A comparison of three alcoholism treatment populations. Implications for treatment

Alcohol use in firefighters: A network model of behaviors and transdiagnostic risk

BACKGROUND AND AIMS

Firefighters are at heightened risk for developing alcohol use disorder (AUD), possibly due to chronic stress and exposure to potentially traumatic events. Daily trauma experiences and transdiagnostic risk factors (i.e., anxiety sensitivity and distress intolerance) are related to posttraumatic stress and depressive symptoms, as well as alcohol use severity and alcohol as a coping strategy. Although alcohol use has been identified as a key target for addressing mental health in firefighters, prior research has not fully integrated transdiagnostic vulnerabilities, internalizing symptoms, posttraumatic stress symptoms, alcohol coping, and overall alcohol use into a dynamic network model.

METHODS

We assessed the symptom structure of overall alcohol use in firefighters with a likely AUD and transdiagnostic risk factors in all firefighters using network analysis.

RESULTS

Failing to meet expectations (Expected Influence [EI]: 1.32), morning dependence (EI: 1.07), and guilt about drinking (EI: 1.10) were most central to the network model developed for firefighters with a likely AUD. In a transdiagnostic model of use in firefighters overall, anxiety sensitivity cognitive concerns (EI: 1.48) and negative alterations to cognitions and mood related to trauma (EI: 1.87) had the highest influence on the network. Notable correlations were also identified between trauma arousal and overall alcohol use, between depression and alcohol coping motives, and between trauma avoidance and alcohol coping motives.

CONCLUSIONS

Alcohol use behaviors may follow a unique etiologic pathway in firefighters and intervention strategies should target factors found to be more central to symptom networks.

The process of treatment selection among previously untreated help-seeking problem drinkers

A sample of 515 untreated problem drinkers was followed up for 1 year after contacting alcohol information and referral or detoxification services. At the 1-year follow-up, participants were placed into one of four treatment status groups: no treatment (24%), Alcoholics Anonymous only (18%), outpatient (25%), and inpatient or residential (32%). Participants with fewer financial resources, more serious drinking problems, and poorer functioning at baseline were more likely to enter inpatient or residential programs than outpatient treatment. Persons who selected AA only for treatment were of lower socioeconomic status than outpatients, and were functioning better than those who opted for treatment in inpatient or residential settings. In general, individuals who entered treatment received a considerable amount of treatment. Poorer baseline functioning was related to attending more AA meetings or outpatient sessions, and to staying longer in inpatient or residential treatment. The results are discussed in the context of a conceptual model of selection into alcoholism treatment.

A community-centered alcoholism assessment/treatment service: a descriptive study

This paper describes socio-demographic, alcohol-related, legal, medical, behavioural and treatment characteristics of 407 patients with problems of alcoholism/drug abuse assessed over a period of three years in a community oriented assessment and treatment program. The results show that patients entering this program represent a cross section of alcoholics in the area. These patients are similar to those entering traditional outpatient and residential facilities on most demographic variables; severity of alcoholism, length of history, and previous treatment experience. However, they are slightly younger and differ significantly from the others on their sources of referral. Over the three year period a significant change has occurred in the relationship between the program and the sources of referral. The implications of these findings for planning comprehensive treatment services for alcoholism are discussed.

Differential mortality among alcoholics by sample site

In a sample of 1,289 alcoholics from four clinical sites, the overall mortality rate after five to eight years of observation was 22.0 per cent, 3.1 times the expected rate. Patients from the medical and surgical services of a general hospital suffered 4.0 times the rate of expected mortality and died most often of medical causes associated with alcoholism. Patients of the public alcoholism ward had a mortality rate 3.3 times the expected rate and died of causes often associated with low social class. Private psychiatric patients had a mortality rate 2.3 times the expected rate, and psychiatric outpatients had an excess mortality ratio of 2.1. Sample site must be considered as a variable in the study of mortality among alcoholics.

Comparison of clients assigned to in-patient and out-patient treatment for alcoholism and drug addiction

This study examined characteristics of 296 alcohol and/or drug abuse clients assigned to either (1) in-patient programmes, (2) out-patient programmers, or (3) a lower cost primary care alternative. Multivariate analysis indicated that clients admitted for in-patient care reported greater alcohol consumption and associated problems, fewer community supports and more severe symptoms such as depression and anxiety. They tended to be more frank about their problems while defence mechanisms were more apparent in clients admitted to out-patient and primary care programmers. In general, out-patients ahd more favourable prognostic indicators, such as higher social stability and lower level of alcoholic involvement. The differences among treatment programmers were along quantitative dimensions of problem severity. In particular, the alcohol dependence syndrome was a major discriminating dimension.