To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.


Saturday, June 8, 2013

Effectiveness of alcohol prevention interventions based on the principles of social marketing: a systematic review

Alcohol education aims to increase knowledge on the harm related to alcohol, and to change attitudes and drinking behaviour. However, little (lasting) evidence has been found for alcohol education, in changing alcohol-related attitudes and behaviour. Social marketing uses marketing techniques to achieve a social or healthy goal, and can be used in alcohol education. Social marketing consists of eight principles: customer orientation, insight, segmentation, behavioural goals, exchange, competition, methods mix, and is theory based. This review investigates the application of social marketing in alcohol prevention interventions, and whether application of social marketing influences alcohol-related attitudes or behaviour.     
A literature search was conducted in PubMed, PsychInfo, Cochrane and Scopus. Inclusion criteria were that original papers had to describe the effects of an alcohol prevention intervention developed according to one or more principles of social marketing. No limits were set on the age of the participants or on the kind of alcohol prevention intervention. The abstracts of the 274 retrieved studies were reviewed and the full texts of potentially relevant studies were screened.     
Six studies met the inclusion criteria and were included in this review. These six studies showed associations for the application of social marketing techniques on alcohol-related attitudes or behaviour; one study relates to participation in a drinking event, four to alcohol drinking behaviour, two to driving a car while under the influence of alcohol, two to recognition of campaign messages or campaign logo, and one to awareness of the campaign. However, no associations were also found. In addition, the studies had several limitations related to a control group, response rate and study methodology.     
Based on this review, the effect of applying the principles of social marketing in alcohol prevention in changing alcohol-related attitudes or behaviour could not be assessed. More research, with a good quality methodology, like using a randomized control trial and measuring short, medium, and long-term effects, is required on this topic. Policy implications are discussed.
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Global Actions: Commitments to Reduce Harmful Drinking. June 5, 2013

Global Actions in Focus
The Global Actions newsletter will periodically feature best practices shared by our readers, including companies that are signatories of the Beer, Wine and Spirits Producers’ Commitments to Reduce Harmful Drinking. In this issue, we focus on HEINEKEN UK and its work in one of the five key areas addressed by the Commitments: providing consumer information and responsible product innovation. We look forward to highlighting more examples from Commitments stakeholders over the course of 2013 and beyond.

HEINEKEN was one of the first companies to introduce unit labeling practices in the United Kingdom that include five key nationally recognized elements:
  • Unit alcohol content;
  • The Chief Medical Officer (CMO) daily guidelines for lower-risk consumption;
  • Warnings about drinking when pregnant;
  • The Drinkaware website at; and
  • A responsibility statement (e.g. “please drink responsibly”).
In fact, 99% of the company’s bottles and cans in the U.K. now carry this information.

"We believe it is important for consumers to have information about units to enable them to make responsible choices on alcohol consumption,” said David Paterson, Head of Public Affairs and Corporate Responsibility. “We recognize we can reach our consumers with information about units and Chief Medical Officer (CMO) guidelines in a way that the Government cannot. It is important that we use this opportunity by including information on our packaging."
Another fundamental aspect of the company’s best practices in the U.K. addresses the fact that many of its products are sold in draught in on-trade establishments. To ensure that on-trade consumers are also informed about the levels of alcohol they are consuming, HEINEKEN UK provided nearly 16 million unit-labeled glasses to the U.K. market in 2012.
Key Recent Milestones

· Estonia: ICAP Deputy President Marjana Martinic was the keynote speaker at a roundtable regarding “Self-Regulation Versus Alcohol Policy” at Tallinn Law School on May 29, 2013. She discussed ICAP activities and how self-regulation can be utilized as an effective tool in a state law framework. Martinic also emphasized that producers, advertising agencies, media, and retailers should be included in the process.

What's Happening Next
· China: In June, the Jiangsu Institute for Health Education and the Nanjing Bureau of Traffic Management will release the results of the 2011-2012 Drink Driving Initiative. Expected attendees include representatives from Jiangsu Provincial Center for Disease Prevention and Control, the Jiangsu Department of Public Security, the Nanjing Provincial Center for Disease Prevention and Control, and the Nanjing Bureau of Traffic Management.

