The Spiritual Characteristics of New Zealanders Entering Treatment for Alcohol/Other Drug Dependence

This study describes the spiritual experiences, beliefs, and practices of New Zealanders entering intensive treatment for alcohol/ other drug dependence, and seeks to determine factors that influence spirituality in a clinical population. Ninety clients entering three residential treatment programs for alcohol and/or cannabis dependence were interviewed about their spiritual beliefs, behaviors, and experiences, using a broad selection of accepted measures.

A number of associations between aspects of spirituality and gender, ethnicity, age, employment, severity of dependence, and depression were found.

In particular, the more religiously active participants were less severely alcohol/other drug dependent, and depression was negatively associated with beliefs and activity related to 12-step participation.

Research; Michael P. Baker, J. Douglas Sellman, & Jacqueline Horn. The Spiritual Characteristics of New Zealanders Entering Treatment for Alcohol/Other Drug Dependence. Alcoholism Treatment Quarterly, Volume: 24 Issue: 4, 2006 Pages: 137 - 155

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Predictors of changes in alcohol-related self-efficacy over 16 years

Self-efficacy is a robust predictor of short- and long-term remission after alcohol treatment. This study examined the predictors of self-efficacy in the year after treatment and 15 years later.

A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years.

Predictors of self-efficacy at 1 year included

• improvement from baseline to 1 year in heavy drinking,
• alcohol-related problems,
• depression,
• impulsivity,
• avoidance coping,
• social support from friends, and
• longer duration of participation in mutual-help Alcoholics Anonymous (AA).

Female gender, more education, less change in substance use problems, and impulsivity during the first year predicted improvement in self-efficacy over 16 years.

Clinicians should focus on

• keeping patients engaged in self-help of AA,
• addressing depressive symptoms,
• improving patient’s coping, and
• enhancing social support

during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.

Research; Predictors of changes in alcohol-related self-efficacy over 16 years. John McKellar Ph.D, Mark Ilgen Ph.D., Bernice S. Moos B.A. and Rudolf Moos Ph.D. J Subst Abuse Treat. 2007 Nov 23.

See also;

• AA and Treatment Work Better Together
• Brief-TSF can assist patients cease alcohol consumption.
• AA Offers Recovery Not Religion

Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment by Marc A. Schuckit Read more about this title…

Seeking Help Could Quadruple the Likelihood of Abstinence

To quantify the effect of help seeking on recovery from alcoholism, researchers in the United States analyzed data from 4,422 adults who had participated in a nationally representative survey and developed alcohol dependence at least 1 year before their participation.

• Only 26 percent of subjects had ever sought help for their alcohol problems;
• 3 percent participated in a 12-step program only,
• 6 percent in formal treatment only, and
• 17 percent in both. 

Help seekers drank more and had higher lifetime prevalences of other drug use, mood disorders, and personality disorders than did subjects who had not sought help.

In analyses adjusted for potential confounders, help seeking significantly increased the likelihood of any recovery (odds ratio [OR] 2.4) and of abstinence (OR 4.0). Any recovery was defined as, in the past year, having no symptoms of alcohol abuse or dependence and either drinking low-risk amounts* or abstaining.

The odds of recovery were greater for those who had participated in 12-step programs with or without formal treatment than for those who had participated in formal treatment only.

Comments by Peter Friedmann, MD, MPH:

Even though they had more comorbidity and therefore were at risk for worse outcomes, seekers of formal and informal treatment had better odds of recovery from alcohol dependence. This study could not separate the motivation inherent in seeking help from the therapeutic effects of help received. However, help seeking—regardless of the patient’s level of readiness—should be encouraged. 

Research Reference: Dawson DA, Grant BF, Stinson FS, et al. Estimating the effect of help-seeking on achieving recovery from alcohol dependence. Addiction. 2006;101(6):824–834.

Brief-TSF can assist patients cease alcohol consumption.

Encouraging post-treatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes

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.

substantially higher abstinence rate among patients treated in 12-step

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%) in contrast to 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.

30% lower costs in the 12-step treatment 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.

Research; Keith Humphreys, and Rudolf H. Moos Alcoholism: Clinical and Experimental Research 2007; 31(1):64-68) - 1 This computation is in 2006 dollars, to which we converted for comparative purposes our prior findings, which had been originally reported in 1999 dollars (Humphreys and Moos, 2001).

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The interplay between help seeking and alcohol related outcomes: divergent processes for professional treatment and self-help groups.

Summary:
This study examined the influence of self-selection on the duration of professional treatment and participation in Alcoholics Anonymous (AA) and the influence of social causation on alcohol-related outcomes.

A sample of alcoholics was surveyed at baseline and 1, 3, and 8 years later. Participants completed an inventory at each survey that assessed participation in treatment and AA since the last assessment and alcohol-related functioning.

There were divergent processes of self-selection and social causation with respect to the duration of participation in professional treatment and AA.

Individuals with more severe alcohol-related problems obtained longer episodes of professional treatment, but this self-selection process was much less evident for AA.

Longer participation in professional treatment in the first year predicted better alcohol-related outcomes, but the duration of subsequent treatment was not associated with better subsequent outcomes.

In contrast, longer participation in AA consistently predicted better subsequent alcohol-related outcomes.

The findings are consistent with a need-based model of professional treatment, in which more treatment is selected by and allocated to individuals with more severe problems, and an egalitarian model of self-help, in which needs play little or no role in continued participation.

