We suggest you first read “How to Recognize a High-Functioning Alcoholic” to help you eliminate any denial or soft-pedaling by family members. The high-functioning alcoholic can be one of the most difficult to do an intervention on because denial is so strong.

Families often proceed with an alcohol intervention when the alcoholic has really done significant damage, such as been arrest for DUIs, ended up in the hospital, been in a car wreck, or has completely ruined their financial, professional, and family lives.

It’s different with the high-functioning alcoholic.

This person is often at the top of their profession, making good money, and managing to keep all those balls in the air despite their heavy drinking. They can be some of the toughest interventions because they will challenge you thus: If I’m such an alcoholic, why am I so successful at work?

A professional alcohol intervention is absolutely critical in getting any high-functioning alcoholic to see that he or she needs help. The professional interventionist will be very experienced in getting past this powerful denial. They will know exactly how to best get across the point that just because you’ve been getting away with it, doesn’t mean it’s not a problem.

An alcohol intervention is essential if the high-functioning alcohol you love is in a profession where impaired judgment can truly harm others – such as a doctor who could harm a patient, an attorney who could seriously undermine a legal case for a client, or a high-level executive who could make decisions that threaten jobs and livelihoods.

The high-functioning alcoholic is not as invulnerable to criticism as you might think at first glance. The professional interventionist will do a thorough pre-intervention and will likely come up with many ways to overcome denial. Certainly if you see a problem that is big enough to warrant looking into an intervention, it has more than likely been a problem for a while. Consequences might not be devastating yet, because the HFA often has the money and the power to hide behavior or make the consequences “go away.” But consequences do eventually pile up for everyone.

Typically the cracks in the armor begin appearing when the alcoholic begins to harm family members. Maybe he gets arrested for drunk driver or embarrasses himself at a work event; maybe she makes poor choices while intoxicated, such as an affair; maybe he develops some health problems such as stomach or liver problems. While the HFA can hide the problem at work, the spouse usually gets the brunt of the bad behavior, and divorce is often one of the signs that the behavior is out of control.

The best way to do an alcohol intervention on a high-functioning alcoholic is to hire a very successful interventionist who has a long history of doing difficult or high-end (such as celebrity) interventions. They will understand the denial, the ego, and the obstacles that can undermine an intervention.

In fact, binge drinking is a serious problem on college campuses across America. It’s also something that your own son or daughter may be involved in, whether you want to admit it or not.

How can you deal with the reality of binge drinking, casual or chronic drug use when it comes your offspring? Better yet, what can or should you do about it? Here we take a look at some important things every parent of a college-age son or daughter need to know.

College Students Drink, But Not All Drink to Excess

First of all, let’s be clear about one thing: not every college student drinks, or, if he or she does, it’s not to excess. But there is no denying that drinking and drug use are rampant across college campuses.

Parents also may have a lot of misinformation and misperception about what’s really going on with their son or daughter. What we may consider to be "normal" drinking may or may not be appropriate in the context of our sons and daughters away at school, or even living at home and going to college.

When we’re able to separate the myths from reality, we have a better likelihood of being able to construct meaningful conversations with our offspring about drinking and, if necessary, arrange for an intervention to get help for their out-of-control abuse of alcohol and/or drugs.

Drinking Problems: Depend on How Much and How Frequent

If someone drinks only occasionally and doesn’t overdo it, it is likely that he or she does not have a problem with alcohol. The same may or may not hold true for drug use, since there are certain drugs that, alone or taken in combination with alcohol, can prove deadly with a single episode.

Frequency of alcohol intake is one measure of drinking. If your son or daughter drinks every day, there may be a problem.

Quantity of alcohol consumed is another measure. If your son or daughter frequently binges, that is consumes five or more drinks in a row in a short period of time, there is clearly a problem with alcohol.

In short, frequency of binge drinking episodes is a fairly accurate indicator of risky drinking behavior among college students.

Heavy drinking is defined as binge drinking on at least five days in the past 30 days.

Statistics Tell Some of the Story

Looking at statistics, it’s possible to get a better picture of the rate of drinking and drug use among college students. But statistics, while they are informative, only tell part of the story. What happens with your own son or daughter may or may not be reflective of the overall statistics.

