Helping Helps the Helper

Aims; The helper therapy principle suggests that, within mutual-help groups, those who help others help themselves. The current study examines whether clients in treatment for alcohol and drug problems benefit from helping others, and how helping relates to 12-step involvement. Design Longitudinal treatment outcome.

Participants; An ethnically diverse community sample of 279 alcohol- and/or drug-dependent individuals (162 males, 117 females) was recruited through advertisement and treatment referral from Northern California Bay Area communities. Participants were treated at one of four day-treatment programs.

Measurements; A helping checklist measured the amount of time participants spent, during treatment, helping others by sharing experiences, explaining how to get help and giving advice on housing and employment. Measures of 12-step involvement and substance use outcomes were administered at baseline and a 6 month follow-up.

Findings; Helping and 12-step involvement emerged as important and related predictors of treatment outcomes. In the general sample, total abstinence at follow-up was strongly and positively predicted by 12-step involvement at followup, but not by helping during treatment; still, helping positively predicted subsequent 12-step involvement. Among individuals still drinking at follow-up, helping during treatment predicted a lower probability of binge drinking, whereas effects for 12-step involvement proved inconsistent.

Conclusions; Findings support the helper therapy principle and clarify the process of 12-step affiliation.

Research report; Sarah E. Zemore, Lee Ann Kaskutas & Lyndsay N. Ammon, In 12-step groups, helping helps the helper. Addiction; March 2004

Peer Support in Action: From Bystanding to Standing By

Bipolar Patients with Comorbid Substance Use Disorders; Diagnostic and Treatment Considerations:

Comorbidity of bipolar disorder (BD) and alcoholism and substance use disorders (SUDs) represents a serious public health problem and a major challenge to treatment systems.

Bipolar disorder is among the top causes of disabilities worldwide, and reportedly the fourth leading mental illness as a source of disease burden in established market economies. Large epidemiologic surveys in the United States have consistently confirmed a high association between bipolar disorder and SUDs. The Epidemiological Catchments Area Study reported bipolar I and bipolar II disorders as having the highest association with SUDs when compared with any other major psychiatric disorder.

The prevalence of lifetime alcohol abuse or dependence in persons with bipolar I disorder and bipolar II disorders were found to be 46%, and 39.2% respectively.

Similarly, the National Comorbidity Survey reported respondents with mania to be 8 to 9 times more likely to have an additional lifetime disorder of drug or alcohol dependence compared with the general population. The most recent and largest epidemiologic survey of more than 42,000 respondents in the United States, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), reported that mania and hypomania were associated with very high rates of SUDs. Those with mania were 6 times more likely to have alcohol dependence and 14 times more likely to have drug dependence over the past 12 months.

Research from; Psychiatric Annals, Volume 38 · Number 11, NOVEMBER 2008

Safe Treatment of Pain in the Patient With a Substance Use Disorder

Conditions associated with severe pain can and do develop in persons who have active addiction or who are in remission from an addictive disease, and these patients may require treatment for pain relief. This presents a challenge to clinicians: How can pain be relieved in these patients without exacerbating or reactivating the addictive disorder?

There is little research data on this topic; however, experiential and anecdotal reports collected over the past 3 decades indicate that there are safe and effective approaches to pain management in these patients. In general, the pain treatment regimen for a person recovering from an addiction involves the use of long-acting opioids, such as sustained-release oxycodone, methadone, or buprenorphine, administered on a fixed dosage schedule, with another person holding the medication. Specific dosing recommendations are provided.

By: Penelope P. Ziegler, MD; Psychiatric Times (CMP Medica), 24(1), 2007.

HTML available online at: http://www.psychiatrictimes.com/showArticle.jhtml?articleID=196902132 (Free registration may be required.)

Brief-TSF professional training is complimentary to pain treatment.

 

Mutual Support: For Professionals

This article at Faces and Voices of Recovery details some of the issues in working with mutual and self-help fellowships for recovery from various substance abuse issues.

Subjects include;

A. Problems and Pitfalls in Working With Mutual Support Groups

• Taking Over the Peer Helper Role
• Over identification with Resistance
• Problems with Religion
• Gender Issues
• Discomfort in groups
• Lack of transportation and other logistical barriers
• Working at Cross Purposes With the Group

B. Indicators of Mutual Support Involvement

C. Aids to Working With Mutual Support Groups

• General
• American Self Help Clearinghouse Self help Sourcebook online
• National Mental Health Consumers’ Self Help Clearinghouse
• Chemical Dependency
• Mental Illness

D. Professional Responsibilties

E. Readings & References

Note: A PDF version of this guide for professionals is also available.

