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Biomedical subjects

Rudolf H Moos

Publications and source records attributed to Rudolf H Moos.

At least 37 records · Page 2Linked to original sources

Predictors of untreated remission from late-life drinking problems.

OBJECTIVE: Studies of mixed-aged samples have suggested that a majority of problem drinkers achieve remission "naturally", without formal treatment. We sought to describe the life history predictors of untreated remission among older adults. METHOD: We compared 330 older untreated remitters to 120 older treated remitters and to 130 untreated nonremitters. RESULTS: A majority (73%) of remitted, older problem drinkers attained remission without any formal treatment for drinking problems. Compared with treated remitters, late-life untreated remitters were more likely to be women and had completed more schooling, reached their peak alcohol consumption and ceased development of new drinking problems earlier, had much less severe drinking and depression histories, and were less likely to have received any advice to reduce consumption. Compared with untreated nonremitters, untreated remitters were more likely to be women, reached their peak alcohol consumption and stopped developing new drinking problems almost a decade earlier, had somewhat less severe drinking histories, were less likely to have been advised to reduce consumption, and were more likely to have reacted to late-life health problems by reducing their alcohol consumption. CONCLUSIONS: Many late-life problem drinkers with milder drinking problems achieve remission without treatment or advice to reduce consumption. However, a notable percentage of untreated older individuals who have more severe drinking problems could benefit from public health efforts to aid detection of late-life drinking problems and interventions aimed at reducing alcohol consumption. Results suggest that such interventions should highlight the negative health consequences of excessive late-life drinking.

Age Factors↗

Self-efficacy, therapeutic alliance, and alcohol-use disorder treatment outcomes.

OBJECTIVE: High abstinence self-efficacy reliably predicts better treatment outcomes for patients with alcohol use disorders, but little is known about aspects of treatment that may be particularly beneficial for patients who enter treatment with low self-efficacy. This study examines whether the relationship between self-efficacy and treatment outcomes is influenced by the quality of the therapeutic alliance in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a multisite clinical trial of three treatments for alcohol use disorders. METHOD: Information on 785 patients in the outpatient sample of Project MATCH was used to test for an interaction between baseline self-efficacy and therapeutic alliance in relation to 1-year alcohol use outcomes. RESULTS: A significant interaction was found between self-efficacy and the therapists' perception of the therapeutic alliance predicting I1year drinking outcomes. Patients with low self-efficacy who established a strong treatment alliance, as judged by the therapist, experienced I1year outcomes that were superior to those of patients with low self-efficacy with poorer treatment alliance and comparable with those of patients with high self-efficacy. Therapeutic alliance was not strongly related to the outcomes of patients with high baseline self-efficacy. CONCLUSIONS: In patients who are treated for alcohol-use disorders, a positive therapeutic alliance may counteract the negative impact of a low baseline self-efficacy. Potential reasons why the therapist's perception of the alliance may be particularly important for patients with low self-efficacy are discussed.

Adolescent↗

Predictors of outcome for patients with substance-use disorders five years after treatment dropout.

OBJECTIVE: Few studies focus on the outcome of patients after they drop out of substance-use disorder (SUD) treatment, and there appear to be no prior studies of the long-term outcomes of these patients. The aim of this study is to determine how well such patients do after dropping out of treatment and to identify predictors of differential outcomes. METHOD: Patients in 15 residential SUD treatment programs were assessed at treatment entry and at 5-year follow-up on their frequency and severity of substance use, expectancies and beliefs about substance use, and social resources and stressors. Patients who dropped out and stayed out of treatment (n = 193) were compared with those who completed treatment (n = 3,204). Predictors of 5-year SUD problems among dropouts were identified. RESULTS: In general, dropouts and treatment completers did not differ significantly on their levels of SUD problems at 5 years. At baseline, patients who dropped out reported more involvement in 12-step organizations and greater cognitive impairment and more closely identified with the label "drug addict" than "alcoholic." Lower severity of SUD, lower self-efficacy, fewer positive substance- use expectancies, and less stress from social networks predicted fewer SUD problems at 5 years among dropouts. CONCLUSIONS: In addition to focusing on substance use, providers should address the adequacy of patients' social support and counter positive substance-use expectancies at the earliest stages of treatment before patients drop out.

Adult↗

Older adults' coping with negative life events: common processes of managing health, interpersonal, and financial/work stressors.

