Recidivism in "controlled drinker" alcoholics: a longitudinal study

This study tested the conflicting positions which maintain that moderate drinking invariably and rapidly leads alcoholics to uncontrolled inebriacy and that alcoholics are capable of sustaining controlled drinking over long periods without special training. We obtained 3-, 6-, 9-, and 12-month control-over-drinking follow-up ratings on 42 treated alcoholics who had been identified as completely controlled drinkers. Between a fourth and a half were rated as abstinent or controlled drinkers at each follow-up, while 21% to 37% were categorized either as uncontrolled or institutionalized. No subject was completely controlled for more than two consecutive trimesters. However, only 19% reportedly regressed to completely uncontrolled consumption within 3 months of their first evaluations, which casts doubt on the contention that even limited drinking ordinarily is followed by rapid regression. At their final follow-ups, 47% were rated as abstinent or controlled drinkers and only 36% as uncontrolled or institutionalized. The findings did not support well either the abstinence or the controlled drinking position.     

Goal choice of alcoholics: A comparison of those who choose total abstinence vs. those who choose responsible,controlled drinking

Examined possible pre-treatment differences between alcoholic veterans who choose total abstinence and those who choose responsible drinking as their drinking goal. The two groups were compared on a variety of behavioral, cognitive, affective, and demographic characteristics. It was found that those who choose responsible drinking had a significantly shorter history of abusive drinking (6.5 years vs. 11.5 years) and more education (12.5 years vs. 10.8 years). In addition, the responsible drinking group showed a stronger belief that their chance for success was 100%.     

Effects of short-term abstinence from alcohol on subsequent drinking patterns of social drinkers

Previous research with both animals and humans has suggested that short-term abstinence from alcohol temporarily may increase subsequent alcohol consumption. To study this issue further, the present investigation evaluated the effect of voluntary, short-term abstinence on the subsequent drinking patterns of female social drinkers. Thirty-six subjects provided a baseline assessment of drinking patterns and then were assigned randomly to either a control group, which drank as usual, or to an experimental group, which abstained from alcohol for 3 weeks. All subjects monitored the frequency and quantity of their subsequent drinking for a 3-week follow-up period. The results showed that voluntary abstinence neither increased nor decreased subsequent alcohol consumption. This finding is discussed in relation to previous research.     

Alcoholics anonymous and relapse prevention as maintenance strategies after conjoint behavioral alcohol treatment for men: 18-month outcomes

Ninety men with alcohol problems and their female partners were randomly assigned to 1 of 3 outpatient conjoint treatments: alcohol behavioral couples therapy (ABCT), ABCT with relapse prevention techniques (RP/ABCT), or ABCT with interventions encouraging Alcoholics Anonymous (AA) involvement (AA/ABCT). Couples were followed for 18 months after treatment. Across the 3 treatments, drinkers who provided follow-up data maintained abstinence on almost 80% of days during follow-up, with no differences in drinking or marital happiness outcomes between groups. AA/ABCT participants attended AA meetings more often than ABCT or RP/ABCT participants, and their drinking outcomes were more strongly related to concurrent AA attendance. For the entire sample, AA attendance was positively related to abstinence during follow-up in both concurrent and time-lagged analyses. In the RP/ABCT treatment, attendance at posttreatment booster sessions was related to posttreatment abstinence. Across treatment conditions, marital happiness was related positively to abstinence in concurrent but not time-lagged analyses.     

Treating alcohol problems with couple therapy

Couple therapy for treating alcohol use disorders (AUDs) results in less drinking and greater relationship stability and satisfaction in both men and women with AUDs. The theoretical tenets, treatment methods, and research evidence for Alcohol Behavioral Couple Therapy (ABCT) are summarized. The application of ABCT is illustrated through the treatment of a 42‐year‐old woman with an AUD and her 56‐year‐old husband. During 12 sessions over a 6‐month period, the woman attained abstinence from alcohol and learned cognitive and behavioral coping skills to deal with drinking antecedents. Her husband learned to support her abstinence by stopping drinking himself, helping her cope with drinking urges, and reinforcing her successes. The couple increased positive pleasurable activities that did not involve alcohol and improved their communication skills. Challenges in the treatment included her ambivalence about abstaining, their complicated work and travel schedules, and other life stressors.     

