Drug-alcohol help for doctors gets review today

Thursday, July 26, 2007







By Aurelio Rojas - Bee Capitol Bureau

The Medical Board of California meets today to discuss its drug and alcohol diversion program for doctors, which has been criticized in several audits for being ineffective and endangering patients.

Stung by adverse publicity, the California Medical Association has taken the unusual step of publicly criticizing the board that licenses its 35,000 physicians for lax enforcement of the program.

The 27-year program, which treats up to 400 doctors at a time with funding from physician fees, is scheduled to be terminated on July 1, 2008, unless the Legislature extends it.
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Association of the Long Allele of the 5-HTTLPR Polymorphism with Compulsive Craving in Alcohol Dependence
Alcohol and Alcoholism Advance Access published online on August 21, 2007




Various studies have reported a role of the serotonin transporter-linked polymorphic region (5-HTTLPR) in alcoholism.

The present study investigated an association of this polymorphism with obsessive-compulsive alcohol craving in 124 male patients admitted for alcohol detoxification treatment.

We found significantly higher compulsive craving in patients with the long allele of the 5-HTTLPR polymorphism .

Our results suggest that the long variant of the 5-HTTLPR polymorphism is associated with higher compulsive alcohol craving at the beginning of alcohol withdrawal.

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Reprint Request E-Mail: stefan.bleich@uk-erlangen.de

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To Do or Not to Do: The Neural Signature of Self-Control
The Journal of Neuroscience, August 22, 2007, 27(34):9141-9145

Voluntary action is fundamental to human existence. Recent research suggests that volition involves a specific network of brain activity, centered on the fronto-median cortex. An important but neglected aspect of intentional action involves the decision whether to act or not. This decision process is crucial in daily life because it allows us to form intentions without necessarily implementing them.

In the present study, we investigate the neural correlates of intentionally inhibiting actions using functional magnetic resonance imaging.

Our data show that a specific area of the fronto-median cortex is more strongly activated when people prepare manual actions but then intentionally cancel them, compared with when they prepare and then complete the same actions.

Our results suggest that the human brain network for intentional action includes a control structure for self-initiated inhibition or withholding of intended actions. The mental control of action has an enduring scientific interest, linked to the philosophical concept of "free will."

Our results identify a candidate brain area that reflects the crucial decision to do or not to do.

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Reprint Request Email: marcel.brass@ugent.be
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Bar staff and publicans have the highest proportions of alcohol-related deaths

Health Statistics Quarterly Autumn 2007

Bar staff, publicans and seafarers were the occupations with the highest proportions of alcohol-related deaths among men, according to new statistics published today, in Health Statistics Quarterly 35*, by the Office for National Statistics. The research also revealed that, in England and Wales in 2001-05, bar staff and publicans were also the occupations with the highest proportions of alcohol-related deaths for women.

Other key findings include:

• Other occupations within the drinks, catering, entertainment and hospitality industries had high proportions of alcohol-related deaths.

• Men who worked as farmers and drivers, and women who worked with children, were found to have low proportions of alcohol-related deaths.

• Male medical practitioners, who historically have had high levels of alcohol-related deaths, were found to have a low proportion of these deaths in 2001-05.

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Alcoholic beverages and risk of renal cell cancer
British Journal of Cancer (2007) 97, 429-433.



Using a mailed questionnaire, we investigated the risk of renal cell cancer in relation to different types of alcoholic beverages, and to total ethanol in a large population-based case-control study among Swedish adults, including 855 cases and 1204 controls.

Compared to non-drinkers, a total ethanol intake of >620 g month^-1 was significantly related to a decreased risk of renal cell cancer. The risk decreased 30-40% with drinking more than two glasses per week of red wine, white wine , or strong beer; there was a clear linear trend of decreasing risk with increasing consumption of these beverages.

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Geographically Separate Increases in the Frequency of the Derived ADH1B*47His Allele in Eastern and Western Asia
The American Journal of Human Genetics, volume 81 (2007), page 000





The ADH1B Arg47His polymorphism has been convincingly associated with alcoholism in numerous studies of several populations in Asia and Europe.

