Article

Substance Abuse Relapse in Oxford House Recovery Homes: A Survival Analysis Evaluation

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Abstract

Background: This study used survival analysis to examine risk factors for substance abuse relapse among residents in Oxford Houses (OH), a national network of self-run, self-financed aftercare homes for individuals recovering from substance use disorders. Methods: Participants who entered OH within 60 days of a 1-year longitudinal study (N = 268) were selected from of a nationally representative US sample. Discrete-time survival analysis compared baseline risk of relapse with 4 hypothesized survival models that included time-invariant and time-varying factors across 3 subsequent time periods. Results: The model predicting higher risk for more severe substance use disorders and psychiatric problems was supported. The hypothesized model that predicted time-varying increases in alcohol (but not drug) abstinence self-efficacy significantly affected risk of relapse. Hypothesized demographic and employment variables did not significantly predict relapse risk. Conclusions: Results suggested that OH recovery homes may reduce relapse by providing closer monitoring and referring additional services to new residents with more severe prior addiction severity. Risk for relapse may also be reduced by enhancing abstinence self-efficacy for alcohol regardless of drug of choice.

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... 6 A prospective survival analysis of 268 residents in Oxford House recovery homes again indicated psychiatric conditions to be predictive of a shorter TTR. 7 In literature exploring the relationship between SUD and shortened TTR, there are additional risk factors that have been reported, including living alone, low education status, previous criminal history, and general disease comorbidity. [6][7][8][9][10] Another more recent finding indicates that benzodiazepine use and a history of anxiety may increase relapse risk among those on buprenorphine therapy for opioid use disorder as well. ...
... 7 In literature exploring the relationship between SUD and shortened TTR, there are additional risk factors that have been reported, including living alone, low education status, previous criminal history, and general disease comorbidity. [6][7][8][9][10] Another more recent finding indicates that benzodiazepine use and a history of anxiety may increase relapse risk among those on buprenorphine therapy for opioid use disorder as well. 10 Our analysis expands the observation of benzodiazepines-associated relapse risk among those with SUDs in general. ...
Article
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Background: The prevalence of substance use disorders (SUD), particularly involving opiates and benzodiazepines, has increased to the detriment of public health and the economy. Objective: To evaluate relapse factors among the high-risk demographic of patients with SUD and comorbid affective disorders. Methods: A retrospective chart review of 76 patients discharged after detoxification and simultaneous psychiatric care for concomitant affective disorders and SUDs. Relapse was assessed by two independent evaluators via postdischarge chart review, which included state-wide healthcare utilization, by patient, through healthcare information exchange systems. A Cox Hazards analysis was performed to characterize relapse risk factors. Results: Benzodiazepine use, admission through the emergency department (ED) rather than direct admission, frequent ED use in the preceding year, and history of prior attendance at multiple detoxification programs were risk factors for shortened time-to-relapse. Polysubstance use and intravenous drug use prolonged time-to-relapse. Conclusions: Notable findings include the significant relapse risk associated with benzodiazepine abuse and frequent prior ED utilization. These risk factors could reflect a number of underlying mediators for relapse, including anxiety, disease burden, and malingering. Additionally, this study recapitulates the observation in other patient populations that the majority of health resource utilization is attributed to a small population of patients. This study is the first to identify relapse predictors among dual-diagnosis affective disorder and SUD patients in survival analysis and replicates the alarming and largely unknown effect that benzodiazepines have on increasing relapse risk.
... Mahoney et al. (2021) found that perceptions of SLH social environments (i.e., support, involvement, practical orientation, order and organization) related to length of stay among residents. Harvey et al. (2016) found that more severe SUD problems and psychiatric problems, but not demographic variables, were related to earlier exits from Oxford Houses over a period of 1 year. Also, in a qualitative study with residents in Oxford Houses, Chavira and Jason (2021) found that participants' decisions to leave an Oxford House was often related to both fulfilled (e.g., financial stability) and unfulfilled (e.g., desire to live with a romantic partner) needs. ...
