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The Drinking Check's in the Mail

Mass mailings may offer low-cost help for some with alcohol problems

TUESDAY, June 18, 2002 (HealthDayNews) -- Neither rain nor snow nor heat nor gloom of night need stay certain people from reducing their alcohol consumption.

That's what a new study suggests, anyway. It says that people with a mild or moderate drinking problem can cut back without outside therapy -- but with a little help from the U.S. Postal Service.

Florida psychologists have found people can reduce their alcohol intake by responding to public service messages that offer to send brochures, surveys, and other material through the mail.

The approach is a version of "natural recovery," a growing but controversial movement within the substance abuse field. Conventional models of addiction stress the need for treatment and abstinence to combat dependence. Advocates of natural recovery, on the other hand, believe many people with mild to moderate drug or alcohol troubles can be their own therapists, and that quitting cold turkey isn't always necessary.

"What we have typically done is look at only the severely dependent people. But the public health model is treating everyone," says Linda Carter Sobell, a psychologist at Nova Southeastern University in Ft. Lauderdale and lead author of the study. "The advantage here is that you would be able to attract more individuals into treatment or prevention early on, and you would reduce the costs to society greatly."

A report on the study appears in the June issue of Alcoholism: Clinical and Experimental Research.

An estimated 10 percent of Americans have a drinking problem. About 60 percent of those are considered alcoholics, according to government figures.

In earlier work, Sobell and her colleagues learned that many problem drinkers are deterred from seeking treatment by the stigma of being labeled an alcoholic. However, Sobell says, these people often hinted they would respond favorably to less formal interventions.

To dangle such a carrot, Sobell's group ran print, radio and television notices asking people if they'd considered drinking less. The messages also told them that three-quarters of people can reduce their drinking on their own, and gave them a telephone number they could call for free additional information.

The notices ran for a year, during which time the researchers received 1,756 responses. They then mailed drinking surveys to 825 of those who reported consuming at least 12 drinks or more each week.

Nearly half described their alcohol problem as either major or very major, 73 percent said they intended to quit drinking within two weeks, and none had received treatment for alcohol abuse in the past.

The researchers sent half the subjects personalized information about how to control their alcohol intake, including motivational tools. The rest received general materials discussing the effects of alcohol and ways to practice "low-risk" drinking and keeping track of intake.

After a year of follow-up, including periodic reminders, those in both groups who stayed in the study had reduced their drinking by essentially equal amounts. They consumed about 28 percent fewer drinks per week on average (from roughly 31 to 22), had about one fewer drinking day each week, and drank less on those days.

The number of people in either group who experienced negative consequences from drinking fell by almost 60 percent, from 4 percent to less than 2 percent. And finally, nearly a quarter of those in either group said they went on to seek some form of additional treatment for alcohol abuse during the year.

Sobell says the cost of the intervention ranged between $46 and $97 a person, depending on whether all 1,756 initial participants were included. In either case, she says, that's a small price to pay for the size of the benefit. "If you could reduce drinking at a very low cost, it's very hard to argue with."

Gerard Connors, an addiction specialist at the University of Buffalo, calls the approach a "creative and cost-effective way of reaching a potentially large number of individuals who are drinking more than they should be."

Any outreach effort that leads to self-evaluation "will have the potential for helping them cut back and suffer fewer consequences" of drinking, he says. And, as the results of the study suggest, it can also spur some drinkers to seek more involved treatment.

However, Carlton Erickson, director of the Addiction Science Research and Education Center at the University of Texas, said most alcohol experts agree that hard-core drinkers can't recover without help.

"Alcohol abuse is not alcoholism. The people who apparently can control their drinking are the abusers, but addicts can't. Ever," Erickson, an associate editor of Alcoholism, says.

Sobell agrees, and says the mailings aren't meant for people with serious drinking problems. "They shouldn't try to [quit] on their own," she says.

What To Do

For more on drug and alcohol abuse, check out the Substance Abuse and Mental Health Services Administration or the National Institute on Alcohol Abuse and Alcoholism.

SOURCES: Linda Carter Sobell, Ph.D., professor, psychology, Nova Southeastern University, Ft. Lauderdale, Fla.; Gerard Connors, Ph.D., director, Research Institute on Addictions, University of Buffalo, Buffalo, N.Y.; Carlton Erickson, Ph.D., director, Addiction Science Research and Education Center, University of Texas, Austin; June 2002 Alcoholism: Clinical and Experimental Research
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