More at; Faces and Voices of Recovery

See also;

• “I’m a doctor and an addict” What happens next?
•  COUNSELOR CHARACTERISTICS

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

A comparative evaluation of substance abuse treatment

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

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

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

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

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

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

Dual dependence upon alcohol and illicit drugs

ABSTRACT – Aims: The study investigates severity of alcohol dependence among drug misusers. Specifically, it investigates the inter-relationship of alcohol and drug dependence and associations with alcohol consumption, drug consumption and substance-related problems.

Design, setting, participants: The sample comprised 735 people seeking treatment for drug misuse problems, who were current (last 90 days) drinkers.

Measurements: Data were collected by structured face-to-face interviews. Dependence upon illicit drugs and upon alcohol was measured by the Severity of Dependence Scale (SDS).

Findings: Three groups of drinkers were identified: non-alcohol-dependent drug misusers (63%); low-dependence (19%); and high-dependence (18%). Many drug misusers were drinking excessively and alcohol dependence was related to patterns of alcohol and drug consumption. High-dependence drinkers were more likely to drink extra-strength beer; they were less frequent users of heroin and crack cocaine but more frequent users of benzodiazepines, amphetamines and cocaine powder; they reported more psychological and physical health problems. The SDS was found to have good reliability and validity as a measure of alcohol dependence. SDS scores for alcohol and drug dependence were unrelated.

Conclusions: Alcohol use is an important and under-rated problem in the treatment of drug misusers. A comprehensive assessment of alcohol use among drug misusers should include separate assessments of alcohol consumption, alcohol-related problems and severity of alcohol dependence.

Research; Gossop, Michael; Marsden, John; Stewart, Duncan. Dual dependence: assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems. Addiction; Volume 97(2), February 2002, p 169-178.

The objectives of this research were to assess the prevalence of substance use among Dutch dental students and to determine their attitudes about substance use and its consequences.

METHODS: In association with a national study of drug use among US dental students, a questionnaire was translated from English into Dutch and administered to dental students at two dental schools in The Netherlands. Students received an anonymous 115-item questionnaire in the fall of 1996.

RESULTS: Alcohol was the students’ drug of choice for

• lifetime (95%),
• past year (94%) and
• past month (88%) use.

No significant correlations were found between alcohol use and gender, schools, and years in dental education.

In the past month,

• 58% of students reported drinking on 5 or more days;
• 53% had 5 or more drinks on the same occasion,
• 20% had 5 or more drinks on the same occasion on 5 or more days; and
• 17% reported getting drunk at least monthly.

Prevalence rates for past month use of tobacco was 24% and marijuana, 4%.

Male students smoked twice as much as females, with significant differences found for all three periods of use (X2>19.00, P<0.01).

When asked whether their schools offered policies and education programs on alcohol and other drugs, 52% of students reported that these were not available.

CONCLUSIONS: Dental schools should develop effective programmes to educate students about responsible use of alcohol and other licit and illicit drugs. Schools should also inform students about their susceptibilities to substance abuse and dependency.

Community Dent Oral Epidemiol. 2001 Feb;29(1):48-54. Substance use among Dutch dental students. Plasschaert AJ, Hoogstraten J, van Emmerik BJ, Webster DB, Clayton RR.

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

Counseling for Relapse Prevention by Terence T. Gorski, Merlene Miller Read more about this title…

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…

A Study of Readiness to Change Profiles in Alcohol and Other Drug Abusers.

The purpose of the study was to measure readiness to change profiles of alcohol and other drug abusers, information which is needed in the individual tailoring of treatment.

The subjects (N = 780) were Finnish alcoholics and polydrug users receiving inpatient treatment. The instrument used to measure readiness to change was the University of Rhode Island Change Assessment Scale (URICA). In the cluster analysis the subjects were placed in groups.

The results revealed wide differences in readiness to change profiles, yet not between alcoholics and polydrug users.

Higher education, female gender, living with minor children and marital state were consistently associated with better readiness to change.

Those coming on an entirely voluntary basis and those aiming at abstinence were also more ready to change than other subjects.

Abstinence in this population is generally a realistic objective, which many clients adopt after some unsuccessful attempts at controlled use.

The article contemplates the significance of the findings in the light of earlier profiling studies and the treatment of substance abuse.

Research; Pekka Saarnio; Vesa Knuuttila. A Study of Readiness to Change Profiles in Alcohol and Other Drug Abusers. Journal of Addictions Nursing, Volume 18, Issue 3 July 2007 , pages 117 – 122.

Brief-TSF can assist patients cease alcohol consumption.