The objectives of this research were to assess the prevalence of substance use among Dutch dental students and to determine their attitudes about substance use and its consequences.

METHODS: In association with a national study of drug use among US dental students, a questionnaire was translated from English into Dutch and administered to dental students at two dental schools in The Netherlands. Students received an anonymous 115-item questionnaire in the fall of 1996.

RESULTS: Alcohol was the students’ drug of choice for

• lifetime (95%),
• past year (94%) and
• past month (88%) use.

No significant correlations were found between alcohol use and gender, schools, and years in dental education.

In the past month,

• 58% of students reported drinking on 5 or more days;
• 53% had 5 or more drinks on the same occasion,
• 20% had 5 or more drinks on the same occasion on 5 or more days; and
• 17% reported getting drunk at least monthly.

Prevalence rates for past month use of tobacco was 24% and marijuana, 4%.

Male students smoked twice as much as females, with significant differences found for all three periods of use (X2>19.00, P<0.01).

When asked whether their schools offered policies and education programs on alcohol and other drugs, 52% of students reported that these were not available.

CONCLUSIONS: Dental schools should develop effective programmes to educate students about responsible use of alcohol and other licit and illicit drugs. Schools should also inform students about their susceptibilities to substance abuse and dependency.

Community Dent Oral Epidemiol. 2001 Feb;29(1):48-54. Substance use among Dutch dental students. Plasschaert AJ, Hoogstraten J, van Emmerik BJ, Webster DB, Clayton RR.

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• Brief-TSF can assist people cease alcohol consumption.
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Counseling for Relapse Prevention by Terence T. Gorski, Merlene Miller Read more about this title…

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Dropout from 12-step self-help groups: Prevalence, predictors, and counteracting treatment influences

The prevalence, predictors, and treatment-related factors affecting dropout from 12-step self-help groups in the first year following professional substance abuse treatment were assessed in 2,778 male patients.

The patients were asked to complete an inventory at baseline, at discharge, and 1 year after discharge.

Attendance at 12-step groups either in the 90 days before treatment or during treatment was reported by 91% (2,518).

Forty percent had dropped out at the 1-year follow-up.

Logistic regression analysis revealed that the odds of having used substances by the time of the 1-year follow-up were almost three times higher for those who had dropped out of 12-step self-help groups than for those who had continued attendance (odds ratio = 2.84; 95% confidence interval, 2.29-3.23; p < 0.0001).

Dropout was predicted by a number of baseline factors. Patients who began 12-step participation during treatment were less likely to drop out.

Other findings suggest that patients at highest risk for dropout may be at lower risk if treated in a more supportive environment.

Clinicians may decrease the likelihood of dropout directly by screening for risk factors and focusing facilitation efforts accordingly, and indirectly by increasing the supportiveness of the treatment environment and facilitating 12-step involvement during treatment.

Research report; Kelly, J.F.; Moos, R. Dropout from 12-step self-help groups: Prevalence, predictors, and counteracting treatment influences. Journal of Substance Abuse Treatment, 24(3):241-250, 2003. (169991)

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There is a long-recognized association between alcohol consumption and aggressive behavior. But does aggression and hostility continue into sobriety?

This study was designed to examine aggression in a group of socially well-adapted recovered alcoholics.

The question addressed was whether the treatment, together with long-term abstinence from alcohol, could reduce aggression and hostility in recovered alcoholics.

Sixty four male stable alcoholics with at least 3 years sobriety were compared with 69 non-alcoholics. Neither group had any other psychological problems.

Both groups were given a questionnaire on general characteristics as well as aggressive and hostility traits.

After a 3-year abstinence, men from the recovering alcoholics group displayed greater signs of hostility and covert aggression. They were different from non-alcoholics on measures for indirect aggression, irritability, negativism, suspicion, resentment, and guilt.

Research report; Ziherl S, Cebasek Travnik Z, Kores Plesnicar B, Tomori M, Zalar B. Trait aggression and hostility in recovered alcoholics. Eur Addict Res 2007; 13(2): 89-93.

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Diagnosis, assessment and management of harmful drinking and alcohol dependence in youths

Description

This clinical guideline offers evidence-based advice on the diagnosis, assessment and management of harmful drinking and alcohol dependence in adults and in young people aged 10–17 years.

