Assessment of spirituality and its relevance to addiction treatment
Journal of Substance Abuse Treatment
Volume 33, Issue 3, October 2007, Pages 257-264




The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders.

We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers.

This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs.

Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees. These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery.

Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities.

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Reprint Request E-Mail: marcgalanter@nyu.edu
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What does recovery mean to you? Lessons from the recovery experience for research and practice
Journal of Substance Abuse Treatment
Volume 33, Issue 3, October 2007, Pages 243-256



Recovery is a ubiquitous concept but remains poorly understood and ill defined, hindering the development of assessment tools necessary to evaluate treatment effectiveness.

This study examines recovery definitions and experiences among persons who self-identify as “in recovery.” Two questions are addressed: (a) Does recovery require total abstinence from all drugs and alcohol? (b) Is recovery defined solely in terms of substance use or does it extend to other areas of functioning as well? Inner-city residents with resolved dependence to crack or heroin were interviewed yearly three times (N = 289).

Most defined recovery as total abstinence. However, recovery goes well beyond abstinence; it is experienced as a bountiful “new life,” an ongoing process of growth, self-change, and reclaiming the self.

Implications for clinical and assessment practice are discussed, including the need to effect paradigmatic shifts from pathology to wellness and from acute to continuing models.

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Reprint Request E-Mail: laudet@ndri.org
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Addiction recovery: Its definition and conceptual boundaries
Journal of Substance Abuse Treatment
Volume 33, Issue 3, October 2007, Pages 229-241


The addiction field's failure to achieve consensus on a definition of “recovery” from severe and persistent alcohol and other drug problems undermines clinical research, compromises clinical practice, and muddles the field's communications to service constituents, allied service professionals, the public, and policymakers.

This essay discusses 10 questions critical to the achievement of such a definition and offers a working definition of recovery that attempts to meet the criteria of precision, inclusiveness, exclusiveness, measurability, acceptability, and simplicity.

The key questions explore who has professional and cultural authority to define recovery, the defining ingredients of recovery, the boundaries (scope and depth) of recovery, and temporal benchmarks of recovery (when recovery begins and ends).

The process of defining recovery touches on some of the most controversial issues within the addictions field.

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Reprint Request E-Mail: bwhite@chestnut.org
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Trends in alcohol consumption in Singapore 1992–2004
Alcohol and Alcoholism 2007 42(4):354-361




To present trends in alcohol consumption between 1992 and 2004 in Singapore.

Prevalence of frequent, regular and binge drinking increased between 1992 and 2004. Prevalence increase in binge drinking was highest (from 5.1 to 10.0%), followed by frequent drinking (from 4.5 to 7.5%) and regular drinking (from 2.9 to 3.1%). Uptake in binge drinking increased in both genders and across all age groups but was most evident among adults aged 18–29.

Frequent drinking increase was observed for both genders but was most pronounced among women aged 18–29. The level of regular drinking declined in men but increased in women, especially those aged 18–29 and 30–49.

Being younger, male, separated, divorced or widowed, a current smoker, or having a monthly household income of S$6000 and above were attributes positively associated with binge drinking.

Alcohol consumption, especially binge drinking, has increased among Singaporeans between 1992 and 2004. There is gender convergence in alcohol consumption.

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Request Reprint E-Mail: Lim_Wei_Yen@moh.gov.sg

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Translational methods in biostatistics: linear mixed effect regression models of alcohol consumption and HIV disease progression over time
Epidemiologic Perspectives & Innovations 2007, 4:8

Longitudinal studies are helpful in understanding how subtle associations between factors of interest change over time. Our goal is to apply statistical methods which are appropriate for analyzing longitudinal data to a repeated measures epidemiological study as a tutorial in the appropriate use and interpretation of random effects models.

