Treatment and Recovery Read and provide an detailed answer to the questions in the attached document. Also, read the attached pdf first then answer the que

Treatment and Recovery Read and provide an detailed answer to the questions in the attached document. Also, read the attached pdf first then answer the questionds. Contemporary Drug Problems 32/Fall 2005
457
“Yes, I’ve received treatment”:
what does this mean in the
context of epidemiological
surveys for alcohol problems?
BY JOHN A. CUNNINGHAM. JAN BLOMQVIST.
JOANNE CORDINGLEY, AND RUSSELL CALLAGHAN
Aim: To assess what it meatis when respondents say they have
received treatment on population survexs. Method: Fonner heavy
drinkers recruited through a random digit dialing telephone survey
were asked about the type, time, and amount of treatment they had
received. Results: When respondents indicated that they had
received treatment, it appeared that they had a specific treatment in
mind, that they completed the treatment program, and that, for the
mafority, treatment occurred at roughly the same time as their
successful change from heavy drinking. The congruence between
age of change and age of treatment use appeared greater among
respondents with abstinent versus reduced-drinking recoveries.
Natural history, alcohol, representative survey,
treatment use.
KEY WORDS:
© 2005 by Federal Legal Publications. Inc.
458
“YES. rVE RECEIVED TREATMENT”
Determining treatment status is an important issue in naturalhistory research about alcohol problems. When examining
pathways to change, it is essential to be able to identify those
who recovered with or without substance abuse treatment. In
studies that employ face-to-face interviews (reviewed in
Blomqvist, 1996, 1999), respondents are asked detailed
questions regarding use of treatment services. However, in
research that involves the .secondary analysis of epidemiological
surveys, detailed assessments of treatment use are usually not
possible. Such secondary analyses are important, providing
the opportunity to estimate the prevalence of treated and of
untreated recoveries in the general population (Cunningham,
1999). However, this research is limited because treatment
status is often determined by the respondent answering yes or
no to a single question about the use of treatment services for
alcohol problems. Although most respondents report
recovering from an alcohol problem without help or treatment
(e.g., 77% in Sobell, Cunningham & Sobell, 1996), a “yes” to
such a single question provides very little information. Within
such analyses, it is impossible to know: 1) the type of
treatment the respondent received; 2) when the treatment
occurred (i.e., did the treatment occur at roughiy the same
time as the respondent’s recovery?); 3) how much treatment
the respondent actually received (i.e., did the respondent go
through the entire program or just attend an initial assessment
before dropping out?); and 4) whether the respondent
received more than one treatment and/or the same treatment
more than once. The present study takes advantage of an
epidemiological telephone survey (the natural-history
telephone survey; Cunningham, Blomqvist, Koski-Jannes,
Cordingley & Callaghan, 2004) to address some of these
issues, using a sample of former heavy drinkers who either
reduced or stopped their drinking.
459
Method
The natural-history telephone survey (Cunningham et ai.,
2004) interviewed a representative sample of 3,006 adults
living in Ontario, Canada. Former heavy drinkers were
defined as respondents who at some point in their lives drank
five or more drinks on one occasion at least once a week for a
month or more (Room, Bondy & Ferris, 1995). These
respondents were asked a series of questions about quitting or
reducing their use if they: 1) had been abstinent in the last
year (n = 99) or 2) drank five or more drinks on one occasion
less than once per month in the last year (n = 371). A detailed
description of these groups is provided elsewhere
(Cunningham et al., 2004). This report concentrates on those
respondents who said they had ever used treatment. “This
next question will ask about any help you might have
received in relation to your drinking. Have you ever gone to
Alcoholics Anonymous or any other community agency, or
seen a physician, counselor, or any other professional for a
reason that was related in any way to your drinking?”
Respondents who said yes to this question were asked about
each of a series of different treatment services (see Table 1
for a list of these services). For each treatment service
endorsed, respondents were asked their age of first and last
use, the number of times or periods they had used the service,
and if they had ever stayed for the whole program. For
treatments that usually have prescribed lengths (e.g., inpatient
or outpatient treatment), respondents were asked if they had
stayed for the entire program. For treatments with no
prescribed treatment length (e.g.. Alcoholics Anonymous),
having attended treatment was defined as going to three or
more sessions during one time period. For services such as
emergency departments, the question was not asked because
it was irrelevant. Finally, respondents were asked if the
program had been helpful or unhelpful in helping them deal
with their alcohol use. Because of the nature of the analyses
presented and the small sample size, results in this report are
460
“YES. rVE RECEIVED TREATMENT”
based on unweighted data. However, as weighting values
were within a fairly narrow range, weighted and unweighted
estimates can be assumed to be fairly similar in this survey.