Article
Despite preliminary research suggesting that length of stay in sober living homes (SLHs) is related to sustained sobriety, little research has examined factors that relate to length of stay in SLHs. The purpose of the proposed exploratory study was to prospectively examine baseline characteristics of women with histories of addiction and victimization as correlates of length of stay in a trauma-informed, gender-responsive SLH. Participants (N = 45) were surveyed three times over a 1-year period. Women were invited to participate within a week of their arrival to the SLH. Nearly two-thirds (62.2%, n = 28) of women stayed under 3 months, and 37.8% (n = 17) of women stayed over 3 months. Whereas older age and greater financial worries were associated with staying over 3 months at the SLH, other variables (e.g., demographics, mental health, recent victimization, recent substance use) were unrelated. Findings indicate that efforts may be needed to ensure that younger women as well as women with less financial worries, who may be less likely to stay for longer periods of times at SLHs, have adequate support for sobriety.
... That is, an African American resident with a given RF score is more likely to increase his/her RF over time than a white resident with the same given score. These findings are also consistent with those of Harvey (2014), who found that African Americans in recovery homes relapsed at lower rates than Non-Hispanic White Americans. In addition, Bishop, Jason and Ferrari (1998), who found that African Americans tended to stay in recovery homes longer than Non-Hispanic White Americans. ...
Article
Recovery homes in the US provide stable housing for over 250,000 individuals with past histories of homelessness, psychiatric comorbidity and criminal justice involvement. We need to know more about how these settings help those who remain in recovery. Our study measured advice seeking and willingness-to-loan relationships, and operationalized them as a dynamic multiplex social network—multiple, simultaneous interdependent relationships—that exist within 42 Oxford House recovery homes over time. By pooling relationship dynamics across recovery houses, a Stochastic Actor-Oriented Modeling (SAOM) framework was used to estimate a set of parameters governing the evolution of the network and the recovery attributes of the nodes simultaneously. Findings indicated that advice and loan relationships and recovery-related attitudes were endogenously interdependent, and these results were affected exogenously by gender, ethnicity, and reason for leaving the recovery houses. Prior findings had indicated that higher advice seeking in recovery houses was related to higher levels of stress with more negative outcomes. However, the current study found that recovery is enhanced over time if advice was sought from residents with higher recovery scores. Our study shows that social embedding, i.e., one’s position in relationship networks affects recovery prospects. More specifically, the formation of ties with relatively more recovered residents is an important predictor of better outcomes.
... According to the World Health Organization (WHO) more than 3 million deaths worldwide are caused by harmful use of alcohol each year 4 . AUD is characterized by very high rates of post-residential treatment relapse (80-92%) 5,6 , especially in the first 3 months after residential treatment 7,8 . Thus, there is a need for more effective treatment regimens. ...
Article
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This study aimed to investigate structural and functional alterations of the reward system and the neurobiology of craving in alcohol use disorder (AUD). We hypothesized reduced volume of the nucleus accumbens (NAcc), reduced structural connectivity of the segment of the supero-lateral medial forebrain bundle connecting the orbitofrontal cortex (OFC) with the NAcc (OFC-NAcc), and reduced resting-state OFC-NAcc functional connectivity (FC). Furthermore, we hypothesized that craving is related to an increase of OFC-NAcc FC. Thirty-nine recently abstinent patients with AUD and 18 healthy controls (HC) underwent structural (T1w-MP2RAGE, diffusion-weighted imaging (DWI)) and functional (resting-state fMRI) MRI-scans. Gray matter volume of the NAcc, white matter microstructure (fractional anisotropy (FA)) and macrostructure (tract length) of the OFC-NAcc connection and OFC-NAcc FC were compared between AUD and HC using a mixed model MANCOVA controlling for age and gender. Craving was assessed using the thoughts subscale of the obsessive-compulsive drinking scale (OCDS) scale and was correlated with OFC-NAcc FC. There was a significant main effect of group. Results were driven by a volume reduction of bilateral NAcc, reduced FA in the left hemisphere, and reduced tract length of bilateral OFC-NAcc connections in AUD patients. OFC-NAcc FC did not differ between groups. Craving was associated with increased bilateral OFC-NAcc FC. In conclusion, reduced volume of the NAcc and reduced FA and tract length of the OFC-NAcc network suggest structural alterations of the reward network in AUD. Increased OFC-NAcc FC is associated with craving in AUD, and may contribute to situational alcohol-seeking behavior in AUD.
