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Biomedical subjects

T J O'Farrell

Publications and source records attributed to T J O'Farrell.

At least 37 records · Page 2Linked to original sources
PubMed1995

Disulfiram (antabuse) contracts in treatment of alcoholism.

Although studies repeatedly demonstrate that alcoholics who consistently take disulfiram experience more favorable drinking outcomes, serious problems with compliance among the majority of alcoholic patients have reduced the effectiveness of disulfiram as a therapeutic adjunct. In general, alcoholism counseling with disulfiram simply prescribed seems no more effective than counseling without disulfiram (Fuller et al. 1986). Problems with compliance as well as problems with acceptance by patients and likely by clinical staff reduce the utility of disulfiram in the treatment of alcoholism. Implants, incentives, and various forms of observed or supervised disulfiram have been studied as possible solutions to the problems with compliance. Disulfiram implants appear largely ineffective due to failure to release adequate levels of disulfiram and risks of surgical complications and rejection. Newer techniques (see Allen and Litten 1992) may ultimately lead to a more effective implant. Incentives with personally relevant and obvious reinforcement value such as money, avoidance of incarceration, remaining employed, and continuation of methadone for opiate addicts, have been used effectively. Enhancement strategies with less tangible incentives also show promise. Among these are feedback on results of biochemical measures of disulfiram compliance and continuation in a familiar treatment program. Although each of the studies of incentives suffers from specific methodological limitations, the findings uniformly demonstrate better disulfiram compliance, less drinking, and better clinical outcomes for those who received a meaningful incentive for taking disulfiram. External monitoring of the patient taking disulfiram to assure compliance is typically used in studies evaluating incentives for taking the medication. Observed or supervised disulfiram in its own right and without tangible incentives also has received increasing attention as a method for enhancing compliance. Incorporation of such a strategy would seem to have potential for wide applicability in alcoholism treatment programs. Three forms of supervised disulfiram have been studied: (1) a written disulfiram contract, such as in BMT, with instructions about the benefits of the disulfiram contract and methods to establish disulfiram use as a daily habit and specifying that the alcoholic will take disulfiram daily while the spouse observes, that the couple will mutually thank each other, and that they will refrain from arguments or discussions about the alcoholic's drinking; (2) the disulfiram contract used in CRA, which is identical in form to the BMT contract except that talk about drinking is not prohibited; and (3) supervised disulfiram without a written contract, special instructions, or explicit verbal thanking. Studies of these three forms of observed disulfiram have been among the better controlled studies. Each approach has produced very promising results. A disulfiram contract with BMT produced less short-term drinking than disulfiram accompanied either by couples or individual counseling. Unfortunately, the superior BMT drinking results eroded because many couples discontinued their disulfiram contract after treatment ended (O'Farrell et al. 1985, 1992). Adding couples RP sessions after BMT led to better fulfillment of the disulfiram contract and better drinking and marital outcomes than BMT alone. These better RP outcomes persisted for 18 to 24 months after BMT for the entire sample and throughout the entire 30-month followup after BMT for those with more severe drinking and marital problems (O'Farrell et al. 1993). Thus, disulfiram contracts used with BMT are associated with less drinking and greater disulfiram compliance, while the specific contribution of disulfiram contracts to BMT remains to be investigated.(ABSTRACT TRUNCATED AT 400 WORDS)

Alcohol Deterrents↗
PubMed1993

End-of-treatment self-efficacy, aftercare, and drinking outcomes of alcoholic men.

In substance abusers, low end-of-treatment self-efficacy is thought to be a predictor of increased vulnerability of relapse following treatment. This study is an evaluation of relationships between end-of-treatment self-efficacy, aftercare, and drinking outcomes in a subsample of male alcoholics participating in a treatment outcome study. After completing Behavioral Marital Therapy (BMT), the alcoholics and their spouses were randomly assigned to either an aftercare or a no additional treatment condition and followed up for 1 year. In subjects who received no additional treatment, low self-efficacy at the end of BMT predicted poorer drinking outcomes, even after drinking behavior during BMT was controlled for. For subjects in the aftercare condition, self-efficacy at the end of BMT did not predict drinking outcomes. Explanations for the results, as well as implications for models of relapse, are discussed.