In a review of literature from the past 30 years, we have identified studies that report allele frequencies of this polymorphism for 131 population samples from many different parts of the world. The derived ADH1B*47His allele reaches high frequencies only in western and eastern Asia.

To pursue this pattern, we report here new frequency data for 37 populations. Most of our data are from South and Southeast Asia and confirm that there is a low frequency of this allele in the region between eastern and western Asia.

The distribution suggests that the derived allele increased in frequency independently in western and eastern Asia after humans had spread across Eurasia.

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Reprint Request E-Mail: HuiLi.Yale@Gmail.com
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A randomized controlled trial of intensive referral to 12-step self-help groups: One-year outcomes
Drug and Alcohol Dependence
Volume 90, Issues 2-3, 8 October 2007, Pages 270-27

This study implemented and evaluated procedures to help clinicians make effective referrals to 12-step self-help groups (SHGs).

In this randomized controlled trial, individuals with substance use disorders (SUDs) entering a new outpatient treatment episode (N = 345; 96% had previous SUD treatment) were randomly assigned to a standard referral or an intensive referral-to-self-help condition and provided self-reports of 12-step group attendance and involvement and substance use at baseline and at six-month and one-year follow-ups (93%). In standard referral, patients received a schedule for local 12-step SHG meetings and were encouraged to attend. Intensive referral had the key elements of counselors linking patients to 12-step volunteers and using 12-step journals to check on meeting attendance.

Compared with patients who received standard referral, patients who received intensive referral were more likely to attend and be involved with 12-step groups during both the first and second six-month follow-up periods, and improved more on alcohol and drug use outcomes over the year. Specifically, during both follow-up periods, patients in intensive referral were more likely to attend at least one meeting per week (70% versus 61%, p = .049) and had higher SHG involvement (mean = 4.9 versus 3.7, p = .021) and abstinence rates (51% versus 41%, p = .048). Twelve-step involvement mediated the association between referral condition and alcohol and drug outcomes, and was associated with better outcomes above and beyond group attendance.

The intensive referral intervention was associated with improved 12-step group attendance and involvement and substance use outcomes. To most benefit patients, SUD treatment providers should focus 12-step referral procedures on encouraging broad 12-step group involvement, such as reading 12-step literature, doing service at meetings, and gaining self-identity as a SHG member.

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Reprint Request E-Mail: ctimko@stanford.edu

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Worker Substance Use by Industry Category

Highlights:

• Based on combined data from SAMHSA's annual National Surveys on Drug Use and Health in 2004 and 2005, rates of alcohol and illicit drug use by industry category were assessed among adult workers aged 18 to 64 currently employed full time.

• An annual average of 8.2% full time workers aged 18 to 64 used illicit drugs in the past month and 8.8% used alcohol heavily in the past month.

• The highest rates of past month illicit drug use were found in the accommodations and food services industry (16.9%) and the construction industry (13.7%).

The highest rates of past month heavy alcohol use were found in the construction industry (15.9%), arts, entertainment, and recreation industry (13.6%), and the mining industry (13.7%).

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New Economics Papers - Cognitive and Behavioural Economics



Cue-Triggered Addiction and Natural Recovery

In this paper we propose a model of natural recovery, a widespread yet unexplained aspect of addictive behavior, starting from the recent theory developed by Bernheim and Rangel (2004).

While the Bernheim and Rangel model generates many distinctive patterns of addiction, it does not explicitly consider pathways to natural recovery. Based on insights from neurosciences, we introduce an ”implicit cognitive appraisal” process depending on past experiences as well as on future expected consequences of addictive consumption.

Such function affects the individual in two ways: it erodes the payoff from use as the decision maker grows older and it increases the cognitive control competing with the hedonic impulses to use, thus reducing the probability of making mistakes.

While we do recognize the importance of allowing for cue-triggered mistakes in individual decision making, our model recovers an important role for cognitive processes, such as subjective cost-benefit evaluations, in explaining natural recovery.

