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Lannoy S, Svikis DS, Stephenson M, Polak K, Kendler KS, Edwards AC. Personality correlates of past-year alcohol use in individuals with severe alcohol use disorder and a lifetime history of involvement in alcoholics anonymous. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1168-1175. [PMID: 38627204 PMCID: PMC11178444 DOI: 10.1111/acer.15330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) is a highly impairing condition with important public health impacts. Despite the availability of treatment options for AUD, research shows that few people receive treatment, and even fewer can maintain abstinence/low-drinking levels. This study investigated the role of personality traits in past-year alcohol use among individuals with severe AUD who ever attended Alcoholics Anonymous (AA), a widespread and easily accessible self-help group for alcohol problems. METHODS Univariable and multivariable regressions were performed separately in females and males with alcohol consumption as an outcome. Socioeconomic factors, genetic liability, and psychopathology were included as covariates in the analyses. RESULTS Results from the multivariable model indicated that in females who attended AA, greater alcohol use was related to both positive and negative urgency and low sensation seeking, while in males, greater alcohol use was related to positive urgency. Results also showed that, in both sexes, younger age and lower educational levels were associated with greater alcohol use. Moreover, single males and individuals with lower AUD severity were at higher risk of using alcohol in the past year. CONCLUSIONS These findings highlight sex-specific correlates of drinking in individuals with AUD who engaged in self-help groups. These findings may help to improve treatment options, as personality encompasses modifiable traits that can be targeted in psychological interventions.
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Affiliation(s)
- Séverine Lannoy
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Dace S. Svikis
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Institute for Women’s Health, Virginia Commonwealth University, Richmond,VA, USA
| | - Mallory Stephenson
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Kathryn Polak
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Kenneth S. Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Alexis C. Edwards
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
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2
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Balbinot P, Pellicano R, Patussi V, Caputo F, Testino G. Alcohol use disorders, self-help groups as a supplement to pharmacological and psychological therapy? A retrospective study in a population with alcohol related liver disease. Minerva Gastroenterol (Torino) 2023; 69:479-485. [PMID: 36255286 DOI: 10.23736/s2724-5985.22.03292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND According to the new criteria in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V), the prevalence of alcohol use disorders (AUDs) is 20-30% in men and 10-15% in women worldwide.2,3 The anticraving therapy/psychotherapy combination is currently used routinely in clinical practice. However, the results after one year are unsatisfactory. Meta-analytic studies found failure rates of 57 to 75%. These percentages vary in relation to the intensity and length of the treatment. In addition, the abstinence rates gradually decrease over time. In this study, the clinical outcome of alcohol related liver disease (ALD) patients who spontaneously attended self-help groups (SHGs) (club of alcoholics in treatment - multi-family community/ alcoholics anonymous) regularly versus those who did not want to start the path or did not complete it was evaluated. METHODS From January 2005 to December 2010, 1337 alcohol use disorder patients affected by compensated alcohol related liver disease, were prospectively followed and retrospectively assessed. Two hundred thirty-one patients were enrolled: 74 attended self-help groups assiduously, 27 attended sporadically and 130 refused participation in SHGs. RESULTS Constant attendance at SHGs compared to non-attendance allows for a significant increase (<0.0001) in the period of sobriety found in the median of distribution. Frequent attendance at SHGs is effectively "preventive," reducing the fraction of relapses by about 30%. The percentage of cases of cirrhosis is significantly different (P=0.0007) between those who have regularly attended SHG meetings (about 1% of patients) and those who have never attended or only occasionally (various percentages between 21 and 31% of patients); in both groups the incidence of new cases would seem to be 0.014 cases/ year. Similar difference in percentages regarding the onset of hepatocellular carcinomas (HCCs), although with a lower level of significance (P=0.017) among those who attended regularly, 4% of patients with an incidence of 0.006 cases/ year, compared to those who have never attended or only occasionally: over 14% of patients with an incidence of 0.022 cases/year. CONCLUSIONS This study suggests the importance of attending SHGs not only for the long-term achievement of alcoholic abstention, but also in positively influencing the course of alcohol-related diseases.
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Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, ASL3 Liguria, Genoa, Italy
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
| | | | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Translational Medicine, Center for the Study and Treatment of Alcohol-Related Diseases, University of Ferrara, Ferrara, Italy
- Department of Internal Medicine, Santissima Annunziata Hospital, University of Ferrara, Ferrara, Italy
| | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, ASL3 Liguria, Genoa, Italy
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
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3
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Nadkarni A, Massazza A, Guda R, Fernandes LT, Garg A, Jolly M, Andersen LS, Bhatia U, Bogdanov S, Roberts B, Tol WA, Velleman R, Moore Q, Fuhr D. Common strategies in empirically supported psychological interventions for alcohol use disorders: A meta-review. Drug Alcohol Rev 2023; 42:94-104. [PMID: 36134481 PMCID: PMC10087716 DOI: 10.1111/dar.13550] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 01/10/2023]
Abstract
ISSUES Despite the large number of effective psychological interventions for alcohol use disorders (AUD), there is still a lack of clarity concerning the strategies that make these interventions effective. APPROACH The overall goal of this review was to identify, examine and synthesise the information about common strategies from evidence-based psychological interventions for AUDs by conducting a review of systematic reviews, that is, a meta-review. We isolated the relevant primary studies from eligible systematic reviews and extracted information about the interventions from these studies to understand the strategies used. Analysis was restricted to narrative summaries. KEY FINDINGS Thirteen reviews were eligible for inclusion in our meta-review. Of these, eight demonstrated the effectiveness of a range of psychological interventions-behavioural couples therapy, cognitive behaviour therapy combined with motivational interviewing, brief interventions, contingency management, psychotherapy plus brief interventions, Alcoholics Anonymous and 12-step treatment programs, family-therapy or family-involved treatment, and community reinforcement approach. The most commonly used component strategies in effective interventions for AUDs included assessment, personalised feedback, motivational interviewing, goal setting, setting and review of homework, problem solving skills and relapse prevention/management. IMPLICATIONS Evidence about commonly used strategies in evidence-based psychological interventions for AUDs offer the possibility of creating menu-driven interventions that can be tailored to respond to individual client needs and preferences in different contexts.
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Affiliation(s)
- Abhijit Nadkarni
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Addictions Research Group, Sangath, Goa, India
| | - Alessandro Massazza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rahul Guda
- Addictions Research Group, Sangath, Goa, India
| | | | - Ankur Garg
- Addictions Research Group, Sangath, Goa, India
| | - Mehak Jolly
- Addictions Research Group, Sangath, Goa, India
| | - Lena S Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Sergiy Bogdanov
- Centre for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Wietse A Tol
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,HealthRight International, New York, New York, USA.,Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Richard Velleman
- Addictions Research Group, Sangath, Goa, India.,Department of Psychology, University of Bath, Bath, UK
| | - Quincy Moore
- Centre for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Daniela Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany.,Health Sciences, University of Bremen, Bremen, Germany
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4
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The Beneficial Role of Involvement in Alcoholics Anonymous for Existential and Subjective Well-Being of Alcohol-Dependent Individuals? The Model Verification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095173. [PMID: 35564567 PMCID: PMC9104992 DOI: 10.3390/ijerph19095173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/21/2022]
Abstract
Involvement in Alcoholics Anonymous (AA) is an important psychosocial factor for the recovery of alcohol-dependent individuals. Recent studies have confirmed the beneficial role of involvement in AA for abstinence and reduction in drinking alcohol. Little is known about the mechanism underlying the relationship between involvement in AA and subjective well-being. This study aims to verify whether in a sample of Polish AA participants involvement in AA is indirectly related to subjective well-being through existential well-being consisting of hope and meaning in life. The achieved results have confirmed that involvement in AA is positively related to existential well-being, which in turn positively predicts subjective well-being including life satisfaction as well as positive and negative affect. It was confirmed that AA involvement in self-help groups indirectly via existential well-being is related to subjective well-being. Theoretical and practical implications were discussed.
