Alcoholics Anonymous and Hazardously Drinking Women Returning to the Community After Incarceration: Predictors of Attendance and Outcome

The number of women incarcerated within the United States has risen dramatically in recent decades, and high rates of alcohol problems are evident among this population. Although little is known about the patterns of help utilization and efficacy for alcohol problems, preliminary evidence suggests that Alcoholics Anonymous (AA) is a widely available resource for this population.

Data were collected as part of a study evaluating the effect of a brief intervention to reduce alcohol use among hazardously drinking (i.e., score of 8 or above on the Alcohol Use Disorders Identification Test or 4 or more drinks at a time on at least 3 days in prior 3 months) incarcerated women. The current study characterized demographic, clinical, and previous AA attendance variables associated with AA attendance in the 6 months following incarceration. Associations between frequency of AA attendance and drinking outcomes following incarceration were also evaluated.

Among the 224 participants who provided data about AA attendance, 54% reported some AA attendance during the follow-up assessment period. AA attendance in the year prior to study entry (OR = 4.02; 95% CI: 3.32 to 4.71) and greater baseline consequences of alcohol use (OR = 2.09; 95% CI: 1.73 to 2.44) were associated with increased odds of higher frequency of AA attendance following incarceration. Weekly or greater AA attendance was associated with reductions in negative drinking consequences (B = −0.45; p < 0.01) and frequency of drinking days (B = −0.28; p < 0.01) following incarceration.

Findings from this study suggest that AA is frequently utilized by hazardously drinking women following incarceration. Alcohol outcomes may be enhanced by AA attendance at a weekly or greater frequency is associated with better alcohol outcomes relative to lower levels of AA attendance. Evaluation of clinical guidelines for prescribing AA attendance for incarcerated women remains a task for future research.


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Protracted Withdrawal Substance Abuse Treatment Advisory, July 2010, Vol. 9, Issue 1

Provides an overview of protracted withdrawal. Discusses symptoms associated with alcohol, opioids, methamphetamine, cocaine, marijuana, and benzodiazepines; compares it to acute withdrawal; and gives tips on how to help clients manage it in recovery.


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Brochure - Should You Talk to Someone About a Drug, Alcohol, or Mental Health Problem?

 

Lists questions consumers can ask themselves to help them decide whether to seek help for a substance abuse problem, a mental health issue, or both. Urges those who answered "yes" to any of the questions to seek help and lists resources for more information.

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Early Release of Selected Estimates Based on Data From the January–June 2010 National Health Interview Survey

9. Alcohol consumption 

PDF Version

• Figure 9.1. Percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year: United States, 1997–June 2010
• Figure 9.2. Percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year, by age group and sex: United States, January–June 2010
• Figure 9.3. Age-sex-adjusted percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year, by race/ethnicity: United States, January–June 2010
• Data tables for Figures 9.1–9.3

Smoking, nutrition, alcohol and physical activity interventions targeting Indigenous Australians: rigorous evaluations and new directions needed

To describe and critique methodological aspects of interventions targeting reductions in smoking, poor nutrition, alcohol misuse and physical inactivity (SNAP risk factors) among Indigenous Australians.
 

An electronic search of eight databases and a manual search of reference lists of literature reviews and reference libraries for Indigenous-specific intervention studies published in peer-reviewed journals (January 1990 to August 2007) were undertaken. Alcohol, smoking, nutrition or physical activity needed to be the primary focus of the study and the intervention needed to specifically target Indigenous Australians.

Twenty studies were selected for inclusion in the review. Methodologically, few studies employed randomisation or a control group, most omitted important details (e.g. costs), some did not report process measures (e.g. attrition rates), and some did not use validated measures. Two-thirds of interventions were implemented at the community level and employed multiple strategies.

There is a need for more rigorous evaluations of interventions targeting reductions in SNAP risk factors among Indigenous Australians, and to establish the reliability and validity of measures to quantify their effect.

