Outpatient Alcohol Research Articles

The prognosis of out-patient alcohol treatment among parents with childcare responsibility.

Despite expansive knowledge on the detrimental effects of growing up with parents with alcohol use disorders (AUDs), little is known about the prognosis of alcohol treatment among parents with childcare responsibility. This observational cohort study aimed to examine the prognosis of patients with and without childcare responsibility, in a conventional out-patient alcohol treatment clinic. A consecutive AUD sample (N = 2201), based on ICD-10 Diagnostic Criteria for Research, was assessed with the European Addiction Severity Index during the clinical routine, at treatment entry and conclusion. Data on addiction severity, treatment course and drinking outcomes were derived, and adjusted odds ratios (AORs) were calculated with logistic-regression models. Drinking outcomes were compared in an intention-to-treat analysis, including all patients in a logistic regression with inverse probability weighting. Patients with childcare responsibility (aged <18 years) had a less severe addiction profile and lower drop-out rate compared with patients without children or with children living out-of-home. They were also more likely to improve on all drinking-related outcomes, including abstinence (AOR 2.68, 95% CI 1.82-3.95), number of drinking days (AOR 2.45, 95% CI 1.50-4.03) and excessive drinking days (AOR 4.66, 95% CI 2.36-9.17); and those with children living out-of-home had better outcomes on abstinence (AOR 1.59, 95% CI 1.08-2.34) than patients without children. Childcare responsibility among out-patients was associated with better treatment course and outcomes than those without or not living with their children. This knowledge can help guide clinical practice, effectuate interventions and inform social authorities.

Comorbid social phobia does not predict the outcome in alcohol use disorder outpatient treatment

BackgroundSocial phobia (SP) is one of the most prevalent anxiety disorders among patients entering treatment for alcohol use disorders (AUD). However, few studies have examined the association between SP and alcohol-related treatment outcomes in naturalistic settings. AimsThe aims of this study were to estimate the prevalence of co-morbid SP and to investigate the impact of the co-morbidity on the treatment course, dropout rates and treatment outcomes in a large sample of AUD patients treated in an outpatient alcohol treatment clinic. MethodsThe study was conducted as an observational cohort study. A consecutive sample of 3.197 treatment-seeking outpatients, with an AUD diagnosis according to the ICD-10 Diagnostic Criteria for Research, was assessed by means of the Addiction Severity Index at treatment start and at treatment conclusion. ResultsApproximately 15% of the patients suffered from SP when entering treatment and patients with and without SP did not differ on the treatment course, compliance or dropout rates. SP did not predict any alcohol-related treatment outcomes either, where no association was found on change scores for abstinence, drinking days and days with excessive drinking relative to AUD patients without co-morbidity. ConclusionAUD patients with and without co-morbid SP were equally likely to achieve benefits when treated similarly with evidence-based pharmacological and psychosocial approaches in a naturalistic setting.

Elderly alcoholics compared to middle-aged alcoholics in outpatient treatment – 6-month follow-up

Purpose: This study examined 6-month drinking outcomes of elderly patients compared with middle-aged patients in a clinical sample after initiation of outpatient treatment for alcoholism.Materials and methods: In a clinical prospective cohort study, 1398 consecutive patients from a municipality outpatient alcohol clinic were included. A total of 208 elderly patients aged from 60 to 82 years and 1190 middle-aged patients from 40 to 59 years participated in the study. The following psychosocial treatment interventions were offered: cognitive behavioral therapy, family therapy and supportive consultations. Using an ‘intention-to-treat’ method, primary outcomes included drinking outcomes (self-reported abstinence rates, drinking 3 drinks or less per day, and change in Addiction Severity Index [ASI] composite scores) during the 30 days prior to 6-month follow-up; secondary outcome was compliance to the recommended treatment.Results: Compared to middle-aged, among elderly patients a higher proportion were females (33.5% vs. 42.8%) and had a lower family/social ASI-composite score (0.17 vs. 0.12) at baseline. Higher alcohol and family/social ASI-composite scores were inversely correlated with abstinence. Elderly patients had a higher chance for abstinence compared to middle-aged patients (Odds ratio 95% [confidence interval]) 1.40 (1.03–1.92). The proportion of elderly patients that drank 3 or less drinks per day was 17.8%, compared to 10.8% among middle-aged (p < .01). Finally, elderly patients obtained a higher compliance, which was similarly associated with abstinence (OR =2.46 (1.95–3.11)).Discussion and conclusions: Elderly patients, who receive psychosocial outpatient treatment for alcoholism, have better 6-month outcomes within a range of drinking outcome measures compared to middle-aged patients.

