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Objective: To evaluate the full range of alcohol treatment effectiveness, it is important to assess secondary nondrinking outcome dimensions in addition to primary alcohol consumption outcomes. Method: We used a large sample (n = 1,226) of alcohol-dependent participants entering the National Institute on Alcohol Abuse and Alcoholism-sponsored COMBINE (Combining Medications and Behavioral Interventions) Study, a multisite clinical trial of pharmacological (naltrexone [ReVia] and acamprosate [Campral]) and behavioral interventions, to examine the effects of specific treatment combinations on nondrinking functional outcomes. We assessed the outcomes at baseline and at the end of 16 weeks of alcohol treatment and again at the 26-week and/or 52-week postrandomization follow-ups. Results: (1) Drinking and secondary outcomes were significantly related, especially at the follow-up periods. A higher percentage of heavy drinking days, more drinks per drinking day, and lower percentage of days abstinent were associated with lower quality-of-life measures. (2) All nondrinking outcomes showed improvement at the end of 16 weeks of treatment and most maintained improvement over the 26-week and 52-week follow-ups. Only two measures returned to pretreatment levels at 52 weeks: percentage of days paid for work and physical health. Improvements of nondrinking outcomes remained even after adjusting for posttreatment heavy drinking status. (3) Although nondrinking outcomes showed overall improvement, specific pharmacological and behavioral treatment combinations were not differentially effective on specific secondary outcomes. Conclusions: In the current study, changes that resulted from treatment were multidimensional, and improvements in nondrinking outcomes reflected the overall significant improvement in drinking but they were not differentiated between treatment combination groups. Findings from this study support the importance of including secondary nondrinking outcomes in clinical alcohol-treatment trials., THE EFFECTIVENESS OF ALCOHOL TREATMENT is typically measured by examining the differences and/or changes in alcohol consumption as the primary outcome dimension (Babor et al., 1994; Finney et al., 2003; [...]

The development of alcohol use behaviors is an ongoing process that lasts through all stages of childhood, adolescence, and young adulthood. Each of these developmental changes is associated with particular [...]

A study to evaluate the efficacy of medication, behavioral therapies, and their combinations for treatment of alcohol dependence and to evaluate placebo effect on overall outcome is presented. A positive effect of receiving placebo medication and medical management over and above that seen with specialist-delivered behavioral therapy alone is observed and so medical management of alcohol dependence with naltrexone appears to be feasible.

Objective: The present article reviews the literature to date dealing with quality of life (QoL) as it relates to drinking behavior, alcohol use disorders and treatment outcome. Method: Articles using the term 'quality of life' to describe a status or outcome construct for individuals diagnosed with or being treated for alcohol use disorders or that used one or more instruments considered to reflect patients' QoL were identified primarily through Psychological Abstracts, MEDLINE and the National Institute on Alcohol Abuse and Alcoholism's ETOH archival database. Results: Thirty-six studies, published between 1993 and 2004, met these criteria. Twelve different QoL measures were used. Frequent heavy drinking or episodic heavy drinking (e.g., five or more drinks per occasion) patterns were associated with reduced QoL. Alcoholics had lower levels of QoL compared with general population norms or with other chronic health conditions. This relationship appears to be moderated by a number of sociodemographic and client characteristics, such as age, education, gender and co-occurring psychiatric disorders. Alcohol-dependent individuals experience improvements in QoL across treatment and with both short-term and long-term abstinence. Despite these improvements, many alcoholic individuals' QoL is unlikely to equal or exceed that of normative groups. Also, among hazardous and harmful drinkers, achieving and maintaining a marked reduction in drinking, even without complete abstinence, is associated with significant increases in QoL. Conclusions: QoL represents an important area to consider in assessing individuals with alcohol use disorders and in evaluating alcoholism treatment outcome., ALTHOUGH QUALITY OF LIFE (QoL) has always been an underlying concern of both patients and clinicians, its use as a formal concept and measurement objective has become firmly established in [...]

