Using Metaphors to Explore the Experiences of Powerlessness among Women in 12-Step Recovery
Substance Use & Misuse, Volume 43, Issue 8 & 9 July 2008 , pages 1027 - 1044

12-Step programs of substance abuse¹ recovery are the most utilized mutual-help models in the United States. A pivotal aspect of 12-Step is the often-controversial idea of powerlessness. There is debate about the usefulness of the concept of powerlessness, especially for women in recovery.

This study used a metaphor-elicitation interviewing technique to examine the experiences of powerlessness among 13 women of varied racial, ethnic, and socioeconomic backgrounds, ages 21 to 60, who had an average of 9.5 years of recovery. Interviews were conducted during a 6-month span between 2004 and 2005 in the Washington, DC metropolitan area. Open and axial coding was used to determine emergent themes.

Concepts of powerlessness were found to be process oriented and developmental. Some metaphors indicated positive emotions around powerlessness such as relief, whereas others indicated negative emotions such as fear.

Implications for future research and study strengths and limitations are included.

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Light in tunnel of addiction

July 17, 2008

The number of problem drinkers is increasing, but so are the options available for treating them, writes Kerry Coleman.

It was early afternoon and Eric, 45, was circling his drug dealer's block in his car, waiting for a fix. He'd just cracked open the last beer in the case that sat on the passenger seat when he hit a telegraph pole.

More than two million Australians drink at risky levels, and the number of people misusing alcohol increased by more than 5 per cent between 1995 and 2005, according to the Australian Bureau of Statistics.

But while alcohol abuse increases, so do the treatment options. Today, alcoholics like Eric can check into rehab like a Hollywood star, attend Alcoholics Anonymous meetings, or pop a pill to kill the cravings. They can even get counselling sessions sent by post.

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News Release - BBPA comments on Department of Health consultation
22.07.2008

Commenting on today’s announcement by the Department of Health on further consultation on alcohol policy, Mark Hastings, BBPA Director of Communications, said:

“The Government’s approach should be to address the underlying culture and change attitudes, not just legislate and regulate. Legislation is a sledgehammer that will not crack the nut.

“There also needs to be the right balance between individual and corporate responsibility. We expect to be held to account for those things we can control, but companies cannot and should not be held to account for individual choices and behaviours that are beyond their ability to control.

“This is an industry that already bears the burden of one the heaviest tax and regulatory regimes in the world.

“With the economy in a precarious position, business under pressure, pubs closing at record rates and people feeling the pinch, now is not the time to be announcing a raft of new costs, regulations and restrictions on either businesses or individuals. The inevitable impact of such measures is to force up costs and prices and push more pubs towards penury.

“This seems to be a classic example of the Government’s tendency towards announcing new laws, rather than enforcing existing ones. There are plenty of laws and regulations to deal with irresponsible pubs and people. All agencies, including local government and the police should first focus on how to ensure these are enforced with greater rigour and consistency.

“We will look at the proposals and respond further when we have had a chance to consider them in detail.
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News Release - BBPA Comment on KPMG report leak
21.07.2008

Commenting on the release of the Government’s release of the KPMG study into the drinks industry’s standards, Rob Hayward, Chief Executive of the Beer & Pub Association said:

“We have not yet seen the report, but from extracts we have seen, it seems long on anecdotal stories and short on hard empirical evidence.

“It totally ignores existing hard evidence from the repeated Government sting operations which have visited thousands of pubs in recent years. Those reports, while identifying some problems, have tracked consistent improvement in standards and high levels of good practice.
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A systematic review of emergency care brief alcohol interventions for injury patients
Journal of Substance Abuse Treatment Volume 35, Issue 2, September 2008, Pages 184-201


This article examines 14 studies that assessed the effectiveness of brief interventions (BIs) delivered to injury patients in emergency care settings.

The aims were to review findings concerning the effectiveness of providing BI in these settings and to explore factors contributing to its effectiveness.

Of the 12 studies that compared pre- and post-BI results, 11 observed a significant effect of BI on at least some of the outcomes: alcohol intake, risky drinking practices, alcohol-related negative consequences, and injury frequency. Two studies assessed only post-BI results.