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5
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Yager J. Why Defend Harm Reduction for Severe and Enduring Eating Disorders? Who Wouldn't Want to Reduce Harms? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:57-59. [PMID: 34152907 DOI: 10.1080/15265161.2021.1926160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Joel Yager
- University of Colorado School of Medicine
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6
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Makin P, Allen R, Carson J, Bush S, Merrifield B. Light at the end of the bottle: flourishing in people recovering from alcohol problems. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1905092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Paul Makin
- Department of Psychology, University of Bolton, Bolton, UK
| | - Rosie Allen
- Department of Psychology, University of Bolton, Bolton, UK
| | - Jerome Carson
- Department of Psychology, University of Bolton, Bolton, UK
| | - Stacey Bush
- Department of Psychology, University of Bolton, Bolton, UK
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7
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Kunreuther E. Autism Spectrum Disorder and Substance Use Disorder: A Dual Diagnosis Hiding in Plain Sight. Psychiatr Clin North Am 2021; 44:35-49. [PMID: 33526236 DOI: 10.1016/j.psc.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Individuals with autism spectrum disorder (ASD) have a significantly higher risk for developing a substance use disorder (SUD) than the general population yet literature addressing cooccurring ASD and SUD is scarce. This article explores connections between ASD and SUD and the impact on development, screening and treatment. The article proposes culturally constructed narratives associated with both diagnoses may be responsible for the dearth of research and literature. Constructed narratives of ASD and SUD do not naturally intersect and the resulting disconnect can create a cognitive dissonance that could allow the medical and general community to neglect this life-threatening dual diagnosis.
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Affiliation(s)
- Elizabeth Kunreuther
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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8
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Segal G. ALCOHOLICS ANONYMOUS "SPIRITUALITY" AND LONG-TERM SOBRIETY MAINTENANCE AS A TOPIC FOR INTERDISCIPLINARY STUDY. Behav Brain Res 2020; 389:112645. [PMID: 32353394 DOI: 10.1016/j.bbr.2020.112645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/16/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Abstract
The foundational literature of Alcoholics Anonymous provides a good example of how ideas from different intellectual paradigms can be woven together to enhance understanding of addiction and recovery. A detailed hypothesis about how the 12 steps of Alcoholics Anonymous work as a program of emotion management is presented. The hypothesis assigns a central role to a secular interpretation of spirituality, consistent with naturalism. Clinical research which appears to indicate that spirituality is not the chief mechanism of recovery in Alcoholics Anonymous is critiqued. Interdisciplinary research is required, if the extent and nature of the efficacy of AA's 12 steps are to be understood.
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9
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Kunreuther E. Autism Spectrum Disorder and Substance Use Disorder: A Dual Diagnosis Hiding in Plain Sight. Child Adolesc Psychiatr Clin N Am 2020; 29:467-481. [PMID: 32471596 DOI: 10.1016/j.chc.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals with autism spectrum disorder (ASD) have a significantly higher risk for developing a substance use disorder (SUD) than the general population yet literature addressing cooccurring ASD and SUD is scarce. This article explores connections between ASD and SUD and the impact on development, screening and treatment. The article proposes culturally constructed narratives associated with both diagnoses may be responsible for the dearth of research and literature. Constructed narratives of ASD and SUD do not naturally intersect and the resulting disconnect can create a cognitive dissonance that could allow the medical and general community to neglect this life-threatening dual diagnosis.
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Affiliation(s)
- Elizabeth Kunreuther
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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10
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Ross CA, Jakubec SL, Berry NS, Smye V. The business of managing nurses’ substance‐use problems. Nurs Inq 2019; 27:e12324. [DOI: 10.1111/nin.12324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/28/2019] [Accepted: 08/31/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Charlotte A. Ross
- Douglas College Coquitlam BC Canada
- Simon Fraser University Burnaby BC Canada
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11
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The efficacy of spiritual/religious interventions for substance use problems: A systematic review and meta-analysis of randomized controlled trials. Drug Alcohol Depend 2019; 202:134-148. [PMID: 31349206 DOI: 10.1016/j.drugalcdep.2019.04.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spiritual/religious (S/R) interventions are commonly used to treat substance use problems, but this is the first systematic review and meta-analysis to examine their efficacy for these problems. METHODS Ten electronic databases were searched to identify eligible studies (i.e., randomized controlled trials) published between January 1990 and February 2018 that examined S/R interventions' efficacy for substance use or psycho-social-spiritual outcomes. Two reviewers independently screened studies, extracted data, and assessed risks of bias. Robust variance estimation in meta-regression was used to estimate effect sizes and conduct moderator analysis. RESULTS Twenty studies comprising 3700 participants met inclusion criteria. Four studies used inactive controls, 14 used active controls, and two used both inactive and active controls and were therefore included in estimating both absolute and relative effect sizes. The absolute effect of S/R interventions (compared with inactive controls such as no treatment) was moderate but non-significant (six studies, d = .537, 95% confidence interval [CI] = -.316, 1.390), possibly due to low power. The relative effect of S/R interventions (compared with other interventions) was statistically significant (16 studies, d = .176, 95% CI = .001, .358). Because only 12-step-oriented interventions were compared with other interventions, this finding does not apply to the relative effect of non-12-step-oriented S/R interventions. Moderator analysis showed that relative effect sizes differ significantly by country. CONCLUSION We found evidence of S/R interventions' efficacy in helping people with substance use problems. More high-quality efficacy studies of non-12-step-oriented S/R interventions for substance use problems are needed.
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12
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Rush B, Urbanoski K. Seven Core Principles of Substance Use Treatment System Design to Aid in Identifying Strengths, Gaps, and Required Enhancements. J Stud Alcohol Drugs Suppl 2019; Sup 18:9-21. [PMID: 30681944 PMCID: PMC6377009 DOI: 10.15288/jsads.2019.s18.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 07/16/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE System planners and funders encounter many challenges in taking action toward evidence-informed enhancement of substance use treatment systems. Researchers are increasingly asked to contribute expertise to these processes through comprehensive system reviews. In this role, all parties can benefit from guiding frameworks to help organize key questions and data collection activities, and thereby set the stage for both high-level and on-the-ground strategic directions and recommendations. This article summarizes seven core principles of substance use treatment system design that are supported by a large international evidence base and that together have proven applicable as a framework for several systems review projects conducted predominantly in Canada. METHOD The methodology was based on a narrative review approach. RESULTS The principles address a wide range of issues. Specifically, a broad systems approach is needed to address the full spectrum of issues; accessibility and effectiveness are improved through collaboration across stakeholders; a range of system supports are needed; need for services should be grounded in self-determination, holistic cultural practices, choice, and partnership; attention to diversity and social-structural disadvantages are crucial to equitable system design; systematic screening and assessment is needed to match people to appropriate treatment services in a stepped service framework; and, last, individualized treatment planning must include the right mix of evidence-informed interventions. CONCLUSIONS By bringing researchers and stakeholders back to the high-level goals of substance use treatment systems, these principles provide a comprehensive, evidence-based, organizing framework that has the potential to improve the quality of system design and review internationally.
