We evaluated alcohol consumption and alcohol-related problems in Korean adults by evaluating alcohol consumption and responses to the CAGE questionnaire obtained from the second Korea National Health and Nutrition Examination Survey.

• The age-adjusted prevalence of males who consumed 0, 0.1-20, 20.1-40, or >40 g/day of alcohol were 28.0, 51.5, 12.5, and 8.0%, respectively;
• 26.9% of male drinkers were CAGE-positive (> or =2 affirmative responses to the CAGE).
• The age-adjusted prevalence of females who consumed 0, 0.1-10, 10.1-20, or >20 g/day of alcohol were 67.7, 26.6, 3.9, and 1.8%;
• 11.9% of female drinkers were CAGE-positive.
• The risk factors for high alcohol consumption were old age, low education level, smoking, and drinking onset at young ages in male drinkers, whereas low education level and smoking in female drinkers.
• The risk factors for a positive CAGE were young age, marriage, low education level, smoking, high amount of alcohol consumed on a single occasion, and high drinking frequency in male drinkers,
• whereas high household income, ex-smoking, high amount of alcohol consumed on a single occasion, and high drinking frequency in female drinkers.

Our results suggest that high alcohol consumption and alcohol-related problems in Korean adults are not negligible and require intervention.

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Abstract: This article describes a unique interdisciplinary alcoholism treatment program created to provide treatment to alcoholics with severe health problems.

There is evidence that severely ill alcoholics may be placed in nursing homes because it is the only available form of care.

It is estimated that up to 49% of patients in nursing homes have an alcohol problem. This high representation may be due to a lack of treatment programs, which are able to manage or treat an alcoholic who also requires skilled nursing care.

One nursing home’s response to this unmet need was to create an alcohol treatment program within its own facility. Working with the State alcohol-treatment-licensing agency, a 10-bed unit was established for the primary treatment of alcoholism for patients who were also medically appropriate for skilled nursing care. The 30-day program was staffed by licensed alcohol counselors and consisted of alcohol education; individual, group and family counseling; and skilled nursing care for co-existing health problems.

This article describes that program and compares the admission status of the first 55 participants in the program to admission status data from the National Nursing Home Survey.

Alcoholism Treatment in a Nursing Home: Meeting the Needs of a Special Population. Lee Ann Mjelde-Mossey Alcoholism Treatment Quarterly: Volume: 25 Issue: 3

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Motivational Enhancement Therapy (MET) is a systematic intervention approach for evoking change in problem drinkers.

It is based on principles of motivational psychology and is designed to produce rapid, internally motivated change. This treatment employs motivational strategies to mobilize the client’s own change resources.

MET consists of four carefully planned and individualized treatment sessions.

The first two focus on structured feedback from the initial assessment, future plans, and motivation for change,

The final two sessions at the midpoint and end of treatment provide opportunities for the therapist to reinforce progress, encourage reassessment, and provide an objective perspective on the process of change.

The counselor seeks to develop a discrepancy in the client’s perceptions between current behavior and significant personal goal; emphasis is placed on eliciting from clients self-motivational statements of desire for and commitment to change.

The working assumption is that intrinsic motivation is a necessary and often sufficient factor in instigating change.

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One-Year Outcomes among Members of a Dual-Recovery Self-Help Program.

Research Objective: Self-help is gaining increased acceptance among treatment professionals as empirical support for of its effectiveness is growing and the advent of managed care warrants the use of cost-effective modalities. Traditional “one disease-one recovery” self-help programs cannot serve adequately the needs of the dually-diagnosed.

This paper presents one-year outcome data from a longitudinal study of the effectiveness of self-help for the dually-diagnosed.

Subjects are members of Double Trouble in Recovery (DTR), a 12-step self-help program designed to meet the special needs of those diagnosed with both a mental health disorder and a chemical addiction.Study.

Design: The study uses a 12-month prospective longitudinal design with follow-ups at 12 and 24 months after baseline. Subjects (N = 310) were recruited at 25 DTR meeting sites throughout New York City. Semi-structured instruments assess history and current status of mental health and substance abuse, treatment in both areas, and self help participation (DTR as well as traditional 12-step groups such as AA and NA).