The 2010 National Survey on Drug Use and Health (NSDUH) (http://www.samhsa.gov/data/NSDUH/2k10Results/Web/PDFW/2k10Results.pdf), from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that alcohol abuse and dependence among those aged 18 to 25 is actually decreasing, from 17.7 percent in 2002 to 17.2 percent in 2008 and 16.0 percent in 2009.

But among college students, young adults aged 18 to 22 who were enrolled full-time were more likely than their peers not enrolled full-time to use alcohol in the past month, binge drink, and drink heavily. The 2010 statistics are particularly frightening. In 2010, among full-time college students, 63.3 percent were current drinkers, 42.2 percent were binge drinkers, and 15.6 percent were heavy drinkers. The pattern of higher rates of current alcohol use, binge alcohol use, and heavy alcohol use among full-time college students compared with rates for others aged 18 to 22 has remained consistent since 2002.

On the other hand, the current use of illicit drugs by young adults aged 18 to 25 increased from 19.6 percent in 2008 to 21.2 percent in 2009 and 21.5 percent in 2010, driven largely by an increase in marijuana use (from 16.5 percent in 2008 to 18.1 percent in 2009 and 18.5 percent in 2010). Marijuana remains the overarching illicit drug of choice.

Other illicit substances and prescription-type drugs misused and abused by young adults include pain relievers and cocaine. From 2009 to 2010, there was a decrease in the nonmedical use of prescription-type drugs by young adults aged 18 to 25 (from 6.3 to 5.9 percent). Cocaine use rates from 2009 and 2010 were similar, from 1.4 to 1.5 percent. Methamphetamine use rates were the same for 2009 and 2010, at 0.2 percent.

Looking at college students in particular, among those aged 18 to 22, the rate of current use of illicit drugs in 2010 among full-time college students (22.0 percent) was similar to the rate of others in that age group (23.5 percent), which includes part-time college students, students in other grades or types of institutions, and nonstudents.

Among full-time college students, marijuana usage increased from 2008 to 2009 (from 17.9 to 20.2 percent). In addition, current nonmedical use of psychotherapeutic drugs overall decreased to 5.0 percent in 2010, similar to the 5.2 percent in 2009, but down from 6.3 percent in 2008.

What to Look For: Danger Signs

Suppose you think you know your college-age son or daughter so well that you believe there is nothing to worry about. Then, when your child comes home for a holiday visit, you see signs that things have changed. It may be that the differences are just subtle, and you may tend to dismiss them as indications your child is growing up or distancing himself or herself from parental influence.

You may be making a big mistake.

Here are some danger signs to be on the lookout for, any one of which may spell a risk for drug and/or alcohol abuse that could require an intervention.

• Poor grades or school performance
• Irritability, sudden and/or unexplained
• Strained relationship with parents, siblings and non-college friends
• Financial difficulties
• Developing a high tolerance for alcohol, which leads to an increased need to drink more
• Developing a preoccupation for obtaining alcohol
• Withdrawing from some social and school activities in order to go out partying or to the bars more
• Getting involved in an accident while drinking
• Getting arrested for DWI or DUI
• Sudden or unexpected weight loss
• Redness of nose or cheeks
• Withdrawal symptoms when stopping drinking, including sweating, anxiety, shakes, nausea
• Blacking out or not remembering what happened while drinking
• Drinking in the morning
• Smell of alcohol on the breath
• Red eyes
• Change in appearance

For more information on the signs and symptoms of alcohol abuse and dependence, check out the Web MD site.

Will an Intervention Help?

Now, let’s say that you’ve noticed several signs that have you worried. What should you do? Will an intervention help? Is there time to get one going? Are you afraid you’ll risk antagonizing your son or daughter if you do arrange for an intervention?

Put this all in perspective. If your son or daughter began drinking before the age of 15, he or she is already engaged in a pattern of risky behavior that, without treatment, will likely result in alcohol dependence or addiction – if it hasn’t come to that already. Similarly, alcohol dependence and addiction frequently go hand-in-hand with other types of substance abuse, both illicit and the misuse of prescription drugs for nonmedical purposes.

The only way you’ll help your son or daughter to get off this vicious cycle of using, coming down, and using again is to encourage your child to get help to overcome the problem.