Objective: This article argues that nondrinking outcomes are essential to include in complex trials such as COMBINE to assess the hypothesized mechanisms of action and behavioral change associated with both medications and psychotherapy. Toward this end, COMBINE is used as a case study for (1) discussing hypothesized mechanisms of action for behavior change, (2) discussing distinctive design features of combined studies, (3) highlighting issues in the selection of outcome measures, (4) providing a framework for organizing outcome domains and measures and (5) providing a dose-response model for assessing alcoholism treatment outcomes. Method: A review of the literature and discussion of methodological issues in assessing nondrinking outcomes is provided as well as a case study in developing a conceptual framework for selecting outcome measures. Results: The results of the review and case study include the development of a framework for categorizing outcome dimensions and measures into condition-specific clinical status, condition-specific symptoms and personal and interpersonal functioning outcomes. In addition, a model is provided for assessing the dose-response of combined alcoholism treatment with multiple dimensions of outcome during and after treatment. Conclusions: Consistent with previous observations that recovery from alcohol dependence is a multidimensional developmental process, the COMBINE Study will examine the effects of different combinations of pharmacotherapy and behavioral interventions on the magnitude and pattern of changes in various outcome dimensions (both drinking and nondrinking) over time., INVESTIGATORS TESTING the efficacy of treatments for alcohol disorders commonly identify alcohol consumption measures as the primary outcome dimension (Finney et al., 2003; Litten and Allen, 1992), as is the [...]

Treatment of alcohol disorders through the use of combinations of pharmacological and behavioral modalities may more effectively address the multicomponent nature of the disorder than single-modality approaches. Interdisciplinary models of the biological, psychological and social components of alcohol disorders are emerging rapidly from basic research, and treatment researchers have begun to test various strategies to combine medications and behavioral treatments. In addition to behavioral and pharmacological combinations, effective treatment pairs can be composed of two medications whose mechanisms of action are believed to be compatible and potentially additive, or even synergistic. Combining Medications and Behavioral Interventions (COMBINE) is a large multisite clinical trial sponsored by the National Institute on Alcohol Abuse and Alcoholism. Its goal is to determine if improvements in treatment outcome for alcohol dependence can be achieved by combining pharmacotherapy and behavioral interventions. Under evaluation is the efficacy of two promising medications (naltrexone and acamprosate), both singly and together, when used in conj unction with two behavioral treatments of differing intensities. This supplement describes in detail the methods and rationale for the approach taken in COMBINE. This first article in the supplement has three objectives: (1) to review strategies for conducting combination treatment studies as illustrated with selected examples from the literature, (2) to summarize the main design features of COMBINE as background for the articles in this supplement and (3) to comment on future directions for combination treatment research as the field moves beyond COMBINE., PROGRESS OVER THE LAST decade in understanding the nature of alcohol abuse and dependence has stimulated the treatment research field to seek new, multifocal treatment approaches. Interdisciplinary models of the [...]

The emergence of validated and enhanced methods of alcoholism treatment necessitates dedicated and systematic efforts to include these new methods in the existing ones to monitor their success and make necessary changes if required. The challenges faced by researchers and practitioners in accomplishing this includes debunking myths, evaluation of the feasibility of making changes and effective communication between people involved in the research. Effective communication between the researchers and the providers is very essential to the success of a research study.

An analysis of the outcome variables in alcoholism treatment research revealed that the relationship between alcohol consumption and specific dimensions of life quality influenced treatment outcome. The studies were based on Project MATCH, a national multisite study on matching clients to alcohol treatment. The definition of quality of life with relevance to alcoholism treatment research, and an analysis of the situations under which the multiple dimensions of quality of life could be measured were also included in the analysis.

A review of the methodological issues associated with client-treatment matching confirms the importance of matching in clinical practice relative to alcoholism. Matching individuals to alcoholism treatments improves the outcome of the treatment. The potential benefits of matching such as treatment resource optimization, increased cost and effectiveness and prevention of therapeutic mismatches are forcing clinicians and researchers to promote studies in this domain.

