A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS.

Since the 1970s, much of the public treatment system in California has been based on a social model orientation to recovery for alcoholics, but there has been minimal research on program outcomes. This article reports on follow-up interviews conducted with a representative sample of 722 people who had entered treatment about a year earlier in public and private programs, including publicly-funded social model detoxification and residential programs, and clinical model programs in hospitals and HMO clinics.

higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems

• Social model clients came to treatment with more severe legal and employment problems, whereas those seeking treatment at clinical programs reported more severe family problems.
• At follow-up, clients at both types of programs reported attending a similar number of Alcoholics Anonymous (AA) meetings, but social model clients reported going to more Narcotics Anonymous (NA) meetings and being involved in more AA activities.
• Social model clients were less likely than clinical model clients to report problems with alcohol or drugs at follow-up, but the odds of reporting other problems (e.g., medical, psychological, legal, family/social) were similar.

The program effect for better alcohol outcomes at the social model programs was partially explained by their clients’ higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems.

• Social networks supportive of abstinence also were predictive of reporting no alcohol problems at follow-up.

In contrast, subsequent detoxification treatment events between baseline and follow-up were associated with a higher odds of reporting alcohol, drug, psychiatric and family/social problems at follow-up.

These findings are consistent with the growing body of literature reporting higher rates of abstinence among those who are able to construct more positive social networks, and who attend and become involved in 12-step programs during and following treatment.

It is important that these results be replicated, as they suggest that social model programs are successful in engaging their clients in AA activities and in NA meeting attendance, and could represent for some an effective alternative to clinical model treatment programs.

Research; LEE ANN KASKUTAS, LYNDSAY AMMON, CONSTANCE WEISNER. A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS. International Journal of Self Help and Self Care; Volume 2, Number 2 / 2003-2004, 111 – 133

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Substance abuse among the elderly: A growing problem

In her early years, Eva would probably have been called a "teetotaler." Except for an infrequent sip of wine on special occasions, she never drank alcoholic beverages. But after her children moved away and her husband and many of her close friends died, Eva turned to the bottle for escape and companionship. Now in her late 70s, Eva is an alcoholic.

Harry has had problems with substance abuse since his late teens. Although drinking binges were often followed by periods of sobriety, he inevitably returned to his addictive ways. At 75, he is on several prescription medications, some of which should not be taken with alcohol. His children, long ago burned out from trying to persuade him to get help, have come to believe that you really can’t "teach an old dog new tricks."

These two composite situations illustrate what has been called one of the fastest growing health problems in this country–substance abuse among the elderly. More people are living longer and more of them are abusing drugs and alcohol in their later years.

Recent census data estimates that nearly 35 million people in the United States are 65 years or older. Substance abuse among those 60 years and older (including misuse of prescription drugs) currently affects about 17 percent of this population. By 2020, the number of older adults with substance abuse problems is expected to double.

As demographics change, attitudes about and use of alcohol and drugs change as well. "In January 2006, the leading edge of the baby-boom generation (those born during the population swell of 1946-1964) will turn 60," said Frederic Blow, professor in the Department of Psychiatry at the University of Michigan and a Huss Research Chair on Older Adults and Alcohol/Drug Problems at Hazelden’s Butler Center for Research. "These individuals have had more exposure to alcohol and illegal drugs, and there is more acceptance among them about using substances to ‘cure’ things. We expect to see an increase in drug and alcohol use; and more use means more problems."

Blow said there has also been an attitude shift regarding addiction and treatment, and that gives him hope that older substance abusers will get the help they need. "There is less shame and guilt associated with substance abuse now and more acceptance of treatment as a way to make things better," he said.

According to Blow and other experts, when people age, their sensitivity to alcohol increases as their tolerance decreases. Also, the percent of their body weight composed of water decreases, and alcohol–which is water-soluble–affects them more quickly and to a greater degree. Alcohol takes longer to metabolize in older persons, accumulating in their bodies and leading to intoxication if consumption is not controlled. Because of their physical make-up, older women are more vulnerable to the negative effects of alcohol.

As a whole, more older men have substance abuse problems than do older women, but women are more likely than men to start drinking heavily later in life. Substance abuse is more prevalent among persons who suffer a number of losses, including death of loved ones, retirement, and loss of health. The fact that women are more likely to be widowed or divorced, to have experienced depression, and to have been prescribed psychoactive medications that increase the negative effects of alcohol help explain these gender differences.

