Evaluating alcoholism treatment programs: An integrated approach.

Examines the interrelationships among 5 major sets of variables (social background, intake symptoms, program type, treatment experiences, and perceptions of the environment) that are related to posttreatment functioning of alcoholic patients (alcohol consumption, rating of drinking problem, physical impairment, and occupational functioning). The sample consisted of 429 patients selected from 5 different treatment programs. All Ss completed the Community-Oriented Program Evironment Scale about 2 wks after admission to measure their perceptions of the program environment. The relative importance of each set of variables as predictors of outcome was estimated by constructing block variables, using path analyses, and partitioning the explained variance. Results show that (a) the combined explanatory power of the program-related variables is considerably more than would be expected from previous research; (b) the importance of patient background relative to intake symptoms varies with the outcome criterion being used; (c) both the treatment experiences and the patient's perceptions of the treatment environment are strong predictors of outcome; and (d) a substantial proportion of the explained variance is shared between patient-related and program-related variables, suggesting important patient-program selection and congruence effects. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of the Computerized Assessment System for Psychotherapy Evaluation and Research (CASPER) as a measure of treatment effectiveness in an outpatient training clinic.

This study evaluated the validity of the Computerized Assessment System for Psychotherapy Evaluation and Research (CASPER), a system that identifies target problems and monitors treatment outcomes. Pre- and posttreatment data were obtained from 78 clients and their therapists in an outpatient training clinic. CASPER scales were significantly correlated with the Brief Symptom Inventory (BSI) and with therapist ratings on the Global Assessment Scale (GAS) at both intake and posttreatment. These measures also showed significant pre- to posttreatment changes. The largest effect sizes were found on CASPER individualized outcome measures. Residual change scores and posttreatment improvement ratings derived from CASPER were significantly correlated with BSI and GAS change scores. There was moderate agreement between clients' and therapists' ratings; clients tended to rate their functioning higher than did therapists on several CASPER scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of individual and couple behavioral alcohol treatment for women.

Although alcohol use disorders (AUDs) adversely affect women, research on efficacious treatments for women is limited. In this randomized efficacy trial of 102 heterosexual women with AUDs, the authors compared alcohol behavioral couple therapy (ABCT) and alcohol behavioral individual therapy (ABIT) on percentage of days abstinent (PDA) and percentage of days of heavy drinking (PDH) over 6 months of treatment and 12 months of posttreatment follow-up. Baseline relationship functioning and comorbid disorders were tested as moderators of outcome. Piecewise linear growth models were used to model outcomes. During treatment, women increased their PDA and decreased their PDH, with significantly greater improvements in ABCT than in ABIT (d = 0.59 for PDA; d = 0.79 for PDH). Differences favoring ABCT were maintained during follow-up. Women with poorer baseline relationship functioning improved more on PDA during treatment with ABCT than with ABIT. For PDH, results during treatment and follow-up favored ABCT for women with better baseline relationship functioning. ABCT resulted in better outcomes than ABIT for women with Axis I disorders at the end of follow-up (PDA), and for women with Axis II disorders at the end of treatment (PDA) and at the end of follow-up (PDH). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demographic, individual, and interpersonal predictors of adolescent alcohol and marijuana use following treatment.

A vulnerability model of adolescent substance abuse treatment outcome provided the basis for selection of demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of 225 adolescents (aged 12–18 yrs) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 mo posttreatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-mo follow-up. Peer substance use at intake and 6-mo posttreatment both predicted substance use frequency outcomes at 12-mo follow-up. Alcohol and marijuana use frequencies at 6-mo follow-up also predicted continued use for these substances throughout the remainder of the 1st posttreatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st posttreatment year. Elevated psychological substance dependence at 6-mo follow-up was a unique risk factor for subsequent marijuana use. Findings support conceptual models that attempt to explain adolescent substance abuse treatment outcome in terms of relationships among demographic, individual, interpersonal, and treatment factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance and its relationship to alcoholism treatment participation and outcome.

The relationship between the therapeutic alliance and treatment participation and drinking outcomes during and after treatment was evaluated among alcoholic outpatient and aftercare clients. In the outpatient sample, ratings of the working alliance, whether provided by the client or therapist, were significant predictors of treatment participation and drinking behavior during the treatment and 12-month posttreatment periods, after a variety of other sources of variance were controlled. Ratings of the alliance by the aftercare clients did not predict treatment participation or drinking outcomes. Therapists ratings of the alliance in the aftercare sample predicted only percentage of days abstinent during treatment and follow-up. The results document the independent contribution of the therapeutic alliance to treatment participation and outcomes among alcoholic outpatients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A naturalistic study of the associations between changes in alcohol problems, spiritual functioning, and psychiatric symptoms.

