Alcohol Counseling Research Articles

Chapter 2.

College counseling center administrators and staff counselors face the increasing challenge to provide best practice counseling in all domains of their work. The present chapter explores the evidence base for alcohol counseling, seeking to determine whether recent empirical evidence suggests the use of particular counseling strategies when working with alcohol related issues. A summary of research findings in general as well as specific to college counseling centers is provided, along with factors to consider when deciding how to best use the current evidence.

Mandatory alcohol intervention for alcohol-abusing college students: A systematic review

Most colleges and universities in the United States have programmatic responses for alcohol policy violators that commonly include some form of mandatory alcohol education or counseling. The purpose of this study was to conduct a review of intervention programs for college students who are required to attend alcohol education or counseling. MEDLINE, PsycINFO, and ERIC databases were searched for reports of college-based mandatory interventions offered on American campuses. When possible, within-group and between-group effect sizes were calculated. Sixteen reports were identified, including three randomized controlled trials. Most of the reviewed studies used qualitative or quasi-experimental designs, did not include comparison or control groups, had small or selective sample sizes, lacked behavioral measures of alcohol consumption, and/or had no follow-up, low follow-up rates, or short follow-up intervals. Recommendations for future research include testing different modes and types of interventions and sanctions, evaluating long-term efficacy, and establishing cost–effectiveness.

Lifestyle Behavior Counseling for Women Patients among a Sample of California Physicians

Physical inactivity, poor diet, excessive alcohol consumption, and smoking are modifiable risk factors associated with development of chronic diseases. Although the prevalence of diseases associated with these detrimental lifestyle behaviors is high among women in the United States, they may not receive adequate counseling from physicians. To predict physicians' lifestyle counseling practices, we assessed personal, professional, and health behavior characteristics from responses to a self-administered survey of breast cancer risk reduction practices. Subjects were California physicians identified through AMA Masterfile, in family practice, internal medicine, or obstetrics/gynecology, who were asked to report the percentages of women patients they counseled on physical activity, diet, alcohol, and smoking. Of 1647 eligible physicians, 822 (50.0%) responded. Fifty-six percent reported counseling at least 75% of patients about physical activity, 54.6% about diet, and 44.8% about alcohol. More than three quarters (78.7%) counseled at least 75% of patients about smoking. In logistic regression analyses, woman gender, family practice, and internal medicine specialties emerged as significant predictors of counseling for all lifestyle behaviors. Older age was associated with dietary and alcohol counseling. Race/ethnicity was associated only with smoking counseling, and country of medical school was associated with counseling for physical activity and smoking. Sources of new medical knowledge emerged as predictors for all types of counseling, whereas physicians' own level of physical activity only predicted counseling about physical activity. Physicians' personal, professional, practice, and health behavior characteristics were associated with reported lifestyle counseling of women patients. Results reveal important directions for future physician-based interventions to improve counseling.

Identifying the Roles and Responsibilities of Addiction Studies Interns in a Child Welfare Agency

ABSTRACT Alcohol and other drug (AOD) counselors often must work collaboratively with other social service agencies, one of which is Child Protective Services (CPS). This study describes a pilot program developed to address AOD/CPS collaborative work, along with the challenges in providing collaborative work. Five AOD Studies interns were placed at a county CPS agency as substance abuse specialists for one year. Qualitative and quantitative data were gathered through monthly focus group meetings and chart abstractions. Results indicate that the interns played multiple roles and provided services beyond typical AOD work. Implications include skill and content areas for AOD Studies curriculum.

Considerations in the Development of a Research to Practice Curriculum for Alcoholism and Substance Abuse Counselors

ABSTRACT Most current substance abuse counselor certification education curricula do not include a systematic introduction to alcohol and substance abuse research. I believe that such an introduction would enhance counselor cooperation in research to practice efforts that are currently underway. In this paper I give a brief history of alcoholism and substance abuse counseling, and then review the education requirements for the substance abuse counseling credential, counselor attitudes toward research, the effect of education on acceptance of research-based interventions, and suggest elements for a curriculum that introduces counselors to research on alcoholism and substance abuse that comprise a course I teach at John Jay College of Criminal Justice as part of the substance abuse counseling curriculum.