Unfortunately, health care providers often overlook substance abuse among older adults because they don’t know what to look for or they mistakenly assume that older adults cannot be successfully treated. Loved ones, too, may excuse an older relative’s substance abuse as a result of grief or loss or a reaction to boredom. Or family members may not want to confront an elder, fearing they will offend or anger them or get "written out of the will," said Blow.

Yet Blow said there is "good evidence" that older adults do as well as young people when it comes to treating substance abuse and that they may even do somewhat better. "Older adults can recognize all kinds of benefit from treatment," stressed Blow. "There are often direct health benefits, improved cognition, more independent living, more and better social connectedness, and new hobbies. The benefits are enormous."

The U.S. Substance Abuse and Mental Health Services Administration (http://www.samhsa.gov/) offers a wide range of information and resources to help identify, treat, and prevent substance abuse among older adults.

The pamphlet " How to Talk to an Older Person Who Has a Problem With Alcohol or Medications" is available on the Hazelden Web site.

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Helping other alcoholics in Alcoholics Anonymous and drinking outcomes: findings from project MATCH.

OBJECTIVE: Although Alcoholics Anonymous (AA) is the largest mutual-help organization for alcoholics in the world, its specific mechanisms that mobilize and sustain behavior change are poorly understood. The purpose of this study is to examine prospectively the relationship between helping other alcoholics and relapse in the year following treatment for alcohol use disorders.

METHOD: Data were derived from Project MATCH, a longitudinal prospective investigation of the efficacy of three behavioral treatments for alcohol abuse and dependence. Kaplan-Meier survival estimates were used to calculate probabilities of time to alcohol relapse. To identify the unique value of helping other alcoholics when controlling for the number of AA meetings attended, proportional hazards regressions were conducted to determine whether the likelihood of relapse was lower for those who were helping other alcoholics.

RESULTS: There were no demographic differences that distinguished participants in regard to involvement in helping other alcoholics, with the exception of age; those who were helping other alcoholics were, on average, 3 years older than those who were not helping alcoholics.

Those who were helping were significantly less likely to relapse in the year following treatment, independent of the number of AA meetings attended.

CONCLUSIONS: These findings provide compelling evidence that recovering alcoholics who help other alcoholics maintain long-term sobriety following formal treatment are themselves better able to maintain their own sobriety. Clinicians who treat persons with substance abuse disorders should encourage their clients to help other recovering alcoholics to stay sober.

Research; Pagano ME, Friend KB, Tonigan JS, Stout RL. Helping other alcoholics in alcoholics anonymous and drinking outcomes: findings from project MATCH. J Stud Alcohol. 2004 Nov;65(6):766-73.

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Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals,

Abstract

This study was a part of a larger qualitative descriptive study designed to explore chronic sorrow as a relapse trigger among female victims of child abuse who were currently enrolled in substance abuse treatment for relapse.

The purpose of this study was to identify coping strategies and other factors these women perceived as helpful to their recovery. A purposive sample of twelve women participated in interviews using a semistructured interview schedule.

The advice the participants offered to women in similar situations reflected interpersonal, cognitive and action-focused positive coping strategies.

They encouraged clinicians in primary care facilities to approach persons suspected of substance abuse in a nonjudgmental manner. Healthcare professionals should be more assertive in recommending resources for substance abuse treatment.

Research; Cheryl Slaughter Smith. Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals, Journal of Addictions Nursing, Volume 18, Issue 2 April 2007 , pages 75 – 80

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Research Evidence for Twelve Step Facilitation

Tonigan, J. Scott1. (2001). Benefits of Alcoholics Anonymous attendance: Replication of findings between clinical research sites in Project MATCH. Alcoholism Treatment Quarterly. Vol 19(1), , US: Haworth Press Inc. 2001, 67-77.

Project MATCH Research Group. (1998). Matching alcoholism treatments to client heterogeneity: Project MATCH three year drinking outcomes. Alcoholism: Clinical and Experimental Research. Vol. 22. No. 6.

“At three years follow-up, . . . , a significantly higher abstinence rate was found with TSF clients. Among TSF clients 36% were abstinent, compared with 27% of Motivational Enhancement Therapy and 24% of Cognitive Behavioural Therapy clients (p< 0.007).”

Patient-Treatment Matching, National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert No. 36, April 1997

“. . . in the outpatient group, 10 percent more patients who received TSF achieved continuous abstinence compared with those who received the other two treatments (24 percent for TSF as opposed to 15 percent for CBT and 14 percent for MET).”

