Correlates of alcohol use among methadone-maintained adults

This prospective study (n = 190) examined correlates of alcohol use from baseline data of a longitudinal trial conducted among moderate and heavy alcohol users receiving methadone maintenance therapy (MMT).

The sample included MMT clients who were 18–55 years of age, and were receiving MMT from five large methadone maintenance clinics in the Los Angeles area.

Half of the sample was heavy drinkers and nearly half (46%) reported heroin use. Using a structured questionnaire, correlates of heavy alcohol use included White and Hispanic ethnicity, and fair or poor physical health combined with older age (?50 years). We also found that MMT clients who were younger than 50 years, regardless of health status, were more likely to be heavy drinkers.

Compared with moderate alcohol consumers, a greater number of heavy alcohol users also experienced recent victimization.

To optimize MMT, alcohol screening should be part of routine assessment and alcohol treatment should be made available within MMT programs.

Moreover, special consideration should be provided to the most vulnerable clients, such as the younger user, those with a long-term and current history of heavy drug use, and those victimized and reporting fair or poor health. In addition, promoting attention to general physical and mental health problems within MMT programs may be beneficial in enhancing health outcomes of this population.

Research report; Adeline Nyamathi, Allan Cohen, Mary Marfisee, Steven Shoptaw, Barbara Greengold, Viviane de Castro, Daniel George and Barbara Leake. Drug and Alcohol Dependence. Volume 101, Issues 1-2, 1 April 2009, Pages 124-127. Correlates of alcohol use among methadone-maintained adults

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• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Treating Alcoholism
• AA and Treatment Work Better Together

Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach

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Alcohol relapse can negatively influence the outcome after liver transplantation (LT).

The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT.

A total of 387 consecutive patients (23.8% women) who underwent LT for alcoholic cirrhosis in Geneva, Switzerland, and Lyon, France, between 1989 and 2005 were evaluated.

• Mean +/- SD age was 51.3 +/-7.5 years. Follow-up time was 61.2 +/- 47.5 months.

Alcohol consumption relapse and potential factors associated with it were studied.

• The relapse rate of harmful alcohol consumption after LT was 11.9%.

In univariate analysis, alcohol relapse was significantly associated with

• age greater than 50 years,
• year of LT 1995 or earlier,
• duration of abstinence less than 6 months,
• presence of psychiatric comorbidities,
• presence of a life partner, and
• a high score on the High-Risk Alcoholism Relapse (HRAR) scale.

Multivariate logistic regression disclosed the following independent factors of relapse:

• duration of abstinence of less than 6 months;
• presence of psychiatric comorbidities; and
• HRAR score higher than 3.

In patients with none of these factors, alcohol relapse was 5%, while the presence of 1, 2, or 3 factors was associated with relapse rates of 18%, 64%, and 100% of the patients, respectively.

In a large cohort of patients undergoing LT for alcoholic cirrhosis,

• a duration of abstinence of less than 6 months before wait-listing for LT,
• the presence of psychiatric comorbidities, or
• an HRAR score higher than 3

was associated with relapse into harmful drinking.

The presence of more than 1 factor dramatically increased this risk over 50%.

In the pre-LT evaluation in this setting, these factors should be accurately determined.

Research; Haber PS, McCaughan GW. “I’ll never touch it again, doctor!” – harmful drinking after liver transplantation. Hepatology. 2007 Sep 25;46(4):1302-1304.

Liver Transplantation & the Alcoholic Patient: Medical, Surgical and Psychosocial Issues by Michael R. Lucey, Robert M. Merion, Thomas P. Beresford Read more about this title…

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Health impacts of long term alcohol misuse
Long term abuse of alcohol creates medical risks to individuals and may contribute to many cases of illness and premature death.

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Adolescent Children of Alcoholics: Vulnerable or Resilient?

BACKGROUND: Children of alcoholics (COAs) have been described as both vulnerable and resilient. Although identified as at-risk for mental and physical health problems, chemical dependency, and child abuse and neglect, many go on to lead successful lives.

OBJECTIVE: The relationship between COA status and various adolescent risk behaviors, such as drug and alcohol abuse and sexual precocity, was assessed by addressing the following research question: Could parental alcoholism be a risk factor for teens engaging in problem behaviors?

STUDY DESIGN: A secondary analysis of a Wyoming high-risk youth data set was conducted (N _ 1632). Werner’s (1992) core resiliency factors provided the conceptual frame for the study.

RESULTS: Adolescent COAs scored significantly (p < .000) lower on all psychosocial factors of family/personal strengths and school bonding and significantly higher on all factors of at-risk temperament, feelings, thoughts, and behaviors than non-COAs.