A study of multisite clinical trials as a method of treating alcoholism reveals that this treatment method has both advantages such as the ability to recruit large sample sizes in a short span of time, the ability to recruit a more heterogeneous pool of subjects and an opportunity to enlist a methodological and clinical expertise and disadvantages such as high costs and complexity in implementation when compared to single-site studies. Project MATCH is the latest multisite alcoholism study conducted, and the various issues of this treatment method have been analyzed based on this study.

The treatment of alcoholics should be based on the individual characteristics of the patient rather than on a defined treatment method, as revealed by 31 empirical studies. The client-treatment matching method observes the different client characteristics with regard to particular types of treatment, and treatment is based on the results of the matching hypothesis. The clients are classified into four basic groups based on demographic factors, alcohol-specific characteristics, intrapersonal characteristics and inter-personal characteristics for the selection of the treatment method. The empirical studies revealed three basic therapy types, cognitively-based approaches, interpersonal or rationally-oriented modalities and treatments based on higher levels of intensity for the treatment of alcoholics.

For many years, the desire to improve the outcome of alcoholism treatment has prompted researchers and clinicians to compare different treatments in the hope of discovering the "best treatment." This […]

The clinical practice of alcoholism treatment can be enhanced by the judicious use of standardized psychometric instruments to characterize clients during the course of treatment. Knowledge of key behavioral, personality, and alcohol-specific factors will increase the clinician's ability to select the most appropriate treatment option, or, even if treatment options are limited, at least to develop a treatment plant with the patient's unique needs in mind. Monitoring of progress towards treatment goals can also be facilitated by the use of selected assessment tools. Seven examples of well-validated instruments are discussed, with suggestions on how data derived from them may be applied in the treatment planning process.

It has been found that cigarette smokers differ from non-smokers on many health-related behaviors in addition to smoking. Smokers exercise and sleep less, drink more coffee and alcohol, take more risks, and have a larger number of sex partners. The diets of smokers may be of poorer quality; studies have found that smokers are more likely to skip breakfast and less likely to take vitamins, and one study found that they ingest smaller amounts of most nutrients than people who do not smoke. It is important to know how smoking and diet may each independently contribute to risk for certain diseases, particularly cancer. Moreover, if smokers tend to increase their risk of disease by having inadequate nutrition, this must be recognized. The effects of poor diet and smoking may even interact to increase risk by more than the simple addition of the two individual risks. This study used dietary data collected from a large sample of Americans during the Second National Health and Nutrition Examination Survey. The subjects were 11,260 adults aged 19 to 74 years who were interviewed about what they ate the previous day; data on race and smoking habits were also collected. The results revealed that smokers in several age-sex-race groupings consumed less fiber, folate, and vitamins A and C than non-smokers. The more they smoked, the less of these nutrients they consumed. Smokers ate less high-fiber grain, low-fat milk, fruits, vegetables, and vitamin and mineral supplements than non-smokers. Since some of these foods and nutrients (vitamins C and A, fiber, and folate) are thought to protect against certain types of cancer, the large increase in cancer risk for people who smoke appears to be compounded by their dietary habits. (Consumer Summary produced by Reliance Medical Information, Inc.)