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Welcome to the latest 'What's new on the Alcohol Information Scotland website'
New on the site
Latest publications include:
Indications of Public Health in the English Regions 8 : Alcohol		Association of Public Health Observatories
Scottish Alcohol Research Framework		Scottish Executive
	Alcohol Misuse 2006: Campaign Evaluation		Scottish Executive
	The Normalisation of binge drinking? An historical and cross cultural investigation with implications for action		The Alcohol Education and Research Council
	Highlights from latest media comment
	Date	Publication	Publisher
	21st August	Rates of alcohol-fuelled violence increase across Scotland	The Scotsman
	19th August	Scottish Ministers propose tougher sentences for drunk-related crime	Scotland on Sunday
	16th August	Ministers consider tax measures to curb youth drinking problems	The Independent
	15th August	Cheshire Police Chief calls for ban on public drinking	Various sources
	14th August	Funding injection for alcohol community work	Alcohol Focus Scotland
	14th August	Alcohol-related illness eclipsing health gains due to reduced smoking rates	The Times
	13th August	Council proposals aim to tackle anti-social behaviour caused by alcohol.	BBC News
	13th August	Survey suggests warnings about drinking and cancer link being missed	The Herald
	Parliamentary Questions - See the latest questions
	Forthcoming Events
	A list of forthcoming workshops, training courses, seminars and conferences
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Jack H. Mendelson, MD (8/30/29 - 8/15/07)





Jack H. Mendelson MD, Professor of Psychiatry at the Harvard Medical School and Co-Director of the Alcohol and Drug Abuse Research Center at the McLean Hospital, died Wednesday, August 15th, 2007, after a brief illness.

Dr. Mendelson received the Jellinek Memorial Award for research on alcoholism in 1978 and the Distinguished Research Award from the Research Society on Alcoholism in 1989. He was Editor of the Journal of Studies on Alcohol from 1984 to 1991.

He leaves his wife of 33 years, Nancy K. Mello, Ph.D., two sons, John E. Mendelson, M.D. and Adam Mendelson, a daughter, Ellen Mendelson Maher, and four grandchildren. Condolences may be sent to his wife: Dr. Nancy K. Mello 1010 Memorial Drive Cambridge, MA 02138 A Memorial Service is being planned for late autumn.

Those wishing to contribute to the establishment of an award for innovative research on substance abuse in honor of his memory, may send donations to the Jack H. Mendelson Memorial Fund, McLean Hospital, 115 Mill Street, Belmont, MA 02478.

Contributor: Albert Pawlowski
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BUSINESS TAXES COMMITTEE MEETING MINUTES




Agenda Item No: 1
Title: Review, discussion and proposed regulations regarding the classification and tax rates of flavored malt beverages

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Delay of First Treatment of Mental and Substance Use Disorders in Mexico

September 2007, Vol 97, No. 9 | American Journal of Public Health 1638-1643

We studied failure and delay in making initial treatment contact after the first onset of a mental or substance use disorder in Mexico as a first step to understanding barriers to providing effective treatment in Mexico.

Many people with lifetime disorders eventually made treatment contact, although the proportions varied for mood (69.9%), anxiety (53.2%), and substance use (22.1%) disorders. Delays were long: 10 years for substance use disorders, 14 years for mood disorders, and 30 years for anxiety disorders. Failure and delay in making initial treatment contact were associated with earlier ages of disorder onset and being in older cohorts.

Failure to make prompt initial treatment contact is an important reason explaining why there are unmet needs for mental health care in Mexico. Meeting these needs will likely require expansion and optimal allocation of resources as well as other interventions.