Population Studied: Community-based individuals dually-diagnosed with a mental health disorder and substance abuse.

Principal Findings: S’s are mostly members of underserved minority groups with long histories of substance abuse and mental health disorders.

Most S’s attend outpatient treatment (for drug use, mental health or dual-diagnosis – 77%) and take psychotropic medications (87%).

At the 12 months follow-up,

• 76% were still attending DTR;
• 68% were also attending AA or NA.

Mean number of symptoms S’s. experienced in the past year decreased significantly;

• two-thirds (69%) of S’s reported that their mental health was “better” in the past month than it was at baseline.
• One-third (29%) reported substance use in the past year, compared to 42% at baseline (p = .002).

Substance use (less) was significantly associated with DTR attendance:

• Total time abstinent was related to lifetime length of DTR attendance (r = .25, p = .002) and
• past year substance use was related to number of months of DTR attendance in the past year (r = -.17, p = .02).

Conclusions: For dually-diagnosed individuals, continued participation in dual recovery self-help groups plays a significant role in the recovery process, particularly in the area of substance use.

Implications for Policy, Delivery or Practice: Participation in dual-recovery self-help groups, both during and after formal treatment, should be encouraged as part of an integrated lifelong recovery plan for dually-diagnosed individuals.

Research; One-Year Outcomes among Members of a Dual-Recovery Self-Help Program. Laudet A, Magura S, Vogel H, Knight E, Staines G; Abstr Acad Health Serv Res Health Policy Meet. 2000; 17.

More at; Double Trouble in Recovery

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Depression in 6050 Former Drinkers; Association With Past Alcohol Dependence.

Background; The association between alcoholism and major depression in the general population has been explained as misdiagnosed alcohol intoxication and withdrawal effects mistaken for depressive syndromes.

To investigate whether this could account for the entire relationship, the association of past alcohol dependence with current major depression (ie, non-overlapping time frames) was investigated in individuals who no longer drink or who drink very little.

We conducted the study using data from the National Longitudinal Alcohol Epidemiologic Survey, a representative sample.

Methods; Former drinkers who did not use drugs or smoke in the past year (n = 6050) were divided into those with and without past DSM-IV alcohol dependence. These 2 groups were compared for the presence of current (last 12 months) DSM-IV major depression. The association between prior alcohol dependence and current major depression was tested with linear logistic regression, controlling for other variables.

Prior alcohol dependence increased the risk of current major depressive disorder more than 4-fold.

Results; Prior alcohol dependence increased the risk of current major depressive disorder more than 4-fold. This relationship was not attenuated by control variables.

The majority of subjects with major depression last used substances 2 or more years prior to the interview, which eliminates acute intoxication or withdrawal effects as an explanation of their depressions.

Conclusions; The strong, specific association between prior alcohol dependence and current or recent major depression in a nationally representative sample of former drinkers indicates that the association is not entirely an artifact of misdiagnosed intoxication and withdrawal effects.

A better understanding of the nature of the relationship between the 2 disorders should be sought and will have important public health significance.

Research report; Deborah S. Hasin; Bridget F. Grant.Major Depression in 6050 Former Drinkers; Association With Past Alcohol Dependence. Arch Gen Psychiatry. 2002;59:794-800.

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Australian Broadcasting Commission, Online, AM, 11 January 2007, journalist Anne Barker

TONY EASTLEY: It’s proven that women who drink in pregnancy risk causing life-long health problems for their unborn children.

What isn’t so well known is that there’s growing evidence that foetal alcohol disorders, as they’re known, are a major cause of crime.

A Canadian lawyer is in Darwin this week talking to judges and barristers about the impact of foetal alcohol.

Anne Barker reports.

ANNE BARKER: It’s common knowledge that women who drink when they’re pregnant can cause permanent and serious brain damage to the unborn child.

But only now is a growing body of research revealing the scale of foetal alcohol disorders in the western world.

One man who has witnessed the consequences of alcohol induced delinquency over 20 years is Canadian barrister David Boulding.

