Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892, USA.
To investigate the effect of help-seeking on the likelihood of recovery from Diagnostic and Statistical Manual version IV (DSM-IV) alcohol dependence, specifically examining the impact of model selection, factors that moderate the effect of help-seeking and distinctions between the effects of 12-Step participation and formal treatment.
This analysis is based on data from the Wave 1 2001-02 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional, retrospective survey of a nationally representative sample of US adults 18 years of age and over. The analytical sample consisted of 4422 individuals with prior-to-past-year (PPY) onset of DSM-IV alcohol dependence.
Logistic regression, proportional hazards and time-dependent proportional hazards models were used to estimate the effects of help-seeking on three outcomes: (1) any recovery from alcohol dependence, which required full remission of all symptoms of alcohol abuse and dependence and excluded asymptomatic drinkers whose alcohol consumption exceeded low-risk drinking guidelines; (2) non-abstinent recovery (NR), representing low-risk asymptomatic drinkers; and (3) abstinent recovery (AR), representing abstainers.
Only one-quarter of individuals with PPY-onset alcohol dependence had ever sought help for alcohol problems, including 3.1% who had participated in 12-Step programs only, 5.4% who had received formal treatment only and 17.0% with both 12-Step and formal treatment. Based on the most appropriate model, help-seeking increased the likelihood of any recovery [hazard rate ratio (HRR) = 2.38], NR (HRR = 1.50) and AR (HRR = 4.01). The impact of help-seeking on AR did not show any significant variation across the exposure period but was modified by severity among other factors. Individuals who participated in 12-Step programs in addition to formal treatment had almost twice the chance of recovery and more than more than twice the chance of AR compared with those who received formal treatment alone.
Help-seeking plays a significant role in the achievement of abstinent recovery from alcohol dependence, with 12-Step participation playing a major role. Appropriate model selection is critical to assessing the impact of help-seeking.
"For instance, while many individuals often attend AA and specialty addiction treatments concurrently (Gossop, Stewart, & Marsden, 2008; Timko, Moos, Finney, & Lesar, 2000) and cross-sector treatment referrals are common (Humphreys, 1997; Riordan & Walsh, 1994), prior studies have considered these treatments as existing in separate domains (e.g., medical versus non-medical) to explore predictors of their use separately (Dawson et al., 2012). Perhaps more importantly , a major limitation of the current literature on alcohol treatment utilization patterns is that research describing the outcomes associated with executed treatment utilization patterns is scant and limited to studies that have analyzed retrospective reports (Dawson, Grant, Stinson, & Chou, 2006; Dawson, Grant, Stinson, Chou, et al., 2006). To our knowledge, no studies have examined outcomes associated with alcohol treatment utilization patterns with longitudinal data from the general population. "
"These authors suggested that people may need to experience substantial alterations in their daily functioning before they seek treatment. Given that help seeking is an important predictor of recovery from AUDs (Dawson et al., 2006), it is essential to identify factors that contribute to service utilization in vulnerable populations to inform related service-delivery policies and practices. "
[Show abstract][Hide abstract] ABSTRACT: Objective:
The purpose of this study was to examine the relationship between childhood maltreatment and alcohol use disorders (AUDs), treatment utilization, and barriers to treatment in a national sample of emerging adults. Multiple types of maltreatment were examined, including childhood emotional abuse and neglect.
The analyses are based on data from 18- to 25-year-olds (N = 4,468) who participated in the National Epidemiologic Survey on Alcohol and Related Conditions.
Adjusted for sociodemographic characteristics, we found that childhood maltreatment was associated with a greater likelihood of an AUD and a greater likelihood of accessing treatment, although these relationships were no longer significant once psychiatric comorbidities and other substance use disorders were included as control variables. We also found significant interaction effects for age; differences in the prevalence of AUDs among those who experienced physical abuse and multiple types of maltreatment were larger for the older age group. Finally, among those with AUDs, maltreatment was associated with specific perceived barriers to treatment.
The current findings highlight childhood maltreatment, including emotional abuse and neglect, as important correlates of AUDs among emerging adults but indicate that these relationships may be accounted for by other psychiatric comorbidities. Barriers to treatment among individuals with AUDs may reflect maltreatment experiences and should be addressed in both policy and practice.
Journal of studies on alcohol and drugs 03/2013; 74(2):185-94. DOI:10.15288/jsad.2013.74.185 · 2.76 Impact Factor
"Treatments for alcohol dependence can be effective and increase the likelihood of recovery from alcohol problems (Dawson et al., 2006; Moos and Moos, 2006; Moyer et al., 2002). Of those who enter and complete treatment, approximately 60% will relapse to some drinking within the first year following alcohol treatment (Maisto et al., 2003; Whitford et al., 2009). "
[Show abstract][Hide abstract] ABSTRACT: Background:
Drinking goals at treatment entry are a promising, yet under-studied mechanism of change in alcohol use following treatment. It is not known who, upon treatment entry, is likely to desire abstinence as a drinking goal and whether desiring abstinence as a drinking goal influences alcohol use following treatment.
Data from a 2.5-year longitudinal study of alcohol-dependent adults from 3 treatment sites is examined in a secondary data analysis. At treatment entry, participants reported sociodemographic and clinical characteristics, as well as whether they desired abstinence as a drinking goal or not. At each subsequent wave, participants reported their alcohol use.
Bivariate analyses showed that individuals from a VA outpatient treatment site, men, and racial or ethnic minorities were most likely to desire abstinence as a drinking goal at treatment entry. Multi-level mixed effects regression models indicated that individuals who at baseline desired abstinence as a drinking goal sustained higher percentage of days abstinent and higher percentage of days since last drink 2.5 years following treatment entry, compared to individuals who did not desire abstinence.
Understanding who is most likely to desire the specific drinking goal of abstinence can assist clinicians in anticipating client response to goal setting. Furthermore, by understanding the benefits and risks associated with drinking goals, clinicians can focus attention to individuals who desire a more risk-laden goal, including goals of non-abstinence, and tailor interventions, including motivational interviewing techniques, to support effective goals.
Drug and alcohol dependence 02/2013; 132(1-2). DOI:10.1016/j.drugalcdep.2013.01.018 · 3.42 Impact Factor
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