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Reprint Request E-Mail: guibor@imp.edu.mx

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ALCOHOL ACROSS THE LIFESPAN


FIVE YEAR STRATEGIC PLAN FY08-13

This document, the NIAAA Strategic Plan for Research, 2008-2013, sets forth research opportunities to increase our understanding of why, how, and when people drink, as well as why and how some people develop alcohol use disorders (AUD). Throughout the years, investigators have pursued answers to these very questions through studies of alcohol’s effects on biological systems, the genetic factors underlying biology, and through the study of environmental and cultural factors. This Plan, however, proposes a significantly different direction for alcohol studies by applying the lifespan perspective -- the consideration of how the emergence and progression of drinking behavior is influenced by multiple changes (in biology, psychology, and in exposure to social and environmental inputs) over a person’s lifetime. These changes occurring throughout the lifespan affect the pattern of drinking (quantity and frequency) and the actions individuals may take to modify their drinking behavior or to seek help for an alcohol use disorder. Viewing alcohol use and alcohol problems through a lifespan perspective will provide knowledge that will, through early identification and intervention, significantly contribute to the ability to decrease the prevalence of alcoholism and other alcohol-related disorders, and to the treatment of these disorders.

This overview describes the origins of the lifespan perspective, highlights the complexity of alcohol issues in health, and provides a view to why solutions to these problems cannot be approached from any single discipline but must be approached in a multidisciplinary and transdisciplinary manner. Further, the findings at any investigative level (molecular, cellular, animal model, human laboratory, human clinical to community) must be translated to other levels and eventually to clinical practice in the world environment. Transdisciplinary and translational research over the course of the next decade will be aided by the intellectual and technical developments arising from the NIH Roadmap and the NIH Neuroscience Blueprint, and their potential application to address health issues related to alcohol use has been integrated into this Plan.

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The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): Reliability of new psychiatric diagnostic modules and risk factors in a general population sample
Drug and Alcohol Dependence Article in Press, Corrected Proof 13 August 2007

This study presents test–retest reliability statistics and information on internal consistency for new diagnostic modules and risk factors for alcohol, drug, and psychiatric disorders from the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV).

Test–retest statistics were derived from a random sample of 1899 adults selected from 34,653 respondents who participated in the 2004–2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

Internal consistency of continuous scales was assessed using the entire Wave 2 NESARC. Both test and retest interviews were conducted face-to-face.

Test–retest and internal consistency results for diagnoses and symptom scales associated with posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and borderline, narcissistic, and schizotypal personality disorders were predominantly good (kappa > 0.63; ICC > 0.69; alpha > 0.75) and reliability for risk factor measures fell within the good to excellent range (intraclass correlations = 0.50–0.94; alpha = 0.64–0.90).

The high degree of reliability found in this study suggests that new AUDADIS-IV diagnostic measures can be useful tools in research settings.

The availability of highly reliable measures of risk factors for alcohol, drug, and psychiatric disorders will contribute to the validity of conclusions drawn from future research in the domains of substance use disorder and psychiatric epidemiology.

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Reprint Request E-Mail: bgrant@willco.niaaa.nih.gov

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Alcohol Consumption and HIV Disease Progression.JAIDS Journal of Acquired Immune Deficiency Syndromes. POST ACCEPTANCE, 19 July 2007

To assess the relation between alcohol consumption and laboratory markers of HIV disease progression.

Among subjects who were not on ART, heavy alcohol consumption was associated with a lower CD4 cell count (adjusted mean decrease of 48.6 cells/[mu]L compared with abstinence; P = 0.03) but not with higher log10 HIV RNA. Among subjects who were on ART, heavy alcohol consumption was not associated with a lower CD4 cell count or higher log10 HIV RNA.

Heavy alcohol consumption has a negative impact on the CD4 cell count in HIV-infected persons not receiving ART. In addition to the known deleterious effects of alcohol on ART adherence, these findings suggest that avoiding heavy alcohol consumption in patients not on ART may have a beneficial effect on HIV disease progression.

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Reprint Request E-Mail: jsamet@bu.edu

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Depressive Symptoms and Subsequent Alcohol Use and Problems: A Prospective Study of Medical Inpatients With Unhealthy Alcohol Use
J. Stud. Alcohol Drugs 68: 673-680, 2007

We sought to determine whether depressive symptoms assessed during hospitalization predicted alcohol use and alcohol-related problems during the subsequent year among medically ill patients.