But most college-age young adults resent the heck out of anyone, especially their parents, trying to tell them they need help. They’ll deny that there’s any sort of a problem with drugs or alcohol, despite mounting negative consequences and obvious signs that there is something wrong.

So just having a discussion with your son or daughter about their drinking and/or drug use may not produce the desired effect. Your child may tell you whatever he or she thinks you want to hear and just as soon as they’re out the door and back at school, they’ll just resume their self-destructive pattern of behavior.

Of course, if your child has gotten into a serious scrape with the law or been kicked out of school for one reason or another, you’ll really have no choice but to deal with it.

Either way, whether you suspect a problem with alcohol or drug use, but your son or daughter denies it, or you know there is a problem and your child refuses to get help, you may wish to consider a professional intervention for your college student.

Intervention: What Is It and How Do You Go About Arranging One?

An intervention is a process by which change is introduced into people’s thoughts, feelings and behaviors. Interventions can be formal or informal, but they have one primary objective: to get the person to listen and accept help. The overall objective is to begin to relieve the suffering caused by the individual’s self-destructive behavior.

In a formal intervention, several people, including family members, loved ones and friends, led by a professional interventionist, get together to approach a person involved in self-destructive behavior, like out-of-control drug and/or alcohol abuse or dependence, and talk to them in a clear and respectful way about the behavior in question. There’s more to it, of course, but the bottom line is that the goal is to get the individual to admit to a problem with substance abuse and to agree to accept help to learn how to overcome it.

Many people are uncertain how to go about finding an interventionist. That’s not anything to be ashamed of. We only tend to find out about such things when we really need them.

You could start with the family doctor and ask for a recommendation. Maybe you know the parents of another college student who went through an intervention prior to going into treatment. If that worked out well, you might explore working with that interventionist or at least giving the individual a call to ask the kinds of questions you naturally have.

Treatment centers are another logical first step, since they may be able to provide counselors to help with an intervention. There are also third-party professional interventionists for hire. These are people who have been thoroughly trained in how to do an intervention.

Always be sure to check out the professional interventionist or intervention service. You want an interventionist with exceptional credentials, sterling references and a great deal of experience, specifically with doing interventions for college students. Check out the Association of Intervention Specialists to find a professional interventionist, all of whom are board registered interventionists and adhere to the AIS Code of Ethics.

Why not do the intervention yourself? For one thing, unless you’re a professional drug and alcohol interventionist, you aren’t properly equipped to handle the emotional aspects of the intervention. You may be swayed by tears and angry outbursts, feel a sense of shame or guilt about confronting your college-age son or daughter. Worst of all, you may back down and allow your son or daughter to continue behaving as before.

With a professional interventionist present, however, you can be assured that the meeting will take place according to evidence-based procedures. There will be a pre-meeting for family members and possibly close friends where everyone meets with the interventionist to go over what will take place during the actual intervention.

During the intervention itself, the interventionist’s sole purpose is to get your son or daughter to acknowledge that his or her abuse is a problem and to accept and be willing to go into treatment. During the meeting, family members and close friends read aloud statements that they have prepared ahead of time, telling your son or daughter how his or her drug or alcohol abuse has impacted them, that they are here out of love for the individual and only want him or her to get the treatment they need.

It’s also critically important that your college student son or daughter realize that there will be no more enabling of the drug or alcohol abuse by family members. Excuses will no longer be tolerated and there will be no further support unless and until the individual accepts treatment.

Once your college-age child agrees to go into treatment, the intervention is over. Arrangements for admission to a drug or alcohol rehab facility should already have been made and the interventionist often accompanies the individual directly to the facility. There’s no downtime, no delay to give your son or daughter an opportunity to back out. This is striking while the iron is hot, so to speak.

Prognosis for Recovery

Look upon the professional intervention as an important part of the healing process from drug or alcohol addiction.

Of course, one time in rehab for drug or alcohol abuse may not be sufficient to overcome chronic addiction. Your college-age son or daughter may relapse, requiring further counseling or treatment one or more times in a rehab facility or private counseling. This does not mean the original rehab was a failure. It only means that there may be more time required for your child to understand the disease of addiction, learn more about how to recognize triggers and learn and practice coping strategies for dealing effectively with cravings and urges.

