Self-help organizations for alcohol and drug problems: toward evidence-based practice and policy

This expert consensus statement reviews evidence on the effectiveness of drug and alcohol self-help groups and presents potential implications for clinicians, treatment program managers and policymakers. Because longitudinal studies associate self-help group involvement with reduced substance use, improved psychosocial functioning, and lessened health care costs, there are humane and practical reasons to develop self-help group supportive policies. Policies described here that could be implemented by clinicians and program managers include making greater use of empirically-validated self-help group referral methods in both specialty and non-specialty treatment settings and developing a menu of locally available self-help group options that are responsive to client's needs, preferences, and cultural background. The workgroup also offered possible self-help supportive policy options (e.g., supporting self-help clearinghouses) for state and federal decision makers. Implementing such policies could strengthen alcohol and drug self-help organizations, and thereby enhance the national response to the serious public health problem of substance abuse.     

Treatment needs and experiences of Australian women with alcohol and other drug problems

Two hundred and sixty-seven women were interviewed as part of a national survey examining the treatment needs and experiences of Australian women who had received assistance for their alcohol and other drug problems. The majority of women had previously received assistance for their substance use, and of these most had left alcohol and other drug treatment programs before completion. While the women cited a number of ways in which they were helped by such services, several areas were identified by the women as important and amenable to improvement. Among the service issues raised were access, models of service delivery, service structure and staffing, physical environment, physical and psychological safety and the handling of issues such as health status and sexual assault.     

Responding to alcohol and drug problems

Despondency about the efficacy of both diagnosis and treatment for alcohol-related problems is common. Several major causes of morbidity and mortality in our community are characterised by under-diagnosis in the community, under-diagnosis on presentation, lack of highly effective treatment or poor delivery of treatment to those most in need. Similar problems are encountered in the delivery of treatment to individuals with alcohol-related problems in the community. Most alcohol-related problems in the community are associated with only moderately elevated alcohol consumption, although the small number of individuals with exceptionally high intake have a higher relative risk of developing problems. The number of individuals exposed to a low risk of problems will be disproportionately influenced by changes in mean alcohol consumption. Approaches to prevention follow socio-cultural, public health, or consumption models. Compelling evidence closely links indices reflecting harm to changes in alcohol consumption. The challenge of prevention of alcohol-related problems is to devise measures which are acceptable to the entire population, yet also deal with problems associated with a small minority.     

Pharmacotherapy of alcohol and drug problems

Substantial progress has been made in the pharmacotherapy of withdrawal syndromes and organic complications of alcohol and drug abuse. Diazepam loading (alcohol withdrawal), phenobarbital loading (barbituate withdrawal) and diazepam tapering (benzodiazepine discontinuation) have considerably simplified treatment of withdrawal syndromes and have enhanced efficacy. Propylthiouracil shows considerable promise in the out-patient treatment of alcoholic liver disease. New medications, particularly those modifying serotonergic function, have efficacy in decreasing alcohol consumption and show considerable therapeutic potential. Human pharmacology and pharmacotherapy should be a central part of training programmes in the field in order that further advances can be made.     

Prospects for smoking treatment in individuals seeking treatment for alcohol and other drug problems

Alcohol and drug using clients of the Addiction Research Foundation were asked about their interest in receiving treatment for cigarette smoking. Forty-six percent said that they were "moderately" to "very much" interested in attending a treatment program if it were available. Despite a consistent preference for receiving smoking treatment after their alcohol or drug problem was treated, there was moderate interest in receiving smoking treatment during the alcohol or drug treatment among those who were very interested in receiving smoking treatment in general. Seventy-one percent reported that it would be "as difficult" or "more difficult" to give up cigarettes than the drug or alcohol which brought them to the hospital for treatment. The importance of treating smoking in alcohol and drug using clients is discussed.     

Discrepancy between how children perceive their own alcohol risk and how they perceive alcohol risk for other children longitudinally predicts alcohol use

This paper examined discrepancies between children's self-perceptions of the riskiness of alcohol use versus their perceptions of the riskiness of alcohol use for other children, and whether these discrepancies predicted children's future alcohol use. Participants included 234 children (M = 11 years, 45.3% female) who completed baseline and one-year follow-up assessments on self-perceived riskiness of alcohol use, perceived riskiness of alcohol use for other same-age children, and own past year alcohol use. When considering child age and gender, baseline alcohol use, and the individual reports of the riskiness of alcohol use, the interaction between alcohol use riskiness reports prospectively predicted greater odds of alcohol use. The highest percentage of childhood alcohol use at one-year follow-up came from those children with both low self-perceived riskiness of alcohol use and high perceived riskiness of alcohol use for other children. Children's perceptions of multiple people's risk from alcohol use result in identifying important subgroups of children at risk for early-onset alcohol use.     

