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Recent Developments in Alcoholism

Methodology Psychosocial Treatment Selected Treatment Topics Research Priorities

By: Marc Galanter

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Hardcover | 31 January 2003

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468 Pages

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From the President of the Research Society on Alcoholism The sixteenth volume of Recent Developments in Alcoholism contains the latest information on the field of alcoholism treatment research. This scholarly volume includes comprehensive reviews of the methodologies available to evaluate treatment outcome, state-of-the art psychosocial interventions, and recent advances in pharmacological adjuncts to treatment that are currently available and those on the brink of application. Other sections of the book address special issues in the treatment of alcohol dependence, including the treatment of the adolescents and other unique populations, the management of tobacco dependence, and the role of spirituality in recovery, among others. The clinician will find these reviews an important resource for learning about e- dence based treatments for alcoholism, and the researcher will find the synt- sis of recent developments informative and forward looking. The research agenda for the future rests soundly on the progress to date and additional advances in the treatment of alcoholism can be predicted in the near future. Stephanie O'Malley, Ph. D. President, Research Society on Alcoholism xi Preface From the President of the American Society of Addiction Medicine This excellent volume presents investigations covering a wide spectrum of scientific issues. It is also evident that many of these articles have clinical s- nificance, ranging from assessments of disorder, monitoring clinical progress, and behavioral and pharmacological interventions.

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You Can Find This Book In

Non-Fiction Medicine Other Branches of Medicine Therapy & Therapeutics Addiction & Therapy Self-Help, Personal Development & Practical Advice Clinical Psychology Society & Culture Social Issues & Processes Social Aspects of Illness & Addictions Social Aspects of Drug & Substance Abuse Medicine in General

