This article presents the results of a qualitative study on lesbians’ recovery from addiction. The study involved semi-structured interviews with 20 lesbians in recovery from addiction and was analyzed using grounded theory method.

The central theme that emerged was self-acceptance, both as a lesbian and as a recovering alcoholic/addict, with considerable interaction between the two.

Categories that contributed to this theme were

• learning to recover,
• relationships with other people, and
• relationship with something bigger than self.

The discussion addresses how this information can be used to assist lesbians trying to recover from addiction.

Research report; Connie R. Matthews, Peggy Lorah, Jaime Fenton, Toward a Grounded Theory of Lesbians’ Recovery from Addiction, Journal of Lesbian Studies, Volume: 9 Issue: 3, 2005 Page Range: 57 - 68

Substance Use Disorders American Dental Association.

Research tells us that dentists are no more-or less-likely to develop substance use disorders (alcohol or drug abuse or dependence) than the general population. In other words, 10-15 percent of dentists will have a drug and/or alcohol problem sometime in their lives.

Substance use disorders are part of the human condition, and touch as many as one in four American families.

What IS different for dentists and other health professionals than for the general population is the public trust that goes with the privilege to practice, and the responsibility to obey the state dental practice acts and controlled substance regulations.

An untreated substance use disorder in a dentist can not only threaten the dentist’s life and family stability, but place patients, and the practice itself, in jeopardy.

More at; American Dental Association

The interplay between help seeking and alcohol related outcomes: divergent processes for professional treatment and self-help groups.

Summary:
This study examined the influence of self-selection on the duration of professional treatment and participation in Alcoholics Anonymous (AA) and the influence of social causation on alcohol-related outcomes.

A sample of alcoholics was surveyed at baseline and 1, 3, and 8 years later. Participants completed an inventory at each survey that assessed participation in treatment and AA since the last assessment and alcohol-related functioning.

There were divergent processes of self-selection and social causation with respect to the duration of participation in professional treatment and AA.

Individuals with more severe alcohol-related problems obtained longer episodes of professional treatment, but this self-selection process was much less evident for AA.

Longer participation in professional treatment in the first year predicted better alcohol-related outcomes, but the duration of subsequent treatment was not associated with better subsequent outcomes.

In contrast, longer participation in AA consistently predicted better subsequent alcohol-related outcomes.

The findings are consistent with a need-based model of professional treatment, in which more treatment is selected by and allocated to individuals with more severe problems, and an egalitarian model of self-help, in which needs play little or no role in continued participation.

Rudolf H. Moos and Bernice S. Moos. The interplay between help-seeking and alcohol-related outcomes: divergent processes for professional treatment and self-help groups. Drug and Alcohol Dependence 75(2):155-164, August 2004.

12 Step Programs Offer Broad Benefits, Study Says

A study of Alcoholics Anonymous and other 12-step oriented self-help programs finds that they can help most people recover from alcoholism, even those who are not religious or have mental-health problems.

The Pacific Institute on Research and Education (PIRE) reported that researchers tracked a group of 227 alcoholics over three years and found that those who had attended AA or other self-help programs after treatment had higher rates of abstinence, and drank less if they did relapse.

The results cut across gender and religious lines and held regardless of psychiatric history or whether the patient had previously attended AA or other similar programs.

"Here’s a widespread, chronic disorder that seems to respond well to an inexpensive resource — mutual-help groups such as AA," said study co-author Robert Stout, Ph.D., director of the Decision Sciences Institute at PIRE. "Not only do we need to get more addicts engaged in these groups, but we also need to gather evidence on this issue and make sure that the public, policy-makers and practitioners know about it."

Added co-author John F. Kelly: "There is a clear dose-response relationship: If you don’t go to any meetings, you have the worst outcomes. If you go to a few, you have a little bit better outcome, and if you go to a lot, you have an even better outcome." Kelly is the associate director of the Massachusetts General Hospital/Harvard Addiction Research Program.

The study was published in the August 2006 issue of Alcoholism: Clinical and Experimental Research.

Brief-TSF intervention training; how best to get alcoholics to AA.

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 works with bipolar disorder

A follow up study on alcoholics with and without coexisting affective disorder Three-hundred male alcoholics were selected from consecutive admissions to hospital. They were divided into three target populations:

• primary alcoholics;
• alcoholics with unipolar affective disorder; and
• alcoholics with bipolar affective disorder.

After three follow-up interviews over a 2-year period after hospital discharge, the three sub- groups reported differences in frequency of mood change, amount of treatment received, and hospital attendance, although there were no clear-cut differences in items associated with their alcoholism.

