The study, published in the Journal of the American Academy of Child and Adolescent Psychiatry and led by Dr. Patricia Conrod, looked at 2,506 adolescents with a mean age of about 14, and asked questions that assess risks for substance abuse with regards to impulsive behavior, sensitivity to anxiety, feelings of hopelessness, and sensation seeking. Of the students, 1, 159 were identified as being at high risk for substance abuse. Of these students, 624 went through an intervention, and 384 did not receive an intervention.

The interventions were two 90-minute group sessions that were held by education professionals who underwent a rigorous 3-day workshop and supervision. Although the interventions, called the Adventure Trial, are designed to analyze mental health symptoms, academic achievement, and substance abuse over a two-year period, the authors focused on six-month outcomes of binge drinking and alcohol-related problems.

Study author and trial coordinator Maeve O’Leary-Barrett said that the interventions significantly decreased the risk of drinking alcohol after six months. Those who didn’t receive the interventions were 1.7 times more likely to drink alcohol than those who received the intervention.

Those who received the interventions also reported lower binge-drinking rates among those who initially reported alcohol use. Compared with those who didn’t receive the interventions, participants were 55% less likely to binge drink after six months. Those who were at high risk for substance abuse reported less alcohol use and fewer alcohol-related problems compared to those who didn’t receive interventions.

The authors conclude that their study suggests that school-based interventions may help youth who are at risk for substance abuse. This study is the first to look at the efficiency of personality-targeted interventions delivered by teachers.

Source: Science Daily, School-Based Intervention Successfully Lowers Drinking Rates in at Risk Children, August 30, 2010

Both programs address the challenges problem drinkers face, including environmental drinking cues and problems with motivation for replacing drinking with healthy activities such as a hobby or exercise.

The study’s lead author, Professor Miles Cox, said the results were very encouraging and show that people can curb their drinking habits with these two simple programs.

Both programs were found to significantly decrease weekly alcohol consumption and alcohol-related problems; increase participants’ confidence in avoiding drinking in risky environments; and increase drinkers’ motivation to curb their drinking habits.

The study, funded by the Economic and Social Research Council (ESRC) could change the way physicians treat people with alcohol problems.

Source: Bangor University, A LEAP Forward in Addiction Awareness and Control, July 30, 2010

Charles J. Neighbors recently led a group of researchers in examining the cost-effectiveness of different types of intervention for youth that enter emergency departments for alcohol-related injuries.

The study was initiated because interventions in the emergency department have been shown to be effective in preventing future youth alcohol involvement, and to reduce future alcohol-related injury. The study modeled the cost-effectiveness of different types of intervention.

The study looked at the cost-effectiveness of a motivational interviewing-based intervention relative to standard card. Standard care is considered offered when brief advice is given to the youth to stop alcohol-related risk behaviors.

The study compared average cost-effectiveness ratios between the two types of interventions. A cost-utility analysis was also completed to look at the incremental cost of motivational interviewing per quality-adjusted life year gained.

The researchers used microcosting methods to estimate the marginal costs of the two types of intervention (motivational interviewing and standard care) in addition to two methods of patient screening: standard questioning by emergency department personnel and a more proactive outreach by counseling staff.

The researchers investigated average cost-effectiveness rations for drinking and driving, injuries, vehicular citations and negative social consequences. The estimates of marginal effect of motivational interviewing in reducing drinking and driving, traffic fatality risk from drinking and driving youth, and national life tables were used to find the societal costs saved per year by motivational interviewing.

These results were compared with those found for standard care. The researchers used national databases to approximate alcohol-attributable traffic fatality risks.

The study found that invention costs per participant were $81 for standard care, $170 for motivational interviewing with standard screening, and $173 for motivational interviewing with proactive screening.

The researchers found that the cost-effectiveness was better for motivational interviewing than standard care across all study outcomes, and that cost-effectiveness was better for men than women.

The results of the study indicate that the benefit of using brief intervention was a good societal investment. The societal cost per quality-adjusted life year of using motivational interviewing was $8,795. The cost of adopting brief intervention was a better investment than the other options available to emergency departments.
 

The qualities of a "teachable moment" are complicated, said Emily C. Williams, research project director at the VA Puget Sound Health Care System and corresponding author for the study. "On one hand, it may be the first time that a patient realizes that their drinking is responsible for a very serious illness or event requiring acute hospital care," she said. "On the other hand, there are people who continue to drink heavily despite knowing the consequences associated with it. For the former group, hospitalization may serve as a strong impetus of change whereas, for the latter group, hospitalization may be met with a neutral attitude (or worse) toward change."

