Anja Koski-Jännes

Recovery from problem gambling without formal treatment

Understanding the process by which problem gamblers recover without formal treatment may improve both formal treatments and assist those who wish to modify their gambling behavior without seeking treatment. Study 1 assessed the recovery process in problem gamblers who had recovered for at least 6 months without formal treatment from those who had recovered with the assistance of formal treatment. The treated recovered gamblers generally had a more severe gambling problem than did untreated recovered gamblers, as indicated by a long problem gambling career and more gambling-related negative consequences (e.g., family, health). Study 2 compared two samples of untreated gamblers, those who had recovered without treatment with a comparable sample of active gamblers who also had never received treatment. The active, untreated gamblers had higher lifetime rates of anxiety and personality disorder. Recovered gamblers may match the behaviorally conditioned problem gamblers as described in Blaszczynskis Pathways Model.

Why Do People Stop Their Drug Use? Results from a General Population Sample

This paper describes results from a pilot study that assessed the reasons for change provided by former drug users in a representative sample of the general population. As part of a random digit dialing telephone survey, people were asked about their past use of cannabis, cocaine/crack, tobacco and alcohol. In a series of open-ended questions, participants who had stopped their consumption of the drug (or reduced it to moderate levels for alcohol) were asked what had led them to stop (or reduce) their consumption. Reasons for change among this representative sample are presented along with comparisons across different drugs.

Population, Professional, and Client Support for Different Models of Managing Addictive Behaviors

This study, funded by the Academy of Finland, explores how different stakeholder groups in Finland attribute responsibility for various addictions. A random general population survey and surveys with addiction treatment professionals and clients (n = 1,338) were conducted in 2007–2008. The data were analyzed with analyses of variance and logistic regression analysis. Individual responsibility was emphasized by all groups. The Moral model dominated in behavioral and the Enlightenment model in hard drug addictions, views on other substance addictions varied more. Some signs of the actor–observer asymmetry were observed. Personal addiction experiences and sex were the major predictors of the average response tendencies. The heavy emphasis on individual responsibility may prevent help-seeking.

Using self-help materials to motivate change at assessment for alcohol treatment.

The utility of a brief self-help booklet provided at assessment for alcohol treatment was evaluated using a quasi-experimental design (booklet provided to all clients for one month at a time, interspersed by one month of no booklets, for a 6-month period). While the booklet did not result in any significant reduction in client attrition, clients who received the booklet at their assessment were drinking less by the 6-month follow-up than those who did not receive the booklet. Limitations of this study, including the quasi-experimental design and the impact of the low baseline attrition rates, are discussed.

Perceptions of addictions as societal problems in Canada, sweden, Finland and st. Petersburg, Russia.

Aims: This study reports on the relative gravity people attribute to various addictive behaviors with respect to other societal concerns in four northern populations with different history, social policy and treatment alternatives for addicted individuals. Methods: Random population surveys were conducted in Canada, Sweden, Finland and St. Petersburg, Russia. In Finland and Sweden, the survey was conducted by mail, in Canada and St. Petersburg by phone. As a part of this survey, the respondents were asked to assess the gravity of various societal problems, some of which involved various addictive behaviors. The data were analyzed by descriptive statistical methods, factor analysis, contextual analysis and multiple regression analysis. Results: Hard drugs, criminality and environmental issues belonged to the topmost problems in all data samples. Overall, Finns and Canadians appeared the least worried about various societal problems, Swedes seemed the most worried and St. Petersburgian views were the most polarized. Two factors were extracted from the combined data. Factor 1 covered criminal behavior and various addictions; it was named Threats to Safety factor. Factor 2 comprised social equality issues. The country context explained 12.5% of the variance of the safety factor and 7.9% of the equality factor. Conclusions: Despite some cultural variation in the gravity assessments, the central core of the social representation of addictive behaviors tends still to be linked with ‘badness’ since they were mainly grouped with various forms of criminal behavior in all these countries.

Maturing Out of Drinking Problems : Perceptions of Natural History as a Function of Severity

This study tested the hypothesis that maturing out descriptions of change were more common among respondents whose drinking problems were less severe prior to reduction and that consequence driven changes were more common among those who had a lifetime diagnosis of alcohol dependence, prior to resolution. As part of a general population telephone survey, former heavy drinkers were asked their reasons for change. These responses were tape-recorded, transcribed and then coded into three categories – consequence driven reasons, drifting out reasons and reflective maturational reasons. As predicted, drifting out reasons were more often provided by those with less severe alcohol use and consequence related reasons appeared associated with respondents who had had more severe alcohol problems. The differing descriptions of pathways to change observed in natural history studies may be the result of research that captures only partial samples of the larger population of former heavy drinkers.