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Affiliation(s)
- Brian Rush
- Centre for Addiction and Mental Health,
Toronto, Ontario, Canada
| | - Karen Urbanoski
- Centre for Addictions Research of British
Columbia, and School of Public Health and Social Policy, University of Victoria,
Victoria, British Columbia, Canada
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13
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Tonigan JS, Pearson MR, Magill M, Hagler KJ. AA attendance and abstinence for dually diagnosed patients: a meta-analytic review. Addiction 2018; 113:1970-1981. [PMID: 29845709 DOI: 10.1111/add.14268] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/14/2017] [Accepted: 05/10/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS There is consensus that best clinical practice for dual diagnosis (DD) is integrated mental health and substance use treatment augmented with Alcoholics Anonymous (AA) attendance. This is the first quantitative review of the direction and magnitude of the association between AA attendance and alcohol abstinence for DD patients. METHOD A systematic literature search (1993-2017) identified 22 studies yielding 24 effect sizes that met our inclusion criteria (8075 patients). Inverse-variance weighting of correlation coefficients (r) was used to aggregate sample-level findings and study aims were addressed using random- and mixed-effect models. Sensitivity and publication bias analyses were conducted to assess the likelihood of bias in the overall estimate of AA-related benefit. RESULTS AA exposure and abstinence for DD patients were associated significantly and positively [rw = 0.249; 95% confidence interval (CI) = 0.203-0.293; tau = 0.097). There was also significant heterogeneity in the distribution of effect sizes and high between-sample variance (I2 = 74.6, P < 0.001). Subgroup analyses indicated that the magnitude of AA-related benefit did not differ between 6- (k = 7) and 12- (k = 12) month follow-up (Q = 0.068, P = 0.794), type of treatment received (in-patient k = 9; intensive out-patient, out-patient, community k = 15; Q = 2.057, P = 0.152), and whether a majority of patients in a sample had (k = 11) or did not have (k = 13) major depression (Q = 0.563, P = 0.453). Sensitivity analyses indicated that the overall meta-analytical estimate of AA benefit was not impacted adversely or substantively by pooling randomized controlled trial (RCT) and observational samples (Q = 0.763, P = 0.382), pooling count, binary and ordinal-based AA (Q = 0.023, P = 0.879) and outcome data (Q = 1.906, P = 0.167) and reversing direction of correlations extracted from studies (Q = 0.006, P = 0.937). No support was found for publication bias. CONCLUSIONS Clinical referral of dual diagnosis patients to Alcoholics Anonymous is common and, in many cases, dual diagnosis patients who attend Alcoholics Anonymous will report higher rates of alcohol abstinence relative to dual diagnosis patients who do not attend Alcoholics Anonymous.
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Affiliation(s)
- J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Matthew R Pearson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Kylee J Hagler
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
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14
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Ray LA, Bujarski S, Grodin E, Hartwell E, Green R, Venegas A, Lim AC, Gillis A, Miotto K. State-of-the-art behavioral and pharmacological treatments for alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:124-140. [PMID: 30373394 DOI: 10.1080/00952990.2018.1528265] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) and its associated consequences remain significant public health concerns. Given that AUD represents a spectrum of severity, treatment options represent a continuum of care, ranging from single-session brief interventions to more intensive, prolonged, and specialized treatment modalities. OBJECTIVE This qualitative literature review seeks to describe the best practices for AUD by placing a particular emphasis on identifying those practices which have received the most empirical support. METHOD This review summarizes psychological and pharmacological intervention options for AUD treatment, with a focus on the relapse prevention phase of recovery. Psychological and pharmacological treatments are summarized in terms of the empirical evidence favoring each approach and the level of AUD severity for which they are most indicated. SCIENTIFIC SIGNIFICANCE One of the broad assertions from this review is that while AUD is highly prevalent, seeking treatment for AUD is not. There are a myriad of behavioral and pharmacological treatments that have shown compelling evidence of efficacy for the treatment of AUD. In the behavioral treatment literature, cognitive behavioral therapy has received the most consistent support. Opioid antagonism (via naltrexone) has been the most widely studied pharmacotherapy and has produced moderate effect sizes. While none of the treatments reviewed herein represents a so-called silver bullet for AUD, they each have the potential to significantly improve the odds of recovery. Precision medicine, or the identification of best treatment matches for individual patients, looms as an important overarching goal for the field, although specific matches are not yet sufficiently reliable in their empirical evidence to warrant clinical dissemination.
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Affiliation(s)
- Lara A Ray
- a Department of Psychology , University of California , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
| | - Spencer Bujarski
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Erica Grodin
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Emily Hartwell
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - ReJoyce Green
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Alexandra Venegas
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Aaron C Lim
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Artha Gillis
- b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
| | - Karen Miotto
- b Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine University of California , Los Angeles , CA , USA
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15
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Gibson S, Woodford M, Czeizinger TJ. Avoiding the Last Ride: Can DUI Programming Address Multiple Risk Factors to Reduce Recidivism? JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2018. [DOI: 10.1002/jaoc.12047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sandy Gibson
- Department of Counselor Education, The College of New Jersey
| | - Mark Woodford
- Department of Counselor Education, The College of New Jersey
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16
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Rubio G, Marín M, Arias F, López-Trabada JR, Iribarren M, Alfonso S, Prieto R, Blanco A, Urosa B, Montes V, Jurado R, Jiménez-Arriero MÁ, de Fonseca FR. Inclusion of Alcoholic Associations Into a Public Treatment Programme for Alcoholism Improves Outcomes During the Treatment and Continuing Care Period: A 6-Year Experience. Alcohol Alcohol 2018; 53:78-88. [PMID: 29087443 DOI: 10.1093/alcalc/agx078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/20/2017] [Indexed: 11/14/2022] Open
Abstract
Aims To investigate whether inclusion of self-help groups into the hospital treatment programme improves the prognosis of alcohol dependence through the treatment period; and to examine therapeutic adherence and prognosis during continuing care. Method Patients attending the treatment programme at the 'Hospital 12 de Octubre' were randomized into two groups. In Group A (n = 123), patients received the usual treatment included in our programme, whereas in Group B (n = 126), patients also attended self-help groups. Patients were assessed with psychological scales at baseline, at the end of the treatment period and after completing the continuing care visits. Data were collected over a total of 6 years. Results During the treatment period, patients in Group B accumulated more months of abstinence and dropped out less. During continuing care, patients in Group B accumulated more months of abstinence and therapeutic adherence was higher. Variables that were associated with these results during the continuing care period were: visits to the GP, scores on anxiety, impulsivity and meaning of life scales, and belonging to the group that attended the alcoholic associations. Conclusions Mutual help groups incorporated into a public treatment programme appear to improve outcomes during treatment and on into continuing care. This experience supports cooperation between public health centres and alcoholic associations in treating alcoholism. Short Summary Including alcoholic associations into the public treatment programme for alcoholism of the 'Hospital 12 de Octubre' in Madrid was shown to be associated with better outcomes in terms of months of accumulated abstinence, dropout rates and therapeutic adherence, during the treatment and continuing care periods.