This is an important issue to address because of the large number of patients and substantial healthcare resources that are involved, added Daniel Kivlahan, director of the Center of Excellence in Substance Abuse Treatment and Education at the VA Puget Sound Health Care System, and associate professor in the department of psychiatry and behavioral sciences at the University of Washington.

"Most providers in inpatient medical settings will see patients similar to those sampled for this study, and we need more evidence about better ways to recognize and address the clinical needs of this diverse group of patients," said Kivlahan. "Hospitalizations need to be considered part of the continuum of integrated healthcare with implications for post-hospital follow-up, rather than isolated events."

Researchers recruited 341 adult medical inpatients from a university medical center (242 men, 99 women) — who self-reported "risky drinking" during the previous month — based on their initial hospital screening. Participants were then enrolled in a randomized trial of brief alcohol counseling, and interviews were conducted at enrollment as well as three months after hospitalization. Information on five measures of physical health was gathered, and compared to two outcomes: abstinence and number of heavy drinking days three months later.

"We found that among inpatients with unhealthy alcohol use whose drinking is less severe — those not dependent on alcohol and those reporting low levels of problem perception — alcohol-attributable illness may serve as a strong catalyst of changes in drinking," said Williams. "As such, alcohol-attributable illnesses could become a focus of hospital-based brief counseling interventions.

"This study provides an important alert to providers that they should not assume that patients recognize a link between their alcohol use and their alcohol-related medical diagnoses," said Kivlahan. "Although most patients may be aware of this link that is typically obvious to providers, a small subset of patients may benefit from having it addressed directly during the hospitalization."

Both Williams and Kivlahan noted the relevance of these findings for helping providers recognize a need for conversation about ways to improve hospital-based brief interventions for patients with unhealthy alcohol use.

"This study offers suggestions regarding the content of hospital-based brief interventions," said Williams. "If physical health is important to the patient, and they see the connection between physical health and their drinking, counseling interventions that make sure to include covering such topics could make the interventions more effective. Also, if the patient links his/her drinking with his/her physical health, they may be willing to follow-up with care in settings where medical and alcohol care are integrated, which could lead to improved outcomes."

"For clinicians, it is worth noting that most of these patients at risk due to unhealthy alcohol use did not have alcohol-attributable medical diagnoses, and only 15 percent had such a diagnosis listed as the primary reason for admission," said Kivlahan.

"Further, even though more than one in five reported abstinence at a three-month follow-up, this was not reliably associated with self-reported worse health after other explanatory variables were considered. Thus, we can see that medical hospitalization is not a sufficient factor to eliminate heavy drinking for many patients. We need to replicate these results under circumstances more similar to clinical practice and with larger samples in the subgroups of interest."

John W. Kindt, professor of business administration at the College of Business at the University of Illinois, called it a major development.

"Gambling interests have been financing so-called studies for many years," he said, "trying to ensure that this is not listed as an addiction,” he said, adding that in 1994 the American Medical Association passed a resolution that showed the medical cost of gambling addictions was $40 billion annually. That would amount to $200 to $300 billion in medical costs to taxpayers and insurance companies by today’s standards.

Representatives of the gambling industry are downplaying the changes in the DSM. Chad Hills, gambling analyst with Focus on the Family Action, said gambling proponents have tried to hide the importance of the change "for a long time."

"For the DSM to actually come out and classify it as such is going to make the industry have to dance a little bit," he said. "Manufacturers of gambling machines and casino operators may now have to assume greater responsibility for the damages their products cause."
 

A comparison of the effects of two interventions on DWI recidivists with alcohol problems found that one—Brief Motivational Interviewing (BMI)—was more effective. Results will be published in the February 2010 issue of Alcoholism: Clinical & Experimental Research.

"Traffic crashes contribute more to morbidity in teenagers and young adults than any other cause, and DWI contributes to about a third of the overall toll," explained Thomas G. Brown, assistant professor in the department of psychiatry at McGill University and principal investigator for the study.

"In dollar terms on a yearly basis, total estimated loss due to DWI is estimated at five percent of the gross national product of Canada. This is a staggering figure, associated with a huge amount of personal suffering and loss, and is all the more tragic given that DWI is preventable,” Brown said.

Sandra C. Lapham, senior scientist and director of the Behavioral Health Research Center of the Southwest in Albuquerque, New Mexico, said the problem is equally huge in the United States.

"Approximately 1.5 million people are arrested in the U.S. each year for this crime," she said. "About one in three to one in five convicted offenders will repeat the offense, and repeat offenders are more likely than other drivers to cause alcohol-related crashes."