To motivate their use, we study the association of alcohol consumption on markers of HIV disease progression in an observational cohort. To make valid inferences, the association among measurements correlated within a subject must be taken into account. We describe a linear mixed effects regression framework that accounts for the clustering of longitudinal data and that can be fit using standard statistical software. We apply the linear mixed effects model to a previously published dataset of HIV infected individuals with a history of alcohol problems who are receiving HAART (n=197).

The researchers were interested in determining the effect of alcohol use on HIV disease progression over time. Fitting a linear mixed effects multiple regression model with a random intercept and random slope for each subject accounts for the association of observations within subjects and yields parameters interpretable as in ordinary multiple regression.

A significant interaction between alcohol use and adherence to HAART is found: subjects who use alcohol and are not fully adherent to their HIV medications had higher log RNA (ribonucleic acid) viral load levels than fully adherent non-drinkers, fully adherent alcohol users, and non-drinkers who were not fully adherent.

Longitudinal studies are increasingly common in epidemiological research. Software routines that account for correlation between repeated measures using linear mixed effects methods are now generally available and straightforward to utilize. These models allow the relaxation of assumptions needed for approaches such as repeated measures ANOVA, and should be routinely incorporated into the analysis of cohort studies.


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A comparison of brief intervention versus simple advice for alcohol use disorders in a North India community-based sample followed for 3 months
Alcohol and Alcoholism 2007 42(4):328-332;

To examine the change in alcohol use parameters following a brief intervention (BI) based on the FRAMES protocol, compared to simple advice (SA), in a community setting in North India.

Of the 90 subjects, 87 (96.7%) were available for follow up in the first month and 86 (95.6%) in the third month. There was significant improvement across many drinking and QOL parameters in both the BI and SA groups, Significant differences were noticed across interventions, with a decrease in severity of dependence as measured by alcohol use in the last 30 days, composite ASI scores & improvement in physical and psychological quality of life, in those who received BI compared to those who received SA.

Changes in motivation toward action were documented at first follow up, but were not sustained in either of the interventions.

BI had a slight advantage over SA in excessive users of alcohol in this community setting in India. It is probable that booster sessions would be needed to achieve sustained effect.

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Reprint Request E-Mail: hemraj_pal@yahoo.co.uk , hemrajpal@gmail.com

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The acute effects of alcohol on auditory thresholds
BMC Ear, Nose and Throat Disorders 2007, 7:4

There is very little knowledge about alcohol-induced hearing loss. Alcohol consumption and tolerance to loud noise is a well observed phenomenon as seen in the Western world where parties get noisier by the hour as the evening matures. This leads to increase in the referrals to the "hearing aid clinic" and the diagnosis of "cocktail party deafness" which may not necessarily be only due to presbyacusis or noise-induced hearing loss.

Our results showed that there was a positive association between increasing breath alcohol concentration and the magnitude of the increase in hearing threshold for most hearing frequencies. This was calculated by using the Pearson Regression Coefficient Ratio which was up to 0.6 for hearing at 1000Hz. Over 90% of subjects had raised auditory thresholds in three or more frequencies; this was more marked in the lower frequencies.

Alcohol specifically blunts lower frequencies affecting the mostly 1000 Hz, which is the most crucial frequency for speech discrimination.

In conclusion alcohol does appear to affect auditory thresholds with some frequencies being more affected than others.

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Home Office tried to hide surge in drunken attacks

By JAMES SLACK -
20th September 2007

Serious violence and murder near pubs and clubs in the early hours rose by almost 130 per cent in the year after licensing laws were relaxed.

But the Home Office omitted the figure from its report into the impact of 24-hour opening, claiming it was "not statistically significant".

Ministers have now been forced under Freedom of Information laws to reveal the missing data, which was simply replaced with a blank space when the research was published in July.

The rise of 127 per cent was recorded across 18 police regions in city centre locations or near pubs and clubs between 3am and 6am.