This is one of three pieces of UK NICE guidance addressing alcohol-related problems and should be read along with:

• Alcohol-use disorders: preventing the development of hazardous and harmful drinking. NICE public health guidance 24 (2010) – public health guidance on the price, advertising and availability of alcohol, how best to detect alcohol misuse in and outside primary care, and brief interventions to manage it in these settings.
• Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications. NICE clinical guideline 100 (2010) – clinical guideline covering acute unplanned alcohol withdrawal including delirium tremens, alcohol-related liver damage, alcohol-related pancreatitis and management of Wernicke’s encephalopathy.

Read the complete summary

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Dissociation and alexithymia among men with alcoholism

Aim: The aim of the present study was to evaluate the relationship between alexithymia (The Inability to label or identify emotions) and dissociation (See below) among men with alcoholism.

Methods: Participants were 176 patients consecutively admitted to the inpatient unit of a addiction treatment center. The Toronto Alexithymia Scale, the Symptom Checklist-Revised, the Dissociative Experiences Scale, the Beck Depression Inventory, the Spielberger State-Trait Anxiety Inventory, and the Michigan Alcoholism Screening Test were administered to all participants.

Results: Fifty-three patients were considered as having alexithymia.

The alexithymic group had a significantly higher rate of dissociative relationships members (patients with pathological dissociation; 62.3%) according to Bayesian probability.

Trait anxiety, overall psychiatric symptom severity, and pathological dissociation predicted alexithymia on covariance analysis.

A multivariate analysis of covariance demonstrated that these predictors were related only to difficulty of identifying feelings, whereas trait anxiety was a significant covariant for difficulty of expressing feelings as well.

Conclusion: Alexithymic phenomena are interrelated with dissociation and chronic anxiety among men with alcoholism.

Definition; Dissociation is a state of acute mental state in which certain thoughts, emotions, sensations, and/or memories are compartmentalized because they are too overwhelming for the conscious mind to integrate.

Evren C, Sar V, Evren B, Semiz U, Dalbudak E, Cakmak D. Dissociation and alexithymia among men with alcoholism Psychiatry Clin Neurosci. 2008 Feb;62(1):40-7.

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Encouraging post-treatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes

Background: Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients’ health care costs in the first year after treatment, but such initially impressive effects may wane over time.

This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.

Methods: A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step-based (n = 887 patients) or cognitive-behavioral (CB, n = 887 patients) treatment programs.

The 12-step-based programs placed substantially more emphasis on 12-step concepts, had more staff members "in recovery," had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs.

The 2-year follow-up assessed patients’ substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.

substantially higher abstinence rate among patients treated in 12-step

Results: As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) in contrast to CB (37.0%) programs.

Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs.

30% lower costs in the 12-step treatment programs

In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p = 0.01).

Conclusions:

• Promoting self-help group involvement appears to improve post-treatment outcomes while reducing the costs of continuing care.
• Even cost offsets that somewhat diminish over the long term can yield substantial savings.
• Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.

Research; Keith Humphreys, and Rudolf H. Moos Alcoholism: Clinical and Experimental Research 2007; 31(1):64-68) – 1 This computation is in 2006 dollars, to which we converted for comparative purposes our prior findings, which had been originally reported in 1999 dollars (Humphreys and Moos, 2001).

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A researcher studying the influence of spirituality on sobriety encourages recovering alcoholics to nourish their spiritual needs through praying, taking a course in meditation, or simply walking in the woods.

“While people’s actual beliefs don’t seem to change during recovery, the extent [to which] they have spiritual experiences and are open to spirituality in their lives does change,” said Elizabeth Robinson, Ph.D., a research assistant professor at the Addiction Research Center at the University of Michigan’s Department of Psychiatry.

While anecdotal evidence indicates that spirituality plays a role in alcohol recovery, until recently there were few hard data to prove if and how it impacts sobriety.

Now a team of researchers at the University of Michigan Addiction Research Center (UMARC) headed by Robinson have found that many measures of spirituality increase during alcohol recovery. And increases in day-to-day spiritual experiences and sense of purpose in life were associated with fewer episodes of heavy drinking six months later, independent of involvement in Alcoholics Anonymous (AA).

Their report appears in the March Journal of Studies on Alcohol and Drugs.