Of the 341 patients enrolled, 90% (men 220; women 88) provided data on at least one follow-up time point during the subsequent year. Gender-stratified longitudinal Pois-son regression models were fit for each alcohol outcome, adjusting for baseline values of age, physical symptoms, randomization group, alcohol outcome, cocaine use, and socioeconomic indicators.

Depressive symptoms were significantly associated with drinks per day (men: incidence rate ratio [IRR] 1.17 per 10-unit increase in CES-D, p < .01; women: IRR 1.00 per 10-unit increase in CES-D, p .98) and alcohol-related problems (men: IRR 1.22 per 10-unit increase in CES-D, p < .001; women: IRR 1.05 per 10-unit increase in CES-D, p .39) for men but not for women.

They were not significantly associated with the number of days abstinent in men or women.

In hospitalized medical patients with unhealthy alcohol use, depressive symptoms predict subsequent drinks per day and alcohol-related problems among men. These findings suggest that symptoms of depression may be important to consider in treatment planning for male medical patients with unhealthy patterns of drinking.

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Reprint Request E-Mail: palfai@bu.edu

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2006 Traffic Safety Annual Assessment –Alcohol-Related Fatalities


In 2006, an estimated 13,470 people were killed in traffic crashes that involved at least one driver or a motorcycle operator with a blood alcohol concentration (BAC) of .08 g/dL or above – a decline of 0.8 percent from the 13,582 fatalities in 2005.

The 2006 Annual Assessment of Motor Vehicle Traffic Crash Fatalities and Injuries shows that 17,602 people were killed in the United States in alcohol-related motor vehicle traffic crashes – essentially unchanged from the 17,590 alcoholrelated fatalities in 2005. Also, as shown in Table 1, fatalities n crashes where the highest BAC among any of the involved drivers, pedestrians or pedalcyclists was .08 g/dL or above increased marginally to 15,121 fatalities in 2006.
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Welcome to 'Harm Reduction 2008: IHRA’s 19th International Conference'





IHRA’s harm reduction conferences have been held around the world each year since 1990, and the next event in this highly successful series takes place in the stunning Mediterranean city of Barcelona in the heart of Catalonia and Spain.

Over five days, this conference will be the main meeting point for all those interested in harm reduction, and an invaluable platform for debate, discussion, and the dissemination of new and evolving good practice in addressing drug use and associated harm. For nearly two decades, these events have been the key forum for the dissemination of harm reduction ideas and practice, and have helped to put harm reduction on the map.

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Contributor: Jaime Bridge
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8th Annual Fetal Alcohol Canadian Expertise (FACE) Research Roundtable

September 7, 2007 - WINNIPEG, MANITOBA

FACE was established in 2000 to promote open discussion and collaboration in all areas of medical and social science research related to the effects of alcohol use during pregnancy and lactation. Today the FACE Network includes researchers, clinicians, front-line workers, government and industry representatives and policy-makers from across Canada.

The 2007 FACE Research Roundtable will feature 30 and 40 minute scientific presentations on some of Canada's most interesting FASD research. Please watch this page for program details. If you will need accommodation in Winnipeg call the Delta at 1-888-311-4990 to reserve a room at the special FACE Research Roundtable rate. Download Registration Form and Call for Abstract Instructions below.

All are welcome.

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Alcohol consumption and risk for stroke among Chinese men
Annals of Neurology Early View Published on-line 20 August 2007

Stroke is a leading cause of death and long-term disability in China. The objective of this study was to examine the relation between alcohol consumption and risk for stroke among Chinese men. Over the course of 493,351 person-years of follow-up, we documented 3,434 incident strokes (1,848 stroke deaths). After adjustment for age, body mass index, physical activity, urbanization (urban vs rural), geographic variation (north vs south), cigarette smoking, history of diabetes, and education, compared with nondrinkers, relative risk (95% confidence interval) of incident stroke was 0.92 for participants consuming 1 to 6 drinks/week, 1.02 for those consuming 7 to 20 drinks/week, 1.22 for those consuming 21 to 34 drinks/week, and 1.22 for those consuming 35 or more drinks per week. The corresponding relative risks for stroke mortality were 0.93, 0.98, 1.15, and 1.30, respectively. These results suggest that heavy alcohol drinking may increase the risk for stroke in Chinese men and should be the target of strategies for prevention. Read Full Abstract Reprint Request E-Mail: lbazzano@tulane.edu ______________________________________________________________________