Emerging adults’ treatment outcomes in relation to 12-step mutual-help attendance and active involvement



Participation in Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) during and following treatment has been found to confer recovery-related benefit among adults and adolescents, but little is known about emerging adults (18–24 years). This transitional life-stage is distinctive for greater distress, higher density of psychopathology, and poorer treatment and continuing care compliance. Greater knowledge would inform the utility of treatment referrals to 12-step organizations for this age-group.

Emerging adults (N = 303; 18–24 years; 26% female; 95% White; 51% comorbid [SCID-derived] axis I disorders) enrolled in a naturalistic study of residential treatment effectiveness assessed at intake, 3, 6, and 12 months on 12-step attendance and involvement and treatment outcomes (percent days abstinent [PDA]; percent days heavy drinking [PDHD]). Lagged hierarchical linear models (HLMs) tested whether attendance and involvement conferred recovery benefits, controlling for a variety of confounds.

The percentage attending 12-step meetings prior to treatment (36%) rose sharply at 3 months (89%), was maintained at 6 months (82%), but declined at 12 months (76%). Average attendance peaked at about 3 times per week at 3 months dropping to just over once per week at 12 months. Initially high, but similarly diminishing, levels of active 12-step involvement were also observed. Lagged HLMs found beneficial effects for attendance, but stronger effects, which increased over time, for active involvement. Several active 12-step involvement indices were associated individually with outcome benefits.

Ubiquitous 12-step organizations may provide a supportive recovery context for this high-risk population at a developmental stage where non-using/sober peers are at a premium.

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Friday, June 7, 2013

Scotland's Licensing Act evaluation indicates progress - lessons for England?

An evaluation of Scotland's Licensing 2005 Act has been released, reporting positive impacts such as fewer irresponsible promotions and benefits of an appointed Licensing Standards Officer (LSO) for each council.

Download the Licensing (Scotland) Act Evaluation Final Report.pdf 
Scotland's Licensing Act came into effect in September 2009 and outlaws promotions providing alcohol free of charge, or at a discounted price on the purchase of one or more drinks. It also bans licensed premises from offering happy hours, drinking games or speed drinking deals.

The report also found that mandatory training for LSOs, Board members and trade staff has increased knowledge and standards of professional practice. However the report also identified a number of challenges and less successful aspects, including imited progress on off-sales and the public health objective.  > > > >   Read More

Thursday, June 6, 2013

Genetics of alcohol dependence and social work research: do they mix?

Since completion of the mapping of the human genome in early 2000, tremendous progress has been made in the identification of many different genes associated with our health and across diseases. Although social work researchers are not expected to conduct genetic research at the molecular level, it is imperative that we are able to understand the basic genetic findings related to behavioral problems and are able to translate and integrate this information into psychosocial treatment approaches and program development.

This article is an introduction and overview of genetic approaches, using studies of the genetics of alcoholism to exemplify important issues.
The literature review is not comprehensive and focuses primarily on the Collaborative Study on the Genetics of Alcoholism project as an example of a multidisciplinary and integrative approach to the genetic study of a major health problem often encountered in social work practice.

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The Impact of Alcohol on Society: A Brief Overview

Alcohol is the most common drug used among adults in the United States. The use of alcohol is associated with an increased risk of injuries and accidents. Even a single episode of excessive drinking can lead to a negative outcome.

Alcoholism and chronic use of alcohol are associated with numerous medical, psychiatric, social, and family problems. Family members, including children, exposed to a first-degree relative's alcohol problem are at risk for problems. Children of parents with alcohol addiction, for example, show higher rates of alcoholism than children who do not have parents with an alcohol addiction.

It is important for social workers to keep in mind that alcohol and alcohol problems affect the health, safety, and well-being of people.

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Wednesday, June 5, 2013

Diagnostic Characteristics and Application of Alcohol Biomarkers

Alcohol biomarkers play a significant role in the early diagnosis of alcohol intoxication/abuse, alcohol-related or-gan damages, assessment of alcoholism therapy outcomes, and in forensic medicine.

Laboratory detection of ex-cessive alcohol consumption can be carried out by direct measuring of the ethanol and/or metabolites in biological samples which is of particular importance in the cases of acute ethanol intoxication/controlling and/or monitoring of alcohol consumption, or indirectly, by using biomarkers.

