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…

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.

Read the rest of this entry

Experiences of alcohol dependence: a qualitative study

INTRODUCTION AND AIMS OF THE STUDY:

Despite the increasing incidence of alcohol misuse and the costs it incurs, British society continues to hold equivocal and ambiguous attitudes towards drinking, and understanding of the nature of alcohol dependence and related issues is limited.

This qualitative study aimed to investigate the experiences of individuals with alcohol dependence to enhance understanding of the illness, identify key issues and common themes and provide insight into the experiences of the participants during their alcohol dependent period and recovery.

METHOD:

A qualitative approach, using narrative method, was used. Eight participants, all members of Alcoholics Anonymous (AA), were interviewed by the researchers. Using a grounded theory approach and content analysis, the in-depth narratives of the eight participants were systematically analysed.

RESULTS:

While participants continued to deny the existence of a problem to those around them, their behaviours indicated that they were aware of the problem but were afraid to admit it openly through fear of other people’s reactions.

Participants generally regarded GP’s as helpful but other health professionals less so, especially nurses and Accident and Emergency staff.

Participants considered that the success of treatment depended on their own motivation and willingness to engage in radical behaviour change.

They considered that reaching this stage represented a turning point in their illness. The point at which this stage was reached appeared to be different for each participant.

CONCLUSIONS:

This systematic analysis of a small sample of alcohol dependent individuals gives insight into their experiences during alcohol dependency and the journey to recovery.

The findings suggest that denial of the problem to the outside world occurs simultaneously with individuals being aware of their problem.

Participants felt the illness carries a stigma and their negative experiences of health professionals other than GP’s suggests that nurses and other health workers need to revise their understanding of alcohol dependence and their approach to it.

AA was a significant factor in recovery for these participants.

Research report; J Fam Health Care. 2007;17(6):211-4. Experiences of alcohol dependence: a qualitative study. Dyson J.

See also;

• BriefTSF is designed to help breakdown denial
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology

Alcoholics Anonymous and Narcotics Anonymous benefit adolescents who attend

While Alcoholics Anonymous (AA) has existed for more than 70 years, and is the most commonly sought source of help for alcohol-related problems in the United States, there is little “hard scientific evidence” showing that AA and Narcotics Anonymous (NA) can improve substance-use outcomes. This study examined how helpful AA and NA may be for adolescents, finding long-term benefits even though many youth discontinue attendance after time.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research.

“It is difficult to evaluate the efficacy of mutual-help organizations like AA through randomized controlled experiments because the AA ‘intervention,’ being a community organization based on anonymity, cannot be directly under the control of the researcher in the usual way,” explained John F. Kelly.

Yet their popularity and cost-effectiveness cannot be denied, added Kelly.

“AA and NA are explicitly focused on abstinence and addiction recovery, they are widely available across most communities, they provide entry to a social network of recovery-specific support and sober events that can be accessed ‘on demand’ – particularly at times of high-relapse risk such as evenings and weekends, the services are free, and AA/NA can be attended as intensively, and for as long, as individuals desire,” he said.

However, he added, despite growing evidence that adults benefit from AA and NA, little is known about how these abstinence-focused organizations help youth, and what is known lacks scientific rigor.

“This knowledge gap is particularly noteworthy given that adolescents and young adults face more barriers to AA and NA than older adults and yet appear to be referred there just as frequently by treatment providers,” said Kelly. “Youth tend to have less severe addiction problems, on average, and consequently do not feel a strong need to stop using alcohol and/or drugs. ‘Why should they bother to go to abstinence-oriented organizations like AA and NA, and would they benefit even if they did go?’” These are the questions Kelly and his colleagues wanted to address.

The researchers recruited 160 adolescent inpatients (96 males, 64 females), with an average age of 16 years, who were enrolled at two treatment centers in California having a focus on abstinence and based on a 12-step model. The study participants’ length of stay ranged from four to six weeks, after which they were re-assessed on a number of clinical variables at six months, and one, two, four, six, and eight years.

“We found that most of the youth attended at least some AA/NA meetings post-treatment,” said Kelly. “Those patients with severe addiction problems and those who believed they could not use alcohol/drugs in moderation attended the most.

The NA and AA focus on abstinence/recovery probably resonates better with these more severely dependent individuals who also typically need ongoing support.”

Even though many of the youth discontinued AA/NA after time, they nonetheless appeared to benefit from attendance.

“We found that patients who attended more AA and/or NA meetings in the first six months post-treatment had better longer term outcomes, but this early participation effect did not last forever – it weakened over time,” said Kelly. “The best outcomes achieved into young adulthood were for those patients who continued to go to AA and/or NA. In terms of a real-world recovery metric, we found that for each AA/NA meeting that a youth attended they gained a subsequent two days of abstinence, independent of all other factors that were also associated with a better outcome.”

A little can go a long way, he added. “During the first six months post-treatment,” said Kelly, “even small amounts of AA/NA participation – such as once per week – was associated with improved outcome, and three meetings per week was associated with complete abstinence. This suggests youth may not need to attend as frequently as every day, sometimes recommended clinically, to achieve very good outcomes.”

