Posted: March 18th, 2023

Enhancing Abstinence and Preventing Relapse

Enhancing Abstinence and Preventing Relapse in Alcoholism

Research paper Alcoholism Research question: Alcoholism affects approximately 10% Americans time lives. Treatment consists psychosocial intervention, pharmacological intervention,, looming question treatment remains: Which drugs effective enhancing abstinence preventing relapse?.

The purpose of this paper is proposing a study for examining the most effective drug in preventing relapse and enhancing abstinence from alcohol. The negative and positive results of the different drugs would be examined based on the data gathered from the participants. One hundred and seventy eight participants suffering from alcoholism will be examined in the study. The participants will undergo a mandatory detoxification period before they can enroll in the study. The participants are drawn from patients admitted in public hospitals suffering from alcoholism. The study is conducted under voluntary basis, and the results are anonymous. No identifiable patient information is gathered during the study. Patient consent is sought before they can enroll in the study.

Literature review

Alcoholism is a progressive chronic disorder that the American Psychiatric Association and American Medical Association identified as a disease. Alcoholism is a common disorder that poses a heavy burden on families, patients, and society Regier et al., 1990.

Estimates indicate that alcoholism affects approximately 10% of Americans. According to statistics, the number of men affected is higher than for women. When compared to other diseases, the prevalence of alcoholism is high, which highlights alcohol dependence significance in the public health Grant, 1997.

Alcoholism costs the United States approximately $166 billion annually Harwood, Fountain, & Livermore, 1998.

This is in addition to the number of people who die because of alcohol related causes. The number of deaths associated with alcohol is 100,000 annually. Individuals become alcoholics out of continuous social drinking. Within a short period, one finds they have become addicted to alcohol. These people will eventually neglect their responsibilities and families. Alcoholism affects the economy adversely. The abuse of alcohol leads costs the nation approximately $99 billion annually Gordis, 1976()

There are various stages involved in the treatment of alcoholism. Detoxification and acute withdrawal occurs in the initial stages. The later stages attempt at maintaining the patients from relapsing and developing a lifestyle that is compatible with long-term abstinence. Traditionally the later aspect involved the use of psychosocial interventions. Some of the psychosocial interventions are Alcoholics Anonymous and other counseling approaches. Undergoing counseling does help an individual to reform their drinking behavior, but a majority of them end up relapsing within a short period. Alcoholics Anonymous provide support groups that individuals attend regularly, and this ensures that an individual does not relapse. Critics have pointed out that use of counseling and support groups alone does not offer an individual the necessary tools to ensure they do not relapse. The groups are not effective at preventing relapse and enhancing abstinence, which necessitates the use of other interventions together with psychological interventions.

An emerging trend is the use of pharmacological treatment in preventing and enhancing abstinence, which would complement psychosocial interventions Garbutt, West, Carey, Lohr, & Crews, 1999.

The drugs used to compliment psychosocial interventions are disulfiram, naltrexone, nalmefence, and acamprosate Volpicelli et al., 1997.

These drugs would complement the psychosocial interventions and reduce the possibility of an individual relapsing Marlatt & Donovan, 2005.

There is a perplexing challenge posed to modern society when treating alcoholism. Several research studies have indicated the efficacy of drugs in preventing and reducing relapse. The true efficacy is somehow unclear as different studies only focus on short periods. In order to establish the true efficacy, researchers need to monitor the patients for a period of not less than a year. This will provide vital information to determine the efficacy of the various drugs. Armor, Polich, and Braiker (1978)

established in their study that there was improvement in 67% of the patients admitted in publicly funded alcoholism centers. According to Gordis (1976)

, there has been no progress in relapse prevention for the last 25 years. These are contradictory studies, which lead to the need for further research and continuous monitoring of the individuals after the study period. The purpose of this research is establishing the drugs that are most effective in preventing relapse and enhancing abstinence.

