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…

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.

How do alcoholics get to AA?¹

AA has grown to over 100,000 groups world wide with more than two million members simply on word-of-mouth recommendation. Often the recommendation has come from friends, family, employers, healthcare workers or law courts.

People progress through stages of affiliation with others and with Alcoholics Anonymous in pursuit of solutions to their problems. Two paths are identified; Direct Affiliation and Facilitated Affiliation².

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The 1956 General Service Conference of A.A. adopted unanimously the following statement of “A.A.’s Public Information

Policy”: In all public relationships, A.A.’s sole objective is to help the still suffering alcoholic. Always mindful of the importance of personal anonymity, we believe this can be done by making known to him, and to those who may be interested in his problem, our own experience as individuals and as a fellowship in learning to live without alcohol. We believe that our experience should be made available freely to all who express sincere interest.

We believe further that all our efforts in this field should always reflect our gratitude for the gift of sobriety and our awareness that many outside A.A. are equally concerned with the serious problem of alcoholism.

This statement reflects a longstanding A.A. tradition of not seeking publicity for promotional purposes, but of always being willing to cooperate with representatives of all media who seek information about the recovery program or about the structure of the Fellowship. Thousands of inquiries of this type are handled each year at the General Service Office (475 Riverside Drive, New York, NY 10115; mail address: Box 459, Grand Central Station, New York, NY 10163; telephone: 2128703400; www.aa.org). Many countries have local website’s that can be accessed from this main site.

Information and public relations matters affecting the Fellowship of A.A. as a whole are the concern of the Public Information Committee and the Committee on Cooperation with the Professional Community/Treatment Facilities of the General Service Board of Alcoholics Anonymous.

Reporters are welcome at A.A. open meetings, dinners, regional gettogethers, or similar gatherings of recovered alcoholics.

The only restriction is a request not to disclose the name of any A.A. member. (For obvious reasons, photographs cannot be taken at A.A. meetings.)

Note: In many areas, A.A. members have established committees on public information and cooperation with the professional community, to assist local media in obtaining accurate information about the Fellowship. Background material on A.A. may also be obtained upon request from these groups.

A.A. FACT FILE; PREPARED BY GENERAL SERVICE OFFICE OF ALCOHOLICS ANONYMOUS

• Early detection, including screening and brief interventions (for nondependent problem drinkers)
• Comprehensive assessment and individualized treatment plan
• Care management
• Individually delivered, proven professional interventions
• Contracting with patients
• Social skills training
• Medications
• Specialized services for medical, psychiatric, employment or family problems
• Continuing care
• Strong bond with therapist or counselor
• Longer duration (for alcohol dependent persons)
• Participation in support groups
• Strong patient motivation

Research Sources: McLellan, T.A. 2002; Miller,W.R. 2002; National Institute on Drug Abuse. 1999; Project MATCH Research Group. 1997.

Active participation in a support group can contribute to long-term recovery.

Project MATCH and other studies in the 1990s definitively proved that AA can be an active ingredient of treatment both during a professional intervention and afterward, depending on the patient’s type of therapy.

Patients who joined the AA fellowship or who had an AA sponsor after receiving twelve step facilitation therapy had better abstinence records than those who received an intervention but did not continue their AA participation upon completion.

Other research indicates AA participation may be less effective for patients who receive cognitive behavior therapy because the programs have different goals that may confuse patients.

What researchers still don’t understand, however, are the precise mechanisms of AA participation.

While AA affiliation is associated with self-efficacy, motivation and coping efforts, all significant predictors of good outcome following a professional intervention, some studies have shown that patients who adopt more of the fellowship’s basic tenets – such as acknowledging that alcoholism is a disease, admission of their powerlessness over alcohol and working the twelve steps of the program – relapse at the same rates as patients who adopt very few.

This suggests that the active ingredient may be less about AA per se than continuing participation in support groups that promote a lifestyle inconsistent with the problematic use of alcohol and other drugs.

From; www.ensuringsolutions.org

Brief-TSF is designed to support active participation in Alcoholics Anonymous.

Does Prayer Decrease Alcohol Consumption?

