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Management of Patients with Alcohol Dependence in Recovery: Options for Maintenance and Anticipating and Managing Relapse in Primary Care

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Addressing Unhealthy Alcohol Use in Primary Care

Abstract

In this chapter we focus our discussion on the challenges primary care clinicians face while identifying those in recovery and facilitating maintenance of sobriety (or at least low risk drinking) in patients with urgent, early, or longer-term recovery from alcohol dependence. We review specific techniques that primary care clinicians can use to help patients with alcohol-related problems and recent studies of technology-based interventions and patient outreach that can be integrated into the primary care patient-centered medical home [(1) Friedmann PD, Saitz R, Samet JH. Management of the patient recovering from alcohol or other drug problems. Relapse prevention in primary care. JAMA. 1998;279;1227–1231. (2) Friedmann PD, Charuvastra A, Herman DS, Dube C, DeSantiago S, Freedman S, Stein MD. PRIMECare. Promote Recovery in Medical Care. A Guideline for the Maintenance Care of Medical Patients in Recovery from Alcohol Abuse or Dependence. Providence: Division of General Internal Medicine, Rhode Island Hospital, 2001.].

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References

  1. Friedmann PD, Saitz R, Samet JH. Management of the patient recovering from alcohol or other drug problems. Relapse prevention in primary care. JAMA. 1998;279:1227–1231.

    Article  PubMed  CAS  Google Scholar 

  2. Friedmann PD, Charuvastra A, Herman DS, Dube C, DeSantiago S, Freedman S, Stein MD. PRIMECare. Promote recovery in medical care. A guideline for the maintenance care of medical patients in recovery from alcohol abuse or dependence. Providence: Division of General Internal Medicine, Rhode Island Hospital; 2001.

    Google Scholar 

  3. Robins LN, Helzer JE, Weissman MM, et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry. 1984;41:949–958.

    Article  PubMed  CAS  Google Scholar 

  4. Buchsbaum DG, Welsh J, Buchanan RG, Elswick RK. Screening for drinking problems by patients self-report. Even “safe” levels may indicate a problem. Arch Intern Med. 1995;155:104–108.

    Article  PubMed  CAS  Google Scholar 

  5. O′Connor P, Samet J. Prevalence and assessment of readiness for behavioral change of illicit drug use among primary care patients [Abstract]. J Gen Intern Med. 1996;11 Suppl:53.

    Google Scholar 

  6. Samet J, Vega M, Nuciforo S, Williams C. Assessment of readiness for behavioral change of substance abusers in primary care [Abstract]. J Gen Intern Med. 1995;11 Suppl:53.

    Google Scholar 

  7. Sobell LC, Cunningham JA, Sobell MB. Recovery from alcohol problems with and without treatment: prevalence in two population surveys. Am J Pub Health. 1996;86:966–972.

    Article  CAS  Google Scholar 

  8. National Institute on Alcohol Abuse and Alcoholism. The physician′s guide to helping patients with alcohol problems. NIH Publication No. 95-3769. Washington, DC: National Institutes of Health; 1995.

    Google Scholar 

  9. Allen JP, Anton R. Biomarkers as aids to identification of relapse in alcohol treatments. In: Galanter M, editor. Recent developments in alcoholism: Volume 16 research on alcoholism treatment. New York: Kluwer; 2003.

    Google Scholar 

  10. Kristenson H, Ohlin H, Hulten-Nosslin M, Trell E, Hood B. Identification and intervention of heavy drinking in middle-aged men: results and follow-up of 24–60 months of long-term study with randomized controls. Alcohol: Clin Exp Res.1983;7:203–209.

    Article  CAS  Google Scholar 

  11. Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York: Guilford; 1991.

    Google Scholar 

  12. Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. 2nd ed. New York: Guilford; 2002.

    Google Scholar 

  13. Barnes HN. Addiction, psychotherapy, and primary care. Subst Abuse. 1995;16:31–38.

    Google Scholar 

  14. Aalto M, Seppa K. Usefulness, length and content of alcohol-related discussions in primary health care: the exit poll survey. Alcohol Alcohol. 2004;39(6):532–535.