This study examined how older adults cope with negative life events in health, interpersonal, and financial/work domains and whether common stress and coping processes hold across these three domains. On three occasions, older adults identified the most severe negative event they faced in the last year and described how they appraised and coped with that event, their ambient chronic stressors, and event and functioning outcomes. The stress and coping process was largely consistent across the three life domains. Individuals who appraised events as challenging and relied more on approach coping were more likely to report some benefit from those events. Individuals who experienced more chronic stressors and favored avoidance coping were more likely to be depressed and to have late-life drinking problems. Chronic stressors, as well as approach and avoidance coping, were predictably associated with overall outcomes in all three event domains. These findings provide a basis for preventive interventions that may help older adults' address the most prevalent stressors of aging more effectively.

Adaptation, Psychological↗

Gender, treatment and self-help in remission from alcohol use disorders.

OBJECTIVES: To examine gender differences in the influence of treatment, self-help groups and life context and coping factors on remission among initially untreated individuals with alcohol use disorders. DESIGN: A naturalistic study in which individuals were assessed at baseline and 1, 8 and 16 years later. SETTING: Participants initiated help-seeking with the alcoholism service system by contacting an information and referral service or detoxification program. PARTICIPANTS: A total of 461 individuals with alcohol use disorders (50% women). METHODS: Participants were assessed by mail surveys and telephone interviews on participation in professional treatment and Alcoholics Anonymous (AA), alcohol-related functioning and indices of life context and coping. RESULTS: Compared to men, women were more likely to participate in treatment and AA, and to experience better alcohol-related and life context outcomes. In general, women and men who participated in treatment and/or AA for a longer duration were more likely to achieve remission. However, women benefited somewhat more than men from extended participation in AA. Continuing depression and reliance on avoidance coping were more closely associated with lack of remission among men than among women. CONCLUSION: Compared to men, women with alcohol use disorders were more likely to obtain help and achieve remission. Women tended to benefit more from continued participation in AA and showed greater reductions in depression and avoidance coping than men did. These findings identify specific targets for clinical interventions that appear to be especially beneficial for women and that may also enhance the likelihood of recovery among men.

Adaptation, Psychological↗

Sixteen-year changes and stable remission among treated and untreated individuals with alcohol use disorders.

AIMS: This study examined changes over a 16-year interval and predictors of stable remission among previously untreated individuals with alcohol-use disorders who did not obtain help or who entered either alcoholics anonymous (AA) or professional treatment in the first year after initially seeking help. DESIGN AND MEASURES: A sample of individuals (N = 461) who initiated help-seeking was surveyed at baseline and 1, 3, 8, and 16 years later. In addition to providing information on life history of drinking at each contact point, participants described their current alcohol-related and psychosocial functioning and life context, and coping responses. FINDINGS: Irrespective of whether or not individuals obtained help, their alcohol-related functioning, life context, and coping improved. However, individuals who obtained help (AA or treatment) in the first year improved more and were more likely to achieve stable remission than those who did not. Nevertheless, the factors associated with stable remission were comparable for individuals who did and those who did not obtain timely help. CONCLUSIONS: Compared with individuals who do not obtain timely help, those who enter either AA or treatment relatively soon after initiating help-seeking improve more quickly and achieve higher long-term remission rates.

Adaptation, Psychological↗

Treatment for dual diagnosis patients in the psychiatric and substance abuse systems.

The purpose of this study was to describe and compare the extent to which psychiatric and substance abuse programs treating dual diagnosis patients in the residential and outpatient modalities offered the components recommended for this client group. Surveys were completed by managers of 753 programs in the Department of Veterans Affairs that had a treatment regimen oriented to dual diagnosis patients. Programs within both the psychiatric and substance abuse systems had some of the key services of integrated treatment (e.g., assessment and diagnosis, crisis intervention, counseling targeted at psychiatric and at substance use problems, medications, patient education, HIV screening and counseling, family counseling and education). However, compared to psychiatric programs, substance abuse programs were more likely to offer some of these services and other critical components (e.g., a cognitive-behavioral treatment orientation, assignment of a single case manager to each patient). Outpatient psychiatric programs were particularly lacking on key management practices (e.g., use of clinical practice guidelines, performance monitoring of providers) and services (e.g., detoxification, 12-step meetings) of integrated treatment. Generally, differences between psychiatric and substance abuse programs appeared to involve difficulties in developing treatment that is fully oriented toward the co-occurring diagnosis. To improve the provision of high-quality dual-focused care, we recommend planners' use of cross-system teams and applications of recently produced tools designed to increase programs' ability to deliver integrated care to dually disordered individuals.