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Affiliation(s)
- Gabriel Rubio
- Centro de Actividades Ambulatorias (CAA) 3ª Planta, Bloque B. Hospital Universitario 12 de Octubre. Avda. de Córdoba S/N, 28042, Madrid, Spain.,Psychiatry Department, Medical School, Complutense University of Madrid, Spain.,Addictive Disorders Network (Carlos III Health Institute, RETICS PROGRAMME), Spain.,Psychiatry Department, University Hospital 12 de Octubre, Spain.,Medical School, Complutense University of Madrid, Spain
| | - Marta Marín
- Centro de Actividades Ambulatorias (CAA) 3ª Planta, Bloque B. Hospital Universitario 12 de Octubre. Avda. de Córdoba S/N, 28042, Madrid, Spain.,Psychiatry Department, University Hospital 12 de Octubre, Spain
| | - Francisco Arias
- Centro de Actividades Ambulatorias (CAA) 3ª Planta, Bloque B. Hospital Universitario 12 de Octubre. Avda. de Córdoba S/N, 28042, Madrid, Spain.,Psychiatry Department, University Hospital 12 de Octubre, Spain
| | - José Ramón López-Trabada
- Centro de Actividades Ambulatorias (CAA) 3ª Planta, Bloque B. Hospital Universitario 12 de Octubre. Avda. de Córdoba S/N, 28042, Madrid, Spain.,Psychiatry Department, University Hospital 12 de Octubre, Spain
| | - Martín Iribarren
- Centro de Actividades Ambulatorias (CAA) 3ª Planta, Bloque B. Hospital Universitario 12 de Octubre. Avda. de Córdoba S/N, 28042, Madrid, Spain.,Psychiatry Department, University Hospital 12 de Octubre, Spain
| | - Susana Alfonso
- Centro de Actividades Ambulatorias (CAA) 3ª Planta, Bloque B. Hospital Universitario 12 de Octubre. Avda. de Córdoba S/N, 28042, Madrid, Spain.,Psychiatry Department, University Hospital 12 de Octubre, Spain
| | - Raquel Prieto
- Centro de Actividades Ambulatorias (CAA) 3ª Planta, Bloque B. Hospital Universitario 12 de Octubre. Avda. de Córdoba S/N, 28042, Madrid, Spain.,Psychiatry Department, University Hospital 12 de Octubre, Spain
| | - Agustín Blanco
- Centro de Actividades Ambulatorias (CAA) 3ª Planta, Bloque B. Hospital Universitario 12 de Octubre. Avda. de Córdoba S/N, 28042, Madrid, Spain.,Psychiatry Department, University Hospital 12 de Octubre, Spain
| | - Belén Urosa
- Psychology School, Methodologic Department, Pontifical University of Comillas, Spain
| | - Victoria Montes
- Psychology School, Methodologic Department, Pontifical University of Comillas, Spain
| | - Rosa Jurado
- Centro de Actividades Ambulatorias (CAA) 3ª Planta, Bloque B. Hospital Universitario 12 de Octubre. Avda. de Córdoba S/N, 28042, Madrid, Spain.,Addictive Disorders Network (Carlos III Health Institute, RETICS PROGRAMME), Spain.,Medical School, Complutense University of Madrid, Spain
| | - Miguel Ángel Jiménez-Arriero
- Centro de Actividades Ambulatorias (CAA) 3ª Planta, Bloque B. Hospital Universitario 12 de Octubre. Avda. de Córdoba S/N, 28042, Madrid, Spain.,Psychiatry Department, Medical School, Complutense University of Madrid, Spain.,Psychiatry Department, University Hospital 12 de Octubre, Spain.,Biomedical Research Centre in the Mental Health Network (CIBERSAM), Spain
| | - Fernando Rodríguez de Fonseca
- Addictive Disorders Network (Carlos III Health Institute, RETICS PROGRAMME), Spain.,Unidad de Gestión Clínica de Salud Mental, Instituto IBIMA, Hospital Regional Universitario de Málaga, Spain
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17
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Aloe AM, Becker BJ, Duvendack M, Valentine JC, Shemilt I, Waddington H. Quasi-experimental study designs series—paper 9: collecting data from quasi-experimental studies. J Clin Epidemiol 2017; 89:77-83. [DOI: 10.1016/j.jclinepi.2017.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 09/13/2016] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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18
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Becker BJ, Aloe AM, Duvendack M, Stanley T, Valentine JC, Fretheim A, Tugwell P. Quasi-experimental study designs series—paper 10: synthesizing evidence for effects collected from quasi-experimental studies presents surmountable challenges. J Clin Epidemiol 2017; 89:84-91. [DOI: 10.1016/j.jclinepi.2017.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 01/22/2023]
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19
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Freyer CH, Morley KC, Haber PS. Alcohol use disorders in Australia. Intern Med J 2017; 46:1259-1268. [PMID: 27813358 DOI: 10.1111/imj.13237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/26/2016] [Accepted: 07/28/2016] [Indexed: 12/19/2022]
Abstract
Alcohol use disorders are common in Australia and are often unrecognised. Alcohol places a significant burden on our healthcare system by increasing the risk of injuries as well as many chronic medical conditions. Diagnosis requires a high index of suspicion and can be aided by the use of specific questionnaires, such as the Alcohol Use Disorder Identification Test-C. The current available laboratory tests are of limited sensitivity and specificity, but can nevertheless aid in the diagnosis in some circumstances. Newer tests, such as ethyl-glucuronide and phosphatidylethanol, are more sensitive and specific but are costly and not widely available. The effective management of alcohol use disorder entails psychosocial or pharmacological treatments or a combination of both. In those who cannot reduce alcohol consumption, harm reduction strategies can be applied to reduce the burden of harm to the drinkers as well as the community at large.
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Affiliation(s)
- C H Freyer
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
| | - K C Morley
- NHMRC Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - P S Haber
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,NHMRC Centre for Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
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20
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Kelley ML, Bravo AJ, Braitman AL. Behavioral Couples Treatment for Substance Use Disorder: Secondary Effects on the Reduction of Youth Internalizing Symptoms. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:731-741. [PMID: 27523819 PMCID: PMC5311033 DOI: 10.1007/s10802-016-0197-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined the secondary effects of Behavioral Couples Treatment (BCT) for parents with substance use disorder on youth reports of internalizing symptoms (i.e., depressive and anxiety symptoms). Participants were 59 triads (father, mothers, and youth; 32 girls, 27 boys) in which one or both parents met criteria for drug or alcohol use disorder (or both). Mothers, fathers, and youth completed pretreatment, post-intervention, and 6-month post-intervention follow-up assessments. Two piecewise latent growth models examined whether number of sessions attended was associated with parents' relationship satisfaction or its growth over time, and in turn if parents' relationship satisfaction was uniquely associated with youth depressive/anxiety symptoms or their growth over time. A significant indirect effect at post-intervention revealed the number of sessions attended contributed to decreases in youth depressive symptoms via increases in mothers' and fathers' relationship satisfaction. Mothers' relationship satisfaction uniquely mediated the relationship between number of sessions attended and youth depressive symptoms at post-intervention. With regards to fathers, there was a non-significant trend such that increases in sessions attended was associated with decreases in youth depressive symptoms post- intervention via increasing relationship satisfaction among fathers. Findings suggest that BCT may have protective secondary effects in reducing youth reports of depressive symptoms among couples in which one or both parents have substance use disorder.
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Affiliation(s)
- Michelle L Kelley
- Department of Psychology, Old Dominion University, MGB Rm 250, 5115 Hampton Blvd., Norfolk, VA, 23529-0267, USA.
| | - Adrian J Bravo
- Department of Psychology, Old Dominion University, MGB Rm 250, 5115 Hampton Blvd., Norfolk, VA, 23529-0267, USA
| | - Abby L Braitman
- Department of Psychology, Old Dominion University, MGB Rm 250, 5115 Hampton Blvd., Norfolk, VA, 23529-0267, USA
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21
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Sagar SM, Gordon JS. Radiation Oncology and Mind-Body Medicine Analysis. Integr Cancer Ther 2016. [DOI: 10.1177/153473540200100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Stephen M. Sagar
- Center for Mind-Body Medicine, 5225 Connecticut Avenue, NW, Suite 414, Washington, DC 20015,
| | - James S. Gordon
- Center for Mind-Body Medicine, 5225 Connecticut Avenue, NW, Suite 414, Washington, DC 20015
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22
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Kelly PJ, Raftery D, Deane FP, Baker AL, Hunt D, Shakeshaft A. From both sides: Participant and facilitator perceptions of SMART Recovery groups. Drug Alcohol Rev 2016; 36:325-332. [DOI: 10.1111/dar.12416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/19/2016] [Accepted: 02/24/2016] [Indexed: 01/18/2023]
Affiliation(s)
- Peter J. Kelly
- Illawarra Institute for Mental Health, School of Psychology; University of Wollongong; Wollongong Australia
| | - Dayle Raftery
- Illawarra Institute for Mental Health, School of Psychology; University of Wollongong; Wollongong Australia
| | - Frank P. Deane
- Illawarra Institute for Mental Health, School of Psychology; University of Wollongong; Wollongong Australia
| | - Amanda L. Baker
- School of Medicine and Public Health; University of Newcastle; Newcastle Australia
| | - David Hunt
- SMART Recovery Australia; Sydney Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre; University of New South Wales; Sydney Australia
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23
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Sotskova A, Woodin E, Cyr KS. Understanding the Role of Group Cohesion and Group Alliance in a Secular Peer Support Group for Recovery from Substance Misuse. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/1556035x.2015.1132400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Mowbray O, Glass JE, Grinnell-Davis CL. Latent class analysis of alcohol treatment utilization patterns and 3-year alcohol related outcomes. J Subst Abuse Treat 2015; 54:21-8. [PMID: 25744651 DOI: 10.1016/j.jsat.2015.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
People who obtain treatment for alcohol use problems often utilize multiple sources of help. While prior studies have classified treatment use patterns for alcohol use, an empirical classification of these patterns is lacking. For the current study, we created an empirically derived classification of treatment use and described how these classifications were prospectively associated with alcohol-related outcomes. Our sample included 257 participants of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who first received alcohol treatment in the 3-year period prior to their baseline interview. We used latent class analysis to identify classes of treatment users based on their patterns of treatment use of 13 types of alcohol treatment. Regression models examined how classes of treatment use at baseline were associated with alcohol-related outcomes assessed at a 3-year follow-up interview. Outcomes included a continuous measure of the quantity and frequency of alcohol use and DSM-IV alcohol use disorder status. Four classes of treatment users were identified: (1) multiservice users (8.7%), (2) private professional service users (32.8%), (3) alcoholics anonymous (AA) paired with specialty addiction service users (22.0%), and (4) users of AA alone (36.5%). Those who utilized AA paired with specialty addiction services had better outcomes compared to those who used AA alone. In addition to elucidating the most common treatment utilization patterns executed by people seeking help for their alcohol problems, the results from this study suggest that increased efforts may be needed to refer individuals across sectors of care to improve treatment outcomes.