Tonigan, J. Scott: Miller, William R: Connors, Gerard J. (2000), Project MATCH client impressions about Alcoholics Anonymous: Measurement issues and relationship to treatment outcome. Alcoholism Treatment Quarterly. Vol 18(1), 2000, 25-41.

Saunders, John B. The efficacy of treatment for drinking problems. International Review of Psychiatry. Vol 1(1-2), Mar 1989, 121-137.

National Drug and Alcohol Research Centre (NDARC) Commonwealth Department of Health and Ageing. Guidelines for the Treatment of Alcohol Problems. June 2003.

Blondell RD.Looney SW. Northington AP. Lasch ME. Rhodes SB. McDaniels RL. Using recovering alcoholics to help hospitalized patients with alcohol problems. Journal of Family Practice, 50(5):E1, 2001 May.

CONCLUSIONS: Among trauma victims with injuries severe enough to require hospital admission, brief advice from a physician followed by a visit with a recovering alcoholic appears to be an effective intervention. Although further study is needed to confirm these findings, in the meantime physicians can request that members of Alcoholics Anonymous (AA) visit their hospitalized patients who have alcohol use disorders. Interventions by recovering alcoholics are part of their twelfth-step work (an essential part of the AA program) and are simple, practical, involve no costs, and pose little patient risk. They can be arranged from the patient’s bedside telephone. Some patients will show a dramatic response to these peer visits.

Riordan, Richard J.; Walsh, Lani. Guidelines for professional referral to alcoholics anonymous and other twelve step groups. Journal of Counseling & Development, Mar/Apr94, Vol. 72 Issue 4, p351.

Sisson Rw & Mullams JH. (1981) The use of systematic encouragement and community access procedures to increase attendance at AA and Alanon meetings. American J of Drug & Alcohol Abuse. V8(3), 371-6.

Participation in Alcoholics Anonymous: Intended and Unintended Change Mechanisms. (Proceedings of Symposium at the 2001 RSA Meeting) Alcoholism: Clinical & Experimental Research, Volume 27(3)., March 2003, pp 524-532. 2003Research Society on Alcoholism.

Summary:

• AA cannot be ignored in understanding treatment outcomes.
• It is possible to facilitate AA attendance.
• Treatment is the time to do it.
• Attendance is not involvement.
• AA participation predicts better outcomes.
• Continuous abstinence is the outcome most likely to be affected by AA.
• The abstinence message of AA does not seem to be deleterious.

Humphreys, Keith. Professional interventions that facilitate 12-step self-help group involvement. Alcohol Research & Health. Vol 23(2), 1999, 93-98.

It is concluded that health care professionals can influence participation in TSF groups.

Caldwell PE. (1999) Fostering client connections with Alcoholics Anonymous; A framework for Social Workers in various practice settings. Social Work in Health Care, V28(4), 45-61.

Parker J & Guest DL, (1999) The clinicians guide to 12-step programs; How, when and why to refer a client. Auburn House; Westport.

TSF shows good effect on behaviors that are generally accepted outcomes.

Robert F. Forman, PhD, Charles Dackis, MD, Rick Rawson, PhD. (2004). Substance abuse: 12 principles to more effective outpatient treatment.

Patients who participate in 12-step programs and treatments have better outcomes than those who do not.

Sheeren. Journal of Studies on Alcohol, 49:104, 1988.

• AA Should be considered essential in treatment of addictive disorders and
• AA reduces relapse

Humphreys, Keith; Moos, Rudolf. Volume 25(5) May 2001 pp 711-716. Can Encouraging Substance Abuse Patients to Participate in Self-Help Groups Reduce Demand for Health Care?

Conclusion; “Professional treatment programs that emphasize self-help approaches increase their patients’ reliance on cost-free self-help groups and thereby lower subsequent health care costs. Such programs therefore represent a cost-effective approach to promoting recovery from substance abuse.”

Riordan, Richard J.; Walsh, Lani. Guidelines for professional referral to alcoholics anonymous and other twelve step groups. Journal of Counseling & Development, Mar/Apr94, Vol. 72 Issue 4, p351.

“ . . . support groups such as AA can serve several adjunctive goals in a counselor’s treatment plan. In the early phases, clients may be very needy as they work through the denial, guilt, and shame, as well as the craving. They may need almost constant support. The counselor cannot realistically be available on a 7-days-a-week basis; AA, however, is. Likewise, in a long-term counseling relationship, AA can be an ally to the counselor, providing extra foundation and support as the client works through more deeply seated issues.”