Drinking Goal Trajectories and Their Association with Client Characteristics and Outcomes among Clients in Outpatient Alcohol Treatment

ABSTRACTBackground: Drinking goal preferences could change over time in alcohol treatment and during follow up. Objectives: To examine the stability of drinking goals over time, types of drinking goal trajectory, and the associations between drinking goal trajectories and baseline client characteristics and treatment outcomes. Methods: We performed secondary analysis of a dataset from a multicenter longitudinal study on the effectiveness of outpatient alcohol treatment (n = 543). Drinking goals (abstinence, controlled drinking, nonrestricted drinking, undecided) and alcohol use were assessed at treatment admission, discharge, and 6- and 12-month follow up. Results: At admission, 32% of the subjects aimed for abstinence and 57% for controlled drinking, while 10% were undecided, and 1% did not want to restrict themselves. The proportions of clients aiming for abstinence and controlled drinking were relatively stable across the four assessments, and the proportion of clients who changed their drinking goal from abstinence to controlled drinking did not differ significantly from the number who changed in the opposite direction. Clients with abstinence-focused trajectories reported higher baseline alcohol use than those focused primarily on controlled drinking. Meanwhile, attaining nonhazardous drinking and reduced alcohol use at 12-month follow up were more likely among clients with abstinence-focused trajectories than those focused on controlled drinking. Conclusions: Since the majority of clients maintain their initially selected drinking goal, counsellors might inform them at treatment admission about the various probabilities of achieving nonhazardous drinking depending on their selected drinking goal.

Augmenting Outpatient Alcohol Treatment as Usual With Online Alcohol Avoidance Training: Protocol for a Double-Blind Randomized Controlled Trial.

BackgroundRecent theoretical models emphasize the role of impulsive processes in alcohol addiction, which can be retrained with computerized Cognitive Bias Modification (CBM) training. In this study, the focus is on action tendencies that are activated relatively automatically.ObjectiveThe aim of the study is to examine the effectiveness of online CBM Alcohol Avoidance Training using an adapted Approach-Avoidance Task as a supplement to treatment as usual (TAU) in an outpatient treatment setting.MethodsThe effectiveness of 8 online sessions of CBM Alcohol Avoidance Training added to TAU is tested in a double-blind, randomized controlled trial with pre- and postassessments, plus follow-up assessments after 3 and 6 months. Participants are adult patients (age 18 years or over) currently following Web-based or face-to-face TAU to reduce or stop drinking. These patients are randomly assigned to a CBM Alcohol Avoidance or a placebo training. The primary outcome measure is a reduction in alcohol consumption. We hypothesize that TAU + CBM will result in up to a 13-percentage point incremental effect in the number of patients reaching the safe drinking guidelines compared to TAU + placebo CBM. Secondary outcome measures include an improvement in health status and a decrease in depression, anxiety, stress, and possible mediation by the change in approach bias. Finally, patients’ adherence, acceptability, and credibility will be examined.ResultsThe trial was funded in 2014 and is currently in the active participant recruitment phase (since May 2015). Enrolment will be completed in 2019. First results are expected to be submitted for publication in 2020.ConclusionsThe main purpose of this study is to increase our knowledge about the added value of online Alcohol Avoidance Training as a supplement to TAU in an outpatient treatment setting. If the added effectiveness of the training is proven, the next step could be to incorporate the intervention into current treatment.Trial RegistrationNetherlands Trial Register NTR5087; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5087 (Archived at WebCite http://www.webcitation.org/6wuS4i1tH)

