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Affiliation(s)
- Diane Rae Davis
- Social work at Eastern Washington State University (MS 19, 526 Fifth St., Cheney, WA 99004–2431)
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Belmer A, Patkar OL, Pitman KM, Bartlett SE. Serotonergic Neuroplasticity in Alcohol Addiction. Brain Plast 2016; 1:177-206. [PMID: 29765841 PMCID: PMC5928559 DOI: 10.3233/bpl-150022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Alcohol addiction is a debilitating disorder producing maladaptive changes in the brain, leading drinkers to become more sensitive to stress and anxiety. These changes are key factors contributing to alcohol craving and maintaining a persistent vulnerability to relapse. Serotonin (5-Hydroxytryptamine, 5-HT) is a monoamine neurotransmitter widely expressed in the central nervous system where it plays an important role in the regulation of mood. The serotonin system has been extensively implicated in the regulation of stress and anxiety, as well as the reinforcing properties of all of the major classes of drugs of abuse, including alcohol. Dysregulation within the 5-HT system has been postulated to underlie the negative mood states associated with alcohol use disorders. This review will describe the serotonergic (5-HTergic) neuroplastic changes observed in animal models throughout the alcohol addiction cycle, from prenatal to adulthood exposure. The first section will focus on alcohol-induced 5-HTergic neuroadaptations in offspring prenatally exposed to alcohol and the consequences on the regulation of stress/anxiety. The second section will compare alterations in 5-HT signalling induced by acute or chronic alcohol exposure during adulthood and following alcohol withdrawal, highlighting the impact on the regulation of stress/anxiety signalling pathways. The third section will outline 5-HTergic neuroadaptations observed in various genetically-selected ethanol preferring rat lines. Finally, we will discuss the pharmacological manipulation of the 5-HTergic system on ethanol- and anxiety/stress-related behaviours demonstrated by clinical trials, with an emphasis on current and potential treatments.
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Affiliation(s)
- Arnauld Belmer
- Translational Research Institute, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Omkar L Patkar
- Translational Research Institute, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Kim M Pitman
- Translational Research Institute, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Selena E Bartlett
- Translational Research Institute, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
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Agley J, Gassman RA, Jun M, Nowicke C, Samuel S. Statewide Administration of the CRAFFT Screening Tool: Highlighting the Spectrum of Substance Use. Subst Use Misuse 2015; 50:1668-77. [PMID: 26579780 DOI: 10.3109/10826084.2015.1027930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adolescent alcohol and drug use in the United States are associated with negative consequences spanning multiple domains. Much of the public health surveillance of these behaviors relies on self-report survey data. These data frequently takes the form of frequency or prevalence data for specific substances, which may not provide a complete picture of use. OBJECTIVES This study analyzes a state-level survey that includes the CRAFFT screening tool. The study's goal is to elucidate the spectrum of substance use severity across a large segment of substance-using adolescents attending schools in the state of Indiana and to assess the contribution of a variety of predictor variables to the variance between users falling into each category of use severity. METHODS Data were collected in 2011 from 168,801 adolescents, of whom 25,204 met the inclusion criteria for this study. The authors utilize multinomial logit analyses to highlight variables, including sociodemographic data, poly-drug use, and risk/protective behavior scales, associated with each category of use. RESULTS Seriousness of use is not uniform across substance-using adolescents; 49% were categorized as nonproblem users, 33% as problem users, and 18% as dependent users. Risk and protective factors predict adolescents' severity of substance use, but do not do so uniformly. Poly-drug use is a significant predictor of problem use and dependent use as well. CONCLUSIONS The CRAFFT may provide a more nuanced perspective of adolescent substance use than frequency/prevalence data alone; the authors describe the implications derived from these data and analyses to the adolescent prevention and treatment systems.
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Affiliation(s)
- Jon Agley
- a School of Public Health , Indiana University , Bloomington , Indiana , USA
| | - Ruth A Gassman
- a School of Public Health , Indiana University , Bloomington , Indiana , USA
| | - Mikyoung Jun
- a School of Public Health , Indiana University , Bloomington , Indiana , USA
| | - Carole Nowicke
- a School of Public Health , Indiana University , Bloomington , Indiana , USA
| | - Susan Samuel
- a School of Public Health , Indiana University , Bloomington , Indiana , USA
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Long CG, Williams M, Hollin CR. Alcoholism Treatment: Intake Variables as Outcome Predictors. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/16066359808993308] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cisler RA, Berger LK. Assessing alcohol treatment composite outcome: Further evidence utilizing brief measures. J Ment Health 2009. [DOI: 10.1080/09638230120041407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Kampman KM, Pettinati HM, Lynch KG, Whittingham T, Macfadden W, Dackis C, Tirado C, Oslin DW, Sparkman T, O'Brien CP. A double-blind, placebo-controlled pilot trial of quetiapine for the treatment of Type A and Type B alcoholism. J Clin Psychopharmacol 2007; 27:344-51. [PMID: 17632217 PMCID: PMC3193934 DOI: 10.1097/jcp.0b013e3180ca86e5] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Atypical antipsychotics may be useful in the treatment of alcohol dependence. Human trials suggest that atypical antipsychotics may reduce alcohol craving and consumption, especially among patients with comorbid psychopathology. Therefore, these medications may be more useful for treating more severely affected alcoholics, such as patients with Type B alcoholism. Type B alcoholics are characterized by an early age of onset of problem drinking, high severity of alcohol dependence, increased psychopathology, and treatment-resistance. Quetiapine is an atypical antipsychotic with a favorable side effect profile, and may be a promising medication for the treatment of alcohol dependence, particularly Type B alcoholism. METHODS Male and female alcoholics (33 Type A and 28 Type B) were included in a 12-week, double-blind, placebo-controlled trial. After detoxification, patients were randomized to receive quetiapine (n = 29), 400 mg/d at bedtime, or placebo (n = 32). The primary outcome measure was the quantity and frequency of alcohol consumption, measured by the timeline follow back. RESULTS Forty-seven patients (77%) completed the trial, with no significant between-group differences in treatment retention. Nine quetiapine-treated patients (31%) maintained complete abstinence compared with 2 placebo-treated patients (6%) (chi(2) = 6.3, P = 0.012). There was a significant interaction between quetiapine and alcoholic subtype. As predicted, quetiapine- versus placebo-treated Type B alcoholics had significantly fewer days of drinking and fewer days of heavy drinking. Alcohol craving was also significantly reduced in quetiapine-treated compared with placebo-treated Type B alcoholics. Among Type A alcoholics, quetiapine provided no advantage over placebo in improving drinking outcomes. CONCLUSIONS Quetiapine may be effective for the treatment of alcohol dependence, particularly in the more complicated Type B, early-onset alcoholics.
