One-Year Outcomes among Members of a Dual-Recovery Self-Help Program.

Research Objective: Self-help is gaining increased acceptance among treatment professionals as empirical support for of its effectiveness is growing and the advent of managed care warrants the use of cost-effective modalities. Traditional “one disease-one recovery” self-help programs cannot serve adequately the needs of the dually-diagnosed.

This paper presents one-year outcome data from a longitudinal study of the effectiveness of self-help for the dually-diagnosed.

Subjects are members of Double Trouble in Recovery (DTR), a 12-step self-help program designed to meet the special needs of those diagnosed with both a mental health disorder and a chemical addiction.Study.

Design: The study uses a 12-month prospective longitudinal design with follow-ups at 12 and 24 months after baseline. Subjects (N = 310) were recruited at 25 DTR meeting sites throughout New York City. Semi-structured instruments assess history and current status of mental health and substance abuse, treatment in both areas, and self help participation (DTR as well as traditional 12-step groups such as AA and NA).

Population Studied: Community-based individuals dually-diagnosed with a mental health disorder and substance abuse.

Principal Findings: S’s are mostly members of underserved minority groups with long histories of substance abuse and mental health disorders.

Most S’s attend outpatient treatment (for drug use, mental health or dual-diagnosis – 77%) and take psychotropic medications (87%).

At the 12 months follow-up,

• 76% were still attending DTR;
• 68% were also attending AA or NA.

Mean number of symptoms S’s. experienced in the past year decreased significantly;

• two-thirds (69%) of S’s reported that their mental health was “better” in the past month than it was at baseline.
• One-third (29%) reported substance use in the past year, compared to 42% at baseline (p = .002).

Substance use (less) was significantly associated with DTR attendance:

• Total time abstinent was related to lifetime length of DTR attendance (r = .25, p = .002) and
• past year substance use was related to number of months of DTR attendance in the past year (r = -.17, p = .02).

Conclusions: For dually-diagnosed individuals, continued participation in dual recovery self-help groups plays a significant role in the recovery process, particularly in the area of substance use.

Implications for Policy, Delivery or Practice: Participation in dual-recovery self-help groups, both during and after formal treatment, should be encouraged as part of an integrated lifelong recovery plan for dually-diagnosed individuals.

Research; One-Year Outcomes among Members of a Dual-Recovery Self-Help Program. Laudet A, Magura S, Vogel H, Knight E, Staines G; Abstr Acad Health Serv Res Health Policy Meet. 2000; 17.

More at; Double Trouble in Recovery

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• Subscribe to Twelve Step Facilitation by e-Mail

Dual Diagnosis; Counseling the Mentally Ill Substance Abuser by Katie Evans, J. Michael Sullivan Read more about this title…

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Depression in 6050 Former Drinkers; Association With Past Alcohol Dependence.

Background; The association between alcoholism and major depression in the general population has been explained as misdiagnosed alcohol intoxication and withdrawal effects mistaken for depressive syndromes.

To investigate whether this could account for the entire relationship, the association of past alcohol dependence with current major depression (ie, non-overlapping time frames) was investigated in individuals who no longer drink or who drink very little.

We conducted the study using data from the National Longitudinal Alcohol Epidemiologic Survey, a representative sample.

Methods; Former drinkers who did not use drugs or smoke in the past year (n = 6050) were divided into those with and without past DSM-IV alcohol dependence. These 2 groups were compared for the presence of current (last 12 months) DSM-IV major depression. The association between prior alcohol dependence and current major depression was tested with linear logistic regression, controlling for other variables.

Prior alcohol dependence increased the risk of current major depressive disorder more than 4-fold.

Results; Prior alcohol dependence increased the risk of current major depressive disorder more than 4-fold. This relationship was not attenuated by control variables.

The majority of subjects with major depression last used substances 2 or more years prior to the interview, which eliminates acute intoxication or withdrawal effects as an explanation of their depressions.

Conclusions; The strong, specific association between prior alcohol dependence and current or recent major depression in a nationally representative sample of former drinkers indicates that the association is not entirely an artifact of misdiagnosed intoxication and withdrawal effects.

A better understanding of the nature of the relationship between the 2 disorders should be sought and will have important public health significance.

Research report; Deborah S. Hasin; Bridget F. Grant.Major Depression in 6050 Former Drinkers; Association With Past Alcohol Dependence. Arch Gen Psychiatry. 2002;59:794-800.

