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Greenfield TK, Lui CK, Cook WK, Karriker-Jaffe KJ, Li L, Wilsnack SC, Bloomfield K, Room R, Laslett AM, Bond J, Korcha R. High Intensity Drinking (HID) Assessed by Maximum Quantity Consumed Is an Important Pattern Measure Adding Predictive Value in Higher and Lower Income Societies for Modeling Alcohol-Related Problems. Int J Environ Res Public Health 2023; 20:3748. [PMID: 36834453 PMCID: PMC9958696 DOI: 10.3390/ijerph20043748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 05/28/2023]
Abstract
Adjusting for demographics and standard drinking measures, High Intensity Drinking (HID), indexed by the maximum quantity consumed in a single day in the past 12 months, may be valuable in predicting alcohol dependence other harms across high and low income societies. The data consisted of 17 surveys of adult (15,460 current drinkers; 71% of total surveyed) in Europe (3), the Americas (8), Africa (2), and Asia/Australia (4). Gender-disaggregated country analyses used Poison regression to investigate whether HID (8-11, 12-23, 24+ drinks) was incrementally influential, beyond log drinking volume and HED (Heavy Episodic Drinking, or 5+ days), in predicting drinking problems, adjusting for age and marital status. In adjusted models predicting AUDIT-5 for men, adding HID improved the overall model fit for 11 of 15 countries. For women, 12 of 14 countries with available data showed an improved fit with HID included. The results for the five Life-Area Harms were similar for men. Considering the results by gender, each country showing improvements in model fit by adding HID had larger values of the average difference between high intensity and usual consumption, implying variations in amounts consumed on any given day. The amount consumed/day often greatly exceeded HED levels. In many societies of varying income levels, as hypothesized, HID provided important added information on drinking patterns for predicting harms, beyond the standard volume and binging indicators.
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Affiliation(s)
- Thomas K. Greenfield
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Camillia K. Lui
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Won K. Cook
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Katherine J. Karriker-Jaffe
- Community Health & Implementation Research Program, Research Triangle Institute, Berkeley Office, CA 94704, USA
| | - Libo Li
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Sharon C. Wilsnack
- Department of Psychiatry and Behavioral Science, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 94704, USA
| | - Kim Bloomfield
- Centre for Alcohol and Drug Research, School of Business and Social Sciences, Aarhus University, 2400 Copenhagen, Denmark
| | - Robin Room
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University (Melbourne Campus), Bundoora, VIC 3086, Australia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, 106 91 Stockholm, Sweden
| | - Anne-Marie Laslett
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University (Melbourne Campus), Bundoora, VIC 3086, Australia
| | - Jason Bond
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Rachael Korcha
- Alcohol Research Group, Public Health Institute (PHI), 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
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Polcin D, Witbrodt J, Nayak MB, Korcha R, Pugh S, Salinardi M. Characteristics of women with alcohol use disorders who benefit from intensive motivational interviewing. Subst Abus 2022; 43:23-31. [PMID: 31697218 PMCID: PMC7202950 DOI: 10.1080/08897077.2019.1686724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Women with alcohol disorders have more severe problems related to their drinking than men. They have higher mortality from alcohol-related accidents and enter treatment with more serious medical, psychiatric, and social consequences. Objective: This study assessed the effects of Intensive Motivational Interviewing (IMI), a new, 9-session counseling intervention for women with drinking problems. Methods: A randomized clinical trial was conducted with 215 women. Most were white (83%), college educated (61%), and older (mean age 51). Half received IMI and half a standard single session of MI (SMI) along with an attention control (nutritional education). Results: Generalized estimating equations models showed women who were heavy drinkers at baseline in the IMI condition reduced heavy drinking more than those in the SMI condition at 2-, 6-, and 12-month follow-up. Analyses of disaggregated subgroups showed IMI was most effective for women with low psychiatric severity, more severe physical and impulse control consequences associated with drinking, and higher motivation. However, formal 3-way interaction models (condition by moderator by time) showed significant effects primarily at 2 months. Conclusions: Improvements associated with IMI were limited to heavy drinking and varied among subgroups of women. Studies of women with more diverse characteristics are needed.
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Affiliation(s)
- Douglas Polcin
- Public Health Institute, Behavioral Health and Recovery Studies, Oakland, 94607-4058 United States
| | - Jane Witbrodt
- Alcohol Research Group, Emeryville, 94608-1010 United States
| | | | | | - Sheila Pugh
- Alcohol Research Group, Emeryville, California, USA
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de Guzman R, Korcha R, Polcin DL. "I have more support around me to be able to change": A Qualitative Exploration of Probationers' and Parolees' Experiences Living in Sober Living Houses. Ther Communities 2019; 40:51-65. [PMID: 31467467 DOI: 10.1108/tc-04-2018-0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Persons in the U.S. who are incarcerated for drug offenses are increasingly being released into the community as a way to decrease prison and jail overcrowding. One challenge is finding housing that supports compliance with probation and parole requirements, which often includes abstinence from drugs and alcohol. Sober living houses (SLHs) are alcohol- and drug-free living environments that are increasingly being used as housing options for probationers and parolees. Although a few studies have reported favorable outcomes for residents of SLHs, little is known about resident experiences or the factors that are experienced as helpful or counterproductive. This study conducted qualitative interviews with 28 SLH residents on probation or parole to understand their experiences living in the houses, aspects of the houses that facilitated recovery, ways residence in a SLH affected compliance with probation and parole, and ways the houses addressed HIV risk, a widespread problem among this population. Interviews were audiotaped and coded for dominant themes. Study participants identified housing as a critically important need after incarceration. For residents nearing the end of their stay in the SLHs, there was significant concern about where they might live after they left. Residents emphasized that shared experiences and goals, consistent enforcement of rules (especially the requirement of abstinence), and encouragement from probation and parole officers as particularly helpful. There was very little focus in HIV issues, even though risk behaviors were common. For some residents, inconsistent enforcement of house rules was experienced as highly problematic. Research is needed to identify the organizational and operational procedures that enhance factors experienced as helpful. This paper is the first to document the views and experiences of persons on probation or parole who reside in sober living recovery houses. These data can be used by SLH operators to develop houses that are responsive to factors experienced as helpful and counterproductive. The significance of this paper is evident in the trend toward decreasing incarceration in the U.S. of persons convicted of drug offenses and the need for alcohol- and drug-free alternative living environments.
