Drug and Alcohol Abuse Programs: Efficacy and Utility in Question

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Drugs and Alcohol are two substances that have plagued people and communities for many years. Drugs and alcohol are very addictive and it can be very difficult to stop using both once someone has formed a habit. Substance abuse addiction can cause chaos in the lives of those with an issue. It ultimately affects and has the possibility to destroy their health, career and personal relationships. Death is also sometimes a grim consequence of drug and alcohol abuse. All of which can possibly be avoided before things escalate to that point if treatment is sought out.

Alcohol alone can have effects on the body and its organs that can be very detrimental to health. According to the National Institute on Drug Abuse (2012) alcohol affects every organ in the drinker’s body, can damage a developing fetus and in addition can impair brain function and motor skills; heavy use can increase risk of certain cancers, stroke, and liver disease. Drug abuse and addiction can have similar effects as well with many drug overdoses happening at alarming rates. The CDC (2013), states that deaths from overdose have been rising steadily over the past two decades and have become the leading cause of death and injury in the United States. In fact in 2010, drug overdose in those ages 25 to 64 was the leading cause of injury death, causing more deaths than motor vehicle traffic crashes (CDC, 2013).

The study I chose is the California Drug and Alcohol Treatment Assessment (CALDATA) 1991-1993. I retrieved the information from the Substance Abuse and Mental Health Data Archive (SAMHDA). I chose this study for a personal reason as I have had relatives who did not seek treatment for their drug and alcohol addictions and ultimately succumbed to the constant abuse. According to the California Department of Alcohol and Drug Programs (1991-1993), this study was designed to study the costs, benefits, and effectiveness of the state's alcohol and drug treatment infrastructure (recovery services) and specifically to assess (1) the effects of treatment on participant behavior, (2) the costs of treatment, and (3) the economic value of treatment to society. They also wanted to increase the availability of data as it relates to alcohol and drug treatment and recovery services in the state of California.

The significance of the California Drug and Alcohol treatment Assessment was to determine changes in subjects after treatment as well as the costs and benefits. CALDATA (1991-1993) states that researchers paired t-tests to test the significance of before-after changes and ANOVA F-tests to test whether before-after changes differ significantly among subclasses. The secondary data set used data that was collected from participants across four different types of treatment programs which included: residential, residential "social model," nonmethadone outpatient, and outpatient methadone (detoxification and maintenance). There were two phases to the in which data was collected. CALDATA (1991-1993) states that In Phase 1, treatment records were abstracted for clients who received treatment or were discharged between October 1, 1991, and September 30, 1992 and in Phase 2, these clients were located and recruited for a follow-up interview.

The record abstract collected information on demographic, drug and alcohol use in addition to information on treatment and services. The follow up questionnaire focused on the times before, during and after treated. According to CALDATA (1991-1993) focuses topics for the follow up included ethnic and educational background, drug and alcohol use, mental and physical health, HIV and AIDS status, drug testing, illegal activities and criminal status, living arrangements and family issues, employment and income, and treatment for drug, alcohol, and mental health problems. While the drugs included alcohol, narcotics, sedatives and methamphetamines. The secondary data set can be accessed from the following link:

Addictions, drug and alcohol abuse affect individuals, the workplace and society in dissimilar ways. Each of these conditions inevitably inspires individual, familial, social and economic costs. Accordingly, workplace policies, public health practices, and court system recommendations or court decisions might influence treatment choices. When these options lie contrary to the needs of the individual or employ methods that are incongruent with the type of substance abuse or underlying contributing factors, treatment can yield mixed results. Given this reality, this literature examines how treatment options and modalities realize positive or negative outcomes for men, women, adolescents and college students.

For the individuals challenged by substance or alcohol abuse, seeking help and making decisions about the best treatment option can be problematic. As Wickizer, Maynard, Atherly, Frederick, Koepsell, Krupski, & Stark revealed in their 1994 study of drug and alcohol abuse rehabilitation programs, completion and efficacy rates varied widely. Notably evaluating the utility of such programs and public funding directed toward such, Wickizer et.al. (1994) analyzed 5827 client records obtained through the Washington State Substance Abuse Monitoring System. Since this population had participated in one of the four state treatment modalities, Wickizer et.al. (1994) posited that outcomes would demonstrate efficacy and active participation rates among the client population.

Through logistic regression of the data, Wickizer et.al. (1994) stated program completion rates for intensive patient alcohol treatment were the highest. The findings showed a 75 percent completion rate. In contrast, the intensive, outpatient drug-abuse programs realized an 18 percent completion rate. Given that four treatment modalities exist for substance and alcohol abuse programs and the goals of each program is behavioral extinction, Wickizer et.al. defined associative characteristics and conducted a subsequent statistical analysis.