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Statistical Signal processing for an implantable ethanol biosensor
Engineering in Medicine and Biology Society, 2006. EMBS '06. 28th Annual International Conference of the IEEE Aug. 2006: 3704-3707

The understanding of drinking patterns leading to alcoholism has been hindered by an inability to unobtrusively measure ethanol consumption over periods of weeks to months in the community environment.

Signal processing for an implantable ethanol MEMS bio sensor under simultaneous development is described where the sensor-signal processing system will provide a novel approach to this need. For safety and user acceptability issues, the sensor will be implanted subcutaneously and therefore measure peripheral-tissue ethanol concentration.

A statistical signal processing system based on detailed models of the physiology and using extended Kalman filtering and dynamic programming tools is described which determines ethanol consumption and kinetics in other compartments from the time course of peripheral-tissue ethanol concentration

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Reprint Request E-Mail: doerschu@purdue.edu
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SAMHSA's Road to Recovery Update

The Road to Recovery Update keeps you informed about activities leading up to National Alcohol & Drug Addiction Recovery Month (Recovery Month) in September. Feel free to forward this information to friends and colleagues, include it in newsletters or listservs, or link to it from your Web site.

Recovery Month Continues....

Recovery Month is off to a great start with over 550 community events listed on the Web site! Please keep those events coming in and help us continue to spread the word of recovery. Have a successful event? Please send us your pictures, videos and comments and encourage other event planners to follow. Click here to post an event and send us your event results today!

Recovery Month Live-Read Radio Scripts Available

It's not too late to help publicize Recovery Month. Here are some tips to help you distribute live-read scripts to local radio stations:

• Call local radio stations to have them read live-read radio scripts.
• Fax, e-mail, or mail copies of the PSA scripts to the contact person for their consideration, after calling to introduce them to Recovery Month. When you send the scripts, remember to include a cover letter. This letter should reference your previous conversation and list your contact name, organization, and phone number. The letter also should summarize the main points that are discussed in the PSA, and be clear about your appreciation for the station's support in disseminating the message of Recovery Month to the community. Click here to view the scripts.

Next Webcast

Wednesday, September 19: "Improving Addiction Treatment Services: Taking Action Now"

View the Trailer

As leaders who can influence and shape policy, civic and elected officials play a crucial role in reducing the toll addiction takes on their communities. Implementing policies that effectively treat substance abuse and dependence leads to increased productivity and profitability in the workplace, as well as decreased costs throughout the criminal justice system and social services system. Therefore, policy implementation lessens the financial burden on taxpayers. This program will look at the role of civic and elected officials in fighting substance abuse and dependence, as well as steps they can take to improve their communities' well-being.

Ask the Expert

Get answers to your questions about the topics covered in the latest Road to Recovery Webcast: "Investing in Treatment: Policymakers' Positive Impact on Their Community."

Submit your questions using our anonymous online form, and answers from our expert will be posted in early October.

Visit Ask the Expert before September 28 to submit questions for this month's expert, Todd Molfenter, Ph.D, Deputy Director, NIATx.

As Deputy Director, Todd Molfenter's role includes managing the technical assistance provided to NIATx members and process improvement coaches. He also oversees the Advancing Recovery project, serves as coach to selected NIATx members, and is a key faculty member in Learning Sessions.

For more information about Todd Molfenter, Ph.D, visit: http://www.recoverymonth.gov/2007/multimedia/
bio.aspx?ExpertID=9.

About Recovery Month

National Alcohol and Drug Addiction Recovery Month, celebrating 18 years of observance in 2007, is an initiative of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Treatment (CSAT). For more information about Recovery Month, visit www.recoverymonth.gov.

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The Search for Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: A Commentary
Alcoholism: Clinical and Experimental Research 31 (s3), 21s–32s.

Definitive results from efforts to identify mechanisms of change in behavioral treatments for alcohol use disorders have been elusive. The working hypothesis guiding this paper is that one of the reasons for this elusiveness is that the models we hypothesize to account for treatments effectiveness are unnecessarily restricted and too simple.