... Further, a higher number of pretreatment quit attempts, higher severity scores, and psychiatric severity predicted relapse in Oxford houses, sober living environments, after treatment (Harvey et al., 2015). For a recent comprehensive review of factors associated with relapse, see Sliedrecht et al. (2019). ...
Article
Background Substance use recovery is a dynamic process. Relapse, often part of the recovery process, is a persistent problem for individuals seeking freedom from their harmful substance use and has become a focus of research on the improvement of recovery outcomes. Delay discounting is associated with substance use disorder severity, both its negative outcomes and the propensity to relapse. However, the association between delay discounting and perceived risk of relapse as measured by the Alcohol Warning of Relapse (AWARE) Questionnaire has not previously been examined in a population of those in long‐term recovery from substance misuse. Methods In this study, using data collected from the International Quit and Recovery Registry, we investigated the association between delay discounting, self‐reported time in recovery, and perceived risk of relapse. Data from 193 individuals self‐reporting to be in recovery from harmful substance use were included in the study. Results Delay discounting rates were significantly negatively associated with length of recovery (p =.036), and positively with perceived risk of relapse (p =.027) even after controlling for age, gender, education, marital status, ethnicity, race, primary substance, and length in the registry. Moreover, a mediation analysis using Hayes’ methods revealed that the association between the length of recovery and perceived relapse risk was partially mediated by delay discounting, accounting for 21.2% of the effect. Conclusions Our finding supports previous characterizations of delay discounting as a candidate behavioral marker of substance misuse and may help identify individuals at higher perceived risk of relapse in an extended recovery population.
... Additionally, recovery improvements have been greater for Black individuals living in Oxford House compared to White individuals. For example, Blacks reside longer (Bishop et al., 1998) and relapse at lower rates than Non-Hispanic White residents (Harvey, 2014), perhaps because Black residents gain more resources than White residents when living in recovery homes (Brown, Davis, Jason, & Ferrari, 2006). Moreover, these resources need not be physical: Black women with more arrests and longer incarceration periods living in recovery homes report less psychological distress over resource loss compared to White women with similar criminal histories (Walt et al.,, 2012). ...
Article
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An important step in reducing health disparities among racial and ethnic minorities with substance use disorders involves identifying interventions that lead to successful recovery outcomes for this population. The current study evaluated outcomes of a community-based recovery support program for those with substance use disorders. Participants included 632 residents of recovery homes in three states in the US. A multi-item recovery factor was found to increase over time for these residents. However, rates of improvement among Black individuals were higher than for other racial/ethnic groups. Black Americans perhaps place a higher value on communal relationships relative to all other racial/ethnic groups, and by adopting such a communitarian perspective, they might be even more receptive to living in a house that values participation and involvement. The implications of these findings for health disparities research are discussed.
... This goes with a study done by EL- Sherbiny. A (2015) in Tanta university hospital in Tanta city, Egypt, they reported that tramadol was most frequent on their subjects (33) , and the same by a study of El galad. (34) .In contrast with the study by Abd elmoniem. ...