Participation in 12-Step groups such as Alcoholics Anonymous, Narcotics Anonymous or other self-help groups is also strongly encouraged following completion of drug and alcohol rehab.

With continued support and encouragement from family and peer support groups, your college-age son or daughter will have a much better chance of maintaining sobriety and living a more fulfilling life. Don’t shortchange your child who may be in trouble with drugs and/or alcohol. The time to act is now if you believe there is, indeed, a problem. It is undoubtedly the most loving thing you can do to get your college-age child off drugs and alcohol and on the way to a happy and drug-free life.

Recognize the Opportunity

Sure, it’s natural to lament what you did or didn’t do as parents to warn your children about the dangers of drugs and alcohol. What you should have done is have early and frequent discussions about how damaging substance abuse can be, even prescription drugs used for non-medical purposes. What you should have done is establish family rules about no drug or alcohol use and clearly communicate them to your children. What you should have done is to keep the lines of communication open, listen to your children, and support them when the going gets rough or they’re subjected to intense peer pressure to experiment with drugs and alcohol.

But, even if you did do those things, that doesn’t mean that your teen might not fall prey to drug and alcohol abuse and addiction. Early experimentation often leads to more frequent use which then can become abuse and finally dependence or addiction.

No use to cry over what might have been. Now is the time to recognize that you have an opportunity, once you first spot the telltale signs of drug or alcohol use. You can take steps to address this problem right here and now and get the appropriate help for your teen.

What is that help? It is in the form of a teen intervention.

Telltale Signs of Drug or Alcohol Abuse

Before we discuss the specifics of a teen intervention, it’s a good idea to recap some of the common signs, those telltale and unmistakable signs, that your teen is fooling around with drugs or alcohol. Maybe your teenager doesn’t exhibit all the signs, but does show a good number of them on a regular basis. That’s enough for concern and alerts you that there is, indeed, a problem with abuse going on here.

There are general signs of drug and alcohol use and more specific symptoms of abuse relative to certain types of drugs or alcohol in general.

General signs include the following:

• Grades drop dramatically. You’ve been accustomed to seeing a certain level of performance with your child, but suddenly your teen starts accumulating lower grades, even failing grades, in school.
• Skipping school becomes a frequent occurrence. It may begin with tardiness, an inability to get up in time to go to school and then progress to outright skipping classes completely.
• Mood changes become a regular thing. When your teen begins to display crying jags, or becomes depressed and moody to the point of days on end, this is a sign that there’s more going on than just typical teen emotions. Something’s out of whack.
• Your teen starts foregoing usual activities. Let’s say your teen loves being involved in after-school activities, playing in the band, taking part in sports, music or other activities. Then, one day, you notice that he or she isn’t doing any of these things anymore. Whatever your teen once enjoyed doing no longer is part of everyday activity. That’s not a good sign.
• You notice your teen’s appearance has changed. Teens aren’t always the most immaculately groomed, but if you start to see that your child’s hygiene starts to suffer, or that there’s a dramatic weight loss or gain, or your teen adopts unusual fashion changes, this is a signal to pay attention to what else may be going on with your child.
• Friends suddenly change. Your teen has had a number of regular friends, pals he or she has hung around with for quite some time. Then, as if out of the blue, they don’t come around anymore. Maybe they’ve been replaced by new friends, some whom you’ve never met or even that your teen won’t introduce you to. What’s happened? There may be something to do with the new friends’ behavior involving drugs and alcohol that you need to be concerned about.
• Money goes missing from the home. If your teenager is getting deep into drugs and alcohol, it takes money to finance this behavior. When money or valuables go missing from the home, this is a telltale sign that the money is being used for something that your teen doesn’t want you to know about. It could very well be drugs or alcohol.
• Your teen exhibits secretive behavior. Every teen guards his or her privacy, but if your teen locks himself or herself in their room and doesn’t come out for hours, gets irate if you enter without knocking, or takes an inordinately long time to come to the door if you knock or call, it just might be a sign that there are things your child is keeping from you.
• Your teen starts being hostile or aggressive. Sudden angry outbursts or outright aggressive behavior toward you or other family members is a definite warning sign that drugs or alcohol use may be going on.
• Motivation is lacking. When a teen is involved in drug or alcohol use, he or she will often become listless, not caring to do much of anything, certainly nothing that requires pursuing goals or exerting effort to achieve. That is, unless the goal is scoring drugs or alcohol. If your teen is abusing substances, this is one of the only things that may get him or her motivated.
• Your child can’t seem to remember things. Forgetfulness is another general telltale sign of drug or alcohol use. Once in a while is normal for every teen. After all, they’re going through a lot of changes. But if your teen can’t remember on a regular basis or seems to “forget” important things like assigned household tasks or family rules, there’s something wrong.
• Your teen’s sleeping habits change. Maybe it’s a gradual change that you begin to notice or it could occur suddenly and without warning, but if your child’s sleeping habits dramatically change, this is a sign that should be concerning to you. Either sleeping much too long or not sleeping well or at all is a sign of trouble.
• Your teen seems depressed. Depression, a state that persists for weeks without letup, is not a good sign. It could be a telltale sign that drugs or alcohol are in the picture.
• Your teen seems overly anxious. Certain drugs make the user extremely anxious, even paranoid, especially when the high wears off. Any frequent or prolonged anxiety is a trouble sign that could have something to do with drugs or alcohol or both.
• Something just doesn’t seem right about your teen. Maybe you can’t pinpoint exactly what it is, but you do know your child and you feel instinctively when something doesn’t seem right. If it doesn’t seem right, it probably means it isn’t right. Drug or alcohol use could be at the bottom of it.