Smart, Reginald G; Mann, Robert E. Recent liver cirrhosis declines: Estimates of the impact of alcohol abuse treatment and Alcoholics Anonymous. Addiction. Vol 88(2), Feb 1993, 193-198.

• AA has been found to be a significant contributor to reductions in cirrhosis mortality & morbidity.
• An increase of 1.0% in AA membership reduces cirrhosis mortality by 0.06%.

Kaner EF, Wutzke S, Saunders JB, Powell A, Morawski J, Bouix JC; WHO Brief Intervention Study Group. Impact of alcohol education and training on general practitioners’ diagnostic and management skills: findings from a World Health Organization collaborative study. J Stud Alcohol. 2001 Sep;62(5):621-7

CONCLUSIONS: Greater exposure to alcohol-related Continuing Medical Education (CME) appears to result in better diagnosis and more appropriate management of alcohol-related problems by GPs.

Longabaugh R, Wirtz PW, Zweben A, Stout RL. Network support for drinking, Alcoholics Anonymous and long-term matching effects. Addiction. 1998 Sep;93(9):1313-33.

“CONCLUSIONS:

• In the long-term TSF may be the treatment of choice for alcohol-dependent clients with networks supportive of drinking;
• Involvement in AA should be given special consideration for clients with networks supportive of drinking, irrespective of the therapy they will receive.”

There is a need for best practice education in alcoholism intervention

Walsh, R A; Sanson-Fisher, R W; Low, A; Roche, A M. Teaching medical students alcohol intervention skills: results of a controlled trial. Volume 33(8) August 1999 pp 559-565

“Conclusions: Training can improve medical student performance in alcohol intervention”

Peter Anderson, Eileen Kaner, Sonia Wutzke, Michel Wensing, Richard Grol1, Nick Heather and John Saunders. ATTITUDES AND MANAGEMENT OF ALCOHOL PROBLEMS IN GENERAL PRACTICE: Alcohol & Alcoholism Vol. 38, No. 6, pp. 597-601, 2003

Conclusion: Both education and support in the working environment need to be provided to enhance the involvement of GPs in the management of alcohol problems.

Mark A. Perini, MD, Alcoholics Anonymous and Drug Therapy in the Treatment of Alcohol Abuse and Dependence. Wake Forest University Baptist Medical Center, Internal Medicine Residency Program, September 26, 2000.

In summary,

• There is evidence supporting a recommendation to attend Alcoholics Anonymous in the literature. One can feel comfortable in stating the following learning points:
• Alcoholics Anonymous (AA) is a safe, low cost, widely available tool of behavioral change that strives to capitalize on the patient’s inner motivation and spirituality.
• AA should be part of any attempt at treatment of alcohol abuse or dependence.
• Success with AA can be enhanced by a twelve-step facilitation treatment implemented concomitantly with AA attendance.
• Referring patients to AA groups composed of individuals of similar age, cultural, and occupational status may improve attendance and outcomes as well.

A World Health Organization Working Group has listed the competencies needed by primary health care doctors and teams for the successful management of potential or established alcohol-related problems:

• a knowledge of the prevalence of hazardous and harmful alcohol consumption and related physical, psychological and social problems;
• a knowledge and appreciation of the effects of patients’ alcohol problems on their partners and families;
• an awareness of the patients’ personal attitudes to alcohol;
• the ability to identify the various physical, psychological and social indications of a drinking problem;
• the ability to communicate accurate information on alcohol and alcohol-related problems, in an appropriate context, to patients and their relatives;
• the ability to distinguish between low-risk, harmful and dependent levels of alcohol consumption;
• the ability to manage the physical consequences and complications of acute intoxication;
• the ability to take an accurate drinking history;
• the ability to recognise signs of alcohol-related disease;
• the ability to interpret laboratory tests accurately;
• the ability to choose an appropriate management plan (brief intervention or referral to appropriate colleagues or clinics);
• and the ability to direct and manage the detoxification of patients at home.

TSF and Alcoholics Anonymous are well accepted by providers and clients.

