Brief-TSF.com

12-Step Programs Offer Broad Benefits, Study Says

A study of Alcoholics Anonymous and other 12-step oriented self-help programs finds that they can help most people recover from alcoholism, even those who are not religious or have mental-health problems.

The Pacific Institute on Research and Education (PIRE) reported that researchers tracked a group of 227 alcoholics over three years and found that those who had attended AA or other self-help programs after treatment had higher rates of abstinence, and drank less if they did relapse. The results cut across gender and religious lines and held regardless of psychiatric history or whether the patient had previously attended AA or other similar programs.

“Here’s a widespread, chronic disorder that seems to respond well to an inexpensive resource — mutual-help groups such as AA,” said study co-author Robert Stout, Ph.D., director of the Decision Sciences Institute at PIRE. “Not only do we need to get more addicts engaged in these groups, but we also need to gather evidence on this issue and make sure that the public, policy-makers and practitioners know about it.”

Added co-author John F. Kelly: “There is a clear dose-response relationship: If you don’t go to any meetings, you have the worst outcomes. If you go to a few, you have a little bit better outcome, and if you go to a lot, you have an even better outcome.” Kelly is the associate director of the Massachusetts General Hospital/Harvard Addiction Research Program.

The study was published in the August 2006 issue of Alcoholism: Clinical and Experimental Research.

From Join Together

12-Step Involvement Increases Sobriety and Reduces Costs

BACKGROUND: Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients’ health care costs in the first year after treatment, but such initially impressive effects may wane over time. This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.

METHODS: A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step-based (n=887 patients) or cognitive-behavioral (CB, n=887 patients) treatment programs. The 12-step-based programs placed substantially more emphasis on 12-step concepts, had more staff members "in recovery," had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs. The 2-year follow-up assessed patients’ substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.

RESULTS: As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) versus CB (37.0%) programs. Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs. In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p=0.01).

CONCLUSIONS: Promoting self-help group involvement appears to improve posttreatment outcomes while reducing the costs of continuing care. Even cost offsets that somewhat diminish over the long term can yield substantial savings. Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.

Humphreys K, Moos RH. Alcohol Clin Exp Res. 2007 Jan;31(1):64-8. Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes.

Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: a prospective randomised controlled trial.

AIMS: To assess the impact of two methods of brief nurse-delivered brief interventions in reducing drinking variables in hazardous drinkers with alcohol-related facial injuries.

METHODS: A randomised controlled trial of two brief interventions involving hazardous drinkers with facial trauma in three Oral and Maxillofacial Surgery outpatient clinics in the West of Scotland; 194 patients were recruited and randomised to have either a nurse-led brief motivational intervention (intervention group) or a leaflet about alcohol misuse (control group). Patients were followed up at 3 and 12 months after the intervention and drinking variables reassessed.

RESULTS: A brief motivational intervention for alcohol provided by a nurse was more effective than a leaflet in helping some patients with facial trauma to reduce their alcohol consumption 12 months after the intervention (p<0.05).

CONCLUSIONS: Facial trauma in the West of Scotland is strongly associated with alcohol misuse and is a recurrent disease, particularly among those who drink heavily. A nurse-delivered brief motivational intervention is effective in helping patients with high scores in the Alcohol Use Disorders Identification Test (AUDIT) to reduce their drinking, and this effect was apparent 12 months after the intervention.

Goodall CA, Ayoub AF, Crawford A, Smith I, Bowman A, Koppel D, Gilchrist G. Br J Oral Maxillofac Surg. 2008 Mar;46(2):96-101. Epub 2007 Dec 21. Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: a prospective randomised controlled trial

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Twelve Step Facilitation is designed to support people returning to their community

Implementing alcohol screening and intervention in a family medicine residency clinic.

The purpose of this study was to evaluate the impact of simultaneous systems interventions and clinician training on management of hazardous and harmful drinking in a residency clinic.

Systems interventions included forming a multi-disciplinary implementation team, training registration clerks to distribute health risk questionnaires using the AUDIT-C alcohol screen, and training nurses to score the AUDIT-C and administer the AUDIT to screen-positive patients.

Clinicians were trained to perform brochure-based interventions on screen-positive patients.

Research staff provided compliance feedback.

Over 12 months,

• 8.0% (241/3014) of patients screened positive and
• 3.8% (115/3014) received brief interventions.

For screen-positive patients, comparisons with baseline measurements found

• increased rates of alcohol assessment (50% vs. 0%, p < .0001) and
• intervention (48.1% vs. 9.4%, p < .0001).

Clinicians intervened more often when prompted with completed AUDITs (72% vs. 23%, p < .0001).

Program modifications resulted in progressive increases in numbers of patients screened. This model shows promise for use in other residency programs.

Seale JP, Shellenberger S, Tillery WK, Boltri J, Vogel R, Barton B, McCauley M. Implementing alcohol screening and intervention in a family medicine residency clinic. Subst Abus. 2005 Mar;26(1):23-31.

