Prevention and Treatment of Alcohol Problems Research Opportunities (1990) / Chapter Skim
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Pages 1-22
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From page 1... ...
Part II also presents an overview of recent studies on the treatment of various medical sequelae of alcohol abuse, concluding with a discussion of research on cost considerations and related issues that are important to the formulation of public policy for the provision of alcohol treatment services. The committee identifies research opportunities in each area explored.
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Prevention research thus includes social, legal, and community-wide interventions that might alter the behavior not only of individuals but of entire societies. Treatment research is concerned with individuals who are at a point on the continuum at which they can be identified as having an actual alcohol problem.
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There is also a widespread belief that child abuse and neglect are associated with alcohol abuse; however, this association is unproven and should be investigated further. Similarly, studies are warranted on the influence of alcohol on sexually transmitted diseases and sexual activity, including early sexual activity and adolescent pregnancy.
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Social Learning Models The social learning perspective on prevention research is the second approach selected by the committee for detailed review. Social learning approaches rest on the processes by which individuals acquire and maintain behavior.
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Research suggestions for testing the social learning model include the following steps, which are geared toward answering a number of specific questions that it raises: · describe the reciprocal interactions among behavioral, cognitive, and environmental processes; · design experiments that explore the role of beliefs and expectations in the acquisition of problem drinking practices, as well as the relevance of self-efficacy in prevention; and ~ explore the motivational factors underlying the stages of readiness to change. Genetic Determinants of Risk Major research efforts are continuing on projects to identify the genetic factors that may predispose an individual to alcohol abuse or dependence.
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Research opportunities to investigate aspects of environmental controls on the availability of alcoholic beverages include identifying the effect of retail price on heavy, high-risk drinking; investigating the role of location, density, and hours of sale of alcohol outlets; and determining the effect or effects of pricing strategies. The standards of a community, both explicit and implicit, play a large role in shaping behavior and determining alcohol availability and consumption.
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Although the studies were conducted to alter unhealthful behaviors other than alcohol abuse, the lessons learned from these efforts and the strategies used may be applicable to the prevention of alcohol-related problems. Do studies have attempted to alter community risk factor profiles for cardiovascular disease (CVD)
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In addition, the methodological issues noted below must be addressed. Methodological Issues in Alcohol Prevention Research: Conclusions and Recommendations There is no single research design or analytical strategy that has characterized prevention research on alcohol problems.
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. alvlues Its discussion of treatment research opportunities into a number of areas: issues of assessment, methodology, and research design; treatment modalities; early identification and treatment; patient-treatment matching; advances in the treatment of other psychoactive substance-use disorders; the health consequences of alcohol abuse; and the public policy considerations that attend treatment costs, benefits, and cost offsets.
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Other demographic trends that may influence the demand for treatment services include changes in the nuclear family, increases in the number of homeless persons, aging of the population, and deinstitutionalization of psychiatric patients. The methods that are currently available for assessing a community's need for alcohol treatment services have improved but still require refinement.
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; consequently, there is a strong need to use newly developed techniques that specify treatment quality, process, and outcome in order to identify the active ingredients of treatment interventions. In recent years, increasingly sophisticated methodological approaches have been developed for use in alcohol treatment evaluation.
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Typically, alcohol treatment programs in the U.S. offer a combination of modalities that include detoxification and health care, AA groups, lectures and films, group therapy, individual counseling, recreational and occupational therapy, medication, and aftercare group meetings.
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; (3) severity of alcohol use/severity of alcohol dependence syndrome (greater severity means worse treatment response)
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Matching to a particular posttreatment environment for aftercare should also be investigated. Advances in the Treatment of Other Psychoactive Substance-Use Disorders: Implications for Alcohol Treatment Research There are many parallels between alcoholism and other addictive disorders, although treatment for alcohol problems has often developed in isolation.
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Controlled treatment trials of detoxification or research on ways of limiting or reversing cognitive impairment could be carried out at either single or multiple sites. Treatment Costs, Benefits, and Cost Offsets: Public Policy Considerations The final topics in the committee's review of research opportunities related to alcohol treatment are cost and public policy considerations.
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The roles of public and private financing for alcohol treatment are an important policy question. Increased private expenditures for treatment may result in public cost offsets (e.g., decreased criminal justice costs, fewer motor vehicle accidents)
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The committee recommends that NIAAA continue to promote collaborative prevention strategies and new prevention research initiatives. Supporting the Scientific Infrastructure for Treatment Research Although federal alcohol research funds in general have increased over the past decade, it was not until 1988 (when NIAAA created its new Division of Clinical and Prevention Research)
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However, the VA recently announced plans to curtail the availability of alcohol treatment, a policy that will have a devastating impact on treatment research in the alcohol field. Given the high percentage of veterans with alcohol-related pathology who are hospitalized in medical/surgical units in VA hospitals, the committee urges the VA to reverse these actions and renew its commitment to both alcohol treatment and treatment research.
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In its discussions, the committee used this owrd to mean both Environment in a specific sense -- the drinking setting and the cultural and economic milieu surrounding the use of alcohol -- as well as in the broader sense of the total developmental setting of a child. The committee has clarified whenever necessary its particular uses of this term.
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REFERENCES Institute of Medicine. Causes and Consequences of Alcohol Problems: An Agenda for Research.
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