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Affiliation(s)
- Orion Mowbray
- University of Georgia School of Social Work, 310 E. Campus Dr., Athens GA, 30602, USA.
| | - Joseph E Glass
- University of Wisconsin-Madison, 1350 University Ave., Madison WI, 53706 USA.
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25
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Bergman BG, DeLucia C. Clinical Trainees' Knowledge and Beliefs about 12-Step Mutual-Help Organizations: Implications for Training and Future Practice. ALCOHOLISM TREATMENT QUARTERLY 2014. [DOI: 10.1080/07347324.2014.949130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Kelly JF, Greene MC. Toward an Enhanced Understanding of the Psychological Mechanisms by which Spirituality Aids Recovery in Alcoholics Anonymous. ALCOHOLISM TREATMENT QUARTERLY 2014. [DOI: 10.1080/07347324.2014.907015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Affiliation(s)
- John F Kelly
- Center for Addiction Medicine , Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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28
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Chiesa A, Serretti A. Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence. Subst Use Misuse 2014; 49:492-512. [PMID: 23461667 DOI: 10.3109/10826084.2013.770027] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mindfulness-based interventions (MBIs) are increasingly suggested as therapeutic approaches for effecting substance use and misuse (SUM). The aim of this article is to review current evidence on the therapeutic efficacy of MBIs for SUM. A literature search was undertaken using four electronic databases and references of retrieved articles. The search included articles written in English published up to December 2011. Quality of included trials was assessed. In total, 24 studies were included, three of which were based on secondary analyses of previously investigated samples. Current evidence suggests that MBIs can reduce the consumption of several substances including alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates to a significantly greater extent than waitlist controls, non-specific educational support groups, and some specific control groups. Some preliminary evidence also suggests that MBIs are associated with a reduction in craving as well as increased mindfulness. The limited generalizability of the reviewed findings is noted (i.e., small sample size, lack of methodological details, and the lack of consistently replicated findings). More rigorous and larger randomized controlled studies are warranted.
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Affiliation(s)
- Alberto Chiesa
- 1Department of Biomedical and NeuroMotor Sciences, University of Bologna , Bologna , Italy
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29
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Wall R, Sondhi A, Day E. What influences referral to 12-step mutual self-help groups by treatment professionals? Eur Addict Res 2014; 20:241-7. [PMID: 24853315 DOI: 10.1159/000357940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 12/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Twelve-step mutual self-help groups provide cost-effective support for recovery from substance misuse problems. Evidence suggests they are successful as an adjunct to formal treatment and that referral from clinicians is important in fostering engagement. METHODS This study surveyed substance misuse treatment professionals employed within two agencies in Birmingham (UK). RESULTS A total of 92 clinicians (79.3%) eligible to participate completed a questionnaire that explored their attitudes, knowledge and referral practices with regard to 12-step groups (TSGs). Most (74%) had a positive attitude, and almost 80% referred at least some of their clients to TSGs. However, 30% had not referred any clients in the past month, and multivariate analysis showed that referral was associated with greater objective knowledge about TSGs when other factors were controlled for. CONCLUSIONS These results have implications for linking professional treatment to mutual self-help groups, and potential strategies to increase referral are discussed.
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30
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Kelly JF, Hoeppner BB. Does Alcoholics Anonymous work differently for men and women? A moderated multiple-mediation analysis in a large clinical sample. Drug Alcohol Depend 2013; 130:186-93. [PMID: 23206376 PMCID: PMC3596430 DOI: 10.1016/j.drugalcdep.2012.11.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/23/2012] [Accepted: 11/04/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alcoholics Anonymous (AA) began as a male organization, but about one third is now female. Studies have found that women participate at least as much as men and benefit equally from AA, but it is unclear whether women benefit from AA in the same or different ways as men. This study tested whether gender moderated the mechanisms through which AA aids recovery. METHODS A cohort study of alcohol dependent adults (N=1726; 24% female; Project MATCH) was assessed on AA attendance during treatment; with mediators at 9 months; outcomes (Percent Days Abstinent [PDA] and Drinks per Drinking Day [DDD]) at 15 months. Multiple mediator models tested whether purported mechanisms (i.e., self-efficacy, depression, social networks, spirituality/religiosity) explained AA's effects differently for men and women controlling for baseline values, mediators, treatment, and other confounders. RESULTS For PDA, the proportion of AA's effect accounted for by the mediators was similar for men (53%) and women (49%). Both men and women were found to benefit from changes in social factors but these mechanisms were more important among men. For DDD, the mediators accounted for 70% of the effect of AA for men and 41% for women. Again, men benefitted mostly from social changes. Independent of AA's effects, negative affect self-efficacy was shown to have a strong relationship to outcome for women but not men. CONCLUSIONS The recovery benefits derived from AA differ in nature and magnitude between men and women and may reflect differing needs based on recovery challenges related to gender-based social roles and drinking contexts.
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Affiliation(s)
- John F Kelly
- Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States.
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31
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Kelly JF, Stout RL, Slaymaker V. Emerging adults' treatment outcomes in relation to 12-step mutual-help attendance and active involvement. Drug Alcohol Depend 2013; 129:151-7. [PMID: 23122600 PMCID: PMC3566342 DOI: 10.1016/j.drugalcdep.2012.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Participation in Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) during and following treatment has been found to confer recovery-related benefit among adults and adolescents, but little is known about emerging adults (18-24 years). This transitional life-stage is distinctive for greater distress, higher density of psychopathology, and poorer treatment and continuing care compliance. Greater knowledge would inform the utility of treatment referrals to 12-step organizations for this age-group. METHODS Emerging adults (N=303; 18-24 years; 26% female; 95% White; 51% comorbid [SCID-derived] axis I disorders) enrolled in a naturalistic study of residential treatment effectiveness assessed at intake, 3, 6, and 12 months on 12-step attendance and involvement and treatment outcomes (percent days abstinent [PDA]; percent days heavy drinking [PDHD]). Lagged hierarchical linear models (HLMs) tested whether attendance and involvement conferred recovery benefits, controlling for a variety of confounds. RESULTS The percentage attending 12-step meetings prior to treatment (36%) rose sharply at 3 months (89%), was maintained at 6 months (82%), but declined at 12 months (76%). Average attendance peaked at about 3 times per week at 3 months dropping to just over once per week at 12 months. Initially high, but similarly diminishing, levels of active 12-step involvement were also observed. Lagged HLMs found beneficial effects for attendance, but stronger effects, which increased over time, for active involvement. Several active 12-step involvement indices were associated individually with outcome benefits. CONCLUSIONS Ubiquitous 12-step organizations may provide a supportive recovery context for this high-risk population at a developmental stage where non-using/sober peers are at a premium.