Adult↗

Predictors of 5-year mortality following inpatient/residential group treatment for substance use disorders.

This study examined the prevalence and predictors of 5-year mortality following treatment for substance use disorders. The predictors were assessed at baseline, at discharge, and at a 1-year follow-up for 3698 male veterans, and included demographic, substance use, medical, and psychological functioning, social support, and continuing care. The annual mortality rate was 2.38%, with an observed/expected ratio of 3.05. After accounting for significant demographic, substance use, psychological, and medical conditions, not having a spouse or partner at intake independently predicted 5-year mortality. After accounting for intake variables, more depression at discharge and more medical conditions, a diagnosis of HIV or AIDS, more ounces of ethanol on a maximum drinking day, and lack of a spouse or partner at the 1-year follow-up independently predicted 5-year mortality. Unexpectedly, good quality relationships were related to a higher mortality risk. Results can be used to increase at-risk patients' motivation for recovery.

Adaptation, Psychological↗

Stress generation, avoidance coping, and depressive symptoms: a 10-year model.

This study examined (a) the role of avoidance coping in prospectively generating both chronic and acute life stressors and (b) the stress-generating role of avoidance coping as a prospective link to future depressive symptoms. Participants were 1,211 late-middle-aged individuals (500 women and 711 men) assessed 3 times over a 10-year period. As predicted, baseline avoidance coping was prospectively associated with both more chronic and more acute life stressors 4 years later. Furthermore, as predicted, these intervening life stressors linked baseline avoidance coping and depressive symptoms 10 years later, controlling for the influence of initial depressive symptoms. These findings broaden knowledge about the stress-generation process and elucidate a key mechanism through which avoidance coping is linked to depressive symptoms.

Adaptation, Psychological↗

The interplay between life stressors and depressive symptoms among older adults.

This study examined mutual predictive associations between life stressors and depressive symptoms in later life. A sample of late-middle-aged and older adults (N = 1,291) was surveyed at baseline and 1 year, 4 years, and 10 years later. At each contact point, participants completed an inventory that assessed chronic and acute life stressors and depressive symptoms. Over the 10-year interval, there was evidence of both social causation and social selection processes: More life stressors were associated with subsequent increases in depressive symptoms (social causation), and more depressive symptoms were associated with subsequent increases in stressors (social selection or stress generation). These findings reflect a mutual influence process in which life stressors and depressive symptoms can alter each other.

Activities of Daily Living↗

The 8-year course of alcohol abuse: gender differences in social context and coping.

BACKGROUND: The aim of this study was to compare women (n=230) and men (n=236) who had alcohol use disorders in terms of social context and coping methods and in terms of changes in these indices associated with participation in professional treatment and Alcoholics Anonymous (AA). METHODS: Initially untreated problem drinkers were followed up for 8 years. RESULTS: Women and men did not differ in regard to the type of help received, but women had longer professional treatment. At baseline, women had more stressors and fewer resources from family and relied more on avoidance coping and drinking to cope. During the next 8 years, women, more so than men, increased on approach coping and reduced their use of avoidance coping and drinking to cope. When baseline status was controlled, women had better social resource, coping, and drinking outcomes than men did at 1 year and 8 years. A longer duration of professional treatment during year 1 was associated with improved approach coping among men but not women. A longer duration of AA attendance during year 1 and the full 8 years was associated with more resources from friends, more use of approach coping, and less drinking to cope. In turn, more friends resources and approach coping and less drinking to cope were associated with better drinking outcomes. Decreases in avoidance coping and drinking to cope were more strongly associated with better drinking outcomes among men than among women. CONCLUSIONS: It may be important to target men for formal services or self-help to increase their use of approach coping in efforts to maintain abstinence. Women's strategies for improving their social context need further explication to be adapted for transfer to male problem drinkers.

Adaptation, Psychological↗

Paths of entry into alcoholics anonymous: consequences for participation and remission.