DAVID BOULDING: Alcohol acts like nail polish remover on your nails. It dissolves brain cells. And when the brain cells are not there, the brain is missing brain function.

So you get kids who are impulsive, suggestive, no abstract thinking, memory problems, learning problems, attention problems.

ANNE BARKER: David Boulding believes one to two per cent of the population has some form of life-long disability caused even before they were born. And contrary to popular belief, he says they’re more likely to come from an affluent background.

DAVID BOULDING: Rich, white stockbrokers have wives who drink while they are pregnant.

The University of California just did a huge multi-year study and they found out that women that drink the most while they are pregnant are white, with four years of university education, earning 400 per cent above the poverty line.

ANNE BARKER: Wealthy or not, youngsters with foetal alcohol disorders, whether it’s learning problems or memory loss appear to account for a staggering proportion of delinquents.

In the only study of its kind in one Canadian province, one quarter of young offenders were found to have some form of permanent foetal alcohol syndrome.

David Boulding says there’s a clear connection to crime.

DAVID BOULDING: They really are missing that little voice. That superior, frontal lobe conscience part of the brain that knows right and wrong.

But also they are alone. They don’t have friends, they’ll do anything to please people. They will confess to murder, they’ll hold the gun, they’ll drive the get away car.

ANNE BARKER: David Boulding is in the Northern Territory this week as a guest of the Aboriginal justice agency NAAJA, which represents Indigenous offenders in court.

One NAAJA lawyer Stewart O’Connell says despite the clear impact of alcohol on crime in the NT, the prevalence of foetal alcohol syndrome is virtually unknown.

STEWART O’CONNELL: We are locking Aboriginal people up in jail at a greater rate than ever before. The sentences are getting longer, and it’s not working.

And we have to ask the question – why is it not working? And one of the reasons may be because of things such as foetal alcohol syndrome.

ANNE BARKER: And David Boulding says while nothing can ever reverse foetal alcohol disorders, a recognition of the problem would lead to more effective solutions than jail.

He says it’s already working in Canada.

DAVID BOULDING: Every probation officer, every judge, every lawyer has got stories where somebody took and interest in somebody and made sure, okay he’s not going to hang out with those guys any more, he’s not going to go there any more. I’m going to get him some kind of job maybe, even if it’s volunteer work, he’s going to have new friends.

And guess what? The crime stops.

TONY EASTLEY: Canadian barrister David Boulding talking to Anne Barker in Darwin.

Link to story: http://www.abc.net.au/cgi-bin/common/printfriendly.pl?http://www.abc.net.au/am/content/2007/s2136186.htm

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The ten effective elements of treatment are;

1. There is no treatment formula that will work for everyone.

2. Medically supervised withdrawal is only one step in addiction treatment; alone it will do little.

3. Length of treatment counts

4. Drug addiction is a multidimensional problem, and treatment needs to address all of an individual’s needs

5. Counseling (individual and/or group) is a critical part of effective addiction treatment.

6. Medications are an important part of treatment for many people.

7. Drug testing during treatment is important.

8. Alcoholics and addicts with mental health disorders should be treated for both at the same time.

9.Addiction Treatment works even for people who don’t choose it of their own free will.

10. Don’t give up.

As with other chronic illnesses, relapses can occur during or after successful treatment episodes. Addicted individuals may need lengthy treatment and more than one time in treatment before they can enjoy long-term abstinence and full restoration to a drug free life. The period after treatment is just as important as being in treatment. Finding support and continuous work to stay drug free will be necessary. A slip or relapse is just an indicator that more work, and possibly more treatment, is necessary. Don’t give up.

Full story at Recovery Today

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Since the 1970s, much of the public treatment system in California has been based on a social model orientation to recovery for alcoholics, but there has been minimal research on program outcomes. This article reports on follow-up interviews conducted with a representative sample of 722 people who had entered treatment about a year earlier in public and private programs, including publicly-funded social model detoxification and residential programs, and clinical model programs in hospitals and HMO clinics.

higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems

• Social model clients came to treatment with more severe legal and employment problems, whereas those seeking treatment at clinical programs reported more severe family problems.
• At follow-up, clients at both types of programs reported attending a similar number of Alcoholics Anonymous (AA) meetings, but social model clients reported going to more Narcotics Anonymous (NA) meetings and being involved in more AA activities.
• Social model clients were less likely than clinical model clients to report problems with alcohol or drugs at follow-up, but the odds of reporting other problems (e.g., medical, psychological, legal, family/social) were similar.