Alcohol Counseling in ED Could Save $2 billion

Alcohol Counseling in ED Could Save $2 billion

Table of Contents

AbstractPrison‐Based Treatment Program Reduces RecidivismNIAAA Survey Finds That Many Recover From AlcoholismAlcohol Counseling in ER Could Save Hospitals $2 Billion AnnuallyReport Finds Increase in Methamphetamine‐Related AdmissionsA ‘StoryCorps’ interview with NCADD President Stacia MurphyResourcesNames in the NewsBriefly NotedComing Up

Alcohol-related advice for Veterans Affairs primary care patients: Who gets it? Who gives it?

Most patients who misuse alcohol do not receive alcohol counseling from their providers. This study evaluated primary care patient and provider characteristics associated with receipt of alcohol-related advice and whether patients were advised to drink less or to abstain. Outpatients from seven Veterans Affairs (VA) general medicine clinics were eligible if they screened positive for alcohol misuse, completed the Alcohol Use Disorders Identification Test (AUDIT) and answered questions about alcohol-related treatment and advice. Hierarchical logistic regression was used to evaluate patient and provider characteristics associated with patient reports of alcohol-related advice from a primary care provider in the past year. Among 5191 patients with alcohol misuse in the past year, 1554 (30%) reported receiving alcohol-related advice from their primary care provider during that time. Of patients advised, 73% reported advice to abstain. The likelihood of reporting advice increased as AUDIT scores increased: from 13% of patients with AUDIT scores <8 to 71% of those with scores > or =20. After adjustment for important confounders, measures reflecting the severity of alcohol misuse were most strongly associated with receipt of alcohol-related advice. Adjusted analyses also revealed increased odds of receiving advice among patients who reported liver disease, hypertension, current smoking or continuity of care. No measured provider characteristic was associated with giving advice in the fully adjusted model. This multisite VA study found that most patients with alcohol misuse did not receive alcohol counseling from a primary care provider. Moreover, providers predominantly offered advice to abstain, and they appeared to focus on patients with the most severe problems due to drinking or medical contraindications to drinking.

Brief alcohol interventions with mandated or adjudicated college students.

This article summarizes the proceedings of a symposium presented at the 2003 RSA Meeting in Ft. Lauderdale, Florida, organized and chaired by Nancy Barnett. The purpose of the symposium was to present information and efficacy data about approaches to brief intervention with students who get into trouble on their campuses for alcohol and as a result are required to attend alcohol education or counseling. Presentations were (1) Differences Between Mandated College Students and Their Peers on Alcohol Use and Readiness to Change, by Tracy O'Leary Tevyaw; (2) An Effective Alcohol Prevention Program for Mandated College Students, by Kim Fromme; (3) Two Brief Alcohol Interventions for a Referred College Population, by Kate Carey; and (4) Brief Motivational Intervention With College Students Following Medical Treatment or Discipline for Alcohol, by Nancy Barnett. The data presented in this symposium indicated that students who are evaluated or disciplined for alcohol use are on average heavy drinkers who drink more heavily than their closest peers. Brief intervention approaches described by the speakers included group classroom sessions, individual motivational intervention, individual alcohol education, and computerized alcohol education. Reductions in consumption and problems were noted across the various intervention groups. Brief motivational intervention as a general approach with mandated students shows promise in that it reduced alcohol problems in a group of mandated students who were screened for being at risk (in the Borsari and Carey study) and increased the likelihood that students would attend further counseling (in the Barnett study).

Alcohol counseling as part of general wellness counseling.

Healthcare providers, and nurses in particular, are increasingly being called upon for health promotion counseling. Alcohol risk assessment is often included in general health screening questionnaires, but often little use is made of this information. Alcohol consumption is infrequently included as a focus of health promotion campaigns. Because alcohol intake influences many other health risks, it is logical and practical to include alcohol risk reduction in general wellness counseling. This article presents evidence that incorporating alcohol counseling lowers alcohol risk and lowers the risk of other chronic diseases. It also provides examples of ways nurses and other health professionals can discuss alcohol risk reduction in the context of general health, thus helping remove the stigma associated with alcohol risk and engage clients in efforts to lower their alcohol risk.

