In this month's column we will cover diverse subjects such as infections, suicidal behavior, clusters of dual disorders, and the Internet. As usual, we will then discuss some practical clinical suggestions and a simple research project for the adventurous reader.

Infections following surgery

While this particular situation may not apply to many of your clients, it seems to be one of those pieces of information that is good to tuck away for a rainy day.

A research team studied the infection rate of 44 patients who had elective cardiac surgery (Sander, von Heymann, Neumann, Braun, Katrup, Beholz, Konertz, & Spies, 2005). Of the sample, 10 patients were long-term alcoholics. Blood samples were examined for before and after surgery. The research team found a four-fold increase in post-operative infections in the long-term alcoholics. This finding suggests an immune suppression element within the long-term alcohol sample.

Try it: counseling suggestions

Given this tidbit of information, you would do well to inform your long-term alcoholic clients facing surgery, particularly cardiac surgery, that they may face a greater chance of getting an infection following the procedure. Now, presenting this information is not meant to frighten clients, only to caution them. In turn, the client may wish to inform the surgeon of his or her situation (addiction). That way, the surgeon can make the necessary precautions during surgery so the client can more easily weather the procedure with minimal complications.

Suicidal behavior

Another research team surveyed a national sample of over 1,200 clients receiving drug and alcohol treatment through the Veterans Administration health care system (Ilgen, Tiet, Finney, & Harris, 2005). Information was gathered at baseline and at six months follow-up on a variety of psychiatric and drug and alcohol problems. At baseline, 53 clients reported making a suicide attempt in the last 30 days before being sampled. These individuals also reported more psychiatric problems and more severe drug and alcohol use. Those reporting a suicide attempt were no more likely to be treated in an outpatient or inpatient setting. However, those suicide clients who were treated in an inpatient setting (compared to the outpatient setting) were significantly more likely to have better drug and alcohol outcomes at six months follow-up. The effect appears to be much stronger in clients who reported a suicide attempt.

Try it: counseling suggestions

The practical suggestion that comes of this research is one directed more at assessment than an actual counseling strategy. Specifically, at intake the assessor needs to be attuned to any suicidal attempts made by the client. Should the client indicate that an attempt has been made within 30 days of the intake, it might be a good idea to refer this individual to an inpatient setting, particularly if there is accompanying psychiatric issues and severe drug and alcohol abuse.

Clusters of psychiatric symptoms

This next research snippet revolves around a study competed just last year. Here, another research team surveyed nearly 3,000 clients in outpatient programs within a comprehensive addictions treatment facility (Castel, Rush, Urbanoski, & Toneatto, 2006). Their aim was to assess overlap of symptom clusters (multimorbidity) and the relation to treatment outcome. Their results indicated that 41 percent of this sample had two or more psychiatric symptoms. Generally, clients with more substance use disorders presented with more psychiatric symptoms. In addition, multimorbidity was more closely associated with females, unemployment, less social support, cannabis problems, fewer legal problems, and more treatment engagements.

Try it: counseling suggestions

The multimorbidity results can practically be directed to both assessment and counseling. In terms of assessment, intake workers need to be perceptive regarding the list of variables (i.e., females, unemployment, less social support, etc.) when these clients present. Such variables should be an indication that a more in depth assessment is needed to evaluate for possible multmorbidity.

Armed with the additional information, the assigned counselor of these cases may wish to make additional treatment adjustments for these clients that he/she would normally do. This specialization would certainly depend on the client. However, the additional attention would hopefully improve the chances of successful outcomes than would have otherwise occurred without the distinctive treatment.

The Internet and adolescent substance abuse

Unquestionably, the Internet provides all sorts of information on drug use. And, adolescents spend a lot of time out there on the Web. With those premises in mind, a research team surveyed a small sample (n=12) of adolescents to study what effect Internet usage had on their drug use knowledge, behaviors, and attitudes (Boyer, Shannon, & Hibbert, 2005). Not surprisingly, they found that the entire samples' use and abuse of substances had been affected by the Internet. Eight of the subjects adopted behaviors intended to minimize the risks of psychoactive substance use. Also, changes were noted in the use of over-the-counter medications and prescription medications. The overall conclusions were that the Internet does affect adolescent drug use behavior.

Try it: counseling suggestions

Patterns of Internet visitations could add notable bits of information in any adolescent intake assessment process. Intake workers are encouraged to ask adolescents, in particular, what Internet sites they visited. If such sites are drug related, it behooves the assessor to try and find out what drug attitude, knowledge, or behavior change resulted from the visit. The same suggestion applies to counselors. That is, once a trusting engagement has been established with the client, the counselor could probe how specific web sites had affected the drug pattern of an adolescent (or adult) client. Such information could go along way in determining possible relapse triggers, or reinforcement of drug use criteria.

Research you can do

Of the four subjects, the last two seem more relevant for a doable piece of research. Again, this section is for those of you who have an itch to produce something more than just an opinion.

For a first attempt, consider doing something similar to the multmorbidity study, but do it for your own facility. It would be a rather simple survey. To make things easy, make your survey one that is retrospective. Basically, examine a set of charts to look for associations between multimorbidity and the variables of females, unemployment, less social support, cannabis problems, fewer legal problems, and more treatment engagements. You could easily construct a frequency count of clients with these variables and their possible multimorbidity. It would be interesting to see if your program obtained the same results as the study above; if it did, take a look at your continuing care data to compare with this data.

A second study would be to track adolescent (or adult) intakes and ask each individual if they visit the Internet often. If they have, ask if they visited drug use sites. If the answer is yes, ask if the Internet information affected their drug use. If they answer yes, ask how. Then place the answers to each question into an appropriate category listing. After about 20 cases take a look at the combined answers to see what kind of pattern may have emerged. The summarized information might prove useful to your treatment team.

I remain interested in your results.

References

Boyer, E.W., Shannon, M. & Hibbert, P.L. (2005). The internet and psychoactive substance use among innovative drug users. Pediatrics, 115, 2, 302-305

Castel, S., Rush, B., Urbanoski, K. & Toneatto, T. (2006). Overlap of clusters of psychiatric symptoms among clients of a comprehensive addiction treatment service. Psychology of Addictive Behaviors, 20, 1, 28-35.

Ilgen, M.A., Tiet, Q., Finney, J.W., & Harris, A.H.S. (2005). Recent suicide attempt and the effectiveness of inpatient and outpatient substance use disorder treatment, Alcoholism: Clinical and Experimental Research 29, 9, 1664-1671.

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