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Affiliation(s)
| | - Rachael Korcha
- Public Health Institute, 936 Dewing Ave, Suite C, 925-381-6782,
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4
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Polcin DL, Nayak MB, Korcha R, Pugh S, Witbrodt J, Salinardi M, Galloway G, Nelson E. Heavy Drinking among Women Receiving Intensive Motivational Interviewing: 6-Month Outcomes. J Psychoactive Drugs 2019; 51:421-430. [PMID: 31327306 DOI: 10.1080/02791072.2019.1634302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Compared to men, women with alcohol use disorders experience more severe consequences related to drinking. Intensive Motivational Interviewing (IMI) is a new 9-session version of Motivational Interviewing (MI) designed for women with alcohol use disorders. The current study reports outcomes from a randomized clinical trial of IMI compared to a single session of MI. Data were collected at baseline, 2-month, and 6-month follow-up. In addition to a standard "intent-to-treat" (ITT) analysis, we conducted disaggregated subgroup analyses of women who were heavy drinkers and a "per protocol" (PP) analysis of women in the IMI condition who attended 7-9 sessions (80% of the IMI sample). Women in both study conditions made large reductions in drinking between baseline and 2 months that were maintained at 6 months. Generalized estimating equation (GEE) models using the full sample (N = 215) did not show time by condition differences, but heavy drinkers(n = 153) receiving IMI showed significantly larger reductions in drinking at 2- and 6-month follow-up than the comparison condition. Assessment of heavy drinkers using the PP sample showed larger between condition differences favoring IMI at both follow-up time points. Results support the efficacy of IMI in terms of reducing drinking, particularly among women who are heavy drinkers.
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Affiliation(s)
- Douglas L Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Lafayette, CA, USA
| | - Madhabika B Nayak
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Rachael Korcha
- Behavioral Health and Recovery Studies, Public Health Institute, Lafayette, CA, USA
| | - Sheila Pugh
- Behavioral Health and Recovery Studies, Public Health Institute, Lafayette, CA, USA
| | - Jane Witbrodt
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Michelle Salinardi
- Behavioral Health and Recovery Studies, Public Health Institute, Lafayette, CA, USA
| | | | - Emily Nelson
- Behavioral Health and Recovery Studies, Public Health Institute, Lafayette, CA, USA
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Ye Y, Shield K, Cherpitel CJ, Manthey J, Korcha R, Rehm J. Estimating alcohol-attributable fractions for injuries based on data from emergency department and observational studies: a comparison of two methods. Addiction 2019; 114:462-470. [PMID: 30347115 PMCID: PMC6384006 DOI: 10.1111/add.14477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/31/2018] [Accepted: 10/16/2018] [Indexed: 01/01/2023]
Abstract
AIM To compare the injury alcohol-attributable fractions (AAFs) estimated using emergency department (ED) data to AAFs estimated by combining population alcohol consumption data with corresponding relative risks (RRs). DESIGN Comparative risk assessment. SETTING AND PARTICIPANTS ED studies in 27 countries (n = 24 971). MEASUREMENTS AAFs were estimated by means of an acute method using data on injury cases from 36 ED studies combined with odds ratios obtained from ED case-cross-over studies. Corresponding AAFs for injuries were estimated by combining population-level data on alcohol consumption obtained from the Global Information System on Alcohol and Health, with corresponding RRs obtained from a previous meta-analysis. FINDINGS ED-based injury AAF estimates ranged from 5% (Canada 2002 and the Czech Republic) to 40% (South Africa), with a mean AAF among all studies of 15.4% (18.9% for males and 8.4% for females). Population-based injury AAF estimates ranged from 21% (India) to 51% (Spain and the Czech Republic), with a mean AAF among all country-years of 36.8% (42.5% for males and 22.5% for females). The Pearson correlation coefficient for the two types of injury AAF estimates was 0.09 for the total, 0.06 for males and 0.32 for females. CONCLUSIONS Two methods of estimating the injury alcohol-attributable fractions-emergency department data versus population method-produce widely differing results. Across 36 country-years, the mean AAF using the population method was 36.8%, more than twice as large as emergency department data-based acute estimates, which average 15.4%.
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Affiliation(s)
- Yu Ye
- Public Health Institute, Alcohol Research Group,
Emeryville, CA, United States
| | - Kevin Shield
- Institute for Mental Health Policy Research, Centre for
Addiction and Mental Health (CAMH), Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto,
Toronto, Canada
| | - Cheryl J. Cherpitel
- Public Health Institute, Alcohol Research Group,
Emeryville, CA, United States
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy,
Technische Universität Dresden, Dresden, Germany
| | - Rachael Korcha
- Public Health Institute, Alcohol Research Group,
Emeryville, CA, United States
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for
Addiction and Mental Health (CAMH), Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto,
Canada
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Mericle AA, Mahoney E, Korcha R, Delucchi K, Polcin DL. Sober living house characteristics: A multilevel analyses of factors associated with improved outcomes. J Subst Abuse Treat 2019; 98:28-38. [PMID: 30665601 PMCID: PMC6605057 DOI: 10.1016/j.jsat.2018.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/06/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
Abstract
Safe and stable housing is integral to addiction recovery. Across numerous studies, recovery housing has been found to be associated with improvements in a variety of domains. Although procedures for operating some types of recovery housing have been manualized and national standards established, there are few empirical findings identifying which recovery residence characteristics may lead to improved outcomes. Using data from 330 newly admitted residents recruited from 49 sober living houses in California and re-contacted for 6- and 12-month follow-up interviews, this study examines the effects of organizational, operational, and programming characteristics on substance use, criminal justice, and employment outcomes. Results from multilevel analyses adjusting for resident demographics and length of stay indicate that organizational characteristics were associated with outcomes. Residents recruited from houses that were part of a larger organization or group of houses had increased odds of total abstinence (aOR = 3.98, p < 0.001) and drug abstinence (aOR = 3.19, p < 0.001). Residents recruited from houses that were affiliated with a treatment program had increased odds of employment (aOR = 2.92, p = 0.003). Operational characteristics such as where the house was located and whether the house required incoming residents to be sober for at least 30 days prior to entry were also related to improved outcomes, but additional work is needed to develop tools to assess and measure recovery housing characteristics and to better understand how these factors contribute to improved outcomes.