This paper aims to accomplish 3 things. First, a typography for locating potential mediators of change will be presented. In the course of doing so, a nomenclature will be proposed with the hope that this will facilitate communications among alcohol treatment researchers studying mechanisms of change. Second, alternatives to the classic test of mediation of alcohol treatment effects will be considered and one such alternative described. Third, alternative ways of conceptualizing, constructing and analyzing variables to measure mediators will be suggested.

It is hoped that this commentary will facilitate research on mechanisms of change in behavioral treatments for alcohol use disorders.

Behavioral change is a complex process, and the models that we develop to account for this process need to reflect this complexity. Advances in statistical approaches for testing mediation, along with a better understanding as to how to use these tools should help in moving toward this goal.

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Reprint Request E-Mail: Richard_Longabaugh@brown.edu

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12-Step Approaches for the Dually Diagnosed: Mechanisms of Change
Alcoholism: Clinical and Experimental Research 31 (s3), 64s–66s.

Existing data indicate that 12-step program involvement is associated with improved outcomes in the dually diagnosed, but there are questions concerning the magnitude and mechanisms of this effect in various dually diagnosed populations.

Dually diagnosed individuals attend 12-step programs at rates comparable to the nondually diagnosed, although specific diagnoses may have some effect on attendance. The benefits of 12-step attendance do not appear to be markedly different for those with psychiatric disorders. Specialized 12-step programs could have benefits for the dually diagnosed over and above those of traditional 12-step programs. Existing data suggest that nonspecific change mechanisms (self-efficacy, social support) are similar to those found in the general AA literature.

Based on existing data, the change mechanisms are broadly similar to those found in the general 12-step literature, but additional factors related to mental illness may also play a significant role. Further work is necessary to test the components of this model and to achieve a firm empirical foundation for understanding the processes of 12-step recovery in the dually diagnosed.

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Reprint Request E-Mail: mbogenschutz@salud.unm.edu

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A Broader View of Change in Drinking Behavior

Alcoholism: Clinical and Experimental Research 31 (s3), 84s–86s.

Most research concerning change in drinking behavior has taken place within the context of specialized treatment for a help-seeking population. However, treatment approaches with different purported mechanisms of action yield very similar results, suggesting that common elements, rather than specific mechanisms, may be responsible for the bulk of the individual change process.

Mechanisms of change have not been explicitly examined. Other factors such as social pressure may be more important mediators of change, which may occur prior to treatment entry. Also, most change occurs outside the context of specific treatment. A broader perspective focusing on mechanisms of change will need to account for change occurring both with and without professional treatment.

Future research must be interdisciplinary in nature, seeking to relate social, behavioral, and neurophysiologic correlates of behavior change.

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Reprint Request E-Mail: mlw@niaaa.nih.gov

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Glycemic effects of moderate alcohol intake among patients with type 2 diabetes: A Multi-center, randomized clinical intervention trial
Diabetes Care Publish Ahead of Print published online ahead of print September 11, 2007

In a randomized controlled trial, we assessed the effect of daily moderate alcohol intake on glycemic control in the fasting and postprandial states in patients with type 2 diabetes who previously had abstained from alcohol.

During the intervention, 17% of participants (12% from the alcohol group) dropped out, leaving 91 who completed the trial. Within the alcohol group, fasting plasma glucose (FPG) decreased from 139.6+/-41 to 118.0+/-32.5mg/dL after 3 months compared to 136.7+/-15.4 to 138.6+/-27.8mg/dL in the controls (Pv=0.015). However, alcohol consumption had no effect on 2-hour postprandial glucose levels (difference=18.5 in the control vs. 17.7mg/dL in the alcohol groups, Pv=0.97). Patients in the alcohol group with higher baseline HbA1c levels had greater reductions in FPG (age-adjusted correlation=-0.57, Pv<0.001).> observed in the levels of bilirubin, alkaline phosphatase, ALT, or AST, and no notable adverse effects were reported. Participants in the alcohol group reported an improvement in the ability to fall asleep (Pv<0.001).