Adult↗
PubMed1993

Family history models of alcoholism: age of onset, consequences and dependence.

The association of a family history of alcoholism to susceptibility to alcoholism has been well documented over the past 3 decades. The classification of a family history of alcoholism commonly involves the division of subjects into family history positive and negative groupings. However, diverse definitions are used to define positive family histories. These diverse definitions of family alcoholism impede the comparison of results from different studies. The present study evaluates several classification schemes and compares them with a new method for the analysis of family patterns of alcoholism (FPA). A sample of 220 male alcoholic veteran inpatients were assessed for age of onset of alcoholism, consequences of drinking and the severity of their dependence. Multiple regression equations were estimated for several dichotomous family history models and each model was evaluated against a comparable FPA model that included the same family members. Comparisons of the classification models with the equivalent FPA analysis model facilitated comparisons of the contribution of each family history designation to changes in amount of explained variance. In all instances, the FPA analyses explained more variance than did the comparable dichotomous family history models. In addition, the FPA analyses reveal the relative explanatory power of each family member and indicate that maternal relatives often have a more important contribution than has been indicated previously.

Adult↗
PubMed1993

Behavioral marital therapy with and without additional couples relapse prevention sessions for alcoholics and their wives.

This study evaluated whether alcoholics who received couples relapse prevention (RP) sessions in the year after short-term behavioral marital therapy (BMT) did better than those who did not receive additional RP. Couples (n = 59) with an alcoholic husband, after participating in weekly BMT couples sessions for 5 months, were assigned randomly to receive or not receive 15 additional conjoint couples relapse prevention (RP) sessions over the next 12 months. Outcome measures were collected before and after BMT and at quarterly intervals for the year after BMT. Significant improvements in the alcoholics' drinking and the couple's marital adjustment occurred from before to after BMT replicating results of our own and other's earlier studies of BMT with alcoholics, and outcomes remained significantly improved through 12-months follow-up independent of the amount of aftercare received. Given these favorable outcomes overall, the present study provided a stringent test of the hypothesized utility of RP. As predicted, alcoholics who received RP after BMT had more days abstinent and fewer days drinking, maintained their improved marriages better and used behaviors targeted by BMT more than those who received BMT alone. The prediction that greater continued use of behaviors targeted by BMT would be associated with better outcomes irrespective of the amount of aftercare received also was supported. The final prediction that couples with more severe alcohol and marital problems at study entry would show the greatest additional benefit from RP was not supported. The relatively clear-cut findings favoring RP may be due to the fact that RP in this study was an intensive, multifaceted booster maintenance intervention delivered in a couples format over a lengthy period of time. Moreover, the present results occurred during the time that couples were still getting RP. Limitations to the generalizability and interpretation of the results are discussed.

Adult↗
PubMed1991

School adjustment of children of alcoholic fathers: comparison to normal controls.

The present study used objective indices of academic performance to test the hypothesis that children of alcoholic fathers (COA's) have poorer school adjustment than children of nonalcoholic parents (non-COA's). Subjects were 39 children of male alcoholics treated for alcoholism in a VA program and 33 control children whose nonalcoholic parents (matched on demographic indices) reported low marital conflict. The results showed that daughters of alcoholics, but not the sons, showed more variability than controls in their school attendance. There was suggestive evidence that they also missed more school days than controls, with a reversed pattern for the sons of alcoholics. Generally, however, the COA group was not compromised academically and did not show more conduct problems compared to controls. Within the COA group, long-term paternal drinking adjustment (years of problem drinking and total number of hospitalizations for drinking) appeared to be related to poorer GPA, while short-term adjustment (alcohol-related days in jail and number of days drinking in year previous to treatment) were more related to poorer attendance. The results are discussed in terms of the mechanism of the effect of paternal drinking on children's school adjustment and the difficulty in making generalizations about the consequences of being the child of an alcoholic.