Preferred diagnostic characteristics of alcohol bio-markers, specificity and sensitivity dependent on the particular demands such as: prevention and treatment of al-coholism in primary and social care, criminal justice, workplace health and safety screening, trafficking control, etc.

Alcohol biomarkers traditionally used in clinical practice [blood alcohol concentration (BAC), gamma-glutamyl transferase (GGT), carbohydrate-deficient transferrin (CDT), the ratio GGT/CDT, alanine aminotransferase (ALT), aspartate aminotransferase (AST), the ratio AST/ALT, mean corpuscular volume (MCV), phosphatidyl-ethanol (PEth)] are well validated. They are used as screening/monitoring markers of acute/chronic excessive al-cohol intake, alcoholism in pregnancy, and other disorders/conditions related to alcohol abuse.

Numerous poten-tial alcohol biomarkers have been discovered, but few are validated. Potential alcohol biomarkers (ethanol and se-rotonin metabolites, sialic acids, etc.) have good diagnostic characteristics, but their application in clinical practice is limited due to the costly equipment necessary for their measurement.

Significant progress has been made in the development of sensitive and practical alcohol transdermal devices that can instantly/continuously measure BAC through human skin. Transdermal sensing of alcohol may become a valuable method for monitoring abstinence.

A special aspect of alcoholism is genetic predisposition to alcohol abuse and alcoholism, or alcohol-related organ damage. Recent genome-wide association studies (GWASs) have proposed several susceptibility loci for alcohol dependence.

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Monday, June 3, 2013

Alcohol News - 23/2013

USA TODAY - Coming soon? Nutritional labels on alcohol

Alcohol beverages soon could have nutritional labels like those on food packaging, but only if the producers want to put them there.

YLE News (Finland) - Paper: Alcohol deaths cost a billion annually

Alcohol-related deaths cost society some one billion euros annually. Every year alcohol costs Finns about 25,000 years of life, according to a report in the regional Sunday supplement Sunnuntaisuomalainen.

Lithuania Tribune (Lithuania) - Sale of low-alcohol drinks to be allowed in the Seimas as of June

On Wednesday, the Seimas board approved a resolution, allowing sale of alcoholic beverages containing up to 18 per cent of alcohol in the parliament’s cafes. The decision is linked to Lithuania’s presidency over the European Union (EU) Council in the second half of this year.

Sydney Morning Herald (Australia) - Call for MPs to be bound by alcohol code of conduct

There are calls for an alcohol code of conduct for MPs after the finance minister, Greg Pearce, was warned by Premier Barry O'Farrell over allegations he was so drunk he was unable to participate in a parliamentary debate.

The Guardian (UK) - Older people are abusing alcohol more than the young

In her two-bedroom flat close to the centre of Brighton, Ann, 72, has not yet cleared out her late husband's clothes, but she's given away his wine. (UK) - Rich 'ladies who lunch' more likely to have alcohol problem, says study

Women who live in exclusive areas such as Esher in Surrey, Merchiston in Edinburgh, and Knightsbridge in London, where many residents often earn six-figure sums, are more also more likely to suffer from mental illness or depression than those living in more modest areas, research has found. (Ireland) - Minister Leo Varadkar supports alcohol strategy proposals

The Transport Minister Leo Varadkar has said that he is supportive of the vast majority of proposals in Junior Minister Alex White's alcohol strategy.

Daily Mail (UK) - Prescriptions for alcohol addiction soar by 70% in the last decade

The use of drugs to treat alcohol addiction increased by 70 per cent in the past decade. Doctors last year prescribed almost £3million worth of drugs, up from £1.72million in 2003. (Hungary) - Hungary's Economy Ministry Will Not Re-Regulate Alcohol Retail

A working draft of the Economy Ministry indicates that the government is considering changes in the sale of alcohol, but without causing serious shortfalls in excise tax and VAT revenues, left-leaning weekly Magyar Narancs reports.

Warc - Alcohol advertising under pressure

Alcohol advertising is coming under increasing regulatory pressure in several markets, with a review in the UK, a ban in Turkey and, in the US, a limited ban proposed in Los Angeles.

PoliceProffesional (UK) - National Twitter campaign highlights alcohol issues

Police forces nationwide took part in an online campaign over the Bank Holiday to raise awareness of the policing problems caused by alcohol abuse. (UK) - Drinkers put strain on NHS

New figures published yesterday revealed just under 26,000 people were admitted to hospital 38,724 times last year with conditions relating to alcohol abuse.

