Alcoholism: a long-term follow-up study of participants in an alcohol treatment programme

Personality traits as predictors of recovery among patients with substance use disorder

INTRODUCTION

Substance use disorder (SUD) is often considered a chronic illness in which prolonged recovery, in terms of abstinence, is uncommon. Personality has been found to predict recovery, but not much is known about its long-term predictive ability as the majority of previous studies have had short follow-up periods (≥ one year). The current longitudinal cohort study therefore investigated whether personality traits predict short- (STR) as well as long-term recovery (LTR) in SUD patients.

METHODS

Treatment-seeking patients with SUD (n = 123) completed the NEO Personality Inventory - Revised. STR and LTR categories were defined as scoring <8 on the Alcohol Use Disorders Identification Test - C and <2 on the Drug Use Disorder Identification Test - C at the one-year and 6-8-year follow-up, respectively. Whether personality traits predicted outcome was investigated by two-tailed independent samples t-tests, α < 0.05. Additional analysis was conducted with latent growth curve model.

RESULTS

Neuroticism (inversely, p = .004, d = 0.55) and Extraversion (p = .04, d = 0.38) predicted STR (n = 114). Although not significant the effect size for Conscientiousness was above the cut-off for a practical significant effect (d = 0.31). No traits predicted LTR category. Still, the effect sizes for LTR regarding Neuroticism (d = 0.36), Extraversion (d = 0.21) and Conscientiousness (d = 0.27) indicated that these traits have relevance for LTR. The latent growth curve model indicated that these traits predicted the short-term use of drugs and long-term use of alcohol in this cohort dominated by patients suffering from severe poly-SUD.

CONCLUSION

Personality traits predict recovery. The effect sizes indicate that more studies with larger samples on personality traits and LTR are required to understand their possible influences on the recovery process.

Psychometric properties of a Recovery Empowerment Scale: Testing emotional, cognitive, behavioral, and relational domains

Psychological empowerment (PE) is a multidimensional construct comprised of emotional, cognitive, behavioral, and relational domains. Although context-specific measures of PE exist, no study to date has introduced and tested a measure of the construct that captures all four domains for both women and men in recovery from substance misuse. Furthermore, research has largely neglected the relational dimension, particularly in studies involving people in recovery. In this study, we tested a measure of PE among a diverse sample (n = 200) of people in recovery who participated in a program designed to expand access to medications for opioid use disorder in the northeastern United States. Factor analysis results supported the hypothesized four-factor structure of the scale, and dimensions of PE were found to be associated in expected ways with measures of quality of life, self-reported health, and depression. Implications of the study are described and directions for future research discussed.

Exercise as a Useful Intervention to Reduce Alcohol Consumption and Improve Physical Fitness in Individuals With Alcohol Use Disorder: A Systematic Review and Meta-Analysis

Objective: This meta-analysis and systematic review examined the effects of exercise interventions on alcohol consumption and binge drinking in individuals with alcohol use disorder (AUD). Data sources: PubMed, Web of Science, Google Scholar, SPORTDiscus, and ERIC databases. Study Inclusion and Exclusion Criteria: Peer-reviewed randomized controlled trials published in English between 1970 and 2021. All studies compared exercise (Ex) and treatment as usual (TAU) to TAU in adults with an alcohol-related diagnosis. All forms of exercise interventions were included (e.g., aerobic exercise, yoga, resistance exercise, etc.). Data Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols standard and the Meta-Analyses and Systematic Reviews of Observational Studies guidelines were followed. Risk of bias was assessed using the Cochrane risk-of-bias tool as described by the Cochrane Handbook for Systematic Reviews and Interventions. Results: The literature searches retrieved a combined 2527 studies, with 1,034 studies screened after removal of duplicates and 973 (94%) rejected after reviewing titles and abstracts. Full-text review was performed on 61 studies, with seven studies meeting inclusion criteria for qualitative and meta-analysis. Across seven studies (n = 492 participants), a significant effect (Z-value = -3.37; g = -0.30; 95% CI [-0.50--0.09]; p = 0.001) was found for Ex+TAU on drinking volume. There was no effect of Ex+TAU on binge drinking. The effect of Ex+TAU on physical fitness (VO2max, ml•kg-1•min-1) was significant (Z-score = 3.70; g = 0.64; 95% CI [0.19-1.08]; p < 0.001). Conclusions: Exercise interventions may decrease alcohol consumption and improve fitness and can be an effective adjunctive treatment for individuals with alcohol-related diagnoses including AUD.