Achievement↗
PubMed1991

Drinking experiences in three populations of male drinkers.

The first drinking experience has been suggested as an important point in etiological processes associated with alcohol use and abuse. In this study, initial drinking experiences were assessed among populations of alcoholics, problem drinkers, and non-problem drinkers. Results showed that the alcoholics and problem drinkers more frequently consumed 5 or more drinks during their initial drinking occasion than the nonproblem drinkers. Alcoholics were most likely to experience their second drinking event within several days. In addition, there was a tendency for alcoholics and problem drinkers to describe more negative effects associated with their initial drinking experience. No effects were found for age of first drink or its location. Such differences in first drinking may have implications for understanding the etiology of drinking problems.

Adult↗
PubMed1991

Sexual satisfaction and dissatisfaction in the marital relationships of male alcoholics seeking marital therapy.

Twenty-six married couples with alcoholic husbands who sought marital therapy were compared with two groups of couples without alcohol-related problems, 26 couples with marital conflict (MC) and 26 with no marital conflict (NC), on a range of sexual satisfaction variables. As predicted, the alcoholic and MC couples did not differ and both of these groups of couples reported less sexual satisfaction than the NC couples. Alcoholic and MC couples, in comparison with NC couples, reported less frequent intercourse, more change desired in intercourse frequency, greater misperception about the amount of change in sex frequency desired by their mate and more disagreement about sex. In addition, the finding that older alcoholics had less frequent intercourse replicated similar results by Jensen. Limitations of the present research and needed future research are discussed.

Adult↗
PubMed1991

Services for families of alcoholics: a national survey of Veterans Affairs treatment programs.

Directors of 70 (75% response rate) inpatient and 51 (54% response rate) outpatient alcoholism treatment programs run by the Department of Veterans Affairs (VA) returned questionnaires about patient and program characteristics and the extent of use of family-focused treatment modalities. Referrals to Al-Anon for spouses and to Alateen for teenage children were by far the most frequently provided services. Conjoint couples therapy was the type of direct service provided most frequently. Couples group therapy for outpatient programs and spouse education groups for inpatient programs were the next most frequently used. Family therapy was not used frequently. The majority of programs did not offer services directed at the individual needs of spouses, such as individual or group therapy and educational groups. Finally, services to children of alcoholics were nearly nonexistent being limited to referral of teenage children to Alateen. Marital and family services other than referral to Al-Anon and Alateen and conjoint couple interviews in inpatient programs were provided to fewer patients than those eligible for the services. The extent of family services offered bore little or no relationship to program characteristics (e.g., funding level, staffing pattern) but was related to patient characteristics. Programs with more middle-aged, employed, high school (or better) educated, married veterans made greater use of family-focused modalities. The results suggest the VA needs to develop policy guidelines for the type and intensity of marital and family services their programs should provide with specific determination of what responsibility, if any, VA programs have to the children living with the alcoholic veterans treated in these programs.

Adult↗
PubMed1990

Using a drinking motivation scale to predict degrees of problematic drinking.

Much of the recent interest in the role of cognitive factors in decisions to drink has focused on alcohol beliefs and drinking motivations. In this study, male alcoholics in treatment, untreated problem drinkers and non-problem drinkers were studied using a variation of the Mulford and Miller Definitions of Alcohol Scale, which assesses personal-deficiency and social/celebratory reasons for drinking. The three groups of drinkers differed significantly on their mean level of endorsement of items comprising each drinking motivation subscale. The alcoholics scored highest on both personal-deficiency and social/celebratory reasons for drinking, followed by the problem drinkers and then non-problem drinkers. The problem drinkers and non-problem drinkers, relative to the alcoholics, rated their social/celebratory reasons for drinking stronger than their personal-deficiency reasons. A multiple discriminant analysis yielded a function which was moderately successful in classifying the alcoholics (70% correctly classified) and non-problem drinkers (67%). The problem drinkers were much more difficult to correctly classify (32% were classified as alcoholic, 49% as non-problem drinkers). The findings suggest that potentially important differences exist in drinkers' motivations to consume alcohol, motivations that vary as a function of problem drinking severity. These are results which might productively be used in assessment and treatment endeavors.