    PubMed  Google Scholar 

  15. Saitz R, Horton NJ, Cheng DM, Samet JH. Alcohol counseling reflects higher quality of primary care. JGIM. 2008;23(9):1482–1486.

    Article  PubMed  Google Scholar 

  16. Kirshenbaum AP, Olsen DM, Bickel WK. A quantitative review of the ubiquitous relapse curve. J Subst Abuse Treat. 2009; 36, 8–17.

    Article  PubMed  Google Scholar 

  17. Zywiak WH, Stout RL, Longabaugh R, Dyck I, Connors GJ, Maisto SA. Relapse onset factors in project MATCH: the relapse questionnaire. J Subst Abuse Treat. 2006;31:341–345.

    Article  PubMed  Google Scholar 

  18. Zywiak WH, Westerberg VS, Connors GJ, Maisto SA. Exploratory findings from the reasons for drinking questionnaire. J Subst Abuse Treat 2003;25:287–292.

    Article  PubMed  Google Scholar 

  19. Alcoholics Anonymous. Living sober. New York: Alcoholics Anonymous World Services; 1975.

    Google Scholar 

  20. Alcoholics Anonymous. Twelve steps and twelve traditions. New York: Alcoholics Anonymous World Services; 1952.

    Google Scholar 

  21. Nowinski J, Baker S, Carroll K. Twelve step facilitation therapy manual: a clinical research guide for therapists treating individuals with alcohol abuse or dependence. National Institute on Alcohol Abuse and Alcoholism Project MATCH monograph series, DHHS publication no. (ADM) 94-3722. Washington, DC: Superintendent of Documents, U.S. Government Printing Office; 1995.

    Google Scholar 

  22. Wallace BC. Psychological and environmental determinants of relapse in crack cocaine smokers. J Subst Abuse Treat. 1989;6:95–106.

    Article  PubMed  CAS  Google Scholar 

  23. Marlatt GA, Gordon JR, editors. Relapse prevention: maintenance strategies in the treatment of addictive behaviors. New York: Guilford; 1985.

    Google Scholar 

  24. Flitcraft AH, Hadley SM, Hendricks-Matthews MK, McLeer SV, Warshaw C. American Medical Association diagnostic and treatment guidelines on domestic violence. Chicago: American Medical Association; 1994.

    Google Scholar 

  25. Gorski TT, Miller M. Staying sober workbook. Independence: Independence Press; 1988.

    Google Scholar 

  26. Connors GJ, Longabaugh R, Miller WR. Looking forward and back to relapse: implications for research and practice. Addiction. 1996;91 Suppl:S191–S196

    Article  PubMed  Google Scholar 

  27. DeJong W, Finn P, Grand J, Markoff LS. Relapse prevention. Clinical report series. DHHS Pub. No. (ADM)93-3845. Washington, DC: Superintendent of Documents, US Government Printing Office, National Institute on Drug Abuse; 1994.

    Google Scholar 

  28. Norcross JC, Koocher GP, Fala NC, Wexler HK. What doesn′t work? Expert consensus on discredited treatments in the addictions. J Addict Med. 2011;4:174–180.

    Article  Google Scholar 

  29. Hoffmann NG, DeHart SS. Committee on benefits project: working toward clinically effective and cost efficient treatment. Providence: National Council on Alcoholism and Drug Dependence and the Brown University Center for Alcohol and Addiction Studies; 1996.

    Google Scholar 

  30. Hirshfeld RMA, Russell JH. Current concepts: assessment and treatment of suicidal patients. N Engl J Med. 1997;337:910–915.

    Article  Google Scholar 

  31. Zywiak WH, Stout RL, Connors GJ, Maisto SA, Longabaugh R, Dyck I. Factor analysis and predictive validity of the Relapse Questionnaire in Project MATCH. In: Zywiak WH, Westerberg VS (Chairs), New perspectives on relapse and treatment outcome from the Replication and Extension Project and Project MATCH. Symposium at the Annual Meeting of the Research Society on Alcoholism, Montreal, QB, 2001

    Google Scholar 

  32. Gorski TT. Relapse—issues and answers. Addiction Recovery. 1991;3:17–18.

    Google Scholar 

  33. McLellan A, Luborsky L, Woody G, O′Brien C, Druley K. Predicting response to alcohol and drug abuse treatments. Role of psychiatric severity. Arch Gen Psychiatry. 1983;40:620–625.

