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

A closer look at the role of a spiritual approach in addictions treatment.

Twelve Step Programs such as AA play a major role in addictions treatment, and their members are increasingly accepting of psychotherapy and medication.

However, many clinicians question the role of an approach defined by these Programs as spiritual.

This paper explores the nature, indications, and limitations of a spiritual approach to addiction and the implications for collaboration with mental health professionals.

It suggests that Twelve Step Programs not only provide accessible group support and a clear ideology regarding addiction but address individuals’ needs for identity, integrity, an inner life and interdependence within a larger social and moral, or spiritual context.

It examines the ways in which the religious connotations of the Program remain an obstacle for many patients and clinicians.

Clarification of the different needs met by modalities such as AA can improve the specificity and the comprehensiveness of treatment for patients with substance use disorders.

Peteet JR. A closer look at the role of a spiritual approach in addictions treatment. J Subst Abuse Treat. 1993 May-Jun;10(3):263-7.

The Measure of a Man: A Spiritual Autobiography (Oprah’s Book Club) by Sidney Poitier Read more about this title…

Patterns of AA involvement five years after treatment entry

BACKGROUND: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of aftercare, but we know very little about treatment seekers’ patterns of AA involvement over time and how these relate to abstinence.

METHOD: This paper applies latent class growth curve modeling to longitudinal data from 349 dependent drinkers recruited when they were entering treatment and were re-interviewed at one or more follow-up interviews one, three and five years later, and who reported having attended AA at least once.

RESULTS: Four classes of AA "careers" of meeting attendance emerged:

• The low AA group mainly just attended AA during the 12 months following treatment entry.
• The medium and high AA groups were characterized by stable attendance at the second and third follow-ups-at about 60 meetings a year for the medium group and over 200 meetings per year for the high group, followed by slight increases for the medium group and slight decreases for the high group by year five.
• The declining AA group doubled its meeting attendance post-baseline, to almost 200 meetings during the year following treatment entry, but by year five they were only attending about six meetings on average.

Decreases in AA meetings did not necessarily signal disengagement from AA; at the five-year follow-up, a third of the low AA group and over half of the declining AA group said they felt like a member of AA.

Activities other than meeting attendance, such as having a sponsor, otherwise paralleled the meeting careers, but social networks were similar by year five.

Rates of abstinence by year five (for the past 30 days) were

• 43% for the low AA group,
• 73% for the medium group,
• 79% for the high group and
• 61% for the declining group.

Rates of dependence symptoms and social consequences of drinking did not differ between the groups at year five.

CONCLUSIONS: The prototypical AA careers derived empirically are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable (and sometimes quite high) rates of AA attendance. However, contrary to AA lore, many who connect only for a while do well afterwards.

Kaskutas LA, Ammon L, Delucchi K, Room R, Bond J, Weisner C. Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry. Alcohol Clin Exp Res. 2005 Nov;29(11):1983-90.

Spirituality in alcoholics during treatment

The purpose of this study was to measure

• spiritual well-being (SWB),
• private religious practices (PRP),
• positive religious coping,
• abstinence self-efficacy (AASE),
• affiliation with Alcoholics Anonymous (AAA),
• and their associations with alcoholics in treatment.

Seventy-four adults in a three-week outpatient addiction treatment program were assessed at admission and discharge. Wilcoxon signed rank and t tests demonstrated significant increases in all variables.

Spearman correlation coefficients detected significant associations between the spiritual variables, SWB and AASE, as well as PRP and AAA.

Findings suggest that spiritual variables can change during treatment and that there may be connections between spiritual variables and variables associated with longer-term recovery.

Piderman KM, Schneekloth TD, Pankratz VS, Maloney SD, Altchuler SI. Spirituality in alcoholics during treatment. Am J Addict. 2007 May-Jun;16(3):232-7

Brief-TSF does not address spirituality. It leaves that to the AA Fellowship.