The Moscow Times (Russia) - How to Reduce Harmful Drinking

Harmful drinking features prominently in Russia's public policy for good reason: The country has the world's fourth-highest rate of per capita alcohol consumption. Alcohol misuse has been a major social, economic and public health problem for decades, and the prevailing drinking pattern has been characterized as "most risky" by the World Health Organization, or WHO.

Ethanol Diverts Early Neuronal Differentiation Trajectory of Embryonic Stem Cells by Disrupting the Balance of Lineage Specifiers

Ethanol is a toxin responsible for the neurodevelopmental deficits of Fetal Alcohol Spectrum Disorders (FASD). Recent evidence suggests that ethanol modulates the protein expression of lineage specifier transcription factors Oct4 (Pou5f1) and Sox2 in early stages of mouse embryonic stem (ES) cell differentiation. We hypothesized that ethanol induced an imbalance in the expression of Oct4 and Sox2 in early differentiation, that dysregulated the expression of associated and target genes and signaling molecules and diverted cells from neuroectodermal (NE) formation.

We showed modulation by ethanol of 33 genes during ES cell differentiation, using high throughput microfluidic dynamic array chips measuring 2,304 real time quantitative PCR assays. Based on the overall gene expression dynamics, ethanol drove cells along a differentiation trajectory away from NE fate. These ethanol-induced gene expression changes were observed as early as within 2 days of differentiation, and were independent of cell proliferation or apoptosis. Gene expression changes were correlated with fewer βIII-tubulin positive cells of an immature neural progenitor phenotype, as well as a disrupted actin cytoskeleton were observed. Moreover, Tuba1a and Gapdh housekeeping genes were modulated by ethanol during differentiation and were replaced by a set of ribosomal genes with stable expression.

These findings provided an ethanol-response gene signature and pointed to the transcriptional dynamics underlying lineage imbalance that may be relevant to FASD phenotype.

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Sunday, June 2, 2013

FASD News - 22/2013


Irish Independent (Ireland) - Mums-to-be are playing 'Russian roulette' with alcohol

Many middle-class women are putting their unborn children at potential risk of brain disorders by ignoring warnings not to drink alcohol during pregnancy, a new report will reveal.

Wawatay News (Canada) - Saugeen man on hunger strike over FASD

Saugeen’s Paul Machimity is into the second week of his hunger strike to raise awareness about fetal alcohol spectrum disorder (FASD). (Australia) - Pregnancy drinking harming hundreds

IT has been described as Australia's "invisible birth defect" and, in the six months since a major report calling for pregnancy warning labels on alcohol, 1300 children have been born with brain damage. (USA) - Lansing to Washington: Advocate begins walk to highlight fetal alcohol exposure and mental illness

Jim Casha is walking to Washington D.C. Again. The 58-year-old Michigan native, who currently resides with his in-laws in Canada but is a regular at the state Capitol and Detroit City Council, made the walk three years ago, and despite his advancing age, set out again on Friday morning with plans to reach D.C. in 40 days.

Irish Independent (Ireland) - Still no warning labels on alcohol one year on

NO LABELS have yet been put on alcohol products sold in Ireland containing health warnings about drinking during pregnancy, despite the recommendations of a report a year ago. - Health Dept. launches campaign: ‘049’ = Zero Alcohol for Nine Months of Pregnancy

A mother’s use of even small amounts of alcohol can cause health problems for her baby, a fact that many women and their health care providers may not realize. Drinking can affect development in the very first weeks – even before a woman knows she’s pregnant – and throughout pregnancy. - Drs. Oz and Roizen: Pregnant? Find ways other than alcohol to de-stress

Gwyneth Paltrow was outed for drinking a Guinness while pregnant, but a brand-new study claims she may not have done anything risky. It seems British docs think two glasses of wine a week or the equivalent doesn’t add up to developmental problems in kids. We think they’re off base. A fetus’ alcohol tolerance level is unknowable. - Drugs and alcohol cause problems during pregnancy

A University of Canterbury psychology researcher has identified the first direct evidence that combined use of ecstasy and alcohol during pregnancy causes brain damage. (Poland) - Woman Gives Birth to Drunk Baby after Binge Drinking Session

Surgeons in Poland were forced into an emergency Caesarean operation to deliver a baby boy born with severe alcohol poisoning. The 24-year-old mother was reportedly on a drinking binge and collapsed while buying more liquor. The incident took place at a bar in the town of Tomaszow.