Education, age, ethnicity, and the screening methodology type at the referral assessment center were defined as characteristics/variables. Each of these was evaluated in light of the client outcomes and the aforementioned sets of characteristics. The Wickizer et.al. (1994) research team believed the findings would illuminate goodness of fit or lack thereof. In fact, the preliminary findings suggested that numerous factors engendered or delimited program efficacy and full participation. Conducting a subsequent statistical analysis for those with additional drug addictions or secondary substance abuse problems the researchers also reexamined the aforementioned characteristics in light of the screening process at the referral center and the type of program(s) suggested. Not surprisingly, the composite of statistical analysis proved that any mismatch between the individual characteristics and types of drug abuse and the types of screenings conducted at the referral centers either rendered a match or a mismatch

Whereas screenings conducted at referral centers should result in the most optimal solution for the individual challenged by substance or alcohol abuse or a combination thereof, other factors affect the process. For example, Chapman- Walsh et.al. (1991) explicated how employee-assistance programs, company sponsored ones or those supported by labor unions ultimately limited choices available. Even though intensive inpatient programs for alcohol abuse are preferred by these stakeholders, several studies such as the Wickizer et.al. (1994) Washington study called into question the efficacy thereof. Given the viable alternatives available to employees who abuse alcohol including but not limited to outpatient self-help groups or outpatient counseling, inpatient intensive rehabilitation programs have elicited comparative efficacy questions. Since these programs inspire greater costs, this is understandable.

The Chapman-Walsh et.al (1991) investigation followed three participant groups; i.e. those assigned to compulsory inpatient treatment, compulsory Alcoholic Anonymous meetings and those who participated in the treatment option of their choosing. The 227 participants were followed for two years. Each group was evaluated based on the 12-job performance variable and 12 measures of drinking and drug use the Chapman-Walsh et.al. (1991) team developed.

The Chapman-Walsh et.al. (1991) findings showed no differences between these three groups relative to job-related variables and outcomes therein. In fact, all three groups improved. However, the drinking and drug use measures revealed relapses. In this area, the participants assigned to intensive inpatient treatment fared the best. The participants allowed to choose the treatment option realized intermediate levels of efficacy. The Wickizer et.al. (1994) study elucidates why the persons allowed to choose might have experienced lesser outcomes. After all, the personal choices made might have resulted in treatment program mismatches. Regardless, the persons assigned to the compulsory Alcohol Anonymous meetings fared the worst. The Chapman-Walsh et.al. (1991) team suggested that compulsory meetings require closer monitoring to reduce chances of relapse.

However, one might also wonder whether the intermediary placement of Alcoholics Anonymous and the limited interruptions in the workplace and in everyday life for its participants might require much more determination or higher levels of self-efficacy than the other treatment options do. Since the participants in the Chapman-Walsh et.al. (1991) study assigned participants to each group, one might wonder whether those assigned to the Alcoholic Anonymous meetings might have selected another option if given the opportunity. Most certainly, in light of the Wickizer et.al. (1994) study, this merits consideration and further study.

Types of Drug and Alcohol Use, Gender and Ethnicity

As evidenced through the preceding passages, client-program mismatches occur even when referral screenings are conducted. Most certainly, gender, ethnicity, lifestyle, socioeconomic status and depression can and do alternately influence alcohol use and substance abuse across social settings and lifestyle accommodations. Yet, gender is often unaddressed through the screening and referral process. As Ashley, Marsden, & Brady (2003) detail, treatment protocols and programs often dismiss gender and its role. Therefore, treatment counselors, program planners, developers, and even those charged with program evaluation fail to report differences in disease progression, substance and alcohol abuse etiology and access to treatment options or health information. Accordingly, most programs are geared to males.

For these reasons, Ashley, Marsden & Brady (2003) statistically analyzed the data from 31 studies of substance abuse programs specifically for women. Using six components for the analysis, Ashley, Marsden, & Brady (2003) revealed how these gender specific programs achieved higher levels of treatment completion, improved birth outcomes, self-reported health status, and employment. These gender specific programs also inspired shorter inpatient stays, reduced levels of substance abuse, fewer mental health symptoms and greater control over HIV risk exposure. This in turn illustrates why gender-specific programs, especially those designed for women, encourage greater levels of self-efficacy and substance abuse extinction.

Copeland & Hall (1992) previously conducted similar studies. Comparing the specialist women’s substance abuse programs with the traditional mixed-sex treatment programs, Copeland & Hall (1992) discovered the key contributing factors otherwise dismissed or unaddressed. Copeland & Hall (1992) stated that the females participating in the gender-specialized treatment plans were more likely to have experienced sexual abuse as a child. These women were more likely to be lesbian, to have dependent children, and to have a maternal history with drug and/.or alcohol abuse. Given these factors, gender specialized treatment plans can provide women with the supportive environment they need to discuss and explore the environmental and personal experiences that led them to experiment with drugs and alcohol. Perhaps more fearful of discussing these tender situations in mixed company while additionally admitting weakness (alcohol or substance abuse), the traditional mixed treatment options have generally resulted in attrition and help-seeking behaviors relative to women specific treatment options.