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

TSF for Dual Diagnosis

The role of 12-step programs and 12-step-oriented treatments for dually diagnosed individuals (DDI) remains unclear. Here are presented the results of a pilot study in a target population of 10 seriously mentally ill patients received an adjunctive modified 12-step facilitation (TSF) therapy emphasizing engagement of DDI in a specialized 12-step program for DDI.

Participants significantly increased their 12-step attendance and decreased their substance use during the 12 weeks of treatment.

Larger and longer-term studies are needed to assess the efficacy of modified TSF for DDI relative to other treatments, and to determine what forms of TSF are most effective in this population.

Research; Bogenschutz MP. Tucker NE Specialized 12-step programs and 12-step facilitation for the dually diagnosed. Community Ment Health J. 2005 Feb;41(1):7-20.

Brief-TSF can be adapted to serve these people.

Spirituality/religiosity promotes acceptance-based responding and 12-step involvement.

BACKGROUND: Previous investigations have observed that spirituality/religiosity (S/R) is associated with enhanced 12-step involvement.

However, relatively few studies have attempted to examine the mechanisms for this effect.

For the present investigation, we examined whether acceptance-based responding (ABR) – awareness or acknowledgement of internal experiences that allows one to consider and perform potentially adaptive responses – accounted for the effect of S/R on 12-step self-help group involvement 2 years after a treatment episode.

METHODS: Data were collected as part of a multi-site treatment outcome study with 3698 substance-dependent male veterans recruited at baseline.

Assessments were conducted at baseline, discharge, 1-year follow-up, and 2-year follow-up. We utilized structural equation modeling to examine the relationships among latent variables of S/R, ABR, and 12-step involvement over time.

RESULTS:

• In the final model, S/R was not directly related to 12-step involvement at 2-year follow-up.
• However, S/R predicted enhanced ABR at 1-year follow-up after accounting for discharge levels of ABR.
• In turn, ABR at 1-year follow-up predicted increased 12-step involvement at 2-year follow-up after accounting for discharge levels of 12-step involvement.

CONCLUSIONS: S/R promotes the use of post-treatment self-regulation skills that, in turn, directly contribute to ongoing 12-step self-help group involvement.

Research report; Carrico AW, Gifford EV, Moos RH. Spirituality/religiosity promotes acceptance-based responding and 12-step involvement. Drug Alcohol Depend. 2007 Jun 15;89(1):66-73. Epub 2007 Jan 16.

Blue Like Jazz: Nonreligious Thoughts on Christian Spirituality by Donald Miller Read more about this title…

A researcher studying the influence of spirituality on sobriety encourages recovering alcoholics to nourish their spiritual needs through praying, taking a course in meditation, or simply walking in the woods.

“While people’s actual beliefs don’t seem to change during recovery, the extent [to which] they have spiritual experiences and are open to spirituality in their lives does change,” said Elizabeth Robinson, Ph.D., a research assistant professor at the Addiction Research Center at the University of Michigan’s Department of Psychiatry.

While anecdotal evidence indicates that spirituality plays a role in alcohol recovery, until recently there were few hard data to prove if and how it impacts sobriety.

Now a team of researchers at the University of Michigan Addiction Research Center (UMARC) headed by Robinson have found that many measures of spirituality increase during alcohol recovery. And increases in day-to-day spiritual experiences and sense of purpose in life were associated with fewer episodes of heavy drinking six months later, independent of involvement in Alcoholics Anonymous (AA).

Their report appears in the March Journal of Studies on Alcohol and Drugs.

“I was surprised that there was a relationship between spirituality and a change in drinking independent of AA involvement, because AA involvement certainly impacts spirituality,” Robinson told Psychiatric News.

The researchers assessed the changes in spirituality and religiosity (S/R) of 123 adults (66 percent men; mean age 39; 83 percent white) with alcohol use disorders at entry into treatment and six months later. They also investigated whether those changes were associated with drinking outcome. The 10 S/R measures of the participants’ spirituality and religiousness, measured with standard research questionnaires, included their views of God, religious practices such as prayer or church attendance, forgiveness, spiritual experiences, using religion or spirituality to cope, and existential meaning. Drinking behaviors were assessed with the Time-line Followback interview. AA participation and attendance were also measured.