• Alcoholics Have Trouble Identifying Emotions
• Cognitive Behavioral Therapy
• Depressed Men Who Drink More Likely to Commit Suicide
• Depression & 12-Step Programs

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Australian Broadcasting Commission, Online, AM, 11 January 2007, journalist Anne Barker

TONY EASTLEY: It’s proven that women who drink in pregnancy risk causing life-long health problems for their unborn children.

What isn’t so well known is that there’s growing evidence that foetal alcohol disorders, as they’re known, are a major cause of crime.

A Canadian lawyer is in Darwin this week talking to judges and barristers about the impact of foetal alcohol.

Anne Barker reports.

ANNE BARKER: It’s common knowledge that women who drink when they’re pregnant can cause permanent and serious brain damage to the unborn child.

But only now is a growing body of research revealing the scale of foetal alcohol disorders in the western world.

One man who has witnessed the consequences of alcohol induced delinquency over 20 years is Canadian barrister David Boulding.

DAVID BOULDING: Alcohol acts like nail polish remover on your nails. It dissolves brain cells. And when the brain cells are not there, the brain is missing brain function.

So you get kids who are impulsive, suggestive, no abstract thinking, memory problems, learning problems, attention problems.

ANNE BARKER: David Boulding believes one to two per cent of the population has some form of life-long disability caused even before they were born. And contrary to popular belief, he says they’re more likely to come from an affluent background.

DAVID BOULDING: Rich, white stockbrokers have wives who drink while they are pregnant.

The University of California just did a huge multi-year study and they found out that women that drink the most while they are pregnant are white, with four years of university education, earning 400 per cent above the poverty line.

ANNE BARKER: Wealthy or not, youngsters with foetal alcohol disorders, whether it’s learning problems or memory loss appear to account for a staggering proportion of delinquents.

In the only study of its kind in one Canadian province, one quarter of young offenders were found to have some form of permanent foetal alcohol syndrome.

David Boulding says there’s a clear connection to crime.

DAVID BOULDING: They really are missing that little voice. That superior, frontal lobe conscience part of the brain that knows right and wrong.

But also they are alone. They don’t have friends, they’ll do anything to please people. They will confess to murder, they’ll hold the gun, they’ll drive the get away car.

ANNE BARKER: David Boulding is in the Northern Territory this week as a guest of the Aboriginal justice agency NAAJA, which represents Indigenous offenders in court.

One NAAJA lawyer Stewart O’Connell says despite the clear impact of alcohol on crime in the NT, the prevalence of foetal alcohol syndrome is virtually unknown.

STEWART O’CONNELL: We are locking Aboriginal people up in jail at a greater rate than ever before. The sentences are getting longer, and it’s not working.

And we have to ask the question – why is it not working? And one of the reasons may be because of things such as foetal alcohol syndrome.

ANNE BARKER: And David Boulding says while nothing can ever reverse foetal alcohol disorders, a recognition of the problem would lead to more effective solutions than jail.

He says it’s already working in Canada.

DAVID BOULDING: Every probation officer, every judge, every lawyer has got stories where somebody took and interest in somebody and made sure, okay he’s not going to hang out with those guys any more, he’s not going to go there any more. I’m going to get him some kind of job maybe, even if it’s volunteer work, he’s going to have new friends.

And guess what? The crime stops.

TONY EASTLEY: Canadian barrister David Boulding talking to Anne Barker in Darwin.

Link to story: http://www.abc.net.au/cgi-bin/common/printfriendly.pl?http://www.abc.net.au/am/content/2007/s2136186.htm

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On any given day in the United States, one million people are in treatment for alcoholism or drug addiction. It is not getting into treatment, however, that makes the difference. Instead, it is what a person gets out of treatment. The fact that many people do not find success in treatment on their first attempt is due in part to a lack of understanding about what makes effective treatment.

The ten effective elements of treatment are;

1. There is no treatment formula that will work for everyone.

2. Medically supervised withdrawal is only one step in addiction treatment; alone it will do little.

3. Length of treatment counts

4. Drug addiction is a multidimensional problem, and treatment needs to address all of an individual’s needs

5. Counseling (individual and/or group) is a critical part of effective addiction treatment.

6. Medications are an important part of treatment for many people.

7. Drug testing during treatment is important.

8. Alcoholics and addicts with mental health disorders should be treated for both at the same time.

9.Addiction Treatment works even for people who don’t choose it of their own free will.

10. Don’t give up.

As with other chronic illnesses, relapses can occur during or after successful treatment episodes. Addicted individuals may need lengthy treatment and more than one time in treatment before they can enjoy long-term abstinence and full restoration to a drug free life. The period after treatment is just as important as being in treatment. Finding support and continuous work to stay drug free will be necessary. A slip or relapse is just an indicator that more work, and possibly more treatment, is necessary. Don’t give up.

