The impact of twelve-step program familiarity and its in-session discussion on counselor credibility.

Cory B. Dennis, Brian D. Roland, Barry Loneck

The American Journal of Drug and Alcohol Abuse
September 2013, Vol 19(5):298-303

http://informahealthcare.com/doi/abs/10.3109/00952990.2012.694522

Background and Objective: 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. Method: 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. Results: 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. Conclusions and Scientific Significance: 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.

Love and faith

http://alcoholreports.blogspot.mx/2013/08/love-and-faith.html

ALCOHOL REPORTS

The field of addiction treatment was flawed in 1973, but not nearly as flawed as some would have you believe. The following is from Marty Mann in 1973 and I could not do a better job of summarizing Dawn Farm’s approach

http://addictionandrecoverynews.wordpress.com/2013/08/16/love-and-faith/

Alcohol and other drug treatment services in Australia 2011-12

Almost 700 agencies provided over 150,000 treatment episodes for alcohol and other drug issues in Australia in 2011-12. Most of the closed episodes provided in 2011-12 were for clients receiving treatment for their own drug use, and these clients tended to be male and in their 20s and 30s. Alcohol was the most common principal drug of concern, accounting for almost half of these closed episodes, and counselling was the most common type of treatment.
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The role of an Aboriginal women's group in meeting the high needs of clients attending outpatient alcohol and other drug treatment

Kim San Kylie Lee, 

Angela Dawson,

Katherine M Conigrave

Drug and Alcohol Review

Article first published online: 23 AUG 2013

Introduction and Aims

Support groups are typically offered as part of specialist alcohol or other drug treatment. However, their usefulness with Indigenous Australians has not been examined. This paper provides a profile of Aboriginal women attending an inner city outpatient alcohol and other drug treatment service, insight into how effective women and staff perceive the support group to be at meeting their needs and suggestions for improvements.

Design and Methods

Structured interviews were conducted with 24 Aboriginal female clients of an outpatient treatment service and with 21 staff from across that service and the local Aboriginal Medical Service. Client interviews also assessed alcohol consumption and mental health risk (Indigenous Risk Impact Screen).

Results

Clients reported social and health indicators illustrating disadvantage and complex needs. Most clients and staff perceived the group to be useful and easily accessible. The participants discussed positive elements including opportunities for shared experience in a non-judgemental environment, practical support and health education. Staff reported how the safe, relaxed environment of the group helped with early identification of issues and user-friendly pathways for treatment access. Suggested improvements included greater involvement from Aboriginal staff and community members and enhanced communication with other staff.

Discussion and Conclusions

Clients and staff recognised the usefulness of the group, including the opportunities it provided for socialisation and early intervention. Comprehensive research is needed to determine the types and sources of support that best assist Aboriginal women with substance use disorders.

Epigenetics—New Frontier for Alcohol Research

The Journal of the National Institute on Alcohol Abuse and Alcoholism

Volume 35, Issue Number 

1     Editors’ Note [PDF]

4     In This Issue [PDF]

6     Alcohol Metabolism and Epigenetic Changes [PDF]
Samir Zakhari, Ph.D.

18   Dysregulation of microRNA Expression and Function Contributes to the Etiology of Fetal Alcohol Spectrum Disorders [PDF]
Sridevi Balaraman, Ph.D.; Joseph D. Tingling; Pai-Chi Tsai; and Rajesh C. Miranda, Ph.D.

25    Alcohol, DNA Methylation, and Cancer [PDF]
Marta Varela-Rey, Ph.D.; Ashwin Woodhoo, Ph.D.; Maria-Luz Martinez-Chantar, Ph.D.; José M. Mato, Ph.D.; and Shelly C. Lu, M.D.

37    In Utero Alcohol Exposure, Epigenetic Changes, and Their Consequences [PDF]
Michelle Ungerer; Jaysen Knezovich, M.Sc.; and Michele Ramsay, Ph.D.

47    Epigenetic Effects of Ethanol on the Liver and Gastrointestinal System [PDF]
Shivendra D. Shukla, Ph.D., and Robert W. Lim, Ph.D.

57    Epigenetic Events in Liver Cancer Resulting From Alcoholic Liver Disease [PDF]
Samuel W. French, M.D.

69    Epigenetic Control of Gene Expression in the Alcoholic Brain [PDF]
Igor Ponomarev, Ph.D.

77    Prenatal Alcohol Exposure and Cellular Differentiation: A Role for Polycomb and Trithorax Group Proteins in FAS Phenotypes? [PDF]
Kylee J. Veazey; Daria Muller; and Michael C. Golding, Ph.D.

