Tracey J. Jarvis

Child sexual abuse as a predictor of psychiatric co-morbidity and its implications for drug and alcohol treatment

A study of 180 women in and outside drug and alcohol treatment showed that CSA survivors had higher overall levels of psychological distress, compared with drug and alcohol treatment clients who had not experienced CSA. They reported elevated levels of anxiety, somatisation and dissociation but not depression. Higher rates of self-harm, eating disorders and sexual dysfunction were also reported by CSA survivors. Women with a history of both CSA and substance abuse were more likely to have attempted suicide than other women. The results highlight the need for improved liaison between substance abuse treatment programs and other health services.

In-patient setting and long duration for the treatment of alcohol dependence? Out-patient care is as good

A combined narrative/meta-analytic review of the results of a number of well-conducted randomized controlled clinical trials indicates that there is no evidence that usual treatment delivered in an in-patient or residential setting is superior to treatment delivered on an out-patient or non-residential basis for the treatment of alcohol dependence. Nor is there any evidence to support the view that in-patient/residential treatment is superior to day patient intervention, or that longer in-patient treatment is superior to shorter in-patient treatment. The studies suggest that in-patient/residential care should not be considered as a standard setting for intervention for alcohol dependence. However, the results of these trials do not contradict the view that in-patient/residential care remains suitable for specific sub-populations of alcohol dependent individuals, such as those requiring closely supervised detoxification, respite care, or who (because of the extreme severity of dependence on alcohol) may require an intense form of supervised intervention. Research should be conducted to establish whether treatment on an in-patient basis does yield an advantage for this last group.

A summary of recommendations for the management of alcohol problems: the quality assurance in the treatment of drug dependence project.

This report presents outlines for approaches to intervening with excessive drinkers and problem/dependent drinkers. These recommendations are based on a meta-analysis of the treatment-outcome literature, a survey of treatment practices used in Australia and the views of a panel of experts. Recommendations for assessment, detoxification and intervention for excessive, problem and dependent drinkers are made. A number of interventions that are deemed unsuitable for use in this area, or that hold promise but require more evidence before they can be advocated for use are set out.