Teen Intervention

What is teen intervention? Simply put, it is the coming together of family and friends, often with the guidance of a trained interventionist, to get the teen to the point of admitting he or she has a problem with drugs or alcohol and accepting treatment.

Some parents prefer to begin with a candid conversation with their teen about drug and alcohol use, particularly if the parents have witnessed several warning signs that their teen has been using substances.

But some teens have already progressed to an out-of-control behavior state where well-meaning parental discussions no longer have any impact. Often the only way to get through to your teen is through a professional intervention.

Early Teen Intervention Can Help Prevent Years of Addiction

Does a teen intervention seem like overkill? Do you think that an intervention is only right for skid row bums or stone alcoholics or drug addicts who’ve been arrested for DUIs, incarcerated for petty crimes, got fired from numerous jobs, lost their homes or families as a result of their substance abuse? If you think that, you’d be wrong.

The statistics about early drug and alcohol use among adolescents and teens are startling. Research studies have shown that the earlier a child begins experimenting with alcohol and drugs, particularly if it occurs before the age of 15, the more likely they are to go on to full-blown drug or alcohol use later in adulthood. They are at greater risk for addiction.

So, the earlier that your teen who has been abusing drugs or alcohol has an intervention that is handled in a professional manner, the sooner he or she – assuming that treatment is accepted – can get the help needed to be able to overcome the substance abuse.

According to some experts, there are four phases of drug or alcohol addiction that apply equally well to teens. Stages one and two are where teens experiment with and use drugs or alcohol in a social setting. During stage three, teens arrange their life around their drug and alcohol use and everything else goes by the wayside. In stage four, all the teen thinks about is getting high, and scoring drugs for the next high. Not surprisingly, intervention and treatment work best if they occur during the first two stages.

Don’t be fooled by your teen’s insistence that there’s nothing wrong, that he or she just tried drugs or alcohol once, or that they’ll never do it again. If they’ve exhibited several of the telltale warning signs of drug or alcohol abuse, they’re already deeply involved. You can’t take their word for it, because it’s not their brain that’s talking. It’s the drugs. Teens, just like adult substance abusers, will deny they have a problem. Some studies have found that most teens won’t seek help for a drug or alcohol problem until they’re in their 30s. By that time, however, their chemical dependence, which began while they were in high school, is problematic. In other words, it’s tougher to overcome substance abuse that’s become entrenched.

Even if your teen doesn’t want to go into treatment, as parents you can insist that this happens. Just because your teen may be against treatment doesn’t mean that he or she can’t benefit from treatment. A study at the University of California Los Angeles showing treatment outcomes among methamphetamine addicts who had been legally pressured into treatment was not dramatically different from those who entered treatment without any pressure.