Brief-TSF is designed with just such a model in mind.

The Classification of Alcoholics

Articles from the journal Alcohol Health and Research

The Classification of Alcoholics: Typology Theories From the 19th Century to the Present

For over 150 years, physicians and researchers have attempted to categorize alcoholics according to various schemes or typologies. Dr. Thomas F. Babor recounts the history of alcoholism typologies through the prescientific period of clinical speculation, the Jellinek era of review and synthesis, and the post-Jellinek period of increasingly sophisticated empirical research. Dr. Babor concludes that although the typologies developed during each of these periods vary greatly with respect to their methodologies, the resulting alcoholism subtypes share enough characteristics to allow grouping them into two overarching categories. (pp. 6-14)

Type I and Type II Alcoholism: An Update

A study of Swedish adoptees and their biological and adoptive parents resulted in the identification of two distinct alcoholism subtypes, type I and type II. These two subtypes differ according to the age at which alcoholism develops; the relative contributions of predisposing genetic and environmental factors; the gender and personality traits of the alcoholic; and whether co-occurring psychiatric disorders, such as antisocial behavior, are present. In this article, Drs. C. Robert Cloninger, Sören Sigvardsson, and Michael Bohman provide an update on the type I-type II typology and discuss findings from a recent study replicating the initial adoption study on which the typology is based. (pp. 18-23)

Subtypes of Alcoholics Based on Psychometric Measures

One approach to subtyping alcoholics is using psychometric tests to assess the patients’ psychological characteristics, notes Dr. John P. Allen. The resulting typologies may potentially have meaningful implications for alcoholism treatment. Several tests have been used to identify alcoholic subtypes. These tests categorize alcoholics according to their personalities, their motivation for treatment, and the existence of co-occurring psychiatric disorders. Dr. Allen reviews typology schemes based on these characteristics, as well as a hybrid model that classifies alcoholics along various sets of criteria. Researchers have not yet evaluated sufficiently, however, how effective these typologies will be in selecting and planning the appropriate treatment strategy for each patient. (pp. 24-29)

Type A and Type B Alcoholism: Applicability Across Subpopulations and Treatment Settings

Alcoholism is a complex disorder with many different causes and outcomes. Some studies suggest that all alcoholic subjects can be assigned to one of two types that differ consistently in several factors related to the causes, symptoms, and adverse consequences of alcohol use. Dr. Samuel A. Ball explores a model developed by researchers at the University of Connecticut in which socalled type B alcoholism appears to represent a more severe form of the disorder than does type A alcoholism. This type A-type B alcoholism typology, which is similar to Cloninger’s type I-type II, may help explain the different causes, courses, prognoses, and outcomes for the disorder. (pp. 30-35)

Patient Placement Criteria: Linking Typologies to Managed Care

Most alcoholism typologies are based on differences in patient characteristics. However, an alternative approach, which was sparked by the managed care movement, focuses on variations in treatment service. With this approach, sets of criteria are developed to match patients to the appropriate treatment (e.g., outpatient versus inpatient treatment). The goal is to contain costs while ensuring the optimal allocation of resources. In this article, Dr. Leslie C. Morey describes one frequently used criteria set developed by the American Society for Addiction Medicine. These criteria evaluate patients along six dimensions before matching them with one of four levels of care. Dr. Morey reviews the advantages and disadvantages of these criteria and examines how patient placement criteria can be linked to other alcoholism typologies. (pp. 36-44)

The Development of Alcoholic Subtypes: Risk Variation Among Alcoholic Families During the Early Childhood Years

Alcoholism frequently is associated with other psychiatric disorders, most commonly with antisocial personality disorder (ASPD). The presence of ASPD in an alcoholic parent also influences the child’s risk for developing alcoholism, according to Drs. Robert A. Zucker, Deborah A. Ellis, C. Raymond Bingham, and Hiram E. Fitzgerald. Such high-risk families frequently have a greater number of alcoholic relatives or a higher prevalence of other psychiatric disorders. Because of this association, researchers are using the presence or absence of ASPD to distinguish different subtypes of alcoholics. The authors review a long-term study that compares alcoholism risk factors among children of alcoholic men with and without ASPD and children of nonalcoholic parents. The study has identified significant differences among the three sets of parents, the children’s home environments, and the children’s behavior, which may influence whether a child develops alcoholism later in life. (pp. 46-54)

Gender and Alcoholic Subtypes

Gender may be used as a distinction in alcoholism subtyping schemes. Some typologies, such as Cloninger’s type I-type II scheme, place female alcoholics in a single category (i.e., type I). Other typologies, including Babor and colleagues’ type A-type B scheme, are based on findings that women, like men, may differ in their risk for and severity of alcoholism. Drs. Francis K. Del Boca and Michie N. Hesselbrock analyzed a population of female and male alcoholics and determined that although those with severe or mild alcoholism differ little from each other in their personal profiles, men and women with a moderately severe form of the disease tend to be divided by sex according to their co-occurring psychopathologies (i.e., depression, anxiety, or antisocial personality). This finding has implications for determining the etiologies and treatment of men’s and women’s alcoholism. The authors caution, however, that conclusions drawn from one set of subjects cannot necessarily be extended to the general population. (pp. 56-62)