"While probably the majority of drivers who are arrested and ultimately convicted for DWI will take appropriate measures to not drive again after recent use of alcohol and drugs, so-called DWI recidivists contribute to a disproportionate amount of the carnage occurring on our roads," said Brown.

"As well, many recidivists do not participate in the DWI evaluation and remedial programs that are an obligatory part of regaining their licenses in most jurisdictions. Unfortunately, there is relatively little research about these individuals’ characteristics and the measures that could be taken to reduce their risk, as most research is conducted with drivers who are participating in intervention programs."

Brown and his colleagues divided 184 male and female recidivists with drinking problems and not currently engaged in DWI intervention into two groups: 92 (86 men, 6 women) received a 30-minute BMI session, a brief but powerful psychosocial intervention where the client was encouraged to review personal reasons for change; 92 (79 men, 13 women) received a 30-minute "control" intervention, where the client received information about the hazards of excessive drinking related to health and DWI. Outcomes measured at six- and 12-month follow-ups included percent of risky drinking days in the preceding 6 months, biomarkers of alcohol abuse, and alcohol abuse-related behaviors.

"The drivers we studied may be among the most dangerous drivers, what some authorities call ‘hardcore drunk drivers,’" said Brown. "We figured that an intervention tailored to their specifications would have to be very brief, something that could be applied opportunistically, say at the time of a court appearance. Our results indicated that BMI, compared to the control procedure, was superior in reducing by around 30 percent the number of risky drinking days for up to a year after receiving the intervention. A risky drinking day is when an individual drank enough on a given day that he or she would probably be impaired if they were to drive shortly after."

As for why the BMI intervention was more effective than the control intervention, Lapham responded: "We all have inner conflicts, but these conflicts between how we act and how we would like to be are sometimes not obvious to us. BMI techniques expose these conflicts and allow the person to be more aware of how their harmful alcohol use is at odds with their self image; in other words, how their behavior sabotages their own personal goals for the future. Some interventions try to lead the person into setting goals developed by the therapist, whereas BMI allows the person to fashion his or her own agenda: uncover their own reasons, and motivations, for changing, and set their own goals."

"What is new here is that this may be the first published report of a beneficial effect of a very brief version of MI with individuals who are not in a clinical setting, not particularly motivated to reconsider their drinking (as an individual in an emergency room following an injury might be), and who are generally considered to be hardcore drunk drivers. Nonetheless, the results underscore how, in the right hands, even very brief psychosocial interventions can have important and enduring effects in individuals who are often seen as impervious to change,” said Brown.

He added that encouraging the DWI offenders to participate was rather easy: offering a monetary incentive of about $70, which not only illustrated the power of "immediate positive rewards" but also seemed like a reasonable investment in the name of public safety.

"We need to remember that these repeat offenders reported…drinking 23 to 24 drinks per week, indicating a need to cut down on drinking for both health and public safety reasons," said Lapham.

"The take-home message here is that brief interventions—which can be administered in a health-care provider’s office during a routine visit, and in a variety of other settings—can be very effective tools for helping people change their harmful drinking patterns, changes that can persist for long periods. That said, the most important comparison has not been done yet. The authors are following up to determine what changes, if any, occur in the drinking and driving arrest statistics over time, and whether re-arrest rates will differ between the two groups."

According to the Chicago Sun-Times, a longtime friend of Lohan’s says yet another attempt at convincing Lohan to return to rehab was derailed this past weekend.

“The only problem was, she saw David Trent [a close friend of her father, Michael Lohan] and immediately bolted,” said the source.

The attempted intervention took place during a party at the West Hollywood home of shipping heir Stavros Niarchos in the wee hours of Friday morning—Paris Hilton and her sister, Nicky, were also in attendance, but they were not involved in the attempted intervention, which took place in another part of the Niarchos house.

At nearly 7:00 am, several friends tried to get Lohan alone in a private area, but Lohan quickly departed after spotting her father’s friend, according to the source.

Though Lohan spent nearly five hours partying at the Niarchos house, “She kept moving from room to room…She was clearly hyped-up on more than just booze. It was impossible to corner her, until a few people tried to—in a bathroom when it was nearly dawn,” added the source, who seemed deeply concerned about Lohan.

Reportedly, Lohan’s former girlfriend Samantha Ronson has tried to talk the actress into getting help with her addiction, as did Lohan’s friend Courtney Semel, who recently left rehab and attempted to talk to Lohan about getting help at a Hollywood party earlier in the week.

