This page is for studies for alcohol abuse since 1992.  In the past 30 years there has been a huge increase in poly-drug abusers and pure alcoholics are now appear in the minority.  Alcohol is still often the most serious drug without the abuse of which the patient could avoid his or her illicit drugs.  I have much more work to do on this page.  However, the results are looking the same as they did in 1992.

Out-Patient Studies

Aftercare Follow-up Appears Helpful: A small random assignment study of 77 alcohol and alcohol and/or heroin patients following a residential program had have go to a structure aftercare program and the other half come in whenever they had a crisis or wanted to.  During the 12 month follow-up, drug abuse was one-third as common in the structured aftercare program. Australia. Aftercare attendance and post-treatment functioning of severely substance dependent residential treatment clients. Sannibale C, Hurkett P, van den Bossche E, O'Connor D, Zador D, Capus C, Gregory K, McKenzie M. Drug Alcohol Rev. 2003 Jun;22(2):181-90

Family Treatment More Successful: A Italian study of 100 patients assigned to either a multiple family oriented Alcoholics-in-Treatment club approach or a standard clinical group meeting for patients and separate meetings for family found the multifamily approach abstinence 79% vs. 50%. Alcohol addiction: evaluation of alcohol abstinence after a year of psycho-medical-social treatment. Giuffredi C, Di Gennaro C, Montanari A, Barilli A, Vescovi PP. Addict Biol. 2003 Jun;8(2):219-28.

Family and Marital Therapy Review Favorable: A review of 38 controlled studies of marital and family therapy (MFT) says that

Coping Skills Treatment Didn't Help: In an 18 month follow-up study of heavy "social" drinkers wanting to reduce or quit drinking who had been recruited by newspaper ads in Sweden, subjects were randomly assigned to one of two treatments. Subjects in the coping skills training group were taught methods to cope with the craving for alcohol, and subjects in the control group had a conventional discussion about their problems and the future. Alcohol consumption decreased as a function of the subjects' initial goals, independent of treatment and a wish to control drinking seemed more efficient than to try to quit drinking completely. Karolinska Institute. The effect of coping skills training on alcohol consumption in heavy social drinking. Kallmen H, Sjoberg L, Wennberg P. Subst Use Misuse. 2003 Jun;38(7):895-903

Primary Care Doctors to Discuss Drinking Problems with Patients: 41 physicians were randomly assigned to receive or not to receive information about the patient's drinking and simple recommendations in a 312-patient 6-month follow-up study. Those receiving the information were more likely to speak with the patients and there was some evidence for a decrease in patient drinking 6 months later. Boston Univ. Addressing alcohol problems in primary care: a cluster randomized, controlled trial of a systems intervention. The screening and intervention in primary care (SIP) study. Saitz R, Horton NJ, Sullivan LM, Moskowitz MA, Samet JH. Ann Intern Med. 2003 Mar 4;138(5):372-82

Twelve Step Program Slightly Better for European-Americans, Cognitive Behavioral and Motivational for Hispanic Americans: A random assignment study of 100 European-Americans and 105 Hispanic Americans to three programs as part of Project MATCH. Up to 12 month follow-up. Univ. New Mexico. The influence of Hispanic ethnicity on long-term outcome in three alcohol-treatment modalities. Arroyo JA, Miller WR, Tonigan JS. J Stud Alcohol. 2003 Jan;64(1):98-104

Cognitive Behavioral Better Satisfaction and Results Than Twelve Step or Motivational Enhancement: An analysis of project MATCH data found cognitive behavioral out-patient treatment had best client satisfaction. Higher levels of satisfaction were associated with higher levels of therapy attendance, greater reductions in drinking during therapy, and better clinical status at the end of therapy. Client satisfaction with three therapies in the treatment of alcohol dependence: results from project MATCH. Donovan DM, Kadden RM, DiClemente CC, Carroll KM. Am J Addict. 2002 Fall;11(4):291-307