There have been various studies conducted to determine the effectiveness of drugs in preventing relapse and enhancing abstinence. The studies have been limited to short periods of two to three months, which led the researchers to believe that some of the drugs are effective in preventing relapse. The studies demonstrated the effectiveness of the various drugs in the market. Upon further inquiry, around 95% of the individuals who had undergone pharmacological treatment during the studies had relapsed within two years. This demonstrates that there is need for long-term follow up in order to establish the true efficacy of pharmacological and psychosocial interventions. The failure to monitor and follow-up on the individuals will lead to success stories that have no long-term effects.

The study conducted by Garbutt et al. (1999)

evaluated five drug categories used for treating alcohol dependence. The clinical trial indicated that acamposate and naltrexone were found to be more effective that other drugs. The researchers analyzed 375 articles related to pharmacological treatment of alcoholism. The researchers used Forty-one studies for data abstraction and analysis. The researchers established that there was a mixed outcome from studies involving the use of disulfiram. The study conducted by Fuller et al. (1986)

revealed that disulfiram usage is widespread, but the clinical trials do not support its effectiveness. The researchers did not conduct any research. They instead focused on evaluating the various articles written by other researchers. Analyzing the different articles and researches conducted allowed the researchers to synthesis and extract information regarding the effectiveness of the five drug categories. The assessment of article quality involved a quality rating that covered study design, outcome measures, diagnostics, discussion, and statistical analysis. Each article had a maximum of 40 points, which the researchers rescaled to 100 points.

Another research conducted by Kiefer et al. (2003)

provided evidence that pharmacological treatment is effective in preventing relapse to alcoholism. The researchers focused on two drugs namely naltrexone and acamprostate in their study. The study used 160 patients who had undergone detoxification. The study was carried over a twelve weeks period, and the patients were in groups of 40 patients. The patients received medication in a double blind, randomized design, which ensured that the study was completely random. In the study, there were placebo drugs similar to the two main drugs administered to some group members. The participants were monitored on a weekly basis using interviews, questionnaires, self-reports, and laboratory screening. The primary outcome measures were time to relapse, time to first drink, and cumulative abstinence time. There was psychotherapy sessions conducted on a weekly basis. The sessions were abstinence oriented, and included relapse prevention and coping skills. The group sessions lasted 90 minutes and each group had between 8 and 14 participants. The patients learnt how to identify and handle different situations that could lead to alcohol relapse. In case a patient relapsed, the case was addressed nonjudgmentally, and patient encouraged to resume abstinence.

The study by Vaillant (1988)

, did follow-ups on patients for a period of 12 years. The focus of the study was identifying the factors related to relapse. Having a stable employment history had proved to be more effective in predicting the long-term outcome of relapse. The study sample comprised of 100 individuals with 83 male and 17 female alcoholics. The alcoholics were all patients admitted to Cambridge Hospital in 1971. They all had a mean age of 45 years. The patients stayed in hospital for a maximum of 10 days. All the patients attended Alcoholics Anonymous sessions twice weekly. The study followed up the alcoholics for 10 years at intervals of 18 months. Hospital records and relatives provided information regarding the relapsed patients. Personal interviews provided information regarding the abstinent alcoholics. In a period of over 8 years, the study established that the average alcoholic underwent detoxification 15 times, and they made almost the same number of clinical and emergency visits. Twenty-five percent of the patients remained abstinent for over 12 years. Thirty seven percent died before the age of 65, and 38% were abstinent at the time of death. This study demonstrated that the success rates of short periods need further follow-up to identify the true efficacy of the treatments. Alcoholics Anonymous claim their 12-step approach is effective, but there is no follow-up of the patients once they leave the facility. This presents biased and unreliable information.

