Severe Alcohol Problems Research Articles

Risk factors for sleep disturbance and its effect on quality of life: An Analysis of Retrospective Cohort Study of adults with neck injuries

Persons with neck injuries often have lasting psychosocial effects. One symptom that occurs in a significant number of persons is problems with sleep. Until recently, it was unclear about the predictors of sleep disturbances after a neck injury that does not tend to resolve within six months post injury. In addition, very little is known about how sleep affects overall self reported quality of life, controlling for other relevant predictors. The study aims to examine predictors of sleep disturbances after a neck injury that does not tend to resolve within six months of post injury and how sleep disturbance affects overall quality of life to those having six months post injuries. Methods Data from a retrospective cohort study of adults have been used to investigate the study. The study population were 258 adults aged (at least 14 years) suffering from moderate to severe neck injury at an acute care Hospital in Toronto, Canada. Both exploratory as well as advanced logistic regression analyses were used in the study. Results The study shows that participants who had alcohol problem are experiencing about two times higher sleep disturbance and participants with lower education are approximately 3 times more likely of having trouble with sleep than those with higher education. The injury severity and marital status are also found to be important determinant for sleep disturbances. Again, as expected, sleep disturbance and mental health are associated with defining quality of life. Conclusion This study reveals that marriage, alcohol problem, education, mental health and injury severity are significantly associated with sleep disturbance. On the other hand, strong associations are observed among sleep, mental health and quality of life. These finding helps in understanding risk factors related to sleep disturbance and their consequences on the quality of life.

The Journal of Inebriety (1876–1914): history, topical analysis, and photographic images

The publication of the Journal of Inebriety (1876-1914) chronicled the rise and fall of the first era of organized addiction medicine in the United States. Findings from historical research, a content analysis of the Journal's 35 volumes and 141 issues and images from the Journal illustrate visually the medical treatment of addiction in the United States in the late 19th and early 20th centuries. Under the editorial direction of Dr T. D. Crothers, the Journal of Inebriety published papers and reviews focused primarily on the medical treatment of alcohol and opiate addiction within a growing international network of inebriate homes and asylums. The history of the Journal of Inebriety mirrors efforts in America to forge a legitimized field of addiction medicine amid conflicting conceptualizations of the nature of severe alcohol and other drug problems.

Ethnic disparities in clinical severity and services for alcohol problems: results from the National Alcohol Survey.

This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over-represented in treatment settings. Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence. While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higher-severity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care. Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care.

Intention to utilize formal help in a sample with alcohol problems: A prospective study

Background Studies investigating factors of treatment entry have predominantly focussed on persons that have already taken an initial step in the process of help-seeking. With particular emphasis on intention to utilize help, this study aims to detect predictors for alcohol-related help-seeking among a non-help-utilizing sample. Methods Using 312 individuals with diverse alcohol problems (dependence, abuse, at-risk drinking), intention to utilize help was assessed in addition to evidence based predictors for utilization of help (e.g. severity of alcohol problem, prior help-seeking). Results In addition to prior utilization of help (OR = 9.76, CI: 4.60–20.74) and adverse consequences from drinking (OR = 1.13, CI: 1.02–1.25), intention to utilize help (OR = 4.84, CI: 2.04–11.51) was a central predictor for help-seeking. Among individuals who had not obtained prior help, individuals intending to seek help were 8.7 times more likely to utilize help than those not intending to seek help (CI: 1.05–72.2). Conclusions In the past, intention to utilize help has been neglected from models investigating treatment entry. This study's findings show that intention is a central factor for utilization of alcohol-specific formal help. Consequently, brief interventions focusing on enhancing motivation are expected to improve early help-seeking among general hospital patients with diverse alcohol problems.

Intimate Partner Aggression Reporting Concordance and Correlates of Agreement Among Men With Alcohol use Disorders and Their Female Partners

This study examined relationship aggression reporting concordance among 303 men with alcohol use disorders and their female partners enrolled in couples-based alcohol abuse treatment. Agreement for physical and psychological aggression was generally consistent with, or higher than, concordance rates reported among other populations. Men's antisocial personality disorder characteristics were the strongest predictor of higher concordance for male- and female-perpetrated aggression. Higher alcohol problem severity, poorer relationship adjustment, and higher psychopathic personality features were associated with better concordance in some analyses. Women reported experiencing more physical aggression than men reported perpetrating, and women reported perpetrating more psychological aggression than men reported experiencing. Findings highlight the importance of obtaining aggression reports from both partners and the need for research investigating methods for improving concordance.