Public Health & Preventive Medicine Psychology

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Introduction
Research on Alcoholism Treatment
Methodology
Overview
Assessment of Alcoholic Patients: Advances and Future Challenges
Introduction	p. 13
Self-Report Screening Measures	p. 14
Biochemical Markers	p. 15
Self-Report Measures of Consumption	p. 17
Diagnostic Measures	p. 18
Treatment Planning Instruments	p. 19
Cross-Cutting Issues	p. 21
Biomarkers as Aids to Identification of Relapse in Alcoholic Patients
Reasons that Relapse Should Be Recognized Early	p. 26
The Role of Biomarkers in Relapse Recognition	p. 26
Desirable Qualities in a Biomarker of Relapse	p. 27
Biomarkers of Relapse	p. 27
Summary of Findings on Biomarkers of Relapse	p. 29
Future Research Questions	p. 33
Recommendations to Clinicians	p. 35
Advances in Research Design and Analysis for Alcohol Treatment
Research Design and Implementation	p. 39
Nonrandomized Designs	p. 40
Research Efficiency	p. 41
Study of Multicomponent Therapies	p. 42
Replicability and Site Differences	p. 43
Longitudinal Research Issues	p. 43
Outcome and Utility	p. 44
Issues in the Analysis of Treatment Data	p. 44
Underutilized Statistical Methods	p. 45
Statistical Methods Requiring Further Development	p. 47
Final Remarks	p. 50
Clinicians' Impact on the Quality of Substance Use Disorder Treatment
Clinicians' Impact on Substance Use Disorder Treatment Retention and Outcome	p. 55
Clinicians' Professional Background Characteristics	p. 58
Matching Patients to Clinicians	p. 58
Clinicians' Recovery Status	p. 59
Adherence and Competence	p. 59
Clinicians' Emotional Responses (Countertransference)	p. 60
Clinicians' Interpersonal Functioning/Therapeutic Alliance	p. 61
Clinicians' Personality Characteristics	p. 62
Clinicians' Beliefs about Substance Use Disorder Treatment	p. 63
Professional Practice Issues	p. 65
Clinician-Targeted Interventions	p. 65
Clinician Selection and Training	p. 66
Methodological Issues in Studying Clinicians	p. 67
Summary and Discussion	p. 68
Natural Resolution of Alcohol-Related Problems
State of Knowledge	p. 78
Epidemiology of Treatment-Assisted and Natural Resolutions	p. 79
Environmental Contexts Surrounding Natural Resolutions	p. 81
Gaps in Knowledge and Research Opportunities	p. 83
Investigating Natural Resolution across the Distribution of Problem Drinkers	p. 83
Explicating Environment-Behavior Relations	p. 84
Determining Pathways to Moderation and Harm Reduction	p. 85
Understanding Relations between Help-Seeking and Drinking Behavior Change	p. 86
Conclusions	p. 87
Psychosocial Treatments
Overview
The Search for a Rational Basis for Treatment Selection
Overview of Models of Treatment Selection	p. 97
Treatment Selection Models Based on Single Patient Characteristics	p. 98
Single Patient Characteristics Matched to Behavioral Interventions	p. 98
Single Patient Characteristics Matched to Pharmacological Therapies	p. 102
Multidimensional Models of Patient Selection	p. 103
Matching Based on Client Resource Needs and Program Services	p. 103
Matching Based on Clients' Changing Status	p. 104
The Prescriptive Approach to Matching	p. 106
ASAM Patient Placement Criteria	p. 106
Future Prospects for Research on Treatment Selection and Matching	p. 108
Summary of Recent Trends	p. 108
Future Prospects	p. 110
Psychotherapy and Motivational Enhancement
Introduction	p. 115
Psychodynamic Treatments	p. 116
Interpersonal Psychotherapy	p. 117
Cognitive Therapy	p. 118
Motivational Enhancement Intervention	p. 120
Historical Foundations	p. 120
Motivational Interviewing and the Stages of Change	p. 121
Current Status of Motivational Enhancement Interventions	p. 122
Motivational Enhancement in the Project MATCH Study	p. 124
Summary	p. 126
Current Status and Future Directions	p. 127
Involvement of Support Networks in Treatment
Self-Help Groups	p. 135
Treatment Involvement by Members of the Natural Social Network	p. 136
Marital and Family Therapy for Alcohol Abusers	p. 138
Moving Outside of the Family Unit	p. 141
A Summary of Research Priorities	p. 144
Alcoholics Anonymous and 12-Step Alcoholism Treatment Programs
Nature and Prevalence of Alcoholics Anonymous	p. 150
Nature and Prevalence of 12-Step Alcoholism Treatment Programs	p. 150
Evaluations of Community-Based AA Groups	p. 151
Evaluation Context	p. 151
Selected Studies	p. 152
Evaluation Research on 12-Step Oriented Professional Treatment Programs	p. 154
Evaluation Context	p. 154
Selected Studies	p. 155
Potential Future Research Directions	p. 159
Process Recommendations	p. 159
Specific Content Areas for Focused Enquiry	p. 160
Behavioral and Cognitive-Behavioral Treatments for Alcoholism: Research Opportunities
Cue Exposure	p. 166
Gaps in Knowledge	p. 166
Research Opportunities	p. 169
Contingency Management	p. 170
Gaps in Knowledge	p. 171
Research Opportunities	p. 171
Coping Skills Training	p. 172
Gaps in Knowledge	p. 172
Research Opportunities	p. 174
Relapse Prevention	p. 174
Gaps in Knowledge	p. 175
Research Opportunities	p. 175
Behavioral Marital Therapy	p. 176
Gaps in Knowledge	p. 176
Research Opportunities	p. 177
Final Note	p. 177
The Community Reinforcement Approach
Community Reinforcement Approach (CRA)	p. 183
CRA Description	p. 183
CRA Empirical Support	p. 185
Community Reinforcement and Family Training (CRAFT)	p. 190
CRAFT Description	p. 190
CRAFT Empirical Support	p. 191
Summary	p. 193
Pharmacotherapy
Overview
Acamprosate
Overview of Clinical Trials	p. 203
Overview of Research Methodology	p. 206
Short-Term Efficacy Studies	p. 207
Six-Month Efficacy Studies	p. 208
Long-Term Efficacy Studies	p. 210
Safety	p. 212
Commentary	p. 212
Advances in the Use of Naltrexone: An Integration of Preclinical and Clinical Findings
Introduction	p. 217
Mechanisms of Action of Naltrexone	p. 218
Effects of Drinking Behavior	p. 220
Maintenance of Abstinence	p. 220