Self-Assessment of Drinking on the Internet―3-, 6- and 12-Month Follow-Ups

AIM The aim of this work was to report on the results of a pilot study of a web-based self-assessment service (DHT) for Finnish drinkers (www.paihdelinkki.fi/testaa/juomatapatesti). METHOD During the 7-month recruitment period in 2004 altogether 22,536 anonymous self-assessments were recorded in the database of this service. The study sample was recruited from the 1598 service users who also participated to a survey evaluating the DHT. Those who consented by providing required baseline data and their e-mail address (n = 343) were sent a message asking them to fill in the follow-up questions 3, 6 and 12 months later. Their self-reported use of alcohol and drinking-related problems served as the main outcome variables in this single-group follow-up study. RESULTS At 3, 6 and 12 months, 78%, 69% and 61% of the study participants, respectively, responded to the follow-up. The intention-to-treat (ITT) results revealed significant reductions (P < 0.001) in all the outcome measures. The reductions occurred during the first 3 months, after which the changes were non-significant. CONCLUSIONS The results are in line with previous studies with mostly shorter follow-up periods suggesting that Internet-based self-assessment services can be useful tools in reducing excessive drinking. A randomized controlled trial would, however, increase our certainty about the causes of the observed changes.

Population, professional and client views on the dangerousness of addictions: testing the familiarity hypothesis

Aims This study compares how different stakeholder groups in Finland perceive the dangerousness of diverse addictions to the individual and society. It also tests the hypothesis that familiar addictions are regarded as less dangerous than unfamiliar ones. Data The data consisted of surveys with 1) a random general population sample (n=740); 2) addiction treatment professionals (n=520); and 3) inpatient clients (n=78). The dangerousness of alcohol, hard drugs, cannabis, prescription drugs, tobacco, gambling and Internet use were assessed by their perceived addiction potential, chances of recovery and relative gravity as societal problems. Results The observed group differences, even if significant, were mostly of degree rather than of kind. The largest disagreements involved cannabis and prescription drugs. Lay respondents worried more about cannabis while professionals were rather more concerned about prescribed drugs. Clients saw less difference in the addiction potential of legal and illegal substances than did lay respondents. Professionals trusted most in treatment but they saw less need to treat cannabis dependence than the others. All groups ranked alcohol as the greatest addiction-related societal problem in Finland. The familiarity hypothesis was not consistently supported by the data. Clients familiar with many addictive substances and behaviours did not downplay their harmfulness.

Characteristics of former heavy drinkers : results from a natural history of drinking general population survey

This study explored the factors associated with reduction from heavy drinking among three groups: current abstinent, moderate, and reduced drinkers. A random-digit-dialing telephone survey was conducted of 3,006 respondents in Ontario, Canada. Of these, 470 respondents (46% female) met criteria as former heavy drinkers (99 abstinent; 237 moderate; 134 reduced but not moderate drinkers). Quantitative and qualitative questions were used to explore current and past drinking, use of treatment, and reasons for change. Qualitative items were tape-recorded and transcribed. Respondents in the abstinent group had more severe problems prior to resolution as compared with those in the moderate group. Reduced drinkers displayed a prior alcohol severity at a level between these two other groups. The most common reasons for change in all groups were new responsibilities, maturation, and health concerns. This study serves as a useful adjunct to other natural-history research, exploring the reasons for change in a representative sample of former heavy drinkers.

Evidence from regression-discontinuity analyses for beneficial effects of a criterion-based increase in alcohol treatment

Brief interventions effectively reduce alcohol problems; however, it is controversial whether longer interventions result in greater improvement. This study aims to determine whether an increase in treatment for people with more severe problems resulted in better outcome. We employed regression‐discontinuity analyses to determine if drinking driver clients (n = 22,277) in Ontario benefited when they were assigned to a longer treatment program (8‐hour versus 16‐hour) based on assessed addiction severity criteria. Assignment to the longer16‐hour program was based on two addiction severity measures derived from the Research Institute on Addictions Self‐inventory (RIASI) (meeting criteria for assignment based on either the total RIASI score or the score on the recidivism subscale). The main outcome measure was self‐reported number of days of alcohol use during the 90 days preceding the six month follow‐up interview. We found significant reductions of one or two self‐reported drinking days at the point of assignment, depending on the severity criterion used. These data suggest that more intensive treatment for alcohol problems may improve results for individuals with more severe problems. Copyright