"I had a conversation with her, her mother and everyone…over the next couple of weeks I’m going to be doing things in a pretty public way," Michael told RadarOnline.com. "But (Lindsay’s mother) has got to get on the same page with me. It’s a serious situation. You can’t just talk about it and tell me that you want to do an intervention and then do nothing."

The Daily News’ Cristina Everett writes that Michael Lohan previously revealed that his daughter has been abusing prescription drugs.

"I’m going to get her off the prescription drugs that she’s on," he said. "I hate it when people talk about illegal drug abuse… because it’s not just drinking and illegal drugs that kill you. Prescription drugs can destroy and kill a person and are sometimes harder to stop. Look at Heath Ledger and Michael Jackson."

He added, "You know why Lindsay’s not acting in feature films right now? Because she can’t. Because the girl with all the talent is hidden and buried deep inside this fungus that’s grown because of the prescription drugs. She can’t be herself. When you hug her she’s like, vacant inside."

According to a source, the 23-year-old actress has been relying on a multitude of prescription medications, including Adderall (used to treat Attention Deficit Disorder), the anti-depressant Zoloft, and anti-anxiety and bi-polar drugs.

Despite the backlash from those who say Michael is betraying his daughter’s privacy by speaking to the media, he is confident in his parenting skills.

"When Lindsay doesn’t adhere or listen to what I say about serious situations, I feel I have to speak publicly to put pressure on her," he said. "If she doesn’t take my advice and do what I say…the more pressure I put on her, the more likely she is to eventually do the right thing."

The eight-episode series follows Goldstein as he tries to help addicts get sober. AM captures the addicts on camera to show them what they are doing to themselves and to their families. In a format similar to that of A&E’s “Intervention,” the show progresses to an intervention and the addict going to rehab.

Goldstein seemed in good spirits while trying to help Amy, who was willing to go to rehab after shooting up one last time in an airport. Throughout her rehab process, AM made frequent journeys to her treatment facility to show his support.

In a follow-up with Amy seven weeks after she completed her treatment—and after Goldstein’s death—she said he shouldn’t be remembered for the way he died. She said he gave her a chance to live and that she’ll be forever thankful.

But there is hope for the compulsive gambler. The process is called gambling intervention.

What Is Gambling Intervention?

Similar to intervention for alcohol or drug addiction, gambling intervention is a process that brings together a professional interventionist and a “team” of family, friends and co-workers with the express purpose of confronting an individual about their compulsive gambling behavior and convincing him or her to seek treatment immediately. The intervention is conducted in a controlled and logical way, focusing attention on changing the addict’s behavior.

Gambling interventions work best when a professional interventionist facilitates the process, as the intervention itself can get very intense. Violent or explosive reactions on the part of the gambling addict may result, and are very difficult, if not impossible, for those present to handle on their own. That’s where the interventionist’s skills and expertise really come into play. He or she works to defuse the intense emotions and bring the situation back into control.

|With the ultimate goal of getting the gambler to agree to go into treatment, all the arrangements for the treatment must be made prior to the actual day of the intervention. The reason for this is that a successful intervention concludes with the addict going off immediately into treatment – not the next day or next week, but that day. Once the gambler admits to having a problem and agrees to seek treatment, that’s the time to put the pre-planned admission into a gambling treatment program into action.

Expert interventionists know that you cannot convene an intervention and then not deliver on the promise to give hope to the problem gambler through a treatment program. Without a plan already set up, there’s nothing to prevent the addict from going right back to gambling.

What Happens In A Gambling Intervention?

Again, gambling intervention takes a page from interventions for drug and alcohol abuse. Since the premise behind the intervention is to make the addict aware of how much damage his or her actions have had on the various relationships – family, friends and co-workers – each individual participating in the intervention makes it clear how he or she has been personally affected by the gambler’s behavior. This often takes the form of reading from a letter the thoughts that the person has put together and practiced in a rehearsal the day before the actual intervention. Yes, there is a pre-intervention meeting of all the participants with the professional interventionist. During that meeting, the interventionist goes over the format and protocol for the intervention and each participant reads from his or her prepared letter in order to be prepared for the following day.

Besides explaining how the gambler’s behavior has affected them, each participant may also list specific incidents that highlight why the gambler needs treatment such as arrests, loss of a job, accidents, or family relationship breakdown. Often the family member, friend or workplace supervisor issue an ultimatum to the gambler. A boss may make returning to work conditional on the gambler’s receiving treatment. Family members or friends may make any future contact contingent on the gambler successfully completing treatment.

