Distribution and Neighborhood Correlates of Sober Living House Locations in Los Angeles.

Sober living houses (SLHs) are alcohol and drug-free living environments for individuals in recovery. The goal of this study was to map the distribution of SLHs in Los Angeles (LA) County, California (N = 260) and examine neighborhood correlates of SLH density. Locations of SLHs were geocoded and linked to tract-level Census data as well as to publicly available information on alcohol outlets and recovery resources. Neighborhoods with SLHs differed from neighborhoods without them on measures of socioeconomic disadvantage and accessibility of recovery resources. In multivariate, spatially lagged hurdle models stratified by monthly fees charged (less than $1400/month vs. $1400/month or greater), minority composition, and accessibility of treatment were associated with the presence of affordable SLHs. Accessibility of treatment was also associated with the number of affordable SLHs in those neighborhoods. Higher median housing value and accessibility of treatment were associated with whether a neighborhood had high-cost SLHs, and lower population density was associated with the number of high-cost SLHs in those neighborhoods. Neighborhood factors are associated with the availability of SLHs, and research is needed to better understand how these factors affect resident outcomes, as well as how SLHs may affect neighborhoods over time.

Edward Forbes (1815-1854) and the exhibition of natural order in Edinburgh.

The roles, affordances and social agency of natural history museums are discussed in relation to the writings of Edward Forbes. These signal a motivation, in the mid-nineteenth-century, to naturalize the established social order through the systematic arrangement and display of natural history specimens. The perceived importance of the embodied messages of social order, as an antidote to radicalism and revolution, overrode concerns about temperance and abstinence and immediate fears for the physical safety of collections. The tensions between temperance, and the broader concerns about social order, were played out over the matter of the museums themselves being licensed premises.

Cost and cost-effectiveness of the COMBINE study in alcohol-dependent patients.

CONTEXT: The COMBINE (Combined Pharmacotherapies and Behavioral Intervention) clinical trial recently evaluated the efficacy of medications, behavioral therapies, and their combinations for the outpatient treatment of alcohol dependence. The costs and cost-effectiveness of these combinations are unknown and of interest to clinicians and policy makers. OBJECTIVE: To evaluate the costs and cost-effectiveness of the COMBINE Study interventions after 16 weeks of treatment. DESIGN: A prospective cost and cost-effectiveness study of a randomized controlled clinical trial. SETTING: Eleven US clinical sites. PARTICIPANTS: One thousand three hundred eighty-three patients having a diagnosis of primary alcohol dependence. INTERVENTIONS: The study included 9 treatment groups; 4 groups received medical management for 16 weeks with naltrexone, 100 mg/d, acamprosate, 3 g/d, or both, and/or placebo; 4 groups received the same therapy as mentioned earlier with combined behavioral intervention; and 1 group received combined behavioral intervention only. MAIN OUTCOMES MEASURES: Incremental cost per percentage point increase in percentage of days abstinent, incremental cost per patient of avoiding heavy drinking, and incremental cost per patient of achieving a good clinical outcome. RESULTS: On the basis of the mean values of cost and effectiveness, 3 interventions are cost-effective options relative to the other interventions for all 3 outcomes: medical management (MM) with placebo ($409 per patient), MM plus naltrexone therapy ($671 per patient), and MM plus combined naltrexone and acamprosate therapy ($1003 per patient). CONCLUSIONS: To our knowledge, this is only the second prospective cost-effectiveness study with a randomized controlled clinical trial design that has been performed for the treatment of alcohol dependence. Focusing only on effectiveness, MM-naltrexone-acamprosate therapy is not significantly better than MM-naltrexone therapy. However, considering cost and cost-effectiveness, MM-naltrexone-acamprosate therapy may be a better choice, depending on whether the cost of the incremental increase in effectiveness is justified by the decision maker.

Alcoholic dogs and glory for all: the Anti-Saloon League and public relations, 1913.

In 1913, the Anti-Saloon League of America declared its intention to pursue national prohibition. While it continued to adhere to its core principles of agitation, it expanded its communication efforts and entered a partnership with the Scientific Temperance Federation, a spin-off of the education arm of the Woman's Christian Temperance Union. The League's tactics were not necessarily new to the temperance movement -- or even to other reform movements of the time. What did set it apart was its single-minded focus on stopping the liquor traffic. Tracing through archival artifacts the League's communication strategies and tactics during 1913, then, this study contributes to a larger body of work that seeks to expand on the traditional model of public relations history.