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Affiliation(s)
- Kyle M Kampman
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Cisler RA, Kowalchuk RK, Saunders SM, Zweben A, Trinh HQ. Applying Clinical Significance Methodology to Alcoholism Treatment Trials: Determining Recovery Outcome Status with Individual- and Population-Based Measures. Alcohol Clin Exp Res 2005; 29:1991-2000. [PMID: 16340456 DOI: 10.1097/01.alc.0000187159.75424.77] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The current analysis applies clinical significance methodology to alcoholism treatment outcome research using data available from Project MATCH. Because of its high internal validity and its inclusion of multiple measures assessing multiple outcome dimensions, MATCH was considered an ideal study to explore the utility of this methodology. METHODS Data reported here are from a total of 1,726 participants enrolled in either aftercare (n = 774) or outpatient (n = 952) arms of the study. First, a cutoff score was determined differentiating functional versus dysfunctional status on three outcome measures: percent days abstinent (PDA), mean drinks per drinking day (DDD) and negative consequences of alcohol use. Second, the reliable change in pre- to post-treatment scores on these three measures was calculated. RESULTS The results reported herein support the importance of distinguishing between statistical and clinical significance of outcomes. During three months post-treatment, approximately one-half of the treated patients were "recovered" (i.e., both functional and reliably changed) with respect to both PDA (i.e., 51%) and negative consequences of drinking (i.e., 47%); however, only about one-third of individuals remained recovered throughout the full one-year follow-up period (i.e., 33% on PDA and 35% on negative consequences). These individual-based change outcomes compared similarly to a population-based indicator of heavy drinking. Alternatively, only about one-quarter of participants were recovered using two distinct criteria for mean DDD (i.e., 23-29%), and even fewer participants remained recovered on mean DDD over the full one-year follow-up period (i.e., about 14-18%). CONCLUSIONS Based on study limitations, more work is required to make clinical significance methodology practically useful to alcoholism treatment trials including more precise definitions of functional status and relative change as well as better interpretation of the inter-relationship between multiple measures assessing multiple outcome domains.
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Affiliation(s)
- Ron A Cisler
- Department of Health Sciences, University of Wisconsin-Milwaukee, WI 53233, USA.
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Hermos JA, Young MM, Gagnon DR, Fiore LD. Patterns of Dispensed Disulfiram and Naltrexone for Alcoholism Treatment in a Veteran Patient Population. Alcohol Clin Exp Res 2004; 28:1229-35. [PMID: 15318122 DOI: 10.1097/01.alc.0000134234.39303.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Short-term treatment trials indicate that two Food and Drug Administration-approved agents, disulfiram and naltrexone, may each curtail alcohol consumption, but two large 1-year Veterans Administration cooperative studies showed no long-term benefits for these agents over placebo. To assess whether these agents are being prescribed for extended periods, as an indicator of long-term use in nonexperimental settings, we compared dispensing patterns in a veteran patient population. METHODS The New England Veterans Integrated Service Network outpatient pharmacy files between January 1, 1998, and June 30, 2001, were analyzed; only patients with prescriptions on or after March 1, 1998, were included. Measurements for each patient included data on new and refilled prescriptions of disulfiram, naltrexone, and control medications. Prescription survival curves with right censoring were constructed. Distinct treatment episodes were defined by having six or more months between the end date of a prior prescription and the start date of a new prescription. RESULTS From eight New England Veterans Integrated Service Network centers, 754 patients were dispensed disulfiram, and 971 were dispensed naltrexone, encompassing 873 and 1075 treatment episodes, respectively. Treatment episode durations were virtually identical for both drugs: more than 35% of episodes were 1 month or shorter, more than 50% were 2 months or shorter, and 75% were 5 months or shorter. Concurrently prescribed neuroleptic or statin medications predicted longer disulfiram and naltrexone treatment episodes. However, for patients newly prescribed common neuroleptic, antidepressant, or statin agents, the risks for discontinuing disulfiram or naltrexone were 1.4 to 2.3 times greater than for discontinuing these other agents. CONCLUSIONS In clinical settings, veteran patients were likely to be dispensed either disulfiram or naltrexone for only several months or less. The contexts and reasons for these predominantly short-term treatment episodes or the benefits derived were not known and merit further study.
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Affiliation(s)
- John A Hermos
- Pharmacoepidemiology Research Project, Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Veterans Affairs Boston Healthcare System, Boston, Massachusetts 02130, USA.