Implementing an effective intervention for problem drinkers on medical wards

Many medical inpatients have alcohol related problems but evidence of the feasibility of instituting a brief intervention is incomplete. An alcohol counsellor trained nurses on five general medical wards to screen patients routinely for alcohol problems. She counselled appropriate patients using one or two counselling sessions. Efficacy of the counselling was assessed at interview six months following the admission. We found that 19.6% of male and 4.8% of female medical patients were drinking more than 50 units (U) or 33 drinks per week (male) or 35 U or 23 drinks per week (female). Counselling, with one or two sessions led to a reduction from a median of 74 U (49 drinks) per week at admission to 26 U (17 drinks) per week at six months follow-up. A second counselling session after discharge showed no advantage over a single one administered while the patient was in the ward. The barriers to developing a successful alcohol screening and counselling service in medical wards can be overcome provided there is also adequate support and training of the ward nursing staff.

Chemical Dependency Counseling, A Practical Guide.: By Robert R. Perkinson. Sage Publications, Thousand Oaks, CA. 2nd edn: 2002, 544 pp., pound39.00. ISBN: 0-7619-2388-8.

The book’s author, Robert R. Perkinson, is a licensed psychologist and a certified alcohol and drug counsellor who is Clinical Director of the Keystone Treatment Centre in South Dakota. The book is intended as a standard training text for those in the addiction field, which in America, is 12-step orientated. The author describes treatment as a ‘spiritual journey’ and examines the importance of the ‘higher power’ in supporting patients through steps …

Seeking Excellence in Counselor Education: One School's Journey

ABSTRACT Assuring learning outcomes that result in expert alcohol and drug dependency counseling is a continuous challenge for educators. Working systemically to craft a solid vision for the future, the Hazelden Foundation developed a graduate school for the sole purpose of educating highly skilled clinicians. Key ingredients included building a school–rather than a program, establishing a center of excellence model, and creating a curriculum that afforded high performance outcomes.

Excessive alcohol consumption and drinking expectations among clients in methadone maintenance.

Excessive alcohol consumption and related problems are common among clients in methadone maintenance treatment (MMT), yet relatively little is known about the psychological and social determinants of alcohol-related attitudes and behaviors during treatment. This study reports on the prevalence of alcohol dependence, patterns of alcohol consumption and preliminary findings about clients' beliefs that they will change their drinking behavior in the future. Data were gathered from personal interviews with 66 clients attending a MMT program in South London (some 80.5% of the eligible caseload). Forty-one percent of the overall sample met DSM-IV criteria for alcohol dependence in the past 12 months. Among clients who reported drinking in the past month (n = 50), 54% were classified as dependent, and these clients reported consuming an average of 23.5 UK standard units of absolute alcohol (188g/6.58 ounces) on a typical drinking day in the past month. Exploratory analyses suggested that expectations to change drinking behavior were predicted by subjective norms (social pressures), perceived functions of alcohol use, past drinking levels and current dose of methadone. Clinicians engaged in alcohol problems assessment and counseling during MMT could usefully examine these influences to strengthen treatment provision.

Development and validation of the Theoretical Orientation Scale for Clinicians: reflecting solution-focused principles.

This article describes the development and validation of the 40-item Theoretical Orientation Scale for Clinicians (TOSCsF), an instrument designed to (a) operationalize attitudes towards the principles of solution-focused brief therapy (SFBT), and (b) assess clinicians' endorsement of this therapeutic approach. Participants (N=284) were members of the National Association of Alcoholism and Drug Abuse Counselors (NAADAC) who responded (63%) to a mail questionnaire containing the TOSCsF. Reliability (Cronbach's alpha = .82) and validity of scores on the TOSCsF are examined in light of the detection of an acquiescent response pattern in 40 respondents. A subsequent three-factor structure derived from a principal components analysis (accounting for 28% of the variance) suggests modest, but positive, support for the construct validity of the TOSCsF. Recommendations for further refinement of the instrument are discussed.