With this in mind, Chasnoff, Landress & Barrett (1990) studied illicit drug use among pregnant women in Pinellas County, Florida and the discrepancies between the mandatory reporting system and the actual levels. Since Chasnoff et.al. (1990) states Pinellas County Florida requires pregnant mothers with a history of alcohol or substance abuse to report to public health authorities for urine testing, the meta-analysis of the data could yield greater insight. After all, biological results might not accurately reflect substance use or alcohol use. As evidenced by drug testing in the workplace, herbal consumption and/or the consumption of certain foods could most certainly influence results and yield false positives. Therefore, public health officials should consider this when reading the results.

The enzyme-multiplied immunoassay used to screen for opiates, alcohol, cocaine and cannabinoids was used weekly (Chasnoff et.al., 1990). The prevalence of drug or substance abuse irrespective of private practice or public health centers was the same for black and white women. Yet, the testing revealed that black women were much more likely to use cocaine than their white counterparts were In comparison, white women used far more cannabinoids that their black counterparts did. Notably, as well, the Chasnoff et.al. (199) research tea also realized that poor pregnant women regardless of race were much more likely to partake in illicit drugs or alcohol. While the Pinellas County, Florida policy is not equally applied to women of all socioeconomic status, the results could inform more congruent program planning for these pregnant women. Failure to develop programs or alter existing ones in light of this would induce results like those realized in the previous Wickizer et.al. (1994) Washington study.

Substance Abuse, Pain, Depression or symptom of the latter?

Within the last few decades, researchers have debated whether substance abuse is really a symptom of depression, of previous sexual abuse, or chronic pain unalleviated through other means. Indeed, any and/or all of these arguments are plausible. After all, the Copeland & Hall (1992) study effectively demonstrated the correlation between maternal history with drug and alcohol abuse, between sexual abuse as a child and later drug or substance abuse. Most certainly, these life experiences, even when suppressed contribute to depression (Hawkins, Catalano, & Miller, 1992).

Nunes & Levin (2004) explore substance abuse treatment in light of the depression theory and the efficacy of antidepressant medications. Despite expectations, the use of anti-depressant medications alone yielded less than impressive results. When combined with other treatment modalities, however, Nunes & Levin contended that individuals realized greater levels of self-efficacy and substance abuse extinction. Given these results, clinicians might consider anti-depressant medication prescriptions on a per case basis. When appropriately prescribed, individuals experience longer periods without substance abuse. In fact, individualized treatment, prevention and focused strategies almost always yield better results than programs with universal treatment strategies do (Larimer & Croce, 2002).

Following these observations then, the persistence of chronic pain, the use and abuse of opioids has coauthored inordinately high levels of prescription drug abuse. Sheu et.al. (2008) clearly detailed the correlation between pain lasting more than six months, its moderate to severe intensity, interference with daily activities and the likelihood of substance abuse. To alleviate the psychosocial effects, patients abused the prescription drugs often without relief. Given the levels of functional impairment, the medical and psychiatric comorbidities, treatment interventions and strategies need to consider these factors when implementing screenings and treatment referrals. Failure to do so could result in extended substance abuse and greater social isolation.

Method

Participants

CALDATA (1991-1993) states that approximately 3,000 clients were selected for abstraction but of these 1,859 clients participated in the follow-up interview. Thirty three interviews were completed too late to be included in the study's final report and these cases are also excluded from the public use dataset, yielding a total of 1,826 cases.

Study Variables and Measures

The data was collected in two phases. There were 1025 variables compiled in this study through questionnaires, record abstractions and personal interviews to measure the costs, benefits, and effectiveness of the state's alcohol and drug treatment infrastructure.

Study Design

For the California Drug and Alcohol Treatment Assessment (CALDATA) 1991-1993, the study design used was multistage stratified design. Crosby et al (2003), states that stratification reduces sampling error to “zero” for variables that may otherwise introduce sampling bias to into a study. The sample design consisted of three stages. In order to ensure state wide coverage, the first stage consisted of the state being geographically stratified into four regions. According to CALDATA (1991-1993), counties within these strata were randomly selected, with large counties being selected with certainty and small counties being clustered to provide sufficiently large sampling units. The second stage of sampling geographically balanced, size weighted random selection was used in the selection of treatment providers. As with counties, the smallest providers were clustered to provide adequately sized sampling units (CALDATA, 1991-1993). In the third stage records of clients were randomly chosen at each sampled facility with the size of the facility determining the number and the extent to which the on-site listing of clients matched the number expected for that provider.