Full story at Recovery Today

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• AA and Treatment Work Better Together
• AA Offers Recovery Not Religion
• If you have healthcare training this manual may help.

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Attitudes and Beliefs About 12-Step Groups Among Addiction Treatment Clients and Clinicians: Toward Identifying Obstacles to Participation.

Abstract; Participation in 12-step groups during and after formal treatment has been associated with positive outcome among substance users. However, the effectiveness of 12-step groups may be limited by high attrition rates and by low participation, areas on which there has been little research.

Clinicians play an important role in fostering 12-step participation, and the insights which they develop in their practice can greatly contribute to informing the research process. Yet, little is known about clinicians’ attitudes about 12-step groups or about their experiences in referring clients.

This study surveyed clients (N = 101) and clinicians (N = 102) in outpatient treatment programs to examine 12-step-related attitudes and to identify potential obstacles to participation. Data collection was conducted between May 2001 and January 2002 in New York City.

Both client and clinician samples were primarily African-American and Hispanic; 32% of clients reported substance use in the previous month, with crack and marijuana cited most frequently as the primary drug problem. On average, clinicians had worked in the treatment field for 8 years.

Both staff and clients viewed 12-step groups as a helpful recovery resource.

Major obstacles to participation centered on motivation and readiness for change and on perceived need for help, rather than on aspects of the 12-step program often cited as points of resistance (e.g., religious aspect and emphasis on powerlessness).

Clinicians also frequently cited convenience and scheduling issues as possible obstacles to attending 12-step groups.

Clinical implications of these findings are discussed, including

• the importance of fostering motivation for change,
• the need to assess clients’ beliefs about and experiences with 12-step groups on a case-by-case basis, and to
• find a good fit between clients’ needs and inclinations on the one hand, and
• the tools and support available within 12-step groups on the other.

Research; Alexandre B. Laudet, Attitudes and Beliefs About 12-Step Groups Among Addiction Treatment Clients and Clinicians: Toward Identifying Obstacles to Participation, Substance Use & Misuse, Volume 38, Issue 14 December 2003, pages 2017 – 2047

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A healthy dentist is one of the most important ingredients in a successful dental practice. An ingredient not to be taken for granted. Professionals, dentists included, can and do experience illnesses and problems that can disrupt or impair a practice.

In addition to the vulnerabilities of the human condition–addictive disorders, psychiatric illnesses, infectious disease, family and relationship problems, or the many varieties of human misery–dentists have undergone a powerful process of socialization into their professional role that makes it difficult to seek help for themselves.

Stigma about addictive and psychiatric illnesses continues to be a problem despite significant advances in scientific understanding of these disorders.

Many people, especially those in positions of community visibility as dentists are, still struggle with shame when they associate problems with personal failure.

Dental societies are in an ideal position to provide resources and support, should they choose to take this opportunity, and the ADA has the information and expertise to help them do this.

PRACTICE IMPLICATIONS: Dentists can become more aware of their own vulnerabilities and enhance their personal and professional effectiveness, as well as evaluate ways they may support their staff and colleagues.

Research; J Am Dent Assoc. 2004 Jan;135(1):84-9. Safeguarding the health of dental professionals. Lavine SR, Drumm JW, Keating LK.

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• Brief-TSF can assist people cease alcohol consumption.
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Subscribe to Twelve Step Facilitation by e-Mail

Natural Health, Natural Medicine: The Complete Guide to Wellness and Self-Care for Optimum Health by Andrew Weil Read more about this title…

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AA Utilization After Introduction in Outpatient Treatment.

Abstract; Treatment for alcohol dependence is often provided in outpatient settings, and often includes introduction to the 12-Step fellowship Alcoholics Anonymous (AA).

Relatively little is known about subsequent AA utilization.

Analyses of survey data collected from 72 clients of an outpatient treatment center introduced to AA revealed that, 6 months following intake, a large portion of the responding sample of 55 were still attending AA meetings.

Principal components analysis of self-reports of the frequencies of 12 AA-related behaviors found three dimensions of AA utilization:

• fellowship or social involvement,
• meeting attendance and participation, and
• involvement in bureaucratic functioning and meeting production.

Results suggest it is important to consider these dimensions of utilization for those wishing to understand AA involvement.