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Pettinati HM, Kranzler HR, Madaras J. The status of serotonin-selective pharmacotherapy in the treatment of alcohol dependence. RECENT DEVELOPMENTS IN ALCOHOLISM : AN OFFICIAL PUBLICATION OF THE AMERICAN MEDICAL SOCIETY ON ALCOHOLISM, THE RESEARCH SOCIETY ON ALCOHOLISM, AND THE NATIONAL COUNCIL ON ALCOHOLISM 2003; 16:247-62. [PMID: 12638641 DOI: 10.1007/0-306-47939-7_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Research performed during the past 20 years has shown that serotonin (5-hydroxytryptamine; 5-HT) neurotransmission is related to alcohol dependence. Both theoretical and empirical research have supported the idea that alcohol dependence is a chronic disease and that, in addition, biological vulnerabilities contribute to the pathogenesis of alcohol dependence. Preclinical studies have consistently demonstrated that there is a relationship between 5-HT function and alcohol consumption. Furthermore, there is evidence building that lends support for the existence of distinct alcoholic subtypes that may be differentiated by the type or complexity of their 5-HT dysfunction. Beyond excessive drinking, behaviors that are indicators of 5-HT dysregulation are depression, anxiety, impulsiveness, and early-onset problem drinking. This chapter will discuss the usefulness of 5-HT-selective pharmacotherapy in treating alcohol dependence and will provide both historical and current perspectives on its use.
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Affiliation(s)
- Helen M Pettinati
- Center for the Study of Addictions, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Kranzler H, Lappalainen J, Nellissery M, Gelernter J. Association Study of Alcoholism Subtypes with a Functional Promoter Polymorphism in the Serotonin Transporter Protein Gene. Alcohol Clin Exp Res 2002. [DOI: 10.1111/j.1530-0277.2002.tb02675.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Davis WT, Campbell L, Tax J, Lieber CS. A trial of "standard" outpatient alcoholism treatment vs. a minimal treatment control. J Subst Abuse Treat 2002; 23:9-19. [PMID: 12127464 DOI: 10.1016/s0740-5472(02)00227-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study sought to examine the effectiveness of a "standard" outpatient alcoholism treatment (ST) program. An outpatient alcoholism treatment as it is commonly practiced in the US (with group and individual therapy, and an emphasis on Alcoholics Anonymous [AA]), was compared with a minimal treatment (MT) approach (weekly alcohol education movies). At 6 months, ST patients surpassed those in MT in terms of complete abstinence, reduction in amount of alcohol consumed, length of sobriety at follow-up, improvement in employment status, number of AA meetings attended, and lower initial drop-out. It is concluded that a ST approach is more helpful than MT in treating severely alcohol-dependent individuals who have not been able to cut down drinking on their own. Those already drinking less appeared to be helped by MT.
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Affiliation(s)
- William T Davis
- Alcohol Dependency Treatment Program, Department of Veterans Affairs Medical Center, 00MH, 130 W. Kingsbridge Road, Bronx, NY 10468, USA.
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Pettinati HM, Volpicelli JR, Luck G, Kranzler HR, Rukstalis MR, Cnaan A. Double-blind clinical trial of sertraline treatment for alcohol dependence. J Clin Psychopharmacol 2001; 21:143-53. [PMID: 11270910 DOI: 10.1097/00004714-200104000-00005] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clinical studies that have evaluated serotonergic medications to reduce alcohol consumption have yielded conflicting results. These studies primarily treated patients with alcohol dependence, excluding those with a current depressive disorder, in an effort to differentiate any medication effects directly on drinking from those on mood. Yet despite the exclusion of current depression, a group of alcohol-dependent patients who are not depressed can be highly heterogeneous. For example, this subgroup can include those with a lifetime depressive disorder. If these patients were more sensitive to serotonergic medications than patients without a lifetime depressive disorder, medication effects in a subgroup of patients who were not depressed could be obscured. Thus, the purpose of this study was to examine the efficacy of sertraline for treating alcohol dependence in patient groups that were differentiated by the presence or absence of lifetime depression. This study examined the effectiveness of sertraline (200 mg/day) or placebo for 14 weeks in 100 alcohol-dependent subjects with (N = 53) or without (N = 47) a lifetime diagnosis of comorbid depression. Sertraline treatment seemed to provide an advantage in reducing drinking in alcohol-dependent patients without lifetime depression, illustrated best with a measure of drinking frequency during treatment. However, sertraline was no better than placebo in patients with a diagnosis of lifetime comorbid depression, and current depression did not change the results. Treatment with selective serotonin reuptake inhibitors may be useful in alcohol-dependent patients who are not depressed. Subtyping those with alcohol dependence on the basis of the absence versus the presence of a lifetime depressive disorder may help to resolve conflicting findings in the literature on the treatment of alcohol dependence with serotonergic medications.
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Affiliation(s)
- H M Pettinati
- Center for the Study of Addictions, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, USA.
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Greenwood GL, Woods WJ, Guydish J, Bein E. Relapse outcomes in a randomized trial of residential and day drug abuse treatment. J Subst Abuse Treat 2001; 20:15-23. [PMID: 11239724 DOI: 10.1016/s0740-5472(00)00147-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Relapse outcomes at 6-, 12-, and 18-month intervals were compared between clients randomly assigned to day (n=114) versus residential (n=147) drug abuse treatment. Day clients were more likely than residential clients to relapse 6 months post-admission (OR=3.06, p<0.001); however, no setting differences at 12 or 18 months were found. Few baseline predictors were prospectively related to relapse at 12 and 18 months. These predictors were usual employment status (part-time OR=17.47, p<0.001; full-time OR=2.54, p<0.001), history of drug injecting (OR=5.39, p<0.01), multiple sex partners (OR=1.16, p<0.01), and not having a gay sexual partner (OR=0.05, p<0.03) during 6 months prior to admission. Still, these baseline predictors, together with the existing literature, could be used by drug treatment professionals to identify individuals who may be at high risk for relapse over time, and to offer specialized treatment and aftercare resources as intervention and prevention measures.
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Affiliation(s)
- G L Greenwood
- Center for AIDS Prevention Studies (CAPS), University of California, 74 New Montgomery, Ste. 502, San Francisco, CA 94105, USA.
