Out-patient behaviour therapy in alcoholism: impact of personality disorders and cognitive impairments

Wölwer, Wolfgang; Burtscheidt, Wilhelm; Redner, C.; Schwarz, Rebecca; Gäebel, Wolfgang

doi:10.1034/j.1600-0447.2001.00149.x

Cited by 37 publications

(29 citation statements)

References 43 publications

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“…A total of 110 patients between 25 and 60 years of age meeting DSM III-R/ICD-10 criteria for alcohol dependence and consuming alcohol in an addictive manner for at least 6 months up to the admission to in-patient detoxification took part in a study comparing three alcoholism treatment programs with regard to drinking status [6, 7], neuropsychological performance [36] and structural magnetic resonance imaging (MRI). Exclusion criteria were other forms of addiction (except nicotine dependency), schizophrenia, mental retardation or severe cognitive impairments and somatic diseases which precluded participation in out-patient psychotherapy.…”

Section: Methodsmentioning

confidence: 99%

Effects of abstinence on brain morphology in alcoholism

Wobrock

Falkai

Schneider‐Axmann

et al. 2009

Eur Arch Psychiatry Clin Neurosci

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Chronic alcohol abuse leads to morphological changes of the brain. We investigated if these volumetric changes are reversible after a period of abstinence. For this reason 41 male and 15 female alcohol patients underwent MRI-scanning after in-patient detoxification (baseline) entering alcoholism treatment programs, and between 6 and 9 months later (follow-up), in a phase of convalescence. Additionally, 29 male and 16 female control subjects were examined. The MRI-scans were delineated and the resulting regions of interest, volumes of lateral ventricles and prefrontal lobes were expressed relatively to total brain volume. Compared to control subjects alcohol patients showed bilaterally decreased prefrontal lobes (11% reduction) and increased lateral ventricles (up to 42% enlargement). The extent of the ventricular increase was depending on patient’s additional psychiatric diagnosis, showing smaller lateral ventricles in patients with additional personality disorder. While at follow-up the size of prefrontal lobes remained unchanged, volumes of the lateral ventricles decreased (5–6% reduction) in alcohol patients with abstinence and improved drinking behavior, especially in patients that underwent only one detoxification. The extent of the ventricular enlargement correlated with the elevation of alcohol related laboratory measures (mean corpuscular volume, gamma-glutamyl transpeptidase). In conclusion this study confirms the hypothesis that alcoholism causes brain damages that are partially reversible. It should be analyzed in further studies with larger sample sizes, if complete brain regeneration is possible maintaining abstinence over a longer period.

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Section: Methodsmentioning

confidence: 99%

Effects of abstinence on brain morphology in alcoholism

Wobrock

Falkai

Schneider‐Axmann

et al. 2009

Eur Arch Psychiatry Clin Neurosci

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“…Interestingly, however, little research has examined the impact of co-occurring personality disorders (with the exception of antisocial personality disorder [ASPD]; e.g., Cacciola et al, 1996; Daughters et al, 2008; Greenberg et al, 1994; Kokkevi et al, 1998) on substance abuse treatment completion, despite evidence for a number of negative outcomes associated with co-occurring personality disorders among patients with SUDs (see Greenberg et al, 1994; Powell and Peveler, 1996; Thomas et al, 1999; Wölwer et al, 2001; Zikos et al, 2010). One personality disorder that warrants particular consideration in this regard is borderline personality disorder (BPD).…”

Section: Introductionmentioning

confidence: 99%

The impact of borderline personality disorder on residential substance abuse treatment dropout among men

Tull

Gratz

2012

Drug and Alcohol Dependence

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Background Research is increasingly focusing on identifying factors distinguishing patients who complete versus dropout of residential substance abuse treatment. One potentially relevant factor that has received relatively little attention is borderline personality disorder (BPD). Method This study sought to examine the effect of BPD on residential substance abuse treatment dropout within a sample of 159 male patients with substance use disorders – a population often understudied with regard to BPD and at high-risk for treatment dropout. Patients were administered a structured diagnostic interview to establish BPD diagnoses. Patients were then followed throughout the course of residential substance abuse treatment to identify those who completed treatment and those who prematurely dropped out of treatment. Results Patients with BPD were significantly more likely to prematurely dropout of treatment, and this finding remained even when taking into account relevant covariates (i.e., court-ordered treatment status, contract duration, and major depressive disorder). Further, patients with BPD were more likely to experience center-initiated dropout as opposed to voluntary withdrawal from treatment. Conclusions These findings add to the literature on BPD-SUD co-occurrence, suggesting that the presence of co-occurring BPD among male SUD patients may increase the risk for dropout from residential substance abuse treatment, necessitating targeted interventions focused on decreasing dropout within this patient subgroup.

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“…In contrast, adults without cognitive impairment did better after coping skills treatment. In another study (36), adult patients with and without cognitive impairment were randomly assigned to three different treatment groups: cognitive behavioral therapy, coping skills training, and standard treatment. The results indicated that cognitively intact patients had higher rates of abstinence than patients with cognitive impairments, regardless of the type of therapy received.…”

Section: Introductionmentioning

confidence: 99%

Neurocognitive Ability in Adults Coping with Alcohol and Drug Relapse Temptations

Tapert

Ozyurt

Myers

et al. 2004

The American Journal of Drug and Alcohol Abuse

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Coping is important for preventing relapse, but may be utilized differently depending on the individual's level of cognitive functioning. Impaired reasoning, attention, and memory are commonly observed in alcohol-dependent individuals. This study describes the prospective relationship between neuropsychological functioning and utilization of coping strategies in predicting outcome one year after discharge from an inpatient alcohol treatment program. Male veterans (n = 43) hospitalized in an alcohol treatment facility were given structured interviews, coping questionnaires, and neuropsychological testing, and were followed three and 12 months after discharge. Neuropsychological ability moderated the relationship between coping and drinking outcomes one year after treatment. This was particularly true for patients with better neurocognitive functioning. Specifically, patients with higher neurocognitive performances and more maladaptive coping responses, such as self-blame, had a greater percentage of drinking days at follow-up. Alcohol-dependent adults with good neuropsychological functioning may be able to benefit more from coping skills training. For those with neuropsychological deficits, coping skills training may need to take cognitive limitations into consideration.

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Out-patient behaviour therapy in alcoholism: impact of personality disorders and cognitive impairments

Abstract: The high amount of early relapses and drop-outs probably hindered larger differentiated treatment effects. Hypotheses will be retested in treatment completers using forthcoming follow-up data.

Cited by 37 publications

References 43 publications

Effects of abstinence on brain morphology in alcoholism

Effects of abstinence on brain morphology in alcoholism

The impact of borderline personality disorder on residential substance abuse treatment dropout among men

Neurocognitive Ability in Adults Coping with Alcohol and Drug Relapse Temptations

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