Prohibition possibly prohibited: Iowans voicing temperance concerns, 1929-1933.

Prohibition voices supported their cause through community events as well as public speeches and political debates between 1929 and 1933, the last years before the repeal of the Eighteenth Amendment. Many activists and average citizens continued to believe in Prohibition with a social, moral, or economic reasoning. Although no Carrie Nations had re-emerged, Prohibition still possessed strong supporters led by strong voices. The three major leaders in Iowa were Senator Smith Wildman Brookhart, John Brown Hammond, and Ida B. Wise. Each created an activist persona. All three believed Prohibition could, should, and would work for the economic, social, and moral welfare not only Iowans but all Americans.

Temperance internationalism: Guy Hayler and the World Prohibition Federation.

The World Prohibition Federation, organized in 1909, and the International Record, published from 1917 to 1968, sought to internationalize the temperance movement by collecting and disseminating anti-drink news from around the globe. The Federation was based in London, and most of its activities were English-speakers. A British reformer named Guy Hayler served as its honorary president for thirty years and edited the "International Record" until his death in 1943. The Federation emphasized that prohibitionists comprised a moral community, united regardless of race, religion, nationality, or politics. Poorly funded, the Federation had difficulty competing with the World League against Alcoholism after the Anti-Saloon League of America organized this rival propaganda society in 1919.

The evolution of U.S. temperance movements since repeal: a comparison of two campaigns to control alcoholic beverage marketing, 1950s and 1980s.

This paper compares the politics of a failed religious movement to ban alcohol advertising in the 1950s with the politics of a more secular, and partially successful, movement to regulate alcohol marketing in the 1970s and 1980s. Although the contexts of the two marketing control movements were quite different, the continuities were equally striking. Both employed arguments about youth, social order, and the power of mass media.

"It's been good, not drinking": Alaska Native narratives of lifetime sobriety.

Alcohol abuse is closely connected with so much hurt and pain in northern communities that it had to be addressed in this session. Much of what is done in the way of prevention and treatment of alcohol abuse originates from outside indigenous cultures. However, many Native people have either remained sober or become sober without ever going into a formal treatment program. Ironically, until very recently, little research effort has gone into understanding the backgrounds and attitudes of this population. "The People Awakening Project," a collaborative effort between a group of Alaska Natives interested in sobriety and the University of Alaska Fairbanks, has changed that. Although the project is not finished, this presentation provides a clear sense of how the research is being conducted, what kinds of data are emerging from it, and what some of the preliminary results look like. Chase Hensel gave the original presentation in Quebec City. Svenne Haakenson and Gerry Mohatt, who are heavily involved in the project, join him in authoring this written version.

Predicting natural resolution of alcohol-related problems: a prospective behavioral economic analysis.

This study investigated whether the relative allocation of discretionary monetary expenditures to alcoholic beverages versus savings (presumed to reflect relative preferences for immediate vs. delayed rewards) before quitting abusive drinking predicted natural resolution among untreated problem drinkers. Drinking, life events, income, and expenditures were assessed for the year before resolution and again 1 and 2 years later (N = 50). Compared with those who relapsed, participants who remained resolved at 2 years reported proportionally more pre-resolution discretionary expenditures on savings and less on alcohol. Income and expenditures were similar across groups. The findings support the predictive utility of this functional index of relative reward preferences that operate over variable time horizons and suggest that temporal discounting is an important process in addictive behavior change.

[Adjuvant drug treatment of alcoholism with acamprosate: between sectoral budgets and disease management]. / Die adjuvante Arzneimitteltherapie der Alkoholkrankheit mit Acamprosa--Zwischen sektoraler Budgetierung und Disease Management.

