Emeritus Faculty - University Medical Line, Psychiatry and Behavioral Sciences
An interactive web-site-based intervention for reducing alcohol consumption was pilot tested. Participants were 145 employees of a work site in the Silicon Valley region of California, categorized as low or moderate risk for alcohol problems. All participants were given access to a web site that provided feedback on their levels of stress and use of coping strategies. Participants randomized to the full individualized feedback condition also received individualized feedback about their risk for alcohol-related problems. Some evidence was found for greater alcohol reduction among participants who received full individualized feedback, although due to difficulties in recruiting participants, the sample size was inadequate for evaluating treatment effects on drinking. The results provide preliminary support for using an interactive web site to provide individualized feedback for persons at risk for alcohol problems. However, the low participation rate (2.7%) suggests that such an intervention must address the challenges of recruiting employees through their work site.
View details for DOI 10.1016/j.jsat.2006.05.020
View details for Web of Science ID 000243326000008
View details for PubMedID 17175400
This study evaluated the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and CAGE, a standardized screening instrument for detecting alcohol dependence in identifying binge drinking among highly educated employees. Brochures were mailed to an entire workforce inviting employees to learn about their coping strategies, stress levels, and risk for alcohol-related problems, with 228 employees providing complete data. Binge drinking in the previous 3 months was reported by 29% of the employees, with greater binge drinking reported by White employees, of mixed/other ethnic background, or younger. The AUDIT achieved a sensitivity of 35% in identifying respondents who reported binge drinking and a specificity of 98% in accurately identifying respondents who did not report binge drinking. Sensitivity using the cut-off of scoring one or more positive hits on the CAGE was 67%, and specificity was 84%. Therefore, neither the AUDIT nor the CAGE achieved adequate sensitivity, as well as specificity, as screening tools for assessing binge drinking. A more accurate method for assessing binge drinking appears to be by directly asking for the largest number of drinks consumed in a single drinking session.
View details for DOI 10.1016/S0306-4603(02)00248-4
View details for Web of Science ID 000185236400007
View details for PubMedID 12915170
The relationships of drinking, stress, life satisfaction, coping style, and antidepressant use to mental health were examined in a highly educated workforce.This study used a one-time mail-out, mail-back cross-sectional survey design to examine the relationships of mental health with three kinds of stress (life events, work stress, home stress); two kinds of life satisfaction (work and home); use of avoidance coping; and antidepressant use.This study was conducted at a large worksite in northern California in which the workforce was comprised of predominantly highly educated employees.Questionnaires were mailed to a random sample of 10% of 8567 employees, and 504 were completed and returned by participants (59%). Complete data were provided by 460 participants (53%).Respondents completed the Mental Health Index, the Alcohol Use Disorders Identification Test (AUDIT), and measures of coping style, work and home stress and satisfaction, stressful life events, and antidepressant use.Mean Mental Health Index scores were at the 32nd percentile of the U.S. population-based norms, with low percentile values associated with worse mental health. Using multiple regression analysis, the factors examined in this study were significantly related to Mental Health Index scores as the dependent variable [F(16, 443) = 27.41, p < .001, adjusted overall R2 = .48]. Poor mental health scores were significantly related to the following: age (p < .05); screening positively for current harmful or hazardous drinking (p < .05); having high levels of stress at work (p < .05) or home (p < .01); experiencing dissatisfaction with work (p < .001) or home life (p = .01); engaging in avoidance coping (p < .001); and using antidepressants (p < .001). Employees currently using antidepressants had significantly more outpatient medical and mental health visits, indicating higher health costs. Furthermore, mental health status was also significantly related to the interactions between several pairs of these variables: education and gender, age and job stress, home satisfaction and work stress, home satisfaction and avoidance coping, and home satisfaction and use of antidepressants.Mental health status was poorer on average in a highly educated workforce compared with general U.S. norms. Most of the factors that were found to be associated with poorer mental health were ones that are potentially modifiable, such as experiencing more stress and less satisfaction in work and home life and engaging in current hazardous or harmful drinking. The findings that mental health is worse among individual employees who exhibit combinations of these factors suggest that we need to better understand possible effects of these factors in the context of one another. As interpretation of these results may be limited by the single worksite that participated in this study, future research should re-examine these relationships in other worksites varying from this one in geography and demographic characteristics.