Early and Prolonged Treatment More Important that Intensity of Treatment: In depth interviews with 473 alcoholics seeking treatment for the first time at detox or information centers with follow-up interviews at 1-, 3-, and 8-years led researchers to conclude that rapid entry into treatment and the duration of treatment for alcohol use disorders may be more important than the intensity of treatment. Treatment providers should consider structuring their programs to emphasize continuity, rather than intensity of care. Stanford. Long-term influence of duration and intensity of treatment on previously untreated individuals with alcohol use disorders. Moos RH, Moos BS. Addiction. 2003 Mar;98(3):325-37

British Programs Don't Help Heavy Alcohol or Crack Cocaine: The National Treatment Outcome Research Study (NTORS) is the first prospective national study of treatment outcome among drug misusers in the United Kingdom. A sample of 418 patients from 54 programs using four treatments interviewed patients at baseline, 1-, 2-,and 4-5 years. Methadone maintenance was successful at reducing abuse and needle sharing decreased. However, patients treated for crack cocaine and heavy drinking were no better 4-5 years later than at baseline. Authors note British programs have many similarities to U.S. programs. Maudsley. The National Treatment Outcome Research Study (NTORS): 4-5 year follow-up results. Gossop M, Marsden J, Stewart D, Kidd T. Addiction. 2003 Mar;98(3):291-303

Violence Against Spouse Decreased by VA Out-Patient Treatment: 301 alcoholic males with female partners had a spousal violence rate of 54% in the year before treatment compared

Bibliotherapy Modest Benefit for Problem Drinking: A meta-analysis of 22 controlled studies of bibliotherapy concludes that it is of modest benefit. Studies comparing bibliotherapy to face to face therapies did not find any difference in outcome. Brown Univ. A meta-analysis of the effectiveness of bibliotherapy for alcohol problems. Apodaca TR, Miller WR. J Clin Psychol. 2003 Mar;59(3):289-304

Bibliotherapy plus Personalized-Assessment Feedback Helps: 86 problem drinkers recruited in Toronto by random telephoning randomized into bibliotherapy, personalized assessment-feedback, both or neither.  Both together did significantly better. Treating alcohol problems with self-help materials: a population study. Cunningham JA, Koski-Jannes A, Wild TC, Cordingley J. J Stud Alcohol. 2002 Nov;63(6):649-54 

CAGE alcohol screen (Cut down on your drinking, Annoyed by criticism of your drinking, Guilty about your drinking, Eye-opener)

Residential Treatment Studies

Two Weeks of In-Patient Therapy After Detox No Additional Value: A study randomly assigned 322 alcohol dependent patients to detox with three counseling sessions before discharge or detox with two additional weeks of in-patient therapy and then four out-patient sessions.  While the greater treatment group was more likely to attend self-help group meetings after discharge, there was no impact on abstinence at 6 or 12 months. Univ Greifswald. Motivational intervention: an individual counselling vs. a group treatment approach for alcohol-dependent in-patients. John U, Veltrup C, Driessen M, Wetterling T, Dilling H. Alcohol Alcohol. 2003 May-Jun;38(3):263-9

Stop Smoking Treatment in Alcoholism

Nicotine Patch Stop Smoking Therapy Did Not Increase Cravings: A 115-patient DB PC study of abstinent and stable alcoholics with an average of five years of sobriety found at six months 24% with patch vs. 6% without were abstinent from tobacco. None relapsed into alcohol abuse. Univ. Vermont. Efficacy of nicotine patch in smokers with a history of alcoholism. Hughes JR, Novy P, Hatsukami DK, Jensen J, Callas PW. Alcohol Clin Exp Res. 2003 Jun;27(6):946-54.

Nicotine Deprivation Doesn't Increase Urge to Drink: A study of 40 alcoholics in day treatment using 34 hours of nicotine deprivation found that during non-deprived sessions, alcohol cue presentations were associated with significant increases in urges to drink and urges to smoke. However, acute nicotine deprivation led to increased smoking urges, but was not associated with increased urges to drink alcohol. The authors conclude that the acute effects of smoking cessation are unlikely to increase risk of relapse to alcohol in alcoholic patients who are undergoing treatment. Connecticut VA. Effects of nicotine deprivation on urges to drink and smoke in alcoholic smokers. Cooney JL, Cooney NL, Pilkey DT, Kranzler HR, Oncken CA. Addiction. 2003 Jul;98(7):913-21

Thomas E. Radecki, M.D., J.D.

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