Alcoholics Anonymous careers

BACKGROUND: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of adjunctive aftercare, but we know very little about treatment seekers’ patterns of AA involvement over time and how these relate to abstinence.

METHOD: This paper applies latent class growth curve modeling to longitudinal data from 349 dependent drinkers recruited when they were entering treatment and were re-interviewed at one or more follow-up interviews one, three and five years later, and who reported having attended AA at least once.

RESULTS: Four classes of AA "careers" of meeting attendance emerged:

The low AA group mainly just attended AA during the 12 months following treatment entry.

The medium and high AA groups were characterized by stable attendance at the second and third follow-ups-at about 60 meetings a year for the medium group and over 200 meetings per year for the high group, followed by slight increases for the medium group and slight decreases for the high group by year five.

The declining AA group doubled its meeting attendance post baseline, to almost 200 meetings during the year following treatment entry, but by year five they were only attending about six meetings on average.

Decreases in AA meetings did not necessarily signal disengagement from AA; at the five-year follow-up, a third of the low AA group and over half of the declining AA group said they felt like a member of AA. Activities other than meeting attendance, such as having a sponsor, otherwise paralleled the meeting careers, but social networks were similar by year five.

Rates of abstinence by year five (for the past 30 days) were

• 43% for the low AA group,
• 73% for the medium group,
• 79% for the high group and
• 61% for the declining group.

Rates of dependence symptoms and social consequences of drinking did not differ between the groups at year five.

CONCLUSIONS: The prototypical AA careers derived empirically are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable (and sometimes quite high) rates of AA attendance. However, contrary to AA lore, many who connect only for a while do well afterwards.

Research; Kaskutas LA, Ammon L, Delucchi K, Room R, Bond J, Weisner C. Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry. Alcohol Clin Exp Res. 2005 Nov;29(11):1983-90.

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Faith Community Nurses and the Prevention and Management of Addiction Problems

Faith Community Nurses can have a role in the prevention and management of problems associated with the use and abuse of psychoactive substances, prescription drugs, and over-the-counter medications.

Religious perspectives of faith communities on the use of drugs vary considerably, as do the religious perspectives of addiction.

Nevertheless, Faith Community Nurses work in these communities and understand the unique culture of these groups.

The Faith Community Nurse has many functions including health educator, health advocate, personal health counselor, referral agent, coordinator of volunteers, developer of support groups, and integrator of health and faith.

Consequently, the Faith Community Nurse is involved with individuals, families, and members of the community.

These connections provide many opportunities for the Faith Community Nurse to institute programs to prevent addictions, help people understand the problems of addiction, help provide a caring community for people suffering from addictions, and guide people to the help they need.

In addition, the nurse has opportunities to conduct research that would enhance the understanding of the topic.

Research; Joan A. Bard. Faith Community Nurses and the Prevention and Management of Addiction Problems. Journal of Addictions Nursing, Volume 17, Issue 2 July 2006 , pages 115 – 120

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Working with Substance Misusers

The 12-step programs are discussed. It is noted that 12-step programs consist of a range of self-help groups, which have their origins in the recovery philosophy of Alcoholics Anonymous.

The Minnesota Model is an adaptation of the 12-step program that is used in some specialist treatment settings.

There is a lack of knowledge and training regarding 12-step methods among professional groups, and misunderstandings are common.

The program does offer a resource which is widely available, free, open to anyone, and that provides support at times when other agencies are unavailable.

The approach may be a useful alternative or adjunct to other treatments for some clients.

Williams, C. Twelve step approaches. In: T. Petersen and A. McBride, Eds., Working with Substance Misusers, London, UK: New York, NY: Routledge, 2002. 362 p. (pp. 134-144).

Brief-TSF satisfies these guidelines

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AA Membership 2005

Because A.A. has never attempted to keep formal membership lists, it is extremely difficult to obtain completely accurate figures on total membership at any given time. Some local groups are not listed with the General Service Office. Others do not provide membership data, thus are not recorded on the G.S.O. computer records. The membership figures listed below are based on reports to the General Service Office as of January 1, 2005, plus an average allowance for groups that have not reported their membership.