OBJECTIVE: On the basis of several controlled clinical investigations the cost-effectiveness of acamprosate as adjuvant therapy of alcohol-dependent patients has yet been evaluated. These optimal conditions cannot be found in the daily ambulant practice and results in asking which of the alternatives, "standard plus acamprosate" or "standard without acamprosate", is more cost-effective in maintaining abstinence in alcohol dependent patients under realistic conditions. PATIENTS AND METHODS: In an open multi-centre study, medical care, costs and therapeutic outcome was prospectively documented. Prior to enrolling, all patients were obliged to undergo a detoxification procedure. At a mean age of 45 years the patients suffered an average of ten years from alcohol dependence. 521 patients were documented in the acamprosate cohort and 265 patients in the cohort "other therapy" over one year. Two thirds of the participating patients were male. RESULTS: At 33.6 % the rate of abstinence was remarkably higher in the acamprosate cohort in comparison to the cohort "other" at 21.1 % abstinent patients. The mean total costs per patient and year amounted to DM 3191 in the acamprosate-cohort and were significantly lower than in the cohort "other" with DM 4046. Effectiveness-adjusted costs of DM 9500 per successfully treated patient in the acamprosate-cohort were superior to the cohort "other", amounting to DM 19 148 per successfully treated patient. CONCLUSION: The described economic benefits may be utilised under conditions of an adequate disease management.

Delay discounting of money and alcohol in actively using alcoholics, currently abstinent alcoholics, and controls.

RATIONALE: Impulsivity is implicated in alcohol dependence, and discounting of delayed rewards may be an objective indicator of impulsiveness. OBJECTIVES: This study evaluated delay discounting functions in alcoholics and controls. It compared discounting rates between different magnitudes ($1000 and $100) and different types (money and alcohol) of rewards. METHODS: Active alcoholics (n = 19), currently abstinent alcoholics (n = 12) and controls (n = 15) indicated preferences for immediate versus delayed rewards using a titration procedure that determined indifference points at various delays. Four conditions were presented, and the delayed rewards in the four conditions were $1000, $100, 150 bottles of an alcoholic beverage, and 15 bottles of an alcoholic beverage. RESULTS: In all three groups across all four conditions, hyperbolic discounting functions provided a good fit of the data. Linear contrasts, predicting the most rapid discounting rates in active alcoholics, intermediary rates in currently abstinent alcoholics, and the least rapid rates in controls, were significant for three of the four conditions. Alcohol was discounted more rapidly than money. CONCLUSIONS: These data provide further evidence of more rapid discounting of delayed rewards in alcohol abusers compared to controls, and especially steep discounting among current users. Rapid discounting of delayed rewards may be a feature related to addictive disorders. A better understanding of how delaying rewards in time impacts their value may have implications for treatment.

The long-term cost-effectiveness of improving alcohol abstinence with adjuvant acamprosate.

A computer model was developed with decision analysis software to explore the long-term clinical and economic outcomes of alcohol abstinence maintenance with either standard counselling therapy or standard therapy plus 48 weeks of adjuvant acamprosate in detoxified alcoholic patients. Important complications of alcoholism were modelled using Markov processes, and included relapse (return to drinking), alcohol-related hepatic disease, acute and chronic pancreatitis, acute and chronic gastritis, oropharyngeal carcinoma, oesophageal carcinoma, alcoholic cardiomyopathy, alcohol-related peripheral neuropathy, alcoholic psychosis, accidental death, and suicide. Probabilities of developing complications were dependent on whether the patients within the cohort remained abstinent or had relapsed. Relapse rates, probabilities, and costs for acamprosate therapy and treatment of complications were taken from published literature. The analysis was performed from the German health insurance perspective. Life expectancy and total lifetime costs (costs of initial abstinence maintenance therapy plus costs of complications) were calculated for a typical male cohort with average age of 41 years, 80% with fatty liver, 15% with cirrhosis, 22% with chronic pancreatitis, and 1% with alcoholic cardiomyopathy at baseline. Life expectancy with and without acamprosate therapy was 15.90 and 14.70 years respectively, and discounted (5% per annum) average total lifetime costs per patient were DEM 46 448 and DEM 49 549 respectively. We conclude that, despite the acquisition costs of DEM 2177, adjuvant acamprosate therapy was both clinically and economically attractive under conservative assumptions.

Substance abuse treatment cost offsets vary with gender, age, and abstinence likelihood.