SAMHSA (USA) - Report reveals special challenges of pregnant teens in substance abuse treatment

A new report shows that among the approximately 57,000 teenage female (ages 12 to 19) substance abuse treatment admissions each year, about 2,000 (4 percent) involve pregnant teens.



These conferences, each the first of its kind, are presented by

These conferences, each the first of its kind, are presented by the Institute of Health Economics, with the support of the Government of Alberta.

National FASD Conference & FACE 2013 – Joint Registration OPEN!

Frontier Regional FASD Training Center - FASD Intervention Strategies Part II – 6.20.13

Thank you for your interest in the FASD Intervention Strategies Part II webinar scheduled for June 20, 2013 brought to you FREE by the Frontier Regional FASD Training Center, funded by a grant from the Centers for Disease Control & Prevention (CDC).


Healthvermont - Alcohol & Pregnancy — Guidance for Health Care Providers

MencapDirector - GP info on Foetal Alcohol Spectrum Disorder (FASD)

This video gives vital information for GPs about Foetal Alcohol Spectrum Disorder (FASD), the signs and symptoms, and the best advice to give to your patients when dealing with FASD.

MencapDirector - Advice for pregnant women about FASD

Information for pregnant women about Foetal Alcohol Spectrum Disorder (FASD). The video is part of a toolkit which aims to help increase understanding of FASD, the effects of alcohol on the foetus, the process of diagnosis for FAS/FASD as well as support and strategies for a person caring for a child or adult with FASD.

CanFASD Research Network - Alcohol Policies to Prevent FASD

"Shining a Light on Canada's Multi-Layered Approach to FASD Prevention," an evening session on promoting women's health and preventing FASD, was held on February 28th, 2013 as a part of the 5th International Conference on Fetal Alcohol Spectrum Disorder in Vancouver, BC. A series of video clips from the event highlights examples of current FASD-related policies, programs, and initiatives from across Canada.

ABC13Channel - Fetal Alcohol Syndrome

You've heard of fetal alcohol syndrome, but most people don't truly understand it.One local center is trying to get a better handle on the condition.As News 13's Jay Siltzer shows us in today's Health Alert, that might lead to earlier diagnoses and care.

David Boulding - FASD and the Law: Training Seminars for Vancouver Coastal Health

Alcohol-Free Pregnancy - Laura - Birth mother of a person with FASD


INTECH - Clinical Implications of a Link Between Fetal Alcohol Spectrum Disorders (FASD) and Autism or Asperger’s Disorder – A Neurodevelopmental Frame for Helping Understanding and Management

The teratogenic effect of alcohol was first observed by paediatrician Paul Lemoine in Nantes, France in 1968, when he linked facial dysmorphic and growth features with maternal use of alcohol (wine) in pregnancy.

Centers for American Indian and Alaskan Native Health - Creating a Culturally Appropriate Web-based Behavioral Intervention for American Indian/Alaska Native Women in Southern California: The Healthy Women Healthy Native Nation Study

Health disparities in fetal alcohol spectrum disorders (FASD) are of high importance to American Indian/Alaska Native (AI/AN) communities.

Alcohol - Impaired odor identification in children with histories of heavy prenatal alcohol exposure

Prenatal alcohol exposure can lead to behavioral and cognitive impairments across multiple domains. Many of the brain regions impacted by prenatal alcohol exposure are also linked with olfactory processing, and odor identification deficits have been documented in certain neurological disorders associated with these brain regions.

IN OTHER LANGUAGES (Poland) - Powstał ośrodek leczenia dzieci z FASD

Pierwszy w Polsce ośrodek kompleksowego leczenia dzieci, których matki spożywały w ciąży alkohol powstał w Specjalistycznym Szpitalu Dziecięcym im św. Ludwika w Krakowie.