The study evaluated how spiritual and religious functioning (SRF), alcohol-related problems, and psychiatric symptoms change over the course of treatment and follow-up. Problem drinkers (n = 55, including 39 males and 16 females) in outpatient treatment were administered questionnaires at pretreatment, posttreatment, and follow up, which assessed two aspects of SRF (religious well-being and existential well-being), two aspects of alcohol misuse (severity and consequences), and two aspects of psychiatric symptoms (depression and anxiety). Significant improvements in SRF, psychiatric symptoms and alcohol misuse were observed from pretreatment to follow-up. Although SRF scores were significantly correlated with psychiatric symptoms at all three time points, improvement in the former did not predict improvement in the latter. When measured at the same time points, SRF scores were not correlated with the measures of alcohol misuse. However, improvement in SRF (specifically in existential well-being) over the course of treatment was predictive of improvement in the alcohol misuse measures at follow-up. These results suggest that the association between SRF, emotional problems, and alcohol misuse is complex. They further suggest that patients who improve spiritual functioning over the course of treatment are more likely to experience improvement in drinking behavior and alcohol-related problems after treatment has ended. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Brief Relationship Therapy for Alcoholism: A Randomized Clinical Trial Examining Clinical Efficacy and Cost-Effectiveness.

The purpose of this study was to examine the clinical efficacy and cost effectiveness of brief relationship therapy (BRT), a shortened version of standard behavioral couples therapy (S-BCT), with alcoholic male patients (N = 100) and their nonsubstance-abusing female partners. Participants were randomly assigned to 1 of 4 treatment conditions: (a) BRT, (b) S-BCT, (c) individual-based treatment (IBT), or (d) psychoeducational attention control treatment (PACT). Equivalency testing revealed that, compared with those assigned to S-BCT, participants who were randomly assigned to BRT had equivalent posttreatment and 12-month follow-up heavy drinking outcomes. Moreover, at 12-month follow-up, heavy drinking and dyadic adjustment outcomes for patients who received BRT were superior to those of patients who received IBT or PACT. BRT was significantly more cost effective than the S-BCT, IBT, or PACT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment settings for persons with alcoholism: Evidence for matching clients to inpatient versus outpatient care.

This study compared inpatient, intensive outpatient, and standard outpatient treatment settings for persons with alcoholism and tested a priori hypotheses about the interaction of setting with client alcohol involvement and social network support for drinking. Participants (N?=?192) were assigned randomly in cohorts to 1 of the 3 settings. The settings did not differ in posttreatment primary drinking outcomes, although inpatients had significantly fewer jail and residential treatment days combined than outpatients. Clients high in alcohol involvement benefited more from inpatient than outpatient care; the opposite was true at low alcohol involvement levels. Network drinking support did not moderate setting effects. Clients low in cognitive functioning also appeared to benefit more from inpatient than outpatient care. Improved outcomes might be achieved by matching degree of alcohol involvement and cognitive functioning to level of care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal analyses of family functioning in veterans and their partners across treatment.

Objective: This study evaluated the relations between posttraumatic stress disorder (PTSD) symptoms and poor family functioning in veterans and their partners. Method: Data were collected from Caucasian veterans with PTSD (N = 1,822) and their partners (N = 702); mean age = 53.9 years, SD = 7.36. Veterans completed the Posttraumatic Checklist Military Version (PCL-M) and, along with their partners, completed the McMaster Family Assessment Device (FAD-12). Assessments were conducted at intake into a treatment program at 3 months and 9 months posttreatment. Results: Structural equation models (SEMs) were developed for veterans as well as for veterans and their partners. Poor family functioning for veterans at intake predicted intrusion (β = .08), hyperarousal (β = .07), and avoidance (β = .09) at 3 months posttreatment. At 3 months posttreatment, family functioning predicted hyperarousal (β = .09) and avoidance (β = .10) at 9 months. For veterans and their partners, family functioning at intake predicted avoidance (β = .07) at 3 months, and poor family functioning at 3 months predicted intrusion (β = .09) and hyperarousal (β = .14) at 9 months. The reverse pathways, with PTSD symptoms predicting poor family functioning, were only evident with avoidance (β = .06). Conclusion: Family functioning may play a role in treatment for veterans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life stressors and social resources affect posttreatment outcomes among depressed patients.

