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| More Handy Research Snippets |
| Columns - Research to Practice | ||||||||||||||||||||||||||||||||
| Written by Michael J. Taleff, PhD | ||||||||||||||||||||||||||||||||
| Tuesday, 07 August 2007 | ||||||||||||||||||||||||||||||||
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This column focuses on five items that can be applied in your everyday
treatment: two smoking and drinking; relapse factors; Alcoholics
Anonymous (AA) attendance; and the effectiveness of workshop attendance
for addiction counselors.
Smoking and alcohol While most addiction practitioners are aware of the high correlation between smoking and drinking, we also know that excessive drinking is associated with neurocognitive deficits. New evidence suggests that smoking is also associated with neurocognitive problems. Glass et al (2006) conducted a study on 172 male subjects who had alcohol problems or alcoholism and were smokers. Her team ran the subject pool through a cognitive proficiency (i.e., fast, accurate performance) evaluation and found a significant relation for those who smoked and had alcohol problems — they have more neurocognitive function problems. A second study searched the literature to examine the ability of smokers with past alcohol problems to quit smoking (Hughes & Kalman, 2006). Part of their findings included research that indicated smokers with past alcohol problems were more nicotine dependent than smokers with no past alcohol problems. Yet in terms of quitting, data from the research indicated a surprising result — smokers with past alcohol problems were just as successful in their ability to quit on a given attempt, as smokers who had no alcohol problems. The rationale given to this surprising finding was that the smokers with past alcohol problems used many of the same skills toward smoking cessation as they used in the past to quit alcohol abuse. Relapse and AA attendance Relapse. Relapse has always been a source of frustration for addiction counselors. Copious information, books and workshops exist on the subject. A recent research project (Zywiak, et al, 2006) re-analyzed the relapse onset data from the questionnaire used in the famous Project Match study (1997). The findings replicate previous research. Although replication studies are often neglected, they are an important component of addiction research, as they add more evidence to a particular finding. This research replicated three significant factors about clients who relapse: 1. Negative affect/Family influences. Clients tend to relapse more often because of depressed feelings, anger and “poor me” feelings, than they do from the so-called positive affects (i.e., celebrations, good news, among others). In terms of family influences, such members who continue to use/abuse substances around a client trying to stay sober will have a more profound impact on the client than an acquaintance. Most of us know these factors contribute significantly to relapse. When you assess relapse issues with your clients, more than likely, the relapse will have its roots in one or more of these broad categories. AA Attendance. Recent data suggests an interesting wrinkle as to why clients do not continue with AA posttreatment (Tonigan, et al, 2006). First, those who attend AA meetings with consistency tend to have greater problems associated with their drinking. Second, those with less alcohol impairment are twice as likely to discontinue AA attendance following treatment. This latter finding reveals methods for identifying potential AA dropouts following discharge from treatment. A treatment intake assessor could conceivably identify such individuals and adjust post-treatment recommendations accordingly. Workshop effectiveness This last research article is directed toward the addiction professional’s training. Workshops have been the preferred training method for addiction professionals for years, but they have not been the focus of empirical investigation. The authors of this research project (Walters et al, 2005) reviewed several evaluations following workshop trainings. Two key findings emerged, (note that findings were only based on the evaluations of the participants, not on the impact of services). First, workshops tend to improve attendees’ knowledge, attitudes and confidence. Some skill improvements were noted from the reviews. Second, all findings tend to fade with time. This is not surprising, but it supports what we all seem to know. Workshops do improve knowledge, but all the good information tends to fade with time. To offset the fade, the authors suggest that follow-up consults occur, as well as ongoing supervision on workshop material. Try it: counseling suggestions Within the article that suggests smoking compounds cognitive impairment in drinkers, consider two practical applications. First, you may want to pass this information to those clients who are only just considering smoking cessation. The information might add weight to their decision to take action. Second, use this information in your assessment process and eventual treatment planning. Incorporate a finding of smoking and drinking as possible indication of heightened impairment with this type of individual that could suggest simplifying treatment recommendations and directions because of the impairment. From the second smoking research finding (quitting), use this information to alter the belief of clients (and counselors) that they cannot stop smoking as easily as they had quit past alcohol use and/or abuse. Let them know that research shows one can the same successful tactics for abstaining from alcohol on smoking cessation. This might engender more hope and motivation. Research you can do From the relapse article by Zywiak, et al. (2006), survey a small sample (about 40 or more subjects) in your program who have relapsed. Either search the charts, or if possible, find and ask the clients what it was that triggered their relapse. You will likely find the reasons fall within one of the three major reasons listed above (negative affect/family influences, urges and cravings, social pressures). If you decide to do this project, you will have completed a replication study with a hint of a factor analysis (finding underlying dimensions). Now, should you find something completely different, e-mail me or contact your local college or university. You may have found something worth additional investigation. References Glass, J.M., Adams, K.M., Nigg, J.T., Wong, M.M., Puttler, L.I., Bau, A., Jester, J.M., Fizgerald, H.E., & Zucker, R.A. (2006). Smoking is associated with neurcognitive deficits in alcoholism. Drug and Alcohol Dependence, 82, 2, 119-126. Hughes, J.R. & Kalman, D. (2006). Do smokers with alcohol problems have more difficulty quitting? Drugs and Alcohol Dependence, 82, 2, 91-102. Tonigan, J.S., Bogenschutz, M.P., Miller, W.R. (2006). Is alcoholism a typology a predictor of both Alcohol Anonymous affiliation and disaffiliation after treatment? Journal of Substance Abuse, 30, 323-330. Walters, S.T., Matson, S.A., Baer, J.S., & Ziedonis, D.M. (2005). Effectiveness of workshop training for psychosocial addiction treatments: A systematic review. Journal of Substance Abuse Treatment, 29, 283-293. Zywiak, W.H., Stout, R.L., Longabaugh, R., Dyck, I., Conners, G.J. & Maisto, S.A. (2006). Relapse-onset factors in Project MATCH: The relapse questionnaire. Journal of Substance Abuse Treatment, 31, 341-345.             
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