The program effect for better alcohol outcomes at the social model programs was partially explained by their clients’ higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems.

• Social networks supportive of abstinence also were predictive of reporting no alcohol problems at follow-up.

In contrast, subsequent detoxification treatment events between baseline and follow-up were associated with a higher odds of reporting alcohol, drug, psychiatric and family/social problems at follow-up.

These findings are consistent with the growing body of literature reporting higher rates of abstinence among those who are able to construct more positive social networks, and who attend and become involved in 12-step programs during and following treatment.

It is important that these results be replicated, as they suggest that social model programs are successful in engaging their clients in AA activities and in NA meeting attendance, and could represent for some an effective alternative to clinical model treatment programs.

Research; LEE ANN KASKUTAS, LYNDSAY AMMON, CONSTANCE WEISNER. A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS. International Journal of Self Help and Self Care; Volume 2, Number 2 / 2003-2004, 111 – 133

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Abstract; Participation in 12-step groups during and after formal treatment has been associated with positive outcome among substance users. However, the effectiveness of 12-step groups may be limited by high attrition rates and by low participation, areas on which there has been little research.

Clinicians play an important role in fostering 12-step participation, and the insights which they develop in their practice can greatly contribute to informing the research process. Yet, little is known about clinicians’ attitudes about 12-step groups or about their experiences in referring clients.

This study surveyed clients (N = 101) and clinicians (N = 102) in outpatient treatment programs to examine 12-step-related attitudes and to identify potential obstacles to participation. Data collection was conducted between May 2001 and January 2002 in New York City.

Both client and clinician samples were primarily African-American and Hispanic; 32% of clients reported substance use in the previous month, with crack and marijuana cited most frequently as the primary drug problem. On average, clinicians had worked in the treatment field for 8 years.

Both staff and clients viewed 12-step groups as a helpful recovery resource.

Major obstacles to participation centered on motivation and readiness for change and on perceived need for help, rather than on aspects of the 12-step program often cited as points of resistance (e.g., religious aspect and emphasis on powerlessness).

Clinicians also frequently cited convenience and scheduling issues as possible obstacles to attending 12-step groups.

Clinical implications of these findings are discussed, including

• the importance of fostering motivation for change,
• the need to assess clients’ beliefs about and experiences with 12-step groups on a case-by-case basis, and to
• find a good fit between clients’ needs and inclinations on the one hand, and
• the tools and support available within 12-step groups on the other.

Research; Alexandre B. Laudet, Attitudes and Beliefs About 12-Step Groups Among Addiction Treatment Clients and Clinicians: Toward Identifying Obstacles to Participation, Substance Use & Misuse, Volume 38, Issue 14 December 2003, pages 2017 – 2047

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A healthy dentist is one of the most important ingredients in a successful dental practice.

In addition to the vulnerabilities of the human condition–addictive disorders, psychiatric illnesses, infectious disease, family and relationship problems, or the many varieties of human misery–dentists have undergone a powerful process of socialization into their professional role that makes it difficult to seek help for themselves.

Stigma about addictive and psychiatric illnesses continues to be a problem despite significant advances in scientific understanding of these disorders.

Many people, especially those in positions of community visibility as dentists are, still struggle with shame when they associate problems with personal failure.

Dental societies are in an ideal position to provide resources and support, should they choose to take this opportunity, and the ADA has the information and expertise to help them do this.

PRACTICE IMPLICATIONS: Dentists can become more aware of their own vulnerabilities and enhance their personal and professional effectiveness, as well as evaluate ways they may support their staff and colleagues.

Research; J Am Dent Assoc. 2004 Jan;135(1):84-9. Safeguarding the health of dental professionals. Lavine SR, Drumm JW, Keating LK.

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