Implications

Many studies have focused on usage of medications for enhancing abstinence, but they have not provided long-term follow-up. This has resulted in relapse of many alcoholics. The studies have not given specific attention towards identifying how effective the drugs are in the end. In the study by Vaillant, 1988()

, the researcher demonstrated that a majority of the patients relapsed even after medication. Therefore, the treatment should focus on long-term enhancing and prevention of relapse. The use of questionnaires for self-assessment will assist in determining how the patients rate themselves. Combining the questionnaires with other methods of gathering information ensures that the patient provides accurate information. Screening the patient using laboratory tests, and pill count determines if the patient is following the treatment. In case a patient has taken alcohol, the laboratory tests will reveal this information. Alcoholics negatively affect their community and finding methodologies that assist in preventing relapse and enhances abstinence is vital for the community. Establishing the effectiveness of the drugs assists the drug manufacturers to concentrate on development of drugs that assist in eliminating alcoholism. The drug manufacturers benefit from the studies as they receive information regarding their drug usage and its effects.

Research questions

Which drugs are most effective in reducing and eliminating relapse? Does the combination of the various drugs have better efficacy? Should alcoholics be treated using drugs only? Why does relapse occur? What are the effects of long-term follow-up on alcoholics?

Understanding the possibilities of reducing alcohol relapse and enhancing abstinence will assist in finding lasting outcomes for alcoholism. The effects of alcoholism have far-reaching consequences to the community. Alcoholism been recognized as a disease, there is need to identify long lasting treatment and prevention methodologies. Enhancing abstinence will improve the society, as there will be minimal vices associated with alcoholism.

Hypothesis

The study on effective drugs is noteworthy as alcoholism is a chronic disease, which affects all members of society. The extent of alcoholism is not limited to a specific group, but any member of the society is vulnerable. The hypothesis of this study proposes that using pharmacological and psychosocial interventions together will provide the necessary means for preventing relapse and enhancing abstinence. The different drugs found in the market have different capabilities and establishing the most effective provides clinicians with information for proper dosages.

Method

The alcoholics related to this study are patients admitted to various public hospitals and willing to participate in the study. The study involves patients aged between 20 to 55 years. The study has 178 patients both male and female. There are four groups, and each group will receive the different drugs associated with alcoholism. There is no placebo drug in the study. Different members of the groups will receive the five drugs associated with preventing relapse and enhancing abstinence. The study will employ self-assessment questionnaires, laboratory testing, and pill counting for the collection of data. Each method has its own advantages, and it complements the other methods. Laboratory testing ensures that the patients do not lie in their self-assessment questionnaire. Using the tests, the researchers are able to confirm the information provided by the patient. Pill counting establishes if the patient is taking the pills as prescribed. This ensures that the patient adheres to the medication regime. There are counseling sessions that provide the patient with coping strategies. The sessions encourage the patients to identify their alcohol inducers and establish methodologies for overcoming the inducers. Patient monitoring occurs on a weekly basis for the duration of the study. The analysis of the participants coping skills, medication taking, environmental effects, and negative situations occurs.

In case a participant relapses more than 3 times, they will not continue participating in the study, but they can continue receiving treatment. The participants are encouraged to continue their lifestyles during the study period. This ensures that the study remains unbiased. There are no confined participants for the study, which provides vital information on how the participants adapt to society and negative influencers. The participants include employed individuals, housewives, students, married, and unmarried. This ensured the study included the various individuals within the society. Excluded from the study were participants with mental disabilities and participants undertaking psychotropic medications.

Procedure and Design

All the participants are given a consent form and counseled. The study is confidential, and no personally identifiable information is collected. Participation in the study is strictly on volunteer basis. The participants attend counseling sessions with other non-participants in order to guarantee the effectiveness of information gathered. The participants can withdraw from the study willingly or due to medical complications. The study analysis is not inclusive of data from the participants withdrawn from the study. Incomplete data would lead to inaccurate conclusions. However, the withdrawn participants are noted, and reasons for their withdrawal included in the final report. The initial counseling session provides baseline information regarding the participants. The participants must undergo a detoxification program before the study begins. The detoxification program takes place in order to establish the coping skills of each participant. The detoxification program is mandatory for inclusion in the study.