87   Circadian Disruption: Potential Implications in Inflammatory and Metabolic Diseases Associated With Alcohol [PDF]
Robin M. Voigt, Ph.D.; Christopher B. Forsyth, Ph.D.; and Ali Keshavarzian, M.D.

97   Epigenetic Targets for Reversing Immune Defects Caused by Alcohol Exposure [PDF]
Brenda J. Curtis, Ph.D.; Anita Zahs, Ph.D.; and Elizabeth J. Kovacs, Ph.D.

                  114  Glossary [PDF]

A Qualitative Study of Alcohol, Health and Identities among UK Adults in Later Life

Graeme B. Wilson mail, Eileen F. S. Kaner, Ann Crosland, Jonathan Ling, Karen McCabe, Catherine A. Haighton

Abstract

Increasing alcohol consumption among older individuals is a public health concern. Lay understandings of health risks and stigma around alcohol problems may explain why public health messages have not reduced rates of heavy drinking in this sector. A qualitative study aimed to elucidate older people's reasoning about drinking in later life and how this interacted with health concerns, in order to inform future, targeted, prevention in this group. In 2010 a diverse sample of older adults in North East England (ages 50–95) participated in interviews (n = 24, 12 male, 12 female) and three focus groups (participants n = 27, 6 male, 21 female). Data were analysed using grounded theory and discursive psychology methods. When talking about alcohol use older people oriented strongly towards opposed identities of normal or problematic drinker, defined by propriety rather than health considerations. Each of these identities could be applied in older people's accounts of either moderate or heavy drinking. Older adults portrayed drinking less alcohol as an appropriate response if one experienced impaired health. However continued heavy drinking was also presented as normal behaviour for someone experiencing relative wellbeing in later life, or if ill health was construed as unrelated to alcohol consumption. Older people displayed scepticism about health advice on alcohol when avoiding stigmatised identity as a drinker. Drinking patterns did not appear to be strongly defined by gender, although some gendered expectations of drinking were described. Identities offer a useful theoretical concept to explain the rises in heavy drinking among older populations, and can inform preventive approaches to tackle this. Interventions should engage and foster positive identities to sustain healthier drinking and encourage at the community level the identification of heavy drinking as neither healthy nor synonymous with dependence. Future research should test and assess such approaches.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0071792

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Comparing barriers to mental health treatment and substance use disorder treatment among individuals with comorbid major depression and substance use disorders

Ramin Mojtabai, 

Lian-Yu Chen, 

Christopher N. Kaufmann, 

Rosa M. Crum

Journal of Substance Abuse Treatment

Available online 29 August 2013

http://www.sciencedirect.com/science/article/pii/S0740547213001773

Barriers to both mental health and substance use disorder treatments have rarely been examined among individuals with comorbid mental health and substance use disorders. In a sample of 393 adults with 12-month major depressive episodes and substance use disorders, we compared perceived barriers to these two types of treatments. Data were drawn from the 2005–2011 US National Surveys on Drug Use and Health. Overall, the same individuals experienced different barriers to mental health treatment versus substance use disorder treatment. Concerns about negative views of the community, effects on job, and inconvenience of services were more commonly reported as reasons for not receiving substance use disorder treatment. Not affording the cost of care was the most common barrier to both types of treatments, but more commonly reported as a barrier to mental health treatment. Improved financial access through the Affordable Care Act and parity legislation and integration of mental health and substance use disorder services may help to reduce treatment barriers among individuals with comorbid mental health and substance disorders.

Keywords

• Comorbidity; 
• Service use; 
• Barriers to care; 
• Substance disorder services; 
• Mental health services

Alcohol questionnaires and HDL: Screening scores as scaled markers of alcohol consumption

• Douglas Berger,
• Emily C. Williams
, 
• Chris L. Bryson
, 
• Anna D. Rubinsky
, Katharine A. Bradley

