Psychological Treatment for Alcohol Abuse/Alcoholism

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Psychological Treatment for Alcohol
Abuse/Alcoholism

• Examples of Research Answers to Six Practical
  Questions

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1. How effective is the psychological treatment
of alcoholism?

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12-month outcomes of U.S. alcoholism treatment
(8329 cases)

• 24 continuously abstinent
• Among those not totally abstinent
• 87 reduction in alcohol consumption
• Most (75) days abstinent
• 60 reduction in alcohol-related problems
• lt2 mortality
• Source Miller, Walters Bennett (2001). How
  effective is alcoholism treatment? Journal of
  Studies on Alcohol, 62, 211-220.

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Mean Percent Days Abstinent as a Function of Time
(Aftercare)
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Mean Drinks per Drinking Day as a Function of
Time (Aftercare)
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Maintaining change across three years after
treatment (outpatients)
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2. Is there something more effective than
traditional disease-model counseling for
alcoholism?

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Investigator Nathan Azrin

• Patients in outpatient treatment for alcoholism
• Location Illinois
• Treatment Community reinforcement approach
• Comparison Traditional counseling
• Follow-up 6 months
• Source Azrin, N. (1976). Improvements in the
  community reinforcement approach to alcoholism.
  Behaviour Research and Therapy, 34339-348.

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6 Month Outcomes (Azrin)
Drinking days reduced by 97
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6 Month Outcome CRA in New Mexico
Alcohol-free days
Source Meyers Miller (2001). A community
reinforcement approach for addiction treatment.
Cambridge University Press.
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3. Is there something we can do to get our
patients more motivated for change at the
beginning of treatment?

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Investigator Thomas Bien

• Veterans entering outpatient treatment for
  alcoholism at a VA medical center
• Location New Mexico
• Treatment 1 session of motivational interviewing
  at intake
• Comparison Usual intake with encouragement
• Follow-up 6 months
• Source Bien, Miller Boroughs (1993).
  Motivational interviewing with alcohol
  outpatients. Behavioural and Cognitive
  Psychotherapy, 21347-356

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6 Month Outcomes (Bien)
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Intoxication level when drinking (BAC)
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Patients totally abstinent (Bien)
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Investigator Janice Brown

• Patients entering private inpatient treatment for
  alcoholism
• Location New Mexico
• Treatment 1 session of motivational interviewing
  at intake
• Comparison Usual intake without MI
• Follow-up 3 months post-discharge
• Source Brown Miller (1993). Impact of
  motivational interviewing on participation and
  outcome in residential alcoholism treatment.
  Psychology of Addictive Behaviors, 7 211-218.

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3 Month Outcomes (Brown)
Doubled of patients abstaining
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Investigator Lauren Lawendowski

• Adolescents entering public outpatient treatment
  for substance abuse
• Location New Mexico
• Treatment 1 session of motivational interviewing
  at intake
• Comparison Usual intake without MI
• Follow-up 3 months post-discharge
• Source Lawendowski, L. (1997). Motivational
  interviewing with adolescents presenting for
  outpatient substance abuse treatment. PhD.
  Dissertation, Department of Psychology,
  University of New Mexico

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Adolescent patients totally abstinent from all
drugs
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Percent days using illicit drugs after adolescent
outpatient treatment
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Treatment sessions attended
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4. How can I help desperate family members whose
loved one refuses to get treatment?

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Community Reinforcement and Family Training

• CRAFT

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130 CSOs randomly assigned to one of three
interventions

• Al-Anon Facilitation Therapy (AFT)
• Johnson Institute Intervention (JII)
• Community Reinforcement (CRAFT)
• Source Miller, Meyers Tonigan (1999).
  Engaging the unmotivated in treatment for alcohol
  problems A comparison of three strategies for
  intervention through family members. Journal of
  Consulting and Clinical Psychology, 67 688-697.

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Treatment Engagement Rates
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CSO Depression Scores (Beck)
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5. Is there an effective treatment for
adolescents in the emergency room with
alcohol-related injuries?

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Investigator Peter Monti

• Adolescents brought to emergency room, injured
  and intoxicated
• Location Rhode Island
• Treatment 1 session of motivational interviewing
  (35-40 min) in the ER
• Comparison ER treatment as usual
• Follow-up 6 months
• Source Monty, Colby OLeary (2001).
  Adolescents, alcohol and substance abuse
  Reaching teens through brief interventions. New
  York Guilford Press.

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6 Month Outcomes

• 27 fewer cases drinking and driving
• 87 fewer new moving traffic violations
• 58 fewer new alcohol-related injuries

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6. If you catch them early, can alcohol problems
be prevented?

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Investigator Hans Kristenson

• Men aged 46-49 participating in a health study,
  with elevated liver enzymes
• Location Sweden
• Treatment Brief behavioral counseling
• Comparison Risk notification by mail
• Follow-up 5 years
• Source Kristenson et al. (1983).
  Identification and intervention of heaby drinking
  in middle-aged men Results and follow-up of
  24-60 months of long-term study with randomized
  controls. Alcoholism Clinical and Experimental
  Research, 7 203-209.

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5 Year Outcomes (Kristenson)