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Understanding the factors influencing alcohol use disorder (AUD) treatment outcomes is essential. More knowledge about patient characteristics that predict treatment outcomes can help personalise interventions, improve treatment planning and address the needs of specific subgroups. The frequency of treatment attendance may also affect drinking outcomes after treatment. Despite research efforts, uncertainty remains about how patient factors and treatment attendance influence treatment outcomes.
Aims
To examine how patient factors and treatment attendance predict high- or low-risk drinking at the end of treatment.
Method
We used data (N = 92) from a multisite observational study of treatment-seeking individuals with AUD attending group treatment. Sociodemographic measures, alcohol and substance use measures, cognitive functioning, psychological distress, personality functioning and quality of life were screened in univariate analyses. Significant variables were entered into a binary logistic regression model.
Results
Individuals with a higher percentage of treatment attendance (odds ratio 0.96 [95% CI 0.93, 0.96]) and with greater responsiblity scores on the Severity Indices of Personality Functioning (odds ratio 0.30 [95% CI 0.14, 0.64]) had a decreased likelihood of high-risk drinking at treatment end. Substance use, psychological distress and cognitive functioning were not associated with drinking levels at the end of treatment.
Conclusion
A higher percentage of treatment attendance has a minor effect on drinking levels. Being more responsible, as reflected in higher scores on the responsibility domain, reduces the likelihood of high-risk drinking at the end of treatment. Clinicians are encouraged to screen and assess personality functioning when planning treatment for individuals with AUD.
This editorial discusses a study by Day and colleagues, in which the authors investigated the prevalence of resolution of alcohol and other drug problems in the UK and compared people who resolved their problems with and without treatment.
This chapter takes as its starting point a research project at the University of Southern Denmark that examines the narratives of drinkers about how the development of alcohol dependency has come about and turned into a problem. The project shows how patterns in narratives about symptoms and suffering can be indications of more general narrative structures and how this has so far resulted in the identification of five “master narratives.” These master narratives can be regarded as fundamental narratives that people with alcohol problems will draw upon when they need to explain the causes of their own alcohol misuse, and they also act as resources that practitioners can make use of. By listening to and recognizing these general but nevertheless significant narratives, practitioners can acquire what might otherwise be a rare insight into how individuals understand their own alco-hol consumption, and they are able to offer the best and most empathetic treatment. The aim of this chapter is to emphasize how charting such mas-ter narratives about alcohol consumption underlines the need to involve narrative skills in treatment.
When we humans set out to understand the world, and ourselves, and when we have to communicate our understanding, one of the ways we do it is by telling stories (Hydén, 1997; Brockmeier, 2018). This is where we grasp the sense of things. Stories allow us to picture things for ourselves to understand them and remember. This is also true when we have to define ourselves, for example, as sick or well (Frank, 1995). When we define ourselves as sick, we subject ourselves to a form of diagnosis; in other words, we create a picture for ourselves of the ex-tent to which we have a problem that can be solved by the health service. This is a process that often takes place in conjunction with our surroundings. The first decision we have to make is to determine if the degree to which the condition we Interventionshave or in which we find ourselves is significantly at deviance from the norm or whether it is a normal part of the life that we otherwise lead and see around us (Eisenberg, 1980; Hammer et al., 2012).
Despite expansive knowledge on the detrimental effects of growing up with parents with alcohol use disorders (AUDs), little is known about the prognosis of alcohol treatment among parents with childcare responsibility.
Aims
This observational cohort study aimed to examine the prognosis of patients with and without childcare responsibility, in a conventional out-patient alcohol treatment clinic.
Method
A consecutive AUD sample (N = 2201), based on ICD-10 Diagnostic Criteria for Research, was assessed with the European Addiction Severity Index during the clinical routine, at treatment entry and conclusion. Data on addiction severity, treatment course and drinking outcomes were derived, and adjusted odds ratios (AORs) were calculated with logistic-regression models. Drinking outcomes were compared in an intention-to-treat analysis, including all patients in a logistic regression with inverse probability weighting.
Results
Patients with childcare responsibility (aged <18 years) had a less severe addiction profile and lower drop-out rate compared with patients without children or with children living out-of-home. They were also more likely to improve on all drinking-related outcomes, including abstinence (AOR 2.68, 95% CI 1.82–3.95), number of drinking days (AOR 2.45, 95% CI 1.50–4.03) and excessive drinking days (AOR 4.66, 95% CI 2.36–9.17); and those with children living out-of-home had better outcomes on abstinence (AOR 1.59, 95% CI 1.08–2.34) than patients without children.
Conclusions
Childcare responsibility among out-patients was associated with better treatment course and outcomes than those without or not living with their children. This knowledge can help guide clinical practice, effectuate interventions and inform social authorities.
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