Ray Hodgson

Effectiveness of treatment for alcohol problems: findings of the randomised UK Alcohol Treatment Trial (UKATT)

Abstract Objective To compare the effectiveness of social behaviour and network therapy, a new treatment for alcohol problems, with that of the proved motivational enhancement therapy. Design Pragmatic randomised trial. Setting Seven treatment sites around Birmingham, Cardiff, and Leeds. Participants 742 clients with alcohol problems; 689 (93.0%) were interviewed at three months and 617 (83.2%) at 12 months. Interventions Social behaviour and network therapy and motivational enhancement therapy. Main outcome measures Changes in alcohol consumption, alcohol dependence, and alcohol related problems over 12 months. Results Both groups reported substantial reductions in alcohol consumption, dependence, and problems, and better mental health related quality of life over 12 months. Between groups we found only one significant difference in outcome, probably due to chance: the social network group showed significantly better physical health at three months. Non-significant differences at 12 months in the motivational group relative to the social network group included: the number of drinks consumed per drinking day had decreased by an extra 1.1 (95% confidence interval −1.0 to 3.2); scores on the Leeds dependence questionnaire had improved by an extra 0.6 (−0.7 to 2.0); scores on the alcohol problems questionnaire had improved by an extra 0.5 (−0.4 to 1.4); but the number of days abstinent from drinking had increased by 1.2% less (−4.5% to 6.9%). Conclusion The novel social behaviour and network therapy for alcohol problems did not differ significantly in effectiveness from the proved motivational enhancement therapy.

Alcohol dependence and the priming effect

Abstract The concepts of loss of control and craving are reviewed and relevant experimental findings are discussed. Speed of drinking is proposed as a behavioural measure of craving and an experiment is described to test the hypothesis that craving is primed by a moderate dose of alcohol (45 gm). The hypothesis was confirmed, but only for the severely dependent alcoholics. The results indicated that the behavioural measure of craving and the assessment of severity of dependence were crucial. Failure to measure either of them would have resulted in failure to identify a priming effect.

The concept of craving and its measurement

Abstract By encouraging short periods of abstinence, conditions representing high and low craving were arranged in the homes of 10 alcoholic subjects on two separate occasions. The alcoholics subjective, physiological and behavioural responses and their interrelationships over a three and a half-hour response prevention period, were recorded in an attempt to define the concept of craving. A behavioural measure, speed of drinking a prescribed amount of alcohol, was validated as a correlate of craving.

Cue exposure and response prevention with alcoholics: A controlled trial

Abstract Ten severely alcohol-dependent subjects were divided into two groups, one of which received only 6 sessions of in-vivo cue exposure and response prevention and the other of which received 6 sessions of imaginal cue exposure, followed by 6 sessions of in-vivo cue exposure and response prevention. The in-vivo cue exposure produced significant decrements on behavioural and subjective measures for both experimental groups on Desire to Drink and Difficulty to Resist Alcohol. Imaginal cue exposure produced trivial changes on these measures. The implications for both theory and practice are discussed.

Alcohol dependence, beliefs and the priming effect

Abstract Twenty hospitalized alcoholics served as their own controls in a study which sought to compare psychophysiological and cognitive factors as mediating influences on the priming effect of alcohol. Ten subjects were independently assessed by a psychiatrist as being severely dependent on alcohol and ten as mildly or moderately alcohol dependent. Physiological, behavioural and subjective indices of the motivation to drink alcohol were employed 15 and 60 min after subjects had consumed beverages on four separate occasions corresponding to four priming conditions. These priming drinks contained either 60 ml vodka in heavy dilution or just tonic water, and in each of these conditions subjects were either led to believe that the beverages contained alcohol or they had no alcohol. The severely-dependent group displayed a degree of concordance between the indices of motivation to drink, and the levels of these tended to be significantly higher than in the less-dependent subjects. The results suggest that severely alcohol-dependent subjects were more disposed to drink 60 min after consuming alcoholic drinks than after soft drinks, regardless of whether they believed that the priming drinks had contained alcohol. Cognitive factors assumed greater importance for the drinking behaviour of less-dependent subjects, although there was evidence of discordance across behavioural, physiological and subjective measures for this group.

