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The interplay between help-seeking and alcohol-related outcomes: Divergent processes for professional treatment and self-help groups

Center for Health Care Evaluation, Department of Veterans Affairs and Stanford University, Palo Alto, CA 94075, USA.
Drug and Alcohol Dependence (Impact Factor: 3.28). 09/2004; 75(2):155-64. DOI: 10.1016/j.drugalcdep.2004.01.016
Source: PubMed

ABSTRACT This study examined the influence of self-selection, as reflected in alcohol-related functioning, on the duration of professional treatment and Alcoholics Anonymous (AA), and the influence of social causation, as reflected in the duration of treatment and AA, on alcohol-related outcomes. A sample of alcoholic individuals was surveyed at baseline and 1, 3, and 8 years later. At each point, participants completed an inventory that assessed participation in treatment and AA since the last assessment and alcohol-related functioning. There were divergent processes of self-selection and social causation with respect to the duration of participation in professional treatment and AA. Individuals with more severe alcohol-related problems obtained longer episodes of professional treatment, but this self-selection process was much less evident for AA. Longer participation in professional treatment in the first year predicted better alcohol-related outcomes; however, the duration of subsequent treatment was not associated with better subsequent outcomes. In contrast, longer participation in AA consistently predicted better subsequent alcohol-related outcomes. These findings are consistent with a need-based model of professional treatment, in which more treatment is selected by and allocated to individuals with more severe problems, and an egalitarian model of self-help, in which need factors play little or no role in continued participation.