Do individuals with a severe mental illness experience greater alcohol and drug-related problems? A test of the supersensitivity hypothesis

The supersensitivity hypothesis posits that individuals with a severe mental illness (i.e., schizophrenia and bipolar disorder; SMI) are more likely to be diagnosed with a substance abuse as opposed to a substance dependence diagnosis, and experience greater negative consequences associated with substance use at lower levels of consumption, as compared with non-SMI substance abusers. This is the first known study to test this hypothesis with a control group of non-SMI substance abusing individuals. Forty-two individuals with only a substance use disorder (SUD-only) and 53 dually diagnosed individuals (DD) were compared on measures of substance use, alcohol and drug dependence, negative consequences, substance use outcome expectancies, and motivation for change. A third group of SMI-only individuals (i.e., no SUD; n = 35) were also recruited and all three groups were compared on psychological symptoms. Substance use, negative consequences, substance use outcome expectancies, motivation for change, and severity of alcohol and drug dependence were not found to differ significantly between the DD and SUD-only groups. However, the DD group had significantly greater levels of psychological symptoms, as compared with the SMI-only and SUD-only groups. Overall, this study does not provide support for the supersensitivity hypothesis.

Krankenhauspatienten mit riskantem Alkoholkonsum sind offen für Beratung

The aim of this study was to determine predictors for openness to alcohol-related counselling among general hospital patients with alcohol problems. We wanted to test whether those with less severe alcohol problems and those with a lack of motivation for behaviour charge or with a lack of motivation to seek help would agree to participate in alcohol-related counselling. A total of 1150 hospital patients with alcohol dependence, alcohol abuse, at-risk drinking or excessive drinking were interviewed. They were asked about their attitude towards alcohol-related counselling, about their motivation to change their drinking and about their motivation to seek professional help. A multi-variable logistic regression analysis was calculated to determine predictors for agreement to counselling. A total of 66 % of all participants agreed to receive information on professional help and on how they could help themselves. Among these were 77 % of the alcohol dependent participants and 56 % of the non-dependent participants. Motivation to change and motivation to seek help were identified as the most significant predictors for agreement to counselling. However, 63 % of the participants open for counselling were not yet ready to change their habits and 62 % were not yet ready to seek profession help. The majority of hospital patients with less severe alcohol problems as well as the majority of hospital patients not ready to seek more intensive professional help were open for alcohol-related counselling. Given a systematic screening, this opens up the opportunity for addiction counsellors, hospital physicians or nurses to actively offer counselling.

Explorations of Parenting Environments in the Evolution of Psychiatric Problems in Children

Explorations of Parenting Environments in the Evolution of Psychiatric Problems in Children

Is alcoholism typology a predictor of both Alcoholics Anonymous affiliation and disaffiliation after treatment?

Twelve Steps (TS) has demonstrated effectiveness; induction into Alcoholics Anonymous (AA) is a primary objective of TS and is a pivotal mechanism explaining its effectiveness. However, evidence suggests that, after treatment, dropout from AA is high. This study investigated whether alcohol problem severity predicted both AA affiliation and disaffiliation among clients receiving TS. This study of a Project MATCH sample included 453 alcohol-dependent clients randomly assigned to TS who reported AA attendance during treatment. Greater alcohol problem severity predicted AA attendance; opposite to prediction, less alcohol-impaired clients were more than twice as likely to discontinue AA attendance after treatment. When sustained AA attendance is desired, the evaluation of client pretreatment alcohol involvement may be useful for identifying potential AA dropout after TS treatment. Findings also indicate that, among treatment-seeking problem drinkers, AA dropout and disaffiliation are distinct, albeit correlated, constructs that require future investigation.