Kelly believes that part of the reason for the success of AA/NA among adolescents who attend meetings is related to their developmental needs.

“Given the need for social affiliation and peer-group acceptance outside of the family at this stage of life, peers can exert strong influence on the behavior of young people,” he noted. “When you couple this fact with the reality that most adolescents and young adults are experimenting with, or heavily using, alcohol and other drugs, it may be hard to find suitable peer contexts that can facilitate recovery. In fact, we know that most youth relapses are connected with social contexts where alcohol/drugs are present; unlike adults, youth rarely relapse alone. So, organizations such as AA/NA may provide support, and encourage and provide alternatively rewarding sober social activities.”

See also;

• AA and Treatment Work Better Together
• Brief-TSF is designed to address these issues.
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Subscribe to Twelve Step Facilitation by e-Mail

The twelve-step recovery model of AA: a voluntary mutual help association

Alcoholism treatment has evolved to mean professionalized, scientifically based rehabilitation.

Alcoholics Anonymous (AA) is not a treatment method; it is far better understood as a Twelve-Step Recovery Program within a voluntary self-help/mutual aid organization of self-defined alcoholics.

The Twelve-Step Recovery Model is elaborated in three sections, patterned on the AA logo (a triangle within a circle): The triangle’s legs represent recovery, service, and unity;

• The circle represents the reinforcing effect of the three legs upon each other as well as the “technology” of the sharing circle and the fellowship.
• The first leg of the triangle, recovery, refers to the journey of individuals to abstinence and a new “way of living.”
• The second leg, service, refers to helping other alcoholics which also connects the participants into a fellowship.
• The third leg, unity, refers to the fellowship of recovering alcoholics, their groups, and organizations.

The distinctive AA organizational structure of an inverted pyramid is one in which the members in autonomous local groups direct input to the national service bodies creating a democratic, egalitarian organization maximizing recovery.

Analysts describe the AA recovery program as complex, implicitly grounded in sound psychological principles, and more sophisticated than is typically understood.

AA provides a nonmedicalized and anonymous “way of living” in the community and should probably be referred to as the Twelve-Step/Twelve Tradition Recovery Model in order to clearly differentiate it from professionally based twelve-step treatments.

From; Borkman T. The twelve-step recovery model of AA: a voluntary mutual help association. Recent Dev Alcohol. 2008;18:9-35.

• See also;
• Twelve Step Facilitation
• Brief-TSF Description
• Alcoholics Anonymous

Epidemiology of Alcoholics Anonymous participation.

This chapter draws on AA membership surveys, US general population surveys, and longitudinal treatment data to compile profiles of those ever exposed to AA in their lifetime, those who no longer report AA meeting attendance, and those who attend AA meetings currently. We consider demographics (gender, age, ethnicity, marital status), receipt of specialty treatment, and short- and long-term abstinence rates among these AA exposure groups.

Results suggest stability in the representation of women and minorities among the AA membership, but a decline among youth.

Fully one-half of those completing AA’s most recent membership survey reported that they had been abstinent for more than 5 years.

Those receiving specialty treatment any given year are likely to report AA exposure that year.

Disengagement from AA does not appear to necessarily translate to loss of abstinence among those with initial high levels of AA exposure, but long-term abstinence is more likely among those with continued engagement.

Research report; Kaskutas LA, Ye Y, Greenfield TK, Witbrodt J, Bond J. Epidemiology of Alcoholics Anonymous participation. Recent Dev Alcohol. 2008;18:261-82.

See also;

• What About This Spiritual Awakening Thing?
• AA and Treatment Work Better Together
• Screening for Alcohol Problems

The Role of AA Sponsors: A Pilot Study

Aims: The aim of this study was to explore the roles of Alcoholics Anonymous (AA) sponsors and to describe the characteristics of a sample of sponsors.

Methods: Twenty-eight AA sponsors, recruited using a purposive sampling method, were administered an unstructured qualitative interview and standardized questionnaires. The measurements included: a content analysis of sponsors’ responses; Severity of Alcohol Dependence Questionnaire—Community version (SADQ-C) and Alcoholics Anonymous Affiliation Scale (AAAS).

Results: Sample characteristics were as follows:

• the median length of AA attendance was 9.5 years (range 5–28);
• the median length of sobriety was 11 years (range 4.5–28);
• the median number of sponsees per sponsor was 1 but there was a wide range (0–17, interquartile range 3.75); and
• the sponsors were highly affiliated to AA (median AAAS score 8.75, range 5.5–8.75, maximum possible score 9).

Past alcohol dependence scores were surprisingly low:

• 5 (18%) sponsors had mild,
• 14 (50%) moderate and
• 9 (32%) severe dependence according to the SADQ-C (median 26.5, range 11–56).

Sponsorship roles were as follows:

16 roles were identified through the initial content analysis. These were distilled into three super-ordinate roles through a thematic analysis:

• encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity);
• support (regular contact, emotional support and practical support); and
• carrying the message of AA (sharing sponsor’s personal experience of recovery with sponsees).