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Abstract
Great strides have been made in recent years regarding the development and evaluation of treatments for cocaine dependence. In particular, several behavioral strategies have been developed with demonstrated effectiveness for diverse populations of cocaine-dependent individuals. These include contingency management, cognitive behavioral treatments, and manualized individual disease model approaches. In addition, large-scale client surveys have identified several correlates of good outcome in the treatment of cocaine dependence, including retention in treatment, increasing compliance, providing services and treatments that address the patient's comorbid psychosocial problems, and encouraging involvement in self-help groups. Finally, greater adoption by treatment providers of strategies commonly used in treatment efficacy research might also contribute to improved treatment quality.
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Affiliation(s)
- K M Carroll
- Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut 06519, USA.
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Shen Q, McLellan AT, Merrill JC. Client's Perceived Need for Treatment and Its Impact on Outcome. Subst Abus 2000; 21:179-192. [PMID: 12466658 DOI: 10.1080/08897070009511431] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives. Based on the concept of "stage of change," this study examines the relationship between patients' motivation for substance abuse treatment and their posttreatment improvements in the areas measured by the Addiction Severity Index (ASI; alcohol, drug, medical, psychiatric). We attempt to answer the following questions: Do clients' perceptions of "need for drug, alcohol, psychiatric, and medical treatment" at admission predict their improvements on these problems at 6-month follow-up? How do clients' perceived needs contribute to their use of treatment and their reported change? Methods. Clinical interview data (N = 696) collected using the ASI from the Target Cities Project in the city of Philadelphia in 1993 and 1995. Results. Clients' motivation made a substantial difference in their improvement following treatment in all problem areas. Clients who said treatment was even slightly important on the ASI at admission made more changes than clients who reported that treatment was "not at all" important. Even when the motivation groups were approximately equated for lifetime problem severity there was still a significant effect of recent motivation as expressed on the ASI. Conclusions. These data are consistent with other findings from the "stage of change" literature suggesting that treatment is only important for patients who are ready or at least somewhat motivated to receive it. These findings underscore the importance of efforts to increase patients' readiness for treatment in order to achieve better treatment effects.
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Affiliation(s)
- Quansheng Shen
- Treatment Research Institute, University of Pennsylvania, Philadelphia, Pennsylvania
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Pettinati HM, Volpicelli JR, Kranzler HR, Luck G, Rukstalis MR, Cnaan A. Sertraline Treatment for Alcohol Dependence: Interactive Effects of Medication and Alcoholic Subtype. Alcohol Clin Exp Res 2000. [DOI: 10.1111/j.1530-0277.2000.tb04648.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weaver GD, Turner NH, O'Dell KJ. Depressive symptoms, stress, and coping among women recovering from addiction. J Subst Abuse Treat 2000; 18:161-7. [PMID: 10716099 DOI: 10.1016/s0740-5472(99)00031-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This article focuses on the variability in well-being of 102 women in continuous recovery from addiction for 1 to 5 years. Univariate and bivariate analyses of cross-sectional data on recent depressive symptomatology, and psychosocial stress and coping strategies before and during recovery yielded the following findings: (a) Nearly a third of the sample reported scores above the 16-point cut-off on the Center for Epidemiologic Studies Depression Scale, indicating risk for depression; (b) over half had a history of diagnosed depression; (c) perceived stress in 16 life domains significantly decreased from prerecovery to recovery; (d) by recovery, participants significantly increase their use of positive strategies, but they continued use some negative ones; and (e) risk for high depressive symptomatology was greatest among those who were married or cohabiting, had a history of clinical of depression, high perceived stress in areas of money and emotional and physical health. Findings are discussed in terms of their implications for treatment and aftercare.
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Affiliation(s)
- G D Weaver
- Department of Health Promotion and Gerontology, School of Allied Health Sciences, University of Texas Medical Branch, Galveston 77555-1028, USA.
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Duckert F. What kind of changes can be expected in drinking patterns after treatment? NORDIC STUDIES ON ALCOHOL AND DRUGS 2000. [DOI: 10.1177/145507250001701s20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Graham K, Gillis K. The relationship between psychosocial well-being and alcohol and drug use following substance misuse treatment. Subst Use Misuse 1999; 34:1199-222. [PMID: 10419220 DOI: 10.3109/10826089909039405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The relationship between psychosocial status and alcohol and drug use at 12-month follow-up was evaluated for clients of two addictions treatment programs (90 treated for alcohol; 51 for drugs or drugs and alcohol). Psychosocial status at follow-up was mostly unrelated to alcohol use among clients who were not using drugs prior to treatment. Among drug users, returning to both alcohol and drug use was strongly associated with poorer psychosocial status, with partial correlational analyses indicating that (a) drug use was the main factor associated with poorer status and (b) poorer status was likely a consequence rather than a precursor of drug use. The implications of these findings are discussed.
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Affiliation(s)
- K Graham
- Addiction Research Foundation, London, Ontario, Canada.
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Mason BJ, Kocsis JH, Melia D, Khuri ET, Sweeney J, Wells A, Borg L, Millman RB, Kreek MJ. Psychiatric comorbidity in methadone maintained patients. J Addict Dis 1998; 17:75-89. [PMID: 9789161 DOI: 10.1300/j069v17n03_07] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Diagnosing comorbid psychiatric disorders in methadone maintained patients may help to identify subgroups with different outcomes and needs for treatment. In this study, 75 methadone maintenance clinic patients in treatment longer than 30 days were assessed with the Addiction Severity Index, Global Assessment Scale and Mini-Mental Status Exam, and were interviewed for DSM-III-R psychiatric diagnosis using the computerized Diagnostic Interview Schedule. Psychiatric diagnoses were prevalent in the sample with depression, phobic disorders, antisocial personality and generalized anxiety the most common. Both number of DSM-III-R diagnoses and severity of psychopathology were correlated with outcome measures such as concurrent drug abuse, family-social problems and employment status.