The cost-offset effect has been promoted as a way for substance abuse treatment to pay for itself by generating reductions in health care utilization in other areas. Clients (n = 5,434) that were abstinent for 24 months following substance abuse treatment had lower posttreatment utilization than clients that had relapsed. An examination of cost offsets revealed a complex interplay between gender, age, and type of utilization (medical versus psychiatric). Cost offsets were especially pronounced for women over 40 years old.

Costs and benefits of a community sobriety checkpoint program.

OBJECTIVE: Alcohol-involved crashes cost society more than $100 billion a year. Sobriety checkpoints are effective in apprehending drunk drivers. This article compares the costs and the estimated monetary benefits from a hypothetical community sobriety checkpoint program. METHOD: The analysis is constructed around a hypothetical community with 100,000 licensed drivers. A literature review suggests that a generously funded intensive checkpoint program (156 checkpoints per year) can be expected to reduce alcohol-attributable crashes by about 15%. The benefits (cost savings) of the checkpoint program are calculated using 1993 alcohol-involved crash incidence from the National Highway Traffic Safety Administration. Costs per alcohol-involved crash and the percentage of alcohol-involved crashes attributable to alcohol are updated from published studies. RESULTS: Estimated annual savings to the hypothetical community total $7.9 million. This includes $3.1 million for averted fatalities, $4.5 million for averted non-fatal injuries, and $0.3 million for averted property damage. Every $1 spent on a sobriety checkpoint program can be expected to save the community more than $6, including $1.30 of insurer costs. CONCLUSIONS: An intensive sobriety checkpoint program can save a community more in automobile crash costs than the program costs.

Evaluation of a four- versus six-week length of stay in the Navy's alcohol treatment program.

OBJECTIVE: Attempts to balance escalating health care costs with resource downsizing have prompted alcohol treatment directors in the U.S. Navy to consider reducing the standard length of stay in treatment. The objectives of this study were to (1) determine whether a 4-week inpatient treatment program is as effective as a 6-week program, and (2) explore the potential for matching patients to a 4- or 6-week program according to the severity of their condition at intake. METHOD: A total of 2,823 active-duty alcohol-dependent inpatients (2,685 men, 138 women) at 12 Navy treatment facilities participated in the evaluation. All facilities conducted a 6-week program until data had been collected for 1,380 participants; they then switched to a 4-week program (n = 1,443). Background information and clinical profile were obtained when patients entered treatment; 1-year outcome data (e.g., alcohol use, behavior problems, job performance, quality of life) were obtained from participants, work supervisors and aftercare advisors. Hierarchical multiple regression analyses were used to assess the effect of length of stay on outcome and to examine patient-program interactions. RESULTS: The single best predictor of success at 1 year was months of aftercare attendance. Program membership failed to explain any of the observed differences in the criterion measures, once the effects of other predictors had been taken into account. Severity of condition and patient-program interactions were likewise nonsignificant. CONCLUSIONS: It was concluded that a reduction in length of stay from 6 weeks to 4 weeks in the Navy's inpatient alcohol treatment program would not have an adverse effect on outcome.

The SECCAT survey: I. The costs and consequences of alcoholism.

The SECCAT survey assessed the Socio-Economic Costs and Consequences of Alcoholism Treatment. Basic demographic and health service resource use data (for a previous 6-month period) were obtained fro a cohort of 586 eligible patients who had had treatment at the Alcohol Problems Clinic (APC) in Edinburgh. The cohort was 75% male with a mean age of 46.0 years. Seventy-six per cent had an initial diagnosis of alcohol dependence and 21% alcohol abuse. Use of health services was highly variable. Thirty-six per cent agreed to be interviewed to provide data on their level of abstinence, on resource use, on quality of life (SF-36), on socio-economic characteristics and key adverse events. These 212 individuals had similar age and sex ratios to the full cohort, but alcohol abusers were under-represented. Nineteen patients reported no days of abstinence and 41 were abstinent over the whole 6-month period. Patients experienced a much poorer quality of life than a normal population in terms of all dimensions of the SF-36. The average total health care costs of the interviewed patients were 1134 pounds of which 38% were related to treatment at the APC. Analysis suggests that alcohol-dependent patients make substantially more costly use of resources than abusers and experience a much poorer quality of life. No clear relationship of cost to degree of abstinence has been found. There is a clear and consistent relationship of SF-36 scores and drinking behavior.