Article
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Background; Substance use disorders are one of the serious health problems that threaten the Egyptian government, as it deals with youth within the age of work and productivity.Studies show that self-efficacy has a vital role in preventing relapse among patients with substance use disorders. It's considered a protective agent toward the challenge or pressures that lead to fall into the cycle of addiction. Aim of the study: The study aims at evaluating the effect of psycho-educational program on self-efficacy of patients with substance use disorders.Study design: A quasi-experimental research design is used in the present study.Setting: The study is carried out at psychiatry and neurology center. The center is affiliated to Tanta University, Tanta city, Egypt .Subjects;the study subjects were 50 patients diagnosed with substance use disorders, they were selected according to the convenience sampling type.Tools of the study: there were four tools:tool (I) was developed by the researchers and consisted of socio-demographic data, clinical data, and patients' knowledge about substance use disorders, Tool (2) was General Self-Efficacy Scale (GSE).Tool (3) was Brief Situational Confidence Scale .Tool (4) Ways of coping questionnaire .The researchers developed psycho-educational program and implemented on study subjects to develop their self-efficacy. Results: self-efficacy of studied patients was improved after implementation of psych educational program. Conclusion: Based on the results of the present study, the findings confirmed the importance of increasing self-efficacy, among those patients with substance related disorders, and also confirmed the effect of the training program.Recommendations: Involved training program about developed self-efficacy for patients with substance use disorders in outpatients' treatment plan.
... Our findings also indicate potentially important differences pertaining to relapse prediction at different time points, which may need to be accounted for in treatment planning. It is well established that the rate of post-treatment relapse is highest during the first 90 days after treatment (Harvey et al., 2016) and is likely multifactorial in nature. Our findings are consistent with previous studies demonstrating the association between relapse and negative mood (Witkiewitz and Bowen, 2010;Abulseoud et al., 2013). ...
Article
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Aims: Replicate the previously reported association of elevated alcohol craving, measured by Penn Alcohol Craving Scale (PACS) during residential treatment, with post-treatment relapse and explore whether elevated craving scores 3 months post-treatment are also associated with subsequent relapse. Methods: Alcohol craving was assessed with the PACS on admission and at several time points post-treatment in 190 subjects with DSM-IV diagnosis of alcohol dependence admitted to residential treatment. Data about relapse to any drinking (primary outcome measure) was collected at 3, 6, 9 and 12 months after treatment. Cox regression models were used to determine whether PACS scores were associated with relapse. Statistical models were adjusted for meaningful demographic and clinical covariates. Results: Follow-up data was available for 149/190 (78%) of subjects. Elevated PACS scores at discharge were associated with increased relapse risk within the first 3 and 12 months after discharge (P = 0.032 and P = 0.045, respectively). Elevated PACS scores at 3 months were associated with increased risk of subsequent relapse within 12 months after treatment in contacted subjects (P = 0.034) and in the intent-to-treat analysis (P = 0.0001). Conclusions: Our findings indicate strong association of post-treatment relapse with elevated alcohol craving measured at treatment completion and at 3 months after treatment and justify the use of this measure to guide relapse-prevention efforts.
... Our findings also indicate potentially important differences pertaining to relapse prediction at different time points, which may need to be accounted for in treatment planning. It is well established that the rate of post-treatment relapse is highest during the first 90 days after treatment (Harvey et al., 2016) and is likely multifactorial in nature. Our findings are consistent with previous studies demonstrating the association between relapse and negative mood (Witkiewitz and Bowen, 2010;Abulseoud et al., 2013). ...
Article
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Background and objectives: Alcoholism treatment interventions, both psychosocial and pharmacologic, aim to reduce cravings to drink. Yet, the role of craving in treatment outcomes remains unclear. This study evaluated craving intensity measured with the Penn Alcohol Craving Scale (PACS) at admission and discharge from residential treatment as a predictive factor of relapse after treatment. Methods: The study cohort included 314 alcohol-dependent subjects. Associations between relapse after discharge, PACS score, and clinical variables were investigated using time-to-event analyses. The primary analysis, based on the intent-to-treat principle, presumed relapse in those declining follow-up or not responding to contact attempts. Secondary analysis utilized data from 226 subjects successfully contacted after discharge with a median follow-up time of 365 days. Results: The intent-to-treat analysis demonstrated that relapse was associated with higher level of craving at admission (p= .002) and discharge (p < .001). The analysis of data from patients successfully contacted after discharge led to similar results. A multivariable analysis indicated that relapse rates increased as PACS scores increased, and a higher discharge PACS score was significantly associated with relapse (p= .006) even after adjusting for covariates. Conclusions and scientific significance: This study demonstrates that higher PACS scores at the time of admission and discharge are associated with relapse following residential addiction treatment. These data support the role of craving in relapse and the utility of craving measurement as a clinical guide in assessing relapse risk.