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Affiliation(s)
- John F. Kelly
- Center for Addiction Medicine Departments of Psychiatry Massachusetts General Hospital and Harvard Medical School, Boston, MA
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32
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Dickson MF, Wasarhaley NE, Webster JM. A Comparison of First Time and Repeat Rural DUI Offenders. JOURNAL OF OFFENDER REHABILITATION 2013; 52:421-437. [PMID: 26225118 PMCID: PMC4516123 DOI: 10.1080/10509674.2013.813616] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of the current study was to examine whether the differences found between first time and repeat rural DUI offenders were the same as those found previously in urban samples. A total of 118 rural DUI offenders were interviewed, approximately half (51.7%) of which were repeat offenders. Although demographic and mental health characteristics were similar across the two groups, repeat offenders reported more extensive substance use and criminal histories. Results suggest that the pattern of differences between rural first time and repeat DUI offenders may be different from the pattern found in prior urban-based studies. Treatment implications are discussed.
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33
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Valentine JC, Thompson SG. Issues relating to confounding and meta-analysis when including non-randomized studies in systematic reviews on the effects of interventions. Res Synth Methods 2012; 4:26-35. [DOI: 10.1002/jrsm.1064] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 09/21/2012] [Accepted: 09/30/2012] [Indexed: 11/07/2022]
Affiliation(s)
- Jeffrey C. Valentine
- College of Education and Human Development; University of Louisville; Louisville KY U.S.A
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34
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Ullman SE, Najdowski CJ, Adams EB. Women, Alcoholics Anonymous, and Related Mutual Aid Groups: Review and Recommendations for Research. ALCOHOLISM TREATMENT QUARTERLY 2012. [DOI: 10.1080/07347324.2012.718969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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35
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Kelly JF, Yeterian JD. Empirical awakening: the new science on mutual help and implications for cost containment under health care reform. Subst Abus 2012; 33:85-91. [PMID: 22489579 DOI: 10.1080/08897077.2011.634965] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Over the past 75 years, Alcoholics Anonymous (AA) has grown from 2 members to over 2 million members. AA and similar organizations (e.g., Narcotics Anonymous [NA]) are among the most commonly sought sources of help for substance-related problems in the United States. It is only relatively recently, however, that the scientific community has conducted rigorous studies on the clinical utility and health care cost-offset potential of mutual-help groups and developed and tested professional treatments to facilitate their use. As a result of this research, AA as an organization has experienced an "empirical awakening," evolving from its peripheral status as a "nuisance variable" and perceived obstacle to progress to playing a more central role in a scientifically informed recovery oriented system of care. Also, professionally delivered interventions designed to facilitate the use of AA and NA ("Twelve-Step Facilitation" [TSF]) are now "empirically supported treatments" as defined by US federal agencies and the American Psychological Association. Under the auspices of health care reform, a rational societal response to the prodigious health and social burden posed by alcohol and other drug misuse should encompass the implementation of empirically based strategies (e.g., TSF) in order to maximize the use of ubiquitous mutual-help recovery resources.
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Affiliation(s)
- John F Kelly
- Massachusetts General Hospital (MGH), Department of Psychiatry, and Harvard Medical School, Boston, Massachusetts 02114, USA.
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36
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Lapham S, England-Kennedy E. Convicted driving-while-impaired offenders' views on effectiveness of sanctions and treatment. QUALITATIVE HEALTH RESEARCH 2012; 22:17-30. [PMID: 21490294 PMCID: PMC3137706 DOI: 10.1177/1049732311406450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In this article we analyze qualitative data from a multiple-method, longitudinal study drawn from 15-year follow-up interviews with a subsample of 82 individuals arrested for driving while intoxicated in a southwestern state (1989-1995). We explore reactions to the arrest and court-mandated sanctions, including legal punishments, mandated interventions, and/or participation in programs aimed at reducing recidivism. Key findings include experiencing certain negative emotional reactions to the arrest, reactions to being jailed, experiencing other court-related sanctions as deterring driving-while-intoxicated behavior, and generally negative opinions regarding court-mandated interventions. We discuss interviewees' complex perspectives on treatment and program participation and their effects on lessening recidivism, and we offer suggestions for reducing recidivism based on our findings.
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Affiliation(s)
- Sandra Lapham
- Behavioral Health Research Center of the Southwest, Albuquerque, New Mexico 87102, USA.
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37
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Sun AP. Helping homeless individuals with co-occurring disorders: the four components. SOCIAL WORK 2012; 57:23-37. [PMID: 22768626 DOI: 10.1093/sw/swr008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Homeless individuals with co-occurring disorders (CODs) of severe mental illness and substance use disorder are one of the most vulnerable populations. This article provides practitioners with a framework and strategies for helping this client population. Four components emerged from a literature review: (1) ensuring an effective transition for individuals with CODs from an institution (such as a hospital, foster care, prison, or residential program) into the community, a particularly important component for clients who were previously homeless, impoverished, or at risk of homelessness; (2) increasing the resources of homeless individuals with CODs by helping them apply for government entitlements or supported employment (3) linking homeless individuals to supportive housing, including housing first options as opposed to only treatment first options, and being flexible in meeting their housing needs; and (4) engaging homeless individuals in COD treatment, incorporating modified assertive community treatment, motivational interviewing, cognitive-behavioral therapy, contingency management, and COD specialized self-help groups.
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Affiliation(s)
- An-Pyng Sun
- School of Social Work, University of Neveda, Las Vegas, Nevada 89154-5032, USA.
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38
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Young LB. Alcoholics Anonymous Sponsorship: Characteristics of Sponsored and Sponsoring Members. ALCOHOLISM TREATMENT QUARTERLY 2012. [DOI: 10.1080/07347324.2012.635553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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39
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Kelly JF, Urbanoski KA, Hoeppner BB, Slaymaker V. Facilitating comprehensive assessment of 12-step experiences: A Multidimensional Measure of Mutual-Help Activity. ALCOHOLISM TREATMENT QUARTERLY 2011; 29:181-203. [PMID: 22081741 DOI: 10.1080/07347324.2011.586280] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Existing measures of 12-step mutual-help activity typically capture only a narrow range of experiences and combine fellowships with explicitly different substance-specific emphases (e.g., Alcoholics versus Narcotics Anonymous). To help expand our knowledge in this important area, we report on the development and use of a comprehensive multidimensional measure of 12-step experiences in two clinical samples of young adults and adolescents (N=430). One-week test-retest reliability was verified on a subsample. Results indicated high content validity and reliability across seven dimensions of experience (meeting attendance, meeting participation, fellowship involvement, step work, mandated attendance, affiliation, and safety), and the measure successfully discriminated between samples on anticipated activity levels. This measure provides rich data on mutual-help activities and deepens our understanding of individuals' experiences across different 12-step organizations.
