Broadening the Base of Treatment for Alcohol Problems (1990) / Chapter Skim
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Chapter 15--Populations defined by structural characteristics
Chapter 15--Populations defined by structural characteristics
Pages 356-380
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From page 356... ...
The groups discussed in this chapter are those which are defined by a common structural (demographic) characteristic: women, adolescents, the elderly, American Indians, Asian Americans and Pacific Islanders, blacks and Hispanics.
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From page 357... ...
Research relating prognostic factors to treatment efficacy in females is equally nondefinitive. Debate continues regarding both how much of what we know about treatment outcome for males with alcohol problems can be applied to women and the extent to which special programs and treatment modalities for females are needed (Blume, 1987; Roman, 1988; Vannicelli, 1988~.
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From page 358... ...
The perpetuation' of this myth ir' the face of available outcome monitoring data, combined with the minimal available data regarding the superiority of any particular treatment for women, demonstrates a critical need for more and better treatment outcome research Such research should clear' specie the treatment process and derne the differential ingredients applicable to men arid Comer'. The results of treatment outcome studies should be analyzed and reported for both males and females.
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From page 359... ...
The Johnston team's Monitoring the Future Project has made an important contribution with its finding that although slightly more than 90 percent of high school seniors reported having had an alcoholic beverage, only approximately 5 percent reported drinking on a daily basis, with a male-to-female ratio of almost 2 to 1 (Johnston et al., 1987~. In addition, the natural history of alcohol abuse through adolescence into young adulthood has been more clearly elucidated by Kandel and her colleagues (Kandel and Logan, 1984; Yamaguchi and Kandel, 1984~.
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From page 360... ...
Thus, definitional issues must be clarified before systematic treatment design and implementation can take place. In addition to questions about what constitutes a youthful problem drinker, there is no agreed-upon standard as to which age groups make up the youth special population.
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From page 361... ...
The premise is that the adolescent peer counselor will be better able to reach the youth new to treatment because of their shared personal and cultural experiences. The use of peer counselors in adolescent programs embodies the same principles as the use of recovered alcoholic counselors in AA-oriented adult programs and of counsels who share a common cultural background in other special population programs.
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From page 362... ...
Yet despite the diversity of approaches, there has been little attempt at treatment matching for adolescents' and no controlled studies of treatment outcomes have ever been undertaken for this special population. The CATOR data base currently provides the most extensive outcome monitoring longitudinal data on juveniles who have been in treatment, conducting 6- and 12-month follow-ups on 493 youths (Harrison and Hoffmann, 1987~.
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From page 363... ...
It is critical to include measures of school and job performance, as well as measures of interpersonal and social adjustment that are tailored to the adolescent's living situation. Such a multidimensional assessment model has rarely, if ever, been applied to assessing adolescent alcohol treatment programs and those who complete treatment.
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From page 364... ...
It has been assumed by some clinicians that all elderly persons with alcohol problems can benefit more from psychological and sociocultural approaches than to physiological approaches (e.g., Zimberg, 1978, 1983~; this assumption remains untested. As with the other special population groups being discussed in this section, reports of empirical studies that compare treatment tailored to the special needs of the elderly with standard, "generics treatment for alcohol problems are lacking.
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From page 365... ...
There is a strong correlation between American Indian alcohol problems and economic factors; in addition, alcohol abuse has been cited consistently as a major disruptive factor in the family life of American Indians (Lex, 1985~. American Indians and Alaska Natives constitute less than 1 percent of the total population in the United States (USDHHS, 1987~.
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From page 366... ...
In 1971 NIAAA adopted the reduction of alcoholism among Indians as a priority goal (USDHEW, 1971~. A consistent problem in planning alcohol treatment for this special population has been the differing cultural orientations of American Indians and mainstream society, upon whose values prevention and treatment programs are generally based.
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From page 367... ...
Even though program developers have made an effort to update guidelines and standards to increase treatment effectiveness, there have been few studies that systematically evaluated alcoholism treatment outcome for American Indians (Shore and Kofoed, 1984~. Until recently, treatment outcome studies have been limited to those with the Chippewa (Westermeyer, 1972)
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From page 368... ...
Such questions include specifying programs that produce successful treatment outcome; identifying individual or blends of treatment modalities that work best for particular subtypes of American Indian patients; and determining the importance of the interplay of sociocultural factors with successful treatment outcome. A wide range of programs has been funded.
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From page 369... ...
The importance of these factors to the development and treatment of alcohol problems among Asian Americans and Pacific Islanders may also have ramifications for American Indians and Alaska native peoples because of their genetic similarities with Asians. A comprehensive research plan for investigating these questions is very much needed.
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From page 370... ...
Blacks treated in each of the NIAAA funded special population grant programs were more like the nonblacks seen in that grant program than like blacks seen in other program categories: when compared with blacks being treated in NIAAA funded drinking driver, poverty, or comprehensive treatment programs, blacks being treated in public inebriate programs reported the lowest income and the highest number of years of heavy drinking and average drinking per day just as their nonblack counterparts did; blacks being treated in drinking driver programs had the highest average household income and the lowest average amount of alcohol consumed per day. With the advent of the alcohol, drug abuse, and mental health services block grant, NIAAA funded treatment programs for blacks and other special populations were shifted to state support, and the ability to make such comparisons of person characteristics was lost.
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From page 371... ...
First, program designers and clinicians must be wary of defining a given person only in terms of his or her gender, age, or racial or ethnic group membership; members of these special populations vary on other important dimensions that have implications for treatment outcome: socioeconomic status, education level, employment status, income level, presence of physical and psychiatric comorbidities, and degree of acculturation and assimilation to the majority culture.
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From page 372... ...
Tribal affiliation is a similar variable for American Indians; there are more than 280 different recognized tribes that have developed unique cultures and individualized norms around drinking and help-seeking behavior. Second, a major factor involved in the perception of underutilization of alcohol problems treatment facilities by racial and ethnic minorities is the lack of means to pay for treatment.
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From page 373... ...
There is an inexcusable lack of systematic research on the application of specific treatment approaches to each of the special populations defined by structural characteristics. There have been few studies of the advantages and disadvantages of providing separate programs and of the difficulties to be encountered in their administration (Maypole and Anderson, 1987~.
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From page 374... ...
1988. Statement presented on behalf of the National Council of Juvenile and Family Court Judges at the open meeting of the IOM Committee for the Study of Treatment and Rehabilitation Services for Alcoholism and Alcohol Abuse, Washington, D.C., January 25.
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From page 375... ...
1986. Alcohol treatment in American Indian populations: An indigenous treatment modality compared with traditional approaches.
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From page 376... ...
1982. Drinking among American Indians.
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From page 377... ...
1985. Alcohol and drug abuse prevention programs for American Indians: Needs and opportunities.
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From page 378... ...
The Indian Health Service approach to alcoholism among American Indians and Alaskan Natives. Public Health Reports.
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From page 379... ...
1982. American Indians, urbanization, and alcohol: A developing urban Indian drinking ethos.
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From page 380... ...
1981. A review of some methods for investigating substance abuse epidemiology among American Indians and Alaskan Natives.
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