It may be beneficial for future Indigenous-specific intervention research to focus on the evaluation of secondary prevention to complement the current concentration of effort targeting primary prevention. 

Community-wide interventions, combining strategies of greater intensity for high risk individuals with those of less intensity targeting lower risk individuals, might also offer considerable promise.


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A Guide to Evaluating Prevention Programs

This Toolkit is intended for those working in the beverage alcohol industry—producers, trade associations, and social aspects organizations (SAOs)—who are currently undertaking or planning to undertake programs to address alcohol-related harm. It provides an overview of what is involved in evaluating prevention programs, laying out the necessary steps and identifying different available options. Two case studies then apply the principles of evaluation to two scenarios that mirror the types of initiatives likely to be implemented by industry stakeholders: an awareness campaign around the use of designated drivers and a school-based alcohol education program. 

• A Guide to Evaluating Prevention Programs 
• Case Study 1: Evaluating an Awareness Campaign around the Use of Designated Drivers
• Case Study 2: Evaluating a School-based Alcohol Education Program

Stages of change

The transtheoretical model, in general, and the stages of change, in particular, have proven useful in adapting or tailoring treatment to the individual. We define the stages and processes of change and then review previous meta-analyses on their interrelationship. 

We report an original meta-analysis of 39 studies, encompassing 8,238 psychotherapy patients, to assess the ability of stages of change and related readiness measures to predict psychotherapy outcomes. 

Clinically significant effect sizes were found for the association between stage of change and psychotherapy outcomes (d = .46); the amount of progress clients make during treatment tends to be a function of their pretreatment stage of change. 

We examine potential moderators in effect size by study outcome, patient characteristics, treatment features, and diagnosis. 

We also review the large volume of behavioral health research, but scant psychotherapy research, that demonstrates the efficacy of matching treatment to the patient's stage of change. 

Limitations of the extant research are noted, and practice recommendations are advanced.


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News Release - Popping a Pill Can Help Some Alcoholics Curb Drinking

A little-used medication can help treat alcoholism, an updated review of studies confirms.

At any given time, about 5 percent of the population suffers from an addiction to alcohol, often with devastating consequences to work, family, friends and health. Twelve-step programs have been the mainstay for helping alcoholics to quit drinking, but a significant number of people who try these programs do not find them helpful or suffer relapses.

The Cochrane review finds that the medication naltrexone — brand names are Depadeand ReVia — when combined with counseling or interventions like Alcoholics Anonymous, can help cut the risk of heavy drinking in patients who are dependent on alcohol.   > > > >  Read More

Ischemic Heart Disease Mortality and Morbidity Rates in Former Drinkers: A Meta-Analysis

Current abstainers from alcohol have been identified as an inadequate reference group in epidemiologic studies of the effects of alcohol, because inclusion of former drinkers might lead to overestimation of the protective effects and underestimation of the detrimental effects of drinking alcohol. 

The authors’ objective in the current study was to quantify this association for ischemic heart disease (IHD). 

Electronic databases were systematically searched for relevant case-control or cohort studies published from 1980 to 2010. Thirty-eight articles fulfilled the inclusion criteria, contributing a total of 5,613 IHD events and 12,097 controls among case-control studies and 1,387 events with combined endpoints and 7,183 events stratified by endpoint among 232,621 persons at risk among cohort studies. 

Pooled estimates for the subset stratified by sex and endpoint showed a significantly increased risk among former drinkers compared with long-term abstainers for IHD mortality ( among men; relative risk = 1.25, 95% confidence interval: 1.15, 1.36; among women relative risk = 1.54, 95% confidence interval: 1.17, 2.03). 

For IHD morbidity, the estimates for both sexes were close to unity and not statistically significant. Results were robust in several sensitivity analyses. 

In future studies, researchers should separate former drinkers from the reference category to obtain unbiased effect estimates. 