Typology Research Questionnaires

Alcoholism typologies often are based on aspects of subjects’ personalities, their drinking patterns, and their family histories of alcoholism. To distinguish these characteristics, researchers often rely on personality questionnaires. In this section, Ms. Kathryn G. Ingle reviews five of the most common questionnaires used in alcoholism typology research: the Minnesota Multiphasic Personality Inventory (MMPII), the MacAndrew Alcoholism Scale (MAC), the Eysenck Personality Questionnaire (EPQ), the Tridimensional Personality Questionnaire (TPQ), and the Connecticut Typology Questionnaire. The development of each questionnaire is traced and examples of their questions and uses are provided. (pp. 63-66

From; Alcohol Research & Health Vol 20.1, 1996

“I’ll never touch it again, doctor!” - harmful drinking after liver transplantation.

Alcohol relapse can negatively influence the outcome after liver transplantation (LT).

The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT.

A total of 387 consecutive patients (23.8% women) who underwent LT for alcoholic cirrhosis in Geneva, Switzerland, and Lyon, France, between 1989 and 2005 were evaluated.

• Mean +/- SD age was 51.3 +/-7.5 years. Follow-up time was 61.2 +/- 47.5 months.

Alcohol consumption relapse and potential factors associated with it were studied.

• The relapse rate of harmful alcohol consumption after LT was 11.9%.

In univariate analysis, alcohol relapse was significantly associated with

• age greater than 50 years,
• year of LT 1995 or earlier,
• duration of abstinence less than 6 months,
• presence of psychiatric comorbidities,
• presence of a life partner, and
• a high score on the High-Risk Alcoholism Relapse (HRAR) scale.

Multivariate logistic regression disclosed the following independent factors of relapse:

• duration of abstinence of less than 6 months;
• presence of psychiatric comorbidities; and
• HRAR score higher than 3.

In patients with none of these factors, alcohol relapse was 5%, while the presence of 1, 2, or 3 factors was associated with relapse rates of 18%, 64%, and 100% of the patients, respectively.

In a large cohort of patients undergoing LT for alcoholic cirrhosis,

• a duration of abstinence of less than 6 months before wait-listing for LT,
• the presence of psychiatric comorbidities, or
• an HRAR score higher than 3

was associated with relapse into harmful drinking.

The presence of more than 1 factor dramatically increased this risk over 50%.

In the pre-LT evaluation in this setting, these factors should be accurately determined.

Research; Haber PS, McCaughan GW. “I’ll never touch it again, doctor!” - harmful drinking after liver transplantation. Hepatology. 2007 Sep 25;46(4):1302-1304.

Liver Transplantation & the Alcoholic Patient: Medical, Surgical and Psychosocial Issues by Michael R. Lucey, Robert M. Merion, Thomas P. Beresford Read more about this title…

BriefTSF Statistic for February 2008

Brief Twelve Step Facilitation

Page views 13,250

Visits 7,000

That’s a 15% increase from January 2008

See; Most Popular Articles Feb 2008

How Is Alcohol Metabolized by the Body?

By Samir Zakhari, Ph.D.

Alcohol is eliminated from the body by various metabolic mechanisms. The primary enzymes involved are aldehyde dehydrogenase (ALDH), alcohol dehydrogenase (ADH), cytochrome P450 (CYP2E1), and catalase. Variations in the genes for these enzymes have been found to influence alcohol consumption, alcohol-related tissue damage, and alcohol dependence. The consequences of alcohol metabolism include oxygen deficits (i.e., hypoxia) in the liver; interaction between alcohol metabolism byproducts and other cell components, resulting in the formation of harmful compounds (i.e., adducts); formation of highly reactive oxygen-containing molecules (i.e., reactive oxygen species [ROS]) that can damage other cell components; changes in the ratio of NADH to NAD+ (i.e., the cell’s redox state); tissue damage; fetal damage; impairment of other metabolic processes; cancer; and medication interactions. Several issues related to alcohol metabolism require further research.

Full text available at; http://pubs.niaaa.nih.gov/publications/arh294/245-255.htm

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

Alcohol support workers have been allowed to interview suspects in police cells in a bid to combat binge drinking and alcohol-related crime.

In a scheme said to be one of the first of its kind, more than 1,000 suspects in Plymouth have taken part.

The scheme aims to find out if a suspect has a drink problem and offer advice about how to get help.

The suspects are assessed in their cells - typically the morning after they have been arrested.

More at BBC News UK.