Alcohol

Issues Available Online

VOAS, R.B., JOHNSON, M. AND LANGE, J.    Permission to Cross the Border: Effective Policy Reduces High-Risk Drinking by Marines

Objective: At a Marine Corps base near the Mexican border, off-base alcohol- related incidents increased when serving alcohol to personnel under age 21 on the base was no longer permitted. The bars across the Mexican border, where the legal drinking age is 18, are an important source of alcohol for the Marine enlisted men. To reduce cross-border drinking, the base command instituted a "chit" system requiring enlisted men to receive written permission to cross the border. This study evaluates the effectiveness of that policy. Method: Breath test surveys of American youths returning from Tijuana to San Diego County provided counts and blood alcohol concentration (BAC) of marines returning from a night of drinking in Mexico before and after the "chit" policy. Comparison counts and breath tests for Navy personnel from a San Diego base not affected by the "chit" policy were available for the same time periods. Results: The number of underage marines returning from Mexican bars was reduced by 78%, and of those the number with illegal (=.08%) BACs was reduced by 84%. There was no significant change for the comparison group of sailors. Conclusions: It appears that the "chit" policy was highly effective at least for the 6-month post-period covered by this study. This apparent success influenced the implementation of the "chit" policy on all naval facilities in the San Diego area. (J. Stud. Alcohol 63: 645-648, 2002)

CUNNINGHAM, J.A., KOSKI-JŽNNES, A., WILD, T.C. AND CORDINGLEY, J.    Treating Alcohol Problems with Self-Help Materials: A Population Study

Objective: An experimental trial was used to assess the effectiveness of a self-help book and a personalized assessment-feedback intervention, both separately and in combination with each other, in a general population survey. Method: Participants (N = 86; 66.3% male) were recruited through a random digit dialing telephone survey conducted by the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Respondents were randomly assigned to one of four conditions in a two-by-two factorial design: "no-intervention" control group, "personalized feedback only," "self-help book only" and "both personalized feedback and self-help book." Respondents were followed up in 6 months' time, and differences in drinking status were compared between experimental conditions using a multivariate analysis of covariance with baseline drinking severity as the covariate. Results: Support was provided for an interaction hypothesis in which respondents who received both interventions reported significantly improved drinking outcomes at 6-month follow-up, compared with respondents who received just one of the interventions or who received no intervention. Conclusions: Because respondents were recruited from a representative sample of the general population into a randomized trial with a no-intervention control group, this research design maximized both external and internal validity in examining the effectiveness of self-help interventions. (J. Stud. Alcohol 63: 649-654, 2002)

WELLS-PARKER, E. AND WILLIAMS, M.    Enhancing the Effectiveness of Traditional Interventions with Drinking Drivers by Adding Brief Individual Intervention Components

Objective: The purpose of the research was to determine whether the effectiveness of a traditional DUI (Driving Under the Influence) group intervention program could be enhanced by the addition of two brief individual intervention sessions and a follow-up. The differential effectiveness of the individual intervention component was examined for four offender subgroups (young minorities, problem drinkers, women and depressed offenders) that had been previously identified as at high risk or vulnerable. Method: Adjudicated first DUI offenders (N = 4,074), of whom 776 (19%) were female, were randomly assigned to a standard first-offender program or an enhanced standard program that included two short individual sessions and a brief follow-up session. The setting was a mandated first-offender program in 10 Mississippi locations. Results: Depressed offenders who were assigned to the enhanced program were 35% less likely to recidivate than those assigned to the standard program. The effectiveness of the two programs did not differ significantly for offenders who self-reported low depression. No significant interaction effects were found between program type and age, minority status or gender. After depressed mood was controlled for, problem-drinker status was not related to program effectiveness; however, problem drinkers had higher depression rates. Conclusions: Results suggest that the combination of a standard first-offender program with brief individual counseling can be effective for DUI offenders who report depressed mood and who are at high risk for recidivism. A five-item screen for sad/depressed mood from a widely used DUI risk assessment instrument identified offenders who benefited from the enhanced intervention. (J. Stud. Alcohol 63: 655-664, 2002)

MORGENSTERN, J., BUX, D., LABOUVIE, E., BLANCHARD, K.A. AND MORGAN, T.J.    Examining Mechanisms of Action in 12-Step Treatment: The Role of 12-Step Cognitions

Objective: Twelve-step treatment appears to be modestly effective in treating alcohol and cocaine dependence, but little is known about its mechanisms of action. The primary aim of this study was to examine the hypothesized mechanism of action of 12-step cognitions. In addition, the psychometric properties of a measure used to assess 12-step cognitions were tested. Method: The psychometric properties of a measure to assess 12-step cognitions were examined in a sample of individuals (N = 370, 61% male) seeking inpatient (n = 118) or outpatient (n = 252) 12-step-oriented community treatment. Additional analyses of data from the inpatient sample examined changes in cognitions from entry to discharge and 12-month follow-up. The univariate and multivariate relationship of cognitions at discharge, and substance use outcomes across the 12-month follow-up were also examined in the inpatient sample. Results: The measure of 12-step cognitions demonstrated good internal consistency. Findings supported some, but not all, of the hypothesized active ingredients of 12-step treatment. Cognitive processes common to many treatment-approaches significantly mediated outcomes, whereas processes unique to the 12-step approach (e.g., spirituality) did not. Overall, some 12-step cognitions at discharge were good predictors of outcome, explaining as much variance in outcome as illness severity factors (e.g., dependence severity). Conclusions: Results provided greater support for 12-step treatment theory than those reported in prior studies. At the same time, findings suggest that diverse treatment approaches may operate through a common set of active ingredients. (J. Stud. Alcohol 63: 665-672, 2002)

WEISNER, C., MATZGER, H., TAM, T. AND SCHMIDT, L.    Who Goes to Alcohol and Drug Treatment? Understanding Utilization within the Context of Insurance

Objective: This study assesses the differential roles of demographic characteristics, problem severity, motivational factors and insurance in entrance into alcohol and drug treatment. Method: A probability sample of adult problem and dependent drinkers from a Northern California county (N = 672) and consecutive adult intakes from the county's public (n = 298) and private (n = 628) alcohol and drug treatment programs. Interviewers conducted telephone screening for individuals meeting problem-drinking criteria in the general population; in-person interviews were conducted for those who screened positive, and also for individuals entering treatment. Results: Insurance did not play an independent role in treatment entry. In logistic regression analysis, using a model from the medical utilization literature, black ethnicity (odds ratio [OR] = 2.98, p < .001); older age (OR = 4.67, p < .001); less education (OR = 1.81, p < .01); legal (OR = 7.46, p < .001) and work (OR = 3.57, p < .001) pressures; higher psychiatric (OR = 4.03, p < .001) and drug (OR = 3.04, p < .001) severity; and social consequences (OR = 1.35, p < .01) predicted treatment entry. Interventions from legal sources (OR = 6.22, p < .01) were related to entering treatment for the uninsured; legal (OR = 7.02, p < .001), workplace (OR = 6.01, p < .001) and family (OR = 1.62, p < .05) pressures were related for the insured. Conclusions: Social consequences, rather than severity of dependence, in both insured and uninsured problem drinkers are important predictors of treatment entry when traditional utilization measures are controlled. Public programs play a crucial part in the alcohol and drug treatment system, and their viability is important as health policy changes. (J. Stud. Alcohol 63: 673-682, 2002)