Among previous alcohol abstainers with type 2 diabetes, initiation of moderate daily alcohol consumption reduced FPG but not postprandial glucose. Patients with higher HbA1c may benefit more from the favorable glycemic effect of alcohol.

Further intervention studies are needed to confirm the long-term effect of moderate alcohol intake.

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Request Reprint E-Mail: irish@bgu.ac.il

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News Release - Family history of alcoholism affects response to drug used to treat heavy drinking

New study in Biological Psychiatry

Philadelphia, PA, September 19, 2007 – Naltrexone is one of four oral medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcoholism. A recent large multicenter research study of alcohol dependence supported by the National Institute of Alcoholism and Alcohol Abuse (NIAAA), the COMBINE Study, suggested that naltrexone produced a modest but significant benefit but another FDA-approved medication, acamprosate, was ineffective.

Perhaps consistent with its modest effects in COMBINE, naltrexone is not widely prescribed in the treatment of alcoholism. Yet, clinicians report that naltrexone may have significant benefits for individual patients.

To make naltrexone a more useful medication, it would be important to begin to identify groups of patients who might be more or less likely to show a significant clinical benefit from naltrexone prescription and to understand the causes of differential naltrexone efficacy. A new study that will appear in the September 15th issue of Biological Psychiatry suggests that alcohol dependent individuals with a family history of alcohol dependence may be more likely than alcohol dependent individuals without a family history of alcohol dependence to reduce their drinking in the laboratory when prescribed naltrexone.
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AMPA Receptor Potentiation can Prevent Ethanol-Induced Intoxication

Neuropsychopharmacology advance online publication 12 September 2007;

We present a substantial series of behavioral and imaging experiments, which demonstrate, for the first time, that increasing AMPA receptor-mediated neurotransmission via administration of potent and selective biarylsulfonamide AMPA potentiators LY404187 and LY451395 reverses the central effects of an acutely intoxicating dose of ethanol in the rat.

Using pharmacological magnetic resonance imaging (phMRI), we observed that LY404187 attenuated ethanol-induced reductions in blood oxygenation level dependent (BOLD) in the anesthetized rat brain. A similar attenuation was apparent when measuring local cerebral glucose utilization (LCGU) via C¹⁴-2-deoxyglucose autoradiography in freely moving conscious rats.

Both LY404187 and LY451395 significantly and dose-dependently reversed ethanol-induced deficits in both motor coordination and disruptions in an operant task where animals were trained to press a lever for food reward. Both prophylactic and acute intervention treatment with LY404187 reversed ethanol-induced deficits in motor coordination.

Given that LY451395 and related AMPA receptor potentiators/ampakines are tolerated in both healthy volunteers and elderly patients, these data suggest that such compounds may form a potential management strategy for acute alcohol intoxication.

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Request Reprint E-Mail: N.Jones@iop.kcl.ac.uk
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Detrimental drinking patterns: Empirical validation of the pattern values score of the Global Burden of Disease 2000 study in 13 countries
Journal of Substance Use, Volume 12, Issue 5 October 2007 , pages 337 - 358

