BACKGROUND: One hundred twenty women alcoholics recruited to a treatment program called EWA (Early Treatment for Women With Alcohol Addiction) were studied. The selected women were not previously treated for alcohol abuse. METHODS: The women were followed up by use of a structured personal interview, biomarkers sensitive for alcohol abuse (i.e., glutamyl transpeptidase), and questionnaires, by using defined criteria for abstinence, social drinking, satisfactory drinking outcome, and unsatisfactory drinking outcome. RESULTS: Drinking outcome was good (i.e., total abstinence, social drinking, or satisfactory drinking outcome) for 67% of the women during the total follow-up time, by use of strict criteria for relapse. The results were corroborated by the biomarkers. Similar results were reported from two previously studied groups of women from the same department. However, the frequency of abstinence was higher and social drinking was significantly lower among this sample of women. Daily drinking, the use of sedatives, and a long duration of pretreatment alcohol abuse predicted an unfavorable outcome. However, a long duration of outpatient treatment predicted a good outcome, whereas treatment dropout was related to an unsatisfactory drinking outcome. A majority of the women (96%) rated the treatment experience and the treatment program favorably. The overall good results might reflect the selection of the subjects studied. CONCLUSIONS: Improving treatment program adherence would probably improve outcome for the women with an unsatisfactory drinking outcome.
Forty-four patients were assessed for three different short-term dynamic therapies, with an evaluation form based on Sifneos' criteria for Short-Term Anxiety-Provoking Psychotherapy (STAPP). Ten patients were ascribed to STAPP, 22 patients to Malan's Brief Psychotherapy (BP), and 12 patients to a more eclectic/integrative form of brief psychotherapy in this project called the FIAT model. 78% of the patients completed their treatment in agreement with the original ascription to therapy, with good results for all three therapies. The evaluation form seems to be a reliable and valid instrument offering a good and systematic basis for designing a tailor-made treatment format for different types of patients.
Change was assessed in 34 patients at the end of short-term dynamic psychotherapy (STDP), and at 2 follow-ups (1 year and 2 years subsequent to treatment). The assessment was made from different perspectives and according to multiple criteria and methods of measurement. The results indicate that, when a particular form of STDP is selected according to each patient's ego resources, motivation for therapy, and motivation for change, approximately 90% of the patients will attain substantial symptom relief. The majority of the patients in this study also gave evidence of positive change in adaptive functioning, while one-third attained some dynamic/structural change as well. Clinically rated improvement was confirmed by changes in the patients' self-reported distress level (SCL-90), and from psychological test findings (MMPI). Improvement observed at the end of therapy was sustained throughout the 2-year follow-up period.
In a long term follow-up study of 44 young women with symptoms of alcohol dependence at index year, only 17 (38%) of the interviewed subjects fulfill the DSM-III criteria for alcohol abuse or dependence the year prior to follow-up according to the interview material. The reason for this is partly that there has been a change in drinking patterns for 24 women (54%), of which eight are abstainers, seven asymptomatic drinkers and nine having an increased tolerance as the only sign of a possibly pathological alcohol use. Partly, however, the lack of diagnosis can be attributed to client denial or substituting drugs for alcohol, and partly due to inadequate criteria. Some of the DSM-III criteria are sex biased, probably leading to men having a diagnosis at an earlier stage of alcoholism. The concept of degree of alcohol dependence, an appropriate time limit for assessment of diagnosis and the difference between primary and secondary alcoholism, should be specified in future diagnostic criteria for alcohol use disorders.
This paper deals with psychiatric comorbidity among 60 women problem drinkers treated in a specialized women-only treatment programme (EWA) at Karolinska Hospital, Stockholm, Sweden. The programme attracts women who have not been previously treated for alcohol problems. The methods used were structured interviews (SCID-I and SCID-II) applied at least 10 days after the start of treatment. All but two of the women had a definite alcohol dependence according to the DSM-III-R, and a majority (60%) also fulfilled the criteria for at least one psychiatric disorder during their lifetime. However, only 23% had a personality disorder (PD), and all subjects with a PD also had at least one Axis I disorder. The most common disorders were mood disorders (48%) and anxiety disorders (38%). However, alcohol dependence developed without definite pre-existing psychiatric disorders among a substantial proportion of the women (40%). It remains to be seen whether and how psychiatric disturbances among female problem drinkers affect treatment compliance and long-term outcome.
This study identifies personality characteristics in a group of Swedish women (N = 60) attending their first treatment for alcohol problems. The treatment programme specifically addressed women in an early phase of their drinking career, and was called "Early Treatment of Women with Alcohol Addiction" (EWA). Rorschach personality profiles of the 60 women differed significantly in almost all investigated aspects in a psychopathological direction from norms reported by Exner for a reference group of female non-patients. The findings are consistent with the assumption that, although the EWA women were socially well-functioning and fairly early in their drinking career, they nevertheless reveal serious underlying psychopathology. Clinical implications of the findings are discussed.
The use of a questionnaire, Symptom Check List-90 (SCL-90), as a screening instrument for psychiatric disorders was studied in 60 women attending their first treatment for alcohol abuse in Stockholm, Sweden. A global SCL-90 index, the General Symptomatic Index (GSI), measuring the total level of recent self-reported psychological distress, showed a high efficacy in distinguishing 'psychiatric cases' from 'non-cases' in the present sample. Psychiatric cases were defined as subjects satisfying the criteria for any current DSM-III-R disorder other than substance abuse. The psychiatric diagnoses were obtained independently by use of the Structured Clinical Interview for DSM-III-R (SCID-I). Psychiatric disorders, especially depression and anxiety disorders, frequently antecede or develop secondary to alcohol abuse among women. The use of structured interviews to diagnose these disorders is, however, time-consuming. Findings from the present study indicate that SCL-90 can be used to detect psychiatric comorbidity among female alcoholics, thus enabling clinicians to be aware of concomitant psychiatric disorders among a subgroup of patients.