Alcohol 47(6):439-445, September 2013

Abstract 

Improving the quality of alcohol-related care requires practical approaches to assessing alcohol consumption to guide management and monitor outcomes. Given the increasing use of alcohol screening questionnaires to identify alcohol misuse it would be ideal if scores on screening questionnaires were also indicators of average alcohol consumption. However, the questionnaires were not designed for this purpose and include dimensions of drinking that may not reflect average consumption (e.g. heavy episodic drinking, alcohol-related problems). In a general population sample, scores on the AUDIT-C screen correlated with reports of alcohol consumption in detailed interviews, but the relationship is unknown for clinical populations and other questionnaires. Serum high-density lipoprotein cholesterol (HDL) is a biomarker routinely obtained in clinical care and is known to rise with average alcohol consumption. This cross-sectional study of 11,175 male U.S. Veterans Affairs patients enrolled in a primary care study used HDL as an objective biomarker to evaluate whether average alcohol consumption increased as scores increased on 3 brief alcohol screens – the AUDIT-C, AUDIT Question #3 (a single-item screen), and the CAGE questionnaire. Mean HDL progressively increased as screening scores increased for the AUDIT-C and AUDIT Question #3: about 12 mg/dL from the lowest to the highest scores. The association was much weaker for the CAGE questionnaire. Results were minimally affected by adjustment for covariates (e.g. age, race, medical comorbidity, smoking, medication count, and depression) but the association was modified (p = 0.008) and mildly attenuated by adherent use of lipid-lowering medications. This study using HDL as a biomarker of average alcohol consumption adds to evidence that some alcohol screening scores may also serve as scaled markers of average alcohol consumption.

Spanish Language Proficiency among Providers and Latino Clients’ Engagement in Substance Abuse Treatment

Erick G. Guerrero, 

Tenie Khachikian, 

Tina Kim, 

Yinfei Kong, 

William A. Vega

Addictive Behaviors

Available online 29 August 2013

http://www.sciencedirect.com/science/article/pii/S0306460313002451

Quality of care, such as provision of services in Spanish, is a common factor believed to improve treatment engagement among Spanish-speaking Latinos in health care. However, there is little evidence that Spanish language proficiency among providers increases treatment access and retention in publicly funded substance abuse treatment. We analyzed client and program data collected in 2010–2011 from publicly funded treatment programs in Los Angeles County, California. An analytic sample of 1,903 Latino clients nested within 40 treatment programs located in minority communities was analyzed using multilevel negative binomial regressions on days to initiate and spent in treatment. As hypothesized, Spanish language proficiency was negatively associated with client wait time and positively associated with retention in treatment, after controlling for individual and program characteristics. The path analysis models showed that Spanish language proficiency played a mediating role between professional accreditation and client wait time and retention. These preliminary findings provide an evidentiary base for the role of providers’ Spanish language proficiency and Latino engagement in treatment for a population at high risk of treatment dropout. Implications related to health care reform legislation, which seeks to enhance linguistically competent care, are discussed.

The importance of age composition of 12-step meetings as a moderating factor in the relation between young adults’ 12-step participation and abstinence

• Allison K. Labbe
, 
• Claire Greene
, Brandon G. Bergman, Bettina Hoeppner, John F. Kelly

Drug and Alcohol Dependence
Published online 12 August 2013. 

http://www.drugandalcoholdependence.com/article/S0376-8716(13)00286-X/abstract

Background

Participation in 12-step mutual help organizations (MHO) is a common continuing care recommendation for adults; however, little is known about the effects of MHO participation among young adults (i.e., ages 18–25 years) for whom the typically older age composition at meetings may serve as a barrier to engagement and benefits. This study examined whether the age composition of 12-step meetings moderated the recovery benefits derived from attending MHOs.

Method

Young adults (n=302; 18–24 years; 26% female; 94% White) enrolled in a naturalistic study of residential treatment effectiveness were assessed at intake, and 3, 6, and 12 months later on 12-step attendance, age composition of attended 12-step groups, and treatment outcome (Percent Days Abstinent [PDA]). Hierarchical linear models (HLM) tested the moderating effect of age composition on PDA concurrently and in lagged models controlling for confounds.

Results

A significant three-way interaction between attendance, age composition, and time was detected in the concurrent (p=0.002), but not lagged, model (b=0.38, p=0.46). Specifically, a similar age composition was helpful early post-treatment among low 12-step attendees, but became detrimental over time.

Conclusions

Treatment and other referral agencies might enhance the likelihood of successful remission and recovery among young adults by locating and initially linking such individuals to age appropriate groups. Once engaged, however, it may be prudent to encourage gradual integration into the broader mixed-age range of 12-step meetings, wherein it is possible that older members may provide the depth and length of sober experience needed to carry young adults forward into long-term recovery.