Conclusions: The roles identified broadly corresponded with the AA literature delineating the duties of a sponsor. This non-random sample of sponsors was highly engaged in AA activity but only had a past history of moderate alcohol dependence.

Research report; Paul J. P. Whelan, E. Jane Marshall, David M. Ball and Keith Humphreys. The Role of AA Sponsors: A Pilot Study. Alcohol and Alcoholism March 18, 2009

See also;

• 12 Step Sponsor
• AA and Treatment Work Better Together
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Double Trouble in Recovery for Alcoholics

From Denial to Recovery: Counseling Problem Drinkers, Alcoholics, and Their Families (Jossey Bass Social and Behavioral Science Series)

Sleep problems – real and perceived – get in the way of alcoholism recovery

Doctors and patients should discuss and address sleep issues as part of recovery

The first few months of recovery from an alcohol problem are hard enough. But they’re often made worse by serious sleep problems, caused by the loss of alcohol’s sedative effects, and the long-term sleep-disrupting impact that alcohol dependence can have on the brain.

Now, a new study gives further evidence that insomnia and other sleep woes may actually get in the way of recovery from alcohol problems. In fact, a person’s perception of how bad their sleep problems are may be just as important as the actual sleep problems themselves, the study suggests.

The study is published in the journal Alcoholism: Clinical and Experimental Research, by a team from the University of Michigan’s Department of Psychiatry. They report the results of a small but thorough evaluation of sleep, sleep perception and alcohol relapse among 18 men and women with insomnia who were in the early stages of alcohol recovery.

The authors say their results show how important it is for alcohol recovery patients, and those who are helping them through their recovery, to discuss sleep disturbances and seek help. Often, sleep isn’t discussed in alcohol recovery programs – but it should be, they stress.

In fact, members of the U-M team have now launched a new study that aims to help those who have just entered treatment for alcohol problems, and are having trouble sleeping. Instead of using sleep medications, which can carry their own risk of addiction, it’s based on a series of “talk therapy” sessions with a trained sleep therapist who can help patients change behaviors and patterns of thinking that contribute to sleep problems.

In the meantime, the newly published results add to the understanding of how alcohol and sleep intertwine.

“What we found is that those patients who had the biggest differences between their perception of how they slept and their actual sleep patterns were most likely to relapse,” says lead author Deirdre Conroy, Ph.D., who led the study as a fellow in the U-M Addiction Research Center. “This suggests that long-term drinking causes something to happen in the brain that interferes with both sleep and perception of sleep. If sleep problems aren’t addressed, the risk of relapse may be high.”

“We are now interested in what brain mechanisms are involved in the disrupted sleep of alcohol-dependent individuals,” says Brower, who has previously led studies illustrating the prevalence of sleep disorders among people with alcohol dependence and abuse issues, and their correlation with relapse back into drinking. He is the executive director of the U-M Addiction Treatment Services, which provides alcohol and drug treatment to hundreds of patients each year.

The new study involved women who had volunteered for a randomized clinical trial of gabapentin, an experimental treatment for alcohol dependence. Each one started the trial when they had been off alcohol for about a week.

The volunteers spent two separate nights in the sleep-monitoring area of the U-M General Clinical Research Center, wearing electrodes on their head and body that measured their brain waves during sleep, as well as their breathing, muscle activity and heart rhythm. The detailed measurements, which together make up a procedure called polysomnography, allowed the researchers to determine when the volunteers were sleeping, when they were awake, and which stage of sleep they were in.

These sleep data were compared with the participants’ answers on morning evaluations of how they slept – including how long they thought it took them to fall asleep, how long they were awake in the night, and other measures. The two nights of sleep monitoring were done several weeks apart. The researchers also asked the participants to report any alcohol they drank during the six weeks following each sleep test.

In all, the patients overestimated how long it took them to fall asleep, but thought they had been awake in the middle of the night for far less time than they actually were. These perceptions about how they slept were actually more accurate in predicting their potential for relapse to alcohol use than were the actual sleep measurements.

“Our study suggests that in early recovery from alcoholism, people perceived that it took them a long time to fall asleep and that they slept through the night,” says Conroy. “The reality was that it did not take them as long to fall asleep as they thought it did, and their brain was awake for a large portion of the night. On average, the participants that were less accurate about how they were sleeping were more likely to return to drinking.”

Conroy explains that poor sleep quality can lead to mood disturbances. “If recovering alcoholics are irritable because they are not getting quality sleep at night, they might be more vulnerable to return to drinking,” she says. “Previous studies show that non-alcoholics with insomnia actually think they are sleeping worse than they are, so they may be more likely to seek appropriate treatment.

Our study shows that an alcoholic in early recovery has a lot of wakefulness in the night but they are not necessarily picking up on this. It is important for the clinician working with the alcohol-dependent patient to have a differential of poor sleep quality in the back of their mind as a potential challenge for the patient throughout alcohol recovery.”

Kara Gavin | Source: EurekAlert!

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Couple Therapy for Alcoholism: A Cognitive-Behavioral Treatment Manual by Phylis J. Wakefield, Rebecca E. Williams, Elizabeth B. Yost, Kathleen M. Patterson Read more about this title…