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…

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.

See also;

• 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…

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

Women Physicians and Addiction.

Doctors get addicted just like other people and female doctors have earlier addiction and develop worse medical conditions.

Researchers compared case histories of 969 male and female (13%) substance dependent doctors. Their conclusions; “These findings suggest different characteristics between male and female impaired physicians which may have implications for identification and treatment of this population.”

The comparison revealed that females;

• Were younger by 4 years (mean 40 years)

• Had 15% more medical problems (49%), and

• 13% more psychiatric issues (76%)

• More past suicidal ideation (52% v 30%), and

• Current suicidal ideation (11% v 5%)

• Had attempted more suicides (20% v 5%) while intoxicated, and

• Had attempted more suicides (14% v 2%) while clean or sober

• Mainly abused alcohol, but

• Were more likely to use hypnotics (11% v 6%)

• Employment and legal problems (65% and 18% respectively) were similar in both genders

Research report; Women Physicians and Addiction. Martha J. Wunsch, Janet S. Knisely, Karen L. Cropsey, Eleanor D. Campbell, Sidney H. Schnoll. Journal of Addictive Diseases, Volume: 26 Issue: 2

Bloggers comment; This research mainly parallels sex differences in the general population which shows that women suffer earlier addiction and greater medical problems.

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

In Alcohol-Dependent Drinkers, What Does the Presence of Nicotine Dependence Tell Us About Psychiatric and Addictive Disorders Comorbidity?

AIM: To examine the pattern of psychiatric comorbidity associated with nicotine dependence among alcohol-dependent respondents in the general population.

METHODS: Drawn from a US national survey of 43,000 adults who took part in a face-to-face interview (The National Epidemiologic Survey on Alcohol and Related Conditions), data were examined on the 4782 subjects with lifetime alcohol dependence, and comparisons were made between those with and those without nicotine dependence.

RESULTS: Nicotine dependence was reported by 48% of the alcohol-dependent respondents. They reported higher lifetime rates of

• panic disorder,
• specific and social phobia,
• generalized anxiety disorder,
• major depressive episode,
• manic disorder,
• suicide attempt,
• antisocial personality disorder and
• all addictive disorders than those without nicotine dependence.

After controlling for the effects of any psychiatric and addictive disorder, alcohol-dependent subjects with nicotine dependence were more than twice as likely as non-nicotine-dependent, alcohol-dependent subjects to have at least one other lifetime addiction diagnosis (adjusted odds ratio 2.36; 95% confidence interval 2.07-2.68).

CONCLUSIONS: Nicotine dependence represents a general marker of psychiatric comorbidity, particularly of addictive comorbidity. It may be used as a screening measure for psychiatric diagnoses in clinical practice as well as in future trials.

Research report; Le Strat Y, Ramoz N, Gorwood P. In Alcohol-Dependent Drinkers, What Does the Presence of Nicotine Dependence Tell Us About Psychiatric and Addictive Disorders Comorbidity? Alcohol Alcohol. 2010 Jan 20.

• See also;
• Alcoholic, Addictive Behaviors
• Wernicke-Korsakoff Syndrome
• Are Families Affected by Alcoholism?
• What are the Styles of Enablers?
• Hazelden Books and Resources

Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study.

This study investigates the relationship between frequency of attendance at Narcotics Anonymous and Alcoholics Anonymous (NA/AA) meetings and substance use outcomes after residential treatment of drug dependence.

It was predicted that post-treatment NA/AA attendance would be related to improved substance use outcomes.

Using a longitudinal, prospective cohort design, interviews were conducted with drug-dependent clients (n = 142) at intake to residential treatment, and at 1 year, 2 years and 4-5 years follow-up. Data were collected by structured interviews. All follow-up interviews were carried out by independent professional interviewers.

• Abstinence from opiates was increased throughout the 5-year follow-up period compared to pre-treatment levels.
• Clients who attended NA/AA after treatment were more likely to be abstinent from opiates at follow-up.
• Abstinence from stimulants increased at follow-up but no additional benefit was found for NA/AA attendance.
• There was no overall change in alcohol abstinence after treatment but clients who attended NA/AA were more likely to be abstinent from alcohol at all follow-up points.
• More frequent NA/AA attenders were more likely to be abstinent from opiates and alcohol when compared both to non-attenders and to infrequent (less than weekly) attenders.