Twelve-Step Orientated Residential Treatment Programs: A Review. (March 2000) Richard Csiernik, Ph.D. School of Social Work, King’s College, University of Western Ontario, London, Ontario

The treatment modality with the longest successful history of rehabilitating alcoholics is a mutual aid/self-help program, Alcoholics Anonymous(A.A.). From A.A. has germinated a network of similar twelve-step approaches that are the most readily accessible means for maintaining abstinence. Individuals with an addiction problem may join a twelve step group on their own or may be introduced to the idea and the process through participation in a formal treatment program.

Vaillant, G. E. (1983). The natural history of alcoholism. Cambridge, MA: Harvard University Press.

Conclusion: that there are many alcohol-dependent individuals regardless of social or psychological make-up who find help for alcoholism through AA. It seems prudent to consider a referral to AA for all alcoholic clients except for those with significant pathology.

Friedmann PD, McCullough D, Chin MH, Saitz R Screening and intervention for alcohol problems a national survey of primary care physicians and psychiatrists. Journal of General Internal Medicine 2000, 15.~4-91, 2000.

The majority of physicians said that they usually or always recommended 12 Step groups to problem drinking patients

Chang, Grace; Astrachan, Boris M; Bryant, Kendall J. Emergency physicians’ ratings of alcoholism treaters. Journal of Substance Abuse Treatment. Vol 11(2), Mar-Apr 1994, 131-135.

Physician agreement on the efficacy of alcoholism treaters was greatest for AA (87%), moderate for mental health professionals (including psychiatrists and psychologists, 55%) and least for physicians and surgeons (excluding psychiatrists, 23%).

Roche AM, Parle MD, Stubbs JM, Hall W, Saunders JB. Management and treatment efficacy of drug and alcohol problems: What do doctors believe. Addiction. 1995;90:1357-66.

A majority of post graduate doctors believed Alcoholics Anonymous to be the referral of choice for alcoholism.

Norman Swan. Naltrexone and Alcohol Dependence. The Health Report, ABC Radio National. Broadcast Monday 1 July 2002

Professor John Saunders: “Some of the alcohol-dependent patients that I have seen over the years have achieved the most stable and rewarding recovery through regular attendance at Alcoholics Anonymous. For example, of the 300,000 to 400,000 alcohol-dependent people in Australia, only 20,000 are regular attenders of AA. I wish more people did attend regularly because I do think it provides very considerable benefit.”

• The Alcoholics Anonymous 2001 Membership Survey reveals a wide cross section of demographics. Age of members ranging from teenagers to over 70 years, of both genders, varied ethnic groups and from all occupations. Only a third of members self-referred to AA with the majority being referred by professionals (38%), family or friends. Sixty one percent attended some form of treatment before attending AA and 64% received some form of treatment after joining.
• Current global membership of AA is estimated to be 2 million people with some 30,000 in Australia.
• The participation rate in AA in the USA and most westernized countries is approximately 5 per 1000 of the adult population (age 15 yrs plus). The Australian AA participation rate is approximately 2 per 1000 adult population. There is room for growth.
• By comparison the participation rate in formal treatment services for alcohol in Australia is approximately 1.9 per 1000 population.

AIHW: Alcohol and other drug treatment services in Australia: Findings from the National Minimum Data Set 2000-01. AIHW Cat. No. AUS 30. Canberra: AIHW.

TSF is based on a clear and well-articulated theory.

Joseph Nowinski, Twelve-Step Facilitation, Approaches to Drug Abuse Counseling. U.S. Department of Health and Human Services, National Institutes of Health. Dual Diagnosis Recovery Network.

Wallace J. (1996) Chapter 1; Theory of 12-step oriented treatment. IN, Roger F, Keller DS & Morgenstern J. Treating substance abuse; theory and technique. The Guilford Press, New York.

Miller WR & Kurtz E. (1994) Models of alcoholism used in treatment; contrasting AA and other perspectives with which it is often confused. J of Studies on Alcohol. V55, 159-66.

Khantzian EJ, Mack JE. (1994) How AA works and why it’s important for clinicians to understand. J of Substance Abuse Treatment. V11(2), 77-92.

Chappel JN. (1997) Spirituality and addiction psychiatry. IN – Miller NS The principles and practices of addictions in psychiatry. WB Saunders; Philadelphia.

Burkhardt MA & Nagai-Jacobson MG. (1997) Spirituality and Healing. IN, Dossey BM (Ed) Core Curriculum for Holistic Nursing. Aspen Publishers, American Holistic Nurses Association, Maryland.

Steffen V. (1997) Life stories and shared experience. Soc Sci Med. V45(1), 99-111.