More intensive interventions tended to yield more favorable results. BI patients achieved greater reductions than control group patients, although there was a tendency for the control group(s) to also show improvements. Five studies failed to show significant differences between the compared treatment conditions.

Variations in the study protocol, alcohol-related recruitment criteria, screening and assessment methods, and injury severity limit the specific conclusions that can be drawn.

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Reference-dose place conditioning with ethanol in mice: empirical and theoretical analysis
Psychopharmacology Online First 17 July 2008

A frequently expressed criticism of the conditioned place preference (CPP) procedure is that it sometimes lacks a graded dose–response curve for many drugs.

We used a combination of standard and reference-dose CPP procedures to examine the dose–response curve for ethanol-induced CPP in DBA/2J mice

Standard procedures yielded similar levels of CPP at doses of 1.5, 2, and 4 g/kg, whereas 0.5 g/kg did not produce significant CPP. However, in the reference-dose procedure, exposure to the 0.5-g/kg dose interfered with CPP normally produced by 1.5 or 2 g/kg. Moreover, mice showed significant preference for the 4-g/kg-paired cue over the 1.5-g/kg-paired cue.

These studies show that a reference-dose procedure can reveal effects of low doses that are sometimes difficult to detect in a standard procedure. The reference-dose procedure may also uncover differences between higher doses that normally produce similar preference. Efficacy of the reference-dose procedure may be explained by a theoretical analysis that assumes the procedure places behavior between the extremes of the performance range, offering a more sensitive method for detecting effects of manipulations that produce small changes and/or differences in the rewarding effects of ethanol.

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Social rank and social separation as determinants of alcohol drinking in squirrel monkeys
Psychopharmacology Online First 19 July 2008


Alcohol may be self-administered for its anxiolytic effects to alleviate symptoms of stress, but different types of stressors have varying effects on alcohol intake. Social stress is particularly relevant to alcohol drinking, and a primate model of stress-induced alcohol self-administration would be useful.

The objective of the study is to determine if social stresses of different lengths and intensities affect voluntary alcohol intake in monkeys.

Materials and methods Subjects were adult male and female squirrel monkeys (Saimiri

Dominance rank was inversely correlated with alcohol intake during social housing but was not correlated with control fluid intake. Acute social separation abolished drinking of both fluids, accompanied by increased anxiety-like behavior. Extended social separation increased salivary cortisol and alcohol drinking but not control fluid intake in males. In females, drinking was unchanged by extended separation.

The chronic stress of social subordination is correlated with increased alcohol drinking. Acute social separation stress suppresses drinking behavior, while extended separation preferentially increases alcohol intake in a subset of individuals. These findings suggest that social stressors of different time-courses and intensities have opposing effects on alcohol self-administration.

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Call for action on alcohol abuse

By Jenny Wiggins

Published: July 22 2008 20:08

The drinks industry on Tuesday called on the government to launch a full-scale education campaign to tackle Britain’s binge drinking culture, claiming it was not responsible for soaring rates of alcohol abuse.

The salvo was fired as the government threatened retailers, alcohol producers and pubs with regulation that could force them to offer drinks in small glasses and provide mandatory health warnings on alcohol products.

Publishing new research that linked cheap alcohol to rising consumption, the government said it would not make a final decision about whether to push for more controls on the industry until later this year.

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Press Release - Model Launched For Underage Alcohol Project

21 July, 2008

The WSTA today publishes a blueprint for community action to tackle underage drinking.

‘A New Way of Tackling Public Underage Drinking: Community Alcohol Partnerships’, draws on the results of a successful Community Alcohol Partnership (CAP) coordinated by the Retail of Alcohol Standards Group with Cambridgeshire Trading Standards, providing a new model for local enforcement to combat underage drinking.

The publication is being submitted to Government departments and local enforcement agencies and is available via the WSTA website. RASG is keen to spread this example of good practice and happy to speak to any local authorities who think CAP can work in their area.