Estimated A.A. Membership and Group Information

• Groups in U.S. . . . . . . . . . . . . . . 52,651
• Members in U.S. . . . . . . . . . . .. . 1,190,637
• Groups in Canada . . . . . . . . . . .. 4,872
• Members in Canada . . . . . . . . . . 95,984
• Groups Outside of U.S./Canada . . 45,209
• Members Outside of U.S./Canada . 729,097
• Internationalists . . . . . . . . . . . . 76
• Groups in Correctional Facilities U.S./Canada. . . . . 2,562
• Members in Correctional Facilities U.S./Canada .. . 66,963
• Lone Members . . . . . . . . . . . . . . 223

Total Reported

• 2,082,980 Members
• 105,294 Groups

From; A.A. FACT FILE at www.aa.org

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Alcoholics Anonymous and Narcotics Anonymous benefit adolescents who attend

While Alcoholics Anonymous (AA) has existed for more than 70 years, and is the most commonly sought source of help for alcohol-related problems in the United States, there is little “hard scientific evidence” showing that AA and Narcotics Anonymous (NA) can improve substance-use outcomes. This study examined how helpful AA and NA may be for adolescents, finding long-term benefits even though many youth discontinue attendance after time.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research.

“It is difficult to evaluate the efficacy of mutual-help organizations like AA through randomized controlled experiments because the AA ‘intervention,’ being a community organization based on anonymity, cannot be directly under the control of the researcher in the usual way,” explained John F. Kelly.

Yet their popularity and cost-effectiveness cannot be denied, added Kelly.

“AA and NA are explicitly focused on abstinence and addiction recovery, they are widely available across most communities, they provide entry to a social network of recovery-specific support and sober events that can be accessed ‘on demand’ – particularly at times of high-relapse risk such as evenings and weekends, the services are free, and AA/NA can be attended as intensively, and for as long, as individuals desire,” he said.

However, he added, despite growing evidence that adults benefit from AA and NA, little is known about how these abstinence-focused organizations help youth, and what is known lacks scientific rigor.

“This knowledge gap is particularly noteworthy given that adolescents and young adults face more barriers to AA and NA than older adults and yet appear to be referred there just as frequently by treatment providers,” said Kelly. “Youth tend to have less severe addiction problems, on average, and consequently do not feel a strong need to stop using alcohol and/or drugs. ‘Why should they bother to go to abstinence-oriented organizations like AA and NA, and would they benefit even if they did go?’” These are the questions Kelly and his colleagues wanted to address.

The researchers recruited 160 adolescent inpatients (96 males, 64 females), with an average age of 16 years, who were enrolled at two treatment centers in California having a focus on abstinence and based on a 12-step model. The study participants’ length of stay ranged from four to six weeks, after which they were re-assessed on a number of clinical variables at six months, and one, two, four, six, and eight years.

“We found that most of the youth attended at least some AA/NA meetings post-treatment,” said Kelly. “Those patients with severe addiction problems and those who believed they could not use alcohol/drugs in moderation attended the most.

The NA and AA focus on abstinence/recovery probably resonates better with these more severely dependent individuals who also typically need ongoing support.”

Even though many of the youth discontinued AA/NA after time, they nonetheless appeared to benefit from attendance.

“We found that patients who attended more AA and/or NA meetings in the first six months post-treatment had better longer term outcomes, but this early participation effect did not last forever – it weakened over time,” said Kelly. “The best outcomes achieved into young adulthood were for those patients who continued to go to AA and/or NA. In terms of a real-world recovery metric, we found that for each AA/NA meeting that a youth attended they gained a subsequent two days of abstinence, independent of all other factors that were also associated with a better outcome.”

A little can go a long way, he added. “During the first six months post-treatment,” said Kelly, “even small amounts of AA/NA participation – such as once per week – was associated with improved outcome, and three meetings per week was associated with complete abstinence. This suggests youth may not need to attend as frequently as every day, sometimes recommended clinically, to achieve very good outcomes.”

Kelly believes that part of the reason for the success of AA/NA among adolescents who attend meetings is related to their developmental needs.

“Given the need for social affiliation and peer-group acceptance outside of the family at this stage of life, peers can exert strong influence on the behavior of young people,” he noted. “When you couple this fact with the reality that most adolescents and young adults are experimenting with, or heavily using, alcohol and other drugs, it may be hard to find suitable peer contexts that can facilitate recovery. In fact, we know that most youth relapses are connected with social contexts where alcohol/drugs are present; unlike adults, youth rarely relapse alone. So, organizations such as AA/NA may provide support, and encourage and provide alternatively rewarding sober social activities.”