BACKGROUND: This study compared individuals with alcohol use disorders who, in the first year after initiating help-seeking, entered Alcoholics Anonymous (AA) only, entered professional treatment and AA together, or entered professional treatment only METHODS: A sample of initially untreated individuals (N = 362) was surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. At each contact point, participants described their participation in AA and treatment and their current alcohol-related functioning. They also described their reasons for entering AA and/or treatment and the perceived benefits of these sources of help RESULTS: Compared with individuals who initially participated only in treatment but later entered AA, those who entered treatment and AA together participated in AA longer and more frequently and were more likely to achieve remission. Among individuals who initially participated only in AA, those who later entered treatment had poorer remission outcomes than those who did not enter treatment. Longer duration of participation in AA was associated with a higher likelihood of remission at all four follow-ups; individuals who dropped out of AA were more likely to relapse or remain nonremitted. CONCLUSIONS: Compared with individuals who participated only in professional treatment in the first year after they initiated help-seeking, individuals who participated in both treatment and AA were more likely to achieve remission. Individuals who entered treatment but delayed participation in AA did not appear to obtain any additional benefit from AA.

Adult↗

Iatrogenic effects of psychosocial interventions for substance use disorders: prevalence, predictors, prevention.

AIMS: To examine the prevalence and personal and intervention-related predictors of potential iatrogenic effects associated with psychosocial interventions for substance use disorders and provide a conceptual framework to guide further research on such effects. METHOD: A review of relevant studies focuses on the prevalence and predictors of potential iatrogenic effects of psychosocial treatment and prevention programs for substance use disorders. RESULTS: Between 7% and 15% of patients who participate in psychosocial treatment for substance use disorders may be worse off subsequent to treatment than before. In addition, several controlled trials of substance use prevention have shown some apparent iatrogenic effects, including more positive expectations about substance use and a rise in alcohol use and alcohol-related problems. Probable person-related predictors of deterioration associated with treatment include younger age and unmarried status, more serious current diagnoses and substance use problems and more psychiatric and interpersonal problems. Probable intervention-related predictors of deterioration include lack of bonding; lack of monitoring; confrontation, criticism and high emotional arousal; deviancy modeling; and stigma, low or inappropriate expectations and lack of challenge. CONCLUSION: A significant minority of individuals with substance use problems appear to deteriorate during or shortly after participation in treatment or prevention programs. Safety standards and monitoring procedures are needed to routinely identify potential adverse consequences of intervention programs; research is needed to clarify whether deterioration is due to iatrogenic effects of interventions and to identify new approaches to counteract any such effects.

Humans↗

Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers.

AIMS: Most older adults report having recently experienced pain, and many older adults have late-life drinking problems. However, to our knowledge, the intersection of pain and alcohol misuse by older adults has not been studied. This research focuses on the implications of pain for older individuals who have problems with alcohol. DESIGN: Longitudinal survey. SETTING, PARTICIPANTS AND MEASUREMENT: Older community-residing adults (n = 401) were classified as problem and non-problem drinkers. At baseline and 3 years later they were asked to provide information about their pain, use of alcohol to manage pain, drinking behavior, chronic health problems and recent serious injury. FINDINGS: At baseline, older problem drinkers reported more severe pain, more disruption of daily activities due to pain and more frequent use of alcohol to manage pain than did older non-problem drinkers. More pain was associated with more use of alcohol to manage pain; this relationship was stronger among older adults with drinking problems than among those without drinking problems. Among older men, more baseline drinking problems interacted with use of alcohol to manage pain to predict more health problems and serious injury 3 years later. Among older women, more baseline drinking problems interacted with use of alcohol to manage pain to predict more drinking problems 3 years later. CONCLUSIONS: The results highlight the importance of monitoring the drinking behavior of older patients who present with pain complaints, especially patients who have pre-existing problems with alcohol.

Activities of Daily Living↗

The influence of partner status, relationship quality and relationship stability on outcomes following intensive substance-use disorder treatment.