Article
Aims Drinking goal has emerged as a promising predictor variable for alcohol-related outcomes. Many patients with alcohol use disorder (AUD) choose another drinking goal than abstinence after residential AUD treatment program. We aimed to examine the effects of an abstinent drinking goal (ADG) and conditional abstinence drinking goal (CADG) 6 months after residential treatment on drinking outcomes in patients with severe AUD and investigate the effectiveness of telephone-based (TEL) or text message-based (TEX) continuing care according to the individual drinking goal. Methods A total of 240 patients from two specialized residential treatment programs for AUD were included in the study. Patients were randomly assigned to high-frequency (nine contacts) or low-frequency (two contacts) TEL, TEX (nine contacts), or control group (no contact) from treatment discharge to the 6-month follow-up. Results Patients with an ADG were significantly more often abstinent (58%) at the 6-month follow-up compared to patients with a CADG (32.1%), and in the case of relapse, showed a significantly longer time to the first drink. Patients with a CADG of the high-frequency TEL showed a tendency to be more abstinent at the 6-month follow-up and reported significantly higher alcohol-related self-efficacy compared to the CADG patients of the control group. Conclusions Patients with CADG are more vulnerable to relapse, and therefore may benefit more from high-frequency telephone contacts to deal with alcohol-related problems and reach their goal. In the case of relapse, the high-frequent contacts may help patients stay connected to health services, preventing chronification and facilitating recovery from AUD.
Article
Background Alcohol use disorder (AUD) is characterized by extremely high rates of postresidential treatment relapse, and as such, continuing care to prevent relapse has become an important element in AUD treatment. In this regard, research has yielded heterogeneous evidence on telephone‐based (TEL) and text message–based (TEX) continuing care. We aimed to compare the effectiveness of TEL and TEX continuing care provided in different frequencies by psychotherapists for patients from residential treatments in mitigating the occurrence of posttreatment relapse in patients who completed a 12‐week abstinence‐oriented residential treatment program for AUD. Methods A total of 240 patients from 2 residential treatment programs for AUD were included in the study. Patients were randomly assigned to high‐ (10 contacts) or low‐frequency (3 contacts) TEL, TEX (10 contacts) continuing care, or control group (1 contact) from discharge to 6‐month follow‐up. The TEL was intended to be supportive and consisted of several cognitive behavioral therapy components, whereas the TEX was based on behavioral self‐monitoring techniques and additional calls in case of relapse or as needed. Sociodemographic, clinical, and alcohol‐specific variables at residential treatment discharge and at 5‐month follow‐up were assessed through interviews and questionnaires. Results Compared with the control group, patients in the high‐frequency TEL were significantly more abstinent at 6‐month follow‐up and, in case of relapse, showed a tendency toward a longer time to first drink. Moreover, the high‐frequency TEL and TEX groups had significantly higher alcohol‐related self‐efficacy 6 months after residential treatment. Conclusion High‐frequency proactive telephone contact by psychotherapists known to the patient may help patients to surmount the vulnerable phase after residential treatment and, in case of relapse, might help patients stay connected to health services, which in turn prevents chronification and facilitates recovery from AUD.
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Criminal and aggressive behaviors are frequently observed among those recovering from substance abuse problems. In the present one-year longitudinal study, a national sample of residents from self-governed, communal living recovery homes for substance abuse completed baseline and follow-up measures of criminal and aggressive behavior. Results indicated that a length of stay of six months or longer was associated with lower levels of self-reported criminal and aggressive behaviors at the one-year follow-up. Environmental mechanisms proposed as influences for these outcomes, as well as treatment implications, are discussed.