Rudolf H. Moos and Bernice S. Moos. The interplay between help-seeking and alcohol-related outcomes: divergent processes for professional treatment and self-help groups. Drug and Alcohol Dependence 75(2):155-164, August 2004.

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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12 Step Programs Offer Broad Benefits, Study Says

A study of Alcoholics Anonymous and other 12-step oriented self-help programs finds that they can help most people recover from alcoholism, even those who are not religious or have mental-health problems.

The Pacific Institute on Research and Education (PIRE) reported that researchers tracked a group of 227 alcoholics over three years and found that those who had attended AA or other self-help programs after treatment had higher rates of abstinence, and drank less if they did relapse.

The results cut across gender and religious lines and held regardless of psychiatric history or whether the patient had previously attended AA or other similar programs.

"Here’s a widespread, chronic disorder that seems to respond well to an inexpensive resource — mutual-help groups such as AA," said study co-author Robert Stout, Ph.D., director of the Decision Sciences Institute at PIRE. "Not only do we need to get more addicts engaged in these groups, but we also need to gather evidence on this issue and make sure that the public, policy-makers and practitioners know about it."

Added co-author John F. Kelly: "There is a clear dose-response relationship: If you don’t go to any meetings, you have the worst outcomes. If you go to a few, you have a little bit better outcome, and if you go to a lot, you have an even better outcome." Kelly is the associate director of the Massachusetts General Hospital/Harvard Addiction Research Program.

The study was published in the August 2006 issue of Alcoholism: Clinical and Experimental Research.

Brief-TSF intervention training; how best to get alcoholics to AA.

Women and the Twelve Steps of Alcoholics Anonymous: A Gendered Narrative

This paper examines how women “work” the twelve steps of Alcoholics Anonymous (AA) from a gendered perspective.

Feminist critics of AA have

• challenged the language of AA’s Twelve Steps,
• the spiritual nature of the steps, and
• the male-dominated culture of the Twelve-Step program.

This paper offers insight into how women in AA approach, interpret, and utilize the Twelve Steps to recover from alcoholism.

Through survey and narrative data, findings suggests

• that women working AA’s Twelve Steps become empowered and
• change for the better in spite of the male-dominated culture and language of the Twelve Steps and
• regardless of the difficulty they may have encountered in completing these steps.

In particular, the first three steps-the “surrender steps”-

• encourage women to let go of their alcoholic obsession and
• begin a spiritual path of recovery.

Steps Four through Nine require

• women to “clean house” and
• get rid of old self-destructive ways so that they may develop a new and stronger sense of self.

Finally, on completing Steps Ten through Twelve, women

• experience a spiritual awakening and
• then, in turn, “pass on” what they have learned from the Twelve Steps to other women in the program.

Woven throughout these women’s experiences is

• an acknowledgment of gender and
• the role it plays in how they work the Twelve Steps.

In the end, these women express a sense of personal empowerment that is particular to a gender-specific orientation to the Twelve Steps of AA.

Research; Jolene M. Sanders, Women and the Twelve Steps of Alcoholics Anonymous: A Gendered Narrative. Alcoholism Treatment Quarterly, Volume: 24 Issue: 3, 2006

Al-anon, Adult Children of Alcoholics, Gambler Anonymous, Narcotics Anonymous,

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Lemberg (1992) proposes a model of development whereby a person moves from voluntary dieting through a number of stages to reach a fully entrenched eating disorder.

Stage 1: Normal, voluntary dieting behaviour.

Unfortunately dieting behaviours have become the “norm”, with

• 47% of people in Australia having tried to lose weight in the past twelve months.
• 68% of fifteen year old girls are dieting at any one time,
• 8% of these are on a severe diet.

While these diets are severe enough to be considered an eating disorder, they are unhealthy and result in rapid weight changes, disrupted metabolism, dehydration, low energy and lack of essential vitamins, minerals and nutrients.

Stage 1B: (in Bulimia Nervosa only).

The hunger associated with dieting and restriction leads to severe and constant cravings, which result in loss of control and overcompensation by bingeing on large amounts of food.

Stage 2: A Diagnosable Disorder.

At this stage the dieting behaviour has become a diagnosable mental illness according to the Diagnostic & Statistical Manual IV-TR (APA, 2000). At this stage there are serious consequences and a morbid fear of fatness, and the dieting is no longer under the person’s control.

However the person is unable to see the negative consequences and is in denial of the eating disorder. In bulimia nervosa the bingeing behaviours, rather than being due to dietary restriction, occur more generally as a result of stress or negative emotional states.

Stage 3A: Autonomous Behaviour.

At this stage the person is generally able to see there is a problem, but as the behaviours are no longer under the person’s control, the disorder does not resolve even if precipitating conditions have been resolved.

Stage 3B: Illness becomes the identity.

At this stage, rather than the eating disorder behaviours being a solution to a problem, the person now identifies him or herself only with the eating disorder and has difficulty separating themselves from the illness. The eating disorder behaviours are now constant rather than used as coping strategies, and the person feels they are nothing without their illness.

They identify with being the illness, i.e. I am anorexic, rather than I have anorexia.  The prospect of giving up the disorder can lead to existential fears of nothingness.

Recovery requires not only finding alternative coping strategies, but helping the person address the underlying issues of existential reality.

Overeaters Anonymous may help with any eating disorder.

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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