Putting Down the Bottle

Paul Gilbert is studying how problem drinkers quit without help from rehabilitation programs.

When alcohol consumption causes so many problems that a person decides to quit drinking, some will turn to clinical rehabilitation for help, but others will just put down the bottle and never pick it up again.

Paul Gilbert is interested in those who go cold turkey and how their experiences can provide insight into alcoholism in general. Gilbert, assistant professor of community and behavioral health in the University of Iowa College of Public Health, is studying people in eastern Iowa whose drinking was causing so many problems in their lives that they quit, but did so without entering a clinical treatment program.

EXPLORING PATHS TO RECOVERY

An expert on adult alcoholism who has conducted numerous studies about problem drinking, Gilbert plans to talk to 30 Iowans about their success quitting drinking. Using interviews and surveys, he’ll ask about their life history, their drinking patterns, what prompted them to quit drinking, and how they did it.

Gilbert is conducting this study as preparation for his next major research project, which will explore different paths to recovery. He will recruit a national sample of 600 former problem drinkers and assess how they define recovery, the degree of “recovery capital” available to them, and the various strategies they used to resolve their problems without treatment. Recovery capital refers to the quantity and quality of internal and external resources that a person has to initiate and sustain recovery from addiction.

Gilbert’s goal is to determine whether there are differences in successful strategies for recovery between men and women or by race/ethnicity. The initial Iowa study will provide preliminary information.

He also hopes the lessons learned ultimately will lead to more ways to minimize the harms from drinking even without clinical treatment.

A VARIETY OF STRATEGIES

Gilbert says the number of problem drinkers who use clinical rehabilitation programs after they make the decision to quit drinking is smaller than people might expect, only about 10 to 15 percent. Many of the rest use some sort of support program, such as a 12-step program. Many others use no program at all and just quit drinking.

Ultimately, Gilbert’s goal is to find out how some people can quit without clinical assistance and how their experience might help others who need help. For instance, the data might show that certain types of people benefit from earlier intervention or a different model of intervention. Some could benefit simply from guidance about moderation rather than complete abstinence.

Gilbert already has interviewed a dozen respondents, and though it’s too soon to draw conclusions, he found people use a variety of strategies to quit drinking. Some attend a 12-step program and continue to use it; others started by attending a program, then leaving when their drinking was controlled; yet others just said they were going to stop drinking or reduce the frequency of their drinking and did so with no assistance.

WHY PEOPLE QUIT

In all of his research, Gilbert says he’s found one important consistency in the reason the people wanted to quit in the first place.

“A family crisis or the role of a relationship,” he says. “Sometimes they quit because of a health crisis or a work crisis too, but most often the abrupt change is the result of a relationship. Maybe the person they were in a relationship with threatened to leave them; maybe they’d lose custody of their kids. But losing a relationship often prompts people to make a change.”

He hopes to answer one important question: Do people who quit on their own see quitting differently than people who go through rehab?

“It seems a lot of people who don’t get treatment have a more flexible view of recovery,” he says. “Maybe it doesn’t involve abstinence, so they allow them-selves to keep drinking as long as it’s at low level, or they drink only during special events.”

This story originally appeared in the fall 2017 issue of InSight.

Gilbert to receive leadership award at APHA

A portrait of Paul Gilbert, assistant professor of community and behavioral health at the University of Iowa College of Public Health.Paul Gilbert, assistant professor of community and behavioral health, will be honored Nov. 7 with the Section Leadership Award from the Alcohol, Tobacco, and Other Drugs (ATOD) Section at the American Public Health Association annual meeting in Atlanta.

The award recognizes an ATOD Section member who has made significant contributions to the Section and the ATOD field.

Congratulations, Paul!

Gilbert, Janssen selected as IIPHRP Policy Fellows

The Iowa Institute of Public Health Research and Policy (IIPHRP) is pleased to announce the newest members of its Policy Fellow Program. The 2017-2018 Policy Fellows are Paul Gilbert, UI assistant professor of community and behavioral health, and Brandi Janssen, UI clinical assistant professor of occupational and environmental health.

The year-long Policy Fellow Program creates opportunities for primary faculty to enhance their skills for translating public health research into practice and policy. Each Policy Fellow develops and implements an “action learning project” focused on a critical public health topic. The project is intended to be completed within a one-year timeline and requires at least one stakeholder meeting and a product, such as a policy brief, proposed legislative language, or an implementation guide to disseminate at the end of the Fellowship.

“The scope of each project can be very diverse,” says Vickie Miene, interim director of the IIPHRP, based in the University of Iowa College of Public Health. “For example, one project may be to develop a position paper on a specific public health issue, while another project may be to implement legislative language that impacts workforce development.”

IIPHRP selects Policy Fellows from a competitive application process. The program provides funds for Fellows to attend specialized conferences or for other approved activities that enhance their learning. In addition, the program supports visits from policy experts, industry leaders, and other faculty who provide education and expertise to the program.

Reducing underage drinking

A portrait of Paul Gilbert, assistant professor of community and behavioral health at the University of Iowa College of Public Health.Gilbert’s project is looking at ways to reduce underage drinking, specifically through social host liability laws. Social host liability holds that adults who provide alcohol to minors, or allow minors to consume alcohol on their property, should be accountable for those violations of the minimum legal drinking age. In 2014, the Iowa state code was amended to enact a statewide social host liability law, covering all jurisdictions.

