C HRONIC A LCOHOL A BUSE Group 2 Samantha Benjamin, Sara Levy, - - PowerPoint PPT Presentation

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C HRONIC A LCOHOL A BUSE Group 2 Samantha Benjamin, Sara Levy, - - PowerPoint PPT Presentation

Oct 13, 2022 226 likes •406 views

C HRONIC A LCOHOL A BUSE Group 2 Samantha Benjamin, Sara Levy, & James Zyckowski B ACKGROUND I NFORMATION A.A was founded by Bill Wilson (Bill W.) and Dr. Bob Smith (Dr. Bob) in Akron Ohio in 1935. In 1946 The 12 Steps were

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SLIDE 1

CHRONIC ALCOHOL ABUSE

Group 2 Samantha Benjamin, Sara Levy, & James Zyckowski

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SLIDE 2

BACKGROUND INFORMATION

 A.A was founded by Bill Wilson (Bill W.) and Dr. Bob Smith (Dr.

Bob) in Akron Ohio in 1935.

 In 1946 “The 12 Steps” were introduced and integrated into

A.A.

 The A.A 12 Step model is a standard protocol intervention with

all drug and alcohol treatment programs.

 A.A principles and concepts are taught, and meetings are

mandatory in most inpatient rehabilitation and prisons. Furthermore, A.A. is a major focus of outpatient treatment.

 A.A is the largest mutual-help group in the US with about 1.2

million members and 53,000 groups (Kelly & Yesterian, 2011).

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SLIDE 3

PICO QUESTION:

 Do adults suffering from chronic alcohol abuse (P)

experience longer periods of sobriety (O) if they participate in alcoholics anonymous (I) as compared to those who do not (C)?

 Type of PICO Question: Therapy/Intervention

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PICO ELEMENTS

Chronic Alcohol Abusers Alcoholics Anonymous Non Attendance at Alcoholics Anonymous Longer periods of sobriety

P I C O

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RESEARCH STRATEGY

Type of Search Electronic Databases

CINAHL COCHRANE MEDLINE PUBMED EBSCO

Keywords

Alcoholics Anonymous, AA chronic alcohol abuse behavioral therapy network support longitudinal, treatment outcomes

Exclusions

children, adolescents, & elderly articles older than 2005 incomplete articles, i.e. abstracts and summaries

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SLIDE 6

SUMMARY OF RESEARCH STUDIES

  • 1 Meta Analyses
  • 1 Cochrane Study

Level I

  • 1 RCT

Level II

  • 1 Systematic Review of

Correlational Studies.

Level III

  • 5 Longitudinal Study

Level IV Level V Level VI Level VII

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TABLE OF EVIDENCE - SARA

Citation Sample Design Outcomes/Results Evidence Level QAL Kelly & Yeterian, 2011 N/A Systematic Review 12-step facilitation (TSF) therapy positively influences alcohol and drug-use outcomes. III A Moos & Moos, 2007 461 initially untreated clients who initiated help-

  • seeking. Follow up

at 1, 3, 8, and 16 year intervals. Longitudinal At the end of a 16 year period, those who received treatment and/or participated in AA had a remission rate of 62% vs. those who did not participate in treatment or AA and had a 43% remission rate. IV B Witbrodt, Mertens, Kaskutas, Bond, Chi, & Weisner, 2012 1825 health care treatment-seeking clients (from two studies). Follow up at years 1, 5, 7, and 9. Meta-analysis Over time, clients reporting a high rate of AA attendance reported the highest stable pattern of abstinence from alcohol and drugs in the past 30 days while those with no AA attendance reported the lowest pattern of abstinence. Over a nine year period the AA participants had abstinence rates at 86%, 81%, 84%, and 75% at interviews at 1, 5, 7, and 9 years. I A

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TABLE OF EVIDENCE - JAMES

Citation Sample Design Outcomes/Results Evidence Level QAL Strickler, Reif, Horgan, & Acevedo, 2012 739 clients in an alcohol services study Longitudinal The data concluded that clients who were referred to A.A and attended meetings regularly were 60% less likely to relapse and to have longer sobriety time. IV A Ferri, Amato & Davoli, 2006 3417 total clients from eight separate trials Cochrane Study An analysis of eight trials with 3417 people, the results were consistent with the outcome indicating that A.A. kept patients in treatment longer with longer sobriety rates. I A Gossop, Stewart & Marsden, 2008 Following 142

  • utpatient

treatment patients where interviews were conducted at 1-2 and 5 year periods . Longitudinal Clients who attended A.A were more likely to be abstinent from alcohol for longer periods of time than non- participants. IV B

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TABLE OF EVIDENCE - SAMANTHA

Citation Sample Design Outcomes/Results Evidence Level QAL Avalos & Mulia, 2012 1013 black and white clients recruited upon entrance into chemical dependency programs Longitudinal Data found that utilization of AA was effective in maintaining abstinence. Whites were found to maintain abstinence via AA utilization for longer