Changing perspectives on alcohol and drug problems

An outline is presented of the extent of the drug and alcohol problem in Australian today and the relative contribution of legal and illicit drugs is discussed. The impact of these problems on clinical practice is highlighted and the importance of detection and benefit of intervention emphasised. The different perspectives with which health professionals approach these problems are presented in an historical overview, and modern concepts of drug (and alcohol) “dependence” and related “disabilities” are described.     

Gender differences in alcohol and other drug use

Scrutinizing alcohol use alone was at one point justified for political, ideological and rational reasons. The rational reasons were based on patterns of use. Thus, one could easily identify the pure alcohol users. The other drug users in conjunction with alcohol were rare and in a minority. This can no longer be said. What seems to remain constant over time is the smaller proportion of female problem drinkers. What has changed is the addition of other drugs, especially legal drugs by women to their alcohol consumption. Such multiple drug use has apparently resulted in a number of overdoses; alcohol-in-combination with other drugs ranking among the top drug used. Since such a higher proportion of these overdoses are found to be accidental it is obvious to some that a public education program and warning labels about the combined usage are very much needed. It is now clear that alcohol has a significantly different effect on women than men and they run a higher risk of alcohol and other drug overdoses at a lower level of consumption. The physiological and possibly psychological basis for this is only beginning to be explored and is a prime area for research. When such knowledge is firmly at hand it may also help to explain the fewer women with drinking problems.     

Roles for researchers in community action projects to prevent alcohol and other drug problems: Methodological choices

Aims: To discuss three alternative roles and associated challenges for researchers as participants in community action projects for prevention of alcohol and other drug problems.

Methods: To undertake a case study of alternative roles for researchers in community action projects in three Nordic countries.

Findings: There are three alternatives roles for researchers in community prevention projects, each with scientific advantages and disadvantages. The researcher role in practice depends on key features of the intervention as well as the focus and overall aim of the evaluation study. The choice of the researcher role has important implications for the entire research methodology and responsibility and ethics of research.

Conclusions: There is a need to assess the stage of local preventive work in a given country when planning evaluation of community action projects. The first stage of development of a solid scientific foundation for local substance prevention requires pilot and early demonstration projects. In the early developmental phases, researchers often choose to be active participants and partners with the communities. Without the researcher or other professional involvement, the risk of lack of any effect is increased. If the pilot projects and their efficacy trials are successful, it is mandatory to move on to the next (more natural) test phase. Effectiveness trials with researchers, who act as unobtrusive observers, will then be useful.     

The relationship of legal coercion to readiness to change among adults with alcohol and other drug problems

Prior research on legally coerced treatment for substance abuse tends to find no difference between coerced and non-coerced clients with respect to treatment retention and treatment outcomes. There is less known about the relationship between coercion and a client's motivation to change. We considered the relationship of legal coercion and readiness to change among 295 consecutive admissions to five publicly funded outpatient treatment programs. A logistic regression analysis indicated that legal coercion was associated with greater readiness to change after controlling for addiction severity, prior treatment history, and gender. Persons entering treatment due to legal coercion were over three times more likely to have engaged in recovery-oriented behavior in the month preceding admission. Entering treatment more prepared to benefit from the experience could contribute to outcomes that are more positive.     

Assessment of alcohol and other drug use behaviors in health professions students.

Alcohol and other drug (AOD) use behaviors of health professions students (HPS) were assessed by surveying both university-based HPS and other nursing programs in a Midwestern state in 1999. Response was 2,646 (56.4%) of surveyed students. Family history of alcohol-related and drug-related problems were reported by 39.8% and 13.9%, respectively, with 42.6% of respondents reporting one or both. Among nursing respondents, 48.1%, 19.2% and 51.1%, respectively, reported family problems with alcohol, drugs, or one or both. Past-year alcohol use was comparable to undergraduate college students (UCS) nationally (83%); heavy drinking, tobacco and recreational drug use by HPS were lower. Past year drug use was highest among medical students. Marijuana was the predominant illicit drug; medical students and males most often reported use. Health professions educational systems should proactively address student AOD prevention, education and assistance needs.     