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Affiliation(s)
- Amy A Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA.
| | - Elizabeth Mahoney
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
| | - Rachael Korcha
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
| | - Kevin Delucchi
- University of California San Francisco, San Francisco, CA 94143, USA
| | - Douglas L Polcin
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
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Cherpitel CJ, Witbrodt J, Ye Y, Korcha R. A multi-level analysis of emergency department data on drinking patterns, alcohol policy and cause of injury in 28 countries. Drug Alcohol Depend 2018; 192:172-178. [PMID: 30266001 PMCID: PMC6200595 DOI: 10.1016/j.drugalcdep.2018.07.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND While individual-level drinking pattern is an important risk factor for alcohol-related injury, societal-level pattern and alcohol policy are also important, and no research exists on the relationship of these variables with specific causes of injury. METHODS A probability sample of 14,142 emergency department (ED) patients from 32 ED studies in 28 countries included in the International Collaborative Alcohol and Injury Study (ICAIS) is analyzed using multilevel modeling of individual-level volume and pattern of drinking, country-level detrimental drinking pattern (DDP), and alcohol policy using the International Alcohol Policy and Injury Index (IAPII) on self-reported drinking prior to the injury event, categorized as traffic, violence, fall or other cause. The IAPII includes four domains: availability, vehicular, advertising, and drinking context. RESULTS Frequent heavy drinking was a strong predictor (p < .0.001) of injuries related to violence (OR = 2.57), falls (OR = 2.86), and other causes (OR = 1.71), while episodic heavy drinking was a significant predictor of injuries related to violence and falls. DDP was a significant predictor (p < 0.05) of traffic (OR = 1.54) and violence-related injuries (OR = 1.38) but lost significance when the IAPII was included. The IAPII was a significant predictor only for traffic injury (OR = 0.97, p < 0.001), and each domain with the exception of context were also significant. CONCLUSIONS Findings here clearly point to the importance of targeted policies for specific causes of injury as well as the importance of individual and societal drinking patterns, the latter of which may be difficult to influence by preventive measures aimed to reduce alcohol-related injury.
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Affiliation(s)
- Cheryl J Cherpitel
- Alcohol Research Group, 6001 Shellmound St. Suite 450, Emeryville, CA 94608, USA.
| | - Jane Witbrodt
- Alcohol Research Group, 6001 Shellmound St. Suite 450, Emeryville, CA 94608, USA
| | - Yu Ye
- Alcohol Research Group, 6001 Shellmound St. Suite 450, Emeryville, CA 94608, USA
| | - Rachael Korcha
- Alcohol Research Group, 6001 Shellmound St. Suite 450, Emeryville, CA 94608, USA
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Polcin DL, Korcha R, Witbrodt J, Mericle AA, Mahoney E. Motivational Interviewing Case Management (MICM) for Persons on Probation or Parole Entering Sober Living Houses. Crim Justice Behav 2018; 45:1634-1659. [PMID: 30559549 PMCID: PMC6293974 DOI: 10.1177/0093854818784099] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The failure of incarceration as a response to drug offenses has resulted in new policies supporting community-based alternatives. One challenge has been finding appropriate housing for persons on probation and parole. Sober living houses (SLHs) are alcohol- and drug-free living environments that are increasingly being used as housing options for these individuals. The current study examined 6- and 12-month outcomes for 330 persons on probation or parole who entered 49 SLHs. Residents in 22 houses (n = 149 individuals) were randomly assigned to receive a "Motivational Interviewing Case Management" (MICM) intervention and residents in the other 27 houses (n = 181 individuals) received SLH residency as usual. At 6-and 12-month follow-up, both study conditions showed significant improvement relative to baseline on substance abuse, criminal justice, HIV risk, and employment outcomes. For persons who attended at least one MICM session, there were better criminal justice outcomes compared to the SLH as usual group.
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Affiliation(s)
- Douglas L. Polcin
- Behavioral Health and Recovery Studies, Public Health
Institute, Lafayette, CA
| | - Rachael Korcha
- Behavioral Health and Recovery Studies, Public Health
Institute, Lafayette, CA
| | - Jane Witbrodt
- Alcohol Research Group, Public Health Institute,
Lafayette, CA
| | - Amy A. Mericle
- Alcohol Research Group, Public Health Institute,
Lafayette, CA
| | - Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health
Institute, Lafayette, CA
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Polcin DL, Korcha R, Mericle AA, Mahoney E, Hemberg J. Problems and Service Needs Among Ex-Offenders with HIV Risk Behaviors Entering Sober Living Recovery Homes. Crim Justice Stud (Abingdon) 2017; 30:381-400. [PMID: 29200972 PMCID: PMC5703424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There is currently a nationwide effort to decrease the number of persons who are incarcerated in jails and prisons. However, many ex-offenders on probation or parole do not have access to affordable housing and larger proportions have histories of HIV risk as well as substance abuse problems. In California, sober living houses (SLHs) are becoming an increasingly popular housing option for these individuals. Based largely on the principles of Alcoholics Anonymous (AA), SLHs require abstinence from alcohol and drugs and provide peer support for recovery. The current study examined the types of problems experienced among 330 ex-offenders with lifetime risk for HIV during the six months prior to entering SLHs. Nearly three fourths (74%) of all ex-offenders entering the houses had at least one HIV risk. The importance of housing was evident in the finding that housing status and participants' perceptions of their housing situation were associated with a variety of problem areas, including substance use, HIV risk, psychiatric severity, and legal problems. SLHs represent an important housing option for ex-offenders, but many residents may need additional services to address various problems.
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Affiliation(s)
- Douglas L Polcin
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608, 510-898-5800, 925-381-6782
| | - Rachael Korcha
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608, 510-898-5800, 925-381-6782
| | - Amy A Mericle
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608, 510-898-5800, 925-381-6782
| | - Elizabeth Mahoney
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608, 510-898-5800, 925-381-6782
| | - Jordana Hemberg
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608, 510-898-5800, 925-381-6782
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Andreuccetti G, Ye Y, Kang J, Korcha R, Witbrodt JA, Carvalho HB, Cherpitel CJ. The Effects of Acute Cannabis Use on Nontraffic Injury Risk: Reviewing the Available Literature and Identifying Ways Forward. ACTA ACUST UNITED AC 2017; 44:147-158. [PMID: 29456273 DOI: 10.1177/0091450917710763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent evidence has indicated that cannabis use before driving is associated with a modest but increased risk for traffic-related injuries. However, the question of whether recent cannabis use is associated with a greater risk for other types of injuries remains unanswered. Aiming to understand better how acute cannabis use might affect the risk for all causes of injury, we have summarized the limited data available in the literature on the risk of non-traffic injuries associated with recent cannabis use. Very few studies were able to provide estimate risks for all injuries or injuries other than those related to road traffic injuries, with the limited evidence available showing mixed findings. The only significant risk found (in only one study) suggests an inverse association between all injuries and cannabis use. Study designs are limited, and the majority of studies have neither data on acute cannabis use among injured individuals nor a valid control group for estimating injury risk attributable to cannabis. In conclusion, studies of the association between cannabis and non-traffic injuries present several limitations, particularly regarding sampling strategies, injury risk assessment for different causes of injury, and a dose-response risk relationship with injury. Further studies, incorporating better design for different causes of injury and drug testing, are required to reach firmer conclusions on the association between cannabis use and non-traffic injury risk.