Relapse to Heavy Drinking	p. 222
Patterns of Drinking	p. 224
Dosing Regimens	p. 226
Dose	p. 226
Continuous Release Formulations	p. 227
Long-Term Intermittent Naltrexone Administration	p. 228
Targeted Naltrexone	p. 229
Drinking Pattern Specific Dosing	p. 230
Factors Predicting Clinical Response to Naltrexone	p. 231
Genetic Response	p. 231
Craving	p. 232
Other Patient Characteristics	p. 233
Interactions with Behavioral Interventions	p. 233
Reduction of Heavy Drinking in Nonalcoholic Populations	p. 234
Combination Therapy	p. 235
Summary	p. 236
The Status of Serotonin-Selective Pharmacotherapy in the Treatment of Alcohol Dependence
Introduction	p. 247
Abnormal Serotonergic Neurotransmission Linked to Alcohol Dependence	p. 248
Historical Overview: Trials of 5-HT-Selective Agents to Reduce Excessive Drinking	p. 249
Current Status: 5-HT Clinical Trials to Treat Subtypes of Alcohol Dependence	p. 251
Alcoholic Subtypes: Presence or Absence of Comorbid Psychiatric Disorders	p. 252
Alcoholic Subtypes: Different Kinds of Alcohol Dependence	p. 254
Conclusions	p. 257
Animal Models of Motivation for Drinking in Rodents with a Focus on Opioid Receptor Neuropharmacology
Positive Reinforcement Animal Models for Development of Medications to Treat Alcoholism	p. 264
Two-Bottle Choice Procedure--Rats	p. 265
Two-Bottle Choice Procedure--Mice	p. 265
Limited Access Operant Self-Administration--Rats	p. 266
Limited Access Operant Self-Administration--Mice	p. 266
Drinking in Alcohol-Preferring Rats	p. 267
Alcohol Deprivation Effect	p. 267
Conditioned Reinforcement: Discriminative Stimulus (Cue)-Induced Reinstatement of Self-Administration	p. 268
Independent Variables Used to Predict Medications for Treating Alcoholism--The [mu]-Opioid System as a Prototype	p. 270
Selective Antagonists	p. 270
Effects of Opioid Antagonists on Self-Administration of Ethanol in Alcohol-Preferring Rats	p. 270
Effects of Chronic Naltrexone Administration on the Alcohol Deprivation Effect	p. 271
Effects of Naltrexone on Responding to Ethanol-Associated Cues	p. 271
Molecular Genetic Manipulations--Knockout of the [mu]-Opioid Receptor	p. 273
Molecular Genetic Manipulations--Knockout of the [partial differential]-Opioid Receptor	p. 275
Summary and Conclusions	p. 277
Recent Development in Alcoholism: Research on Alcoholism Treatment
Overview
Outcomes of Alcohcol Treatment for Adolescents
Prevalence	p. 289
Assessment and Diagnosis	p. 290
Treatment Outcome Research	p. 293
Intervention Studies	p. 296
Self-Help Programs	p. 296
Systems Oriented Interventions	p. 296
Brief Interventions	p. 298
Cognitive and Behavioral Therapy	p. 298
Pharmacotherapy	p. 299
Self-Change Efforts	p. 300
Outcome Process Research for Adolescence	p. 301
Developmental Factors and Family Context	p. 301
Heterogeneity of the Adolescent Treatment Population	p. 302
Relapse and Posttreatment Functioning	p. 304
Summary and Conclusions	p. 307
Treatment for Alcohol-Related Problems: Special Populations: Research Opportunities
Women	p. 315
Recommendations	p. 320
The Elderly	p. 321
Alcohol	p. 322
Treatments	p. 324
Ethnicity	p. 325
Treatment of Tobacco Dependence in Alcoholics
Introduction	p. 335
Prevalence of Smoking in Alcoholics	p. 336
Tobacco-Caused Morbidity and Mortality in Alcoholics	p. 337
Addressing Tobacco Dependence in Addictions Treatment	p. 338
Efficacy of Behavioral Treatment for Alcoholic Smokers	p. 339
Addressing Depression in the Behavioral Treatment of Alcoholic Smokers	p. 342
Effect of Tobacco Dependence Treatment on Alcohol Relapse	p. 343
Pharmacological Treatment of Tobacco Dependence in Alcoholics	p. 344
First-Line Pharmacotherapy	p. 344
Second-Line Pharmacotherapy	p. 350
Combination Pharmacotherapy	p. 351
Unproven Pharmacotherapies for Tobacco Dependence	p. 351
Alcohol and Psychiatric Comorbidity
Introduction	p. 362
Comorbidity with Major Depression	p. 364
Comorbidity with Bipolar Disorder	p. 365
Comorbidity with Anxiety Disorders	p. 366
Comorbidity with Psychotic Disorders	p. 367
Comorbidity with Drug Use Disorders	p. 368
Conclusions	p. 369
Brief Interventions and the Treatment of Alcohol Use Disorders: Current Evidence
Introduction	p. 375
Brief Intervention: The Evidence--What We Know and Don't Know	p. 376
What We Know About Brief Intervention!	p. 377
What We Don't Know About Brief Intervention!	p. 378
Methodological Concerns and Challenges	p. 380
Other Methodological Considerations	p. 382
Review of Selected Brief Intervention Trials	p. 382
Recommendations	p. 388
Spirituality, Treatment, and Recovery
Defining Spirituality	p. 391
Spirituality and Alcoholism	p. 392
Spirituality and Recovery	p. 394
Spirituality and Treatment	p. 395
AA and Treatment	p. 395
AA and Treatment Outcome	p. 396
Twelve-Step Facilitation (TSF) Therapy	p. 397
Beyond 12-Step Spirituality	p. 399
Spirituality and Science	p. 401
Research Priorities for Alcoholism Treatment
Context for Setting Research Priorities	p. 405
Impact of Prior Portfolio Reviews in Stimulating Research	p. 406
New Research Priorities	p. 407
Mechanisms of Action of Treatment	p. 407
Combinations and Sequencing of Treatments	p. 408
Health-Seeking Patterns and Processes	p. 408
Concurrent Disorders: Medical, Drug, and Psychiatric	p. 409
Help Agent Behaviors	p. 409
Crosscutting Issues	p. 410
Special Populations	p. 410
Patient-Treatment Matching	p. 411
Measurement Techniques	p. 411
Technology Transfer	p. 412
Mechanisms of Funding	p. 412
Summary and Conclusions	p. 413
Contents of Previous Volumes	p. 415
Index	p. 433
Table of Contents provided by Ingram. All Rights Reserved.

Recent Developments in Alcoholism

Methodology Psychosocial Treatment Selected Treatment Topics Research Priorities

At a Glance

Hardcover

Shipping

How to return your order

Defective items

You Can Find This Book In

Other Editions and Formats

Paperback

Paperback

Paperback

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