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Affiliation(s)
- John F Kelly
- Center for Addiction Medicine, Harvard Medical School, Boston, MA
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Groshkova T, Best D, White W. Recovery Group Participation Scale (RGPS): Factor Structure in Alcohol and Heroin Recovery Populations. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/1556035x.2011.571132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Teodora Groshkova
- a National Addiction Center , Institute of Psychiatry,King's College London , London, United Kingdom
| | - David Best
- b Center for Criminal Justice and Policing , University of the West of Scotland , Hamilton, Lanarkshire, Scotland, United Kingdom
| | - William White
- c Addiction Studies , Chestnut Health Systems , Punta Gorda, Florida, USA
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Odgaard‐Jensen J, Vist GE, Timmer A, Kunz R, Akl EA, Schünemann H, Briel M, Nordmann AJ, Pregno S, Oxman AD. Randomisation to protect against selection bias in healthcare trials. Cochrane Database Syst Rev 2011; 2011:MR000012. [PMID: 21491415 PMCID: PMC7150228 DOI: 10.1002/14651858.mr000012.pub3] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Randomised trials use the play of chance to assign participants to comparison groups. The unpredictability of the process, if not subverted, should prevent systematic differences between comparison groups (selection bias). Differences due to chance will still occur and these are minimised by randomising a sufficiently large number of people. OBJECTIVES To assess the effects of randomisation and concealment of allocation on the results of healthcare studies. SEARCH STRATEGY We searched the Cochrane Methodology Register, MEDLINE, SciSearch and reference lists up to September 2009. In addition, we screened articles citing included studies (ISI Science Citation Index) and papers related to included studies (PubMed). SELECTION CRITERIA Eligible study designs were cohorts of studies, systematic reviews or meta-analyses of healthcare interventions that compared random allocation versus non-random allocation or adequate versus inadequate/unclear concealment of allocation in randomised trials. Outcomes of interest were the magnitude and direction of estimates of effect and imbalances in prognostic factors. DATA COLLECTION AND ANALYSIS We retrieved and assessed studies that appeared to meet the inclusion criteria independently. At least two review authors independently appraised methodological quality and extracted information. We prepared tabular summaries of the results for each comparison and assessed the results across studies qualitatively to identify common trends or discrepancies. MAIN RESULTS A total of 18 studies (systematic reviews or meta-analyses) met our inclusion criteria. Ten compared random allocation versus non-random allocation and nine compared adequate versus inadequate or unclear concealment of allocation within controlled trials. All studies were at high risk of bias.For the comparison of randomised versus non-randomised studies, four comparisons yielded inconclusive results (differed between outcomes or different modes of analysis); three comparisons showed similar results for random and non-random allocation; two comparisons had larger estimates of effect in non-randomised studies than in randomised trials; and two comparisons had larger estimates of effect in randomised than in non-randomised studies.Five studies found larger estimates of effect in trials with inadequate concealment of allocation than in trials with adequate concealment. The four other studies did not find statistically significant differences. AUTHORS' CONCLUSIONS The results of randomised and non-randomised studies sometimes differed. In some instances non-randomised studies yielded larger estimates of effect and in other instances randomised trials yielded larger estimates of effect. The results of controlled trials with adequate and inadequate/unclear concealment of allocation sometimes differed. When differences occurred, most often trials with inadequate or unclear allocation concealment yielded larger estimates of effects relative to controlled trials with adequate allocation concealment. However, it is not generally possible to predict the magnitude, or even the direction, of possible selection biases and consequent distortions of treatment effects from studies with non-random allocation or controlled trials with inadequate or unclear allocation concealment.
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Affiliation(s)
- Jan Odgaard‐Jensen
- Norwegian Knowledge Centre for the Health ServicesGlobal Health UnitPO Box 7004, St. Olavs PlassOsloNorwayN‐0130
| | - Gunn E Vist
- Norwegian Knowledge Centre for the Health ServicesPrevention, Health Promotion and Organisation UnitPO Box 7004St Olavs PlassOsloNorway0130
| | - Antje Timmer
- Carl von Ossietzky University of OldenburgDepartment of Health Services ResearchOldenburgGermany
| | - Regina Kunz
- University of Basel Hospitalasim, Swiss Academy of Insurance MedicineUniversity of BaselPetersgraben 4BaselSwitzerland4031
| | - Elie A Akl
- American University of BeirutDepartment of Internal MedicineRiad El Solh StBeirutLebanon
| | - Holger Schünemann
- McMaster UniversityDepartments of Clinical Epidemiology and Biostatistics and of Medicine1280 Main Street WestHamiltonONCanadaL8N 4K1
| | - Matthias Briel
- University Hospital Basel (USB)Basel Institute for Clinical Epidemiology and BiostatisticsBaselSwitzerland
| | - Alain J Nordmann
- University Hospital BaselInstitute for Clinical Epidemiology and BiostatisticsHebelstrasse 10BaselSwitzerland4031
| | - Silvia Pregno
- University of Modena and Reggio EmiliaCattedra di Statistica MedicaVia del Pozzo 7141100 ModenaItaly
| | - Andrew D Oxman
- Norwegian Knowledge Centre for the Health ServicesGlobal Health UnitPO Box 7004, St. Olavs PlassOsloNorwayN‐0130
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Terra MB, Barros HMT, Stein AT, Figueira I, Athayde LD, Silveira DXD. Internal consistency and factor structure of the adherence scale for alcoholics anonymous. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2011. [DOI: 10.1590/s0103-166x2011000100011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The objective of the article was to estimate the internal consistency and factor structure of the Adherence Scale for Alcoholics Anonymous Groups. The scale was applied to 257 alcoholic patients who had been admitted for treatment in 3 hospitals in Porto Alegre, about 6 months earlier. The scale was produced based on an adaptation of the Drug Attitude Inventory Scale. Internal consistency was measured using Cronbach alpha. Data were subjected to a principal component analysis. The coefficient of internal consistency was 0.71. All items showed corrected item-total correlation coefficients above 0.29. Questionnaire items with factor loading of 0.57 or above were considered in the final factor solution. The factor analysis resulted in 2 dimensions which corresponded to 67.01% of the total variance. This scale appears to be a valid instrument for use in a population of alcoholic patients.
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Rotheram-Borus MJ, Richter L, Van Rooyen H, van Heerden A, Tomlinson M, Stein A, Rochat T, de Kadt J, Mtungwa N, Mkhize L, Ndlovu L, Ntombela L, Comulada WS, Desmond KA, Greco E. Project Masihambisane: a cluster randomised controlled trial with peer mentors to improve outcomes for pregnant mothers living with HIV. Trials 2011; 12:2. [PMID: 21205302 PMCID: PMC3022743 DOI: 10.1186/1745-6215-12-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 01/04/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnant women living with HIV (WLH) face daily challenges maintaining their own and their babies' health and mental health. Standard Prevention of Maternal to Child Transmission (PMTCT) programs are not designed to address these challenges. METHODS/DESIGN As part of a cluster randomized controlled trial, WLH are invited to attend four antenatal and four postnatal small group sessions led by a peer WLH (a Peer Mentor). The WLH and their babies are assessed during pregnancy and at one week, six months, and twelve months post-birth. Mobile phones are used to collect routine information, complete questionnaires and remain in contact with participants over time. Pregnant WLH (N = 1200) are randomly assigned by clinic (N = 8 clinics) to an intervention program, called Masihambisane (n = 4 clinics, n = 600 WLH) or a standard care PMTCT control condition (n = 4 clinics; n = 600 WLH). DISCUSSION Data collection with cellular phones are innovative and effective in low-resource settings. Standard PMTCT programs are not designed to address the daily challenges faced by WLH; Peer Mentors may be useful in supporting WLH to cope with these challenges. TRIAL REGISTRATION ClinicalTrials.gov registration # NCT00972699.
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Affiliation(s)
- Mary-Jane Rotheram-Borus
- Global Center for Children and Families, University of California at Los Angeles, Los Angeles, California, USA.
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Abstract
Peer support may improve self-management among the millions of people with diabetes around the world. A major challenge to international promotion of peer support is allowing for tailoring to population, cultural, health system and other features of specific settings, while also ensuring congruence with standards for what peer support entails. One strategy to address this challenge was used in the Robert Wood Johnson Foundation Diabetes Initiative. Key functions of self-management-Resources and Supports for Self-Management-were identified. Individual programmes were then encouraged to implement these resources and support in ways that were feasible in their settings and responsive to the needs and perspectives of those they serve. Extending this to peer support, three Key functions are (i) assistance in managing and living with diabetes in daily life; (ii) social and emotional support and (iii) linkage to clinical care. International promotion may be advanced by emphasizing these key functions and then encouraging local variation in the specific ways they are addressed. Similarly, evaluation of the general benefits of peer support across several individual programmes may rest on measurement of implementation of the key functions, participants' reports of receipt of them and common end points. Challenges to promoting peer support include integrating peers amidst others in the health care system, harmonizing peers with family and other social networks, maintaining the engagement of peer supporters and those they assist and preventing training, quality improvement and professionalism from distorting the fundamental benefits of support from a peer.