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Download Publication (PDF)

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July's Webcast: "Real People, Real Recovery: Effectively Delivering Recovery-Oriented Systems of Care"

In 2006, an estimated 22.6 million persons aged 12 or older were classified with substance dependence or abuse in the past year. Of these, only 4 million received some kind of treatment for a problem related to the use of alcohol or illicit drugs. Luckily, a host of services exists for those who need them. From 12-step programs to inpatient and outpatient treatment, and from recovery-oriented housing to sober recreational activities like those celebrated each September during Recovery Month, there is an entire network of treatment and support services available for those dealing with substance abuse and mental health disorders. This Webcast will examine some of those services and explore ways to increase awareness and better deliver these services to those who need them. Watch the Webcast Now

Cheap alcohol is fuelling binge drinking, study says

By Robert Winnett, Deputy Political Editor
22 Jul 2008

Cut price alcohol is causing young people to drink to excess, a Government-backed study has found.

The research, carried out by Sheffield University, examined the impact of cheap supermarket deals on beer, wine and spirits and identified a link with binge drinking.

It is the first time academics have established a direct link and will add to pressure on supermarkets to stop selling alcohol as a "loss leader" - sometimes below its cost price.

The research also warned that cheap alcohol was leading to cancer and strokes and boosting the divorce rate.

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Industry warned of tougher action over binge drinking

By Jane Kirby, PA
Tuesday, 22 July 2008

The Government promised tougher action against the alcohol industry today unless it steps up efforts to encourage sensible drinking.

Research has shown the drinks trade is failing to adhere to its own voluntary code on providing alcohol unit information to consumers.

More than 10 years after industry and the Government agreed a way forward for clearer labelling, only 57 per cent of products contain details of the alcohol units in a drink.

Meanwhile, just 3 per cent of products contain all the information ministers want to see, including a warning to pregnant women to avoid alcohol.

The Government is considering banning happy hours, forcing pubs and clubs to serve drinks in smaller glasses as well as larger ones, and stopping off-licences and other retailers from displaying alcohol at checkouts.

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The Marshak Method: Merging Traditional 12-Step and Holistic Methods

Written by Dr. Jacob Marshak

Tuesday, 22 July 2008

In the early 1990s, after the break-up of the Union of Soviet Socialist Republics (USSR), the newly established Russian Federation faced a fast growing heroin epidemic, created by two factors: veterans returning from the war in Afghanistan; and the dramatic impact of a diet that consisted primarily of high-glycemic processed foods and fast foods, rich in sugars and corn syrup. In the USSR alcohol and drug abuse was officially minimized by the government, and addicts were neglected — the worst addicts, mainly alcoholics, were sent to forced labor camps.

Only after Mikhail Gorbachev’s 1986 economic restructuring, known as perestroika, were U.S. activists allowed to introduce 12-Step philosophy to Russia for the first time. I was personally invited to spend a year in the United States as a guest of American addiction professionals. When I returned to Russia as a certified addiction professional, I opened the country’s first private practice specializing in addiction medicine in 1991. My practice began with six heroin addicts. I combined the 12-Step program with a methodology I had personally developed 10 years earlier to stop myself from drinking. It is a holistic method, which allows an addict to quickly achieve sobriety without the help of pharmaceutical medications, and to rapidly improve his or her mood, so as to remain happy, positive and sober long term. A few years later the Marshak alumni “club” included about 30 sober, happy and creative members.
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Predictors of changes in alcohol-related self-efficacy over 16 years
Journal of Substance Abuse Treatment Volume 35, Issue 2, September 2008, Pages 148-155

Self-efficacy is a robust predictor of short- and long-term remission after treatment.

This study examined the predictors of self-efficacy in the year after treatment and 15 years later.

A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years.

Predictors of self-efficacy at 1 year included improvement from baseline to 1 year in heavy drinking, alcohol-related problems, depression, impulsivity, avoidance coping, social support from friends, and longer duration of participation in Alcoholics Anonymous (AA).

Female gender, more education, less change in substance use problems, and impulsivity during the first year predicted improvement in self-efficacy over 16 years.

Clinicians should focus on keeping patients engaged in AA, addressing depressive symptoms, improving patient's coping, and enhancing social support during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.

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Request Reprint E-Mail: john.mckellar@va.gov
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Circadian phenotype in patients with the co-morbid alcohol use and bipolar disorders
Alcohol and Alcoholism Advance Access published online on July 20, 2008


Alcohol misuse is associated with bipolar disorder. Abnormalities in the circadian clockwork play a role in the pathogenesis of bipolar disorder. Alcohol intake is likely to affect the circadian phenotype.