CONCLUSIONS: Adolescent COAs are at risk for depression, suicide, eating disorders, chemical dependency, and teen pregnancy. It has been proposed that mental health professionals teach core resiliency factors to promote healthy behaviors for this vulnerable population.

Children of addicted parents are the highest risk group of children to become alcohol and drug abusers because of both genetic and family environment factors.

Twenty-two percent (n _ 352) of the combined sample identified themselves as a child of an alcoholic. This is consistent with current estimates of children of parental period alcoholics, which is calculated to be 22% (Eigen & Rowden, 2000). Rodney and Mupier (1997), in a recent study among 595 African American boys age 13 to 17 years, identified that 23% of the participating teens were COAs. The National Association of Children of Alcoholics (NACOA, n.d.) estimates that there are 11 million COAs under 18 years of age.

COA’s scored lower on psychosocial factors;

• Family cohesion
• Self-esteem
• Education and school bonding
• Family adaptability

COA’s scored higher on risk factors;

• Negative temperament
• Negative self directed feelings, thoughts and behaviours
• Drug and alcohol use
• Sexual behaviours

COA’s scored higher on negative self directed feelings, thoughts and behaviours

• Depression and hopelessness
• Takes physical risks
• Feels excited doing risky things
• Thought of suicide in last year
• Tried suicide in last year

Research; Adolescent Children of Alcoholics: Vulnerable or Resilient? MaryLou Mylant, Bette Ide, Elizabeth Cuevas, and Maurita Meehan. J Am Psychiatr Nurses Assoc 2002; 8; 57.

Acoa’s Guide to Raising Healthy Children: A Parenting Handbook for the Adult Children of Alcoholics by William Brines, James Mastrich Read more about this title…

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“Spirituality is an awakening—or is it all the loose ends woven together into a mellow fabric?

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Patterns of alcohol consumption and blood alcohol levels in emergency room patients.

The study was conducted in a public hospital of the province of Jujuy, Argentina.

A survey was conducted among all patients during the 24 hours of 4 consecutive days (N = 500) using the Alcohol Use Disorders Identification Test, short version (AUDIT-C). Blood samples were collected in 84% of participants.

Results showed that;

• 37% were hazardous drinkers (men 50% vs. women 23%),
• 29% had symptoms of dependence (men 48% vs. women 11%);
• 17% of men and 3% of women had high blood alcohol levels, equal or greater than 50 mg/dl.

In multivariate logistic regression models men had;

• increased likelihood of hazardous drinking (Adjusted OR 3.2; 95% CI 2.1-5.0),
• symptoms of dependence (Adjusted OR 7.5; 95% CI 4.4-12.7) and
• increased blood alcohol levels (Adjusted OR 8.0; 95% CI 2.2-28.8), compared with women.

Patients admitted due to accidents, violence, or drug use, had;

• increased likelihood of hazardous drinking (Adjusted OR 2.4; 95% CI 1.5-3.9),
• dependence symptoms (Adjusted OR 2.0; 95% CI 1.2-3.3) and
• increased blood alcohol levels (Adjusted OR 7.7; 95% CI 3.0-19.8), compared with those admitted for other reasons.

Alcoholism has a significant impact on the occurrence of injuries and on the demand imposed on health services.

Prevention programs can potentially reduce the negative health and social impact of alcoholism.

Research; Medicina (B Aires). 2008;68(1):31-6. Alcohol consumption in the emergency room. Alderete E, Bianchini P.

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• Brief-TSF can assist patients cease alcohol consumption.
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Subscribe to BriefTSF by e-Mail

Understanding and Counseling: Persons With Alcohol, Drug, and Behavioral Addictions by Howard Clinebell Read more about this title…

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Research supports the idea that involvement with 12-step fellowships is a very good way to achieve and maintain recovery, but it is not for everyone.

Some research has indicated that although 12-step and other treatment approaches are compatible, patients’ level of commitment or engagement in prescribed behaviors is very low.

They stress that some way must be found to get patients engaged and committed and that the 12-step affiliation needs to be considered an important, rather than a casual, part of treatment.

Patients, many of whom have already been attending meetings before entering treatment, must recognize that 12-step organizations, including Alcoholics Anonymous (AA), are social organizations with a way of living with a program and a fellowship.

At the end of formal treatment, patients must become engaged in and committed to the processes of 12-step programs.

Research report; Forman, R.F.; Humphreys, K.; Tonigan, J.S. Response: The marriage of drug abuse treatment and twelve-step strategies. Science and Practice Perspectives, 2(1):52-54, 2003.

