Learning to abstain from alcohol or addictive drugs after years of dependence involves suppressing old, maladaptive habits of thought and behavior and establishing new, adaptive ones.

AA Involvement Might Help Abstinence: A 3 year follow-up of 10 public and private programs in Northern California on 655 adults with alcohol problems reports that those most involved with AA did best. Predictors of 90-day abstinence at 1- and 3-years included AA participation, the percentage of heavy or problem drinking friends, the percentage of friends encouraging alcohol reduction, and AA-based support for reducing drinking. The authors claim that AA participation between 12 and 36 months increased the odds of abstinence at 3 years by 35% above those at 12 months. The only significant mediator of AA's effect on abstinence was the number of AA-based contacts supporting reduced drinking, which reduced the magnitude of the relationship by 16%. Alcohol Research Group, Berkeley. The persistent influence of social networks and alcoholics anonymous on abstinence. Bond J, Kaskutas LA, Weisner C. J Stud Alcohol. 2003 Jul;64(4):579-88; 

    Ed: This study is totally uncontrolled.  Therefore, it is impossible to tease out cause and effect.  It could easily be that those who were going to do better due to some other reason, e.g. pressure from the family, were more likely to attend AA meeting, stay away from old drinking friends, and spend more time with those support of abstinence all because of family pressure.  Yet the wording of the report seems to imply cause-effect, "CONCLUSION: AA involvement and the type of support received from AA members were consistent contributors to abstinence 3 years following a treatment episode."  So I sent Dr. Bond an email.

    Author Agrees with Me!: While Dr. Jason Bond appears to conclude cause and effect, he replied to my email saying, "Indeed you make a valid point.  There could be several underlying variables which are responsible for the observed effects.... In this particular case, there wasn't a specific treatment being applied in the study (sic) but even for studies for which there is, the missing variable problem still lurks.  If nothing else, these variables provide a set markers which are associated with positive outcomes that further studies may consider.  I always try to use "was associated with" in discussing relationships, as causality is so difficult to establish."

    Ed: Actually, cause-effect is not difficult to establish.  It only requires two different treatments or one treatment vs. no treatment and a randomization of patients at the beginning of the study.  Unfortunately, few programs ever do this since they are all certain that they already know the one and only way to treat substance abuse.  Even when such studies are done, government and the treatment community usually ignore the results and keep on doing what they have always done.  

Pregnancy Drinking Prevention Program May Be Successful: 2368 women in 3 large cities were screened and 230 qualified based on their heavier drinking and lack of contraception for a 4-session counseling program on alcohol and 1-session on contraception. 190 enrolled and 143 completed the program. At 6-month follow-up, 68% were no longer at risk either due to contraception (23%), not drinking (13%), or both. Reducing the risk of alcohol-exposed pregnancies: a study of a motivational intervention in community settings. Ingersoll K, Floyd L, Sobell M, Velasquez MM; Project CHOICES Intervention Research Group. Pediatrics. 2003 May;111(5 Part 2):1131-5

Treatment Might Help: Comparing Those Seeking Treatment to Alcohol Abusers Not Seeking Treatment: A study by the Univ. of Calif, San Francisco, comparing 371 alcohol with 111 in the common found in a random population survey found that those seeking treatment had a higher 30-day abstinence rate and higher rate of non-problem drinking 1 year later. Having more drug users and heavy drinkers in one's social network was negatively associated with progress in both groups. In the treatment group, having more psychiatric difficulties, and more social consequences were inversely related to abstinence and non-problematic use. How important is treatment? One-year outcomes of treated and untreated alcohol-dependent individuals. Weisner C, Matzger H, Kaskutas LA. Addiction. 2003 Jul;98(7):901-11. Ed: While the authors once again claim that their report in some way shows that treatment helps, patients seeking treatment and wanting to quit are very different than alcoholics chosen at random.  Even without treatment, one would predict that those wanting to quit would do better.

Depressed Substance Abusers Did the Worst: A Washington Univ study of 401 substance abusers starting treatment with one year follow-up on 94% of them (very good) found that women with phobias had better outcomes and that men with psychiatric disorders in general, men with major depression, and men with antisocial personality disorder had worse outcomes. Those with depression had most substances abused and most symptoms. The role of psychiatric disorders in predicting drug dependence treatment outcomes. Compton WM 3rd, Cottler LB, Jacobs JL, Ben-Abdallah A, Spitznagel EL. Am J Psychiatry. 2003 May;160(5):890-5

Relapse Prevention Therapy: Marlatt and Gordon developed the popular relapse prevention therapy in 1985. Factors causing relapse are classified by categories. Coping strategies are discussed and rehearsed. Reasons for drinking and past relapses along with relapse precipitants are gathered. These might be negative affect relapses, social pressure relapses, or craving/cued relapses. Some evidence suggests that social pressure relapses are more likely to repeat, and that negative affect and craving/cued relapses are more severe. Craving/cued relapses appear to subside during the first 6 months but risk for this type of relapse returns once the client relapses again. Exploratory findings from the Reasons for Drinking Questionnaire. Zywiak WH, Westerberg VS, Connors GJ, Maisto SA. J Subst Abuse Treat. 2003 Dec;25(4):287-92

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

www.modern-psychiatry.com

Email: c4tf@hotmail.com