In all, the study showed that during the six-month period there were statistically significant changes in half of the measures of spirituality, including daily spiritual experiences, use of religious practices, forgiveness, positive use of religion for coping, and feelings of purpose in life.

But the measures that assessed individuals’ core beliefs and values about God or religion didn’t change. At the same time there was a statistically significant decrease in alcohol use, and 72 percent of participants did not relapse to heavy drinking. Heavy drinking was defined as five or more drinks a day for men and four or more drinks a day for women. Increases in Daily Spiritual Experiences and Purpose in Life scores were associated with increased odds of no heavy drinking at six months, even after controlling for AA involvement and gender. Changes in the other measures of spirituality were not statistically associated with likelihood of sobriety.

Robinson and her colleagues said that because spiritual practices and experiences increased significantly over time while spiritual and religious beliefs did not, the results suggest that proactive and experiential dimensions of spirituality, rather than cognitive dimensions of spirituality, were contributing to recovery and less drinking during the first six months.

They noted that this pattern of differential changes in S/R experiences and behavior rather than beliefs is consistent with two AA slogans: “Bring your body, your mind will follow,” and “Fake it ’til you make it.” In other words, changes in core beliefs and values don’t have to occur for someone to be more open to spiritual experiences or to take part in more spiritual activities.

Robinson said that including spirituality of all kinds into recovery programs for alcoholism may indeed provide benefit. Many individual faiths or religious institutions offer recovery services, and some advocates have suggested that faith-based recovery is effective for most people. But Robinson noted that the spirituality seen in the study was not necessarily a matter of believing in one interpretation of God, religions, or even belief in a God of any kind.

Each individual’s spirituality the ability to experience growth in that spirituality appear to be paramount, the authors suggested. Thus, each individual alcoholic might do best by searching for a recovery program that best matches his or her belief system.

By David Milne at Psychiatric News. From research; Psychiatr News May 4, 2007, Volume 42, Number 9, page 19.

The author of this article describes a psychological model, based on studies he and his colleagues have conducted, to clarify the operation of Alcoholics Anonymous (AA) and other movements that operate through social and ideologically grounded support and can be characterized as “spiritual recovery movements.”

Taken together, the findings from the cited studies make evident that peer-led ideologically oriented self-help programs illustrate the value of combining intense mutual support with the psychology of commitment to a health-related ideology.

Although peer-led self-help programs are not among the approaches employed by traditional psychiatrically grounded providers of care, their success underlines their potential value to mental health professionals who can make use of these programs to complement conventional treatment.

This would require the introduction of certain elements in professional curriculums, such as;

• an understanding of the psychology underlying these programs,
• an openness to the contribution of such programs to recovery from illness, and
• competency in referral to and even collaboration with these programs.

The current practice of psychiatrists and general medical caregivers does not reflect acceptance of these programs, however.

The author recommends that physicians in psychiatric residency programs should, as part of their standard curriculum, attend AA meetings, visit drug-free therapeutic community programs, and serve as co-leaders of peer-led therapy groups on ambulatory services.

Research report; Galanter, M. Alcohol and drug abuse: Healing through social and spiritual affiliation. Psychiatric Services, 53(9):1072-1074, 2002.

Brief-TSF is designed to address these issues.

Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals,

Abstract

This study was a part of a larger qualitative descriptive study designed to explore chronic sorrow as a relapse trigger among female victims of child abuse who were currently enrolled in substance abuse treatment for relapse.

The purpose of this study was to identify coping strategies and other factors these women perceived as helpful to their recovery. A purposive sample of twelve women participated in interviews using a semistructured interview schedule.

The advice the participants offered to women in similar situations reflected interpersonal, cognitive and action-focused positive coping strategies.

They encouraged clinicians in primary care facilities to approach persons suspected of substance abuse in a nonjudgmental manner. Healthcare professionals should be more assertive in recommending resources for substance abuse treatment.

Research; Cheryl Slaughter Smith. Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals, Journal of Addictions Nursing, Volume 18, Issue 2 April 2007 , pages 75 – 80