Iatrogenic effects of psychosocial interventions: treatment, life context, and personal risk factors

Between 7% and 15% of individuals who participate in psychosocial interventions for substance use disorders may be worse off after treatment than before. Intervention-related predictors of iatrogenic effects include lack of bonding; lack of goal direction and monitoring; confrontation, criticism, and high emotional arousal; models and norms for substance use; and stigma and inaccurate expectations. Life context and personal predictors include lack of support, criticism, and more severe substance use and psychological problems. Ongoing monitoring and safety standards are needed to identify and counteract adverse consequences of intervention programs.

Individuals receiving addiction treatment: are medical costs of their family members reduced?

AIMS

To examine whether alcohol and other drug (AOD) treatment is related to reduced medical costs of family members.

DESIGN

Using the administrative databases of a private, integrated health plan, we matched AOD treatment patients with health plan members without AOD disorders on age, gender and utilization, identifying family members of each group.

SETTING

Kaiser Permanente Northern California.

PARTICIPANTS

Family members of abstinent and non-abstinent AOD treatment patients and control family members.

MEASUREMENTS

We measured abstinence at 1 year post-intake and examined health care costs per member-month of family members of AOD patients and of controls through 5 years. We used generalized estimating equation methods to examine differences in average medical cost per member-month for each year, between family members of abstinent and non-abstinent AOD patients and controls. We used multilevel models to examine 4-year cost trajectories, controlling for pre-intake cost, age, gender and family size.

RESULTS

AOD patients' family members had significantly higher costs and more psychiatric and medical conditions than controls in the pre-treatment year. At 2-5 years, each year family members of AOD patients abstinent at 1 year had similar average per member-month medical costs to controls (e.g. difference at year 5 = $2.63; P > 0.82), whereas costs for family members of non-abstinent patients were higher (e.g. difference at year 5 = $35.59; P = 0.06). Family members of AOD patients not abstinent at 1 year, had a trajectory of increasing medical cost (slope = $10.32; P = 0.03) relative to controls.

CONCLUSIONS

Successful AOD treatment is related to medical cost reductions for family members, which may be considered a proxy for their improved health.

Three-year changes in adult risk drinking behavior in relation to the course of alcohol-use disorders

OBJECTIVE

This study examines the associations between the course of alcohol-use disorder (AUD) and changes in average daily volume of ethanol intake, frequency of risk drinking, and maximum quantity of drinks consumed per day over a 3-year follow-up interval in a sample of U.S. adults.

METHOD

Data were taken from a longitudinal study of a nationally representative sample of U.S. adults, who were 18 years of age and older (mean age = 46.4) when initially interviewed in 2001-2002 and successfully reinterviewed approximately 3 years later (n = 22,245 baseline drinkers). The time reference period for the drinking measures was the 12 months preceding the interview. Changes in consumption reflect differences between Wave 1 and Wave 2 measures for individuals with nonmissing values at both Waves (n = 22,003 for volume of intake, 22,132 for frequency of risk drinking and 21,942 for maximum quantity of drinks).

RESULTS

There were positive changes in all consumption measures associated with developing an AUD and negative changes associated with remission of an AUD, even among individuals who continued to drink. Increases and decreases associated with onset and offset of dependence exceeded those associated with onset/ offset of abuse only, and the decreases associated with full remission from dependence exceeded those associated with partial remission. There were few changes in consumption among individuals whose AUD status did not change. Interactions of AUD transitions with other factors indicate that development of an AUD is associated with a greater increase in consumption among men, possibly reflecting their greater total body water and lower blood alcohol concentration in response to a given dose of ethanol, and among individuals with high baseline levels of consumption.