While the level of smoking in the US has fallen in the years since the Surgeon General issued his report on smoking, the level of smoking in China has increased. During the years 1976 to 1986 half of the net global increase in tobacco use occurred within the People's Republic of China. The smoking rate in China today is similar to that in the United States during the 1950s. Sixty-one percent of Chinese males over the age of 15 now smoke. Based on these statistics, China can expect to experience an epidemic of smoking-related illness and death far into the next century. Given the current smoking rate, and known statistics of smoking-related illness, it is estimated that by 2025, two million Chinese men will succumb annually to smoking. The beginnings of that epidemic are already being seen. In 1957 the urban rate for tumors, cardiovascular, and cerebrovascular disease was 36.9, 47.2 and 39.0 cases per 100,000, respectively. When these same rates were determined in 1984, the respective levels had climbed to 116.8, 124.64 and 116.27. In the industrial city of Shanghai, lung cancer in men rose from 28.5 per 100,000 in the period 1963-65, to 52 per 100,000 in the period 1976-79. Lung cancer deaths among male Chinese are expected to increase from 30,000 in 1975 to 900,000 in 2025. The reduction of cigarette markets in the West has led to aggressive marketing in other areas of Asia by Western tobacco companies. Western companies have begun billboard and television advertising in China. 'The Marlboro Man' has been at the center of at least one campaign, and sponsorship of sporting events has become common. At present smoking-control efforts in China are very limited; however, China must engage in a comprehensive anti-smoking campaign if the anticipated health disaster is to be averted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective: There is a growing appreciation that emotional, physical and sexual abuse events are frequently part of the life histories of individuals in treatment for alcohol disorders. The present study examines reports of lifetime abuse in a clinical trial for treatment of alcohol dependency. Method: Data were obtained from baseline assessments conducted with participants (N = 1,726; 1,307 men) entering Project MATCH, a multisite clinical trial conducted at nine geographically dispersed research sites. Differences on a broad range of participant characteristics were examined by gender and by reported abuse type. Results: More than half (59%) of the participants reported lifetime abuse. Women were more likely (77%) to report abuse than were men (54%). A lower proportion of men than women (6% vs 31%) reported experiencing both physical and sexual abuse. Gender differences were found on the majority of psychosocial measures. Comparisons of the psychosocial measures by abuse type generally indicated that participants without abuse histories had better functioning than did participants reporting abuse. Conclusions: The high frequency of lifetime abuse in this geographically dispersed sample underscores the necessity for including assessment of emotional, physical and sexual abuse with alcoholism treatment seeking populations. Participants reporting such events may require other treatment in addition to that for alcohol dependency. (J. Stud. Alcohol 62:114-123, 2001), EPIDEMIOLOGICAL SURVEYS and clinical studies of substance abusers conclude that alcohol and drug dependent individuals frequently report experiencing some type of trauma, with estimates of lifetime physical or sexual abuse [...]

UNTIL THE 1990s, the treatment for alcohol dependence consisted largely of addiction peer counseling or behavioral therapies. Pharmacotherapy was rarely prescribed outside the confines of detoxification. In 1994, the approval [...]

Nine volunteers who were exposed to nicotine from cigarette smoking in the cabin of a commercial aircraft were evaluated for the presence of a metabolic byproduct (metabolite) of nicotine, cotinine, in their urine for the 72 hours following exposure. In addition, the volunteers carried personal monitors which measured the level of ambient nicotine in the cabin atmosphere. In some cases, individuals in the nonsmoking areas of the cabin were exposed to levels no different from the smoking sections. The level of secreted cotinine varied with exposure to nicotine, and the urine level of cotinine was measurable in the urine of volunteers for more than 72 hours following exposure. The volunteers' subjective experience was measured, and their discomfort was found to be related to the degree of exposure and levels of excreted cotinine. Irritability of eyes and nose between the beginning and end of the study correlated with exposure levels to nicotine. The type of ventilation system varied with aircraft and was an important factor in determining the level of ambient exposure to nicotine. This report demonstrates that various factors are involved in the establishment of a microenvironment within enclosed spaces such as an airplane. Separation of smoking and nonsmoking sections of an aircraft is not meaningful from a health perspective. Passive exposure to smoking represents another contribution to the cumulative health risk from smoking., ABSTRACT: In-flight exposure to nicotine, urinary cotinine levels, and symptom self-reports were assessed in a study of nine subjects (five passengers and four attendants) on four routine commercial flights each of approximately four hours' duration. Urine samples were collected for 72 hours following each flight. Exposures to nicotine measured during the flights using personal exposure monitors were found to be variable, with some nonsmoking areas attaining levels comparable to those in smoking sections. Attendants assigned to work in nonsmoking areas were not protected from smoke exposure. The type of aircraft ventilation was important in determining the levels of in-flight nicotine exposure. The environmental tobacco smoke levels that occurred produced measurable levels of cotinine (a major metabolite of nicotine) in the urine of passengers and attendants. Passengers who experienced the greatest smoke exposure had the highest levels of urinary cotinine. Changes in eye and nose symptoms between the beginning and end of the flights were significantly related both to nicotine exposure during the flight and to the subsequent urinary excretion of cotinine. In addition, subjects' perceptions of annoyance and smokiness in the airplane cabin were also related to in-flight nicotine exposure and urinary excretion measures.