Examined pre- and posttreatment changes in life stressors and social resources and their association with treatment outcomes in a 12-mo follow-up of 424 Ss (aged 18–83 yrs) with unipolar depression. Assessment measures included the Family Environment Scale, Work Environment Scale, and Health and Daily Living Form. As expected, Ss reported significant, multidimensional improvements in their functioning at follow-up. There were modest increases in Ss' social resources but, suprisingly, no overall decrease in stressors. Life stress and resource factors were significantly related to Ss' functioning at follow-up, even after considering the severity of their dysfunction at treatment intake and their length of treatment. Implications for developing a general body of knowledge about the process of recovery and relapse in behavioral disorders are discussed. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial processes of remission in unipolar depression: Comparing depressed patients with matched community controls.

Investigated the posttreatment phase of unipolar depression by examining the personal and social-environmental characteristics of remitted, partially remitted, and nonremitted depressed patients. The sample was based on a 12-mo follow-up of 424 depressed persons who received psychiatric treatment and a comparable follow-up of demographically matched, nondepressed community controls. 98.8% of the Ss were located at 12-mo follow-up. Analyses were based on 380 Ss. At follow-up, the 138 Ss whose depressive symptoms remitted also reported improvement in other aspects of their adjustment as well as in personal resources such as self-esteem and coping responses to posttreatment stressors. In contrast, the 133 nonremitted Ss continued to report deficits in each of these domains. 124 Ss were categorized as partially remitted. Remitted Ss approached normal levels of life stressors and social resources, whereas nonremitted Ss continued to report heightened stressors and lower levels of support. Risk factors identified at treatment intake were predictive of these Ss' subsequent outcome at follow-up. These findings imply that many successfully treated depressed patients can resume near-normal patterns of functioning and that remission is linked to normalization of personal and social context factors. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Twelve-step and cognitive-behavioral treatment for substance abuse: A comparison of treatment effectiveness.

The comparative effectiveness of 12-step and cognitive-behavioral (C-B) models of substance abuse treatment was examined among 3,018 patients from 15 programs at the US Department of Veterans Affairs Medical Centers. Across program types, participants showed significant improvements in functioning from treatment admission to a 1-year follow-up. Although 12-step patients were somewhat more likely to be abstinent at the 1-year follow-up, 12-step, C-B, and combined 12-Step–C-B treatment programs were equally effective in reducing substance use and improving most other areas of functioning. The finding of equal effectiveness was consistency over several treatment subgroups: Patients attending the "purest" 12-step and C-B treatment programs, and patients who had received the "full dose" of treatment. Also, patients with only substance abuse diagnoses, those with concomitant psychiatric diagnoses, and patients who were mandated to treatment showed similar improvement at the 1-year follow-up, regardless of type of treatment received. These data provide important new evidence supporting the effectiveness of 12-step treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Work and nonvocational domains of functioning in persons with severe mental illness: a longitudinal analysis

In this study we sought to understand the relationship between obtaining competitive employment and changes in nonvocational domains of functioning (symptoms, substance abuse, hospitalizations, self-esteem, quality of life) in persons with severe mental illness. A group of 143 unemployed patients participating in a study of vocational rehabilitation programs were assessed in nonvocational areas of functioning at baseline and 6, 12, and 18 months later. Statistical analyses examined the relationship between work status at the follow-up assessments and nonvocational functioning, controlling for baseline levels of nonvocational variables. Patients who were working at follow-up tended to have lower symptoms (particularly thought disorder and affect on the Brief Psychiatric Rating Scale), higher Global Assessment Scores, better self-esteem, and more satisfaction with their finances and vocational services than unemployed patients. Employment is associated with better functioning in a range of different nonvocational domains, even after controlling for baseline levels of functioning.     

Random versus nonrandom assignment in the evaluation of treatment for cocaine abusers.

Cocaine-abusing patients randomly assigned to day-hospital or inpatient rehabilitation were compared with patients who self-selected these treatment settings to examine differences in substance use and psychosocial outcomes under experimental and nonexperimental designs. There was little evidence of setting or assignment effects or Setting?×?Assignment interactions over the 12-month follow-up period. However, Assignment?×?Time interactions were obtained with 2 measures of cocaine use and measures of family-social and psychiatric problem severity. These interactions indicated greater problem severity at intake among the randomized patients coupled with greater improvements by the 3-month follow-up relative to the nonrandomized patients. Findings suggest that randomized studies of treatment for cocaine abuse may produce somewhat larger estimates of improvement than what is observed in more typical treatment situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcoholics Anonymous involvement and positive alcohol-related outcomes: Cause, consequence, or just a correlate? A prospective 2-year study of 2,319 alcohol-dependent men.