Improving Outpatient Alcohol Treatment Systems: Integrating Focus on Motivation and Actuarial Matching

ABSTRACTThis study investigates the benefit of adding a data-driven actuarial matching system and focus on motivation to routine outpatient alcoholism treatment. The study is a two-cohort quasi-experimental study. One cohort (188 clients) were assigned to treatment based on clinician judgment. Cohort 2 (175 clients) were assigned to treatment based on actuarial matching procedures. Both cohorts were followed for 12 months. A total of 37% of Cohort 2 dropped out of treatment, compared to 52% of Cohort 1. Cohort 2 also showed greater reduction in alcohol consumption and greater improvement. Actuarial matching procedures appear to have improved treatment retention and outcome.

Can We Predict Which Adolescents Will Engage in Outpatient Substance Abuse Treatment?

Understanding which adolescents remain in substance abuse treatment may facilitate the development of effective strategies for enhancing engagement and retention. Using clinical service data from a large naturalistic sample of adolescents, we examined whether client characteristics predict retention in outpatient alcohol and other drug (AOD) treatment. χ2 tests and multinomial logistic regressions were conducted to examine relationships between sociodemographic and substance use variables and clinic attendance. Client characteristics of ethnicity, sex, age, living situation (whether living with or away from family), and substance use severity were associated with retention in community AOD treatment. Pacific Island youth, females, 13- to 15-year olds, clients living with family, and clients with more severe substance use were generally more likely to be “engaged” with the service (ie, attended 4+ sessions) than their European and Maori, male, 16- to 19-year-old, and living away from home counterparts. These findings may inform more targeted engagement strategies in the future.

Thirty- Versus Ten-Day Diazepam Treatment for Alcohol Detoxification and a Comparison of Drinking Patterns, Craving, and Anxiety for up to 12 Weeks: A "Proof-of-Concept" Open-Label Randomized Controlled Trial.

The aim of this study was to evaluate whether a prolonged detoxification treatment could decrease the relapse rate at 3 months after alcohol cessation in alcohol-dependent individuals through decreasing the levels of postdetoxification craving and anxiety. Twenty-six adult patients with alcohol dependence (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) who began an outpatient alcohol cessation program with an initial drinking goal of abstinence were enrolled in a 3-month, parallel, randomized (1:1 ratio), controlled, open-label, pilot trial. Participants were randomized to receive a detoxification treatment of diazepam with a duration of 30 (n = 12) or 10 days (n = 14). All participants received BRENDA-based psychotherapy during follow-up. No significant between-group difference in relapse to any drinking was found at 3 months (P = 0.20). However, relapse to any heavy drinking at 3 months and regular drinking or heavy drinking during follow-up were significantly lower in the 30-day diazepam group (P = 0.009, P = 0.049, and P = 0.004, respectively). These differences were corroborated by significant differences in the alcohol-specific biological marker carbohydrate deficient transferrin at 3 months. Participants in the 30-day diazepam group also displayed significantly lower scores for alcohol craving (P = 0.007), self-reported anxiety (P = 0.024), and clinician-assessed anxiety (P = 0.002) throughout the follow-up. No serious adverse event was reported during the study. This study provides an evidence-based rationale for a double-blind, randomized, placebo-controlled trial to confirm the efficacy of such a procedure on short-term and mid-/long-term drinking outcomes after alcohol cessation in alcohol-dependent individuals.

Exercise as adjunctive treatment for alcohol use disorder: A randomized controlled trial.