There were, however, some indications that bipolar patients functioned at a better level during the follow-up period, particularly those who were older, had a previous history of longer periods of abstinence, and maintained more frequent contact with Alcoholics Anonymous (AA) and their family doctor.

K O’Sullivan, C Rynne, J Miller, S O’Sullivan, V Fitzpatrick, M Hux, J Cooney and A Clare. (1998), A follow up study on alcoholics with and without coexisting affective disorder. The British Journal of Psychiatry 152: 813-819 (1988)

Which to treat first; Comorbid anxiety or alcohol disorder?

Therapies that target just one problem are in sufficient for patients who have both.

Men and women with anxiety disorders are at three times the general population’s risk of being alcohol-dependent, and those who seek treatment for an anxiety disorder are at even higher risk of alcohol disorder. This comorbidity can complicate treatment attempts if either disorder remains unaddressed, leading to increased relapse risk and multiple treatment episodes.

Based on our research and clinical work in helping patients with comorbid alcohol dependence and anxiety disorders, this article describes:

• potential relationships between anxiety disorders and alcohol disorder
• pros and cons of 3 approaches to treating this comorbidity
• how to identify and address alcohol disorder in patients with anxiety disorders, depending on available resources.

Research by; Matt G. Kushner, Brenda Frye, Christopher Donahue, Sarah W. Book and Carrie L. Randall.

From; Current Psychiatry, Vol. 6, No. 8 / August 2007

Integrating Primary Medical Care With Addiction Treatment

A Randomized Controlled Trial

Context; The prevalence of medical disorders is high among substance abuse patients, yet medical services are seldom provided in coordination with substance abuse treatment.

Objective; To examine differences in treatment outcomes and costs between integrated and independent models of medical and substance abuse care as well as the effect of integrated care in a subgroup of patients with substance abuse-related medical conditions (SAMCs).

Design; Randomized controlled trial conducted between April 1997 and December 1998.

Setting and Patients; Adult men and women (n = 592) who were admitted to a large health maintenance organization chemical dependency program in Sacramento, Calif.

Interventions; Patients were randomly assigned to receive treatment through an integrated model, in which primary health care was included within the addiction treatment program (n = 285), or an independent treatment-as-usual model, in which primary care and substance abuse treatment were provided separately (n = 307). Both programs were group based and lasted 8 weeks, with 10 months of aftercare available.

Main Outcome Measures; Abstinence outcomes, treatment utilization, and costs 6 months after randomization.

Results Both groups showed improvement on all drug and alcohol measures. Overall, there were no differences in total abstinence rates between the integrated care and independent care groups (68% vs 63%, P = .18).

For patients without SAMCs, there were also no differences in abstinence rates (integrated care, 66% vs independent care, 73%; P = .23) and there was a slight but nonsignificant trend of higher costs for the integrated care group ($367.96 vs $324.09, P = .19).

However, patients with SAMCs (n = 341) were more likely to be abstinent in the integrated care group than the independent care group (69% vs 55%). This was true for both those with medical and psychiatric SAMCs. Patients with SAMCs had a slight but nonsignificant trend of higher costs in the integrated care group ($470.81 vs $427.95, P = .14).

Conclusions Individuals with SAMCs benefit from integrated medical and substance abuse treatment, and such an approach can be cost-effective. These findings are relevant given the high prevalence and cost of medical conditions among substance abuse patients, new developments in medications for addiction, and recent legislation on parity of substance abuse with other medical benefits.

Research report; Integrating Primary Medical Care With Addiction Treatment; A Randomized Controlled Trial, Constance Weisner, DrPH; Jennifer Mertens, MA; Sujaya Parthasarathy, PhD; Charles Moore, MD, MBA; Yun Lu, MPH. JAMA. 2001;286:1715-1723.

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.

Special populations in Alcoholics Anonymous.

The vast majority of Alcoholics Anonymous (AA) members in the United States are white, and only a few studies have investigated the program’s effectiveness for ethnic minorities. Other demographics need to be examined.

Project MATCH, a multisite research study aimed at developing guidelines for assigning alcoholics to appropriate treatment approaches, also assessed AA effectiveness for minority clients.

Some differences in AA attendance existed among white, African-American, and Hispanic Project MATCH participants who had received some inpatient treatment before entering the study, but not among participants who had not received inpatient treatment.

Further analyses of white and Hispanic Project MATCH participants demonstrated that although Hispanic clients attended AA less frequently than white clients, their involvement with and commitment to AA was higher than among white clients. For these target populations, both Hispanics and whites, AA involvement predicted increased abstinence.

Research; Tonigan JS, Connors GJ, Miller WR. Special populations in Alcoholics Anonymous. Alcohol Health Res World. 1998;22(4):281-5.