Bradley, A. M. (1988). Keep coming back: The case for a valuation of Alcoholics Anonymous. Alcohol Health and Research World,12, 192-199.

Tonigan, J.S., Connors, G.J. & Miller, W.R. (1996) The Alcoholics Anonymous Involvement (AAI) Scale: Reliability and norms. Psychology of Addictive Behaviors, 10(2), 75-80.

Alcoholics Anonymous shows good retention rates for clients.

William W (1994) The society of AA; 1949. (Classic reprint) Am J Psychiatry. V151(6), 259-62.

Humphreys K; Huebsch PD; Finney JW; Moos RH. A comparative evaluation of substance abuse treatment: V. Substance abuse treatment can enhance the effectiveness of self-help groups. Alcoholism: Clinical and Experimental Research 23(3): 558-563, 1999.

“Affiliation with Alcoholics Anonymous (AA) and other 12-Step self-help groups is becoming more common at the same time as professional substance abuse treatment services are becoming less available and of shorter duration. As a result of these two trends, patients’ outcomes may be increasingly influenced by the degree to which professional treatment programs help patients take maximum advantage of self-help groups.”

Moos RH; Finney JW; Ouimette PC; Suchinsky RT. A comparative evaluation of substance abuse treatment: I. Treatment orientation, amount of care, and 1-year outcomes. Alcoholism: Clinical and Experimental Research 23(3): 529-536, 1999.

“The study was conducted among 3018 patients from 15 Veterans Affairs programs that emphasized 12-Step, cognitive-behavioral (CB), or eclectic treatment. Casemix-adjusted 1-year outcomes showed that patients in 12-Step programs were the most likely to be abstinent, free of substance abuse problems, and employed at the 1-year follow- up. These findings support the effectiveness of 12-Step treatment and show that patients with substance use disorders who become more involved in outpatient care and self-help groups tend to experience better short-term substance use outcomes”

TSF addresses cultural diversity and different populations.

Gabriele Bardazzi, Andrea Quartini, Grazia Filippini, Maria Luisi Marcias, Alberto Centurioni, Ginetta Fusi, Allaman Allamani (1999) Cost-effectiveness in the treatment of alcohol abuse: a treatment program experience. Journal For Drug Addiction And Alcoholism. 22nd year: 1999 no 4.

Tonigan JS. Miller WR. Schermer C. Atheists, agnostics and Alcoholics Anonymous. Journal of Studies on Alcohol. 63(5):534-41, 2002 Sep.

Timko, Christine; Moos, Rudolf H.; Finney, John W.; Connell, Ellen G. Gender differences in help-utilization and the 8-year course of alcohol abuse. Addiction, Volume 97(7) July 2002 p 877-889.

“Conclusions: The results suggest that although alcoholism interventions were designed primarily for men, they are currently delivered in ways that are also useful to women. Problem-drinking women appear to benefit from sustained participation in AA, which emphasizes bonding with supportive peers to maintain abstinence.”

Gabhainn, S.N. Assessing sobriety and successful membership of Alcoholics Anonymous. Journal of Substance Use, 8(1):55-61, 2003. (168538)

“There were few differences across sociodemographic groups in perceived successful membership.”

Humphreys K. (196) Worldview change in adult children of Alcoholics/ Alanon self-help groups; reconstructing the alcoholic family. Int J of Group Psychotherapy. V46(2), 255-63.

Kramer TH & Hoisington D. (1992) Use of AA & NA in the treatment of chemical dependencies of traumatic brain injury survivors. Brain Injury. V6(1), 81-8.

Kus RJ (1988) “Working the Program”; The Alcoholics Anonymous experience and gay American men. Holistic Nursing Practice. August, pp 62-74.

Obuchwsky M & Zweben JE. (1987) Bridging the gap; The methadone client in 12-step programs. J of Psychoactive Drugs. V19(3), 301-2.

McGonagle D. (1994) Methadone Anonymous; A 12-STEP PROGRAM. Reducing the stigma of methadone use. J Psychosoc Nurs Ment Health V32(10), 5-12.

Cermak TL. Al-Anon and recovery. Recent Dev Alcohol 1989;7:91-104

Humphreys K; Ribisl KM. The case for a partnership with self-help groups. (editorial). Public Health Reports. V114(4): 322-329, 1999.