A positive correlation between Alcoholics Anonymous (AA) involvement and better alcohol-related outcomes has been identified in research studies, but whether this correlation reflects a causal relationship remains a subject of meaningful debate. The present study evaluated the question of whether AA affiliation appears causally related to positive alcohol-related outcomes in a sample of 2,319 male alcohol-dependent patients. An initial structural equation model indicated that 1-year posttreatment levels of AA affiliation predicted lower alcohol-related problems at 2-year follow-up, whereas level of alcohol-related problems at 1-year did not predict AA affiliation at 2-year follow-up. Additional models found that these effects were not attributable to motivation or psychopathology. The findings are consistent with the hypothesis that AA participation has a positive effect on alcohol-related outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcoholics' perceptions of factors in the onset and termination of relapses and the maintenance of abstinence: Results from a 30-month follow-up.

Male alcoholics were interviewed at 6 points during a 30-month follow-up about their perceptions of the causes of relapses, factors in the termination of relapses, and coping strategies used to promote abstinence. Cognitive factors were generally rated as having a stronger influence on relapse than emotional or interpersonal factors. Several factors were perceived to be important in terminating relapse. Active cognitive coping strategies were rated as more important in the maintenance of abstinence than other coping behaviors. The relative importance of factors in termination and coping strategies at each follow-up point was highly consistent. A greater reliance on active as opposed to avoidance coping in the 1st 3 months predicted better drinking outcomes during the next follow-up period. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of goal choice interventions for alcohol use disorders among men who have sex with men.

This study tested the efficacy of behavioral treatments for alcohol use disorders (AUD) among men who have sex with men (MSM) and who are at risk for HIV transmission. HIV-negative MSM with current AUD (N = 198) were recruited, offered treatment focused on reducing drinking and HIV risk, and followed during treatment and 12 months posttreatment. Participants (n = 89) accepted treatment and were randomized to either 4 sessions of motivational interviewing (MI) or 12 sessions of combined MI and coping skills training (MI + CBT). Other participants (n = 109) declined treatment but were followed, forming a non-help-seeking group (NHS). MI yielded significantly better drinking outcomes during the 12-week treatment period than MI + CBT, but posttreatment outcomes were equivalent. NHS participants significantly reduced their drinking as well. Service delivery and treatment research implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Combined use of root conditioning, fibrin-fibronectin system and a collagen membrane to treat a localized gingival recession: a 10-case report

The relationship between the therapeutic alliance and treatment participation and drinking outcomes during and after treatment was evaluated among alcoholic outpatient and aftercare clients. In the outpatient sample, ratings of the working alliance, whether provided by the client or therapist, were significant predictors of treatment participation and drinking behavior during the treatment and 12-month posttreatment periods, after a variety of other sources of variance were controlled. Ratings of the alliance by the aftercare clients did not predict treatment participation or drinking outcomes. Therapists ratings of the alliance in the aftercare sample predicted only percentage of days abstinent during treatment and follow-up. The results document the independent contribution of the therapeutic alliance to treatment participation and outcomes among alcoholic outpatients.     

Implications of family and peer relations for treatment engagement and follow-up outcomes: An integrative model.

An integrative analytic model was proposed to explain deviance in terms of the family of origin, perceived peer and family relations, psychosocial functioning, motivation for treatment, and treatment engagement. The model was tested by using data from opioid-addicted persons who completed methadone treatment and were interviewed 1 year after discharge. The hypothesized model was shown to fit the data for outcomes at follow-up. A history of poor family relations was related to perceived family dysfunction and peer deviance at treatment entry; these 2 factors in turn predicted poor psychosocial functioning, which was related to higher levels of motivation. Higher motivation was associated with greater treatment engagement, which was associated with reduced opioid use and criminality. The importance of examining associations between family and peer relations and posttreatment outcomes within the context of treatment engagement is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning predicts outcomes for veterans in treatment for chronic posttraumatic stress disorder.

A longitudinal framework was used to examine the competing hypotheses of (a) whether family functioning predicts changes in posttraumatic stress disorder (PTSD) symptoms or (b) whether PTSD symptoms predict changes in family functioning. Veterans (N = 311) admitted to a treatment program completed a series of questionnaires at 3 time points: at intake, from intake to completion of a treatment program, and at the 6-month follow-up. Alcohol use and general mental health symptoms were also measured at intake. A cross-lagged panel model using structural equation modeling analyses indicated that family functioning was a moderate predictor of PTSD symptoms at posttreatment and at the 6-month follow-up. PTSD was not a significant predictor of family functioning across time and alcohol use, and general mental health symptoms did not affect the overall findings. Further analyses of PTSD symptom clusters indicated that the avoidance symptom cluster was most strongly related to family functioning. Targeting family relationships for treatment may be important in the future for veterans with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)