Adolescents entering chemical dependency treatment in private managed care: ethnic differences in treatment initiation and retention

Purpose There has been little research on adolescents of different ethnicities in chemical dependency (CD) treatment, despite a focus on ethnic disparities in health care in recent years. In particular, little is known about ethnic differences in utilization of adolescent CD services. Methods We examined treatment initiation and treatment retention in a sample of African American, Native American, Latino, Asian American, and Caucasian adolescents entering CD treatment in a private, managed care health plan (n = 419). Our conceptual framework included ethnicity as the main factor as well as measures of external pressure and internal motivation/readiness for treatment, family environment, psychiatric co-morbidities, and severity of alcohol and drug problems. Logistic and Poisson regression were used to examine differences. Results The study found ethnic differences in treatment initiation and treatment retention. Native American adolescents had lower odds of returning after intake to initiate treatment compared with Caucasians (odds ratio [OR] .35, p = .009), and African American youth spent less time in treatment than Caucasians (RR: .49, p < .001). Conclusions Study findings indicate differences in treatment initiation for Native Americans and in treatment retention for African Americans. Intake and orientation sessions offer an opportunity to intervene with Native American youth. Given their high psychiatric co-morbidity, they may also benefit from the availability of psychiatric services. Even after adjusting for severity, we found shorter treatment retention for African American adolescents and suggest that organizational factors, such as cultural competency, may play an important role.

Correlates of motivation to quit smoking among alcohol dependent patients in residential treatment

Substance use and smoking co-occur at high rates and substance abusers smoke more and have greater difficulty quitting smoking compared to the general population. Methods of increasing smoking cessation among alcoholics are needed to improve their health. This study investigated predictors of motivation to quit smoking among patients early in residential treatment for substance abuse. The 198 alcohol dependent patients were participating is a larger smoking study at an inner-city residential substance abuse treatment program. Motivation was measured by the Contemplation Ladder. A hierarchical multiple regression was conducted to assess whether perceived barriers to smoking cessation and self-efficacy about quitting were associated with motivation to quit smoking independent of the influence of degree of tobacco involvement, substance use, and comorbid depressive symptoms. Motivation was higher with longer previous smoking abstinence, fewer barriers to quitting, and greater self-efficacy but was not influenced by smoking rate, dependence, or gender. While the combination of alcohol and drug use, alcohol and drug problem severity, and depressive symptoms predicted motivation, no one of these variables was significant. Since barriers to change and self-efficacy are potentially modifiable in treatment, these could be salient targets for intervention efforts. This could be integrated into treatment by assessing barriers and providing corrective information about consequences and methods of overcoming barriers and by providing coping skills to increase confidence in one's ability to quit smoking.

Relationship between Custodial Status and Psychosocial Problems among Cocaine‐Abusing Parents Initiating Substance Abuse Treatment

Using the Addiction Severity Index and Brief Symptom Inventory, drug use and psychosocial problems are compared between 93 custodial and 125 non-custodial mothers and fathers initiating outpatient treatment for cocaine dependence. Compared to non-custodial parents, custodial parents experienced more severe current cocaine and alcohol problems, including spending more money on cocaine and alcohol, as well as using more cocaine and being intoxicated on more days. Non-custodial parents demonstrated more psychological distress, more prior history of alcohol problems, and greater current employment and legal problems than custodial parents. Suggestions are made for differential treatment plans based on these findings.

READINESS FOR CHANGE AND READINESS FOR HELP-SEEKING: A COMPOSITE ASSESSMENT OF CLIENT MOTIVATION

To investigate the correspondence between readiness for behaviour change in general and readiness for alcohol related help-seeking in particular. A related aim was to examine how, if at all, measures of dependence severity, use, and consequences were related to a composite measure depicting agreements and disagreements between general change readiness and help-seeking readiness. Non-treatment seeking alcohol-dependent patients, numbering 549, from general hospitals in Germany were interviewed. When taking into account both dimensions of motivation, findings indicate 42% of the subjects were characterized by different motivation levels regarding readiness for change and readiness for help-seeking. Higher help-seeking readiness was associated with higher alcohol problem severity. Readiness to change was not affected by alcohol problem severity. Findings underscore the need to evaluate both motivational constructs in determining clients' need and receptivity to formal help.