Laboratory test changes in young abstinent male alcoholics

Data collected over time from an abstaining young alcoholic population were analyzed together with data from a nonalcoholic population, which served as a reference group. The laboratory tests of the abstaining alcoholics were measured at baseline (zero weeks), three weeks, and six weeks, while those of the nonalcoholic group were measured once, at baseline. The analysis attempts to reveal how abstinence from beverage alcohol consumption in an alcoholic population affects 25 commonly ordered laboratory tests over time and whether cigarette smoking mediates any observed effects. The primary findings of this detailed examination of clinical chemistries in abstaining alcoholics indicate that drinking and smoking have independent effects and that the effects of drinking persist even after six weeks of abstinence.     

Thirty-month follow-up of drinking moderation training for women: a randomized clinical trial

This study examined the durability of a group-based drinking moderation training for heavily drinking women reporting low physical dependence on alcohol. A 30-month follow-up of participants was conducted based on a previous study of 144 women randomly assigned to treatment conditions (G. J. Connors & K. S. Walitzer, 2001). Thirty-month follow-up results indicated that women who at baseline were relatively heavier drinkers had significantly greater benefit from the drinking moderation training when exposed to intervention enhancements entailing life skills training and booster sessions. Further, the initial improvements in drinking, relative to baseline levels, did not statistically deteriorate over the 30-month follow-up. The findings support the application of treatment enhancements among women in this population who at baseline are relatively heavier drinkers.     

Context-specific morphine withdrawal in rats: duration and effects of clonidine

Rats previously injected with morphine in a particular environment (paired rats) emitted more withdrawal symptoms in that environment than did rats previously injected with morphine in another environment (unpaired rats) after both 1 day and 5 days of morphine abstinence. Thus, reexposure to an environment previously associated with morphine can elicit context-specific withdrawal even after several days of morphine abstinence. Clonidine (0.06 mg/kg) reduced most of the withdrawal symptoms seen 5 days after morphine abstinence in both the paired and unpaired rats. However, clonidine enhanced many of the withdrawal symptoms in both groups of rats during naltrexone-precipitated withdrawal 1 day after morphine abstinence.     

Longitudinal changes in cognition, gait, and balance in abstinent and relapsed alcoholic men: relationships to changes in brain structure

Chronic alcoholism is associated with cognitive and motor deficits, and there is evidence for reversibility with sobriety. Alcoholic men were examined after 1 month of sobriety and 2 to 12 months later with cognitive and motor tests and magnetic resonance imaging. In this naturalistic study, 20 alcoholic participants had abstained and 22 had resumed drinking at retesting. Abstainers sustained greater improvement than relapsers on tests of delayed recall of drawings, visuospatial function, attention, gait, and balance. Shrinkage in 3rd ventricle volume across all participants significantly correlated with improvement in nonverbal short-term memory. Additional brain structure-function relationships, most involving short-term memory, were observed when analyses were restricted to alcoholic men who had maintained complete abstinence, were light relapsers for at least 3 months, or had consumed no more than 10 drinks prior to follow-up testing. Thus, alcoholic men who maintain abstinence can show substantial functional improvement that is related to improvement in brain structure condition.     

Analysis of carbohydrate deficient transferrin serum levels during abstinence

An alcohol-associated change in the serum transferrin glycoform pattern, carbohydrate-deficient transferrin (CDT), is used as a biomarker of chronic moderate to heavy alcohol consumption. Furthermore, CDT is employed as a marker of abstinence. Here, we analyzed CDT in patients with chronic excessive alcohol abuse at the beginning and during abstinence. Twenty-nine alcohol dependent patients were recruited from an in-patient abstention program. Reported drinking levels were at least 100 g/d (range up to 450 g/d; mean: 248.9±94.7 g/d) within the last month before study entry. Blood samples were drawn at the beginning and during the abstention program and the relative concentration (%CDT) of CDT was determined using ion exchange followed by immunodetermination of CDT. At study entry, 25/29 patients had a %CDT level above the established cutoff. Although CDT levels declined during abstinence in most patients, in ten patients with %CDT levels just above the cutoff at the start of the program, the CDT values remained elevated 6 weeks after cessation of drinking. Our data indicate that %CDT levels below the cutoff cannot even rule out long lasting excessive alcohol abuse. Further, measurement of %CDT should be interpreted with special care when used as a marker of alcohol abstinence.     

