Role of shame in women’s recovery from alcoholism: The impact of childhood sexual abuse

This study compares the recovery experience of female members of Alcoholics Anonymous (AA) who reported a history of childhood sexual abuse (68 percent) with those who did not report experiencing childhood sexual abuse.

A sample of 53 women was obtained from AA.

A significant relationship was found between shame and two measures of difficulties in recovery,

• problems in social adjustment and
• relapse.

Though the hypothesis that experiences of child sexual abuse predicted difficulty in recovery was not supported, these data suggest that shame may be an important variable in both the etiology and treatment of alcoholism in women.

Research; Wiechelt, S.A.; Sales, E. Role of shame in women’s recovery from alcoholism: The impact of childhood sexual abuse. Journal of Social Work Practice in the Addictions, 1(4):101-116, 2001.

Healing the Shame that Binds You: Recovery Classics Edition (Recovery Classics) by John Bradshaw Read more about this title…

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The twelve-step recovery model of AA: a voluntary mutual help association

Alcoholism treatment has evolved to mean professionalized, scientifically based rehabilitation.

Alcoholics Anonymous (AA) is not a treatment method; it is far better understood as a Twelve-Step Recovery Program within a voluntary self-help/mutual aid organization of self-defined alcoholics.

The Twelve-Step Recovery Model is elaborated in three sections, patterned on the AA logo (a triangle within a circle): The triangle’s legs represent recovery, service, and unity;

• The circle represents the reinforcing effect of the three legs upon each other as well as the “technology” of the sharing circle and the fellowship.
• The first leg of the triangle, recovery, refers to the journey of individuals to abstinence and a new “way of living.”
• The second leg, service, refers to helping other alcoholics which also connects the participants into a fellowship.
• The third leg, unity, refers to the fellowship of recovering alcoholics, their groups, and organizations.

The distinctive AA organizational structure of an inverted pyramid is one in which the members in autonomous local groups direct input to the national service bodies creating a democratic, egalitarian organization maximizing recovery.

Analysts describe the AA recovery program as complex, implicitly grounded in sound psychological principles, and more sophisticated than is typically understood.

AA provides a nonmedicalized and anonymous “way of living” in the community and should probably be referred to as the Twelve-Step/Twelve Tradition Recovery Model in order to clearly differentiate it from professionally based twelve-step treatments.

From; Borkman T. The twelve-step recovery model of AA: a voluntary mutual help association. Recent Dev Alcohol. 2008;18:9-35.

• See also;
• Twelve Step Facilitation
• Brief-TSF Description
• Alcoholics Anonymous

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Despite decades of using a chronic disease metaphor for alcoholism and, more recently, drug addiction, we continue to provide treatment based on an acute model of care.

Is it time to shift to a chronic care approach similar to disease management models?

To explore this question, a recent study analyzed data demonstrating the chronic nature of addiction.

• Over 50% of people who resolve drug problems following treatment receive multiple episodes of care, usually over several years.
• Data from 2003 from programs receiving public funds revealed that 64% of people were readmissions to treatment and 19% had more than four admissions.
• In a study of 448 persons following treatment, 82% transitioned at least once between relapse, treatment re-entry, incarceration, and periods of abstinence over a 2-year period.
• Alarming results of a study from 23 states revealed that only 17% of persons discharged from intensive treatment were transitioned to outpatient continuing care.

Several emerging practices for a chronic care model and their results were also reviewed, revealing the following:

• telephonic follow-up resulted in fewer positive cocaine urine tests;
• assertive continuing care for adolescents demonstrated greater access to and participation in continuing care as well as greater abstinence;
• recovery management check-ups at 90-day intervals combined with motivational interventions for those who had relapsed provided a faster return to, and greater participation in, treatment as well as a lesser need for treatment at 2-year follow-up.

The authors discuss the need for substantial system changes required across all elements of the addiction treatment system if a chronic care model is to be implemented.

Comments by Michael Boyle, PhD:
Providers do what they are paid to deliver. If we want to change to a potentially more effective model of addiction treatment, the funding bodies must implement new billing codes and rates for continuing recovery management. Providers need to strive to remove any sense of failure, shame, or guilt persons may have regarding their return to use and need for additional assistance.