Four methodologically diverse studies (N = 1,758) show that prayer frequency and alcohol consumption are negatively related.

In Study 1 (n = 824), we used a cross-sectional design and found that higher prayer frequency was related to lower alcohol consumption and problematic drinking behavior.

Study 2 (n = 702) used a longitudinal design and found that more frequent prayer at Time 1 predicted less alcohol consumption and problematic drinking behavior at Time 2, and this relationship held when controlling for baseline levels of drinking and prayer.

In Study 3 (n = 117), we used an experimental design to test for a causal relationship between prayer frequency and alcohol consumption. Participants assigned to pray every day (either an undirected prayer or a prayer for a relationship partner) for 4 weeks drank about half as much alcohol at the conclusion of the study as control participants.

Study 4 (n = 115) replicated the findings of Study 3, as prayer again reduced drinking by about half.

Research; Nathaniel M. Lambert, Frank D. Fincham, Loren D. Marks and Tyler F. Stillman; Psychology of Addictive Behaviors; Volume 24, Issue 2, June 2010, Pages 209-219; Invocations and Intoxication: Does Prayer Decrease Alcohol Consumption?

• Not God – A History of AA
• Improving Treatment Compliance

Prayer Steps to Serenity The Twelve Steps Journey: New Serenity Prayer Edition by L. G. Parkhurst Jr.

Spirituality in Alcoholism Recovery: A model of progression

The spiritual progression of 14 members of Alcoholics Anonymous (AA) was studied using a transtheoretical approach, with object relations theory as a primary framework.

The subjects were aged 35-45, had a minimum of one year of continuous sobriety, and professed belief in the efficacy of the Twelve Steps.

The subjects participated in multiple-subject interviews and completed a questionnaire.

A six-stage model of spiritual progression was developed. It is noted that within AA, spiritual progression in recovery is based on application of AA’s Twelve Suggested Steps of Recovery.

• stage one marks the beginning of recovery,
• stages two and three address relationships with God;
• stage four relates to subjects’ relationships with themselves;
• stage five relates to subjects relationships with others;
• stage six relates to maintenance of spirituality through application of the Twelve Steps.

Three case studies representing successful, moderately successful, and unsuccessful spiritual integration illustrate the experiences of alcoholics in working through AA’s Twelve Suggested Steps of Recovery.

The results of the study indicated that spiritual integration comprising a sound triadic relationship with God, self, and others is not easily attained.

Of the 14 AA members included in the study,

• 9 have achieved spiritual integration;
• 3 have achieved moderately successful spiritual integration, and
• 2 have been unsuccessful.

Research report; McGregot, J.G. Spirituality in recovery: A model of progression. Dissertation Abstracts International, 63(2):509A, 2002.

The concept of spirituality in relation to addiction recovery and general psychiatry.

This chapter is directed at defining the nature of spirituality and its relationship to empirical research and clinical practice.

A preliminary understanding of the spiritual experience can be achieved on the basis of diverse theoretical and empirically grounded sources, which will be delineated: namely, physiology, psychology, and cross-cultural sources.

Furthermore, the impact of spirituality on mental health and addiction in different cultural and clinical settings is explicated regarding both beneficial and compromising outcomes.

Illustrations of its application in addiction and general psychiatry are given: in meditative practices, Alcoholics Anonymous, and treatment programs for addiction singly and comorbid with major mental illness.

Given its prominence in Alcoholics Anonymous and related Twelve-Step groups, spirituality plays an important role in the rehabilitation of many substance-dependent people.

The issue of spirituality, however, is prominent within contemporary culture as well in the form of theistic orientation, as evidenced in a probability sampling of American adults, among whom 95% of respondents reply positively when asked if they believe in “God or a universal spirit.”

Responses to a follow-up on this question suggest that this belief affects the daily lives of the majority (51%) of those sampled, as they indicated that they had talked to someone about God or some aspect of their faith or spirituality within the previous 24 h.

Research report; Galanter M. The concept of spirituality in relation to addiction recovery and general psychiatry. Recent Dev Alcohol. 2008;18:125-40.