See also;

• AA and Treatment Work Better Together
• Brief-TSF is designed to address these issues.
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Subscribe to Twelve Step Facilitation by e-Mail

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Can 12-step group participation strengthen and extend the benefits of adolescent addiction treatment? A prospective analysis

Background

Despite advances in the development of treatments for adolescents with substance use disorders (SUD), relapse remains common following an index treatment episode. Community continuing care resources, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), have been shown to be helpful and cost-effective recovery resources among adults. However, little is known about the clinical utility and effectiveness of AA/NA for adolescents, despite widespread treatment referrals.

Method

Adolescents (N = 127; 24% female, 87% White, M age = 16.7 years) enrolled in a naturalistic, prospective study of community outpatient treatment were assessed at intake, and 3 and 6 months later using a battery of standardized and validated measures.

Results

Just over one-quarter of youth attended AA/NA meetings during the first 3 months, which was predicted by a goal of abstinence, prior AA/NA attendance, and prior SUD treatment experiences. Controlled multiple regression analyses revealed an independent effect of AA/NA on abstinence, in both contemporaneous and lagged models, which persisted over and above the effects of pre-treatment AA/NA attendance, prior treatment, self-efficacy, abstinence goal, and concomitant outpatient treatment.

Conclusions

Results suggest that, similar to findings comparing adult outpatients to inpatients, AA/NA participation is less common among less severe adolescent outpatients. Nonetheless, attendance appears to strengthen and extend the benefits of typical community outpatient treatment. Given the dramatic increase in rates of substance use among same-aged peers in the population at this life-stage, and the relative dearth of abstainers and recovery-specific supports, these resources may provide a concentrated cost-effective social recovery resource for young people.

Can 12-step group participation strengthen and extend the benefits of adolescent addiction treatment? A prospective analysis. John F. Kelly, Sarah J. Dow, Julie D. Yeterian and Christopher W. Kahle. Drug and Alcohol Dependence

See also

• Improving Treatment Compliance
• Brief-TSF can assist patients cease alcohol consumption.
• AA & NA Work for Teens Too
• Treatment Resources for providers

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Detoxification from alcohol abuse.

The alcohol withdrawal syndrome (AWS) is a common management problem in hospital practice for neurologists, psychiatrists and general physicians alike.

Although some patients have mild symptoms and may even be managed in the outpatient setting, others have more severe symptoms or a history of adverse outcomes that requires close inpatient supervision and benzodiazepine therapy.

Many patients with AWS have multiple management issues;

• withdrawal symptoms,
• delirium tremens (DT’s),
• the Wernicke–Korsakoff syndrome,
• seizures,
• depression,
• polysubstance abuse,
• electrolyte disturbances and
• liver disease,

These require a coordinated, multidisciplinary approach. Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients.

The alcohol withdrawal syndrome; Journal of Neurology, Neurosurgery, and Psychiatry 2008;79:854-862, A McKeon, M A Frye, Norman Delanty.

See also;

• 12-Step Treatment More Effective than Alternative
• Brief-TSF can assist people cease alcohol consumption.
• Alcohol Related Brain Injury

Slaying the Dragon: The History of Addiction Treatment and Recovery in America by William L. White Read more about this title…

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Impact of parental history of substance use disorders on the clinical course of anxiety disorders.

Abstract; Background Among the psychological difficulties seen in children of parents with substance use problems, the anxiety disorders are among the most chronic conditions.

Although children of alcoholic parents often struggle with the effects of parental substance use problems long into adulthood, empirical investigations of the influence of parental substance use disorders on the course of anxiety disorders in adult offspring are rare.

The purpose of this study was to examine prospectively the relationship between parental substance use disorders and the course of anxiety disorders in adulthood over the course of 12 years.

Methods; Data on 618 subjects were derived from the Harvard/Brown Anxiety Research Project (HARP), a longitudinal naturalistic investigation of the clinical course of multiple anxiety disorders. Kaplan-Meier survival estimates were used to calculate probabilities of time to anxiety disorder remission and relapse. Proportional hazards regressions were conducted to determine whether the likelihood of remission and relapse for specific anxiety disorders was lower for those who had a history of parental substance use disorders than for individuals without this parental history.

Results; Adults with a history of parental substance use disorders were significantly more likely to be divorced and to have a high school level of education.