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The contributions to this Special Issue illustrate research on several important types of environmental units, including psychiatric and substance abuse treatment programs, neighborhood block groups, and entire communities. They also exemplify alternative methodologies, such as assessing environments by relying on participants' appraisals, external observers' ratings, historical archives, and direct observation. I draw on these contributions and some of my own work to discuss four recurrent issues: (a) how to conceptualize environmental domains and dimensions; (b) how to understand environmental dynamics, that is, the interplay of environmental factors both within one setting and across settings; (c) how to comprehend the processes that link environmental factors to outcomes, especially with respect to the power and evanescence of environmental influence; and (d) how to use information about environments to monitor and improve them. Increased knowledge in these four areas is essential to help fulfill a major aim of community psychology: to understand social processes and improve intervention program outcomes.
Article
The present study is the first report on a client-treatment matching protocol (CMP) to guide admissions to residential and outpatient substance abuse treatment settings. Two cohorts, a field test sample (n = 318) and cross-validation (n = 407) sample were drawn from consecutive admissions to nine geographically distributed multisetting therapeutic communities (TCs). A passive matching design was employed. Clients received the CMP on admission, but agencies were "blind" to the CMP treatment recommendation (i.e., match) and assigned clients to treatment by the usual intake procedures. Bivariate and logistical regression analyses show that positive treatment dispositions (treatment completion or longer retention in treatment)) were significantly higher among the CMP-matched clients. The present findings provide the empirical basis for studies assessing the validity and utility of the CMP with controlled designs. Though limited to TC-oriented agencies, the present research supports the use of objective matching criteria to improve treatment.
Article
The purpose of this study was to develop an index of risk factors to identify patients prospectively with substance use disorders whose substance use symptoms exacerbate during or shortly after treatment, and to identify characteristics of care that may reduce the likelihood of exacerbation. On the basis of data obtained from a nation-wide outcomes monitoring system, a group of 2809 treated patients experienced an exacerbation of their substance use symptoms. These patients were matched on baseline substance abuse problems with 5618 patients who remained stable or improved. Risk factors for substance use symptom exacerbation included younger age, non-married status and residential instability; long-term use of drugs, prior arrests, prior alcohol treatment, alcohol and drug abuse or dependence diagnoses, cocaine abuse or dependence and more severe self-rated drug problems; and psychiatric problems. High-risk patients who obtained a longer episode of mental health care were less likely to experience an exacerbation of symptoms. Clinicians can identify at treatment entry patients whose substance use symptoms are likely to exacerbate and, by providing these patients a longer duration of care, may reduce the likelihood of symptom exacerbation.
Article
To consider key issues in understanding effective treatment and recovery, the author reviews selected principles and unresolved puzzles about the context of addictive disorders and the structure, process, and outcome of treatment. The principles focus on the process of problem resolution, the duration and continuity of care, treatment provided by specialist versus nonspecialist providers, alliance and the goals and structure of treatment, characteristics of effective interventions, and the outcome of treatment versus remaining untreated. The unresolved puzzles involve how to concepualize service episodes and treatment careers, connections between the theory and process of treatment effective patient-treatment matching strategies, integration of treatment and self-help, and the development of unified models to encompass life context factors and treatment within a common framework.
Article
The main purpose of the present study is to investigate the differences between alcoholics and heroin addicts in some relapse dimensions and self-efficacy. The sample consisted of 180 inpatient males, who admitted to Al-Amal Hospital, Jeddah, Saudi Arabia, for treatment from substance abuse. The total sample was divided into two groups: 105 participants were heroin addicts and 75 were alcoholics. Two standardized questionnaires [inventory of drug taking situations (IDTS) and situational confidence questionnaire (SCQ)] were used. Heroin addicts have statistically significant high mean IDTS scores compared with the alcoholics sample, whereas the alcoholics have significantly higher mean SCQ scores than did their heroin counterpart. Again, the alcoholics had significantly lower admission and relapse rates compared with the heroin group. Furthermore, the results indicate that the highest high-risk relapse situations are negative emotions (NE), testing personal control (TPC), social pressure (SP), and urge and temptations (UT).