Mechanisms of Action in Integrated Cognitive-Behavioral Treatment Versus Twelve-Step Facilitation for Substance-Dependent Adults With Comorbid Major Depression
Journal of Studies Alcohol and Drugs Volume 68, 2007 > Issue 5: September 2007



In a population of veterans with co-occurring substance use disorders and concomitant major depressive disorder, the current study compared mechanisms of change and therapeutic effects relevant to both disorders between integrated, dual disorder-specific cognitive behavioral therapy (ICBT) and twelve-step facilitation (TSF).

Self-efficacy increased among both TSF and ICBT participants during treatment, whereas self-reported ability to regulate negative affect did not change.

Consistent with predictions, TSF participants increased community TSA during treatment, whereas those receiving ICBT reduced TSA. Changes in self-efficacy and TSA were associated with improvement in substance use outcomes at the end of treatment. Hypothesized changes in social support were not supported.

Both ICBT and TSF produce improvements in self-efficacy, and these changes are related to substance use outcomes for depressed substance abusers. In TSF, intervention-specific changes in TSA occur during the course of treatment and are related to substance use outcomes.

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Reprint Request E-Mail: sglasner@ucla.edu
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Examining the effect of linkage disequilibrium between markers on the Type error rate and power of nonparametric multipoint linkage analysis of two-generation a multigenerational pedigrees in the presence of missing genotype data
Genetic Epidemiology Early View Published Online: 8 Aug 2007

Because most multipoint linkage analysis programs currently assume linkage equilibrium between markers when inferring parental haplotypes, ignoring linkage disequilibrium (LD) may inflate the Type I error rate.

We investigated the effect of LD on the Type I error rate and power of nonparametric multipoint linkage analysis of two-generation and multigenerational multiplex families.

Using genome-wide single nucleotide polymorphism (SNP) data from the Collaborative Study of the Genetics of Alcoholism, we modified the original data set into 30 total data sets in order to consider six different patterns of missing data for five different levels of SNP density.

To assess power, we designed simulated traits based on existing marker genotypes. For the Type I error rate, we simulated 1,000 qualitative traits from random distributions, unlinked to any of the marker data. Overall, the different levels of SNP density examined here had only small effects on power (except sibpair data).

Missing data had a substantial effect on power, with more completely genotyped pedigrees yielding the highest power (except sibpair data). Most of the missing data patterns did not cause large increases in the Type I error rate if the SNP markers were more than 0.3 cM apart.

However, in a dense 0.25-cM map, removing genotypes on founders and/or founders and parents in the middle generation caused substantial inflation of the Type I error rate, which corresponded to the increasing proportion of persons with missing data.

Results also showed that long high-LD blocks have severe effects on Type I error rate.

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Reprint Request E-Mail: hokim@snu.ac.kr
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Equality and difference: persisting historical themes in health and alcohol policies affecting Indigenous Australians
Journal of Epidemiology and Community Health 2007;61:759-763;

Disseminating national health and alcohol policies to Aboriginal and Torres Strait Islander people in Australia has been a challenging task for governments and public servants.

This has been for a number of reasons, including the enduring (negative) legacy of past "Aboriginal affairs" policies, the fact that Indigenous health programmes and alcohol programmes have been treated separately since the 1970s, and a more recent context in which the recognition of cultural difference was privileged.

Confronted with the politics of difference, health departments were slow to examine avenues through which best practice advice emanating from WHO, and alcohol policies such as harm minimisation and early identification and treatment in primary health care, could be communicated in culturally recognisable ways to independent Indigenous services.