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Affiliation(s)
- Gabriel Andreuccetti
- Alcohol Research Group, Emeryville, CA 94608, United States.,University of Sao Paulo Medical School, SP 01246-903, Brazil
| | - Yu Ye
- Alcohol Research Group, Emeryville, CA 94608, United States
| | | | - Rachael Korcha
- Alcohol Research Group, Emeryville, CA 94608, United States
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Polcin DL, Korcha R. Social Support Influences on Substance Abuse Outcomes Among Sober Living House Residents with Low and Moderate Psychiatric Severity. J Alcohol Drug Educ 2017; 61:51-70. [PMID: 28757663 PMCID: PMC5529042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Social support and psychiatric severity are known to influence substance abuse. However, little is known about how their influences vary under different conditions. We aimed to study how different types of social support were associated with substance abuse outcomes among persons with low and moderate psychiatric severity who entered Sober Living Houses (SLHs). Two hundred forty-five individuals entering 16 SLHs were interviewed at baseline and 6, 12, and 18 months. The Brief Symptom Inventory assessed psychiatric symptoms and the Important People Instrument and a modified AA Affiliation Scale assessed social support. Social support variables predicted substance abuse outcomes for persons with low and moderate psychiatric severity. However, they were the strongest and most consistent predictors for the low severity group.
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Affiliation(s)
- Douglas L Polcin
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608
| | - Rachael Korcha
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608
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Polcin DL, Witbrodt J, Korcha R, Gupta S, Mericle AA. Course of Psychiatric Symptoms and Abstinence among Methamphetamine-Dependent Persons in Sober Living Recovery Homes. J Psychoactive Drugs 2016; 48:173-80. [PMID: 27184803 DOI: 10.1080/02791072.2016.1180466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although studies of co-occurring psychiatric disorders among methamphetamine (MA)-dependent persons have been conducted in treatment programs, none have examined them in service settings used to sustain long-term recovery, such as sober living houses (SLHs). METHODS Residents entering SLHs (N = 243) were interviewed within two weeks and at 6-, 12-, and 18-month follow-up. Measures assessed psychiatric symptoms using the Brief Symptom Inventory (BSI), past-year drug and alcohol dependence, and abstinence over six-month time periods. RESULTS Overall, severity of psychiatric symptoms on the BSI was similar among MA-dependent and other dependent residents. Global psychiatric severity, depression, and somatization scales on the BSI predicted abstinence for both groups. However, phobic anxiety and hostility scales were associated with abstinence for MA-dependent residents but not for those dependent on other substances. CONCLUSION The similarity of psychiatric symptoms among persons with and without MA dependence in SLHs is different from what studies have found in treatment programs. The association between psychiatric symptoms and abstinence for both groups suggests SLHs should consider provision of on- or off-site mental health services. Additional research is needed to understand why phobic anxiety and hostility are associated with abstinence among MA-dependent residents but not those dependent on other substances.
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Affiliation(s)
- Douglas L Polcin
- a Senior Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Jane Witbrodt
- b Associate Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Rachael Korcha
- b Associate Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Shalika Gupta
- c Research Associate , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Amy A Mericle
- d Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
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Abstract
OBJECTIVE Sober living houses are alcohol- and drug-free recovery residences that help individuals with substance use disorders maintain long-term abstinence. Given the prevalence of co-occurring mental disorders among individuals entering substance use treatment, it is likely that many such residents are also contending with psychiatric symptoms, and it is unclear how these symptoms may affect their sobriety. This study sought to describe the prevalence and trajectories of different types of symptoms among sober living house residents and examine how these symptoms affect substance use outcomes. METHODS Data for this study were collected as part of a larger study on outcomes among sober living house residents in Northern California. The current study examined data from 300 residents in two housing groups; residents were interviewed upon entry and re-interviewed at 6-, 12-, and 18-month follow-ups. Psychiatric symptoms were assessed using the Brief Symptom Inventory (BSI). General estimating equations tested changes in BSI global psychological distress and clinical symptom scales over time and examined the relationship between scale scores and substance use in longitudinal models controlling for demographics, length of stay, and psychiatric service utilization. RESULTS The average age of residents was 38.5 years (SD = 10.1) and they were mostly male (80%) and Caucasian (65%). Retention rates were high, with 90% (n = 269) participating in at least one follow-up interview. Overall psychological distress (Wald χ(2) = 7.99, df = 3, p = .046), symptoms of depression (Wald χ(2) = 13.57, df = 3, p = .004), and phobic anxiety (Wald χ(2) = 7.89, df = 3, p = .048) significantly improved over time. In all models examining the relationship between BSI scale scores and substance use, rates of abstinence and days of use among those who reported using substances also improved over time. Overall distress (OR = 0.48, p < .001) as well as higher scores on the somatization (OR = 0.56, p < .001), depression (OR = 0.53, p < .001), hostility (OR = 0.71, p = .006), and phobic anxiety (OR = 0.74, p = .012) subscales were significantly associated with a decreased likelihood of abstinence. Symptoms of somatization (B = 0.092, SE = 0.029, p = .002) were associated with an increase in the number of days substances were used among those who reported use. CONCLUSIONS Psychological symptoms among sober living house residents improve over time, but they are risk factors for relapse, suggesting that additional support provided to residents with psychiatric symptoms could improve substance use outcomes.
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Affiliation(s)
- Doug Polcin
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
| | - Rachael Korcha
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
| | - Shalika Gupta
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
| | | | - Amy A Mericle
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
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Abstract
Background The study of motivation in the substance abuse field has typically examined the extent to which substance users want to quit or reduce substance use. Less frequently examined is the desire to maintain sobriety after achieving abstinence. The current study examined motivation to maintain sobriety among residents of sober living houses (SLHs), a type of recovery home for individuals with alcohol and drug problems. Previous research on this population showed favorable longitudinal outcomes over 18 months. Resident views about the costs of not using substances (ie, the difficulties encountered when not using), as well as the perceived benefits of not using, were strong predictors of substance use outcomes. Methods This study adds to these findings by conducting two focus groups with individuals familiar with the structure and day-to-day operations of SLHs, including administrators of SLH organizations, owners, and peer managers. Results Focus group results supported the importance of costs and benefits as motivational forces influencing abstinence. However, participants also emphasized characteristics of the sober living recovery environment as important factors influencing motivation. Interactions among recovering peers offer unique opportunities for feeling understood, recognizing vulnerability in others, identifying with the recovery processes of others, receiving supportive confrontation, and engaging in mutual accountability. These experiences are important elements of motivation that become activated by involvement in the SLH environment and are difficult to replicate outside of that context. Conclusion In addition to recognizing how motivation can be enhanced by addressing costs and benefits experienced by individuals, operators of recovery homes need to understand motivation as a function of the recovery home social environment. Additional studies are needed on motivation as a longitudinal construct in a variety of peer-oriented environments. Studies are also needed to better specify interactions within SLHs that increase and hinder motivation among different types of residents.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Rachael Korcha
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
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Polcin DL, Korcha R, Bond J, Galloway G, Nayak M. Changes in psychiatric symptoms among persons with methamphetamine dependence predicts changes in severity of drug problems but not frequency of use. Subst Abus 2015; 37:209-14. [PMID: 25775225 DOI: 10.1080/08897077.2015.1015701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few studies have examined how changes in psychiatric symptoms over time are associated with changes in drug use and severity of drug problems. No studies have examined these relationships among methamphetamine (MA)-dependent persons receiving motivational interviewing within the context of standard outpatient treatment. METHODS Two hundred seventeen individuals with MA dependence were randomly assigned to a standard single session of motivational interviewing (MI) or an intensive 9-session model of MI. Both groups received standard outpatient group treatment. The Addiction Severity Index (ASI) and timeline follow-back (TLFB) for MA use were administered at treatment entry and 2-, 4-, and 6-month follow-ups. RESULTS Changes in ASI psychiatric severity between baseline and 2 months predicted changes in ASI drug severity during the same time period, but not changes on measures of MA use. Item analysis of the ASI drug scale showed that psychiatric severity predicted how troubled or bothered participants were by their drug us, how important they felt it was for them to get treatment, and the number of days they experienced drug problems. However, it did not predict the number days they used drugs in the past 30 days. These associations did not differ between study conditions, and they persisted when psychiatric severity and outcomes were compared across 4- and 6-month time periods. CONCLUSIONS Results are among the first to track how changes in psychiatric severity over time are associated with changes in MA use and severity of drug problems. Treatment efforts targeting reduction of psychiatric symptoms among MA-dependent persons might be helpful in reducing the level of distress and problems associated with MA use but not how often it is used. There is a need for additional research describing the circumstances under which the experiences and perceptions of drug-related problems diverge from frequency of consumption.