Relationship Between Service Utilization and Runaway Youths' Alcohol and Other Drug Use

Runaway youths represent a vulnerable, high-risk population that has received little societal attention. Studies show that youths at greatest need are the least likely to access mental health, medical, and other social services. This study evaluated service utilization, including medical visits, psychological, alcohol and drug counseling and 12-step attendance, and substance use. Runaway youths (n = 51) between the ages of 12 and 17 with a diagnosis of alcohol abuse or dependence were recruited from two southwestern runaway shelters. Results showed that psychological counseling and medical visits were associated with less alcohol use while 12-step attendance was associated with more alcohol use at pretreatment. Service utilization was not associated with illicit drug use. The findings suggest that alcohol and other drug use are affected differently by service utilization in this sample of youths. More research is required to evaluate and develop treatments which can effectively intervene with this high-risk group.

Alcoholism: beliefs and attitudes among Canadian alcoholism treatment practitioners.

To explore differences in views concerning adjunctive medications and theoretical orientation among Canadian practitioners from different professional backgrounds who treat alcoholism. A survey of clinicians from different disciplines was conducted by mail. The response rate was 56%: 95 drug and alcohol counsellors, 46 social workers, 81 nonpsychiatrist addiction physicians, and 74 addiction psychiatrists. The number of items in the questionnaire was reduced using principal component analysis. Group differences were explored using analysis of variance with Bonferroni correction and Scheffé's posthoc comparisons. Physicians and nonphysicians differed in their views on the utility of medications in treating alcohol problems, the disease concept of alcohol problems, and the classification of alcohol abuse or dependence as psychiatric conditions. No group differences emerged on views regarding cognitive-behavioural treatment, pharmacological-only interventions, combined treatment, and recovery without treatment. Psychopathology in the alcoholic was significantly more likely to be considered as secondary to the use of alcohol by nonpsychiatrist physicians. Nonphysician practitioners viewed alcoholic behaviour as self-medication. Groups differed on questionnaire items concerning medication use and the disease concept of alcoholism. Agreement on several areas may facilitate bridging the gap across disciplines. The implications of these results are discussed.

A Resource for Addiction Counseling: Licensed Chemical Dependency Counselors in Texas

Licensed Professional Counselors (LPCs) and school counselors increasingly find themselves asked to work cooperatively with Licensed Chemical Dependency Counselors (LCDCs) in a variety of work settings. This article addresses the scope of practice of LCDCs, their current licensing requirements, and some misconceptions about the alcohol and other drug (AOD) counseling field. Unfamiliarity with the role of the LCDC, combined with misunderstandings about the AOD field may prevent productive working relationships between mental health professionals and LCDCs. This may interfere with providing quality service to the many clients who present with AOD issues.

Counsellors' perspectives on the use of the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) in an alcohol counselling setting

As part of a randomised controlled trial to investigate the feasibility of using the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) within an alcohol counselling setting, counsellors' views of using the tool were sought. Data about the service users' use of SEIQoL were collected during the counselling session, and focus groups and questionnaires were used to collect data on counsellor perceptions and experiences of using the tool. SEIQoL was easy and quick to use and provided users with a graphic, visual and dynamic means to identify important areas that contributed to their quality of life; it appeared to enhance the reflective process early on in counselling. Counsellors reported that service users requested the tool be used more frequently during the counselling process and they felt it could be a useful review tool.

Counsellors' perspectives on the use of the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) in an alcohol counselling setting

As part of a randomised controlled trial to investigate the feasibility of using the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) within an alcohol counselling setting, counsellors' views of using the tool were sought. Data about the service users' use of SEIQoL were collected during the counselling session, and focus groups and questionnaires were used to collect data on counsellor perceptions and experiences of using the tool. SEIQoL was easy and quick to use and provided users with a graphic, visual and dynamic means to identify important areas that contributed to their quality of life; it appeared to enhance the reflective process early on in counselling. Counsellors reported that service users requested the tool be used more frequently during the counselling process and they felt it could be a useful review tool.