This study examined types of internal and external motivation for seeking treatment and the predictive utility of different types of motivation among 180 women with an alcohol use disorder (AUD) participating in a two-armed trial testing different individual and couple therapies for AUDs. Reasons for seeking treatment were coded for type of internal or external motivation. Most women (97%) cited internal reasons for seeking help, including: concern about progression of AUD (61.1%), health (43.3%), mental health (38.9%), and family (38.3%). Occupational concerns, an internal motivator cited by 6% of women, were associated with better drinking outcomes; interpersonal-family concerns were associated with poorer outcomes. Some motivators for seeking treatment may not be related to sustained changes in drinking, suggesting that understanding motivators for treatment may be inadequate to maintain change. Reasons for help-seeking may need to be addressed in treatment to produce long-lasting change.
Coping style may partially account for the frequent co-occurrence of posttraumatic stress disorder (PTSD) and alcohol-use disorders (AUD). We hypothesized that PTSD symptom severity, avoidant coping, and action-oriented coping would interact, such that veterans high on PTSD symptoms and avoidant coping and low on action-oriented coping would report more negative alcohol-related consequences and drinking a greater number of drinks per week compared to veterans without all three risk factors. The sample (N = 128) of veterans (85.2% male, M = 37.8 years old, 63.3% Caucasian) completed a diagnostic assessment and self-report measures assessing PTSD, alcohol use disorders, coping styles, and alcohol outcomes. Consistent with the main hypothesis, a threeway interaction among PTSD symptom severity, avoidant coping, and action-oriented coping was found in the predicted direction. In addition, post-hoc descriptive analyses indicated that Veterans with a current PTSD diagnosis, low action-oriented coping, and high avoidant coping had worse alcohol outcomes and were twice as likely to meet criteria for current AUD compared with Veterans with two or fewer risk factors. These findings suggest that the combination of PTSD and maladaptive coping styles may be more important for understanding alcohol-related outcomes than the presence of any of these variables in isolation.As many as 63% of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with an alcohol (AUD) or drug use disorder who access Veterans Affairs healthcare are estimated to have co-occurring posttraumatic stress disorder (PTSD;Seal et al., 2011). Veterans with co-occurring PTSD-AUD exhibit higher unemployment and less social support compared with veterans with only one of these disorders (Riggs, Rukstalis, Volpicelli, Kalmanson, & Foa, 2003 U.S. Department of Veterans Affairs VA Author ManuscriptVA Author Manuscript VA Author ManuscriptPTSD-AUD has important implications for understanding the functional recovery of veterans.The tension-reduction (Keane, Gerardi, Lyons, & Wolfe, 1988) hypothesis has been used to explain PTSD-AUD comorbidity. Another factor that might influence PTSD-AUD is coping style, which has been associated with both PTSD and alcohol use (e.g., Blake, Cook, & Keane, 1992;Yeater, Austin, Green, & Smith, 2010). Despite controversy regarding the optimal coping taxonomy, Kapsou, Panayiotou, Kokkinos, and Demetriou (2010) suggest the presence of at least two higher-order coping factors: one that is action-oriented and social (hereafter "action-oriented") and one that is avoidant and emotion-focused ("avoidant"). Avoidant coping is associated with PTSD symptom severity among veterans (Blake et al., 1992) and interacts with frequency of combat exposure to predict PTSD severity (Rodrigues and Renshaw, 2010). In addition, Boden, Bonn-Miller, Vujanovic, and Drescher (2012) found that increased avoidant coping and decreased active coping prospectively predicted PTSD symptom severity among veterans in residential treatment for P...
Alcohol use disorders (AUDs) are among the most common psychological disorders experienced by Americans. Only 10% of individuals with this disorder receive treatment, and the most popular treatment is some form of 12-Step involvement. Although there is evidence for the efficacy of 12-Step treatment, most AUD treatment providers are not well versed in 12-Step principles and practices. Recent work suggests that clinicians and training directors do not feel confident in their knowledge about and training in 12-Step programs. This concern is not new, and programs have struggled to find ways to help trainees bridge this knowledge gap in a way that would be beneficial to clients. Therefore, the current article seeks to address this by clarifying common misconceptions about Alcoholics Anonymous (AA), describing AA’s conceptualization of alcoholism, and its goal. We also offer a number of ways in which the 12-Steps share principles and skills/techniques with cognitive behavioral therapies for AUD. Finally, we provide training recommendations for closing the training gap through increased trainee exposure to 12-Step programs and interprofessional training opportunities. It is our hope that once AUD treatment providers understand that the 12-Steps are meant to accomplish similar goals using similar techniques to Evidence Based Practices (EBPs) for AUDs, they will be able to provide more integrated, or at least less disparate, treatments to individuals with AUDs.
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