History of parental substance use disorder was a significant predictor of relapse of social phobia and panic disorders.

Conclusions; These findings provide compelling evidence that adult children of parents with substance use disorders are more likely to have relapses of social phobia and panic disorders.

Clinicians who treat adults with anxiety disorders should assess parental substance use disorders and dependence histories. Such information may facilitate treatment planning with regards to their patients’ level of vulnerability to perceive scrutiny by others in social situations, and ability to maintain a long-term panic-free state.

Research; Impact of parental history of substance use disorders on the clinical course of anxiety disorders. Maria E. Pagano, Richard Rende, Benjamin F. Rodriguez, Eric L. Hargraves, Amanda T. Moskowitz, & Martin B. Keller. Substance Abuse Treatment, Prevention, and Policy 2007, 2:13

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Study Finds Significant Financial Benefits of Providing Substance Abuse Treatment. Latest study addresses policy makers’ concerns on spending public dollars on drug and alcohol treatment

Every dollar spent on substance abuse treatment generates $7 in monetary benefits for society, according to a new study from researchers at the University of California at Los Angeles (UCLA).

Published in the online early edition of the peer-reviewed journal, Health Services Research, the study finds that the average cost of substance abuse treatment is $1,583, resulting in monetary benefits of $11,487 through reduced medical expenses, reduced costs of crime and increased employment earnings.

“Policy-makers are generally more inclined to support treatment programs for substance abuse if they pay for themselves through reductions in other types of costs, such as health care, criminal justice expenses, social programs, and unemployment benefits. This study clearly demonstrates the financial benefits of providing treatment for drug and alcohol problems,” according to Susan Ettner, lead author and professor of general internal medicine and health services research at UCLA’s David Geffen School of Medicine and School of Public Health.

The researcher team used data from 2,567 clients in 43 treatment programs in 13 California counties during 2000 and 2001, through the California Treatment Outcome Project (CalTOP).

The research team estimated cost of treatment for an individual by multiplying the number of days spent in each treatment setting, such as residential or outpatient, by the average daily cost of each mode of treatment, estimated using cost data collected from treatment providers.

Monetary benefits associated with treatment were estimated using administrative records as well as data provided by each client prior to treatment and nine months after treatment began. The study examined costs of medical care, mental health services, criminal activity, earnings, and related costs of government programs such as unemployment and public aid.

The California Department of Drug and Alcohol Programs, the Center for Substance Abuse Treatment and the Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program (SAPRP) provided primary support for the study.

“Substance abuse treatment is often needed by those who are indigent and are therefore dependent on services that are publicly financed. Given the stigma associated with substance abuse and the skepticism about the value of rehabilitation, financing for substance abuse treatment often runs into the question of whether or not it is beneficial in human and monetary terms. This study adds to a growing body of research showing the benefits of substance abuse treatment,” according to Ettner.

The study’s other findings:

• Treatment costs of clients who began with outpatient care totaled $838 compared to $2,791 for those who began in residential care.
• Reductions were seen in hospital inpatient, emergency room and mental health services costs, but only the $223 reduction in emergency room costs was statistically significant.
• Reduction in the cost of victimization and other criminal activities averaged $5,676.
• No significant changes were seen related to unemployment or disability costs. However, welfare payments increased slightly, perhaps due to increased referrals to public aid programs.

See full report at; http://www.rwjf.org/pr/product.jsp?id=21822

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All Kids Should Be Screened for Alcohol, Pediatricians Say

The American Academy of Pediatricians has recommended that doctors screen all of their young patients for alcohol use starting in middle school, the Wausau Daily Herald reported May 15.

The group’s Committee on Substance Abuse released a revised policy statement on youth alcohol use on May 1. "A remarkable amount of brain development is still occurring for young people through their 20s," said report lead author Patricia Kokotailo of the University of Wisconsin School of Medicine and Public Health. "This policy statement provides better evidence about how alcohol affects the brains of young people and why it is important to screen children."

Committee chair Janet Williams of the University of Texas Health Science Center at San Antonio said that most doctors don’t routinely ask about youth alcohol use, and need to know how to provide prevention guidance and where to refer young drinkers to treatment.

From Join Together

See also

• 12 Steps and Post Traumatic Stress
• Al-anon / Alateen for family and friends of alcoholics
• Improving Treatment Compliance
• Kids with Alcoholic, Addicted Parents

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