A 2-year follow-up of 120 Swedish female alcoholics treated early in their drinking career: prediction of drinking outcome.

BACKGROUND: One hundred twenty women alcoholics recruited to a treatment program called EWA (Early Treatment for Women With Alcohol Addiction) were studied. The selected women were not previously treated for alcohol abuse. METHODS: The women were followed up by use of a structured personal interview, biomarkers sensitive for alcohol abuse (i.e., glutamyl transpeptidase), and questionnaires, by using defined criteria for abstinence, social drinking, satisfactory drinking outcome, and unsatisfactory drinking outcome. RESULTS: Drinking outcome was good (i.e., total abstinence, social drinking, or satisfactory drinking outcome) for 67% of the women during the total follow-up time, by use of strict criteria for relapse. The results were corroborated by the biomarkers. Similar results were reported from two previously studied groups of women from the same department. However, the frequency of abstinence was higher and social drinking was significantly lower among this sample of women. Daily drinking, the use of sedatives, and a long duration of pretreatment alcohol abuse predicted an unfavorable outcome. However, a long duration of outpatient treatment predicted a good outcome, whereas treatment dropout was related to an unsatisfactory drinking outcome. A majority of the women (96%) rated the treatment experience and the treatment program favorably. The overall good results might reflect the selection of the subjects studied. CONCLUSIONS: Improving treatment program adherence would probably improve outcome for the women with an unsatisfactory drinking outcome.

Personality characteristics of women with alcohol addiction: a Rorschach study of women in an early treatment programme.

This study identifies personality characteristics in a group of Swedish women (N = 60) attending their first treatment for alcohol problems. The treatment programme specifically addressed women in an early phase of their drinking career, and was called "Early Treatment of Women with Alcohol Addiction" (EWA). Rorschach personality profiles of the 60 women differed significantly in almost all investigated aspects in a psychopathological direction from norms reported by Exner for a reference group of female non-patients. The findings are consistent with the assumption that, although the EWA women were socially well-functioning and fairly early in their drinking career, they nevertheless reveal serious underlying psychopathology. Clinical implications of the findings are discussed.

Screening for psychiatric comorbidity among female alcoholics: the use of a questionnaire (SCL-90) among women early in their treatment programme.

The use of a questionnaire, Symptom Check List-90 (SCL-90), as a screening instrument for psychiatric disorders was studied in 60 women attending their first treatment for alcohol abuse in Stockholm, Sweden. A global SCL-90 index, the General Symptomatic Index (GSI), measuring the total level of recent self-reported psychological distress, showed a high efficacy in distinguishing 'psychiatric cases' from 'non-cases' in the present sample. Psychiatric cases were defined as subjects satisfying the criteria for any current DSM-III-R disorder other than substance abuse. The psychiatric diagnoses were obtained independently by use of the Structured Clinical Interview for DSM-III-R (SCID-I). Psychiatric disorders, especially depression and anxiety disorders, frequently antecede or develop secondary to alcohol abuse among women. The use of structured interviews to diagnose these disorders is, however, time-consuming. Findings from the present study indicate that SCL-90 can be used to detect psychiatric comorbidity among female alcoholics, thus enabling clinicians to be aware of concomitant psychiatric disorders among a subgroup of patients.

Improving the usefulness of the Karolinska Psychodynamic Profile in research: proposals from a reliability study.

The interrater reliability of data obtained by use of the Karolinska Psychodynamic Profile (KAPP) was tested among 60 women seeking treatment for drinking problems. The first rater had a psychodynamic background but was minimally trained rating the KAPP subscales and performing KAPP interviews. Independent, blind ratings of audiotaped interviews by an experienced KAPP rater revealed that 8 of the subscales obtained satisfactory reliability, whereas 6 subscales showed unsatisfactory reliability. Furthermore, data for one subscale (normopathy) showed a zero correlation between raters, probably due to the novelty of the construct. Additionally 3 subscales related to bodily aspects were of little clinical significance among the present study group. Our data were compared with data from previous KAPP reliability studies, and the reasons for similarities and discrepancies of results are discussed.

Early treatment of women with alcohol addiction (EWA): a comprehensive evaluation and outcome study. I. Patterns of psychiatric comorbidity at intake.

This paper deals with psychiatric comorbidity among 60 women problem drinkers treated in a specialized women-only treatment programme (EWA) at Karolinska Hospital, Stockholm, Sweden. The programme attracts women who have not been previously treated for alcohol problems. The methods used were structured interviews (SCID-I and SCID-II) applied at least 10 days after the start of treatment. All but two of the women had a definite alcohol dependence according to the DSM-III-R, and a majority (60%) also fulfilled the criteria for at least one psychiatric disorder during their lifetime. However, only 23% had a personality disorder (PD), and all subjects with a PD also had at least one Axis I disorder. The most common disorders were mood disorders (48%) and anxiety disorders (38%). However, alcohol dependence developed without definite pre-existing psychiatric disorders among a substantial proportion of the women (40%). It remains to be seen whether and how psychiatric disturbances among female problem drinkers affect treatment compliance and long-term outcome.