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Affiliation(s)
- B J Mason
- Laboratory of the Biology of Addictive Diseases, Rockefeller University, New York, NY, USA
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Smith JW, Frawley PJ, Polissar NL. Six- and twelve-month abstinence rates in inpatient alcoholics treated with either faradic aversion or chemical aversion compared with matched inpatients from a treatment registry. J Addict Dis 1997; 16:5-24. [PMID: 9046442 DOI: 10.1300/j069v16n01_02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Two hundred forty-nine patients who were treated for alcoholism in an inpatient multimodal treatment program that included aversion therapy were matched post hoc on 17 baseline variables with patients from a national treatment outcome registry. The latter patients received inpatient treatment that emphasized individual and group counseling as the primary therapeutic elements but did not include aversion therapy for alcohol. Six- and 12-month abstinence rates from alcohol and all mood-altering chemicals are reported. The patients treated with aversion therapy for alcohol had higher alcohol abstinence rates at 6 and 12 months (p < 0.01). The abstinence rates from all mood-altering chemicals were higher in the aversion group at 6 months (p < 0.05) but not at 12 months. These comparisons pooled faradic aversion and chemical aversion results. In order to determine whether or not the faradic aversion gave comparable results to the chemical aversion, the two groups were separately analyzed. No significant differences in outcome were found. In fact, the faradic aversion group showed a slight (nonsignificant) increase in abstinence rate.
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Affiliation(s)
- J W Smith
- Schick Shadel Hospital, Seattle, WA 98146, USA
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Zweben A, Cisler R. Composite outcome measures in alcoholism treatment research: problems and potentialities. Subst Use Misuse 1996; 31:1783-805. [PMID: 8958638 DOI: 10.3109/10826089609064001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Alcoholism treatment researchers have increasingly incorporated multiple measures representing multiple dimensions in assessing treatment outcomes. However, no satisfactory model exists for examining the dynamic interrelationships of multiple measures in determining clinically meaningful and interpretable outcomes. One approach to analyzing multiple outcomes is to combine them into a composite measure. In their most elementary form, composite measures combine alcohol consumption and consumption-related problems dimensions into treatment outcome classifications. This paper discusses conceptual and methodological issues in studies reporting composite outcomes and provides a model and recommendations for using composite measures in alcohol treatment research.
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Affiliation(s)
- A Zweben
- Center for Addiction and Behavioral Health Research, School of Social Welfare, University of Wisconsin-Milwaukee 53201-0786, USA
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24
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Abstract
This study presents a review of existing human studies that examine the role of serotonin [5-hydroxytryptamine (5-HT)] selective agents in the treatment of alcohol dependence. Findings of abnormally low 5-HT levels in many alcohol-dependent patients led investigators to explore the use of 5-HT selective pharmacotherapy in the treatment of alcoholism. Several studies reported that the administration of 5-HT selective pharmacological agents to alcohol-dependent patients effectively reduced alcohol intake, although results have been relatively modest. The most recent study by Kranzler et al. (Am. J. Psychiatry 152:391-397, 1995) found no added benefit over cognitive-behavioral treatment. However, the original relationship between the presence of alcohol dependence and low 5-HT levels in the brains of patients with alcoholism was predicated on subtypes of alcohol dependence. Research has suggested that 5-HT plays an important role in some forms of alcoholism that may be genetically or developmentally mediated. Thus, additional studies are needed to determine if treatment with 5-HT selective agents is viable therapeutic option for alcoholism, specifically in types of alcohol-dependent patients who are most likely to benefit from treatment with 5-HT selective pharmacotherapy.
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Affiliation(s)
- H M Pettinati
- Addiction Treatment Research Center, University of Pennsylvania, Philadelphia 19104-6178, USA
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25
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Schneider KM, Kviz FJ, Isola ML, Filstead WJ. Evaluating multiple outcomes and gender differences in alcoholism treatment. Addict Behav 1995; 20:1-21. [PMID: 7785474 DOI: 10.1016/0306-4603(94)00037-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study followed 592 alcoholics (180 women and 412 men) after discharge from inpatient treatment. Multiple measures of treatment outcome were used to broaden our understanding of the process of recovery from alcohol abuse, and how that process differs for men and women. Patients were interviewed by telephone between 3 and 15 months after discharge to gather information about post-treatment experiences including: relationship with family, role performance, psychological impairment, and effort toward recovery. Additionally, if any alcohol use took place after treatment, information was collected about the pattern of alcohol consumption. Results indicated being married is consistently related to less drinking for men, while for women, being married contributes to relapse in the short term. The determinants of each measure of outcome were different for women and men, indicating that the process of recovery is not the same for both genders. The study confirms that drinking is related to other adverse outcomes for men, but not necessarily for women. It is evidence that women and men have different post-treatment functioning, and that different characteristics are predictive of these outcomes.
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Affiliation(s)
- K M Schneider
- School of Public Health, University of Illinois at Chicago, USA
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26
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Abstract
The "matching hypothesis"--the concept that treatment will be improved if matched to individual needs or characteristics--has, over recent years, attracted attention, and some research to test its validity has been conducted. These studies are briefly reviewed and an analysis then reported which focuses on exploration of the possible interaction between treatment intensity, patient characteristics with particular reference to degree of dependence on alcohol, and 12-month treatment outcome. The data derive from a controlled trial in which patients were randomized between "Treatment" and "Advice". No significant interactions of the kind postulated were identified and, at least for this data set, the matching hypothesis is not confirmed. Possible interpretations of these findings are discussed.