  • periods. Religious reinforcement

affected utilization of AA for abstinence maintenance . IV B Kaskutas, Ammon, Delucchi, Room, Bond & Weisner, 2005 349 clients recruited via treatment entrance Longitudinal Data showed that the rate of abstinence for the four AA attendance “classes” (low, medium, high, and declined) was highest for those in the high AA attendance “class” by. At year 5 follow up, 80% abstinence reported. IV B Litt, Kadden, Kabela- Cormier,& Petry, 2009 210 clients solicited via newspaper, radio and university medical center programs RCT The data indicated that network support (A.A.) is shown to be more effective in maintaining sobriety. At the two year follow up patients reported 80% abstinence. II A

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STRENGTHS & WEAKNESSES OF THE STUDIES

  • Longitudinal studies
  • Large sample sizes
  • Preponderance of data
  • Diversity of research models
  • Current research: ≥2005

Strengths

  • Self-reporting of subjective data
  • Infrequent data collection
  • Short sobriety timeframe
  • Culture and religion not considered
  • Attrition

Weaknesses

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BARRIERS AND FACILITATORS TO IMPLEMENTATION

Facilitators

  • No cost
  • 24/7 availability of support through

meetings and mentors

  • Referral programs in community and

healthcare facilities

  • Healthcare worker intervention
  • Run by A.A. members

Barriers

  • Dual diagnoses
  • Clients on psychotropic drugs
  • Low social functioning
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SLIDE 12

MAJOR FINDINGS AND SUMMARY

 Our findings indicate that A.A. can be correlated to

maintaining sobriety for longer periods of time.

 A.A as a self-help therapy has shown over time its

success with the personal and psychosocial rehabilitation of chronic alcohol abusers.

 A.A provides a safe community as well as education and

support for those struggling with addiction. The group therapy model provides interaction with other abusers as well as self reflection on one’s journey towards recovery.

 From meta-analyses, to RCTs, to Longitudinal studies,

the rates of remission and sobriety related to A.A. as an intervention are all similar indicating a preponderance of evidence.

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RECOMMENDATION

  • As student and registered nurses we should

strongly recommend Alcoholics Anonymous or 12- step programs to clients, particularly if they are seeking help.

 Remember! The recommendation of 12-step programs

from a nurse makes it more likely the patient will attend. Furthermore, the earlier the patient starts participating the better their prognosis for a positive outcome!

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REFERENCES

Avalos, L. A., & Mulia, N. (2012). Formal and informal substance use treatment utilization and alcohol abstinence over seven years: Is the relationship different for blacks and whites? Drug & Alcohol Dependence, 121(1-2), 73-80. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2011431168&site=eh

  • st-live

Ferri, M., Amato, L., Davoli. (2006). Alcoholics Anonymous and other 12- step programmes for alcohol dependence. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No: CD005032. DOI: 10.1002/14651858.CD005032.pub2 Gossop, M., Stewart, D., & Marsden, J. (2008). Attendance at narcotics anonymous and alcoholics anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: A 5-year follow-up study. Addiction, 103(1), 119-125. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009769859&site=ehos t-live

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REFERENCES CON’T

Kaskutas, L. A., Ammon, L., Delucchi, K., Room, R., Bond, J., & Weisner, C. (2005). Alcoholics anonymous careers: Patterns of AA involvement five years after treatment

  • entry. Alcoholism: Clinical & Experimental Research, 29(11), 1983-1990. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2009580223&site=eh

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Kelly, J.F., & Yeterian, J.D. (2011). The role of mutual-help groups in extending the framework of treatment. Alcohol Research & Health, 33(4), 350-355. Retrieved fromhttp://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011032306&site= ehost-live Litt, M. D., Kadden, R. M., Kabela-Cormier, E., & Petry, N. M. (2009). Changing network support for drinking: Network support project 2-year follow-up. Journal of Consulting and Clinical Psychology, 77(2), 229-242. doi: 10.1037/a0015252

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REFERENCES CON’T

Moos, R. H., & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 101(2), 212-222. Retrieved fromhttp://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009119607&site= ehost-live Strickler, G.K., Reif, S., Horgan, C.M. & Acevedo, A. (2012): The Relationship Between Substance Abuse Performance Measures and Mutual-Help Group Participation after

  • Treatment. Alcoholism Treatment Quarterly, 30:2, 190-210.

http://dx.doi.org/10.1080/07347324.2012.663305 Witbrodt, J., Mertens, J., Kaskutas, L. A., Bond, J., Chi, F., & Weisner, C. (2012). Do 12-step meeting attendance trajectories over 9 years predict abstinence? Journal of Substance Abuse Treatment,43(1), 30-43. doi: 10.1016/j.jsat.2011.10.004