µ-Opioid Receptor Gene (OPRM1) Polymorphism A118G: Lack of Association in Finnish Populations with Alcohol Dependence or Alcohol Consumption


The molecular epidemiological studies on the association of the opioid receptor µ-1 (OPRM1) polymorphism A118G (Asn40Asp, rs1799971) and alcohol use disorders have given conflicting results. The aim of this study was to test the possible association of A118G polymorphism and alcohol use disorders and alcohol consumption in three large cohort-based study samples.

The association between the OPRM1 A118G (Asn40Asp, rs1799971) polymorphism and alcohol use disorders and alcohol consumption was analyzed using three different population-based samples: (a) a Finnish cohort study, Health 2000, with 503 participants having a DSM-IV diagnosis for alcohol dependence and/or alcohol abuse and 506 age- and sex-matched controls; (b) a Finnish cohort study, FINRISK (n = 2360) and (c) the Helsinki Birth Cohort Study (n = 1384). The latter two populations lacked diagnosis-based phenotypes, but included detailed information on alcohol consumption.

We found no statistically significant differences in genotypic or allelic distribution between controls and subjects with alcohol dependence or abuse diagnoses. Likewise no significant effects were observed between the A118G genotype and alcohol consumption.
These results suggest that A118G (Asn40Asp) polymorphism may not have a major effect on the development of alcohol use disorders at least in the Finnish population.

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Who Is Not Drinking Less in Sweden? An Analysis of the Decline in Consumption for the Period 2004–2011

This study aimed to analyse if changes in drinking in Sweden have been similar in different population subgroups between 2004 and 2011, a period when per capita consumption declined significantly.

The analysis starts out from monthly alcohol survey data including 1500 telephone interviews every month. The population is divided into 20 equally large consumption groups separately for men and women and two broad age groups. Both absolute and relative changes in drinking are studied.

Most findings confirmed a collectivity of change in drinking: a decline was found at all consumption levels overall, among men and women, and among those under 50 years of age. The decline was smaller in groups with the highest consumption, and among those over 50 years consumption rather increased among the heaviest drinkers.

Support was obtained for the conception of a social component in recent consumption changes in Sweden. This finding has an important policy message in line with the total consumption model, namely that measures that reduce per capita consumption are likely to imply fewer heavy drinkers. Some exceptions from the collectivity theory that deserves attention in future studies were also noted, e.g. the development among heavier drinkers above 50 years of age.

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The Alcohol Improvement Programme: Evaluation of an Initiative to Address Alcohol-Related Health Harm in England

The evaluation aimed to assess the impact of The Alcohol Improvement Programme (AIP). This was a UK Department of Health initiative (April 2008–March 2011) aiming to contribute to the reduction of alcohol-related harm as measured by a reduction in the rate of increase in alcohol-related hospital admissions (ARHAs).

The evaluation (March 2010–September 2011) used a mix of qualitative and quantitative methods to assess the impact of the AIP on ARHAs, to describe and assess the process of implementation, and to identify elements of the programme which might serve as a ‘legacy’ for the future. (etc. the part changed is highlighted)

There was no evidence that the AIP had an impact on reducing the rise in the rate of ARHAs. The AIP was successfully delivered, increased the priority given to alcohol-related harm on local policy agendas and strengthened the infrastructure for the delivery of interventions.

Although there was no measurable short-term impact on the rise in the rate of ARHAs, the AIP helped to set up a strategic response and a delivery infrastructure as a first, necessary step in working towards that goal. There are a number of valuable elements in the AIP which should be retained and repackaged to fit into new policy contexts.

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The Impact of Twelve-Step Program Familiarity and Its In-Session Discussion on Counselor Credibility

The therapeutic relationship is an important factor in substance abuse treatment. Because Twelve-Step Program (TSP) concepts and principles are often incorporated into substance abuse treatment, we investigated whether counselor familiarity and time spent on TSPs impact counselor credibility.
A sample of 180 clients receiving residential treatment in the capital region of a northeastern state in 2009 completed a Client Demographic Questionnaire and the Counselor Rating Form – Short Version. Their counselors (N 31) completed a corresponding Counselor Demographic Questionnaire.
The effect of the estimated percentage of in-session time discussing TSPs (p .010) and the effect of TSP familiarity for counselors in recovery (p .017) had significant effects on counselor credibility.
The credibility of counselors is important for a working relationship with clients. These results highlight counselor influence stemming from a TSP presence in treatment, indicating positive ramifications for the therapeutic relationship.

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