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…

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

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

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

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

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

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

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

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

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

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

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

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

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

The ten effective elements of treatment are;

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

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

3. Length of treatment counts

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

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

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

7. Drug testing during treatment is important.

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

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

10. Don’t give up.

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

Full story at Recovery Today

See also;

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

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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AA Utilization After Introduction in Outpatient Treatment.

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

Relatively little is known about subsequent AA utilization.

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

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

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

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

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

Brief Intervention as a Bridge to AA

Brief Intervention Is Insufficient for Medical Inpatients With Unhealthy Drinking

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

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

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

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

Comments:

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

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

• Brief-TSF extends brief intervention to lifelong recovery.

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

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

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

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

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

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

See also;

• What About This Spiritual Awakening Thing?
• 12-Step Treatment More Effective than Alternative
• Bill W.Biography
• 12 Steps and Post Traumatic Stress
• Psychology Books

If you continue to attend AA and not drop out you have nearly double chance of remaining abstinent.

Estimated Alcoholics Anonymous Membership 1991-1992

• New members during past year – 0.9 million
• On-going members – 1.5 million
• Total membership – 2.4 million

Continuation Rate in Alcoholics Anonymous

In 1991-1992 4.8 million respondents reported ever attending an Alcoholics Anonymous (AA) meeting, for reasons related to their drinking, prior to the last 12 months and 31% reported continued AA attendance during the last 12 months.

Rate of continued AA attendance was associated with years since first AA meeting

• 1-4 years since first AA meeting – 36% remained
• 5-9 years since first AA meeting – 30% remained
• 10-19 years since first AA meeting – 29% remained
• 20 years or more since first AA meeting – 32% remained

Comparison of Past Year Drinking Status – Dropouts and Continuing AA Members

Dropouts:

• Abstinent 33%
• Low risk drinking 14%
• High risk drinking 53%

Continued AA attendance:

• Abstinent 62%
• Low risk drinking 9%
• High risk drinking 29%

1. low risk drinking = never exceed 4 drinks per day(male) or 3 drinks per day (female)
2. high risk drinking = exceeds 4 drinks per day (male) or 3 drinks per day (female)

Research Source: NIAAA 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). Data Brief – National Longitudinal Alcohol Epidemiologic Survey (NLAES) Findings on Alcoholics Anonymous Membership by Loran Archer.

Thus, 36% remain attending A.A. at the end of one year and 32% are still attending at the end of 20 years.

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.