Adult↗
PubMed1990

Alcohol use by alcoholics with and without a history of parental alcoholism.

The association between parental history of alcoholism and the nature of alcoholism was assessed using a more reliable measure of family history (Family Tree Questionnaire) and a more comprehensive inventory of alcoholism (Alcohol Use Inventory) than used in earlier studies. Parental alcoholism was associated with more severe alcoholism on most parameters of alcohol use (age of onset, quantity, frequency, preoccupation, and sustained use) and alcohol-related problems (social, vocational, physical, cognitive, and loss of control). The association between parental history of alcoholism and more severe alcoholism in the probands was independent of age of onset of alcoholism, current age, socioeconomic background, and marital status. Parental history positive (PH+) alcoholics were more reliant on alcohol to manage their moods but did not differ significantly from parental history negative (PH-) alcoholics in the use of alcohol to improve sociability or mental functioning or to cope with marital problems. Surprisingly, the degree of concern, guilt, and worry over the negative consequences of drinking was not significantly different for PH+ alcoholics although the negative consequences were clearly much more severe for this group. While the data are inconclusive about the reasons for more severe alcoholism in PH+ alcoholics, greater reliance on ethanol to manage moods and a relative insensitivity to negative consequences could theoretically account for the vulnerability to more severe alcoholism found in PH+ alcoholics.

Adaptation, Psychological↗
PubMed1989

Biases in relapse attributions made by alcoholics and their wives.

Although numerous studies have investigated the relapse attributions of alcoholics, few have considered the biases inherent in such attributions. Two sources of bias were investigated in the relapse attributions of 26 alcoholic men and their wives: the passage of time and actor-observer perspective. As predicted: (a) Wives made more dispositional attributions than their husbands (an actor-observer difference); (b) the attributions of the husbands showed a dispositional shift over time, while their wives' attributions showed no temporal effects; and (c) attributional concordance within couples increased over time. Several explanations for these results were considered and implications for couples therapy with recovering alcoholics and their spouses were discussed.

Adult↗
PubMed1989

Marital and family therapy in alcoholism treatment.

This synopsis of the outcome literature on marital and family treatment (MFT) drew three conclusions. First, intervening at the marital/family level with nonalcoholic family members can motivate an initial commitment to change in the alcoholic who is unwilling to seek help. Second, MFT alone, or with individual alcoholism treatment, produces better marital and/or drinking outcomes during the 6 months following treatment entry than methods that don't involve the spouse or other family members. The most promising MFT approach is behavioral marital therapy (BMT) that combines a focus on the drinking with work on other marital relationship issues via direct instigation of positive couple/family activities and teaching of communication and conflict resolution skills. Two BMT alcohol-focused methods have been used: a behavioral contract between alcoholic and spouse to maintain disulfiram ingestion; and "Alcohol-Focused Spouse Involvement," which rearranges reinforcement contingencies to decrease family behaviors that trigger or enable drinking and to increase positive reinforcement for sobriety. Third, studies of long-term maintenance suggest that BMT with an alcohol and relationship focus may reduce marital and/or drinking deterioration better than individual methods during long-term recovery. The following recommendations were made when to intervene at the level of the individual alcoholic only, at the marital/family level, or at both the individual and marital/family levels: (a) Intervene only at the individual level when the alcoholic refuses consent to contact family members or the family refuses involvement. (b) Include adult family members who live with the alcoholic in the assessment process for all who consent.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcoholism↗
PubMed1988

Alcoholics' attributions of factors affecting their relapse to drinking and reasons for terminating relapse episodes.