Reference:
Dennis M, Scott CK. Managing addiction as a chronic condition. Addict Sci Clin Pract. 2007;4(1):45-55.

From; Join Together Online

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12-Step Involvement Increases Sobriety and Reduces Costs

BACKGROUND: Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients’ health care costs in the first year after treatment, but such initially impressive effects may wane over time.

This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.

METHODS: A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step-based (n=887 patients) or cognitive-behavioral (CB, n=887 patients) treatment programs.

The 12-step-based programs placed substantially more emphasis on 12-step concepts, had more staff members “in recovery,” had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs.

The 2-year follow-up assessed patients’ substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.

RESULTS: As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) versus CB (37.0%) programs.

Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs.

In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs.

This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p=0.01).

CONCLUSIONS: Promoting self-help group involvement appears to improve post-treatment outcomes while reducing the costs of continuing care.

Even cost offsets that somewhat diminish over the long term can yield substantial savings.

Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.

Humphreys K, Moos RH. Alcohol Clin Exp Res. 2007 Jan;31(1):64-8. Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes.

See also;

• Twelve Step Facilitation
• Brief-TSF can assist patients cease alcohol consumption.

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Recovery glossary | Mutual aid groups.

Mutual aid groups (sometimes known as self-help or peer support groups) provide non-professional support to those who identify as sharing a similar problem. Members of mutual aid groups both give and receive support in regular group meetings that supplements or replaces the support offered by professional services. Mutual aid groups are independent, self-governing and institutionally autonomous; they may be local and unaffiliated, or part of a larger organisation. Mutual aid groups do not provide treatment.

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Stricter Sobriety Standards for California Health Professionals November 30, 2009

Nurses, doctors, dentists and other health professionals in California who are in treatment for alcohol and other drug problems will now be subject to stricter oversight and could be immediately removed from practice should they relapse, the Los Angeles Times reported.

Health workers will now be required to take more than 100 drug tests during their first year in treatment. One positive drug test result will be enough to have a health professional be temporarily suspended from practice.

All restrictions to licenses will be posted online for public access.

The new standards were created by the state legislature last year to address the way recovery programs for doctors were being handled. The Medical Board of California ended its diversion program in 2008 after several audits found that doctors were not monitored properly and those who relapsed were not being fired.

The new standards will apply to the seven boards that oversee diversion programs, which allow licensed health professionals with addiction problems to undergo drug tests and group therapy to address their illness.

Licensed health professionals who are on probation for abusing substances will also be subject to the new rules.

Critics of the new standards include Ellen Brickman, president of the National Organization of Alternative Programs, which advocates for treatment rather than punishment for impaired healthcare professionals. “I’m listening to this and I’m cringing,” said Brickman. “I’m not optimistic that this is going to work the way they want it to. It won’t keep people from abusing substances. It will keep them out of the system, where they’ll be sicker before anybody can do anything about it.”

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Integrating Primary Medical Care With Addiction Treatment

A Randomized Controlled Trial

Context; The prevalence of medical disorders is high among substance abuse patients, yet medical services are seldom provided in coordination with substance abuse treatment.

Objective; To examine differences in treatment outcomes and costs between integrated and independent models of medical and substance abuse care as well as the effect of integrated care in a subgroup of patients with substance abuse-related medical conditions (SAMCs).

Design; Randomized controlled trial conducted between April 1997 and December 1998.

Setting and Patients; Adult men and women (n = 592) who were admitted to a large health maintenance organization chemical dependency program in Sacramento, Calif.

Interventions; Patients were randomly assigned to receive treatment through an integrated model, in which primary health care was included within the addiction treatment program (n = 285), or an independent treatment-as-usual model, in which primary care and substance abuse treatment were provided separately (n = 307). Both programs were group based and lasted 8 weeks, with 10 months of aftercare available.

Main Outcome Measures; Abstinence outcomes, treatment utilization, and costs 6 months after randomization.

Results Both groups showed improvement on all drug and alcohol measures. Overall, there were no differences in total abstinence rates between the integrated care and independent care groups (68% vs 63%, P = .18).