Results
Of 470 former heavy drinkers, 64 indicated that they had
received treatment, 59 of whom endorsed one or more of the
treatments listed on Table 1. By far the most commonly
endorsed treatment was Alcoholics Anonymous, followed by
talking to a professional in a private office (e.g., medical
doctor) and inpatient treatment. While in development
(Ogbome, Braun & Rush, 1998), there are no published reports
of the numbers of problem drinkers who use the various
treatment services in Ontario. TTierefore it is hard to ascertain
how well the reported proportions of treatment used correspond
to the types and numbers of treatment services actually offered.
However, an earlier population survey (Cunningham, Lin, Ross
& Walsh, 2000) also found private office visits and Alcoholics
Anonymous to be the most common types of help mentioned
by problem drinkers. Of the 59 respondents who endorsed at
least one treatment service, 56 had attended an entire treatment
program at least once or had attended Alcoholics Anonymous
for three or more sessions in a row.
The next analyses examined whether respondents who went
to treatment actually attended the service at roughly the same
time that they successfully changed their drinking. Figure 1
shows the age at which each of the 56 respondents first and
last attended any alcohol treatment and the age at which they
had successfully changed their drinking to its present level.
This figure is divided into two groups, reduced recoveries and
abstinent recoveries. Visual inspection of the figure indicated
that those in the abstinent group were more likely to have the
“age during which they attended treatment” be congruent
with when they successfully changed their drinking. Age
during which they attended treatment was defined as the
period between age of first treatment and age of last
461
TABLE 1
Treatment services used by former heavy drinkers
Treatment
Percent Ever Accessed
(n = 64)
Alcoholics Anonymous
Overnight detoxification
3-day to 3-month inpatient
Long-term residential or therapeutic community
Assessment or outpatient
Outpatient mental health care facility
Employee assistance program
Family or marital counseling
Emergency room
Private office with professional
Family or marital counseling
Jail or prison
Minister, rabbi, clergy or spiritual leader
Drinking-driving program
Other
None specified
70
28
33
0
14
9
6
11
19
36
11
3
16
2
4
8
treatment. Chi-square tests were conducted to test whether
respondents in the two recovery groups were more likely or
less likely to have attended treatment at an age similar to
when they changed their drinking to its present level (within
one year of calendar-year age versus more than one year of
calendar-year age). As can be seen in Table 2, respondents in
the abstinent group were more likely to have attended
treatment within one year of when they had successfully dealt
with their drinking (X” = 5.7, 1 df, p < .02). Table 2 also displays similar analyses comparing age of treatment with: 1) the age at which respondents experienced their last International Classification of Diseases 10 (ICD-IO) alcohol dependence symptom; 2) the age of experiencing their last psychosocial consequence; and 3) the age at which they stopped drinking at their heaviest. As can be seen, a similar and significant pattern of results occurred for the variable age of last dependence symptom (X' = 5.6, 1 df, p < .02). While in the same direction, the variables age of last psychosocial consequence and age the respondent stopped drinking at his/her heaviest did not reach significance {p > .05).
462
“YES. I’VE RECEIVED TREATMENT-
FIGURE 1
Age respondent first and last attended treatment and age
reported successfully changing drinking among two
groups—reduced-drinking and abstinent recoveries
100
age last treatment
age first treatment
80
•
age changed
60
40
PL
-D
CD
20
Reduced
TABLE 2
Abstinent
Attended treatment at time of change?
Percent within one year of treatment
Type of Recovery
Drinking
Abstinent
(n = 24)
(n = 32)
Successfully changed drinking
58
90
.02
Last ICD-IO dependence symptom
38
73
.02
Last psychosocial symptom
61
83
>.O5
Stopped period of heaviest drinking
64
64
87
>.O5
463
Also apparent from inspection of Figure 1 was the variability
in the age range from first to last treatment among different
respondents. Of particular interest were those respondents
who reported treatment many years after their age of change.