AimsTo examine whether physical activity as an adjunct to outpatient alcohol treatment has an effect on alcohol consumption following participation in an exercise intervention of six months’ duration, and at 12 months after treatment initiation.MethodsThe study is a randomized controlled study with three arms: Patients allocated to (A) treatment as usual, (B) treatment as usual and supervised group exercise, (C) treatment as usual and individual physical exercise. The primary outcome measure was excessive drinking six months after treatment start and completion of the intervention. A logistic regression model was used to evaluate the odds of excessive drinking among the three groups, based on intention-to-treat. Changes in level of physical activity in all three groups were tested by using a generalized linear mixed model. A multiple linear model was used to test if there was an association between amount of performed physical activity and alcohol consumption.ResultsA total of 175 patients (68.6% male) participated. Response rates were 77.7% at six months and 57.1% at 12 months follow-up. OR 0.99 [95% CI: 0.46; 2.14], p = 0.976 for excessive drinking in the group exercise condition, and 1.02 [95% CI: 0.47; 2.18], p = 0.968 in the individual exercise condition, which, when compared to the control group as reference, did not differ statistically significantly. Participants with moderate level physical activity had lower odds for excessive drinking OR = 0.12 [0.05; 0.31], p<0.001 than participants with low level physical activity. Amount of alcohol consumption in the intervention groups decreased by 4% [95% CI: 0.03; 6.8], p = 0.015 for each increased exercising day.ConclusionsNo direct effect of physical exercise on drinking outcome was found. Moderate level physical activity was protective against excessive drinking following treatment. A dose-response effect of exercise on drinking outcome supports the need for implementing physically active lifestyles for patients in treatment for alcohol use disorder.

Effectiveness of Optional Videoconferencing-Based Treatment of Alcohol Use Disorders: Randomized Controlled Trial.

BackgroundTreatment of alcohol use disorders (AUDs) is characterized by an adherence rate below 50%. Clinical research has found that patient adherence enhances treatment effect; hence, health authorities, clinicians, and researchers strive to explore initiatives contributing to patients receiving treatment. Concurrently, videoconferencing-based treatment is gaining ground within other addiction and psychiatric areas.ObjectiveThe aim of this study was to test whether optional videoconferencing increases adherence to and effectiveness of AUD treatment in a randomized controlled trial (RCT). We hypothesized that the intervention would decrease premature dropout (the primary outcome), as well as increase successful treatment termination, treatment duration, and treatment outcome (secondary outcomes).MethodsWe conducted this study in the public outpatient alcohol clinic in Odense, Denmark, between September 2012 and April 2013. It was an RCT with 2 groups: treatment as usual (TAU) and treatment as usual with add-on intervention (TAU+I). The TAU+I group had the option, from session to session, to choose to receive treatment as usual via videoconferencing. Data consisted of self-reported responses to the European version of the Addiction Severity Index (EuropASI). We collected data at baseline, at follow-up at 3, 6, and 12 months, and at discharge.ResultsAmong consecutive patients attending the clinic, 128 met the inclusion criteria, and 71 of them were included at baseline. For the primary outcome, after 180 days, 2 of 32 patients (6%) in the TAU+I group and 12 of 39 patients (31%) in the TAU group had dropped out prematurely. The difference is significant (P=.008). After 365 days, 8 patients (25%) in the TAU+I group and 17 patients (44%) in the TAU group had dropped out prematurely. The difference is significant (P=.02). For the secondary outcomes, significantly more patients in the TAU+I group were still attending treatment after 1 year (P=.03). We found no significant differences between the 2 groups with regard to successful treatment termination and treatment outcome.ConclusionsThe results indicate that offering patients optional videoconferencing may prevent premature dropouts from treatment and prolong treatment courses. However, the small sample size precludes conclusions regarding the effect of the intervention, which was not detectable in the patients’ use of alcohol and severity of problems.Trial RegistrationThe Regional Health Research Ethics Committee System in Denmark: S-20110052; https://komite.regionsyddanmark.dk/wm258128 (Archived by WebCite at http://www.webcitation.org/6tTL3CO6u)

Effects of Treatment Type on Alcohol Consumption Partially Mediated by Alcoholics Anonymous Attendance