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Affiliation(s)
| | - Rachael Korcha
- a Alcohol Research Group , Emeryville , California , USA
| | - Jason Bond
- a Alcohol Research Group , Emeryville , California , USA
| | - Gantt Galloway
- b California Pacific Medical Center , San Francisco , California , USA
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Polcin DL, Sterling J, Brown T, Brown M, Buscemi R, Korcha R. Client and Therapist Views about Intensive and Standard Motivational Interviewing. J Contemp Psychother 2014; 45:167-176. [PMID: 26185335 DOI: 10.1007/s10879-014-9280-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although motivational interviewing (MI) is a widely used intervention for alcohol and drug problems, little is known about client and therapist experiences. Client and therapist views could help better understand how MI works and what factors are important. This paper investigates experiences of clients and therapists who participated in a study that examined a standard single session of MI (MI 1) and a more intensive 9-session model (MI 9) for methamphetamine dependence. Qualitative methods included open ended questions presented to 184 clients at 2-month follow-up and 189 clients at 6-month follow-up. In addition, a focus group consisting of two therapists who delivered the interventions and two adherence monitors who listened to audiotape recordings of sessions was conducted. Clients in both conditions felt supportive, nonjudgmental therapist attitudes were helpful. Most clients in the MI 9 condition but few receiving MI 1 volunteered that feedback and advice were helpful. A strong majority in both conditions desired more sessions. Expert panel members emphasized: 1) multiple benefits of a nonjudgmental stance, 2) finding the right balance among different MI interventions, and 3) understanding the interaction of supportive and directive interventions. Panel members also emphasized that one advantages of MI 9 over MI 1 was that it enabled client change plans to be implemented over time.
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Abstract
An intensive, 9-session motivational interviewing (IMI) intervention was assessed using a randomized clinical trial of 217 methamphetamine (MA) dependent individuals. Intensive motivational interviewing (IMI) was compared with a single standard session of MI (SMI) combined with eight nutrition education sessions. Interventions were delivered weekly over 2 months. All study participants also received standard outpatient group treatment three times per week. Both study groups showed significant decreases in MA use and Addiction Severity Index drug scores, but there were no significant differences between the two groups. However, reductions in Addiction Severity Index psychiatric severity scores and days of psychiatric problems during the past 30 days were found for clients in the IMI group but not the SMI group. SMI may be equally beneficial to IMI in reducing MA use and problem severity, but IMI may help alleviate co-occurring psychiatric problems that are unaffected by shorter MI interventions. Additional studies are needed to assess the problems, populations, and contexts for which IMI is effective.
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Affiliation(s)
- Douglas L Polcin
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
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Polcin DL, Henderson DM, Korcha R, Evans K, Wittman F, Trocki K. Perceptions of sober living houses among addiction counselors and mental health therapists: knowledge, views and perceived barriers. J Psychoactive Drugs 2012; 44:224-36. [PMID: 23061322 DOI: 10.1080/02791072.2012.703103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Affordable alcohol- and drug-free housing that supports recovery is limited in many areas. Sober living houses (SLHs) offer a unique living environment that supports abstinence and maintenance of a recovery lifestyle. Previous studies show that SLH residents make improvements on alcohol, drug and other problems that are maintained at 18-month follow-up (Polcin et al. 2010). However, for SLHs to maximize their impact they must recognize how they are viewed by community stakeholders and successfully address barriers. This pilot study recruited a convenience sample of two stakeholder groups, certified alcohol and drug counselors (N = 85) and licensed mental health therapists (N = 49), to explore knowledge and views about SLHs using an online survey. Therapists and counselors had similar views about SLHs, although counselors had more direct experience with them and were more knowledgeable. Both groups were highly supportive of increasing the role of SLHs to address addiction problems in their communities. Those who were most supportive had more knowledge about SLHs, agreed that alcohol and drug problems were caused by a physical disease, and agreed that successful recovery required an abstinent living environment. Both groups identified a variety of barriers, particularly social stigma. Recommendations are made for knowledge dissemination and decreasing barriers.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608-1010, USA.
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Andreuccetti G, Carvalho HB, Korcha R, Ye Y, Bond J, Cherpitel CJ. A review of emergency room studies on alcohol and injuries conducted in Latin America and the Caribbean region. Drug Alcohol Rev 2012; 31:737-46. [PMID: 22340601 PMCID: PMC3360159 DOI: 10.1111/j.1465-3362.2012.00419.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
ISSUES Alcohol-attributable burden of injury is one of the most serious public health problems in Latin America and the Caribbean region (LAC). Although knowledge on alcohol's involvement in injuries has progressed along with the implementation of evidenced-based alcohol policies in developed countries, this was not true for the most part of LAC countries for which reducing alcohol-related injuries is an urgent necessity. APPROACH A systematic review was performed in order to identify the most up-to-date information on alcohol and injuries derived from emergency room (ER) studies conducted in LAC. KEY FINDINGS Findings corroborate that alcohol has a high prevalence among injured patients in the ER setting in LAC, with violence-related injuries showing an increased association with alcohol use compared to unintentional injuries. However, a large number of studies did not include all types of injury and the measurement of injury risk associated with alcohol consumption. The amount of alcohol consumed in the event and hazardous drinking patterns seem to be strongly associated with injury occurrence, as well as drinking in public spaces, but a paucity of data relating to social-contextual factors limits the interpretation of the heterogeneity in the magnitude of the association of alcohol and injuries found across studies. CONCLUSIONS There is a lack of ER studies able to support strategies to reduce alcohol-related injuries in a region where effective alcohol policies are scant. Future research should focus on understanding how drinking influenced by local contexts and drinking behaviours may affect the risk of injury within each LAC country.
