Constance Weisner

Factors associated with coercion in entering treatment for alcohol problems

Although the importance of coercion in entry to treatment for alcohol problems is recognized, few studies have focused on different types and levels of coercion among heterogeneous groups of clients entering treatment agencies. This paper describes demographic and problem characteristics associated with various sources and levels of coercion. More than 40% (n = 377) of individuals entering a representative sample of a countys HMO, public, and private indemnity-based non-DUI alcohol treatment services (n = 927) indicated they received an ultimatum to enter treatment from at least one person. The most common source of an ultimatum to enter treatment was from family members (n = 222), followed by the legal system (n = 78), and healthcare professionals (n = 55). Respondents experiencing pressure to enter treatment reported that ultimatums from more than one source were common. Individuals entering treatment who were most likely to report being coerced were white, young adults (age 18-39), and married or living with a partner. When controlling for demographic characteristics and problem severity, family problem severity and legal problem severity predicted having received an ultimatum to enter treatment. Alcohol and drug problem severity were not related to receiving a treatment ultimatum.

Alcohol drinking patterns and medical care use in an HMO setting.

The objective of this study was to examine the association of medical care use (outpatient visits and hospitalization) with alcohol drinking patterns in a large health maintenance organization (HMO). Data were gathered from a random sample of 10,292 adult respondents through a telephone survey conducted between June 1994 and February 1996. Findings indicate that current non-drinkers with no past history of drinking had higher rates of outpatient visits and hospitalizations than current drinkers. Among current drinkers, medical care use declined slightly as drinking levels increased. Among nondrinkers, those with a drinking history exhibited significantly higher use of outpatient visits and hospital care than nondrinkers with no drinking history and current drinkers. Controlling for demographic and socioeconomic factors, health status, and common medical conditions in multivariate analyses suggests that nondrinkers with a drinking history use more services because they are sicker than other nondrinkers or current drinkers.

The relationship of pre-treatment Alcoholics Anonymous affiliation with problem severity, social resources and treatment history

Little research has examined the relationship of substance abuse patients prior Alcoholics Anonymous (AA) affiliation to important treatment-related variables. This study of 927 individuals seeking treatment in public, health maintenance organization (HMO) and private-for-profit medical programs, found that 82.8% of patients presented at treatment with a history of AA affiliation. Degree of prior AA affiliation was significantly associated with more extensive prior utilization of formal and informal helping resources, current seeking of treatment in the public sector, having low income, being divorced/separated and having more severe alcohol, employment/support and psychiatric problems. Implications for service delivery and future research are discussed.

Developments in Alcoholism Treatment

Alcohol treatment systems expanded and diversified considerably over the past decade. This reflects adaptation to a variety of forces, including developments in national health care financing and policy, changes in other health care systems with which alcohol treatment had strong ties, the more diffuse effects of social movements and a drying trend in American public opinion, as well as agitation by advocacy and provider groups within the alcohol field. Drawing on national monitoring data, this chapter reviews developments at the levels of financing policy, organizations, client populations, and treatment modalities, documenting expansion in private sector alcohol treatment units, a growing emphasis on providing outpatient treatment, a merger between services for alcohol and drugs at the organizational and conceptual levels, increases in service delivery to coerced populations, as well as demographic change in alcohol treatment caseloads during the 1980s.

The Emergence of Problem-Drinking Women as a Special Population in Need of Treatment

This chapter chronicles the development of advocacy for improvements in alcohol treatment services for women during the 1970s and 1980s, tracing its influence in terms of real change in treatment systems in the United States. We follow the development of a womens alcoholism movement from its inception in the late 1970s through its transition during the late 1980s into a broader movement focused on drug abuse and perinatal addiction. We describe the new governing images of problem-drinking women that advocates presented, their claims about the nature of substance abuse problems in women, and their recommendations for a more gender-sensitive treatment system. We also review increased federal involvement in this issue over the course of the 1980s, as pressure mounted on policymakers to respond to the crisis over drug-exposed infants by making treatment services more accessible to women. The chapter concludes by considering these developments from the perspective of national treatment system statistics, finding modest growth in specialized and women-only treatment units, as well as moderate increases in the representation of women in substance abuse treatment caseloads.