The participants are encouraged to provide accurate responses in the self-assessments and during the interviews. Accurate information benefits the study and eliminates data collection errors. Failure to design properly the data collection would result in reporting errors or inconclusive information. This renders the study a failure and a waste of funds. Emphasis is placed on the participants to continue with their normal life in order to gather their coping skills and influencers. Participants are encouraged to approach the counselors with any problem they might face during the course of the study. Counseling is not a critical focus of the study, and it is only been used for accurate data gathering. Counseling is provided to the participants during the study period, but the results of counseling are not included in the final report. The counselor is only requested to confirm that the information provided in the self-assessment report is accurate. In case counseling has any effects when combined with the drugs, the effects will not be analyzed during this study.

The interviews provide supporting information in regards to the participant’s assessment. The participant is encouraged to provide accurate information, but the researchers need to ensure the information provided is accurate. The interviews allow for the confirmation of the answers provided by the participant. Laboratory testing might be biased as some of the participants could fail to attend the testing. Encouraging the participants to attend the testing as this would ensure the data gathered leads to accurate results.

Instruments

The self-assessment questionnaire consists of 20 questions. The questions include the effects of the drugs, if any alcohol has been consumed, reasons for not relapsing, the patients coping skills, any alcohol inducers the patient faces, and their mental capability. The participants are asked to identify any side effects from the drugs. The self-assessment provides the participant with an opportunity to truly assess themselves, which contributes to the overall treatment process. Self-assessment encourages the participant to remain truthful to his/her assessments, which would positively influence the study.

The interviews and counseling sessions will extract more information regarding the participant. The interviews provide the researcher with an avenue to question the participant and gauge their mental state. Counseling is critical as it is used in conjunction with the drugs. Counselors can pick information from the participant’s body language and encourage them to remain sober. The laboratory tests assist in ensuring that the participants remain alcohol free. Testing the patient’s blood and urine for alcohol levels provides information regarding the participant’s alcohol levels. Participants could lie about their alcohol consumption, but the tests will reveal the truth. Pill counting confirms the participant is taking the medication as prescribed. Dosage skipping can adversely affect the results of the study.

Monitoring of the participants for a period of a year after the study is completed is vital to gauge the long-term effects of the medications. Follow-up is voluntary only, and participants are encouraged to provide information willingly. The follow-up will be conducted on a monthly basis and involve interviews only. Laboratory testing might not be possible due to the costs involved. The research funding will not include continuous laboratory testing, but if the funds are available laboratory testing would be beneficial. Counseling sessions would be availed to participants during the follow-up period. The sessions would be upon request by the participant.

Limitations

Self-reporting can be faulty as participants might provide false or inaccurate information Polich, 1982.

Failure to understand the questions is a limitation of the study, which would be countered by using interviews and counseling sessions. Some participants might relapse or opt not to continue participating in the study. Laboratory tests might not correctly disclose the alcohol levels in the blood. Undergoing testing on a weekly basis might fail to identify if the participant has consumed alcohol lately. Participants who relapse might fail to disclose this information to the researchers out of fear. Using relatives in the study for information collection would assist in determining if the participant has relapsed. Some participants might stop taking the medications and hide the pills during the pill count. This would result in inaccurate data as the participants are not taking their pills. Interviewing the participants is time consuming and the interviewers might not recognize if the participant is lying. The study should include relatives in order for them to provide monitoring of the participants.

Medical complications might occur for some participants due to complications with the drugs. Initial testing might not reveal the complications and the researchers would not recognize the complications until it is too late. Withdrawal symptoms might lead to relapse if the participants are not properly counseled. Counseling and support groups could have negative effects on the participants. The participants might assume they are better off without the medications and result to using counseling only. This will adversely affect the study as its focus is on the effectiveness of the various drugs.

The study is anonymous, and this might lead to difficulties of determining if the participants have lied on their self-assessment questionnaires. Linking the questionnaires to the interviews and laboratory results could be difficult due to anonymity. The interviews should be conducted based on the self-assessment questionnaire. The participants should be encouraged to return the questionnaire during their interview and laboratory testing. This will allow the researchers to associate the data gathered for each participant.