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Polcin DL, Buscemi R, Nayak M, Korcha R, Galloway G. Gender Differences in Psychiatric Symptoms among Methamphetamine Dependent Residents in Sober Living Houses. Addict Disord Their Treat 2012; 11:53-63. [PMID: 23559891 DOI: 10.1097/adt.0b013e3182213ef1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Although psychiatric symptoms among methamphetamine (MA) dependent individuals have been studied in treatment programs, they have not been examined in services designed to support sustained recovery in the community (e.g. sober living houses). In addition, some disorders more common among women, such as somatoform and bulimia, have been understudied among MA dependent individuals. This study aimed to examine psychiatric symptom differences between MA dependent men and women who we entering sober living houses (SLHs). METHODS Two hundred forty five individuals were interviewed within one week of entering SLHs. Instruments included a DSM IV based measure for MA dependence, a psychiatric screen (the Psychiatric Diagnostic Screening Questionnaire), demographics, recent substance use and recent use of services. RESULTS Of the 245 participants, 103 men and 25 women met criteria for MA dependence. Womenwith MA dependence reported more psychiatric symptoms than men. They also trended toward reporting more psychiatric symptoms than non-MA dependent women. For men, psychiatric symptoms did not vary between those with and without MA dependence. Some understudied disorders (e.g., somatoform) had large proportions of women meeting the screening criteria. CONCLUSIONS Additional research is needed on understudied psychiatric disorders that are common among MA dependent women. SLH's should consider ways to address psychiatric symptoms among MA dependent individuals, especially women. Strategies could include increasing linkages with professional mental health services as well as developing peer oriented strategies for managing symptoms.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group Public Health Institute 6475 Christie Avenue, Suite 400 Emeryville, CA 94608-1010 Phone (510) 597-3440 Fax (510) 985-6459
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21
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Abstract
OBJECTIVE Individuals with alcohol problems often receive pressure to change their drinking. However, when they enter treatment it is unclear how often it is because of the pressure they received or other reasons. METHOD A secondary analysis was conducted using four cross sectional National Alcohol Surveys (NASs) collected at 5-year intervals between 1995 and 2010. Treatment seekers (N=476) were interviewed about 1) all reasons for seeking treatment, 2) their primary reason, 3) lifetime heavy drinking, and 4) whether they ever received pressure from six different sources (spouse, family, friends, doctor, work and police). RESULTS Over 90% of the sample received pressure from at least one source. Thirty-four percent identified legal problems/felt forced as their primary reason for seeking treatment. Other primary reasons included a desire to improve relationships (25%) and health (15%). When asked about all reasons, 46% endorsed five or more reasons and 74% included legal problems/felt forced. When pressure was received from police it was often the primary reason for seeking treatment. When pressure was received from physicians or work, legal problems/felt forced was less likely to be the primary reason. Most reasons, including legal problems/felt forced, did not change significantly over time. CONCLUSIONS A primary reason for seeking alcohol treatment is drinking-related legal problems or feeling forced. However, legal problems/feeling forced occurs along with a variety of additional reasons. Future research should assess pathways between receipt of pressure from different sources, recognition of different types of problems, and reasons given for seeking treatment.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA94608-1010, Phone (510) 597-3440 extension 277, Fax (510) 985-6459
| | - Rachael Korcha
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA94608-1010, Phone (510) 597-3440 extension 277, Fax (510) 985-6459
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA94608-1010, Phone (510) 597-3440 extension 277, Fax (510) 985-6459
| | - Jason Bond
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA94608-1010, Phone (510) 597-3440 extension 277, Fax (510) 985-6459
| | - William Kerr
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA94608-1010, Phone (510) 597-3440 extension 277, Fax (510) 985-6459
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Abstract
BACKGROUND The vast majority of individuals with alcohol problems in the United States and elsewhere do not seek help. One policy response has been to encourage institutions such as criminal justice and social welfare systems to mandate treatment for individuals with alcohol problems (Addiction, 1997;92:1133). However, informal pressures to drink less from family and friends are far more common than institutional pressures mandating treatment (Addiction, 1996;91:643). The prevalence and correlates of these informal pressures have been minimally studied. METHODS This analysis used data from 5 Alcohol Research Group National Alcohol Surveys (NAS) collected at approximately 5-year intervals over a 21-year period (1984 to 2005, pooled N = 16,241) to describe the patterns of pressure that drinkers received during the past year from spouse, family, friends, physicians, police, and the workplace. RESULTS The overall trend of pressure combining all 6 sources across all 5 NAS data sets indicated a decline. Frequent heavy drinking and alcohol-related harms also declined, and both were strong predictors of receiving pressure. Trends among different sources varied. In multivariate regression models, pressure from friends showed an increase. Pressure from spouse and family showed a relatively flat trajectory, with the exception of a spike in pressure from family in 1990. CONCLUSIONS The trajectory of decreasing of pressure over time is most likely the result of decreases in heavy drinking and alcohol-related harm. Pressure was generally targeted toward higher risk drinkers, such as heavy drinkers and those reporting alcohol-related harm. However, demographic findings suggest that the social context of drinking might also be a determinant of receiving pressure. Additional studies should identify when pressure is associated with decreased drinking and increased help seeking.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA.
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Abstract
Lack of a stable, alcohol- and drug-free living environment can be a serious obstacle to sustained abstinence. Destructive living environments can derail recovery for even highly motivated individuals. Sober living houses (SLHs) are alcohol- and drug-free living environments for individuals attempting to abstain from alcohol and other drugs. They are not licensed or funded by state or local governments and the residents themselves pay for costs. The philosophy of recovery emphasizes 12-Step group attendance and peer support. We studied 300 individuals entering two different types of SLHs over an 18-month period. This article summarizes our published findings documenting resident improvement on measures of alcohol and drug use, employment, arrests, and psychiatric symptoms. Involvement in 12-Step groups and characteristics of the social network were strong predictors of outcome, reaffirming the importance of social and environmental factors in recovery. This article adds to our previous reports by providing a discussion of implications for treatment and criminal justice systems. We also describe the next steps in our research on SLHs, which will include: (1) an attempt to improve outcomes for residents referred from the criminal justice system and (2) a depiction of how attitudes of stakeholder groups create a community context that can facilitate and hinder the legitimacy of SLHs as a recovery modality.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608-1010, USA.