Implications for the overall beneficial and detrimental effects of alcohol consumption on IHD are discussed below. 

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Does Gamma-Hydroxybutyrate (GHB) Have a Role in the Treatment of Alcoholism?

Alcoholism (alcohol abuse and dependence) is a chronic disorder affecting both brain and behavior that has worldwide public health consequences. 

Primary goals for alcoholism pharmacotherapy include mitigating withdrawal, maintaining abstinence and reducing the severity of relapse, usually in combination with behavioral treatment or self-help groups. 

Currently, only three medications for the treatment of alcoholism are approved for use in the USA—disulfiram, acamprosate and naltrexone—and the efficacy of each is modest at best. 


In this context, the recent Cochrane Review of the use of gamma-hydroxybutyrate (GHB) for the treatment of alcoholism is a welcome addition to the literature ( Leone et al., 2010). The Cochrane Collaboration is a group of >27,000 volunteers in >90 countries who prepare, maintain and make accessible systematic reviews of the effects of healthcare interventions tested in randomized controlled trials (RCTs), with the goal of helping clinicians to make well-informed decisions about health care. Cochrane Reviews have a reputation for stringent assessment methods and generally cautious conclusions. 

In this case, the authors conclude that, despite some limitations, there is enough evidence to recommend GHB's use both for treating alcohol withdrawal and for preventing relapse. In fact, they argue that GHB is more effective than either naltrexone or disulfiram, the current mainstays in alcoholism pharmacotherapy. 

GHB, or as a pharmaceutical product, sodium oxybate, is a pharmacologically intriguing short-chain fatty acid structurally similar to the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and is approved for treatment of alcoholism in Italy. GHB is a weak agonist at the inhibitory GABA _B receptor and a potent agonist at the newly characterized … 


Request Reprint E-Mail:   ismene.petrakis@yale.edu
 

Population estimates of alcohol misusers who access DWP benefits Working Paper No. 94

This paper presents the findings of a study commissioned by the Department for Work and Pensions (DWP) to develop estimates of the number of alcohol misusers who access DWP benefits. 

The main results of the study show the number of AUDIT 20+ dependent drinkers who accessed four main benefits in 2008. These main benefits include Disability Living Allowance, Incapacity Benefit, Income Support and Jobseeker’s Allowance. 

The estimates contained in this paper will inform the development of DWP policy to support individuals in overcoming their addiction and moving off benefits and into employment.

The estimates were produced by researchers at the University of Glasgow and the University of Bath.

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Alcohol misusers’ experiences of employment and the benefit system

A number of key themes and issues emerge from the study and there is a clear relationship between the literature and the empirical findings, as well as important gaps where more research is needed. In particular, there are a number of potential recommendations for policy and practice. These recommendations are intended to provide some practical suggestions for solutions to issues identified within the report. The current uncertainties about cost reductions within the public services may affect what can be implemented.
 
Treatment, recovery and employment – Findings demonstrate that engagement with and completion of treatment is an important first step on the route to employment. However it is recovery (involving the resolution of other life issues and stresses such as housing problems) rather than treatment completion that is a key component of coming off benefits and securing employment. Interventions and policies need to recognise this distinction. A recovery allowance involving a relaxation of benefit conditionality that could be accessed by those who are undertaking or have recently completed a treatment course for alcohol or drug addiction would assist individuals in focusing on recovery and moving forward with more confidence and less fear of financial hardship.
 
A step-wise approach starting with voluntary work, part-time work or work experience to provide a gradual reintegration to the workplace, and ensuring that individuals are better off in work than they would be on benefits, would help this group make the transition to employment.
 
Further evidence is needed around longer-term employment outcomes from programmes, and the role that abstinence plays in helping those leaving treatment to gain and sustain employment.
 