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Students with a dense family history of alcoholism are most at risk of alcohol-use disorders

This study looks at first-, second- and third-degree relatives instead of just one parent, usually paternal

Not all university students will “mature out” of their heavy-drinking habits.

A new study examines the density of college students’ family history of alcoholism.

This type of measure – looking at first-, second- and third-degree relatives – identified a significant number of at-risk individuals who would have been missed using regular family-history measures.

While many university students tend to “mature out” of heavy-drinking behavior by the time they become young adults, some go on to develop alcohol-use disorders (AUDs). Most genetic research on an individual’s family history of alcoholism (FHA) has looked at the parents’ – usually paternal – alcohol use. New findings indicate that looking at the density of FHA – including first-, second- and third-degree relatives – is much more telling.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research.

“Using a density measure of FHA can identify a greater number of individuals who may be at risk for developing an alcohol problem,” said Christy Capone. “The greater number of affected relatives … the greater the potential risk of developing an AUD. Ours is the first published study to examine this measure among college students.”

“Family density appears to be a promising method to identify a higher percentage of at-risk individuals,” agreed John Hustad, research associate at Brown University. “For example, in this study, approximately 44 percent of the at-risk participants would have been missed if a typical family-history measure had been used instead of the family-history density approach.”

The study population for this research consisted of 408 undergraduate students (293 females, 115 males) from a northeastern U.S. university who were asked to complete an anonymous survey for course credit during the 2005-2006 academic year.

“Our use of a density measure identified a large proportion of students, about 29 percent, who are at potentially greater risk for development of AUDs based on their report of alcoholism among first- and second-degree relatives,” said Capone. “Our other key finding was the relationship between FHA and other potential risk factors – behavioral undercontrol, age of onset of drinking (AOD), and cigarette use.”

All of these risks factors are inter-related, added Hustad. “First, family-history density was related to AOD, behavioral undercontrol, and current cigarette use which, in turn, are related to alcohol use and/or alcohol-related problems in this sample of college students. Second, behavioral undercontrol was associated with alcohol problems but not the degree of alcohol consumption; this suggests that individuals with a family-history density of AUDs and behavioral undercontrol are more likely to behave irresponsibly when drinking.”

“The importance of identifying these risk factors is the idea that they can be useful markers of at-risk status and can help us to develop appropriate intervention strategies,” said Capone. “Although, given the fact that many students come to college already having experience with alcohol, I believe that preventive interventions should begin early in the high-school years or during the transition from middle school to high school.”

Hustad agreed. “Due to the relationship between earlier AOD and more alcohol-related problems during college, it is clear that education and prevention efforts should begin well before the college years,” he said. “Until that happens, the risk factors identified in this research can be easily implemented in any screening and brief intervention for incoming college students. For example, these results suggest that effective interventions addressing tobacco use may have a positive influence on both smoking and alcohol-related consequences.”

“It is important to remember that not everyone with density of familial alcoholism will go on to develop a long-term problem with alcohol themselves,” said Capone. “Alcohol dependence is a very complex disorder and FHA is but one influence on its development. However, college students who are heavy drinkers and have a greater density of familial alcoholism are certainly at higher risk of continuing to drink in a problematic fashion after the college years.”

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The relation between alcohol and jealousy is a deeply rooted belief within the general population as well as in the medical, and particularly psychiatric, environment.

Furthermore, in recent years there has been a growing interest on the forensic aspects of pathological jealousy, since they are a frequent cause of severe violence, homicide and suicide.

Some authors have described a high prevalence of pathological jealousy in alcoholic patients, even awarding it a specific value in alcoholism.

Nevertheless, recent studies do not completely support this relation, and draw attention to other factors.

Results from the various studies contain several definitions and classifications of pathological jealousy, and although most of them highlight the prevalence of jealousy in alcoholic patients, they question its specific quality.

Also, the presence of pathological jealousy in subjects with psychiatric disorders other than alcoholism is suggested, indicating the existence of predisposing and triggering factors which could explain the development of pathological jealousy.

Yet, the important methodological difficulties in the published articles and the shortage of studies do not allow the confirmation of the alcoholic etiology in pathological jealousy; this is the reason why considering alcoholic jealousy as a separate entity is debatable.

In this sense, the best diagnosis in these patients would be paranoid disorder combined with alcoholic dependence, hence, a dual diagnosis.

Research; Jiménez-Arriero MA, Hernández B, Mearin Manrique I, Rodríguez-Jiménez R, Jiménez Giménez M, Ponce Alfaro G. Alcoholic jealousy: an old and current dilemma. Adicciones 2007; 19(3): 267-72

Emotional Wellness: Transforming Fear, Anger, and Jealousy into Creative Energy

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