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Polcin DL, Korcha R, Bond J, Galloway G. Eighteen Month Outcomes for Clients Receiving Combined Outpatient Treatment and Sober Living Houses. J Subst Use 2010; 15:352-366. [PMID: 21197122 DOI: 10.3109/14659890903531279] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
One of the most frequent and frustrating challenges facing clients in outpatient treatment is finding a living environment that is free of alcohol and drugs and supportive of recovery. Sober Living Houses (SLHs) have been suggested as one potential solution (Polcin, 2009). Among other advantages, SLHs are financially self-sustaining and residents can remain there as long as they wish, provided they comply with house rules and expectations. This study examined 18-month outcomes for 55 individuals receiving outpatient treatment combined with residence in a SLH. Repeated measures analyses comparing 6-month time periods showed significant improvement on measures of alcohol and drug use, arrests, and days worked. The Addiction Severity Index (ASI) showed significant improvement on legal and employment scales. On ASI alcohol and drug scales, individuals entered SLHs with very low severity that was maintained at 18 months. Involvement in 12-step groups was associated with reductions in alcohol and drug use.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608-1010, Phone (510) 597-3440, Fax (510) 985-6459
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Polcin DL, Galloway GP, Bond J, Korcha R, Greenfield TK. Confirmatory Factor Analysis and Test-Retest Reliability of the Alcohol and Drug Confrontation Scale (ADCS). J Drug Issues 2010; 39:931-948. [PMID: 20686635 DOI: 10.1177/002204260903900408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The addiction field lacks an accepted definition and reliable measure of confrontation. The Alcohol and Drug Confrontation Scale (ADCS) defines confrontation as warnings about the potential consequences of substance use. To assess psychometric properties, 323 individual entering recovery houses in U.S. urban and suburban areas were interviewed between 2003 and 2005 (20% women, 68% white). Analyses included test-retest reliability, confirmatory factor analysis, and measures of internal consistency. Findings support the ADCS as a reliable way of assessing two factors: Internal Support and External intensity. Confrontation was experienced as supportive, accurate and helpful. Additional studies should assess confrontation in different contexts.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group, Public Health Institute 6475 Christie Avenue, Suite 400 Emeryville, CA 94608-1010 Telephone (510) 597-3440 Fax (510) 985-6459 E-Mail:
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Polcin DL, Galloway GP, Bond J, Korcha R, Greenfield TK. How do residents of recovery houses experience confrontation between entry and 12-month follow-up? J Psychoactive Drugs 2010; 42:49-62. [PMID: 20464806 DOI: 10.1080/02791072.2010.10399785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The role of confrontation in recovery has been vigorously debated. Proponents suggest confrontation can break down denial and increase motivation. Critics point to counseling studies showing confrontation harms the therapeutic alliance and increases resistance. Frequently missing in these debates is an operational definition of confrontation that can be reliably measured. The Alcohol and Drug Confrontation Scale (ADCS) is a new 72-item measure that defines confrontation as "warnings about potential harm" that might result from substance use (e.g., arrests, loss of job, loss of relationships, etc.). Previous psychometric work indicated the ADCS had acceptable reliability and validity when administered to 323 individuals entering recovery houses. Confrontation from different sources (e.g., family, friends and professionals) was generally experienced as supportive and helpful. The goals of the current study were twofold: (1) to see if the psychometric properties of the ADCS among the same sample were maintained at six and 12 month follow-up, and (2) to see if experiences and perceptions of confrontation changed over time. Despite minor variations in the factor structure between baseline and follow-up, the ADCS generally maintained good reliability and validity. At follow-up, the amount of confrontation participants received declined, but it continued to be generally experienced as supportive and helpful.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608-1010, USA.
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Bond JC, Roberts SC, Greenfield TK, Korcha R, Ye Y, Nayak MB. Gender differences in public and private drinking contexts: a multi-level GENACIS analysis. Int J Environ Res Public Health 2010; 7:2136-60. [PMID: 20623016 PMCID: PMC2898041 DOI: 10.3390/ijerph7052136] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 04/26/2010] [Accepted: 04/27/2010] [Indexed: 01/22/2023]
Abstract
This multi-national study hypothesized that higher levels of country-level gender equality would predict smaller differences in the frequency of women's compared to men's drinking in public (like bars and restaurants) settings and possibly private (home or party) settings. GENACIS project survey data with drinking contexts included 22 countries in Europe (8); the Americas (7); Asia (3); Australasia (2), and Africa (2), analyzed using hierarchical linear models (individuals nested within country). Age, gender and marital status were individual predictors; country-level gender equality as well as equality in economic participation, education, and political participation, and reproductive autonomy and context of violence against women measures were country-level variables. In separate models, more reproductive autonomy, economic participation, and educational attainment and less violence against women predicted smaller differences in drinking in public settings. Once controlling for country-level economic status, only equality in economic participation predicted the size of the gender difference. Most country-level variables did not explain the gender difference in frequency of drinking in private settings. Where gender equality predicted this difference, the direction of the findings was opposite from the direction in public settings, with more equality predicting a larger gender difference, although this relationship was no longer significant after controlling for country-level economic status. Findings suggest that country-level gender equality may influence gender differences in drinking. However, the effects of gender equality on drinking may depend on the specific alcohol measure, in this case drinking context, as well as on the aspect of gender equality considered. Similar studies that use only global measures of gender equality may miss key relationships. We consider potential implications for alcohol related consequences, policy and public health.
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Affiliation(s)
- Jason C. Bond
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA; E-Mails:
(T.G.);
(S.R.);
(Y.Y.);
(M.N.)
| | - Sarah C.M. Roberts
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA; E-Mails:
(T.G.);
(S.R.);
(Y.Y.);
(M.N.)
- NIAAA Training Program, School of Public Health, University of California Berkeley, Berkeley, CA 94709, USA
| | - Thomas K. Greenfield
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA; E-Mails:
(T.G.);
(S.R.);
(Y.Y.);
(M.N.)
- Clinical Services Research Training Program, Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Rachael Korcha
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA; E-Mails:
(T.G.);
(S.R.);
(Y.Y.);
(M.N.)
| | - Yu Ye
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA; E-Mails:
(T.G.);
(S.R.);
(Y.Y.);
(M.N.)
| | - Madhabika B. Nayak
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA; E-Mails:
(T.G.);
(S.R.);
(Y.Y.);
(M.N.)