In addition, there was hostility towards harm minimisation policies from Indigenous service providers, and Indigenous treatment programmes remained largely committed to abstinence-oriented modalities and the disease model of alcoholism, despite moves away from these approaches in the mainstream.

However, genuinely innovative acute interventions and environmental controls over alcohol have been developed by Indigenous community-based organisations, approaches that are reinforced by international policy research evidence.

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Reprint Request E-Mail: Maggie.brady@anu.edu.au
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Externalizing symptoms among children of alcoholic parents: Entry points for an antisocial pathway to alcoholism.
J Abnorm Psychol. 2007 Aug;116(3):529-42.




The authors examined heterogeneity in risk for externalizing symptoms in children of alcoholic parents, as it may inform the search for entry points into an antisocial pathway to alcoholism.

That is, they tested whether the number of alcoholic parents in a family, the comorbid subtype of parental alcoholism, and the gender of the child predicted trajectories of externalizing symptoms over the early life course, as assessed in high-risk samples of children of alcoholic parents and matched controls.

Through integrative analyses of 2 independent, longitudinal studies, they showed that children with either an antisocial alcoholic parent or 2 alcoholic parents were at greatest risk for externalizing symptoms. Moreover, children with a depressed alcoholic parent did not differ from those with an antisocial alcoholic parent in reported symptoms.

These findings were generally consistent across mother, father, and adolescent reports of symptoms; child gender and child age (ages 2 through 17); and the 2 independent studies examined.

Multialcoholic and comorbid-alcoholic families may thus convey a genetic susceptibility to regulation's along with environments that both exacerbate this susceptibility and provide few supports to offset it.

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Reprint Request E-Mail: hussong@unc.edu
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Nonnormality and divergence in posttreatment alcohol use: Reexamining the Project MATCH data "another way."
Journal of Abnormal Psychology. 2007 May Vol 116(2) 378-394






Alcohol lapses are the modal outcome following treatment for alcohol use disorders, yet many alcohol researchers have encountered limited success in the prediction and prevention of relapse.

One hypothesis is that lapses are unpredictable, but another possibility is the complexity of the relapse process is not captured by traditional statistical methods.

Data from Project Matching Alcohol Treatments to Client Heterogeneity (Project MATCH), a multisite alcohol treatment study, were reanalyzed with 2 statistical methodologies: catastrophe and 2-part growth mixture modeling.

Drawing on previous investigations of self-efficacy as a dynamic predictor of relapse, the current study revisits the self-efficacy matching hypothesis, which was not statistically supported in Project MATCH.

Results from both the catastrophe and growth mixture analyses demonstrated a dynamic relationship between self-efficacy and drinking outcomes. The growth mixture analyses provided evidence in support of the original matching hypothesis: Individuals with lower self-efficacy who received cognitive behavior therapy drank far less frequently than did those with low self-efficacy who received motivational therapy.

These results highlight the dynamical nature of the relapse process and the importance of the use of methodologies that accommodate this complexity when evaluating treatment outcomes.

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Reprint Request E-Mail: kate19@u.washington.edu
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Correspondence -
Alcohol consumption and public health in Russia


We thank Jürgen Rehm and Gerhard Gmel for their Comment (June 16, p 1975)1 on our paper (p 2001)2 on alcohol-related mortality in Russia. It is, however, necessary to correct some factual errors. They state that we provided no chemical analysis of non-beverage alcohols and that we did not consider the possibility that methanol poisoning might be important. In fact we
did provide data on the composition of non-beverage products, on the basis of our earlier detailed analysis of these substances (which Rehm and Gmel also cite).

Our key finding was that eau de colognes and medicinal tinctures were highly concentrated sources of ethanol, with no detectable quantities of methanol or long-chain alcohols. Although Rehm and Gmel are correct that we did not collect data on samogon (a home-produced spirit mainly found in rural areas), methanol is not usually found in home-produced Russian spirits because they are made from grain or sugar.
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Contributor: Philippe Arvers
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