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    • "Recognizing social infl uences on behavior change, both positive and negative, interventions have been developed that specifi cally target social resources to help individuals sustain adaptive social changes (Henggeler et al., 2002; Litt et al., 2009; McCrady et al., 2006; Nichols and Schwartz, 2006; United Kingdom Alcohol Treatment Trial [UKATT] Research Team, 2001). In terms of continuing care and recovery management, social contexts are also believed to play a central role in sustaining long-term change (McKay, 2011; Moos and Moos, 2004; Stout et al., 1999; White, 2009). The link between participation in recovery-oriented mutual-help organizations—such as Alcoholics Anonymous (AA) and Narcotics Anonymous—and better substance use outcomes may be due in large part to social changes in the networks of attendees that support abstinence (Bond et al., 2003; Kaskutas et al., 2002; Kelly et al., 2011). "
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    ABSTRACT: Multiple studies have shown social network variables to mediate and predict drinking outcome, but, because of self-selection biases, these studies cannot reliably determine whether the influence is causal or correlational. The goal of this study was to evaluate evidence for a causal role for social network characteristics in determining long-term outcomes using state-of-the-art statistical methods. Outpatient and aftercare clients enrolled in Project MATCH (N = 1,726) were assessed at intake and at 3, 6, 9, 12, and 15 months; the outpatient sample was also followed to 39 months. Generalized linear modeling with propensity stratification tested whether changes in social network ties (i.e., number of pro-abstainers and pro-drinkers) at Month 9 predicted percentage of days abstinent and drinks per drinking day at 15 and 39 months, covarying for Alcoholics Anonymous (AA) attendance at Month 9. An increase in the number of pro-drinkers predicted worse drinking outcomes, measured by percentage of days abstinent and drinks per drinking day, at Months 15 and 39 (p < .0001). An increase in the number of pro-abstainers predicted more percentage of days abstinent for both time periods (p < .01). The social network variables uniquely predicted 5%-12% of the outcome variance; AA attendance predicted an additional 1%-6%. Network composition following treatment is an important and plausibly causal predictor of alcohol outcome across 3 years, adjusting for multiple confounders. The effects are consistent across patients exhibiting a broad range of alcohol-related impairment. Results support the further development of treatments that promote positive social changes and highlight the need for additional research on the determinants of social network changes.
    Journal of studies on alcohol and drugs 05/2012; 73(3):489-97. DOI:10.15288/jsad.2012.73.489 · 2.27 Impact Factor
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    • "Recognizing social infl uences on behavior change, both positive and negative, interventions have been developed that specifi cally target social resources to help individuals sustain adaptive social changes (Henggeler et al., 2002; Litt et al., 2009; McCrady et al., 2006; Nichols and Schwartz, 2006; United Kingdom Alcohol Treatment Trial [UKATT] Research Team, 2001). In terms of continuing care and recovery management, social contexts are also believed to play a central role in sustaining long-term change (McKay, 2011; Moos and Moos, 2004; Stout et al., 1999; White, 2009). The link between participation in recovery-oriented mutual-help organizations—such as Alcoholics Anonymous (AA) and Narcotics Anonymous—and better substance use outcomes may be due in large part to social changes in the networks of attendees that support abstinence (Bond et al., 2003; Kaskutas et al., 2002; Kelly et al., 2011). "
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    ABSTRACT: Objective: Multiple studies have shown social network variables to mediate and predict drinking outcome, but, because of self-selection biases, these studies cannot reliably determine whether the infl uence is causal or correlational. The goal of this study was to evaluate evidence for a causal role for social network characteristics in deter-mining long-term outcomes using state-of-the-art statistical methods. Method: Outpatient and aftercare clients enrolled in Project MATCH (N = 1,726) were assessed at intake and at 3, 6, 9, 12, and 15 months; the outpatient sample was also followed to 39 months. Generalized linear modeling with propensity stratifi cation tested whether changes in social network ties (i.e., number of pro-abstainers and pro-drinkers) at Month 9 predicted percentage of days abstinent and drinks per drinking day at 15 and 39 months, covarying for Alcoholics Anonymous (AA) attendance at Month 9. Results: An increase in the number of pro-drinkers predicted worse drinking outcomes, measured by percentage of days abstinent and drinks per drinking day, at Months 15 and 39 (p < .0001). An increase in the number of pro-abstainers predicted more percentage of days abstinent for both time periods (p < .01). The social network variables uniquely predicted 5%–12% of the outcome variance; AA attendance predicted an additional 1%–6%. Conclusions: Network composition following treatment is an important and plausibly causal predictor of alcohol outcome across 3 years, adjusting for multiple confounders. The effects are consistent across patients exhibiting a broad range of alcohol-related impairment. Results support the further development of treatments that promote positive social changes and highlight the need for additional research on the determinants of social network changes.
    Journal of studies on alcohol and drugs 11/2011; 73(2012):489-497. · 2.27 Impact Factor
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    • "mental health treatment (e.g., Grosz, 1968; Kenney, 1994; Kunkel & Williams, 1991; Tinsley & Harris, 1976) with mixed results (Arnkoff et al., 2002); however, most studies indicated that individuals who expected to do better in treatment had a better outcome than those who did not (e.g., Sotsky et al., 1991). Help-seeking is also associated with treatment outcome (Grencavage & Norcross, 1990); however, a review of the literature indicated that most of the research on helpseeking and outcome is related to substance abuse treatment (e.g., Moos & Moos, 2004; Tucker & Gladsjo, 1993). For traditional psychotherapy, the research on help-seeking has not emphasized the effects of help-seeking on treatment outcome, rather which variables effect help-seeking (e.g., Kushner & Sher, 1989, 1991). "
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    ABSTRACT: This study examined inmate attitudes toward treatment, mental health treatment utilization, and treatment effects that maximize treatment effectiveness. Participants consisted of 278 incarcerated male adult offenders from the Kansas Department of Corrections. Multiple linear regression analysis indicated that inmate attitudes toward treatment were predictive of the number of mental health treatment sessions (dosage) inmates received. Hierarchical linear regression analyses indicated positive help-seeking attitudes were associated with institutional behavior (decreased number and severity of disciplinary infractions) and scores on a measure assessing risk for future criminal behavior; however, the amount of mental health treatment an inmate received (treatment dosage) was associated with problematic institutional behavior (i.e., increased severity and number of disciplinary infractions). These results indicated that treatment dosage and behavioral outcomes were impacted by inmate attitudes toward treatment. As a result, correctional psychologists may be better able to predict which inmates will receive the most benefit from services. Implications of these findings for practitioners and policy makers are discussed.
    Law and Human Behavior 05/2010; 35(4):249-61. DOI:10.1007/s10979-010-9233-5 · 2.16 Impact Factor
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