Contingent Gambling-Drinking Patterns and Problem Drinking Severity Moderate Implicit Gambling-Alcohol Associations in Problem Gamblers

Although problem gambling and problem drinking often co-occur, the processes underlying this association are not well understood. This study investigated the effects of contingent gambling-drinking patterns and problem drinking severity on implicit gambling-alcohol associations. Participants were 144 (34 female) problem gamblers. The South Oaks Gambling Screen (SOGS) measured severity of problem gambling. The Brief Michigan Alcohol Screening Test (BMAST) measured severity of problem drinking. The Implicit Association Test (Greenwald, McGhee, & Schwartz, 1998, Journal of Personality and Social Psychology, 74, 1464-1480) measured gambling-alcohol associations. Participants who reported drinking when they won displayed faster response time (i.e., priming) on trials where alcohol words were paired with gambling win (e.g., jackpot) vs. gambling loss (e.g., forfeit) words. The tendency to drink in response to losses did not influence the priming effect of win cues or moderate the effects of Win-Drinking Pattern on priming. Severity of problem drinking on the BMAST also correlated positively the priming effects of win cues. These findings indicate that a tendency to drink in response to gambling wins and more severe alcohol problems each coincide with stronger associations between gambling win and alcohol concepts in memory. Such associations can promote drinking and its attendant effects (e.g., poor decision-making) in problem gamblers, and thus, may contribute to co-morbid gambling and alcohol use disorders.

Stepped Care: A Promising Treatment Strategy for Mandated Students

Over the past decade, there has been a steady increase in the number of mandated students who have been referred to campus alcohol programs for violating campus alcohol policies. However, the severity of alcohol use and problems varies widely in mandated students, indicating that a “one size fits all” delivery of treatment may be inappropriate. Instead, an approach that tailors treatment may be more clinically effective, efficient, and cost-effective. Stepped care assigns individuals to different levels of treatment based on personal characteristics. This article discusses the promise of implementing stepped care with mandated students. We review previous applications of stepped care in the alcohol field, along with empirically validated interventions that could be incorporated into this approach. In addition, we address several issues to be considered when implementing stepped care with mandated students.

Toward Efficient and Comprehensive Measurement of the Alcohol Problems Continuum in College Students: The Brief Young Adult Alcohol Consequences Questionnaire

Although a number of measures of alcohol problems in college students have been studied, the psychometric development and validation of these scales have been limited, for the most part, to methods based on classical test theory. In this study, we conducted analyses based on item response theory to select a set of items for measuring the alcohol problem severity continuum in college students that balances comprehensiveness and efficiency and is free from significant gender bias. We conducted Rasch model analyses of responses to the 48-item Young Adult Alcohol Consequences Questionnaire by 164 male and 176 female college students who drank on at least a weekly basis. An iterative process using item fit statistics, item severities, item discrimination parameters, model residuals, and analysis of differential item functioning by gender was used to pare the items down to those that best fit a Rasch model and that were most efficient in discriminating among levels of alcohol problems in the sample. The process of iterative Rasch model analyses resulted in a final 24-item scale with the data fitting the unidimensional Rasch model very well. The scale showed excellent distributional properties, had items adequately matched to the severity of alcohol problems in the sample, covered a full range of problem severity, and appeared highly efficient in retaining all of the meaningful variance captured by the original set of 48 items. The use of Rasch model analyses to inform item selection produced a final scale that, in both its comprehensiveness and its efficiency, should be a useful tool for researchers studying alcohol problems in college students. To aid interpretation of raw scores, examples of the types of alcohol problems that are likely to be experienced across a range of selected scores are provided.