Research; Lisa Thomassen. AA Utilization After Introduction in Outpatient Treatment. Substance Use & Misuse, Volume 37, Issue 2 February 2002 , pages 239 – 253

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Brief Intervention as a Bridge to AA

Brief Intervention Is Insufficient for Medical Inpatients With Unhealthy Drinking

Data show that brief intervention reduces consumption and consequences among outpatients with unhealthy, but not dependent, alcohol use. To assess whether brief interventions work among medical inpatients with unhealthy drinking,* researchers randomized 341 of such patients to a 30-minute session of motivational counseling in the hospital or to usual care.

Most subjects had alcohol dependence, were unemployed during the previous 3 months, used other drugs, and had substantial psychiatric symptoms. Almost half were hospitalized for an alcohol-related medical diagnosis.

At 3 months among subjects with alcohol dependence, similar proportions of the intervention and control groups received alcohol assistance (e.g., specialty treatment) (49% and 44%, respectively).

At 12 months among all subjects, decreases in alcohol consumption did not significantly differ between the groups (e.g., adjusted mean decreases in drinks per day, 1.5 for intervention subjects and 3.1 for usual care subjects).

Comments:

Unlike most brief intervention studies in outpatients, this study enrolled a predominantly alcohol-dependent sample with major comorbidities—a group reflective of the treatment-resistant population identified when screening occurs in inpatient settings. The study suggests that screening, assessment, and brief counseling are necessary but not sufficient to change alcohol consumption in this population. Although the findings are disappointing, this study underscores that alcoholism—like cancer, atherosclerosis and other complex diseases—will not succumb to simple solutions.

References: Saitz R, Palfai TP, Cheng DM, et al. Brief intervention for medical inpatients with unhealthy alcohol use: a randomized controlled trial. Ann Intern Med. 2007;146(3):167–176.

• Brief-TSF extends brief intervention to lifelong recovery.

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Primary Care Clinicians Lack Comfort, Skills in Discussing Alcohol Use

Often, primary care clinicians inadequately address alcohol use with their patients.

To describe alcohol-related discussions in primary care, investigators audiotaped and performed qualitative analysis of outpatient visits involving 14 primary care clinicians (physicians and nurse practitioners) and 29 of their patients.

All patients were male veterans who screened positive for unhealthy alcohol use.*

Three themes emerged:

• Patients often disclosed that they consumed large amounts of alcohol and/or experienced negative health consequences from drinking.
• Clinicians commonly responded by changing the subject, minimizing the significance of their patients’ drinking, or pursuing a nonalcohol-related issue.
• Hesitation, stuttering, inappropriate laughter, and ambiguous statements were apparent when clinicians discussed alcohol but not other topics.
  Advice about drinking was tentative and vague while advice about smoking was more common, decisive, and specific.

Brief alcohol counseling — an evidence-based practice — has been poorly disseminated into primary care practice. This exploratory study suggests that clinicians’ discomfort and limited skills in assessing and advising patients with unhealthy alcohol use are partly to blame.

Although training alone is not sufficient to increase alcohol counseling, these findings indicate that educational initiatives to improve primary care clinicians’ comfort levels and skills are necessary, nonetheless.

Reprinted with permission from Alcohol and Health: Current Evidence.

Reference: McCormick KA, Cochran NE, Back AL, et al. (2006) How primary care providers talk to patients about alcohol: a qualitative study. J Gen Intern Med., 21(9): 966-972.

From Join Together Online

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What can be confidently said about AA in general and about the role of spirituality in AA in particular?

• First, there is convincing evidence that alcoholism severity predicts later AA attendance.
• Second, atheists are less likely to attend AA, relative to individuals who already hold spiritual and/or religious beliefs. However, belief in God before AA attendance does not offer any advantage in AA-related benefits, and atheists, once involved, are at no apparent disadvantage in deriving AA-related benefits.
• Third, the spiritually-based principles of AA appear to be endorsed in AA meetings regardless of the perceived social dynamics or climate of a particular meeting, eg, highly cohesive or aggressive.
• Fourth, significant increases in spiritual and religious beliefs and practices seem to occur among AA-exposed individuals.
• Fifth, in spite of much discussion to the contrary there is little evidence that spirituality directly accounts for later abstinence.

We are finding, however, that spirituality has an important indirect effect in predicting later drinking reductions. Specifically, in the past 20 years a number of effective methods have been developed to facilitate initial AA attendance. Such as Brief-TSF.

Interventions that lead to initial increases in spirituality appear to lead to sustained AA affiliation, which, in turn, produces sustained recovery over time.

Research; Tonigan JS. Spirituality and alcoholics anonymous. South Med J. 2007 Apr;100(4):437-40.

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