    Article  PubMed  CAS  Google Scholar 

  34. Rounsaville BJ, Dolinsky Z, Babor T, Meyer R. Psychopathology as a predictor of treatment outcome in alcoholics. Arch Gen Psychiatry. 1987;44:505–513.

    Article  PubMed  CAS  Google Scholar 

  35. Connors GJ, Maisto SA, Zywiak WH. Understanding relapse in the broader context of post-treatment functioning. Addiction. 1996;91 Suppl:S173–S19.

    Article  PubMed  Google Scholar 

  36. Ziedonis D, Brady K. Dual diagnosis in primary care. Detecting and treating both the addiction and mental illness. Med Clin N America. 1997;81:1017–1036.

    Article  PubMed  CAS  Google Scholar 

  37. Mason BJ, Kocsis JH, Ritvo EC, Cutler RB. A double-blind, placebo-controlled trial of desipramine for primary alcohol dependence stratified on the presence or absence of major depression. JAMA. 1996;275:761–767.

    Article  PubMed  CAS  Google Scholar 

  38. Ziedonis DM, Kosten TR. Depression as a prognostic factor for pharmacological treatment of cocaine dependence. Psychopharm Bull. 1991;27:337–343.

    CAS  Google Scholar 

  39. Saitz R, O′Malley SS. Pharmacotherapies for alcohol abuse. Med Clin N America. 1997;81:881–907.

    Article  PubMed  CAS  Google Scholar 

  40. Anton RF, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2003;295(17):2003–2017.

    Article  Google Scholar 

  41. Monti PM, Kadden RM, Rohsenow DJ, Cooney NL, Abrams DB. Treating alcohol dependence: A coping skills training guide. 2nd ed. New York: Guilford; 2002.

    Google Scholar 

  42. McKay JR. Treating substance use disorders with adaptive continuing care. Washington, DC: American Psychological Association; 2009.

    Book  Google Scholar 

  43. Mark TL, Dilonardo JD, Chalk M, Coffey RM. Factors associated with receipt of treatment following detoxification. J Subst Abuse Treat. 2003;24: 299–304.

    Article  PubMed  Google Scholar 

  44. Zywiak WH, Stout RL., Schneider R., Shepard D, Swift RM. Case monitoring following detoxification: 1-year clinical outcomes. [Abstract]. Alcohol: Clin Exp Res 2007;31(6) Suppl:271A.

    Google Scholar 

  45. Lynch, KG, Van Horn D, Drapkin M, et al. Moderators of response to telephone continuing care for alcoholism. Am J Health Behav. 2010:34(6):788–800.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Primary Care and Hospitalist Services, Providence VA Medical Center, Providence, RI, USA

    Thomas J. Doyle

  2. Warren Alpert Medical School of Brown University, Providence, RI, USA

    Thomas J. Doyle

  3. Research Service, Providence VA Medical Center, Providence, RI, USA

    Peter D. Friedmann

  4. Division of General Internal Medicine, Rhode Island Hospital, Providence, RI, USA

    Peter D. Friedmann

  5. Health Services, Policy & Practice, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Peter D. Friedmann

  6. Decision Sciences Institute, Pawtucket, RI, USA

    William H. Zywiak

  7. Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA

    William H. Zywiak

Authors
  1. Thomas J. Doyle
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  2. Peter D. Friedmann
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  3. William H. Zywiak
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Correspondence to Thomas J. Doyle .

Editor information

Editors and Affiliations

  1. , Section of General Internal Medicine, Boston Medical Center, Massachusetts Avenue, 2nd Floor 801, Boston, 02118-2335, Massachusetts, USA

    Richard Saitz

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Doyle, T., Friedmann, P., Zywiak, W. (2013). Management of Patients with Alcohol Dependence in Recovery: Options for Maintenance and Anticipating and Managing Relapse in Primary Care. In: Saitz, R. (eds) Addressing Unhealthy Alcohol Use in Primary Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4779-5_8

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  • DOI: https://doi.org/10.1007/978-1-4614-4779-5_8

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