CONCLUSIONS

Changes in consumption associated with onset and offset of AUD are substantial enough to have important implications for the risk of associated physical and psychological harm.

Transitions in and out of alcohol use disorders: their associations with conditional changes in quality of life over a 3-year follow-up interval

AIMS

The aim of this study was to investigate longitudinal changes in quality of life (QOL) as a function of transitions in alcohol use disorders (AUD) over a 3-year follow-up of a general US population sample.

METHODS

The analysis is based on individuals who drank alcohol in the year preceding the Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions and were reinterviewed at Wave 2 (n = 22,245). Using multiple linear regression models, changes in SF-12 QOL were estimated as a function of DSM-IV AUD transitions, controlling for baseline QOL and multiple potential confounders.

RESULTS

Onset and offset of AUD were strongly associated with changes in mental/psychological functioning, with significant decreases in mental component summary (NBMCS) scores among individuals who developed dependence and significant increases among those who achieved full and partial remission from dependence. The increases in overall NBMCS and its social functioning, role emotional and mental health components were equally great for abstinent and nonabstinent remission from dependence, but improvements in bodily pain and general health were associated with nonabstinent remission only. Onset of abuse was unrelated to changes in QOL, and the increase in NBMCS associated with nonabstinent remission from abuse only was slight. Individuals with abuse only or no AUD who stopped drinking had significant declines in QOL.

CONCLUSIONS

These results suggest the possible importance of preventing and treating AUD for maintaining and/or improving QOL. They are also consistent with the sick quitter hypothesis and suggest that abuse is less a mental disorder than a maladaptive pattern of behavior.

Predictors of 2-year drinking outcomes in a Swedish treatment sample

BACKGROUND

Few studies have investigated predictors of short- and longer-term outcomes in relatively well functioning treatment samples.

METHODS

Multivariate logistic regression analyses were used to identify predictors of continuous abstinence in 188 individuals during their 2nd year after private 12-step treatment in Sweden, and findings are related to a previous report on 1-year outcomes.

RESULTS

Individual baseline characteristics were not directly related to 2nd year outcomes, while a higher 1st-year drinking severity decreased the likelihood of 2nd-year abstinence. Satisfaction with treatment and affiliation with Alcoholics Anonymous, but not program aftercare during the 1st year increased the likelihood of 2nd-year abstinence.

CONCLUSION

Results are consistent with previous studies showing that shorter-term outcomes are likely to be maintained, and that baseline characteristics and treatment factors account less for outcomes over longer terms.

Course of recovery from alcoholism

This article represents the proceedings of a symposium at the 2005 Research Society on Alcoholism meeting in Santa Barbara, California, organized and chaired by Kamilla L. Venner. This symposium integrated current empirical research on the course of recovery from alcoholism from multiple perspectives, an aim that is consistent with NIAAA's new focus on the process of recovery. The presentations and presenters were as follows: (1) The Role of Community Services and Informal Support on 7-Year Drinking Outcomes in Treated and Untreated Drinkers, by Helen Matzger; (2) The Sequence of Recovery Events in a Native American Sample, by Kamilla L. Venner; (3) Transformational Change in Recovery, by Alyssa A. Forcehimes; (4) Social Settings and Substance Use: Contextual Factors in Recovery, by Rudolf H. Moos; and (5) A Broader View of Change in Drinking Behavior, by discussant Mark L. Willenbring. A theme connecting the presentations was that treatment is but one discrete aspect to recovery and that sustained recovery is often influenced by an individual interaction with others within a social context. Collectively, presentations underscored the need to think more broadly about factors contributing to the remission of alcohol dependence.