Article
The nationally representative Alcohol and Drug Services Study (ADSS, 1996--1999) is used to examine employment counseling's impact on treatment participation and on postdischarge abstinence and employment. Employment counseling (EC) is among the more frequently received ancillary services in substance user treatment. The ADSS study sample showed it was received by 13% of all (N=988) nonmethadone outpatient clients, and 42% of the 297 clients with a need for it. Clients who received needed EC (met need) are compared to clients who did not receive needed EC (unmet need). Met-need clients had significantly longer treatment duration and greater likelihood of employment postdischarge than unmet-need clients. Both groups were as likely to complete treatment and be abstinent at follow-up. Implications are discussed. Future needed research and unresolved critical issues are also noted.
Article
Anxiety disorders are present in a high percentage of alcoholism treatment patients. We tested the prediction that having a comorbid anxiety disorder increases the prospective risk for relapse to drinking after alcoholism treatment. We also explored the prospective associations of specific anxiety syndromes (and depression) with drinking and anxiety outcomes. We assessed the diagnostic status and daily drinking patterns of 82 individuals approximately one week after they entered alcoholism treatment (baseline) and again approximately 120 days later (follow-up) (n=53). Consistent with study predictions, those with a baseline anxiety disorder (approximately 55%) were significantly more likely than others to meet various definitions of drinking relapse over the course of the follow-up. Regression models showed that baseline social phobia was the single best predictor of a return to any drinking after treatment, whereas panic disorder was the single best predictor of a relapse to alcohol dependence after treatment. Having multiple anxiety disorders (versus any specific anxiety disorder) at the baseline was the strongest predictor of having at least one active ("persistent") anxiety disorder at the follow-up. Cross-sectional analysis at the follow-up showed that anxiety disorder persisted in the absence of a relapse to alcohol dependence far more often than relapse to alcohol dependence occurred in the absence of a persistent anxiety disorder. Screening for comorbid anxiety disorder in alcoholism treatment patients is warranted and, where found, should be considered a marker of high relapse risk relative to that of noncomorbid patients. The capacity of specific anxiety treatment to mitigate relapse risk among comorbid patients remains an open question.
Article
To determine whether there is evidence to support the implementation of extended interventions (i.e. longer than 6 months) for individuals with alcohol or other drug use disorders. Literature on extended behavioral and pharmacotherapy interventions was reviewed, along with findings from studies of extended monitoring and monitoring paired with adjunctive counseling. Studies were identified through database searches, citations in prior reviews and examinations of recent volumes of relevant journals. Key terms were defined, and a theoretical rationale was presented for extended treatment. Several adaptive treatment studies that made use of stepped care or continuation protocols were also described. The primary outcomes that were considered were alcohol and drug use during the intervention and post-intervention follow-ups. Other outcomes were examined when they were included in the articles reviewed. Most of the studies in the review provided support for the effectiveness of extended interventions for alcohol and drug abusers, whether the extended care was delivered through face-to-face contact or via the telephone. These findings held across all types of interventions that were examined (e.g. behavioral treatment, pharmacotherapy and monitoring). However, only a few studies directly compared extended and standard length version of the same intervention. New developments in addiction treatment with implications for extended care models were also described and discussed. The findings of the review indicate that maintaining therapeutic contact for extended periods of time with individuals with alcohol and other drug disorders appears to promote better long-term outcomes than 'treatment as usual', although more studies are needed that compare extended and standard versions of interventions. Achieving good compliance and successful disease management with extended interventions will probably require adaptive protocols in which the intensity of treatment can be adjusted up or down in response to changes in symptoms and functioning over time. Future directions in research on extended interventions were discussed.