Discriminating neuropsychological sequelae of head injury from alcohol-ABUSE-induced deficits: A review and analysis

Alcohol abuse is linked strongly with neuropsychological deficits that may resemble deficits seen in head-injured individuals. Heavy daily drinking appears more damaging than episodic abusive consumption. Cognitive deficits associated with alcohol include abstraction, perceptuospatial, and problem- solving skills. Verbal abilities are spared. For alcoholics younger than 40, abstinence is associated with improved functioning. For those over 40, deficits may be permanent. Intelligence tests are unlikely to pick up alcohol-induced deficits. Points for neuropsychologists to consider in differentiating between head injury and alcohol-induced deficits include abstinence from drinking prior to testing, intactness of remote memory and verbal functions, and changes in tolerance for alcohol.     

健康教育路径在酒依赖厌恶治疗中的对照研究

目的 探讨路径健康教育在酒依赖厌恶治疗中的作用及效果.方法 将酒依赖住院患者随机分为两组,实验组在厌恶治疗基础上,按健康教育路径进行宣教,而对照组予以常规健康教育.两组分别于4周末,采用自行设计的护理服务满意度调查袁及健康教育知识测试卷进行评定;随访12周末对出院后的累加戒酒时间和复饮率进行评定.结果 实施健康教育4周...     

THE CARROT AND THE STICK: A CROSS‐SECTIONAL STUDY OF THE INFLUENCES ON RESPONSIBLE MERCHANT PRACTICES TO REDUCE UNDERAGE DRINKING

Alcohol merchants (N = 331) completed a cross‐sectional survey assessing their attitudes and beliefs about underage drinking, its likely consequences, requirements for responsible beverage service (RBS) training, and performance of RBS practices and checking IDs. Merchants requiring more rigorous RBS training (i.e., state‐approved vs. in‐house or none) have stronger beliefs that outlets who sell to minors will get cited and that their employees know RBS practices. Also, merchants who engage in more RBS practices require more rigorous RBS training, and believe more strongly that outlets who sell to minors are more likely to face, and deserve, stricter sanctions. Merchants who check IDs more strictly conduct more RBS practices and believe more strongly that underage drinking is serious and will result in stronger consequences if caught selling to minors. These findings about the attitudes, practices, and enforcement of alcohol merchants suggests ways communities can better target their limited resources to prevent underage drinking.     

Assessment of alcoholics' moods at the beginning and end of a hospital treatment program

The Profile of Mood States was administered weekly to 122 completers and 91 noncompleters of a hospital alcohol rehabilitation program. Ss initial mood scores were not significant predictors of whether they would complete the program or of whether they would attain abstinence or show improvement in drinking practices at 3-month follow-up. When Ss left the program their final mood scores indicated significant improvement in mood states compared to their initial scores. Completers who later were found to be abstinent showed a trend toward affective improvement on all 6 Profile scales. It is suggested that assessment of an alcoholic's mood can contribute to formulation of treatment plans.     

Efficacy of group motivational interviewing (GMI) for psychiatric inpatients with chemical dependence

Dually diagnosed patients with chemical dependency and a comorbid psychiatric disorder typically show poor compliance with aftercare treatment, which may result in costly and pervasive individual and societal problems. In this study, the authors investigated the effect of adding motivational interviewing in a group format to standard treatment for dually diagnosed psychiatric inpatients. The patients (n = 101) all received standard care and in addition were assigned to either group motivational interviewing (GMI) or a therapist attention activity control group (TAAC). Of patients who attended aftercare and who used alcohol or drugs, those who participated in GMI attended significantly more aftercare treatment sessions, consumed less alcohol, and engaged in less binge drinking at follow-up compared with those in TAAC. Differences between conditions in the overall percentage of participants who achieved complete abstinence or who attended aftercare treatment were not significant, possibly because of a lack of power. These results provide preliminary evidence for the efficacy of GMI when added at the outset to an inpatient program.     