ABSTRACTBackground: As insurance coverage, funding sources and venues for drug and alcohol treatment evolve in the United States, it is important to assess how the type of treatment received may impact long-term outcomes. The current study aims were to examine effects of treatment type on alcohol consumption in the year after treatment intake and to test mediators of effects of treatment type on later alcohol use. Methods: Longitudinal data from clients in inpatient and outpatient alcohol treatment programs in California (n = 560) were used in ordinary least squares path analysis adjusting for respondent characteristics typically associated with both treatment completion and alcohol use. The primary outcome was amount of alcohol consumed in the 12 months after treatment entry; hypothesized mediators were treatment duration and participation in Alcoholics Anonymous (AA). Results: Despite higher baseline problem severity and a shorter treatment duration, inpatient clients consumed less alcohol after treatment than outpatient clients (B [95% CI] = −0.95 [−1.67, −0.23]). AA involvement was a significant mediator of the relationship between treatment type and alcohol consumption, with inpatient clients being more involved in AA and also drinking less after treatment than outpatient clients; the bias-corrected bootstrap 95% confidence interval for the indirect effect (B = −0.20) was entirely below zero (−0.43 to −0.05). Conclusions: Outpatient clients may benefit from customized posttreatment recommendations to identify additional resources to assist in the recovery process during the first year after treatment.

Alexithymia influences craving through facets of emotion regulation in alcoholic patients

ABSTRACTThere is evidence that alexithymia is related to alcohol problems. However, no study has been conducted to show whether emotion regulation (ER) subscales such as reappraisal and suppression mediate the relationship between alexithymia and craving. The aim of this study was to evaluate the effects of ER subscales (i.e., reappraisal and suppression) as mediators on the relationships between alexithymia and subscales of craving (i.e., obsessive and compulsive subscales). A total of 205 alcoholic outpatients completed the Farsi version of the Toronto Alexithymia Scale (FTAS-20), the Emotion Regulation Questionnaire (ERQ), the Obsessive Compulsive Drinking Scale (OCDS), the Alcohol Use Disorders Identification Test (AUDIT), and the Beck Depression Inventory-II (BDI-II). Results revealed that alexithymia indirectly influenced obsessive and compulsive cravings through both paths of ER decreased reappraisal and increased suppression subscales. Also, the relations of alexithymia to obsessive and compulsive cravings through the mediation pathway of decreased reappraisal were stronger than the path of suppression. It was concluded that low reappraisal and high suppression seem to be important in predicting obsessive and compulsive cravings for alcoholics with alexithymia. This suggests that the efforts based on increasing reappraisal and decreasing suppression may be important in reducing craving in alcoholic patients.

Patients' Knowledge and Attitudes Towards Regular Alcohol Urine Screening: A Survey Study.

Despite its wide implementation, there is a paucity of data supporting the effectiveness of regular alcohol urine screening (RAUS) in maintaining abstinence. This study aims at investigating if RAUS serves other purposes, what attitudes patients display towards it, and patients' technical knowledge about basic screening notions. We conducted a cross-sectional survey among adults with alcohol dependence, attending outpatient alcohol-dependence treatment. It aimed at investigating patients' attitudes and beliefs towards RAUS, and technical notions of alcohol urine screening. For attitude assessment, we adapted the Drug Attitude Inventory (DAI-10) to the field of alcohol urine screening. Internal consistency, test-retest reliability, and concurrent validity were evaluated for the adapted questionnaire. In all, 128 patients completed the questionnaire. Patients rated RAUS as high. The DAI-10 mean score was 7.2 (SD = 3.6). Internal consistency analysis revealed a Cronbach alpha of 0.718. Test-retest reliability evaluation yielded an intraclass correlation coefficient of 0.932. The score of a single Likert-type question about overall perceived value was 8.5 (SD = 2). Their correlation with mean DAI-10 score was of r = 0.254, with P = 0.009. Apart from relapse prevention, patients frequently reported other functions such as showing professionals and family members that they do not drink, or having a closer contact with professionals. A majority of patients believed alcohol use goes undetected after 48 hours from last ingestion. Regular alcohol screening is highly valued by alcohol outpatients. It seems that apart from relapse prevention, other functions related to therapeutic alliance building, social desirability, and impression management also play a key role.