Conclusions NA/AA can support and supplement residential addiction treatment as an aftercare resource.

In view of the generally poor alcohol use outcomes achieved by drug-dependent patients after treatment, the improved alcohol outcomes of NA/AA attenders suggests that the effectiveness of existing treatment services may be improved by initiatives that lead to increased involvement and engagement with such groups.

Gossop M, Stewart D, Marsden J. Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study. Addiction. 2007 Nov 20.

Brief-TSF can assist patients cease alcohol consumption.

Models of Craving and Implications for Treatment

By Raymond F. Anton, M.D.

Although many alcoholics experience craving, researchers have not yet developed a common, valid definition of the phenomenon. Numerous models of the mechanisms underlying craving have been suggested, however. One of those models-the neuroadaptive model-suggests that the prolonged presence of alcohol induces changes in brain-cell function. In the absence of alcohol, those changes cause an imbalance in brain activity that results in craving. Furthermore, the adaptive changes generate memories of alcohol’s pleasant effects that can be activated when alcohol-related environmental stimuli are encountered, even after prolonged abstinence, thereby leading to relapse.

Similarly, stressful situations may trigger memories of the relief afforded by alcohol, which could also lead to relapse. Neurobiological and brain-imaging studies have identified numerous brain chemicals and brain regions that may be involved in craving. Psychiatric conditions that affect some of these brain regions, such as depression or anxiety, also may influence craving. A better understanding and more reliable assessment of craving may help clinicians tailor treatment to the specific needs of each patient, thereby reducing the risk of relapse.

Alcohol Research & Health Vol. 23, No. 3, 1999

Persistent pain is prevalent among people with substance use disorders.

It is not known, however, whether such pain increases the risk of relapse following periods of abstinence.

Researchers assessed data on pain and substance use in 397 adults who, as part of a larger randomized trial, had been interviewed periodically in the 24 months after their discharge from an urban, residential alcohol and drug detoxification unit.

Pain was measured with the pain item on the SF-36 Health Survey. Analyses were adjusted for potential confounders (e.g., demographics, addiction severity, depressive symptoms).

• Sixteen percent of subjects reported persistent pain (moderate-to-higher levels of pain at all available interviews) in the 24 months after detoxification.
• Subjects reporting persistent pain were significantly more likely than those with mild or no pain to have used the following in the past 30 days at the 24-month follow-up:
• heroin/opioids not prescribed for pain (odds ratio, 5.4);
• heavy amounts of alcohol* (odds ratio, 2.2).

Comments: Persistent pain is common among alcohol and drug users who have undergone residential detoxification and increases the likelihood of relapse. This study suggests that clinicians must be careful to screen for pain symptoms in patients with substance dependence. When persistent pain is present, thoughtful management is required to minimize risks associated with undertreatment while not fostering opioid analgesic abuse.

Research References:Larson MJ, Paasche-Orlow M, Cheng DM, et al. Persistent pain is associated with substance use after detoxification: a prospective cohort analysis. Addiction. 2007.

The Mindbody Prescription: Healing the Body, Healing the Pain by John E. Sarno Read more about this title…

The Process of Reconnecting: Recovery from the Perspective of Addicted Women

This study examined women’s experiences with addiction to drugs and/or alcohol and their process of recovery. The techniques of in-depth interviews and participant observations were employed to elicit the perspectives of the women. The study consisted of 12 participants, 6 who were currently involved in a 90-day community-based drug and alcohol treatment program and 6 who had more than five years of recovery.

Grounded theory method guided data collection and analysis. The women in this study described experiences of connectedness and disconnectedness throughout their lives, their addiction, and their recovery. The researcher constructed a substantive theory and model to explain this process of connectedness and disconnectedness.

The findings support that making connections and establishing healthy relationships play a significant role for women in achieving sobriety and maintaining recovery.

Research; The Process of Reconnecting: Recovery from the Perspective of Addicted Women. Carolynn Masters & Dorothy S. Carlson. Journal of Addictions Nursing, Volume 17, Issue 4 December 2006 , pages 205 – 210