The contributions of sex and drinking history to the CT brain scan changes in alcoholics

Consecutive series of male and female alcoholics, Alcoholic Anonymous (AA) members and controls were examined by interview and with a CT brain scan. Male controls were shown to have larger CT brain parameters than healthy females of the same age. Female alcoholics revealed equivalent CT scan abnormalities, apart from less sulcal widening, after a markedly shorter drinking history and at a lower estimated peak alcohol consumption than male alcoholics. The CT scan findings persisted after accounting for body weight and after matching for age and length of drinking history. The CT scan parameters of female AA members approached control values more completely and after briefer abstinence than did those of male AA members. Methodological problems and sex differences in selection and other processes are discussed. The findings are consistent with sex differences in the vulnerability of the brain to alcohol toxicity, and in its recovery with abstinence.     

Drinking patterns in general practice patients

Patients from 47 group practices recruited from the Medical Research Council's general practice research framework participated in a study involving the collection of information about smoking, drinking, exercise and dieting and weight. This paper is concerned with the data on alcohol consumption obtained in the first stage of the study in which a self-administered questionnaire, the health survey questionnaire, was distributed by hand or by post to patients registered with the participating practices.

Of the 25496 men who completed the questionnaire, 83.6% stated that they had been drinking in the previous three months compared with 69.2% of the 36657 women. For both sexes, abstinence rates were significantly lower in the younger age groups (P<O.001). Of the men, 7.6% admitted to a weekly alcohol consumption of 35 units or more and 2.7% women were drinking 21 units per week or more.

Of the 1948 male excessive drinkers 45.9% expressed concern about their drinking through a positive CAGE response and/or self assessment of a drinking problem, while for the 989 female excessive drinkers the figure was 44.1%. A positive response to these questions was strongly related to alcohol consumption and was more frequent among women than men at most levels of consumption.

     

Survey of alcoholism and excessive drinking in a suburb of Buenos Aires.

A cross-sectional household survey of drinking patterns, categorized as alcoholism, excessive drinking, moderate drinking, and abstinence, was conducted in a middle and lower-class section of Greater Buenos Aires. Alcoholism and excessive drinking were present almost exclusively among males, and were more prevalent among the lower levels of education, occupation, or residential area, and also among migrants. Prevalence rates for males, aged 15 +, were: alcoholics 4.4% +/- 2.1 and excessive drinkers 12.2+/- 3.4. Details of the methods, the implication of the findings, and comparisons with other surveys are reported and discussed.     

Induced behavior during precipitated abstinence in rats

Active avoidance, hypothalamic self-stimulation, and deprivation-induced water-drinking were examined in rats during the lengthy somnolent phase of precipitated morphine abstinence. Avoidance behavior occurred at the control level but only if amphetamine was administered to counteract the somnolence. It was necessary to increase the current progressively during abstinence to keep the rate of self-stimulation at the control level. Deprivation-induced drinking was absent during the first hour of abstinence precipitated during the day and much reduced in a night-time test. Both groups eventually made up their deficits as accurately as control rats do, the only difference being that a longer time was required. These results indicate that the neural subsystems serving memory and the execution of learned behaviors still function normally during abstinence. The functional impairment seen in this state appears only to involve the brain areas controlling awareness of the environment, both external and internal. The possible involvement of the ascending dopaminergic system is discussed.     

Moderate alcohol intake is related to increased heart rate variability in young adults: Implications for health and well‐being

Epidemiological literature indicates that the relationship between alcohol consumption and health outcomes reflects a J‐shaped curve such that moderate alcohol consumption confers a protective effect in comparison to abstinence, while heavy consumption is associated with poorer health. While heart rate variability (HRV) may underpin the relationship between drinking and poor health in heavy drinkers, it is unclear whether HRV is increased in moderate, habitual drinkers relative to nonhabitual drinkers. HRV and drinking habits were assessed in 47 volunteers. Results supported hypotheses suggesting that moderate, habitual drinking increases HRV. Although not supported by a significant interaction between drinking group and sex, planned follow‐up analysis also revealed that these findings may be specific to males. Regardless, results highlight HRV as a candidate mechanism for the findings reported in the epidemiological literature.