Drinking in violent and nonviolent events leading to arrest: Evidence from a survey of arrestees

The minimal requirements for evaluating the relative magnitude of acute and chronic effects of alcohol on violent crimes include: (a) a selection of comparable samples of violent and nonviolent events, and (b) adequate controls for the anticipated positive correlation between drinkers and drinking in feasible samples. Following these requirements, hypotheses about the impact of personal drinking patterns and drinking in events on violent crimes in a random sample of 1,147 arrestees interviewed in a California detection facility in 1989 were tested. Using multiple indicators of drinking in events, and taking into account errors of misclassification and correlations between drinkers and drinking, it was found that arrestees charged with violent crimes showed significantly higher rates of drinking in events related to arrest. On the other hand, the twelve-month drinking pattern of arrestees did not discriminate between violent and nonviolent charges in this sample, given controls for drinking in events.

Gender Differences in the Relationship of Alcohol and Drug Use to Criminal Behavior in a Sample of Arrestees

This paper examines differences between men and women in the relationship of alcohol and drug use to criminal offenses, including violent behavior. A probability sample of men (N = 959) and women (N = 188) arrestees were interviewed in a northern California county. No significant differences were found between men and women in patterns of drug use, but more men than women reported heavy drinking. A higher proportion of men than women reported violence in the events related to their arrest (p < or = .02). Logistic regression examined the relationship of heavy drinking and violent offenses, controlling for drug use and demographic variables. Frequent heavy drinking (OR = 1.47), white ethnicity (OR = .51), and being married (OR = 1.93) were significant; gender was not significant. The results have implications for future research on gender and violence.

A comparison of alcohol and drug treatment clients : are they from the same population ?

As part of the Alcohol Research Groups Community Epidemiology Laboratory, representative samples of clients from a northern California countys public alcohol and drug treatment systems were interviewed. This paper compares clients in alcohol treatment agencies (N = 381) with those in drug treatment agencies (N = 307). In the United States the traditional separation of the two systems is in question, as there is a belief that most clients of both systems have dual alcohol and drug problems. This study found that while large numbers of clients reported use of both alcohol and other drugs, important differences were found between the two treatment systems. Alcohol treatment clients reported significantly higher alcohol consumption rates and lower drug use than did drug treatment clients. However, a higher proportion of alcohol treatment clients reported consuming alcohol with other drugs and attributing problems to both alcohol and drugs than did drug treatment clients. Discriminant function analysis found sociodemographic characteristics, problems attributed to alcohol, and problems attributed to drugs to provide significant contributions in predicting membership in the alcohol versus the drug treatment system.

Methods for evaluating policy changes in alcohol services.

Policy research assesses how outside forces affect alcohol treatment services. In this primer, we examine a range of effective methods that can be brought to bear by researchers and address the issues involved in conceptualizing and conducting studies of policy formation, implementation and policy implications. Because there is no single superior methodology for studying policy change, researchers have relied on five broad methodologies for studying policy context, formation, change and implications. We provide specific examples of each approach, addressing the following issues: data sources and samples; the problems, challenges, strengths, and limitations of the approach; and whether (and how) the method has been used in the alcohol field. The five methods are archival studies; key informant studies; ethnographic and observational studies; surveys; and meta-analyses. The strongest research designs in alcohol services research often combine methods and sources to get different vantage points on questions about policy change.

Achieving the Public Health and Safety Potential of Substance Abuse Treatments

Heavy use of alcohol and drugs is associated with serious public health and public safety problems, including transmission of infectious diseases, disproportionate use of medical and social services, traffic accidents, and street crime (Gerstein & Harwood, 1990; Institute of Medicine, 1990; Merril, 1993; Rice, Kelman, & Miller, 1991). These alcohol- and drug-“related” problems not only reduce the safety and quality of daily life throughout this country, but they are also a source of substantial expense. For example, Rice and colleagues have estimated that the total cost to the country in 1990 was