Fast screening for alcohol misuse

UNLABELLED The Fast Alcohol Screening Test (FAST) has been developed from the AUDIT questionnaire. AUDIT The Alcohol Use Disorders Identification Test: guidelines for use in primary health care. Geneva, Switzerland: World Health Organization for use in very busy medical settings. One feature of the FAST is its ease and speed of administration, especially since one question identifies over 50% of patients as either alcohol misusers or not. This study further explores the sensitivity and specificity of the FAST across ages, gender, and locations using the AUDIT as the gold standard. Two other quick tests are also compared with the AUDIT and the FAST, namely the Paddington Alcohol Test and the CAGE. All tests were quicker to administer than the AUDIT with the FAST taking just 12 s on average. All tests identified drinkers who would accept a health education booklet (over 70% of those identified) or 5 min of advice (over 40%). The FAST was consistently reliable when sensitivity and specificity were tested against AUDIT as the gold standard.

To what factors do clients attribute change? Content analysis of follow-up interviews with clients of the UK Alcohol Treatment Trial.

The UK Alcohol Treatment Trial compared outcomes after a social treatment (Social Behavior and Network Therapy) and a motivational treatment (Motivational Enhancement Therapy). As part of the process element of the trial, a subsample of clients were interviewed 3 months after treatment allocation and another subsample 12 months after allocation (N = 397) to explore the factors to which clients attributed positive changes that might have occurred in their drinking. Postinterview reports were content analyzed using three types of code: social, motivational, and general. At 3 months, Social Behavior and Network Therapy clients made significantly more social attributions and Motivational Enhancement Therapy clients more motivational attributions, and the difference for motivational attributions was maintained at 12 months (with a trend for social attributions). Overall, the factors to which change was most frequently attributed were involvement of others in supporting behavior change (a social factor), awareness of the consequences of drinking (a motivational factor), and three general factors--determination, commitment, and decision; detoxification or medication; and feeling comfortable talking. Change was more frequently attributed to general factors than it was to either social or motivational ones. Some of the difficulties in eliciting and coding attribution material are referred to. The results may help understand the absence of between-treatment type outcome differences in UK Alcohol Treatment Trial and other trials.

Personality and alcohol dependence

Abstract In this study, groups of ‘alcoholic’ subjects were independently rated as to their degree of dependence by a technique previously validated. The two groups of moderately and severely dependent subjects were then given the 101-item EPQ. In keeping with other similar studies, the data suggested that high N, high P and low E in men were related to the Clinical Alcohol Personality. Further analysis of these and other data suggest that whilst raised N scores may be a spurious artefact which is a consequence of heavy alcohol consumption, the E and P findings may reflect stable predispositions. There were no sex differences, but there was a major group difference on P, with both severely dependent men and women scoring significantly higher than their less dependent counterparts.

Why people enter treatment for alcohol problems: Findings from UK Alcohol Treatment Trial pre-treatment interviews

Aim: To develop a model of why people seek professional treatment for drinking problems, grounded in what clients say about the process at treatment entry. Participants: Three sets of consecutive entrants to the UK Alcohol Treatment Trial, sets commencing at intervals during trial recruitment (total n = 98). Location: Statutory and non‐statutory alcohol problem treatment agencies in three areas of England and Wales. Data: Open‐ended interviews according to a brief interview guide, leading to 400–800‐word post‐interview reports used for analysis (tape recordings used for auditing the interview and analysis process). Analysis: Reports analysed by a team according to grounded theory principles, involving an iterative process with successive refinement of interviewing and analysis with each successive set of data. Findings: A model of professional treatment entry was developed, refined and “tested” with the last set of data. The process of seeking professional treatment was depicted in the model as involving a realization of worsening, accumulating and multiple problems related to drinking, especially in health and family domains; in conjunction with, in most cases (but not all), a trigger event and/or family or professional influence; combined with rejection of the possibility of unaided change or non‐professional help; leading to the seeking or accepting of professional help. Conclusions: The findings support conclusions already in the literature about the process of seeking professional help for a drinking problem, but provide further refinement of existing ideas: for example regarding the accumulation of drinking‐related problems, the ways in which a realization of those problems combines with triggers or pressure, and the complex role of the family and primary care professionals in assisting motivation to seek treatment.

Brief interventions for patients with alcohol-related trauma.

Patients who have sustained alcohol-related injuries are frequently treated in departments of oral and maxillofacial surgery. Often, an alcohol intervention will not be possible in accident and emergency departments due to intoxication but, when attending out-patient clinics for follow-up, patients are usually sober. This presents a unique opportunity for encouraging patients to review their alcohol consumption at a time when their facial injury may make them more receptive to advice. This article reviews the convincing evidence of the effectiveness of advice and brief interventions designed to be incorporated into standard out-patient consultations and describes practical screening of patients for harmful drinking, the Stages of Change Model of behaviour change and motivational interviewing for facilitating behavioural change.