The three year course of alcohol use disorders in the general population: DSM-IV, ICD-10 and the Craving Withdrawal Model

AIMS

To determine the course of alcohol use disorders (AUD) in a prospective general population study using three different classification systems: Diagnostic and Statistical Manual version IV (DSM-IV), International Classification of Diseases version 10 (ICD-10) and the craving withdrawal model (CWM). The latter is an alternative classification, which requires craving and withdrawal for alcohol dependence and raises the alcohol abuse threshold to two criteria.

DESIGN, SETTING AND PARTICIPANTS

Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large (n=7,076) representative general population study with a baseline and 1- and 3-year follow-up assessments.

MEASUREMENTS

Diagnostic status according to DSM-IV, ICD-10 and CWM at baseline and at follow-up was established using a structured interview (Composite International Diagnostic Interview: CIDI).

FINDINGS

DSM-IV abuse, ICD-10 harmful use and CWM abuse all showed a favourable course with remission rates of 81, 89 and 71%, respectively, at 1-year follow-up and 85, 92 and 79% at 3-year follow-up. Dependence according to DSM-IV, ICD-10 and CWM had a somewhat less favourable course, with remission rates (no dependence) of 67, 67 and 57% at 1-year follow-up and 74, 69 and 73% at 3-year follow-up, respectively. Subjects who were remitted at 1-year follow-up showed relapse-rates of 0-14% for dependence and 4-12% for abuse at 3-year follow-up. Although CWM diagnoses tended towards greater diagnostic stability than DSM-IV and ICD-10, most differences were not significant.

CONCLUSION

The conviction that addiction is a chronic relapsing disease may apply to treatment-seeking alcoholics, but our data show a far more favourable course of alcohol use disorders in the general population.

The long-term course of alcoholism, 5, 10 and 16 years after treatment

AIMS

To discover the long-term stability of drinking behaviour following an in-patient treatment episode.

DESIGN

Three follow-up periods were used at 5, 10 and 16 years. The patients were classified as being abstinent, improved or unimproved on the basis of self-reported drinking behaviour. Patients who could not be interviewed at follow-up were classified as unimproved.

SETTING

An alcohol dependence treatment programme at the University Hospital Tuebingen, Germany.

PARTICIPANTS

We were able to locate all 96 patients at the 16-year follow-up. Seventy were alive and 26 had died. We collected information from 59 of the 70 surviving patients. The remaining 11 patients could be located and were definitely alive.

FINDINGS

Thirty-eight of the 70 patients were abstinent, 10 were improved and 22 (including the 11 living patients without further information) were classified as unimproved. Our main finding indicates that the so-called 'improved drinking' is very inconsistent over time. In contrast, the abstinent and unimproved patients were much more stable in their drinking behaviour.

CONCLUSIONS

This study extends our knowledge of the drinking trajectory and outcome from only a few years of follow-up to 16 years. Complete abstinence and unimproved drinking behaviour were the most stable drinking patterns observed over the long term, confirming study results obtained primarily from English-speaking countries.

Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence, predictors, prevention

AIMS

To examine the prevalence and personal and intervention-related predictors of potential iatrogenic effects associated with psychosocial interventions for substance use disorders and provide a conceptual framework to guide further research on such effects.

METHOD

A review of relevant studies focuses on the prevalence and predictors of potential iatrogenic effects of psychosocial treatment and prevention programs for substance use disorders.

RESULTS

Between 7% and 15% of patients who participate in psychosocial treatment for substance use disorders may be worse off subsequent to treatment than before. In addition, several controlled trials of substance use prevention have shown some apparent iatrogenic effects, including more positive expectations about substance use and a rise in alcohol use and alcohol-related problems. Probable person-related predictors of deterioration associated with treatment include younger age and unmarried status, more serious current diagnoses and substance use problems and more psychiatric and interpersonal problems. Probable intervention-related predictors of deterioration include lack of bonding; lack of monitoring; confrontation, criticism and high emotional arousal; deviancy modeling; and stigma, low or inappropriate expectations and lack of challenge.