“I was surprised that there was a relationship between spirituality and a change in drinking independent of AA involvement, because AA involvement certainly impacts spirituality,” Robinson told Psychiatric News.

The researchers assessed the changes in spirituality and religiosity (S/R) of 123 adults (66 percent men; mean age 39; 83 percent white) with alcohol use disorders at entry into treatment and six months later. They also investigated whether those changes were associated with drinking outcome. The 10 S/R measures of the participants’ spirituality and religiousness, measured with standard research questionnaires, included their views of God, religious practices such as prayer or church attendance, forgiveness, spiritual experiences, using religion or spirituality to cope, and existential meaning. Drinking behaviors were assessed with the Time-line Followback interview. AA participation and attendance were also measured.

In all, the study showed that during the six-month period there were statistically significant changes in half of the measures of spirituality, including daily spiritual experiences, use of religious practices, forgiveness, positive use of religion for coping, and feelings of purpose in life.

But the measures that assessed individuals’ core beliefs and values about God or religion didn’t change. At the same time there was a statistically significant decrease in alcohol use, and 72 percent of participants did not relapse to heavy drinking. Heavy drinking was defined as five or more drinks a day for men and four or more drinks a day for women. Increases in Daily Spiritual Experiences and Purpose in Life scores were associated with increased odds of no heavy drinking at six months, even after controlling for AA involvement and gender. Changes in the other measures of spirituality were not statistically associated with likelihood of sobriety.

Robinson and her colleagues said that because spiritual practices and experiences increased significantly over time while spiritual and religious beliefs did not, the results suggest that proactive and experiential dimensions of spirituality, rather than cognitive dimensions of spirituality, were contributing to recovery and less drinking during the first six months.

They noted that this pattern of differential changes in S/R experiences and behavior rather than beliefs is consistent with two AA slogans: “Bring your body, your mind will follow,” and “Fake it ’til you make it.” In other words, changes in core beliefs and values don’t have to occur for someone to be more open to spiritual experiences or to take part in more spiritual activities.

Robinson said that including spirituality of all kinds into recovery programs for alcoholism may indeed provide benefit. Many individual faiths or religious institutions offer recovery services, and some advocates have suggested that faith-based recovery is effective for most people. But Robinson noted that the spirituality seen in the study was not necessarily a matter of believing in one interpretation of God, religions, or even belief in a God of any kind.

Each individual’s spirituality the ability to experience growth in that spirituality appear to be paramount, the authors suggested. Thus, each individual alcoholic might do best by searching for a recovery program that best matches his or her belief system.

By David Milne at Psychiatric News. From research; Psychiatr News May 4, 2007, Volume 42, Number 9, page 19.

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Integrating Primary Medical Care With Addiction Treatment

A Randomized Controlled Trial

Context; The prevalence of medical disorders is high among substance abuse patients, yet medical services are seldom provided in coordination with substance abuse treatment.

Objective; To examine differences in treatment outcomes and costs between integrated and independent models of medical and substance abuse care as well as the effect of integrated care in a subgroup of patients with substance abuse-related medical conditions (SAMCs).

Design; Randomized controlled trial conducted between April 1997 and December 1998.

Setting and Patients; Adult men and women (n = 592) who were admitted to a large health maintenance organization chemical dependency program in Sacramento, Calif.

Interventions; Patients were randomly assigned to receive treatment through an integrated model, in which primary health care was included within the addiction treatment program (n = 285), or an independent treatment-as-usual model, in which primary care and substance abuse treatment were provided separately (n = 307). Both programs were group based and lasted 8 weeks, with 10 months of aftercare available.

Main Outcome Measures; Abstinence outcomes, treatment utilization, and costs 6 months after randomization.

Results Both groups showed improvement on all drug and alcohol measures. Overall, there were no differences in total abstinence rates between the integrated care and independent care groups (68% vs 63%, P = .18).

For patients without SAMCs, there were also no differences in abstinence rates (integrated care, 66% vs independent care, 73%; P = .23) and there was a slight but nonsignificant trend of higher costs for the integrated care group ($367.96 vs $324.09, P = .19).

However, patients with SAMCs (n = 341) were more likely to be abstinent in the integrated care group than the independent care group (69% vs 55%). This was true for both those with medical and psychiatric SAMCs. Patients with SAMCs had a slight but nonsignificant trend of higher costs in the integrated care group ($470.81 vs $427.95, P = .14).