“This essay discusses the origins and nature of self-help groups. The authors note three ways they can be effective in addressing public health issues: (1) By offering accessible and effective interventions for specific problems; (2) By enhancing profesionally run health promotion and health care programs; and (3) By enriching community life and building a base for public health advocacy. An organization the American Self-Help Clearinghouse is noted.”

Vaughn C; Long W. Surrender to win: How adolescent drug and alcohol users change their lives. Adolescence, 34(133): 9-24, 1999.

This paper offers a phenomenological analysis of seven young adults who managed to surrender their addictions and, for anywhere from five to fifteen years, construct sober identities. The participants came from highly dysfunctional homes, began substance use as children, and were polydrug users. A series of catastrophic life events led them to Alcoholics Anonymous, where they were exposed to self-reflective prayer, a cadre of recovering adolescents and, in particular, adults who offered detached nurturing. This provided the support they needed to confront their addictions through the Twelve Steps of Alcoholics Anonymous.

TSF can be used by staff with a wide diversity of backgrounds and training.

Riessman F. (1965) The ‘Helper’ therapy principle. Social Work. April.

Borkman T (1976) Experiential knowledge; a new concept for the analysis of self-help groups. Social Service Review. (Sep), 445-56.

Davis DR & Jansen GG. (1998) Making meaning of Alcoholics Anonymous for social workers; Myths, metaphors and realities. Social Work. V43(2), 169-82.

Nowinski J, Baker S, Carroll KM. Twelve-Step facilitation therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. NIAAA Project MATCH Monograph Series, vol. 1. DHHS Pub. No. (ADM)92-1893. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism, 1992.

Nowinski J. (1996) Chapter 2; Facilitating 12-step recovery from substance abuse and addiction. IN, Roger F, Keller DS & Morgenstern J. Treating Substance Abuse; Theory and Technique.

Thompson DL & Thompson JA. (1993) Working the 12 steps of Alcoholics Anonymous with a client; a counselling opportunity. Alcoholism Treatment Quarterly. V10(1/2), 49-61.

Borman LD. (1976) “Self-help and the professional.” Social Policy. V7(2), 46-7.

Wheeler, Sue; Turner, Linda. Counselling problem drinkers: The realm of specialists, Alcoholics Anonymous or generic counsellors. British Journal of Guidance & Counselling, Aug97, Vol. 25 Issue 3, p313.

Counsellors usually had some knowledge of AA but had little understanding of the 12-step programme that forms the basis of recovery for alcoholics as described by AA. They were, however, in favour of clients attending AA as an adjunct to individual counselling.

Tobie L Sacks and Nicholas A Keks. (No date) Medical Journal of Australia, Practice Essentials, Mental Health #14, Alcohol and drug dependence: diagnosis and management

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Spirituality/religiosity promotes acceptance-based responding and 12-step involvement.

BACKGROUND: Previous investigations have observed that spirituality/religiosity (S/R) is associated with enhanced 12-step involvement. However, relatively few studies have attempted to examine the mechanisms for this effect. For the present investigation, we examined whether acceptance-based responding (ABR) – awareness or acknowledgement of internal experiences that allows one to consider and perform potentially adaptive responses – accounted for the effect of S/R on 12-step self-help group involvement 2 years after a treatment episode.

METHODS: Data were collected as part of a multi-site treatment outcome study with 3698 substance-dependent male veterans recruited at baseline. Assessments were conducted at baseline, discharge, 1-year follow-up, and 2-year follow-up. We utilized structural equation modeling to examine the relationships among latent variables of S/R, ABR, and 12-step involvement over time.

RESULTS: In the final model, S/R was not directly related to 12-step involvement at 2-year follow-up. However, S/R predicted enhanced ABR at 1-year follow-up after accounting for discharge levels of ABR. In turn, ABR at 1-year follow-up predicted increased 12-step involvement at 2-year follow-up after accounting for discharge levels of 12-step involvement.

CONCLUSIONS: S/R promotes the use of post-treatment self-regulation skills that, in turn, directly contribute to ongoing 12-step self-help group involvement.

Authors: Carrico AW, Gifford EV, Moos RH. Spirituality/religiosity promotes acceptance-based responding and 12-step involvement. Drug Alcohol Depend. 2007 Jun 15;89(1):66-73

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Prayer as medicine: how much have we learned?

SPIRITUALITY AND HEALTH

Many people use prayer, and some studies have shown a positive association between prayer and improved health outcomes. This article explores four possible mechanisms by which prayer may lead to improved health.

