Study Tests New Method to Instill Abstinence after Detox

BUFFALO, N.Y. -- An addiction specialist at the University at Buffalo has received a $1.28 million grant from the National Institute of Alcohol Abuse and Alcoholism to develop and test a new program designed to improve abstinence rates after alcohol detoxification.

"About 50 percent of problem drinkers never get into treatment after detox, and half the people who do go through detox are drinking again after 30 days," said Richard D. Blondell, M.D., UB associate professor of family medicine and principal investigator on the study. "Detoxification costs approximately $3,500 each time, so there are lots of reasons to look at how to improve on this."

Blondell will conduct the pilot study with patients in the alcohol detoxification unit at the Erie County Medicine Center. Researchers from UB's research Institute on Addictions will help direct the project.

The pilot study will compare three approaches to encourage alcoholics to stop using alcohol and to enter a rehabilitation or self-help program after leaving the hospital detoxification unit. The interventions will involve a total of 150 patients and will take place while patients are in the hospital. The typical detoxification hospital stay is three and a half days, Blondell said.

Participants will be assigned randomly to one of three groups: a "usual care" group, a professional-counseling group and a group that will participate in a novel, peer-delivered "12-step facilitation" delivered by trained volunteers who are recovering from alcoholism.

"Usual care" in this detoxification unit involves a physical exam, an interview with a case manager to plan for aftercare, and twice-a-day group discussion sessions.

Patients randomized to the second protocol will receive usual care plus a 60-minute "Motivational Enhancement Therapy" (MET) intervention, a well-established program used with alcohol abusers delivered by a paid professional trained in the method. MET, based on a therapist-patient relationship, comprises a discussion on the pros and cons of drinking and factors that brought the patient to treatment. The therapist provides feedback, addresses long-term consequences of alcohol abuse, makes a plan with the client for aftercare and attempts to generate motivation to change.

The third and novel intervention employs pairs of volunteers trained in Blondell's "Peer-delivered Twelve Step Facilitation," or P-TSF. This interpersonal approach calls for volunteers to approach the patient as a friend. They talk about their own experiences with alcohol problems and describe how they changed their lives. They refer to alcoholism as a fatal illness, express the difficulty of overcoming it without help, attempt to instill hope, and discuss a spiritual aspect of recovery without discussing religion.

Data on the interventions will be collected at admission and at one, three and six months. Blondell hypothesizes that MET will be better than usual care in inducing participation in a rehabilitation program and in maintaining abstinence, and that the peer volunteers will be at least as successful as MET.

"If peer volunteers are successful at improving the outcomes of patients admitted for alcohol detox, then recovering alcoholics could be used by programs throughout the country to help patients improve their lives," Blondell said. "This could be done with little additional costs to hospitals and health insurance companies.

"It is also likely that this service work will help the volunteers as well," he said. "It is known that helping others helps to protect volunteers from relapsing back to drinking."

The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York.