Conclusions Individuals with SAMCs benefit from integrated medical and substance abuse treatment, and such an approach can be cost-effective. These findings are relevant given the high prevalence and cost of medical conditions among substance abuse patients, new developments in medications for addiction, and recent legislation on parity of substance abuse with other medical benefits.

Research report; Integrating Primary Medical Care With Addiction Treatment; A Randomized Controlled Trial, Constance Weisner, DrPH; Jennifer Mertens, MA; Sujaya Parthasarathy, PhD; Charles Moore, MD, MBA; Yun Lu, MPH. JAMA. 2001;286:1715-1723.

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Persistent Next-Day Effects of Excessive Alcohol Consumption on Laparoscopic Surgical Performance

Purpose; To examine the effect of previous-day excessive alcohol consumption on laparoscopic surgical performance.

Study 1 was a randomized controlled trial. Study 2 was a cohort study. Sixteen science students (laparoscopic novices) participated in study 1. Eight laparoscopic experts participated in study 2. All participants were trained on the Minimally Invasive Surgical Trainer Virtual Reality (MIST-VR).

The participants in study 1 were randomized to either abstain from alcohol or consume alcohol until intoxicated. All study 2 subjects freely consumed alcohol until intoxicated. Subjects were assessed the following day at 9 AM, 1 PM, and 4 PM on MIST-VR tasks.

Assessment measures included time, economy of diathermy use, and error scores.

In study 1, both groups performed similarly at baseline, but the alcohol group showed deterioration on all performance measures after alcohol consumption. Overall, although the time score differences between the 2 groups were not statistically significant (P = .29), there was a significant difference between the 2 groups’ diathermy (P < .03) and error (P < .003) scores. There was also a significant effect for time of testing (P < .003), diathermy (P < .001), and errors (P < .001). In study 2, experts demonstrated a similar postalcohol performance decrement for time (P < .02), diathermy (P < .001), and error scores (P < .001).

Excessive consumption of alcohol appeared to degrade surgical performance the following day even at 4 PM, suggesting the need to define recommendations regarding alcohol consumption the night before assuming clinical surgical responsibilities.

Arch Surg. 2011;146(4):419-426. doi:10.1001/archsurg.2011.67

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Long-term effects of pharmacotherapy on relapse prevention in alcohol dependence.

Background: There is growing evidence that pharmacological treatment with two of the best validated anticraving medications, acamprosate and naltrexone, is efficacious in promoting abstinence in recently detoxified alcohol-dependent subjects.

Objective: The stability of effects after termination of treatment remains to be answered, especially when combining both the drugs.

Method: After detoxification, 160 alcohol-dependent subjects participated in a randomized, double-blind, placebo-controlled trial. Patients received naltrexone or acamprosate or a combination of naltrexone and acamprosate or placebo for 12 weeks. Patients were assessed weekly by interview, self-report, questionnaires and laboratory screening. Additionally, follow-up evaluation based on telephone interview of participants, general practitioners and relatives was conducted 12 weeks after terminating the medication.

Results: At week 12, the proportion of subjects relapsing to heavy drinking was significantly lower in the group with combined medication compared with both placebo and acamprosate (P < 0.05).

No difference was detectable between acamprosate and naltrexone, both of which were superior to placebo (P < 0.05).

12 Week Relapse rates were;

• 28% (combined medication),
• 35% (naltrexone),
• 50% (acamprosate) and
• 75% (placebo).

After follow-up (week 24), combined medication led to relapse rates significantly lower than placebo, but not lower than acamprosate.

Again, both naltrexone and acamprosate were superior to placebo.

24 Week Relapse rates were

• 80% (placebo),
• 54% (acamprosate),
• 53% (naltrexone) and
• 34% (combined medication).

Conclusions:

The results of this study highlight the stability of effects of pharmacotherapy on relapse prevention in alcohol dependence.

Research; Kiefer F; Andersohn F; Otte C; Wolf K; Jahn H; Wiedemann K. (2004), Long-term effects of pharmacotherapy on relapse prevention in alcohol dependence. Acta Neuropsychiatrica, October 2004, vol. 16, no. 5, pp. 233-238(6)

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