While acknowledging the efficacy of prayer and recognizing the needs of patients, prayer, being a personal spiritual practice, cannot be prescribed, nor should it be used in place of medical care.

The spiritual search for meaning and hope in life is integral to human existence. This is particularly evident during times of personal stress and crisis. Recent census findings indicate that 74% of Australians and 96% of Americans believe in a higher power, and similar percentages claim some form of religious affiliation.1,2 Evidence also suggests that certain spiritual beliefs and the practice of prayer are associated with improved coping and better health outcomes.3-6 Although North Americans have been the predominant participants in most of the research available, the findings are relevant to the Australian experience, as they reflect a basic human desire for supernatural involvement in matters of health and wellbeing.

Research; Marek Jantos and Hosen Kiat. Medical Journal of Australia, 2007; 186: S51-S53

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A comparative evaluation of substance abuse treatment

This article first explains the conceptual framework and plan of a naturalistic, multisite evaluation of Department of Veterans Affairs (VA) substance abuse treatment programs. It then examines the effectiveness of an index episode of inpatient treatment and the effectiveness of continuing outpatient care and participation in self-help groups.

The study was conducted among 3018 patients from 15 VA programs that emphasized 12-Step, cognitive-behavioral (CB), or eclectic treatment.

Casemix-adjusted 1-year outcomes showed that patients in 12-Step programs were the most likely to be abstinent, free of substance abuse problems, and employed at the 1-year follow-up.

Patients who obtained more regular and more intensive outpatient mental health care, and those who participated more in 12-Step self-help groups, were more likely to be abstinent and free of substance use problems at the 1-year follow-up.

These findings support the effectiveness of 12-Step treatment and show that patients with substance use disorders who become more involved in outpatient care and self-help groups tend to experience better short-term substance use outcomes.

Moos RH, Finney JW, Ouimette PC, Suchinsky RT. A comparative evaluation of substance abuse treatment. Alcohol Clin Exp Res. 1999 Mar;23(3):529-36.

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An Evaluation of the Therapeutic Programme Conducted by the Southern Regional Alcohol-Abuse Treatment Centre: Study on the Programme’s Results One Year after Discharge from Inpatient Care.

Given the clinical and social problems caused by the consumption of alcohol in most industrialised countries, there is a strong need to develop and evaluate the effectiveness of integrated care programmes.

In this study, the authors describe the results observed in 124 sequentially admitted subjects at various points throughout the course of the first year after their discharge from the Southern Regional Alcohol-Abuse Treatment Centre (CRAS) in Lisbon, Portugal.

An inpatient stay at this unit of CRAS lasts for between 5 and 7 weeks and implies that the patient must submit him/herself to a therapeutic model which has been adapted from the Minnesota model which includes attendance at 12 Step Alcoholics Anonymous meetings.

At the end of the year under study 44.3% of the patients were still abstinent, 40.3% were consuming alcohol and 15.4% did not reply.

51 patients (41.1% of the initial sample) were still in regular contact with CRAS for further treatment at that point.

The variable that was found to possess the most significant association with a favourable outcome was adherence to the therapeutic programme over the course of that year.

Domingos Neto, Miguel Xavier, Paula Lucena, Ana Vieira da Silva. An Evaluation of the Therapeutic Programme Conducted by the Southern Regional Alcohol-Abuse Treatment Centre: Study on the Programme’s Results One Year after Discharge from Inpatient Care. European Addiction Research 2001;7:61-68

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Brief-TSF Treatment Setting

Brief-TSF can be used with both individuals who have never sought treatment and those who had previous treatment and aftercare clients. The model is flexible enough to accommodate all of these client groups.

However, since Brief-TSF relies heavily on client involvement in community-based 12 step fellowship and meetings, it would be less ideally implemented in a long-term inpatient setting.

Many Twelve Step Fellowship members are willing to visit ‘Newcomers’ in hospital. Brief-TSF can easily be integrated into a general mental health outpatient clinic setting.

BriefTSF is designed to be used in the context of short-term individual adjunct therapy by general healthcare and other helping profession workers. BriefTSF is specifically intended to be implemented by nurses, doctors, psychologists, social workers, counselors etc while addressing other current issues (ie, medical treatment, relationship counselling, legal issues).

Brief-TSF is not time limited. After assessment support can last as long as the healthcare worker is seeing the client. It is intended to be implemented within a scheduled session often with another focus. The initial assessment session can last up to one hour, and regular support can be incorporated into other sessions.

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