Make no mistake about it. Interventions are not easy to do. They’re emotionally exhausting, often eliciting very strong emotions on the part of the gambler and the participants. Team members must be prepared to convey their thoughts and any ultimatums in the kindest manner possible. Despite all the exhortations, screaming, denial and promises to quit from the gambler, the team members have to keep to their resolve. If the individual team members feel unable to deliver their ultimatum, the interventionist may deliver it for them.

Experts in interventions caution that young children should generally not be permitted to attend the session unless their contribution or presence is considered to be helpful to the gambling addict. This also applies to teenagers. As a practical matter, parents should be very careful about allowing any children to attend an intervention.

What Type Of Treatment Should Be Arranged?

This depends upon individual circumstances. The goal, remember, is to get the compulsive gambler into treatment. There are various treatment programs and help available to the gambling addict, including residential treatment, outpatient treatment, Gamblers Anonymous (GA), different therapy modalities or counseling or any combination of these.

Of all the treatment options, the one that works best is to remove the gambler from his or her environment, free of all the distractions and temptations and opportunity to gamble, and take them to a treatment center that specializes in treating compulsive gambling. Ideally this requires a facility that can provide a one-on-one approach that allows the gambler to dig deep into the root causes of his or her compulsion and to work toward learning new behaviors to overcome the addiction.

Since gambling affects many people beyond just the gambler, often the goal of the intervention is to get help for the family and concerned others as well. This may take the form of education, attendance at self-help groups, individual and/or group therapy or some other form of treatment that’s appropriate. Gam-Anon is one such group that offers support for family members and friends of compulsive gamblers.

After The Intervention

Once the compulsive gambler has gone off to treatment, participants in the intervention often feel an immense sense of relief. No, there’s no guarantee that the gambler will stay in treatment, or even fully commit to treatment, but there is one certainty: everyone’s addressed their concerns with the addict. There’s no more need for lies and deception. Now, everything’s out in the open relative to the individual’s addiction. Ultimatums may have been given that have some meaning to the addict.

• “If you don’t go into treatment, I will no longer have any contact with you.”

• “Either you accept treatment, or you no longer have a job.”

• “Although you’re my friend and I’d do anything for you, I won’t bail you out anymore. I’m not going to take your calls or see you if you don’t seek treatment.”

Family, friends and co-workers need to make plans for when the gambling addict returns from treatment. Just as an alcoholic cannot return to an environment where drinking occurs, or a drug addict can’t be around others who use drugs, the compulsive gambler can’t be exposed to gambling of any kind. This means no lotto, bingo, card playing – even for no wager – casinos, Internet gambling, sports or track betting.

Expect some difficult times, especially during periods of high stress or when something unexpected throws the recovering compulsive gambler for a loop. These may be financial, rejection by friends, family problems, physical or mental problems. The recovering compulsive gambler will continue to need your support during these situations. Encourage him or her to attend and participate in Gamblers Anonymous meetings. Make sure that you attend Gam-Anon or other support meetings yourself in order to better prepare you for how to deal with any crisis that occurs.

If Intervention Fails

It’s important to recognize that not everyone will be ready and able to accept that they need help. The compulsive gambler may not yet have hit bottom to the extent that he or she can even admit that they have a problem and need help. They may still be deluding themselves that they have everything under control, despite all the evidence to the contrary.

There isn’t much that you can do at this point. The compulsive gambler will sooner or later reach that lowest rung of hopelessness. Perhaps then they will accept an offer of help. Until that time, all anyone can do is to be ready to get the addict into treatment if and when the individual says yes.

How To Find A Gambling Treatment Facility

Resources are available to help you locate a treatment facility that can provide treatment for gambling addiction. One is the National Council on Problem Gambling, which also operates a 24-hour confidential hotline at 1-800-522-4700. In the state of California, there’s the California Council on Problem Gaming, and the California Department of Alcohol and Drug Programs, with information and links relative to problem gambling.

Get a referral to treatment facilities and then contact them to inquire about their gambling treatment programs. Many times, gambling addiction is a specialized track in the facility’s substance abuse treatment program. Make sure that the facility has nationally certified gambling counselors on its staff. If you are attempting to arrange a gambling intervention, be sure that the interventionist has expertise in conducting such interventions.

Above all, do gather as much information and educate yourself about all aspects of gambling addiction. This will prepare you for the hard work ahead, for the compulsive gambler and all those affected. The most important point to remember is that gambling addiction is treatable. You and your loved ones can be free of the negative consequences of compulsive gambling. There is hope – as long as the gambling addict seeks treatment.