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Affiliation(s)
- G Edwards
- National Addiction Centre, Institute of Psychiatry, London, UK
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27
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Wing DM. Applying the "Model of recovering alcoholics' behavior stages and goal setting" to nursing practice. Arch Psychiatr Nurs 1993; 7:197-202. [PMID: 8239722 DOI: 10.1016/0883-9417(93)90027-t] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In 1990, the author developed the Model of Recovering Alcoholics' Behavior Stages and Goal Setting as a result of grounded theory research. The model explains the natural progression of recovery through four behavior stages. Each stage is characterized by specific patient goals. Application of the model provides a framework for nursing care planning that is both stage-focused and patient-centered. In this article, the author discusses nursing intervention in relation to the model.
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Affiliation(s)
- D M Wing
- University of Tulsa, School of Nursing, OK 74104-3189
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28
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Smith JW, Frawley PJ. Treatment outcome of 600 chemically dependent patients treated in a multimodal inpatient program including aversion therapy and pentothal interviews. J Subst Abuse Treat 1993; 10:359-69. [PMID: 8105103 DOI: 10.1016/0740-5472(93)90021-s] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A sample of 600 patients treated in a multimodal treatment program using aversion therapy and narcotherapy at three Schick freestanding addiction treatment hospitals and one Schick unit in a general hospital were followed-up. Contact was made a minimum of 12 months and as many as 20 months after completion of treatment (mean 14.7 mos.). Telephone contact was made by an independent research organization with 427 of the patients (71.2%). Of these, 65.1% were totally abstinent for 1 year after treatment and 60.2% were abstinent until follow-up a mean of 14.7 months later. Fifty-two percent of the alcoholics were using or dependent on other drugs at admission. Seventy-five of these treated for cocaine dependence and 47 treated for marijuana dependence. The cocaine 12 month and "total" abstinence (mean 14.7 mos.) rates for the 49 contacted patients were 83.7% and 81.6%, respectively. The marijuana 12 month and "total" abstinence (mean 14.7 mos.) rates for the 30 contacted patients was 70.0% for both groups. Abstinence rates for alcohol and/or other drugs were also calculated including noncontacted patients who had chart documented evidence of relapse. The most powerful predictor of success was whether or not all urges to drink or use had been eliminated (presumably by aversion therapy). Of additional importance was the use of support groups and reinforcement treatments after completion of the initial hospitalization. The two most prominent factors initiating a relapse were "intrapersonal determinants" such as stress from work or marriage/family relationships and "interpersonal determinants" such as being around others who were drinking/using or being at a celebration or special event. The two factors were of equal importance in the alcoholics. However, interpersonal determinants were far more important in the cocaine and marijuana treated patients. Increased utilization of reinforcement treatments was associated with decreased urges to drink/use and increased abstinence rates. In contrast, increased frequency of support group utilization was associated with increased urges to drink/use and lower abstinence rates. This suggests the need to take seriously patient reports of "urges" in the first year after treatment and to carefully assess the cause and initiate or update an individualized plan of treatment. Such treatment may include increased reinforcement treatments, treatment of depression, and additional assistance in coping with intrapersonal and interpersonal determinants of relapse.
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Affiliation(s)
- J W Smith
- Schick Shadel Hospital of Seattle, WA 98146
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29
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Duckert F. Predictive factors for outcome of treatment for alcohol problems. JOURNAL OF SUBSTANCE ABUSE 1993; 5:31-44. [PMID: 8329879 DOI: 10.1016/0899-3289(93)90121-q] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Two samples of problem drinkers were followed up 2 and 4 years after they completed treatment. The first consisted of 72 men and 16 women admitted to a program for alcoholics (the inpatient sample), and the second, of 57 men and 35 women who participated in a program of outpatient treatment (the outpatient sample). At start of treatment, the outpatient sample, was generally characterized by a higher degree of social integration and more moderate alcohol problems than those found in the inpatient sample. These differences were sustained during the part of the follow-up period for which comparative data existed. In both samples it was possible to identify subgroups whose alcohol consumption throughout the observation period did not exceed average consumption in a comparative group of the Norwegian population. The most important predictive factors for alcohol consumption in the inpatient sample were degree of social integration, consumption before start of treatment, and sex. In the outpatient sample the most important factors were level of consumption and relative contribution of heavy drinking to the drinking pattern before start of treatment and the client's own goals as regards to alcohol. In both samples there was a close connection between alcohol consumed, total situation, and individual degree of satisfaction. For both groups, less frequent drinking and reduction of heavy drinking were most important for feeling satisfied with the drinking outcome. The therapeutic implications of the qualitative changes in drinking patterns are discussed.
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Affiliation(s)
- F Duckert
- University of Oslo, Institute of Psychology, Norway
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Litten RZ, Allen JP. Reducing the desire to drink. Pharmacology and neurobiology. RECENT DEVELOPMENTS IN ALCOHOLISM : AN OFFICIAL PUBLICATION OF THE AMERICAN MEDICAL SOCIETY ON ALCOHOLISM, THE RESEARCH SOCIETY ON ALCOHOLISM, AND THE NATIONAL COUNCIL ON ALCOHOLISM 1993; 11:325-44. [PMID: 8234930 DOI: 10.1007/978-1-4899-1742-3_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The past decade has witnessed major advances in understanding of neural functioning and neurobiological bases of alcohol consumption. Concurrent with this, a range of exciting investigations have been conducted on pharmacologic agents that may curb drinking behavior. Research is reviewed on several promising medications influencing neurotransmitter and endocrine systems with particular attention to the serotonergic and opioid systems. Following this overview, recommendations are offered regarding research methodology to support future pharmacotherapy trials.
