Bill Saunders

The impact of a brief motivational intervention with opiate users attending a methadone programme

During the 1980s Motivational Interviewing emerged as one of the memes of the addictions field. This occurred despite the lack of scientific evidence supporting its utility. In this paper findings of a controlled trial of a brief motivational intervention with illicit drug users (n = 122) attending a methadone clinic are reported. Clients who met the studys inclusion criteria were randomly allocated to either a motivational (experimental, n = 57) or educational (control, n = 65) procedure. Over the 6-month follow-up period the motivational subjects demonstrated a greater, immediate, commitment to abstention, reported more positive expected outcomes for abstention, reported fewer opiate-related problems, were initially more contemplative of change, complied with the methadone programme longer and relapsed less quickly than the control group. There was, however, no difference in terms of the severity of reported opiate dependence and the control group fared better on reported self-efficacy. It was concluded that motivational interventions of the type investigated are useful adjuncts to methadone programmes.

CROSS-CULTURAL EVALUATION OF TWO DRINKING ASSESSMENT INSTRUMENTS: ALCOHOL TIMELINE FOLLOWBACK AND INVENTORY OF DRINKING SITUATIONS

This article describes the psychometric characteristics of two major assessment instruments used in a World Health Organization (WHO) clinical trial: (a) Alcohol Timeline Followback (TLFB, which assesses daily drinking patterns), and (b) Inventory of Drinking Situations (IDS, which assesses antecedents to “heavy” drinking). Clients (N=308) were outpatient alcohol abusers from four countries (Australia, Canada, Mexico, and Sweden). Generally, the Alcohol TLFB and IDS were shown to be reliable and valid with outpatient alcohol abusers in four countries, and in three languages. These results suggest that the Alcohol TLFB and the IDS can be used in clinical and research settings with Swedish-, Spanish-, and English-speaking alcohol abusers.

Do our guardians need guarding? An examination of the Australian system of self-regulation of alcohol advertising.

In this study the Australian system of self-regulation of alcoholic beverage advertising was examined. Sixteen advertisements, eight print and eight television advertisements, were subjected to public scrutiny. Respondents rated advertisements using a self-completion questionnaire based directly on the Australian Alcoholic Beverage Advertising Code. Responses were collated and where a majority of respondents had endorsed items that constituted a breach of the cose, a complaint, ostensibly from a member of the general public, was made to the Advertising Standards Council. All sixteen advertisements were regarded by the public as containing aspects which breached the code. However, the Advertising Standards Council rejected all but one of the sixteen complaints, often directly contradicting the opinions of our respondents. The social policy implications of these results are considered. It is contended that the system of self-regulation of alcohol advertising does not serve the public interest.

Drinking-Related Assessment Instruments: Cross-Cultural Studies

In recent years a number of drinking-related assessment instruments have undergone extensive developmental work and are in widespread use. These include measures that are designed to assess: 1) patterns of alcohol consumption. Timeline Followback Method (TLFB); and 2) antecedents to alcohol use, Inventory of Drinking Situations (IDS)-two constructs that would be expected to be sensitive to cross-cultural variability in drinking practices. These assessment tools present opportunities for the study of cross-cultural differences in drinking patterns and the circumstances under which drinking occurs. A World Health Organization project utilizing these assessment tools is currently underway in five countries (Australia, Canada, Mexico, Poland, and Sweden). This project focuses on the identification of profile differ.

Motivation and addiction behaviour: a psychological perspective

In this paper traditional ideas about motivation and the addiction behaviours are critically considered. It is proposed that rather than viewing motivation as a static quality that clients either have or have not, motivation is more usefully perceived as the balance between the costs and benefits of undertaking any behaviour, juxtaposed with the costs and benefits of ceasing the behaviour. It is also proposed that confrontation approaches, rather than inducing motivation, actually increase the clients resistance. Motivational interventions therefore need to be based on a client-generated inventory of problems and concerns rather than a therapist-dictated one. A decision-making framework for motivational intervention is emphasized and the effectiveness of motivational strategies based on this paradigm is considered.

Relapse revisited: A critique of current concepts and clinical practice in the management of alcohol problems

How a problem is understood dictates how it is responded to. In this paper the problem of relapse and alcohol dependence is reconsidered. The existing major relapse paradigm is evaluated against the last two decades of research. It is concluded that the available research strongly questions the notion that relapse is an addiction-specific event. Instead, relapse is probably better understood as a complex, generic, human behaviour, undertaken at times by all of us. Given this, it is possible that mainstream psychological theories, such as decision making and attribution theory, are important in coming to any understanding of the phenomenon of relapse. It is also contended that the investigation of relapse is potentially an error of focus. Such study invites the investigation of those who do not succeed in changing behaviour, as against the study of those who do. For those concerned with the treatment of alcohol dependence, studying the successes may be a more informative process than studying the putative failures. Given the burgeoning of research over the past two decades the impact on treatment practice is reviewed. It is concluded that relapse prevention and management is very much on the alcohol-intervention agenda. However, the research evidence to date is consistent with the general psychotherapy literature in that doing something appears better than no intervention, but that an optimum, effective, intervention has yet to be devised.

Alcohol and young people: minimizing the harm

In this paper the literature on patterns of use of alcohol by teenagers is reviewed. The model as proposed by Thorley is used to describe the specific nature of alcohol problems experienced by young people. A systemic approach to prevention is explored and recommendations are made about ways to minimise the harm associated with alcohol use by young people.

An Investigation of Alcohol Dependent Respondents' Attributions for Their Own and “Others” Relapses

In this study the attributions made by alcohol dependent respondents for their “own” and “others” relapses were examined. Seventy alcohol dependent inpatients participated. Each respondent completed a research questionnaire which assessed demographic details, drinking history, alcohol dependence and included an attribution scale on which respondents rated their own last relapse, and four relapse scenarios of “other” people, in terms of locus of causality (external/internal), personal control, external control, stability and globality. There were significant differences in the attributions made by alcohol dependent respondents for their “own” relapses as against the relapses of “others”. The relapses of “others” were seen as being significantly different; having greater internal locus of causality, lower external control and higher personal control attributions. No differences were found on the dimensions of globality and stability. The existence of such differences suggest that attribution theory is of relevance to any model of relapse that is based on client self report. It is also possible that the current emphasis in clinical work on the identification and management of high risk external situations as pre-cipitants of relapse, may be a consequence of the attribution process rather than the “real” cause of relapse.

Preventing drug use problems: the university as a site for local action

While the prevention of drug use problems comes well recommended, there is limited agreement on which preventive strategies are the most effective. Furthermore there is debate as to where activity most effectively occurs-should it be at the national or local level? In this study a university community was investigated with the aim of determining whether members of that community appreciated the need for prevention of drug use problems and which preventive strategies they deemed to be of value. The difficulties inherent in taking action within a tertiary environment are also considered and an agenda for action described.

Stepping on to foreign shores

The 20,000 kilometre journey from the United Kingdom to Australia has been made for 200 years by explorers, tradesmen, entrepreneurs, families keen to explore the land of opportunity and by a fair number of adventurers, paupers and vagabonds. Nowadays, the essential qualification for a Briton to gain entry into Australia is to be a drug and alcohol specialist. In this paper two professional brethren give their impressions of the drug and alcohol field in Australia from an old world perspective.