See also;

• AA Offers Recovery Not Religion
• ABC’s of Recovery
• Alcohol intervention may help.

Blue Like Jazz: Nonreligious Thoughts on Christian Spirituality

Alcoholics Anonymous is not organized in the formal or political sense. There are no governing officers, no rules or regulations, no fees or dues.

The need for certain services to alcoholics and their families throughout the world has, however, been apparent from the beginning of the Fellowship. Inquiries have to be answered. Literature has to be written, printed, and distributed. Requests for help are followed up.

There are two operating bodies:

1. A.A. worldwide services, directed by A.A. World Services, Inc., are centered in the General Service Office in New York City, where 79 workers keep in touch with local groups, with A.A. groups in treatment and correctional facilities, with members and groups overseas, and with the thousands of “outsiders” who turn to A.A. each year for information on the recovery program. A.A. Conference approved Literature is prepared, published, and distributed through this office.

2. The A.A. Grapevine, Inc., publishes the A.A. Grapevine, the Fellowship’s monthly international journal. The magazine currently has a circulation of about 106,000 in the U.S., Canada, and other countries. The Grapevine also produces a selection of special items, principally cassette tapes and anthologies of magazine articles, which are spin offs from the magazine.

The two operating corporations are responsible to a board of trustees (General Service Board of A.A.), of whom seven are nonalcoholic friends of the Fellowship, and 14 are A.A. members.

A General Service Conference, consisting of 93 delegates from A.A. areas in the United States and Canada, and trustees, A.A.W.S. and Grapevine directors, and staff from the General Service Office and the Grapevine in New York, meets once a year and provides a link between the groups throughout the U.S. and Canada and the trustees who serve as custodians of A.A. tradition and interpreters of policies affecting the Fellowship as a whole.

At the local group level, formal organization is kept to a minimum. The group may have a small steering committee and a limited number of rotating officers — “trusted servants” whose responsibilities include arranging meeting programs, providing refreshments, participating in regional A.A. activities, and maintaining contact with the General Service Office.

The principle of consistent rotation of responsibility is followed in virtually all A.A. service positions. Positions in the local group are usually rotated semiannually or annually. Delegates to the General Service Conference traditionally serve no longer than two years and alcoholic trustees of the General Service Board are limited to a four year term.

A.A. FACT FILE PREPARED BY GENERAL SERVICE OFFICE OF ALCOHOLICS ANONYMOUS

This document is available on the A.A. Web site: www.aa.org

The impact of Alcoholics Anonymous (AA) on professional treatment.

Several forces combined in the 1950s to profoundly change the way alcoholism was treated in the United States. Anderson, Bradley, and Hazelden staff combined strategies to revolutionize alcoholism treatment across the spectrum of social rehabilitation services and hospital-based care.

Prevailing psychiatric services, heavily influenced by psychoanalytic practices, were abandoned in favor of an emphasis on patient education, therapeutic group process, peer interaction, and the development of life-long support systems through AA.

The addition of the alcoholism counselors, many of whom were recovering AA members, was a key ingredient in aligning a closely identified professional with the alcoholic to foster integration of Twelve Step principles and practices in everyday life.

Dignity, respect, and hope for recovery became the cornerstone of the Minnesota/Hazelden Model. The resulting treatment model is recognized as an effective, evidence-based approach for alcohol and drug dependence. One of the strongest commendatory statements has come from the staff of the National Institute on Alcohol Abuse and Alcoholism who, in a report to the U.S. Congress, identified Twelve Step-based professional treatment as effective as other approaches and a model that "…may actually achieve more sustained abstinence" (2000, p. 448).

Clearly, AA’s impact on professional treatment cannot be underestimated. Perhaps Dan Anderson summarized it best: "Without the initial and sustaining impetus of [AA], none of our treatment efforts could have been realized"

Slaymaker VJ, Sheehan T. The impact of Alcoholics Anonymous (AA) on professional treatment. Recent Dev Alcohol. 2008;18:59-70.

See also;

• ABC’s of Recovery
• Alcoholic Recovery for Gay and Lesbian People
• Definition of Codependency
• Spiritual Assessment