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Affiliation(s)
- R Z Litten
- Treatment Research Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland 20857
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31
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Stephens RS, Wertz JS, Roffman RA. Predictors of marijuana treatment outcomes: the role of self-efficacy. JOURNAL OF SUBSTANCE ABUSE 1993; 5:341-53. [PMID: 8186669 DOI: 10.1016/0899-3289(93)90003-t] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study tested the ability of sets of demographic, socioeconomic, marijuana use/abuse, psychological distress, and self-efficacy variables to predict posttreatment indices of marijuana intake and problems related to use. Subjects were 167 adults who participated in one of two outpatient treatments for marijuana dependence and completed the 3-, 6-, and 12-month posttreatment follow-ups. Only pretreatment marijuana quantity-frequency of intake and self-efficacy variables made significant and consistent contributions to the regression equations predicting posttreatment frequency of use. In contrast, socioeconomic and severity of abuse indicators predicted posttreatment marijuana-related problems. Contrary to social cognitive theory (Bandura, 1986), there was no evidence that self-efficacy mediated the effects of other predictors. Results are discussed in terms of the specificity of predictor-outcome relationships and the need for improvements in self-efficacy measurement.
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Affiliation(s)
- R S Stephens
- Virginia Polytechnic Institute and State University, Department of Psychology, Blacksburg 24061-0436
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32
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Babor TF, Dolinsky ZS, Meyer RE, Hesselbrock M, Hofmann M, Tennen H. Types of alcoholics: concurrent and predictive validity of some common classification schemes. BRITISH JOURNAL OF ADDICTION 1992; 87:1415-31. [PMID: 1330126 DOI: 10.1111/j.1360-0443.1992.tb01921.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study evaluated the discriminative power and predictive validity of five common typological schemes used to classify alcoholics for theoretical or clinical purposes. A heterogenous sample of 321 alcoholics was classified according to primary vs secondary alcoholism, parental alcoholism, Fellinek's gamma-delta distinction, gender, and subtypes derived from MMPI profiles. A prospective longitudinal cohort design was employed to compare the relative ability of these typologies to differentiate alcoholics according to natural history, alcohol-related consequences, response to treatment, and post-treatment adjustment. The findings indicate that while 'one-dimensional' typologies discriminate subgroups in terms of etiological variables, presenting symptoms, and drinking patterns, none of the classification systems emerges as a strong predictor of outcome status. In addition, these typologies do not discriminate well with respect to the alcoholic's drinking patterns and presenting symptoms, except in areas closely connected with the model (e.g. alcoholics with antisocial personality (ASP) indicate more social problems related to alcohol use than do primary alcoholics). Because there is a great deal of overlap among certain subtypes identified within different typological models (e.g. alcoholics with primary ASP tended to have a positive family history and a gamma pattern of impaired control), we hypothesize that empirical clustering techniques that search for naturally occurring commonalities among alcoholics may be a better way to identify homogeneous subtypes.
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Affiliation(s)
- T F Babor
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington 06030-1410
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33
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Smith JW, Frawley PJ, Polissar L. Six- and twelve-month abstinence rates in inpatient alcoholics treated with aversion therapy compared with matched inpatients from a treatment registry. Alcohol Clin Exp Res 1991; 15:862-70. [PMID: 1755521 DOI: 10.1111/j.1530-0277.1991.tb00614.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Two hundred forty-nine patients who were treated for alcoholism in an inpatient multimodal treatment program that included aversion therapy were matched post hoc on 17 baseline variables with patients from a national treatment outcome registry. The latter patients received inpatient treatment that emphasized individual and group counseling as the primary therapeutic elements but did not include aversion therapy for alcohol. Six- and 12-month abstinence rates from alcohol and all mood-altering chemicals are reported. The patients treated with aversion therapy for alcohol had higher alcohol abstinence rates at 6 and 12 months (p less than 0.01). The abstinence rates from all mood-altering chemicals were higher in the aversion group at 6 months (p less than 0.05) but not at 12 months. The largest differences between treatment groups in 6-month alcohol abstinence rates were noted for males (p less than 0.001), those over 35 (p less than 0.001), daily drinkers (p less than 0.001), and those with alcohol-related work performance problems (p less than 0.05).
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Affiliation(s)
- J W Smith
- Schick Shadel Hospital of Seattle, Washington 98146
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34
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Abstract
Evaluation of alcoholism treatment effectiveness needs to be based on the healthy goals that alcoholics themselves identify as important. This research uses ethnography and grounded-theory methods to develop a model of recovering alcoholics' goal progression. The author spent 28 days in a treatment center, engaging in all patient activities, and observed and interviewed 42 participants to determine what they wanted from treatment. The research indicates that recovering alcoholics' goals develop through four stages. Certain kinds of behavior must be accomplished for an alcoholic to move from one stage to another. Behavior that facilitates and inhibits goal progression is identified.
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Affiliation(s)
- D M Wing
- School of Nursing, University of Wisconsin, Milwaukee 53201
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35
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Glenn SW, Parsons OA. Prediction of resumption of drinking in posttreatment alcoholics. THE INTERNATIONAL JOURNAL OF THE ADDICTIONS 1991; 26:237-54. [PMID: 1889923 DOI: 10.3109/10826089109053186] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The ability of five factors (depressive symptomatology, neuropsychological performance, psychosocial maladjustment, previous treatment history, and childhood attention deficit disorder symptomatology) to predict relapse was examined in a follow-up experimental design. Fifty-eight male and 45 female alcoholics were interviewed immediately following release from inpatient treatment units. Fourteen months later, 41 subjects (41%) were classified as resumers; 62 (59%) were abstainers. Resumers showed significantly poorer scores than abstainers on all five of the predictor variables. Discriminant function analysis resulted in 75% correct classification of resumers and abstainers (chi 2 = 22.1, p less than .001). Stepwise multiple regression resulted in isolation of depressive symptomatology as the best single predictor of relapse.
