The influence of psychiatric comorbidity on the course and outcome in a nationwide representative sample (n = 351) of treatment-seeking substance users over a 28-month period was studied prospectively. The patients were administered the Diagnostic Interview Schedule and a questionnaire on drinking history. At 16 and 28 months after admission the patients returned a questionnaire on drinking history and mental health. In cases of those lacking information on either follow-up (45%), details on drinking status was obtained from informants. Completely abstinent were 16%. Generalized anxiety disorder and/or social phobia at the index admission predicted abstinence during the follow-up [odds ratio (OR) = 0.25], whereas onset of alcoholism among these patients after age 25 years predicted a worse prognosis (OR = 13.5). Also increasing number of social consequences related to abuse (OR = 1.3) and drinking more than the median (OR = 2.1) predicted a poor outcome. The abstinent group had significantly better mental health at follow-up. The patients with comorbid psychiatric disorders at admission were worse at follow-up. Although substance use disorders and comorbid psychiatric disorders have to a certain degree separate courses, there is nevertheless significant interaction between them. Early treatment and recognition of comorbid psychiatric disorders among substance abusers is necessary.
The present study was conducted to provide a nationwide survey of acceptance of nonabstinence goals and related alcoholism treatment practices by Canadian alcoholism treatment services.
A random sample of 335 Canadian alcoholism treatment service agencies were mailed a 4-page questionnaire designed to assess acceptance of moderate drinking as a drinking goal and related alcoholism treatment practices.
Acceptance varied by type of service, with considerably more acceptance by outpatient programs (62%) and mixed inpatient/outpatient programs (43%) than inpatient/detoxification/ correctional facilities (27%) and halfway houses (16%). Two-thirds of the respondents who reported moderate drinking as unacceptable in their own agencies categorically rejected moderation for all alcoholism clients.
Individuals seeking services in Canadian alcoholism treatment agencies are more likely to have a choice of drinking goals if they present to an outpatient program than a residential institution, and Canadian agencies appear more accepting of moderation goals than American programs, but less accepting than British and Norwegian service agencies.
To explore differences in views concerning adjunctive medications and theoretical orientation among Canadian practitioners from different professional backgrounds who treat alcoholism.
A survey of clinicians from different disciplines was conducted by mail. The response rate was 56%: 95 drug and alcohol counsellors, 46 social workers, 81 nonpsychiatrist addiction physicians, and 74 addiction psychiatrists. The number of items in the questionnaire was reduced using principal component analysis. Group differences were explored using analysis of variance with Bonferroni correction and Scheffé's posthoc comparisons.
Physicians and nonphysicians differed in their views on the utility of medications in treating alcohol problems, the disease concept of alcohol problems, and the classification of alcohol abuse or dependence as psychiatric conditions. No group differences emerged on views regarding cognitive-behavioural treatment, pharmacological-only interventions, combined treatment, and recovery without treatment. Psychopathology in the alcoholic was significantly more likely to be considered as secondary to the use of alcohol by nonpsychiatrist physicians. Nonphysician practitioners viewed alcoholic behaviour as self-medication.
Groups differed on questionnaire items concerning medication use and the disease concept of alcoholism. Agreement on several areas may facilitate bridging the gap across disciplines. The implications of these results are discussed.
This article describes a cross-cultural experience in teaching alcoholism treatment skills and therapy techniques. The current treatment model in America has to be shaped to the requirements of the local scene. The immediate problem was to import a disease-oriented model of alcoholism to a land where most people view alcoholism in terms of individual moral failing. The Norwegian cultural value orientations are defined; then the alcoholism treatment adaptation across language and custom is discussed.
A questionnaire used by Rohsenow in 1983 was administered to 87 alcoholic men and women taking part in rehabilitation programs at local Swedish outpatient rehabilitation clinics. The purpose was to explore their alcohol-related expectancies for themselves and for others and to compare these with the results from other similar studies in other cultures. The answers, scored according to Rohsenow's eight factors, indicated that alcoholics expected larger positive and negative effects for others than for themselves. This discrepancy was slightly modified by such variables as sex, age, and drinking habits. Alcoholics in Sweden seem to have alcohol-related expectancies similar to those of social drinkers both in Sweden and in other Western countries.
To evaluate the characteristics of patients with various substance-related disorders, and to examine rates of retention in treatment.
We assessed the demographic characteristics, substance abuse, and psychological distress of 239 men and women at admission. Six-month performance was evaluated, using as criteria length of stay in treatment, abstinence, attendance in therapy sessions, and completion status at discharge.
Moderate to severe psychological distress was observed among these individuals. Higher levels of depression were found among women and in individuals with alcohol and sedative use disorders. The primary drug of abuse, frequency of use, and reason for entering treatment were the most significant predictors of retention.
Opiate-addicted clients had the worst prognosis and treatment profiles. Further research is needed to identify factors that would optimize treatment for opiate dependence.
Women with alcohol problems constitute an increasing number of patients in medical service. Do they need special care? How should the treatment program be designed? The specialized female Karolinska Project for Early Treatment of Women with Alcohol Addiction (EWA) unit at the Karolinska Hospital in Stockholm, Sweden, was opened in 1981. The aim of the project is to reach women in an early stage of alcohol dependence behavior and to develop treatment programs specific to the needs of females alone. In order to investigate the value of such a specialized female unit a controlled 2-year follow-up study was carried out including 200 women. The probands were treated in the female only EWA-unit, whereas the controls were placed in the care of traditional mixed-sex alcoholism treatment centers. The 2-year follow-up study showed a more successful rehabilitation regarding alcohol consumption and social adjustment for the women treated in the specialized female unit (EWA). Improvement was noted also for the controls but to a lesser extent. Probably one of the most important achievements of a specialized female unit, such as EWA, is to attract women to come for help earlier.
This retrospective cross-sectional study explored the associations of personality characteristics with parenting problems among 25 couples, one or both members of which were identified as alcoholics by virtue of their voluntary past completion of a residential program for alcoholics. Most of them (90%) scored lower, indicating their more problematic parental attitudes and behaviors, on all four scales of the Adult-Adolescent Parenting Inventory (AAPI: inappropriate parental expectations of children, lack empathy for children's needs, value physical punishment, and parent-child role reversal) than average "normal" nonalcoholic, nonabusive adults. Such parenting problems were found to be very highly associated with clients' personality characteristics. For example, schizoid, schizotypal, histrionic, and passive aggressive characteristics (DSM-III-R-based) along with a few other personal characteristics of the couples, accounted for nearly all (90.2%, R2 = .902) of their propensity to reverse roles with their children. Findings also suggested that the identified parenting problems among alcoholic couples are amenable to programmatic intervention: the longer couples had participated in aftercare programs offered by the treatment facility the more appropriate and empathetic was their parenting.