For patients without SAMCs, there were also no differences in abstinence rates (integrated care, 66% vs independent care, 73%; P = .23) and there was a slight but nonsignificant trend of higher costs for the integrated care group ($367.96 vs $324.09, P = .19).

However, patients with SAMCs (n = 341) were more likely to be abstinent in the integrated care group than the independent care group (69% vs 55%). This was true for both those with medical and psychiatric SAMCs. Patients with SAMCs had a slight but nonsignificant trend of higher costs in the integrated care group ($470.81 vs $427.95, P = .14).

Conclusions Individuals with SAMCs benefit from integrated medical and substance abuse treatment, and such an approach can be cost-effective. These findings are relevant given the high prevalence and cost of medical conditions among substance abuse patients, new developments in medications for addiction, and recent legislation on parity of substance abuse with other medical benefits.

Research report; Integrating Primary Medical Care With Addiction Treatment; A Randomized Controlled Trial, Constance Weisner, DrPH; Jennifer Mertens, MA; Sujaya Parthasarathy, PhD; Charles Moore, MD, MBA; Yun Lu, MPH. JAMA. 2001;286:1715-1723.

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DUI Courts Cut Recidivism, But More Research Needed on Why

A new study from Pire’s Behavioral Health Research Center finds that drunk-driving recidivism declines when offenders are sent to DUI courts and ordered to wear electronic monitoring devices and sell their cars, but experts say that it remains unclear exactly what makes the courts effective.

A PIRE press release noted that DUI courts can prescribe a range of sanctions against offenders, including intensive probation, random drug testing, and addiction treatment. “While evidence indicates that these court intervention programs and DUI courts reduce recidivism, few studies have tried to determine what exactly accounts for their success,” said study author Sandra Lapham, M.D.

The study of a DUI court in Portland, Ore., found that arrest rates declined 96 percent among offenders forced to sell their vehicles, while those who wore monitoring devices were four times less likely to re-offend. “But the positive effects of electronic monitoring may be short lived because the re-offense rates increased over time, and after 3 years were similar to those without monitoring devices,” Lapham said. “Therefore, the search for the active ingredient in this successful intervention continues.”

The study was published in the October 2007 issue of the journal Addiction.

Research Reference: Lapham, SC, C’de Baca, J, Lapidus, J, McMillan, GP. (2007) Randomized sanctions to reduce re-offense among repeat impaired-driving offenders. Addiction, 102(10): 1618–1625.

From; Join Together Online

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Professional Interventions That Facilitate 12-Step Self-Help Group Involvement.

Facilitating patients’ involvement with 12-step self-help organizations, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), is often a goal of substance abuse treatment.

Twelve-step-facilitation (TSF) interventions have been found to be more effective than comparison treatments in increasing patients’ 12-step group involvement and in promoting abstinence.

Future TSF evaluation research should address the effectiveness of incorporating TSF interventions with cognitive-behavioral treatment methods, the relative impact of brief versus extended TSF interventions, and the cost-effectiveness and health care cost-offset of TSF interventions within managed health care systems.

Although the United States has developed an extensive array of professional alcohol treatment services over the past 30 years, the peer-led, voluntary fellowship known as Alcoholics Anonymous (AA) continues to be the most widely accessed resource for people with alcohol problems (McCrady and Miller 1993).

This article discusses the rationale for interventions that facilitate alcohol-dependent patients’ affiliations with AA and related mutual-help organizations (e.g., Narcotics Anonymous [NA]).

The article also reviews recent research comparing those interventions with other treatment methods.

Research; Professional Interventions That Facilitate 12-Step Self-Help Group Involvement. Journal article by Keith Humphreys; Alcohol Research & Health, Vol. 23, 1999

The Twelve-Step Facilitation Handbook: A Systematic Approach to Early Recovery from Alcoholism and Addiction by Joseph Nowinski

• See also;
• Twelve Step Facilitation is designed to support people returning to their community
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Brief-TSF can assist patients cease alcohol consumption.
• Brief-TSF Description
• Brief-TSF ASSESSMENT

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