What we, as parents, can take away from this is that the important thing is to get teens with substance abuse problems into treatment. How they feel before they go into treatment is not the determining factor over whether or not they’re helped by treatment.

How to Find a Teen Interventionist

If you’re at your wits end and nothing you’ve tried thus far has worked out with getting your teen to stop using drugs or alcohol and put some healthy behaviors back into his or her life, now may be the time to go for a teen interventionist. The question then becomes, how do you find one?

You could start with the family doctor and ask for a recommendation. Maybe you know the parents of another teen who went through an intervention prior to going into treatment. If that worked out well, you might explore working with that interventionist or at least giving the individual a call to ask the kinds of questions you naturally have.

Treatment centers are another logical first step, since they may be able to provide counselors to help with an intervention. There are also third-party professional interventionists for hire. These are people who have been thoroughly trained in how to do an intervention.

Always be sure to check out the professional interventionist or intervention service. You want an interventionist with exceptional credentials, sterling references and a great deal of experience, specifically with doing teen interventions. Check out the Association of Intervention Specialists to find a professional interventionist, all of whom are board registered interventionists and adhere to the AIS Code of Ethics.

What to Expect in the Teen Intervention

There’s more to the teen intervention that simply the family and the interventionist sitting down with the teen. There’s pre-intervention planning and work, the actual intervention, getting your teen to the right treatment facility that specializes in treating teens with substance abuse problems, monitoring the treatment and developing an after-care program. Some recovery experts recommend that parents choose an interventionist with case management experience.

During the actual intervention, there will be a lot of open discussion, tears and brutal honesty, as well as tough love on the part of family and close friends. Your teen may at first be outright hostile, resentful, or even try to run away, either literally or by distancing himself or herself emotionally. This is quite normal behavior during a teen intervention. In any case, whether the person for whom the intervention is being conducted is a teen or an adult, this is a highly-charged emotional time.

It is also a crucial time for your teen. It may be the best chance your teen has to get the help that he or she so desperately needs but doesn’t know or believe it yet.

The ultimate goal of the teen intervention is that your teen accepts and goes into treatment. The best scenario is that the interventionist or other “escort” literally accompanies your teen to the treatment facility, ideally a residential drug and alcohol rehab facility that specializes in treating teens with substance abuse problems. Many times transportation this is by car, although in the cases where the treatment facility is in a distant city or another state, a plane or train trip may be required. The reason why it’s best for your teen to immediately go into treatment is that this is striking while the iron is hot, so to speak. Once your teen says, “Yes,” the object is to get your teen into treatment.

Delay can cause all sorts of other perceived obligations or obstacles to get in the way. You don’t want that. Although it may be stressful to see your teen go through this experience of an intervention and your heart naturally goes out to your child, the absolute best thing that you can do for your teen is to remain steadfast in both your support and demand that your teen go into treatment.

Think of teen intervention for drug or alcohol abuse as the first step on your teen’s road to recovery. Healing does take time and your teen will need your unwavering support and encouragement as he or she begins a new life of sobriety.

Be ready to intervene with the help of a professional interventionist who can conduct a safe and effective teen intervention to start the process of recovery for your child. It is undoubtedly the most loving thing you can do to get your teen off drugs and alcohol and on the way to a happy and drug-free life.

In a collaborative approach described in a ScienceDaily article, researchers from the California Institute of Technology and Trinity College in Ireland examined what happens in the brains of gamblers when they’re making choices at the game table.

Specifically, the difference may lie in the way the dorsal striatum functions and if a person made a gambling decision based on success with previous decisions – or if they are making a decision based on areas they suspect will be lucky, also referred to as the gambler’s fallacy.

The activities of the dorsal striatum seemed more related to decisions that were reinforcement-based, suggesting that when people decide at the gambling table based on perceptions of luck, they may not be considering prior lessons they have learned.

When the participants made choices related to things they had experienced in the past, their dorsal striatum seemed more active than when they made choices based on perceptions toward luck. Researchers believe this means that the brain area that is activated in the learning process is also activated at the moment people make a decision.

As researchers learn more about these processes involved in choice and the recall of previous actions, they hope to learn more about why some people are more susceptible to psychiatric diseases or are more prone to addictions.

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."

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.