[Women with alcohol problems]. / Kvinner med alkoholproblemer.

The article discusses differences between male and female alcoholics with respect to clinical symptoms and biochemical markers. 89% of our study group of female alcoholics had pathological values on Mean Corpuscular Volume (MCV) and/or gamma Glutamyl Transferase (GT). 82% of the women reported sleep problems and/or had tobacco-stained fingers. Our findings show less marked differences between male and female alcoholics than previously reported. On the other hand, greater differences were found between earlier and later stage female problem drinkers. These differences are important for the development of new instruments for detecting and managing early stage female problem drinkers.

Factor analysis of the evaluation form for selecting patients for short-term anxiety-provoking psychotherapy. The Bergen project on brief dynamic psychotherapy.

The selection criteria of Sifneos' short-term anxiety-provoking psychotherapy has been assumed to consist of two separate dimensions, resources and motivation. A factor analysis revealed three factors: ego-resources, motivation for psychotherapy and motivation or desire to change. The resource items on the evaluation form constitute one factor as assumed, it is the items on the motivation section that are split into two independent factors. The evaluation form might become more useful if the motivation items are reorganized according to the two different dimensions of the concept.

Assessment for three different forms of short-term dynamic psychotherapy. Findings from the Bergen Project.

Forty-four patients were assessed for three different short-term dynamic therapies, with an evaluation form based on Sifneos' criteria for Short-Term Anxiety-Provoking Psychotherapy (STAPP). Ten patients were ascribed to STAPP, 22 patients to Malan's Brief Psychotherapy (BP), and 12 patients to a more eclectic/integrative form of brief psychotherapy in this project called the FIAT model. 78% of the patients completed their treatment in agreement with the original ascription to therapy, with good results for all three therapies. The evaluation form seems to be a reliable and valid instrument offering a good and systematic basis for designing a tailor-made treatment format for different types of patients.

Comprehensive assessment of change in patients treated with short-term dynamic psychotherapy: an overview. A 2-year follow-up study of 34 cases.

Change was assessed in 34 patients at the end of short-term dynamic psychotherapy (STDP), and at 2 follow-ups (1 year and 2 years subsequent to treatment). The assessment was made from different perspectives and according to multiple criteria and methods of measurement. The results indicate that, when a particular form of STDP is selected according to each patient's ego resources, motivation for therapy, and motivation for change, approximately 90% of the patients will attain substantial symptom relief. The majority of the patients in this study also gave evidence of positive change in adaptive functioning, while one-third attained some dynamic/structural change as well. Clinically rated improvement was confirmed by changes in the patients' self-reported distress level (SCL-90), and from psychological test findings (MMPI). Improvement observed at the end of therapy was sustained throughout the 2-year follow-up period.

Brief dynamic psychotherapy for patients presenting physical symptoms.

Ten outpatients who complained of physical symptoms, without organic pathology, were treated with brief dynamic psychotherapy. Outcome ratings were provided by independent assessors at the end of therapy and 2 years post treatment. Improvement criteria included symptoms, adaptive functioning, and specific internal predispositions. The results showed that most of the patients gained substantially from their therapy experiences. Change did not only occur with regard to psychological difficulties, but also in their particular physical symptoms. Therapy gains at termination were maintained, and had even increased, at follow-up. Clinical improvement was confirmed by psychological test findings. In several patients marked positive change was also observed in their general body response patterns.

Female alcoholics. V: The relationship between family history of alcoholism and outcome 3-10 years after treatment.

In a long-term follow-up study of 44 female alcoholics, a family history of alcoholism was related to younger age of onset of problem drinking, but did not necessarily imply a poorer outcome within this highly selected group of individuals. Alcoholism in father and his family was not related to either antisocial or borderline personality disorder nor outcome. However, alcoholism in mother and her family correlated with both borderline personality disorder and a significantly poorer outcome. The findings are discussed within different frames of reference, considering genetic mechanisms, psychodynamic factors and family systems theory.

Female alcoholics: IV. The relationship between family violence and outcome 3-10 years after treatment.

In a long-term follow-up study of 44 female alcoholics, the women's childhood history of family violence was found to be related to violence in partner relationship as an adult and to outcome of treatment. The number of violent relations experienced during childhood was significantly related to a repetitive pattern of violent partnerships after treatment, which added to a poor outcome. The small number of selected women studied limits the generalization of data. However, treatment intervention in violent partner relationships of female alcoholics probably would benefit long-term outcome.