View details for Web of Science ID 000181466000005
View details for PubMedID 12640782
This study examined alcohol and licit and illicit drug use in a highly educated workforce. A comprehensive health survey of a 10% random sample of a workforce (n = 8,567) yielded a 60% response rate (n = 504) after accounting for 15 undeliverable surveys. Many respondents reported past-year use of alcohol (87%). Thirteen percent of respondents consumed three or more drinks daily; 15% were binge drinkers. Twelve percent of the workforce was assessed as having a high likelihood of lifetime alcohol dependence; 5% of respondents met criteria for current problem drinking. Overall, 42% reported using mood-altering prescription drugs (analgesics, antidepressants, sedatives, or tranquilizers). Eleven percent reported using illicit drugs (cocaine, hallucinogens, heroin, or marijuana) in the past year. Significant relationships were found between gender, age, ethnicity, and occupation with some measures of alcohol consumption and use of mood-altering drugs. These results indicate prevention and early intervention programs need to address use of mood-altering substances (including alcohol) in highly educated workforces.
View details for Web of Science ID 000173693300003
View details for PubMedID 11840903
The Employee Stress and Alcohol Project (ESAP) developed an interactive computer-based alcohol abuse prevention and early intervention program accessible to employees over the Internet. Behavioral health research recommends that specialists develop and provide comprehensive yet cost-effective approaches to alcohol abuse prevention, early intervention, and treatment within the context of workplace managed care. ESAP is implementing this web site for a diverse 8,567-employee work site. ESAP's web site enables employees to self-assess their stress levels, coping styles, and risk for alcohol-related problems. It provides personalized feedback, recommendations, mini-workshops, a drinking journal, links to other online resources, and an interactive forum for direct participant-to-participant communication. ESAP's web site provides resources for employees who are concerned about another individual's drinking as well as information about adolescent alcohol use. This article discusses the implications of incorporating the ESAP web site into worksite alcohol abuse prevention and early intervention programming.
View details for Web of Science ID 000086498200004
View details for PubMedID 10795126
View details for Web of Science ID A1995QW75600004
Alcohol-dependent outpatients were clustered on the basis of their responses on the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983) personality disorder scales; male and female patients were clustered separately. The clusters were compared with respect to self-reported psychiatric, interpersonal, and drinking problems. The results, along with those of previous cluster analyses with male inpatients, suggest several reliable personality subtypes. One type (more common in inpatient settings) scores high on Negativistic and Avoidant/Schizoid or Dependent scales and reports numerous problems and intense distress. A second type (more common in outpatient settings) reports few problems and scores highest on Compulsive or Histrionic/Narcissistic scales. A third group (found in all and only male samples) scores high on Narcissism and Antisocial scales, readily admits substance problems, and may be interpersonally controlling and distancing.
View details for Web of Science ID A1994PK45600005
View details for PubMedID 7965570
Though the focus on interpersonal interaction is a powerful therapeutic factor in group therapy, traditional chemical dependency therapy groups generally fail to employ the interactional group orientation. An interactional approach can be effectively applied to alcoholics if the following guidelines are observed: (1) recovery is always accorded priority, (2) the patient accepts identification as an alcoholic, (3) anxiety is carefully modulated, (4) the proper distinction is made between what the alcoholic is and is not responsible for, (5) the therapist is thoroughly familiar with Alcoholics Anonymous language, steps, and traditions. It is important that therapists not permit misperceptions of A.A. to be used as therapy resistance and that they be able to harness the wisdom of A.A. for psychotherapeutic ends. Group therapists must also be prepared to deal with common themes arising in the treatment of the alcoholic patient: idealization, devaluation, externalization, defiance, grandiosity, conning, and avoidance.
View details for Web of Science ID A1991FV13000001
View details for PubMedID 1885248
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