Computer tablet or telephone? A randomised controlled trial exploring two methods of collecting data from drug and alcohol outpatients

ObjectiveBoth computerised and telephone surveys have potential advantages for research data collection. The current study aimed to determine the: (i) feasibility, (ii) acceptability, and (iii) cost per completed survey of computer tablet versus telephone data collection for clients attending an outpatient drug and alcohol treatment clinic. DesignTwo-arm randomised controlled trial. MethodClients attending a drug and alcohol outpatient clinic in New South Wales, Australia, were randomised to complete a baseline survey via computer tablet in the clinic or via telephone interview within two weeks of their appointment. All participants completed a three-month follow-up survey via telephone. ResultsConsent and completion rates for the baseline survey were significantly higher in the computer tablet condition. The time taken to complete the computer tablet survey was lower (11min) than the telephone condition (17min). There were no differences in the proportion of consenters or completed follow-up surveys between the two conditions at the 3-month follow-up. Acceptability was high across both modes of data collection. The cost of the computer tablet condition was $67.52 greater per completed survey than the telephone condition. ConclusionThere is a trade-off between computer tablet and telephone data collection. While both data collection methods were acceptable to participants, the computer tablet condition resulted in higher consent and completion rates at baseline, therefore yielding greater external validity, and was quicker for participants to complete. Telephone data collection was however, more cost-effective. Researchers should carefully consider the mode of data collection that suits individual study needs.

Difficulties in emotion regulation mediate negative and positive affects and craving in alcoholic patients

The aim of this study was to assess the mediating effects of difficulties in emotion regulation (DER) on the relations of negative and positive affects to craving in alcoholic patients. 205 treatment-seeking alcoholic outpatients were included. DER, positive and negative affects as well as craving were evaluated by the Difficulties in Emotion Regulation Scale (DERS), the Positive/Negative Affect Scales, and the Obsessive Compulsive Drinking Scale (OCDS) respectively. Clinical factors including depression and severity of alcohol dependence were investigated by the Alcohol Use Disorders Identification Test (AUDIT) and the Beck Depression Inventory-II (BDI-II) respectively. Results revealed that both increased negative affect and decreased positive affect indirectly influenced craving through limited access to emotion regulation strategies. It was concluded that limited access to emotion regulation strategies may be important in predicting craving for alcoholics who experience both increased negative affect and decreased positive affect. This suggests that treatment and prevention efforts focused on increasing positive affect, decreasing negative affect and teaching effective regulation strategies may be critical in reducing craving in alcoholic patients.

Integration of Outpatient Alcohol Treatment in Drug Use Disorder Treatment Centers in Iran: Study Protocol

Background: Alcohol use is a health concern in Iran, the most populated Persian Gulf country. However, alcohol use disorder treatment is a new issue in Iran, which needs consideration. Objectives: In this article, we present a study protocol that aims to investigate the feasibility and effectiveness of integration of outpatient alcohol use disorder treatment in drug treatment centers in Iran. Methods: The study design is a prospective cohort and multi-center research, which will be conducted in major cities of Iran in 2016 - 2017. Overall, 750 participants with psychiatric diagnosis of hazardous alcohol drinking or dependence will be recruited. The settings will be 150 outpatient drug treatment centers. This project will be implemented in 3 phases. Phase I will be the preparation phase, Phase II will focus on training treatment providers and Phase III will be the main phase of the study and will evaluate the feasibility and effectiveness of integration of alcohol use disorder treatment services within outpatient network of drug treatment centers. Five questionnaires will be used to assess the study outcomes. Completing the study questionnaires at baseline, weeks 4, 12, 24, and 52 will assess participants. Data analyses, including descriptive statistics, regression models, and repeated measures of ANOVA will be performed using SPSS version 22. Conclusions: This is the first study to investigate the feasibility and effectiveness of integration of outpatient alcohol use disorder treatment in drug treatment centers in Iran. If found effective, the results of this study will be useful for applying in Iran and other countries in Western and Central Asia.