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Abstract
AIMS Previous studies have found that stress contributes to problem drinking, while social support can buffer its effects. However, these studies are confined largely to middle-class and general populations. We extend what is known by examining how the unique stressors and forms of social support experienced by women in poverty impact alcohol problems over a 4-year time-period. DESIGN, SETTING AND PARTICIPANTS This prospective study used generalized estimating equations (GEE) transition modeling and four annual waves of survey data from 392 American mothers receiving Temporary Assistance for Needy Families (TANF) in a large Northern California county. MEASUREMENTS We examined the effects of neighborhood disorder, stressful life events and economic hardship on psychological distress and problem drinking over time, and whether social support moderated these relationships for women in poverty. FINDINGS Neighborhood disorder and stressful life events increased significantly the risk for problem drinking, largely through their effect on psychological distress. We found little evidence, however, that social support buffers poor women from the effects of these stressors. CONCLUSIONS Women in poverty are exposed to severe, chronic stressors within their communities and immediate social networks which increase vulnerability to psychological distress and problem drinking. The finding that social support does not buffer stress among these women may reflect their high level of exposure to stressors, as well as the hardships and scarce resources within their networks. If the 'private safety net' of the social network fails to provide a strong buffer, more effective environmental interventions that reduce exposure to stressors may be needed to prevent alcohol problems in poor women's lives.
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Affiliation(s)
- Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, CA 94608-1010, USA.
| | - Laura Schmidt
- Institute for Health Policy Studies and Department of Anthropology, History and Social Medicine, School of Medicine, University of California at San Francisco, USA
| | - Jason Bond
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Laurie Jacobs
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA, Department of Psychology, Portland State University, Oregon, USA
| | - Rachael Korcha
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
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Lown EA, Goldsby R, Mertens AC, Greenfield T, Bond J, Whitton J, Korcha R, Robison LL, Zeltzer LK. Alcohol consumption patterns and risk factors among childhood cancer survivors compared to siblings and general population peers. Addiction 2008; 103:1139-48. [PMID: 18554347 PMCID: PMC2791534 DOI: 10.1111/j.1360-0443.2008.02242.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS This study describes alcohol consumption among adult survivors of pediatric cancer compared to sibling controls and a national sample of healthy peers. Risk factors for heavy drinking among survivors are described. DESIGN, SETTING AND PARTICIPANTS Cross-sectional data were utilized from the Childhood Cancer Survivor Study including adult survivors of pediatric cancer (n = 10 398) and a sibling cohort (n = 3034). Comparison data were drawn from the National Alcohol Survey (n = 4774). MEASUREMENT Alcohol consumption, demographic, cancer diagnosis, treatment and psychosocial factors were measured. FINDINGS Compared to peers, survivors were slightly less likely to be risky [adjusted odds ratio (ORadj) = 0.9; confidence interval (CI) 0.8-1.0] and heavy drinkers (ORadj = 0.8; CI 0.7-0.9) and more likely to be current drinkers. Compared to siblings, survivors were less likely to be current, risky and heavy drinkers. Risk factors for survivors' heavy drinking included being age 18-21 years (ORadj = 2.0; 95% CI 1.5-2.6), male (ORadj = 2.1; 95% CI 1.8-2.6), having high school education or less (ORadj = 3.4; 95% CI 2.7-4.4) and drinking initiation before age 14 (ORadj = 6.9; 95% CI 4.4-10.8). Among survivors, symptoms of depression, anxiety or somatization, fair or poor self-assessed health, activity limitations and anxiety about cancer were associated with heavy drinking. Cognitively compromising treatment, brain tumors and older age at diagnosis were protective. CONCLUSIONS Adult survivors of childhood cancer show only a modest reduction in alcohol consumption compared to peers despite their more vulnerable health status. Distress and poorer health are associated with survivor heavy drinking. Screening for alcohol consumption should be instituted in long-term follow-up care and interventions among survivors and siblings should be established to reduce risk for early drinking.
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Affiliation(s)
| | - Robert Goldsby
- Pediataric Hemotology/Oncology, University of California, San Francisco, CA
| | | | | | | | - John Whitton
- Fred Hutchison Cancer Research Center, Seattle, WA
| | | | | | - Lonnie K. Zeltzer
- Department of Pediatrics and DCPCR, Jonsson Cancer Center, David Geffen School of Medicine at the University of California, Los Angeles, CA
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Witbrodt J, Kaskutas LA, Korcha R, Armstrong MA. Under-estimation of Alcohol Consumption among Women At-risk for Drinking during Pregnancy. Contemp Drug Probl 2008; 35:37-58. [PMID: 20589228 PMCID: PMC2892911 DOI: 10.1177/009145090803500103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
This study adds to a growing literature showing that definitions for "standard drinks" are often difficult to conceptualize and that people often underestimate their actual drink sizes. As part of an intervention aimed at reducing negative neonatal and maternal outcomes, insured at-risk women were asked to identify the vessels from which they drank each of 6 beverages (n=266). We calculated differences between their actual and standard drink sizes. Additionally, differences were compared to those reported in an earlier study of uninsured inner city minority women that used identical vessels methodology. Over half of the spirits, fortified wine and malt liquor drinkers underestimated the actual number of ounces their drinks contained. Most spirits drinkers (90%) and approximately three-quarters of the wine and malt liquor drinkers drank larger-than-standard drink sizes, with the median drink size 1.5 to 2.0 times larger than the standard size for those beverages. Heavier drinkers (>/=3 drinks per sitting) were more likely than lighter drinkers to underestimate their drink sizes. Findings were similar to those in the previous study using identical drink size measurements. Accurately assessing true drink sizes is underscored when the social, health and epidemiologic consequences associated with miscalculation are considered.
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Affiliation(s)
- Jane Witbrodt
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608
| | - Lee Ann Kaskutas
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608
| | - Rachael Korcha
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608
| | - Mary Anne Armstrong
- Kaiser Permanente Medical Care Program, Division of Research, 2000 Broadway, Oakland, CA 94612
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Wasserman DA, Korcha R, Havassy BE, Hall SM. Detection of illicit opioid and cocaine use in methadone maintenance treatment. Am J Drug Alcohol Abuse 1999; 25:561-71. [PMID: 10473015 DOI: 10.1081/ada-100101879] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Urine toxicology is the gold standard for estimating the prevalence of illicit drug use in methadone maintenance treatment (MMT). The frequency of urine testing may be crucial for establishing accurate use rates. Infrequent testing may lead programs to undercount active drug users and to target interventions too narrowly. This study compared results from frequent testing (twice per week) versus less frequent testing of 166 patients at four MMT programs. As part of a research study, all patients were tested by research staff for opioid and cocaine use twice per week on a fixed schedule for 10 weeks. During the same period, the four MMT programs tested the patients according to their standard protocols, approximately weekly (one program) or every 3-4 weeks (three programs). The research tests identified approximately 50% more illicit opioid users and 70% more cocaine users than the less frequent program tests. Patients who were drug positive according to the research tests but drug negative according to the program tests tended to be infrequent users. The data suggest that standard urine testing practices in MMT programs may result in underestimates of the prevalence of opioid and cocaine use. More frequent testing, even for time-limited periods, should produce more accurate depictions of drug use prevalence and help indicate the direction of interventions.
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Affiliation(s)
- D A Wasserman
- University of California, San Francisco, Mental Health Service, San Francisco Veterans Affairs Medical Center, 94121, USA.
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