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Heisler M. Different models to mobilize peer support to improve diabetes self-management and clinical outcomes: evidence, logistics, evaluation considerations and needs for future research. Fam Pract 2010; 27 Suppl 1:i23-32. [PMID: 19293400 PMCID: PMC2902359 DOI: 10.1093/fampra/cmp003] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Much of diabetes care needs to be carried out by patients between office visits with their health care providers. Yet, many patients face difficulties carrying out these tasks. In addition, many adults with diabetes cannot count on effective support from their families and friends to help them with their self-management. Peer support programmes are a promising approach to enhance social and emotional support, assist patients in daily management and living with diabetes and promote linkages to clinical care. This background paper provides a brief overview of different approaches to mobilize peer support for diabetes self-management support, discusses evidence to date on the effectiveness of each of these models, highlights logistical and evaluation issues for each model and concludes with a discussion of directions for future research in this area.
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Affiliation(s)
- Michele Heisler
- Veterans Affairs Center for Clinical Practice Management Research, VA Ann Arbor Healthcare System, MI, USA.
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Dadich A. Expanding our understanding of self-help support groups for substance use issues. JOURNAL OF DRUG EDUCATION 2010; 40:189-202. [PMID: 21133331 DOI: 10.2190/de.40.2.f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Self-Help Support Groups (SHSGs) for substance use issues are recognized in current policies for their role in reducing substance use. However, these policies recognize only their therapeutic value. This article argues that SHSGs can offer more than therapeutic advantage. This contention follows a study involving young people who were involved in a 12 Step fellowship. They valued group involvement for the connectedness, support, and opportunities to learn. These findings have important policy implications, highlighting a need to broaden the scope of current policies so they reflect the array of potential benefit associated with SHSGs. For clinicians and practitioners who are guided by social policy, this would offer an enhanced understanding of these groups, given that they are in prime position to advise clients about available options.
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Affiliation(s)
- Ann Dadich
- Research in Health Organisation and Management (RHOaM), Centre for Industry and Innovation Studies (CInIS) Research Group, University of Western Sydney, Penrith South DC NSW, Australia.
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Magill M, Ray LA. Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. J Stud Alcohol Drugs 2009; 70:516-27. [PMID: 19515291 DOI: 10.15288/jsad.2009.70.516] [Citation(s) in RCA: 336] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This meta-analysis examined 53 controlled trials of cognitive-behavioral treatment (CBT) for adults diagnosed with alcohol- or illicit-drug-use disorders. The aims were to provide an overall picture of CBT treatment efficacy and to identify client or treatment factors predictive of CBT effect magnitude. METHOD The inverse variance weighted effect size (Hedges' g) was calculated for each study and pooled using fixed and random effects methods. Potential study-level moderators were assessed in subgroup analyses by primary drug, type of CBT, and type of comparison condition. In addition, seven client and treatment variables were examined in meta-regression analyses. RESULTS Across studies, CBT produced a small but statistically significant treatment effect (g = 0.154, p < .005). The pooled effect was somewhat lower at 6-9 months (g = 0.1 15, p < .005) and continued to diminish at 12-month follow-up (g = 0.096, p < .05). The effect of CBT was largest in marijuana studies (g = 0.513, p < .005) and in studies with a no-treatment control as the comparison condition (g = 0.796, p < .005). Meta-regression analyses indicated that the percentage of female participants was positively associated and the number of treatment sessions was negatively associated with effect size. CONCLUSIONS The findings demonstrate the utility of CBT across a large and diverse sample of studies and under rigorous conditions for establishing efficacy. CBT effects were strongest with marijuana users, when CBT was compared with no treatment, and may be larger with women than with men and when delivered in a brief format.
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Affiliation(s)
- Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Box G S121-4, Providence, Rhode Island 02912, USA.
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Abstract
Research on the effectiveness of Alcoholics Anonymous (AA) is controversial and subject to widely divergent interpretations. The goal of this article is to provide a focused review of the literature on AA effectiveness that will allow readers to judge the evidence effectiveness of AA for themselves. The review organizes the research on AA effectiveness according to six criterion required for establishing causation: (1) magnitude of effect; (2) dose response effect; (3) consistent effect; (4) temporally accurate effects; (5) specific effects; (6) plausibility. The evidence for criteria 1- 4 and 6 is strong: rates of abstinence are about twice as high among those who attend AA (criteria 1, magnitude); higher levels of attendance are related to higher rates of abstinence (criteria 2, dose-response); these relationships are found for different samples and follow-up periods (criteria 3, consistency); prior AA attendance is predictive of subsequent abstinence (criteria 4, temporal); and mechanisms of action predicted by theories of behavior change are present in AA (criteria 6, plausibility). However, rigorous experimental evidence establishing the specificity of an effect for AA or Twelve Step Facilitation/TSF (criteria 5) is mixed, with 2 trials finding a positive effect for AA, 1 trial finding a negative effect for AA, and 1 trial finding a null effect. Studies addressing specificity using statistical approaches have had two contradictory findings, and two that reported significant effects for AA after adjusting for potential confounders such as motivation to change.
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Affiliation(s)
- Lee Ann Kaskutas
- School of Public Health, University of California-Berkeley, Berkeley, California, USA.
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Hettema JE, Sorensen JL. Access to Care for Methadone Maintenance Patients in the United States. Int J Ment Health Addict 2009; 7:468-474. [PMID: 22876215 PMCID: PMC3412296 DOI: 10.1007/s11469-009-9204-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This policy commentary addresses a significant access to care issue that faces methadone maintenance patients seeking residential treatment in the United States. Methadone maintenance therapy (MMT) has demonstrated strong efficacy in the outpatient treatment of opiate dependence. However, many opiate dependent patients are also in need of more intensive interventions, such as residential care. Many publically-funded residential treatment programs explicitly decline to admit MMT patients, contending that methadone raises both clinical and administrative problems in treatment. Although advocates within the field believe that this issue is a violation of the American's with Disabilities Act (ADA) in the United States, no lawsuits have been brought forth, and there is no legal precedent or public policy to inform the debate. The present paper provides an overview of this problem and discusses factors that may contribute to the problem, including an abstinence-oriented philosophy and treatment program operational concerns. The paper also draws parallels between methadone and other medical conditions and analyzes the problem in the context of disabilities encompassed in the ADA. Finally, recommendations on strategies for increasing access to residential care for MMT patients are provided.
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Affiliation(s)
- Jennifer E Hettema
- University of Virginia, Department of Psychiatry and Neurobehavioral Sciences and University of California San Francisco, San Francisco General Hospital, Department of Psychiatry
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Groh DR, Jason LA, Ferrari JR, Davis MI. Oxford House and Alcoholics Anonymous: The Impact of Two Mutual-help Models on Abstinence. ACTA ACUST UNITED AC 2009; 4:23-31. [PMID: 20689661 DOI: 10.1080/15560350802712363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Two examples of mutual-help approaches for substance abuse recovery are 12-step groups (AA and NA) and Oxford House. The present study examined the combined effects of AA and Oxford House residence on abstinence over a 24-month period with 150 individuals randomly assigned to either an Oxford House or to usual after-care. Among individuals with high 12-step involvement, the addition of Oxford House residence significantly increased the odds of abstinence (87.5% vs. 52.9%). However, among participants with low 12-step involvement, rates of abstinence were fairly similar across conditions (31.4% vs. 21.2%). Results suggested that the joint effectiveness of these mutual-help programs may promote abstinence.
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