Evaluation of Subclinical Left Ventricular Systolic Dysfunction in Chronic Asymptomatic Alcoholics by Speckle Tracking Echocardiography.

By using two-dimensional speckle tracking echocardiography, we aimed to investigate the structural and functional changes on myocardium in chronic asymptomatic alcoholics without any cardiovascular disease. Forty-one consecutive asymptomatic male alcoholics who were admitted to the outpatient alcoholism unit and 30 age matched healthy male volunteers selected as the control group were enrolled in the study. The study group were investigated by using standard two-dimensional echocardiography and speckle tracking echocardiography. The left ventricular (LV) global longitudinal strain and LV global circumferential strain were significantly lower in alcoholics when compared with control subjects. There was no difference in global radial strain between the two groups. To demonstrate the effect of total life time dose of ethanol (TLDE) on echocardiographic abnormalities, we assessed the correlation analysis. There was a nonsignificant weak correlation between global LV circumferential strain and TLDE (r = 0.27, p = 0.083). Speckle tracking echocardiography derived left ventricular systolic function was impaired in chronic alcoholic patients when compared with healthy controls.

Percepcja programów redukcji szkód skierowanych do osób uzależnionych od alkoholu. Wyniki badania jakościowego wśród terapeutów alkoholowego lecznictwa ambulatoryjnego w Polsce

Percepcja programów redukcji szkód skierowanych do osób uzależnionych od alkoholu. Wyniki badania jakościowego wśród terapeutów alkoholowego lecznictwa ambulatoryjnego w Polsce

Effects of distance to treatment on subsequent alcohol consumption

Background: Distance and travel time are barriers to attending and completing drug and alcohol treatment. Few studies have examined proximity to treatment in relation to long-term outcomes.Objectives: Aims were to examine effects of distance to treatment on alcohol consumption in the year after treatment intake; assess moderation of distance effects by treatment type; and test mediators of effects of distance to treatment on later alcohol use.Methods: Data from clients in inpatient and outpatient alcohol treatment programmes in California (n = 560) were used in linear regression models.Results: There was a significant interaction between treatment type and distance on later drinking, with a significant positive association of distance to treatment with alcohol use after treatment for inpatient clients only. Among inpatient clients, none of the mediators significantly explained the relationship between a longer distance to treatment and greater subsequent alcohol use.Conclusion: Inpatient clients may benefit from customized post-treatment recommendations to identify recovery resources near home.

Drinking Goals and Their Association With Treatment Retention and Treatment Outcomes Among Clients in Outpatient Alcohol Treatment

ABSTRACTBackground: Few studies have compared characteristics of clients entering alcohol treatment who differ in their drinking goal preferences or have investigated the relevance of drinking goals as a predictor of treatment outcomes. Objectives: To investigate associations between baseline drinking goal preferences and client characteristics as well as treatment retention and outcomes among clients in outpatient alcohol treatment. Methods: Secondary data analyses on a longitudinal multicenter study investigating the effectiveness of outpatient alcohol treatment in Switzerland among 805 clients. Assessments were conducted at treatment admission, discharge, and at 6- and 12-month follow ups. At-risk drinking was assessed through the alcohol use disorders identification test. Treatment retention was defined as regular discharge with or without transition into another institution. Results: Clients aiming to abstain from drinking were more likely to be in retreatment, to be assigned to treatment by a health institution, to have no at-risk alcohol use, and to be already alcohol abstinent at the time of admission relative to clients who aimed to control their drinking. Clients without at-risk alcohol use at admission showed higher treatment retention when aiming for controlled drinking than for abstinence, while there was no difference in treatment retention among clients with at-risk use. Clients with at-risk use at admission were more likely to reach not-at-risk alcohol use status when aiming for alcohol abstinence than for controlled drinking. Conclusions: Drinking goals are associated with variables of alcohol use and treatment assignment. They have different effects on treatment retention and treatment outcomes according to alcohol use at the time of admission.