatrist and a senior investigator on the project, says this new evidence is likely to lead to the development of innovative strategies for the treatment of addiction

“These findings tell us that we need to provide a combination of pharmaceutical and psychological treatments that will help bolster the efficiency of the frontal cortex and hence the individual’s ability to stop their urge to use drugs.” Dr Lubman said.

“To improve treatments for long term drug users we need to understand at what stage these brain deficits occur. The next question we need to ask is are these latest research findings a consequence of addiction or do they explain people’s vulnerability to problematic drug use?” he said.

In future, the researchers would like to examine whether these processes recover with abstinence.

From a press release of the University of Melbourne, Australia.

Brain Damage, Brain Repair by James W. Fawcett, Anne E. Rosser, Stephen B. Dunnett Read more about this title…

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Thyroid function in depression and alcohol abuse : a retrospective study

Admission thyroid function tests were reviewed in 115 euthyroid patients with depression (66), depression and alcohol abuse (30), or alcohol abuse (19).

Estimated free thyroxine (EFT) levels ranged from 0.7 to 2.7 ng/100 ml (normal, 1.0 to 2.1).

Levels above 2.1 ng/100 ml were associated with agitation and values under 1.1 with alcohol abuse.

Mean EFT levels differed significantly among six diagnostic subgroups and paralleled rank order for severity of depression (none, secondary, reactive, single uncategorized, recurrent, psychotic).

Alcohol abuse negatively affected EFT: there was a significant decrease of mean EFT level from nonabusers to abusers and, further, to intoxicated abusers. A positive association between EFT level and severity of depression, and a negative one with alcohol use, were significant when other variables considered were controlled. These two factors accounted from 28.2% of variability in EFT levels, with a minimal additional contribution of medication effect.

T. Kolakowska and M. E. Swigar. Thyroid function in depression and alcohol abuse: a retrospective study. Arch of general Psychiatry. Vol. 34 No. 8, August 1977

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