Additional support from Jobcentre Plus staff – Alcohol misusers face a number of barriers to both accessing appropriate benefits and moving off them and into employment, and some reported feeling that they didn’t receive the support they felt they needed from Jobcentre Plus staff . They would benefit from better access to those with specialist knowledge in order to negotiate the benefit system. A caseloading system in which alcohol misusing customers see the same Jobcentre Plus adviser every time they visit may help to improve the experience for this group by removing the need for them to repeat often sensitive and difficult personal information to different advisers.
 
Mandation to treatment – The literature suggests that the receipt of benefits does not encourage or increase alcohol dependency. Alcohol misuse can cause unemployment which may result in being on benefits, but it is not the benefit receipt in itself that causes or escalates alcohol misuse. In our view there is inadequate evidence from either the literature or qualitative research that making treatment a condition of benefit receipt would improve treatment outcomes for clients or result in more alcohol misusers re-entering employment.
 
Interagency working – One of the clearest findings from our study is that interagency working can result in better support for adults with alcohol misuse problems and better access to future training and employment opportunities. The clients interviewed in our study expressed frustration about having to deal with multiple agencies and individuals and having to provide the same information repeatedly. They also reported that Jobcentre Plus staff were not always responsive to their needs, particularly when these were related to substance misuse. The professionals we interviewed also identified a need for benefit and employment advice for their clients in the context of some understanding of alcohol misuse. One model for increasing interagency working would be the introduction of Jobcentre Plus outreach sessions in treatment provider premises.


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ATLAS 2010: First global report on substance use disorders launched

To better prevent and treat alcohol and illicit drug use disorders, the World Health Organization has launched the first global report on resources currently in use to respond to these health concerns. 

The Atlas on substance abuse: Resources for the prevention and treatment of substance use disorders has collected information from 147 countries, representing 88% of the world's population. It has a particular focus on low- and middle-income countries.

"Alcohol and illicit drugs are harming millions of people in many ways, from becoming dependent on such substances to causing a range of other health problems, such as injuries, cardiovascular diseases, HIV and hepatitis C or cancers," says Dr Shekhar Saxena, director of WHO's Department of Mental Health and Substance Abuse.

Dr Saxena adds: "WHO's new Atlas on substance abuse lays out what resources exist today in different parts of the world to reduce this harm, and highlights critical gaps in service delivery which should be overcome."   > > > > Read More

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Community Recovery

The concept of recovery within the addictions arena has most often been applied to the personal resolution of severe alcohol and other drug (AOD) problems. The emergence of the concept of family recovery suggests that social systems beyond the individual can be wounded by and experience recovery from the effects of AOD and related problems. 

This paper defines community recovery, posits a set of preliminary principles related to community recovery, presents a case study of community recovery, and outlines strategies used in the City of Philadelphia that are promoting processes of community recovery.


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The novel, selective, brain-penetrant neuropeptide Y Y2 receptor antagonist, JNJ-31020028, tested in animal models of alcohol consumption, relapse, and anxiety

Neuropeptide Y (NPY) signaling has been shown to modulate stress responses and to be involved in regulation of alcohol intake and dependence.

The present study explores the possibility that blockade of NPY Y2 autoreceptors using a novel, blood–brain barrier penetrant NPY Y2 receptor antagonist, JNJ-31020028 (N-(4-{4-[2-(diethylamino)-2-oxo-1-phenylethyl]piperazin-1-yl}-3-fluorophenyl)-2-pyridin-3-ylbenzamide), may achieve a therapeutically useful activation of the NPY system in alcohol- and anxiety-related behavioral models. 

We examined JNJ-31020028 in operant alcohol self-administration, stress-induced reinstatement to alcohol seeking, and acute alcohol withdrawal (hangover)-induced anxiety. 

Furthermore, we tested its effects on voluntary alcohol consumption in a genetic animal model of alcohol preference, the alcohol-preferring (P) rat. 

Neither systemic (0, 15, 30, and 40mg/kg, subcutaneously [s.c.]) nor intracerebroventricular (0.0, 0.3, and 1.0nmol/rat) administration of JNJ-31020028 affected alcohol-reinforced lever pressing or relapse to alcohol seeking behavior following stress exposure. 