LITTLE IS KNOWN about the best methods for conducting treatment outcome research on combining pharmacological and behavioral interventions to develop optimal treatments for alcohol dependence. To facilitate this type of [...]

Objective: The literature suggests that women exhibit 'telescoped' development of (i.e., faster progression to) alcoholism, with fewer years drinking than men. The purpose of this study was to use data gathered in the course of a large clinical trial to further examine this issue. Method: Subjects in this retrospective study were from a pool of 1,307 men and 419 women enrolled in Project MATCH, a multisite alcohol treatment matching study. MATCH subjects were recruited from both outpatient and aftercare settings over a 2-year period. Age-of-onset for landmark events in the development of alcoholism were determined from self-report and clinical interviews given at baseline entry into the study. Gender differences in age-of-onset variables were assessed within both outpatient and aftercare settings. Gender differences in progression times between successive landmarks were also examined. Differences were tested with both multivariate and univariate ANOVA techniques. Results: Women generally began getting drunk regularly at a later average age than men (26.6 versus 22.7 years, p [is less than or equal to] .001), began experiencing their first drinking problems at a later average age than men (27.5 versus 25.0 years, p [is less than or equal to] .001) and exhibited loss of control over their drinking at a later average age than men (29.8 versus 27.2 years, p [is less than or equal to] .001). However, these gender differences were most pronounced for older individuals and attenuated for younger subjects. Women also progressed faster than men, on average, between first getting drunk regularly and first encountering drinking problems (0.9 versus 2.3 years, p [is less than or equal to] .001) and between first loss of drinking control and onset of worst drinking problems (5.5 versus 7.8 years, p [is less than or equal to] .001). Women also exhibited shorter average progression times between first getting drunk regularly and first seeking treatment (11.6 versus 15.8 years, p [is less than or equal to] .001), although this effect was negligible for younger subjects. Conclusions: Telescoping is a relatively robust phenomenon in treatment-seeking alcoholics and indicates that women are more likely to progress faster through the landmark events in the development of alcoholism than are men. (J. Stud. Alcohol 60: 252-260, 1999), There is growing interest in differences between male and female alcoholics (e.g., Gomberg, 1993a; Schneider et al., 1995). Areas of research include gender differences in amount and pattern of alcohol [...]

Abstract: We calculated the long-term risks of death from smoking for individuals of various ages and smoking status in terms of the excess mortality contributed by smoking, over and above the baseline mortality from the same diseases caused by factors other than smoking using standard life table procedures. Since mortality data for specific smoking categories were available only From prospective studies in the late 1950s, we scaled these to the 1982 mortality levels. We assumed, for lung cancer, that the death rates for nonsmokers have not changed and, for other smoking-related diseases, that the risks of death for smokers relative to those for nonsmokers have not changed since the 1950s. Probabilities that result from alternative assumptions were also investigated and are presented. As many as one-third of heavy smokers age 35 will die before age 85 of diseases caused by their smoking. The probabilities of death from smoking when compared with other causes may be persuasive as public education tools. Their effective use for this purpose is affected not only by the deficiencies in the public's factual knowledge of the magnitude of the risks from smoking, but also by numerous apparent misconceptions relating to the interpretation of risk information. Risk data should be presented to the public in a manner thru clarifies these misconceptions and facilitates their understanding of the overwhelming risk imposed by smoking. (Am J Public Health 1987; 77:425-431.) [ABSTRACT FROM AUTHOR]

Reports on the interest of researchers in matching patients with alcoholism treatments based on the characteristics that each patient possess. Definition of patient-treatment matching; Types of patient-treatment matching; Evidence of patient-treatment matching effectiveness.