OBJECTIVE: Addiction treatment studies examining the influence of patients' partners suggest that partner behaviors affect patients' substance-use outcomes. We examine the influence of having a partner at treatment entry as well as the influence of the general quality of support and substance-using status of the partner, on outcomes following treatment for substance-use disorder. We also examine the influence of relationship stability on treatment outcomes and examine baseline partner behaviors that may predict relationship stability. METHOD: A prospective, intact-group design was utilized with data analyzed using logistic regression. Participants (N = 3,014) from 15 intensive substanceuse disorder treatment programs were assessed at treatment entry and 1-year postdischarge. RESULTS: Although patients with partners possessed a more favorable clinical profile, their outcomes were no better than those of their single counterparts. However, patients whose relationships lasted through the first year posttreatment had better outcomes than patients whose relationships ended. Relationships with more positive partner behaviors and fewer negative partner behaviors at intake were more likely to remain intact over the course of the first year posttreatment. Positive partner behaviors did not enhance patients' outcomes directly, but partner interpersonal stressors and patients' belief that their partner had a substance-use problem had a significant, deleterious impact on patients' substance-use outcomes. CONCLUSIONS: Clinicians should routinely assess the quality of patients' relationships with partners. If deleterious partner behaviors exist, empirically supported interventions (e.g., behavioral couples therapy) could be utilized to reduce these behaviors and ultimately reduce relapse risk.

Adult↗

Sequencing the lifetime onset of alcohol-related symptoms in older adults: is there evidence of disease progression?

OBJECTIVE: The purpose of this study was to evaluate evidence of orderly symptom progression in alcohol-use disorders (disease-progression model). METHOD: A sample of community-residing older problem drinkers provided information about their life history of drinking, including the age at which they had experienced alcohol-related symptoms that correspond to criteria for alcohol abuse and dependence. Symptom sets and possible sequences were formulated separately for women and men, based on the average number of years from drinking initiation to symptom onset and on symptom prevalence. We assessed how well the ordering of symptoms experienced by individual respondents matched the sequences derived with these group-level measures; we also assessed whether individuals progress from alcohol abuse to dependence as is implied in some conceptualizations of alcohol-use disorders. RESULTS: Half or more of these older adults experienced symptom onset in an order that was inconsistent with the possible symptom sequences derived from group-level analysis (e.g., reversals from the expected order or concurrent onset of symptoms expected to occur sequentially). Similarly, alcohol abuse did not appear to be a precursor to the development of alcohol dependence in individual patterns of symptom onset. CONCLUSIONS: Although group-level results based on the number of years from drinking initiation to symptom onset or on symptom prevalence may seem to point to orderly progression in the development of alcohol-related symptoms, these group-level results do not capture individual experiences very well. In this community-residing sample of problem drinkers, most of whom had never sought treatment, there was marked variability in the course of symptom development, which raises questions about the utility of a disease-progression model.

Age of Onset↗

The interplay between help-seeking and alcohol-related outcomes: divergent processes for professional treatment and self-help groups.

This study examined the influence of self-selection, as reflected in alcohol-related functioning, on the duration of professional treatment and Alcoholics Anonymous (AA), and the influence of social causation, as reflected in the duration of treatment and AA, on alcohol-related outcomes. A sample of alcoholic individuals was surveyed at baseline and 1, 3, and 8 years later. At each point, participants completed an inventory that assessed participation in treatment and AA since the last assessment and alcohol-related functioning. There were divergent processes of self-selection and social causation with respect to the duration of participation in professional treatment and AA. Individuals with more severe alcohol-related problems obtained longer episodes of professional treatment, but this self-selection process was much less evident for AA. Longer participation in professional treatment in the first year predicted better alcohol-related outcomes; however, the duration of subsequent treatment was not associated with better subsequent outcomes. In contrast, longer participation in AA consistently predicted better subsequent alcohol-related outcomes. These findings are consistent with a need-based model of professional treatment, in which more treatment is selected by and allocated to individuals with more severe problems, and an egalitarian model of self-help, in which need factors play little or no role in continued participation.

Adult↗

Help-seeking careers: connections between participation in professional treatment and Alcoholics Anonymous.

This study examined the relationships between participation in professional treatment and Alcoholics Anonymous (AA) among 473 initially untreated individuals with alcohol use disorders. These individuals were assessed at baseline and at 1-year, 3-year, and 8-year followups. There were moderate positive concurrent associations between the duration of participation in professional treatment and in AA. More important, a longer duration of treatment in year 1 was associated with more sustained participation in AA in years 2 and 3, which was associated with less time in treatment in years 4 through 8. The strength of these findings varied somewhat in relation to whether individuals chose to enter treatment or AA first. The findings suggest that referral and alliance processes contribute to a positive association between the duration of an initial episode of treatment and subsequent AA, and then extended participation in AA contributes to better alcohol-related outcomes and reduced need for subsequent treatment.

Adult↗