Two analy.ses were run to explore this issue—the first to see
whether use of Alcoholics Anonymous was associated with a
greater age range of treatment use, and the second to see
whether use of multiple treatments was associated with a
greater age range of treatment use. Respondents who attended
Alcoholics Anonymous displayed a greater age range
between first and last treatment compared with respondents
who did not use Alcoholics Anonymous (Mean [SD] = 9.2
[7.8] and 2.8 [5.5] years, respectively; t = 2.8, 53 df, p < .01). In addition, the correlation between the number of treatment modalities used and the age range between first and last treatment was r = .56 ij> < .001). Finally, respondents were asked if they found the treatment helpful or not. Of the respondents who endorsed at least one specific treatment service, 78% found at least one treatment very helpful, and only two respondents did not find any treatment at least somewhat helpful. Discussion This paper explored a number of questions about what it means when people say they have attended treatment on epidemiological surveys. It appears that most people have a specific treatment in mind, that they attended the whole program, and that they found it helpful. Finally, the majority of individuals sought treatment at roughly the same time they changed their drinking. For this latter point, it also appeared that respondents with abstinent recoveries were more likely than those with reduced-drinking recoveries to have had some treatment experience congruent with their age of successful change. It is possible that this finding reflects the fact that persons with abstinent recoveries tend to have had more 464 "YES. rVE RECEIVED TREATMENT" severe problems prior to resolution compared with those with moderate-drinking recoveries (Cunningham et al., 2000). However, the present data set is not of sufficient size to adequately test this hypothesis. It is also possible that recovery to abstinence is inherently a more memorable experience than a moderate-drinking recovery, making estimates of age of recovery to abstinence more accurate. The primary limitation of this study was that the survey assessed only age of first and of last treatment. Respondents were said to have changed their drinking within one year of accessing treatment if they reported an age of change within the one year after the age of last treatment, at one year younger than the first treatment, or at some age between these two time points. It is possible that respondents could have changed their drinking between the ages of first and last treatment but still have these events be several years apart (e.g.. Respondent 1641: first treatment at age 37; selfreported change at age 42; last treatment at age 51). If this is the case, should the respondent be classified as having had a treated recovery? Did the respondent continue with treatment during the time between the ages first and last treatment? Two possible explanations for this pattern of results were that respondents with long treatment histories went to treatments that encouraged lifetime attendance (e.g.. Alcoholics Anonymous) or went to multiple different treatment modalities. As there are limitations to the amount of detail that can be collected on a telephone survey, this issue might best be explored with a face-to-face interview employing an instrument such as the help-seeking timeline followback (Breslin, Borsoi, Cunningham & Koski-Jannes, 2001). Also apparent from these analyses is the fact that many problem drinkers attended multiple treatments over an extended period of time. Such protracted treatment careers have been noted in previous research (e.g., Dennis, Scott, Funk & Foss, 2005). 465 References Blomqvist. J. (1996). Paths to recovery from substance mi.suse: Change of lifestyle and the role of treatment. Substance Use & Misuse. 31(13). 1807-1852. Blomqvist. J. (1999). Treated and untreated recovery from alcohol misuse: Environmental influences and perceived reasons for change. Substance Use and Misuse. 34. 1371-1406. Bresiin. F. C . Borsoi. D., Cunningham. J. A. & Koski-Jiinnes. A. (2001). Heip-.seeking timeline followback for problem drinkers: Preliminary comparison with agency records of treatment contacts. Journal of Studies on Alcohol, 62. 262-267. Cunningham. J. A. (1999). Resolving alcohol-related problems with and without treatment: The effects of different problem criteria. Journal of Studies on Alcohol, 60. 463-466. Cunningham. J. A.. Blomqvist. J., Koski-Jannes. A.. Cordingley. J. & Callaghan, R. (2004). Characteristics of former heavy drinkers: Results from a natural history of drinking general population survey. Contemporary Drug Problems, 31(2), 357-369. Cunningham. J. A.. Lin. E.. Ross, H. E. & Walsh, G. W. (2000). Factors associated with untreated remissions from alcohol abuse or dependence. Addictive Behaviors, 25(2), 317-321. Dennis. M. L.. Scott. C. K.. Funk, R. & Foss. M. A. (2005). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment. 28 SuppI L S51-62. Ogbome, A. C . Braun. K. & Rush. B. R. (1998). Developing an integrated information .system for specialized addiction treatment agencies. Joumal of Behavioral Health Services Research, 25{ 1), 100-107. Room. R.. Bondy, S. & Ferris, J. (1995). The risk of harm to oneself from drinking. Canada 1989. Addiction. 90, 499-513. Sobell. L. C . Cunningham. J. A. & Sobell. M. B. (1996). Recovery from alcohol problems with and without treatment: Prevalence in two population surveys. American Journal of Public Health, 86(1). 966972. Read “'Yes, I've Received Treatment': What Does This Mean in the Context of Epidemiological Surveys for Alcohol Problems?” What is the difference(s) between treatment and recovery? Address if anyone is ever “recovered,” or is she/he always “in recovery?” Purchase answer to see full attachment