Also, when its effects were tested on unlimited access to alcohol in P rats, preference for alcohol solution was transiently suppressed but without affecting voluntary alcohol intake. 

JNJ-31020028 (15mg/kg, s.c.) did reverse the anxiogenic effects of withdrawal from a single bolus dose of alcohol on the elevated plus-maze, confirming the anxiolytic-like properties of NPY Y2 antagonism. 

Our data do not support Y2 antagonism as a mechanism for reducing alcohol consumption or relapse-like behavior, but the observed effects on withdrawal-induced anxiety suggest that NPY Y2 receptor antagonists may be a putative treatment for the negative affective states following alcohol withdrawal.

 

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News Release - Marijuana use is rising; ecstasy use is beginning to rise; and alcohol use is declining among U.S. teens

Several important findings come out of this year’s Monitoring the Future study, the 36th annual, national survey of American teens in a series that launched in 1975.
 
 Marijuana use, which had been rising among teens for the past two years, continues to rise again this year—a sharp contrast to the considerable decline of the preceding decade.


 Ecstasy use—which fell out of favor in the early 2000s as concerns about its dangers
grew—appears to be making a comeback this year, following a considerable recent decline in the belief that its use is dangerous.
 
 Alcohol use—and, specifically, occasions of heavy drinking—continues its long-term
decline among teens into 2010, reaching historically low levels.


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Mental Health and Substance Use 2011 Essay Competition

Mental Health and Substance Use welcomes entries for its annual Essay Competition.
 
As well as prizes for students who are undertaking, or have recently
completed a mental health and substance use (coexisting, dual diagnosis, co-occurring, comorbid) course, at any level of study, there is a section for new writers who have not previously published in this field. Submitted essays/articles may be on any subject that falls within the scope of the journal, including:
 
• clinical practice
• management or administrative practice
• ethics
• transcultural issues and ethnicity
• organisation and service development
• legal issues
• critical appraisal of     programmes/articles
• concept exploration and analysis
• policy and procedural issues
• education and training
• research and evidence-based practice
• leadership
• complementary and alternative therapies
• communication
• prevalence and incidence
• case study


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The relationship between addiction and religion and its possible implication for care.

Spirituality is a topic of increasing interest to clinicians and researchers interested in addiction because its perceived role in the promotion of meaningfulness in the recovery from addiction. 

Our review of the literature evaluates different domains relative to the relation between addiction, religion, and psychiatric treatment. 

Spirituality as a protective or precipitating factor for substance use and as a key component of recovery will be debated. Illustrations of its potential and limitations as a component of treatment will be presented. 

Types of investigation and integration of this dimension in an eventual therapeutic process strictly respecting the needs and specificities of each one will be discussed.


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Request Reprint E-Mail:   Yasser.Khazaal@inst.hospvd.ch

Cohabitation, Gender, and Alcohol Consumption in 19 Countries: A Multilevel Analysis

We used an ecological paradigm and multilevel analytic techniques to analyze gender-specific relationships of cohabitation (versus marriage) to drinking in 19 countries (n = 32,922) and to “heavy episodic drinking” (HED) in 17 countries (n = 24,525) in surveys (1996–2004) from Gender, Alcohol, and Culture: An International Study. 

Cohabitation was associated with elevated risk of HED among drinkers of both genders, controlling for age, education, and societal characteristics. 

The association between cohabitation and HED tended to be stronger for female drinkers than for male drinkers. HED was more prevalent among younger drinkers, especially among younger women in countries with higher per capita gross domestic product. 

Cross-culturally, cohabiters deserve special attention in prevention efforts for hazardous drinking, considering both individual-level and societal factors.