In addition to volume, patterns of drinking have an effect on disease and injury. Depending on the prevailing way alcohol is coghnsumed (i.e. on drinking patterns), mortality and morbidity should vary across cultures even if per capita consumption is about the same. In a Comparative Risk Analysis (CRA), the WHO estimated for the year 2000 the Global Burden of Disease stemming from alcohol consumption by including both dimensions of intake (volume and patterns). For this purpose, a detrimental drinking pattern scale was developed. This scale used expert ratings of six dimensions of the prevailing drinking patterns in each country. The present study attempts first to replicate the expert ratings based on survey data from 13 countries. Secondly, it compares the scaling of individual level data with the scaling of aggregate level data. For the latter, such survey measures as percentage usually drinking with meals and percentage usually getting drunk when drinking to approximate the pattern scoring system used in CRA were constructed. Aggregate and individual level analyses resulted in similar orderings of countries on a one-dimensional scale. There was a good correspondence between the orderings and country's values on the CRA detrimental drinking pattern scale. The ordering of countries varied if men and women were scaled separately. The results indicated a bias of expert ratings towards focusing on male drinking patterns. From analysis of the survey data, the patterns in Nigeria appeared relatively more detrimental than the CRA score based on expert ratings, while the patterns in Finland appeared less detrimental. Future attempts to include drinking patterns in addition to volume should take gender differences into account.

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Request Reprint E-Mail: ggmel@sfa-ispa.ch
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Intelligent Data Analysis for Diagnostics of Alcohol Dependency
Twentieth IEEE International Symposium on Computer-Based Medical Systems (CBMS'07) pp. 445-450


The alcohol dependency is hard to diagnose since none of the existing laboratory markers has sufficient specificity and sensitivity. Therefore the goal of our study was to find better laboratory markers and / or their combinations. For that purpose the intelligent data analysis using the decision tree induction method was used.

The results show that the combination of three or even two markers can prove alcohol dependency with almost 85% accuracy.

However the remark has to be made that the induced decision tree offers a qualitatively different access to diagnostic evaluation of laboratory findings and varies from common practice, because it sets up its new and own borders and criteria what is the unlike from generally accepted or set up reference values. All selected markers are widely accessible, inexpensive and part of a routine laboratory tests.

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Request Reprint E-Mail: {petra.povalej, kokol}@uni-mb.si
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The Search for Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: A Commentary
Alcoholism: Clinical and Experimental Research 31 (s3), 21s–32s.

Definitive results from efforts to identify mechanisms of change in behavioral treatments for alcohol use disorders have been elusive. The working hypothesis guiding this paper is that one of the reasons for this elusiveness is that the models we hypothesize to account for treatments effectiveness are unnecessarily restricted and too simple.

This paper aims to accomplish 3 things. First, a typography for locating potential mediators of change will be presented. In the course of doing so, a nomenclature will be proposed with the hope that this will facilitate communications among alcohol treatment researchers studying mechanisms of change. Second, alternatives to the classic test of mediation of alcohol treatment effects will be considered and one such alternative described. Third, alternative ways of conceptualizing, constructing and analyzing variables to measure mediators will be suggested.

It is hoped that this commentary will facilitate research on mechanisms of change in behavioral treatments for alcohol use disorders.

Behavioral change is a complex process, and the models that we develop to account for this process need to reflect this complexity. Advances in statistical approaches for testing mediation, along with a better understanding as to how to use these tools should help in moving toward this goal.

Read Full Abstract

Request Reprint E-Mail: Richard_Longabaugh@brown.edu

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Mechanisms, Determinants and Processes of Change in the Modification of Drinking Behavior
Alcoholism: Clinical and Experimental Research 31 (s3), 13s–20s.

This article explores the conceptual foundations of the search for mechanisms of change in psychotherapy and behavior change approaches.

A series of key questions is addressed. The first critical question is, Where are the appropriate places to look for mechanisms of change in the modification of drinking behavior: person, provider, intervention, or environment? The second questions what we know about change mechanisms from recent research. The third addresses the appropriate methods and designs to isolate and understand these mechanisms. The final question is, How should we proceed to advance our understanding of the critical mechanisms that drive the process of the modifying drinking and recovery from alcoholism?

We propose a dynamic, life course and an interactive, multidimensional perspective that focuses on personal mechanisms of change and how they interact with interventions, providers, policies, and other life context factors that facilitate or act as barriers to engaging these mechanisms of change.

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Reprint Request E-Mail: diclemen@umbc.edu

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