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Affiliation(s)
- S W Glenn
- Oklahoma Center for Alcohol and Drug-Related Studies, University of Oklahoma Health Sciences Center, Oklahoma City 73104
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36
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Hesselbrock MN. Gender comparison of antisocial personality disorder and depression in alcoholism. JOURNAL OF SUBSTANCE ABUSE 1991; 3:205-19. [PMID: 1668227 DOI: 10.1016/s0899-3289(05)80037-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study compared male and female alcoholics in terms of family history of alcoholism, Antisocial Personality (ASP), and depression on the course, consequences, and 1-year treatment outcome. The sample included 266 subjects (197 men and 69 women) who were hospitalized for treatment of alcoholism from three facilities in the greater Hartford area. Female alcoholics reported higher rates of alcoholism among their fathers than men across all diagnostic categories. Both male and female alcoholics who were diagnosed as having ASP reported higher alcoholism among their fathers than those with depression or no other diagnoses. Male alcoholics reported a longer duration of alcohol abuse and a higher number of lifetime alcohol-related problems than women. Subjects with ASP reported more childhood behavior problems, higher levels of alcohol consumption, and more affective and physical disturbances in the month prior to hospitalization whereas no gender differences were found on those variables. ASP alcoholics reported poorer 1-year treatment outcomes than non-ASP alcoholics. Males who were diagnosed as having depression tended to relapse, although the diagnosis of depression tended to modify the rate of relapse among women. The rate of depression was higher among women than men at the 1-year follow-up.
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Affiliation(s)
- M N Hesselbrock
- School of Social Work, University of Connecticut, West Hartford 06117-2698
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37
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Akerlind I, Hörnquist JO, Elton M, Bjurulf P. Overall functioning and criteria of progress in rehabilitation of alcohol abusers: longitudinal analyses of changes. Alcohol Clin Exp Res 1990; 14:856-62. [PMID: 2088121 DOI: 10.1111/j.1530-0277.1990.tb01828.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim was to compare alcohol consumption and vocational adjustment as criteria of rehabilitation progress of alcoholics, with regard to links to concomitant changes in functioning in other life areas. Thirty-four advanced alcohol abusers in rehabilitation were examined twice with an interval of 2 years between each examination. Change scores in alcohol consumption and work capacity were correlated with change scores in social network, activities, life-satisfaction, psychological well-being, psychiatric symptoms, and biomedical functioning. Improved drinking habits were connected with some changes in overall functioning, however not solely in a favorable direction. Negative mood changes were especially noteworthy. Improvements in vocational adjustment, on the other hand, appeared to be somewhat more unequivocally and encompassingly associated with amelioration in the wider range of functioning. The results indicate that drinking measures alone are not sufficient indicators of progress in rehabilitation and underscores the need of more global criteria of general adjustment.
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Affiliation(s)
- I Akerlind
- Department of Community Medicine, Faculty of Health Sciences, Linköping University, Sweden
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39
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Drummond DC. The relationship between alcohol dependence and alcohol-related problems in a clinical population. BRITISH JOURNAL OF ADDICTION 1990; 85:357-66. [PMID: 2334822 DOI: 10.1111/j.1360-0443.1990.tb00652.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The relationship between alcohol dependence and alcohol-related problems was studied in a group of 103 problem drinkers. Responses to a 46-item Alcohol Problems Questionnaire (APQ) were compared with the Severity of Alcohol Dependence Questionnaire (SADQ), alcohol consumption and demographic data. A strongly positive correlation was found between aggregate problems and dependence scores (r = 0.63; p = 0.001) which existed independently of the quantity of alcohol consumed. Analysis of questionnaire subscales revealed that certain problem domains were more closely related to particular aspects of dependence than others. A higher level of problems was found in subjects of younger age and lower socio-economic class. No significant sex differences were found. The implications of these findings are discussed.
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Affiliation(s)
- D C Drummond
- Addiction Research Unit, Institute of Psychiatry, London, UK
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40
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Smith JW, Frawley PJ. Long-term abstinence from alcohol in patients receiving aversion therapy as part of a multimodal inpatient program. J Subst Abuse Treat 1990; 7:77-82. [PMID: 2167389 DOI: 10.1016/0740-5472(90)90002-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A sample of 200 patients who had been treated for alcoholism in a multimodal inpatient program that used aversion therapy as a treatment component was selected for outcome evaluation. One hundred sixty (80%) were located. A minimum of 13 months had elapsed since treatment (mean 20.5 months) collateral reports were used to verify self-reports in 36% of the cases. Abstinence status was determined for the first 12 months since treatment, the entire elapsed time since treatment (range 13 to 25 months, mean 20.5 months), and "current abstinence" (last 6 months). The abstinence rate for the first 12 months was 71.3%; for the total period since treatment, the rate was 65% (mean 20.5 months); the current abstinence rate was 78.1%. The data was also viewed from other perspectives. The findings of this study suggest that a multimodal alcoholism treatment program utilizing aversion conditioning is at least as acceptable to patients as counseling centered programs and can be expected to yield favorable abstinence rates.
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Affiliation(s)
- J W Smith
- Schick Health Services, Seattle, WA 98146
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41
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Abstract
A cross-sectional study of alcoholics who varied widely in duration of abstinence was combined with a four-year follow-up study of the same subjects. Together, the data demonstrated a course of recovery in abstinent alcoholics measured in three ways: severity of symptoms, probability of relapse, and work history. Additionally, the subjects showed high rates of smoking cessation. By every measure, the course of recovery seemed essentially the same in men and women. The recovery process was most rapid in the early years of abstinence but continued for 10 or more years. It was suggested that keys to full recovery in alcoholics are abstinence and time, which are necessary for recovery from a protracted withdrawal syndrome and brain dysfunction, for the repair of social relationships, for vocational rehabilitation, and for abstinence itself to become stable.
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Affiliation(s)
- C B De Soto
- Department of Psychology, Johns Hopkins University, Baltimore, Maryland 21218
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