CONCLUSION

A significant minority of individuals with substance use problems appear to deteriorate during or shortly after participation in treatment or prevention programs. Safety standards and monitoring procedures are needed to routinely identify potential adverse consequences of intervention programs; research is needed to clarify whether deterioration is due to iatrogenic effects of interventions and to identify new approaches to counteract any such effects.

Phoning logistics in a longitudinal follow-up of batterers and their partners

More needs to be known about the phoning logistics of interviewing subjects for longitudinal follow-up studies in the domestic violence field. Using phoning logs from a 4-year follow-up of batterer intervention, the authors calculated the number, results, and costs of phone calls from a subsample of 100 men and 138 women. The number of calls is high (5.5 per man and 7.1 per woman), locators play a substantial role (for 25% of the men and women), and mailed questionnaires are a useful supplement (increasing response rate 5% for men and 11% for women). On average, about half of the subjects were interviewed at each interval. The main obstacle is not refusals but no response and not being able to locate a subject. Strategies to address "no response" are considered.

Dependent and problem drinking over 5 years: a latent class growth analysis

Understanding the long-term course of problematic drinking is a fundamental concern for health services research in the alcohol field. The stability of, or change in, the course of drinking--especially heavy drinking--has both theoretical and applied relevance to alcohol research. We explore the application of latent class growth modeling to 5 years of survey data collected from dependent and problem drinkers--some not in treatment at baseline--in an attempt to uncover prototypical longitudinal drinking patterns. Results indicated that five profiles of drinkers can be used to represent their longitudinal course of alcohol consumption: early quitters (N = 88), light/non-drinkers (N = 76), gradual improvers (N = 129), moderate drinkers (N = 229), and heavy drinkers (N = 572). Significant baseline factors included ASI drug severity, dependence symptoms, and marital status. Attendance at AA meetings, the size of one's heavy drinking and drug using social network, past treatment, receiving suggestions about one's drinking, and contacts with the medical system were significant influences. The size of heavy drinking and drug using social networks was noticeably larger for the heavy drinkers. Findings also support the usefulness of a semi-parametric latent group-based approach as a tool for analyzing alcohol-related behaviors.

Risk factors for symptom exacerbation among treated patients with substance use disorders

AIMS

The purpose of this study was to develop an index of risk factors to identify patients prospectively with substance use disorders whose substance use symptoms exacerbate during or shortly after treatment, and to identify characteristics of care that may reduce the likelihood of exacerbation.

DESIGN, SETTING, PARTICIPANTS

On the basis of data obtained from a nation-wide outcomes monitoring system, a group of 2809 treated patients experienced an exacerbation of their substance use symptoms. These patients were matched on baseline substance abuse problems with 5618 patients who remained stable or improved.

MEASUREMENTS AND FINDINGS

Risk factors for substance use symptom exacerbation included younger age, non-married status and residential instability; long-term use of drugs, prior arrests, prior alcohol treatment, alcohol and drug abuse or dependence diagnoses, cocaine abuse or dependence and more severe self-rated drug problems; and psychiatric problems. High-risk patients who obtained a longer episode of mental health care were less likely to experience an exacerbation of symptoms.

CONCLUSIONS

Clinicians can identify at treatment entry patients whose substance use symptoms are likely to exacerbate and, by providing these patients a longer duration of care, may reduce the likelihood of symptom exacerbation.

Predictors of deterioration among patients with substance-use disorders

The purpose of this study was to identify patients with substance-use disorders who deteriorate during treatment, and to examine baseline predictors of deterioration. Three groups of 872 patients each, matched on number of problems at baseline, were selected from a larger sample based on their treatment outcome (improved, nonresponsive, deteriorated). Deterioration was predicted by younger age and African-American race; four aspects of patients' history (psychiatric symptoms, arrests, prior drug treatment, and recent inpatient or residential care); and having no close friends. Patients who had both an alcohol and a drug diagnosis, a personality-disorder diagnosis, and those who had a shorter episode of care and fewer outpatient-mental-health visits, also were more likely to deteriorate.