Article
High abstinence self-efficacy reliably predicts better treatment outcomes for patients with alcohol use disorders, but little is known about aspects of treatment that may be particularly beneficial for patients who enter treatment with low self-efficacy. This study examines whether the relationship between self-efficacy and treatment outcomes is influenced by the quality of the therapeutic alliance in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a multisite clinical trial of three treatments for alcohol use disorders. Information on 785 patients in the outpatient sample of Project MATCH was used to test for an interaction between baseline self-efficacy and therapeutic alliance in relation to 1-year alcohol use outcomes. A significant interaction was found between self-efficacy and the therapists' perception of the therapeutic alliance predicting I1year drinking outcomes. Patients with low self-efficacy who established a strong treatment alliance, as judged by the therapist, experienced I1year outcomes that were superior to those of patients with low self-efficacy with poorer treatment alliance and comparable with those of patients with high self-efficacy. Therapeutic alliance was not strongly related to the outcomes of patients with high baseline self-efficacy. In patients who are treated for alcohol-use disorders, a positive therapeutic alliance may counteract the negative impact of a low baseline self-efficacy. Potential reasons why the therapist's perception of the alliance may be particularly important for patients with low self-efficacy are discussed.
Article
There is a need to explore the processes of social support and self-efficacy change over time among individuals in recovery homes, and to assess the extent to which residents remain abstinent, obtain and maintain employment, refrain from criminal activity, and utilize health care systems both while within the and after leaving such settings. Residents were recruited and interviewed at an initial baseline phase and then re-interviewed at three subsequent 4-month intervals. Oxford Houses are recovery home residences for individuals with substance abuse and dependence problems who seek a supportive, democratic, mutual-help setting. A national US sample of Oxford House residents (n=897: 604 men, 293 women). Information was gathered on abstinence, social support, self-efficacy, employment, criminal history, and medical care utilization. Change in cumulative abstinence was predicted by support for alcohol use, abstinence self-efficacy, and length of residency in OH (i.e., less than versus >or=6 months), even after controlling for initial time spent in OH. Results suggest that receiving abstinence support, guidance, and information from recovery home members committed to the goal of long-term sobriety may enhance residents' abstinence self-efficacy and enable persons recovering from alcohol and other drug addiction to reduce the probability of a relapse.
Article
The majority of U.S. adults with substance abuse or dependence are gainfully employed. However, little is known about outcomes among stably employed people in treatment for substance dependence. Participants (N = 212) entering a residential treatment program completed the Addiction Severity Index (ASI) at intake and 6 and 12 months follow-up. Significant improvements were seen in absenteeism, number of employment problem days, and whether their job was in jeopardy 12 months later. Overall, 65% were retained by their original employer. ASI composite alcohol, drug, legal, family, and psychiatric scores also improved significantly. Continuous abstinence was achieved by 65% and 51% at 6 and 12 months, respectively. Although less likely to be referred to treatment by their employer, women responded to treatment as well as men, reporting similar abstinence rates and overall quality of life during the year following discharge from treatment.
Article
Social support may be considered from several different dimensions. While general social support promotes well-being, specific social support is tied to particular functions, such as alcohol use. Not only may the form of social support vary, but also the source (ie, friends vs. family). This study investigated the impact of general and specific support for alcohol use from family versus friends on alcohol use among 897 U.S. residents of abstinent communal-living settings (Oxford Houses). Results indicated that general support from friends and length of stay in Oxford House significantly predicted less alcohol use. Implications for alcohol recovery are discussed.
Oxford House Manual: An Idea Based on a Sound System for Recovering Alcoholics and Drug Addicts to Help Themselves
  • Oxford House Inc
Oxford House Inc. Oxford House Manual: An Idea Based on a Sound System for Recovering Alcoholics and Drug Addicts to Help Themselves. Silver Spring, MD: Oxford House World Services, Inc; 2011.