Female alcoholics: III. Patterns of consumption 3-10 years after treatment.

In a follow-up study of 55 female alcoholics, 44 women (80%) were interviewed on an average of 6.5 years after treatment. According to the reported quantity and frequency of drinking the year prior to follow-up, eight women (18%) were classified as abstainers, nine (20%) as light drinkers, ten (22%) as moderate drinkers, and 17 (39%) as heavy drinkers. In a longitudinal perspective, four main patterns of outcome could be discriminated: long-term abstinence, short-term abstinence intermingled with drinking, asymptomatic drinking and continuous heavy drinking. Most of the asymptomatic drinkers reported a consumption of very small amounts of alcohol, avoiding becoming intoxicated. Those women who reported consumption of more than 2/3 of a bottle of spirits on any single drinking day or consumed more than 7 liters of pure alcohol annually, usually satisfied the DSM-III criteria for alcohol abuse or alcohol dependence.

Female alcoholics. II. Factors associated with psycho-social outcome 3-10 years after treatment.

In a follow-up study of 44 female alcoholics, different aspects of outcome were studied. These were alcohol consumption, the use of drugs and psycho-social functioning. Also studied was a sumscore of these items called total outcome score. Childhood experiences such as having had a mentally disturbed father, a violent mother and/or unstable childhood environment were associated with a poor total outcome score. The same was true for alcohol abuse and violence in partner during follow-up period. Those women who had had their children removed from the home by the social authorities during follow-up period, also had a poor outcome. Destructive patterns of interaction experienced in family of origin may repeat themselves in adult life in relationship with partner and children. The successful treatment of female alcoholics would require modification of these behavioral patterns as well as drinking behaviour.

Female alcoholics. I. Psycho-social outcome six years after treatment.

In a long-term follow-up study of 44 young female alcoholics, 57% were abstainers, light, or moderate drinkers with good social functioning. The women's vocational functioning had improved compared with the situation at intake. Nevertheless, many needed public financial support, and 62% reported mental disturbances relevant to their present functioning. Anxiety disorders with phobias, depression and psycho-somatic complaints were most frequently reported. A few women suffered from a post-traumatic stress syndrome following a relationship with a violent partner. The symptom picture of the abstainers and heavy drinkers was much the same when measured by the SCL-90, whereas the light and moderate drinkers had fewer symptoms and lower symptom intensity. The article discusses the complicated relationship between life situation, mental disorders, and personality disorders, in women alcoholics. All these aspects must be dealt with to allow a more effective treatment of female alcoholics.

The DSM-III diagnosis of alcohol use disorders in women: findings from a follow-up study of 44 female alcoholics.

In a long term follow-up study of 44 young women with symptoms of alcohol dependence at index year, only 17 (38%) of the interviewed subjects fulfill the DSM-III criteria for alcohol abuse or dependence the year prior to follow-up according to the interview material. The reason for this is partly that there has been a change in drinking patterns for 24 women (54%), of which eight are abstainers, seven asymptomatic drinkers and nine having an increased tolerance as the only sign of a possibly pathological alcohol use. Partly, however, the lack of diagnosis can be attributed to client denial or substituting drugs for alcohol, and partly due to inadequate criteria. Some of the DSM-III criteria are sex biased, probably leading to men having a diagnosis at an earlier stage of alcoholism. The concept of degree of alcohol dependence, an appropriate time limit for assessment of diagnosis and the difference between primary and secondary alcoholism, should be specified in future diagnostic criteria for alcohol use disorders.

Perceptibility of schematic face stimuli: Evidence for a perceptual Gestalt.

The perceptibility of face, scrambled face, and single-feature stimuli was investigated in three experiments. Stimuli were presented tachistoscopically, followed by a visual noise mask and a forced-choice test of one of three features (eyes, nose, and mouth). In Experiment I, two processing strategies which have been proposed for word perception (involving expectancy and redundancy) were investigated for the stimuli employed here. In Experiments II and III, experimentally induced familiarity was studied for its effect on recognition and perception, and an immediate and delayed perceptual test was employed. Across all three experiments, perception of single-feature and face stimuli were consistently superior to scrambled faces; in Experiment III, differences between single features and faces were eliminated. The effects of perceptual expectancy, internal feature redundancy, familiarity, guessing biases, etc., were shown to be insufficient to account for the superiority of face to scrambled face stimuli. It was argued that the perceptibility of nonredundant features are enhanced when those features are aligned in a well-defined form class. The view that familiarity operates directly on recognitive processes but indirectly on perceptual ones was discussed.