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We used an ecological paradigm and multilevel analytic techniques to analyze gender-specific relationships of cohabitation (versus marriage) to drinking in 19 countries (n = 32,922) and to “heavy episodic drinking” (HED) in 17 countries (n = 24,525) in surveys (1996–2004) from Gender, Alcohol, and Culture: An International Study. Cohabitation was associated with elevated risk of HED among drinkers of both genders, controlling for age, education, and societal characteristics. The association between cohabitation and HED tended to be stronger for female drinkers than for male drinkers. HED was more prevalent among younger drinkers, especially among younger women in countries with higher per capita gross domestic product. Cross-culturally, cohabiters deserve special attention in prevention efforts for hazardous drinking, considering both individual-level and societal factors.

Read More: http://informahealthcare.com/doi/abs/10.3109/10826081003692106

Alcohol and older people: a public health perspective Vintage Project Report

Compared with younger people, there is a paucity of data describing alcohol use, alcohol-related harm and effective policy and preventive approaches amongst older people. 

Nevertheless, compared with their younger counterparts, older people do not suffer from disproportionally higher levels of harm: in general, they drink less, drink less hazardously, and suffer less harm. In absolute terms, they experience a much lower number of deaths and hospital admissions for conditions wholly attributable to alcohol than their younger adult counterparts. When considering conditions partially attributable to alcohol, the estimated number of deaths and particularly the number of hospital admission become much higher, although these numbers are likely to be inflated due to the application of attributable fractions estimated for younger adults applied to older adults. Many surveys have suggested that light drinking older people (up to 20g alcohol per day) experience a better quality of life than non-drinking or heavy drinking counterparts.

However, it is unknown the extent to which this is due to other factors, including drinking patterns, and it may simply mean that lighter drinkers are healthier, wealthier and better socially integrated people than non-drinkers or heavier drinkers.
 
It is questionable that older people are at particular risk of alcohol-related conditions that might be more common for their age. The evidence is simply inconclusive to suggest that there are at greater risk of falls and fractures. If anything, small doses of alcohol seem to reduce the risk of dementia and Alzheimer’s disease. Light older drinkers also have less risk of dying over short follow-up periods than non-drinkers or heavier drinkers, although, again, it is difficult to be certain how much of this effect is due to other confounding variables. The one area where older people might be at special risk is interactions with medications, older people being more likely to take medications than younger adults. Although, the extent to which this is a significant health problem is not known.
 
There are a wide range of evidence based alcohol policies that reduce the harm done by alcohol, but none of these have been evaluated for their specific impact on older people. However, there is no reason to assume that older people would not react to alcohol policy interventions different from younger adults. Certainly, the policy option that is likely to have the greatest impact is increasing the price of alcohol, which, amongst other things, leads to immediate reductions in alcohol dependence, liver cirrhosis and alcohol-related mortality. For those older people, whose consumption of alcohol is hazardous or harmful, the, albeit limited, evidence suggests that screening and brief intervention programmes are just as effective as for the younger adult populations.
 
The number of older Europeans will increase enormously over the coming years - in the next twenty years alone, people aged 65 years and older will increase in number from the current 87 million to 123 million, and people over 80 years of age will increase in number from the current 23 million to 36 million. These people are the present middle age, who have high levels of both frequency and volume of drinking. They are also the group of people with the highest levels of wholly attributable alcohol related hospitalization and death. 

To prevent burgeoning alcohol-related problems amongst older people over the coming twenty years, it is important to target policy on the present middle age, which will also have an immediate impact in reducing alcohol-related hospitalizations and deaths. Further, many alcohol-related conditions, and in particular cancers, have a long latency period in terms of both cause and reduction in risk. Thus, if one wishes to prevent an increase in alcohol-related cancers and other conditions in older people, action should also be taken on the middle-aged. From a policy perspective, actions that reduce the consumption of the middle aged, will not only prevent problems for a future cohort of older people but, at the same time, reduce patterns of hazardous and harmful alcohol consumption amongst the existing cohort of older people.




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