This study was designed to examine alcoholics' attributions about their relapses. The subjects were 36 male alcoholic participants in a study of the effectiveness of group behavioral marital therapy (BMT) for alcoholism. Subjects' treatment condition had been determined by random assignment to either the BMT, interactional marital therapy, or control group. At a two year posttreatment follow-up interview, subjects were asked what they thought the main reasons were for starting and stopping drinking in their two most recent relapses. Subjects' responses showed that both interpersonal and psychological factors were perceived to affect relapses, with some treatment group differences in how relapses were viewed. Subjects reported a variety of factors in their stopping drinking, with anticipation of negative consequences the most frequently reported reason. The treatment groups did not differ on their attributions for relapse termination. The results were interpreted as replicating and extending previous studies of relapse among alcoholics by showing the importance of spouse and other family members in subjects' attributions of relapse and their termination.

Adult↗
PubMed1988

Alcoholic and spouse concordance on attributions about relapse to drinking.

The purpose of this paper is to report a descriptive study of the degree of concordance between male alcoholics' and their wives' perceptions of the alcoholics' relapse to drinking within two years of their participation in an outcome study of behavioral marital therapy for alcoholism. At the end of a two-year follow-up period, the 23 alcoholics who had relapsed and their wives were independently interviewed. The results showed that both the alcoholics and their spouses reported both intrapsychic and situational determinants of the relapses. Among types of determinants, the situational spouse was reported disproportunately more often by patients and disproportunately less often by spouses. Furthermore, the concordance between patient and spouse reports was low. Use of these findings for marital therapy in the treatment of alcohol abuse is discussed.

Alcoholism↗
PubMed1987

Experience with alcohol and the endogenous opioid system in ethanol analgesia.

This study employed naloxone, an opiate antagonist, to explore whether a learned opioid response, mediated by drinking experience, accounts for ethanol and placebo analgesia. Cold pressor pain was evaluated before and after ethanol (0.5 g/kg), placebo, and no-alcohol control treatments (administered in randomized order) and again after double-blind administration (6 mg/kg) of naloxone to 11 men and saline to 9. A triple interaction of treatments, antagonist conditions, and drinking experience indicated that naloxone as compared to saline diminished ethanol and placebo analgesia among experienced drinkers but had opposite effects among the same men in the control treatment. Six men, who reported that the injection of naloxone had an effect on pain, had higher drinking experience scores than the five men who reported naloxone had no effect. The similar pattern of response to both the alcohol and the placebo treatments suggests that the opioid system response to alcohol is learned.

Adult↗
PubMed1987

Inpatient treatment of alcoholism: a behavioral approach.

After detoxification has been completed (if needed), a comprehensive assessment of the individual patient's drinking and other problems is the first step in inpatient behavioral treatment of alcoholism. On the basis of the assessment results, treatment is planned and delivered in an individualized manner to achieve three major goals. The first goal of treatment is to facilitate and consolidate the patient's commitment to change by carefully reviewing the evidence from the assessment of negative consequences of the patient's drinking. Alcohol education about the long-term negative consequences of drinking and the use of a decision matrix to clarify the patient's reasons for not drinking also are useful in this regard. The second goal is to stabilize the change in the drinking that occurred when the patient decided to enter the inpatient treatment program. Aversion therapy to decrease desire for alcohol, teaching alternative skills to deal with likely precipitants of renewed alcohol use, and strengthening behaviors incompatible with alcohol abuse all can be used to help maintain abstinence. Antabuse (including behavioral contracting procedures to increase compliance with this drug), along with psychotropic medication for additional psychopathology, are pharmacological interventions that often can be used to stabilize change. A final very important goal is the careful planning of aftercare and post-discharge life to help maintain the changes started during inpatient treatment. A case is presented to illustrate the above notions.

Alcohol Drinking↗