Addiction Research Foundation Site, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada and University of Toronto, Toronto, Canada
Correspondence: Tel.: +1416-535-8501 ext. 6701; Fax: +1416-595-6899; E-mail: John_Cunningham{at}camh.net
(Received 4 December 2004; first review notified 28 December 2004; in revised form 24 January 2005; accepted 9 March 2005)
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ABSTRACT |
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INTRODUCTION |
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What else can be learnt about treatment from population samples? Is it possible to find any indication whether some types of treatment might be more effective than others? There are limitations to which population surveys can be used to address this question. Such surveys are often cross-sectional, hence any findings are limited by the lack of longitudinal data. The incidence of treatment use in the general population of problem drinkers is also low (e.g. Cunningham and Breslin, 2004), hence sample sizes are often not large enough to compare different treatment modalities. Finally, population surveys are usually not designed to explore this question, so the items contained in these surveys are often not detailed enough to be of any use for this purpose. One possible approach to take, however, is to explore the short-term impact of treatment using population survey data. Population surveys usually have their focus on drinking and service use in the last year so it should be possible, given a large enough sample, to explore whether different treatment modalities are associated with short-term resolutions from alcohol problems in the last year.
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SUBJECTS AND METHODS |
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The 2002 NSDUH assessed the past-year alcohol dependence or abuse using items from DSM-IV (American Psychiatric Association, 1994) and asked about treatment use as well. Questions about treatment use were asked after all the sections assessed the use of different illicit drugs. Treatment was defined as accessing any treatment services for either illicit drug use or alcohol use in the past year, i.e. These next questions deal with treatment for alcohol and drug problems, not including cigarettes. Please report treatment or counseling designed to help you reduce or stop your alcohol or drug use. Please include detoxification and any other treatment for medical problems associated with your alcohol or drug use. Have you ever received treatment or counseling for your use of alcohol or any drug, not counting cigarettes? Respondents agreeing to this item were then asked, During the last 12 months, have you received treatment or counseling for your use of alcohol or any drug, not counting cigarettes? Both alcohol and drug treatment were included because there is some overlap in treatment modalities for all substance abuse problems (Rotgers et al., 1996
). If respondents answered yes to these screener questions, they were asked about use of the specific treatment options identified on Table 1. For the purposes of this study, short-term recoveries were assessed in two ways. First, respondents were asked if they had ever consumed
5 drinks on one occasion in the past 30 days. Second, respondents were asked if they had consumed any alcohol in the past 30 days. A standard drink was defined for the respondent at the time these questions were asked. Prevalence estimates were calculated using weighted data on the online data analysis system of the Substance Abuse and Mental Health Data Archive. Sample sizes are presented as unweighted data.
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RESULTS |
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DISCUSSION |
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What can be concluded from these findings? First, it is probably true that people with alcohol dependence or abuse will do better if they seek treatment, as the present study demonstrated an 10% increase in the past-month abstinence and binge-free rates between respondents who sought treatment compared with those who did not. However, this conclusion should be viewed with some caution because respondents were not randomly assigned to treatment, so causal statements cannot be made and it is possible that some systematic difference that covaried with treatment access could be the true explanation as to why these respondents did better as opposed to this improvement being the result of treatment use. Another alternative explanation is that the association of no binge or abstinence in the past month with treatment could occur because alcohol abusers who were formerly continuous drinkers and are now episodic heavy drinkers may be more likely to seek treatment than those who remain as continuous heavy drinkers. This might happen if the continuous abuser tried to abstain using his or her own resources, then finds he or she can only do so for periods (becomes episodic) and then, seeks help.
Caution should also be used in interpreting the results for several other reasons. First, the present study only investigated past-month drinking and provided no evidence regarding sustained recoveries from alcohol abuse or dependence. Second, while it is justified to ask about use of alcohol and drug treatment because there is overlap in the content and target population of these services, this analytic choice should be taken into consideration when interpreting the findings. Third, while the results of this study can probably be used to indicate that there is variation in the impact of different treatment modalities, it would be inappropriate to use the findings to state that one treatment modality is superior to the other. This type of analysis does not offer any information about the type of person that ends up in different treatment services. How do their characteristics vary and what impact does this variation have on drinking outcome, irrespective of the treatment used?
Moreover, these treatment sub-samples were partially overlapping because the sum of respondents who used each of the treatment modalities exceeded the total number of respondents who accessed any of the treatments. Despite these limitations, the final conclusion that can be drawn from these findings is that, while the provision of treatment services is a laudable effort that has some impact, it is still the pathway chosen by the minority of respondents in their drinking careers (Burton and Williamson, 1995; Cunningham and Breslin, 2004
).
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REFERENCES |
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