Helping Behaviors and Alcohol Use Disorders
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1 Helping Behaviors and Alcohol Use Disorders Maria E. Pagano, Ph.D. Assistant Professor of Psychiatry Case Western Reserve University Medical School Copyright Alcohol Medical Scholars Program 1
2 This Lecture Will Cover Why HB are important Behavioral modification in Alcohol Use Disorder (AUD) treatment Behavioral modification in 12-step programs Role of HB in Alcoholics Anonymous Copyright Alcohol Medical Scholars Program 2
3 Helping Behaviors (HB) Altruism, volunteering, service 5 elements Benefit other person Voluntary Intentional Benefit to another = primary goal Given without reward expectation Copyright Alcohol Medical Scholars Program 3
4 Importance of Helping Behaviors ~Process important to recovery and prevention of health conditions ~Furthers knowledge: mechanisms of action within 12-step programs ~Clinical approach for all patients Copyright Alcohol Medical Scholars Program 4
5 Alcohol Dependence 3+ in past 12 months: Not been able to cut down or stop Not been able to stick to drinking limits Shown tolerance Shown signs of withdrawal Kept drinking despite problems Spent a lot of time drinking Spent less time on other matters Copyright Alcohol Medical Scholars Program 5
6 Health Benefits of Getting 8458 men, 5 year study OR Duodenal ulcer 0.6 Mortality 0.5 Controls for Demographic factors Biological factors Health habits Copyright Alcohol Medical Scholars Program 8
7 Health Benefits of Giving Mortality OR Giving 0.6 Getting 1.0 Controls for Demographic factors Biological factors Health habits Copyright Alcohol Medical Scholars Program 9
8 Overall Health Benefits Greatest for isolated adults Alcoholism is socially isolating Copyright Alcohol Medical Scholars Program 11
9 Mental Health Benefits Depression: d=.5 Post Traumatic Stress Disorder symptoms: d=.2 Self-esteem: d=.2 Life satisfaction: d=.4 Sense of purpose: d=.6 Michigan Study of Life Transitions, 2003; America s Changing Lives, 1999 Copyright Alcohol Medical Scholars Program 12
10 Overall Mental Health Benefits Greatest for givers with same chronic disease Depression: d=.9 Self-esteem: d=3.2 Life satisfaction: d=9.4 Sense of purpose: d=1.3 Alcoholism: a chronic disease Copyright Alcohol Medical Scholars Program 13
11 Social Benefits Arrests/delinquent acts: d=.2 Alcohol/marijuana use: d=.3-.5 College attendance: d=.4 Michigan Study of Life Transitions, 2003 Copyright Alcohol Medical Scholars Program 14
12 AUD Treatments Cognitive Behavior Treatment (CBT) - Enhance motivation - Rebuild health, functioning - Relapse prevention Same core used for chronic disorders Copyright Alcohol Medical Scholars Program 16
13 Motivational Enhancement (ME) Express empathy Develop discrepancy Roll with resistance Support self-efficacy Copyright Alcohol Medical Scholars Program 17
14 Relapse Prevention Coping skills for precipitants - Intrapersonal - interpersonal Lifestyle changes If slip: get back on track Copyright Alcohol Medical Scholars Program 19
15 Same Tripartite Approach in Alcoholics Anonymous (AA) Motivation increased Restoration of functioning Relapse prevention Copyright Alcohol Medical Scholars Program 23
16 AUD Chronicity 70%: 1+ AUD criterion High risk period post treatment Self-help groups can help Copyright Alcohol Medical Scholars Program 24
17 AA: A Common Source of Help 60% of men go to AA 80% of women go to AA Copyright Alcohol Medical Scholars Program 25
18 AA Facts 100,000+ groups 2,000,000+ members 150 countries No cost 77% inform their doctor Copyright Alcohol Medical Scholars Program 26
19 AA Benefits: Short-Term months of abstinence Abstinence: r=.3 Psychological adjustment: r=.3 Copyright Alcohol Medical Scholars Program 27
20 AA Benefits: Long-Term 50% retention: first 90 days Retention rates: after 90 days 70% - 3 months 60% - 6 months 55% - 1 year 50% - 5 years Copyright Alcohol Medical Scholars Program 28
21 Service Dimension of AA AA s primary purpose Oxford Group 3 sided program: - Unity - Recovery - Service Copyright Alcohol Medical Scholars Program 30
22 Service in AA Anything that helps fellow sufferers Forms of HB Formal roles at AA meetings Helping newcomers Sharing experience (12 th step) Being a sponsor Copyright Alcohol Medical Scholars Program 31
23 Active Ingredients of AA: What Works? 107 cross-sectional studies Increases involvement: r=.3 Has AA sponsor: r=.3 Leads a meeting: r=.2 Does 12 th step work: r=.2 HB: half of modest effects Copyright Alcohol Medical Scholars Program 32
24 Longitudinal Studies of HB: Project MATCH 8% HB during treatment HB not limited to subgroups Drinking severity Demographic characteristics 40% versus 20% sober at 15 months Copyright Alcohol Medical Scholars Program 33
25 Conclusions HB important to health One-third of AA s program Evidenced-based method for abstinence Clinical approach for all patients Copyright Alcohol Medical Scholars Program 35
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