We aimed at analysing the behavioural trait of the preference to morning or evening hours for the daily activities in bipolar disorder patients with or without the co-morbid alcohol use.

Patients with the co-morbid alcohol use disorder were more of the morning type as compared with patients with bipolar disorder only.

Co-morbid patients preferred more the morning hours for their daily activities, indicative of alcohol consumption having an effect on the circadian clock.

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Safe, Sensible, Social – consultation on further action

22 July 2008

Pricing and promotion review

In Safe. Sensible. Social: next steps in the national alcohol strategy, the Department of Health committed to commission an independent review of the relationship between alcohol price, promotion and harm. The review is being conducted by the School of Health and Related Research at the University of Sheffield. This Phase 1 report is a comprehensive summary of international evidence. Phase 2, reporting in the autumn of 2008, will provide detailed policy models.

• Download The Independent Review of the Effects of Alcohol Pricing and Promotion.
  
• Summary of Evidence to Accompany Report on Phase 1: Systematic Reviews (PDF, 176K)

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New Homelessness Resource Center Web Site Launched

SAMHSA's new Homelessness Resource Center (HRC) Web site launched this week. Targeted toward providers who work with people who are homeless, the Web site shares state-of-the art knowledge, evidence-based practices, and practical resources.

The Web site provides an interactive learning community for researchers, providers, consumers, and Government agencies at all levels. It is an easy-to-manage resource with content that informs, features that engage, and training that is useful. These elements are brought together to promote recovery-oriented and consumer-centered services for people who are homeless.

Read the related news release

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Drinks industry regulations 'not fit for practice'

21 July 2008

By Harriet Shawcross

THE regulations governing the alcohol industry are "not fit for practice" and should be scrapped, according to an independent review to be published this week.

An investigation commissioned by the Home Office into the alcohol industry's Social Responsibility Standards found the regulations were flouted to allow "irresponsible and harmful practices".
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Binge drinking strategy on rocks

Siobhain Ryan | July 21, 2008

LABOR risks falling off the wagon of its national binge drinking strategy after missing by three months its own deadline for tabling options to tackle alcohol abuse.

In May, a meeting of federal and state ministers with responsibility for drug strategy pledged to fast-track an interim report on binge drinking in recognition of the "urgency'' of the issue.

The document was to go before the Council of Australian Governments in July.
Last week, the ministers met again, with the July 3 COAG event behind them but no report at hand. A spokeswoman for Parliamentary Secretary Jan McLucas, representing the federal Government on drug strategy, attributed the delay to "extensive'' consultations with the alcohol industry and health groups.
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Health, alcohol and EU law: understanding the impact of European single market law on alcohol policies
European Journal of Public HealthVolume 18, Number 4 Pp. 392-398


Many professionals in the alcohol field see the role of the the European Court of Justice (ECJ) as negative for health.

This review examines ECJ and European Free Trade Association (EFTA) case law in the context of two broader debates: firstly the extension of European Union (EU) law into alcohol policy (the ‘juridification’ of alcohol policy), and secondly the extent to which alcohol policy is an example of the dominance of ‘negative integration’ (the removal of trade-distorting policy) over ‘positive integration’ (the creation of European alcohol policies).

A comprehensive review of all ECJ/EFTA Court cases on alcohol, with interpretation aided by a secondary review on alcohol and EU law and the broader health and trade field.

From looking at taxation, minimum pricing, advertising and monopoly policies, the extension of the scope of the these courts over alcohol policy is unquestionable. However, the ECJ and EFTA Court have been prepared to prioritise health over trade concerns when considering alcohol policies, providing certain conditions have been met.

While a partial juridification of alcohol policy has led to the negative integration of alcohol policies, this effect is not as strong as sometimes thought; EU law is more health friendly than it is perceived to be, and its impact on levels of alcohol-related harm appears low. Nevertheless, lessons emerge for policymakers concerned about the legality of alcohol policies under EU law. More generally, those concerned with alcohol and health should pay close attention to developments in EU law given their importance for public health policy on alcohol.

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