Similarity of university students' and their parents' attitudes toward alcohol

It is proposed that older adolescents become more sensitive to parental norms about alcohol use. Seventy-two father-mother-daughter triads and 30 father-mother-son triads rated structural attitude statements about alcohol and drinking. Factor analyses yielded six dimensions of attitudes toward alcohol. Sons and parents had similar attitudes overall, with perceptions differing more on the sociability factor. There were a larger number of differences in the attitudes of parents and their daughters, especially concerning women drinking, moderate uses of alcohol and social status benefits from drinking. Daughters' attitudes were more likely to be different from both parents' attitudes than were sons' attitudes. The attitudes of daughters toward alcohol were discussed with reference to changes in women's roles and differences in their education and lifestyle.     

Training in drug and alcohol problems for Family Medicine

The elective terms and courses offered by the Victoria Faculty of the Royal Australian College of General Practitioners are described.     

The relationship between alcohol problems, perceived risks and attitudes toward alcohol policy in Canada

Introduction and Aims. Approval of alcohol policies by the public in democratic countries is critical for instituting social change. With respect to alcohol policies, mounting research indicates that a higher price per unit of ethanol is an effective approach for reducing alcohol‐related problems, yet surveys have found this approach is usually unpopular. The purpose of this paper is to assess the relationship between amount of drinking and support for various alcohol policies. Design and Methods. A secondary analysis was conducted on the Canadian Addictions Survey, a randomised telephone survey of over 10 000 Canadians. The relationship between the amounts of drinking reported by the respondents was examined in relation to the perceived seriousness of alcohol problems in their communities and the endorsement of several alcohol policies. Results. Increased amount of drinking was significantly related to lower perceptions of drinking‐related risks. Furthermore, heavier consumers had less favourable attitudes than lighter drinkers and abstainers toward alcohol policies, such as increased taxation. Aggregated data across the 10 Canadian provinces showed a strong effect size (r = ?0.515, P = 0.128) between endorsement of alcohol taxation and rates of hospital separations for alcohol. Discussion and Conclusions. Results from this study show that the more that people drink, the more they oppose taxation. The implications of these findings are that as alcohol problems in communities become worse, the population may become more resistant to effective alcohol policies. Strategies are suggested for implementing effective policies.[Macdonald S, Stockwell T, Luo J. The relationship between alcohol problems, perceived risks and attitudes toward alcohol policy in Canada. Drug Alcohol Rev 2010;30:652–658]     

Dissemination of research findings to alcohol and other drug practitioners

This article provides an overview of the literature in the area of research dissemination, and suggests ways of increasing communication between researchers and clinicians. It then describes a dissemination project based at the Centre for Education and Information on Drugs and Alcohol (CEIDA) which was designed to convey the results of a major research project in the alcohol and other drug area to practitioners in New South Wales. The article includes the development, implementation and evaluation of the project. The format employed—an intensive workshop conducted in different locations—was found to be a useful strategy, particularly when used to promote a large research project of clinical significance and when used in conjunction with other dissemination strategies.     

Early onset and recent drug use among children of parents with alcohol problems: data from a national epidemiologic survey.

There is good evidence that children of parents with alcohol problems have more drug involvement, plus related mental health and behavioral problems. In this study, we sought to estimate the degree to which these children might be more likely to initiate drug use precociously. A sample of 2888 parent-child pairs was identified within public data files of the National Household Survey on Drug Abuse (NHSDA), 1995-1997. Alcohol dependence of one parent was assessed by that parent's report of three or more dependence manifestations. Independently, one randomly selected 12-17 year-old child of the parent answered self-report survey questions on age at first use of tobacco, alcohol, and marijuana. In analyses contrasting 114 children of alcohol dependent parents (AD+) with 2774 other children (AD-), youths with alcohol dependent parents had higher odds than other kids to have used tobacco in the past year (odds ratio, OR=3.2, 95% confidence interval, CI=2.05-4.98), as well as alcohol (OR=1.6, 95% CI=1.05-2.50), and marijuana (OR=2.9, 95% CI=1.71-4.90). Survival analyses were used to clarify excess risk of early-onset drug use. For example, by age 17, an estimated 73% of AD+ children had smoked tobacco cigarettes, 70% had started drinking, and 41% had smoked marijuana, versus 44%, 57%, and 26% of AD- children, respectively. This new evidence helps build a case that children of parents with alcohol problems experience precocious drug use.     

Planning the prevention of alcohol and other drug-related problems among women

The aim of this paper is to report on the findings from a survey of key respondents with regard to the prevention of alcohol and other drug problems among women. The findings suggest that key respondents were concerned about the problems related to legal substances, alcohol, nicotine, minor tranquillisers, over-the-counter medication and major psychotropic medication. The problems described by these respondents included both physical and psychological health problems. The implications of these findings for prevention activity are discussed.