Expectations

In order for the study to be successful, the researchers need to identify the most effective drug for preventing relapse and enhancing abstinence. The drug with the highest number of relapse prevention would be assumed the most effective. Having information regarding the most effective drug will allow health practitioners to prescribe the drug over the other drugs. Drug manufacturers could use the drug as a basis for developing drugs that could be used by other alcoholics suffering from other diseases. It is expected that the study might not provide a conclusive hypothesis as the study does not include a long-term follow-up proposal. Monitoring participants for a period of one year is not enough to determine conclusively the efficacy of the drugs. There is need to have a study that includes at least five years of follow-up. The study does not focus more on the counseling, as that is not its focus, which might affect the actual results. Counseling plays a role in preventing relapse and failure to include its effects together with the drugs might result in inaccurate information. The study method should be revised in order to include the effects of counseling together with drugs. Combining the two interventions is vital for the long-term prevention of relapse and enhancement of abstinence.

It is accepted that counseling does play a role in preventing relapse, but failure to include its effects in this study renders any effects it has on the participants null. The researchers identified this failure and recommend that further research to identify the actual effect of counseling in combination with drugs be investigated. In order to maintain focus on the hypothesis of the study, the researchers insist in excluding counseling from their results.

The study results shall be presented, and conclusions made based on the effectiveness of the drugs. In case the study does not support the hypothesis, the researchers will provide guidelines for further research. The researchers will also encourage other researchers to build upon the study for purposes of extending the study to include the areas not covered by the study. The results of the study will be published and made available to the respective organizations and government agencies. The researchers will be available to provide guidelines to other researchers interested in furthering the study.

References

Armor, D.J., Polich, J.M., & Braiker, H.B. (1978). Alcoholism and treatment (Vol. 232). New York: Wiley.

Fuller, R.K., Branchey, L., Brightwell, D.R., Derman, R.M., Emrick, C.D., Iber, F.L., . . . Lowenstam, I. (1986). Disulfiram treatment of alcoholism. JAMA: the journal of the American Medical Association, 256(11), 1449-1455.

Garbutt, J.C., West, S.L., Carey, T.S., Lohr, K.N., & Crews, F.T. (1999). Pharmacological treatment of alcohol dependence. JAMA: the journal of the American Medical Association, 281(14), 1318-1325.

Gordis, E. (1976). What is Alcoholism Research? Annals of Internal Medicine, 85(6), 821-823.

Grant, B.F. (1997). Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: results of the National Longitudinal Alcohol Epidemiologic Survey. Journal of Studies on Alcohol and Drugs, 58(5), 464.

Harwood, H.J., Fountain, D., & Livermore, G. (1998). The economic costs of alcohol and drug abuse in the United States, 1992: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, Office of Science Policy and Communications.

Kiefer, F., Jahn, H., Tarnaske, T., Helwig, H., Briken, P., Holzbach, R., . . . Naber, D. (2003). Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism: a double-blind, placebo-controlled study. Archives of General Psychiatry, 60(1), 92.

Marlatt, G.A., & Donovan, D.D.M. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York, NY: Guilford Press.

Polich, J.M. (1982). The validity of self-reports in alcoholism research. Addictive Behaviors, 7(2), 123-132.

Regier, D.A., Farmer, M.E., Rae, D.S., Locke, B.Z., Keith, S.J., Judd, L.L., & Goodwin, F.K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse. JAMA: the journal of the American Medical Association, 264(19), 2511-2518.

Vaillant, G.E. (1988). What Can Long-term Follow-up Teach us About Relapse and Prevention of Relapse in Addiction? British Journal of Addiction, 83(10), 1147-1157.

Volpicelli, J.R., Rhines, K.C., Rhines, J.S., Volpicelli, L.A., Alterman, A.I., & O’Brien, C.P. (1997). Naltrexone and alcohol dependence: role of subject compliance. Archives of General Psychiatry, 54(8), 737.

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