Functioning and Health Service Use Among Elderly Nursing Home Residents With Alcohol Use Disorders: Findings From The National Nursing Home Survey

<h3>Objective</h3> The author asked whether older nursing home residents with alcohol use disorders differ from demographically-matched residents without alcohol use disorders on functioning, admission characteristics, and health services use. <h3>Method</h3> National Nursing Home Survey data were used to compare nursing home residents with alcohol use disorders (N = 216) with demographically-matched residents without alcohol use disorders (N = 216) on functioning, admission characteristics, and health services use. <h3>Results</h3> Residents with alcohol use disorders functioned somewhat better than did residents in the demographically-matched sample group, as indicated by performance of basic activities of daily living. However, they were significantly more likely to have lived alone before admission and to have obtained mental health and social services. There was a significant group × gender interaction on length of stay: men with alcohol use disorders had shorter lengths of stay than did men without alcohol use disorders; women with alcohol use disorders had longer lengths of stay than did women without such disorders. <h3>Conclusions</h3> Having fewer social resources may contribute to elevated admission risk and need for mental health and social services among older nursing home residents who have alcohol use disorders. Duration and severity of alcohol problems may help explain gender differences in length of stay among these residents.

Functioning and Health Service Use Among Elderly Nursing Home Residents With Alcohol Use Disorders: Findings From The National Nursing Home Survey

The author asked whether older nursing home residents with alcohol use disorders differ from demographically-matched residents without alcohol use disorders on functioning, admission characteristics, and health services use. National Nursing Home Survey data were used to compare nursing home residents with alcohol use disorders (N=216) with demographically-matched residents without alcohol use disorders (N=216) on functioning, admission characteristics, and health services use. Residents with alcohol use disorders functioned somewhat better than did residents in the demographically-matched sample group, as indicated by performance of basic activities of daily living. However, they were significantly more likely to have lived alone before admission and to have obtained mental health and social services. There was a significant group x gender interaction on length of stay: men with alcohol use disorders had shorter lengths of stay than did men without alcohol use disorders; women with alcohol use disorders had longer lengths of stay than did women without such disorders. Having fewer social resources may contribute to elevated admission risk and need for mental health and social services among older nursing home residents who have alcohol use disorders. Duration and severity of alcohol problems may help explain gender differences in length of stay among these residents.

Health and Psychosocial Correlates of Disordered Gambling in Older Adults

A number of regional prevalence studies suggest that disordered gambling is a clinically significant problem among older adults. However, little research has evaluated whether older adults with a gambling disorder experience increased health, psychiatric, substance use, and social problems as compared with older adults without a gambling disorder. A group of 48 older-adult disordered gamblers and 48 older adult non/infrequent gamblers, matched by age, sex, race, and recruitment site, completed the Addiction Severity Index (ASI), Brief Symptom Inventory (BSI), and Short Form-36 Health Survey (SF-36). Multivariate general-linear models evaluated between-group differences on these indices. Compared with non/infrequent gamblers, disordered gamblers reported increased severity of medical, family/social, psychiatric, and alcohol problems on the ASI. They also scored higher on depression, anxiety, paranoid ideation, and psychoticism subscales of the BSI, and lower on vitality, physical functioning, role-physical, general health, and social functioning subscales of the SF-36. These results suggest that older adults with a gambling disorder experience increased severity of health and psychosocial problems, compared with older adult non/infrequent gamblers matched by age, sex, race, and recruitment site.

Health and Psychosocial Correlates of Disordered Gambling in Older Adults

A number of regional prevalence studies suggest that disordered gambling is a clinically significant problem among older adults. However, little research has evaluated whether older adults with a gambling disorder experience increased health, psychiatric, substance use, and social problems as compared with older adults without a gambling disorder. A group of 48 older-adult disordered gamblers and 48 older adult non/infrequent gamblers, matched by age, sex, race, and recruitment site, completed the Addiction Severity Index (ASI), Brief Symptom Inventory (BSI), and Short Form–36 Health Survey (SF–36). Multivariate general-linear models evaluated between-group differences on these indices. Compared with non/infrequent gamblers, disordered gamblers reported increased severity of medical, family/social, psychiatric, and alcohol problems on the ASI. They also scored higher on depression, anxiety, paranoid ideation, and psychoticism subscales of the BSI, and lower on vitality, physical functioning, role-physical, general health, and social functioning subscales of the SF–36. These results suggest that older adults with a gambling disorder experience increased severity of health and psychosocial problems, compared with older adult non/infrequent gamblers matched by age, sex, race, and recruitment site.