As a first step, Gilbert will assess variation in enforcement of Iowa’s recent social host liability law. He will review county-level enforcement records and interview stakeholders to understand when and how the law is enforced, including barriers to enforcement. As a second step, Gilbert will draw on the local knowledge and scientific literature to make recommendations to strengthen Iowa’s adolescent alcohol prevention policy.

An issue brief outlining the problem of adolescent drinking and describing the social host liability law is forthcoming. The final policy recommendations will be shared at a public summit in summer 2018.

Improving safe farm practices

Portrait of Brandi Janssen, clinical associate professor in the Department of Occupational and Environmental Health at the University of Iowa College of Public Health.Janssen’s project will focus on partnering with agricultural lenders to improve farm safety in Iowa. Injuries among farmers and agricultural workers remain higher than nearly every other industry in the United States. In most years in Iowa, agriculture is responsible for more occupational fatalities than any other industry.

These high injury and fatality rates are partially a result of the nature of agricultural work, in which farmers and their employees are regularly exposed to multiple hazards on the job (equipment, livestock, chemicals, and environmental hazards such as extreme heat and cold). In addition, because most farms employ fewer than 10 non-related workers, there are very few enforceable policies that require safety protocols or enact penalties for unsafe working conditions.

Many other industries, including manufacturers, grain co-ops, and financial lenders, rely on a safe and healthy farm workforce. In particular, agricultural lenders, who also aim to reduce risk, may be good partners in farm safety promotion and policy. Recognizing that safe farms benefit both farmers and lenders, whose investments are better protected, this project aims to identify strategies for agricultural lenders to encourage and improve safe farm practices in Iowa.

More information about the Policy Fellow Program can be found at https://www.public-health.uiowa.edu/iiphrp/.

Gilbert leading survey of LGBTQ health needs in Iowa

LGBT rainbow flag and health care providerThis year, Iowa becomes one of just a handful of states to conduct a health assessment of its lesbian, gay, bisexual, transgender, and queer (LGBTQ) residents. The University of Iowa College of Public Health, the Iowa Cancer Consortium, and One Iowa (a state-wide LGBTQ advocacy organization) have partnered to conduct a comprehensive survey to describe the health status and identify the health needs of LGBTQ Iowans.

“There’s a saying in public health that no data equals no problem,” says Paul Gilbert, CPH assistant professor of community and behavioral health and principal investigator. “We’re doing this survey to find out what LGBTQ Iowans need in order to be the healthiest they can be.”

The group began with an in-person survey earlier this summer at LGBTQ Pride events in Des Moines, Iowa City, Council Bluffs, and Cedar Rapids, and have just launched an online survey to ensure participation across the state. The group also plans to augment findings through several focus groups to be held later this year.

Lauren Pass, an MPH student in community and behavioral health, has helped develop and launch the LGBTQ health assessment. “Designing the survey, we wanted to account for the diversity within the community so we can represent all LGBTQ Iowans as best and accurately as possible,” she says.

LGBTQ Iowa residents can take the online survey at tinyurl.com/lgbtqhealthsurvey. For more information, contact Dr. Gilbert by phone (319-384-1478) or email (paul-gilbert@uiowa.edu).

Gilbert receives New Faculty Research Award

A portrait of Paul Gilbert, assistant professor of community and behavioral health at the University of Iowa College of Public Health.Paul Gilbert, assistant professor of community and behavioral health, has been selected to receive a College of Public Health New Faculty Research Award of $10,000. The grant funding will be used for a project titled “Natural Recovery from Alcohol Use Disorders in Southeast Iowa.” The project will be funded for the 2017 calendar year.

The purpose of the New Faculty Research Award is to assist CPH primary faculty in collecting preliminary data or pilot studies leading to larger projects.

Project Description

The majority of people in the United States with an alcohol use disorder (AUD) do not receive treatment, and some social groups, such as women and racial/ethnic minorities, are less likely to receive help than their male and White counterparts, respectively. Nevertheless, as many as three-quarters of those with AUD will achieve remission without treatment. This paradoxical phenomenon of unassisted self-change, known as natural recovery, has been long recognized by alcohol scholars but remains poorly understood.

Research over the past three decades has identified a number of factors associated with natural recovery, such as individual psychosocial characteristics, interpersonal networks, individual health status and health events, and environmental circumstances. In turn, these findings have been applied in a wide variety of intervention trials to promote natural recovery, often with only modest success in reducing problematic drinking. Such limited effectiveness may be due to incomplete understanding of the processes at work.

Further, there has been scant attention to variability of this phenomenon. Only one study to-date has examined effect modification by gender, finding differences in the psychosocial and interpersonal factors associated with natural recovery between men and women. To the researcher’s knowledge, there has been no reported investigation of differences between racial/ethnic groups, despite criticism that many early studies of natural recovery relied on overly homogeneous, predominantly White samples.

In response, this study will use qualitative methods to elaborate the processes of natural recovery among White, Black, and Latino men and women in southeast Iowa.

The specific aims of the project are:

  • To identify and characterize the process of natural recovery among adults who have not received treatment for alcohol misuse.
  • To determine the most productive recruitment strategies to reach adults who have experienced natural recovery.

The study’s preliminary data will be used in support of a larger, subsequent study to examine natural recovery.