Edna Oppenheimer

Abstinence or control: The outcome for excessive drinkers two years after consultation

Abstract This report presents the two-year follow-up results for a sample of married male alcoholics who had been the subjects of a controlled treatment trial. Cumulative relapse curves for the two-year period were found to be similar in form to those which Hunt and Matarazzo (1970) have drawn for drug addicts, alcoholics and smokers. Outcome at 12 and 24 months were compared: changes from good to bad outcome, or vice versa, were rare. The degree of hardship reported by wives remained predictive of outcome two years later. Not all drinking reported at two years was uncontrolled. Of 26 men with a good outcome. 11 were agreed by husband and wife to be abstaining, and 10 were agreed to be controlling their drinking. Most of the latter had not shown lengthy periods of abstinence prior to resuming drinking. Controlled drinkers reported fewer symptoms at intake (morning drinking, shakes, secret drinking, hallucinations etc.), were more likely to have been sub-diagnosed as Alpha alcoholics (psychologically dependent), and were more likely to have been only briefly counselled. Abstainers reported more symptoms at intake, were more likely to be sub-diagnosed as Gamma alcoholics (physically dependent), and were more likely to have been intensively treated. These results suggest an interaction between degree of dependence, type of treatment, and goal of treatment. If confirmed by future research this would have strong implications for the planning of comprehensive alcoholism treatment services.

Rapid assessment and response studies of injection drug use: knowledge gain, capacity building, and intervention development in a multisite study.

OBJECTIVES We evaluated the World Health Organizations rapid assessment and response (RAR) method of assessing injection drug use and its associated health problems, focusing on knowledge gain, capacity building, and whether RAR leads to the development of interventions reducing the health effects of injection drug use. METHODS Data were derived from RAR studies conducted in Beijing, China; Bogotá, Colombia; Greater Rosario, Argentina; Hanoi, Vietnam; Kharkiv, Ukraine; Minsk, Belarus; Nairobi, Kenya; Penang, Malaysia; St. Petersburg, Russia; and Tehran, Iran. RESULTS Substantial gains in knowledge and response capacity were reported at all of the study sites. Before RAR initiation, prevention and intervention programs had been absent or inadequate at most of the sites. The RARs resulted in many new or modified interventions; 7 sites reported 24 health-related interventions that were subsequently developed and influenced by the RARs. CONCLUSIONS RARs, which require relatively little external funding, appear to be effective in linking assessment to development of appropriate interventions. The present results add to the evidence that rapid assessment is an important public health tool.

SEVEN YEAR FOLLOW-UP OF HEROIN ADDICTS: LIFE HISTORIES SUMMARISED

Data from a seven-year follow-up study of heroin addicts were analysed to show group trends. Time spent in various activities was quantified for each person for each year of the follow-up period and used to provide a composite life history. Time spent by the sample using drugs has decreased over the follow-up period. The most marked decrease appeared in the use of heroin, but the analysis suggests that a hard core of heroin users still used heroin several years after coming to the clinic. There seems to be an overall congruence between abstinence and non-clinic attendance. For this sample the use of illegal opiates without attending a clinic was relatively rare, and total time spent in hospitals and in prisons was rather small. Death occurred randomly during the follow-up period.