Cognitive rehabilitation of chronic alcohol abusers

The current literature suggests that individuals who chronically abuse alcohol exhibit a wide variety of cognitive deficits resulting from cerebral dysfunction that is either directly or indirectly related to their alcohol consumption history. Cognitive deficits have been hypothesized as having implications for standard alcohol treatment efficacy as they may directly affect cognitively impaired individuals’ abilities to utilize various treatment modalities. Although evidence is accumulating that suggests this is actually the case, the majority of alcohol treatment programs neither directly consider the impact cognitive deficits have on treatment efficacy nor do they employ cognitive rehabilitation treatment strategies to remediate identified cognitive deficits. Few studies exist that investigate the remediability of neurobehavioral deficits or the efficacy of integrating cognitive rehabilitation strategies into more traditional treatment programs. Empirical investigations conducted to date indicate that some cognitive deficiencies secondary to alcoholism are amenable to cognitive rehabilitation and this remediation is generalizable. Rigorous well-controlled treatment outcome investigations are needed in order to determine the efficacy of cognitive rehabilitation techniques in naturalistic settings using ecological outcome measures. Also, emphasis should be placed on integrating cognitive rehabilitation techniques with proven efficacy into traditional alcoholism treatment programs.     

Alcohol: Effects on Neurobehavioral Functions and the Brain

Alcoholism results from an interplay between genetic and environmental factors, and is linked to brain defects and associated cognitive, emotional, and behavioral impairments. A confluence of findings from neuroimaging, physiological, neuropathological, and neuropsychological studies of alcoholics indicate that the frontal lobes, limbic system, and cerebellum are particularly vulnerable to damage and dysfunction. An integrative approach employing a variety of neuroscientific technologies is essential for recognizing the interconnectivity of the different functional systems affected by alcoholism. In that way, relevant experimental techniques can be applied to assist in determining the degree to which abstinence and treatment contribute to the reversal of atrophy and dysfunction.     

Defense mechanisms in alcoholics attending outpatient treatment. Results from the MCT-test (Meta-Contrast Technique)

Defensive strategies were studied in 72 alcoholics participating in outpatient treatment by using, before the treatment started, the Meta-Contrast Technique, MCT, a percept-genetic method. Alcoholics had less often adaptive strategies than controls. A lack of adaptive defense strategies was related to a more impaired psychic status, more psychological benefits from drinking, and more psychiatric symptoms but not to severity of alcoholism or results of psychometric tests (intellectual level, field-dependence, spatial performance). It does not seem inconceivable that the MCT could be used as a diagnostic tool in treatment planning.     

The Retrospective Family Unpredictability Scale: Reliability and Validity

Family unpredictability or inconsistency may be responsible, in part, for the detrimental outcomes associated with parental divorce, parental alcoholism, and family poverty. We assessed behavior patterns and regulatory systems in one’s family of origin for the purposes of developing the Retrospective Family Unpredictability Scale (Retro-FUS). In the first study (N = 416, 89% Caucasian, 59% female), confirmatory factor analysis indicated a six-factor solution was appropriate and the six subscales (meals, money, mother nurturance, father nurturance, mother discipline, and father discipline) were reliable. A second study (N = 305, 82% Caucasian, 77% female) demonstrated that Retro-FUS scores related to other conceptually similar factors. Specifically, Retro-FUS scores were higher among participants reporting these factors while growing up: parental divorce, family economic adversity, more neighborhood crime, and a greater likelihood of parental alcoholism. Thus, the Retro-FUS appears to be a multi-dimensional, retrospective measure of family unpredictability that demonstrates internal consistency and preliminary construct validity. We discuss implications for research and clinical applications as well as ideas for further research using the Retrospective Family Unpredictability Scale.     

La codépendance : nouvel outil clinique ou flou conceptuel ? Une revue de la littérature

The goal of this literature review is to introduce, present and analyze the clinical phenomenon that is codependency. It will present explanatory models, measurement tools and therapeutic strategies, before introducing a critical analysis of this concept and its use. Codependency is an entity defined by several major symptoms such as denial, hyper-control, emotional repression, compulsions, self-neglect and a difficulty setting healthy boundaries. It is evaluated with a valid and reliable tool, called the Codependency Assessment Tool (CODAT). On a therapeutic level, specialists underline the importance of a pre-therapeutic diagnosis and the development of targeted therapeutic strategies. They also emphasize the benefits of combined individual and group therapy. On a collective level, 12 step programs, such as Al-Anon and Codependents Anonymous, offer support groups adapted to these symptoms although they insist on certain limits that must be understood. Despite an interest for this concept because of its clinical usefulness and its resonance with certain patients that suffer from it, certain authors mention conceptual flaws and insufficient empirical data. Thus, exploratory research concerning this phenomenon and its effects must continue.     

Alcoholics treated by individualized behavior therapy: One year treatment outcome

One-year treatment outcome results are reported for 70 male alcoholics who, while hospitalized at Patton State Hospital, served as subjects in an experiment evaluating ‘Individualized Behavior Therapy (IBT)’ techniques. Initially, subjects had been assigned to a controlled drinking or non-drinking (abstinence) treatment goal, and then were randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment. One year follow-up results demonstrated that IBT treated subjects had functioned significantly better than control subjects. Dependent variable measures included daily drinking disposition, general emotional adjustment, vocational satisfaction, occupational status, driving status and an index of residential status and stability. The results support the view that some ‘alcoholics’ can acquire and maintain controlled drinking behavior over at least a 1-yr follow-up interval. The difficulties of designing and applying sophisticated follow-up procedures and measures are discussed.     

The effects of venlafaxine and cognitive behavioral therapy alone and combined in the treatment of co-morbid alcohol use-anxiety disorders

The effects of the antidepressant venlafaxine (VEN-225 mg daily) and transdiagnostic cognitive behavioral treatment (CBT) alone and in combination on alcohol intake in subjects with co-morbid alcohol use disorders (AUDs) and anxiety disorders were compared. Drinking outcomes and anxiety were assessed for 81 subjects treated for 11 weeks with one of 4 conditions: 1) VEN–CBT, 2) VEN-Progressive Muscle Relaxation therapy (PMR), 3) Placebo (PLC)-CBT and 4) a comparison group of PLC-PMR. For subjects who reported taking at least one dose of study medication, the Time × Group interaction was significant for percent days of heavy drinking and drinks consumed per day. For the measure of percent days heavy drinking, the paired comparison of PLC-CBT versus PLC-PMR group indicated that the PLC-CBT group had greater drinking reductions, whereas other groups were not superior to the comparison group. In Week 11, the proportion of subjects in the PLC-CBT group that had a 50% reduction from baseline in percent days heavy drinking was significantly greater than those in the comparison group. Of the 3 “active treatment” groups only the PLC-CBT group had significantly decreased heavy drinking when contrasted to the comparison group. This finding suggests that the transdiagnostic CBT approach of Barlow and colleagues may have value in the management of heavy drinking in individuals with co-morbid alcoholism and anxiety.     

The Behavioral Genetics of Alcoholism

Twin and adoption studies consistently implicate the importance of genetic influences on alcoholism risk, especially in men. Heritability estimates suggest that approximately 50% to 60% of the variability in alcoholism liability is associated with genetic factors. Although there has been progress in identifying specific genes that predispose toward alcoholism, we know relatively little about the nature of the genetic influence on alcoholism risk. We also know relatively little about how genetic factors combine with environmental factors to affect alcoholism risk. Genotype-environment interaction models posit that alcoholism occurs when individuals both inherit a vulnerability to develop alcoholism and are reared in a provocative environment. Such models hold great promise for understanding alcoholism's etiology.