Mutuality is a feature of many ’self-help groups’ for people with mental health and/or substance misuse needs.

These groups are diverse in terms of membership, aims, organisation and resources.

Collectively, in terms of the pathways for seeking help, support, social capital or simply validation as people, mutual aid groups figure at some time in the life story of many psychiatric and/or substance misuse patients.

From the viewpoint of clinical services, relations with such groups range from formal collaboration, through incidental shared care, via indifference, to incomprehension, suspicion, or even hostility.

How should mental health and substance misuse clinicians relate to this informal care sector, in practice?

Aims: To synthesise knowledge about three aspects of the relationship between psychiatric/substance misuse services and mutual aid groups:

• profile groups’ engagement of people with mental health and/or substance misuse needs at all stages of vulnerability, illness or recovery;
• characterise patterns of health benefit or harm to patients, where such outcome evidence exists;
• identify features of mutual aid groups that distinguish them from clinical services.

Method: A search of both published and unpublished literature with a focus on reports of psychiatric and substance misuse referral routes and outcomes, compiled for meta-synthesis.

Results: Negative outcomes were found occasionally, but in general mutual aid group membership was repeatedly associated with positive benefits.

Conclusions: Greater awareness of this resource for mental health and substance misuse fields could enhance practice.

Mutual aid groups in psychiatry and substance misuse. Alex Baldacchino;  Woody Caan; Carol Munn-Giddings. Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 2 June 2008 , pages 104 – 117

See also;

• 12-Step Treatment More Effective than Alternative
• AA Offers Recovery Not Religion
• Brief-TSF can assist patients cease alcohol consumption.
• Subscribe to Twelve Step Facilitation by e-Mail

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

Are Brief Alcohol Interventions Likely to be Effective in Routine Primary Care Practice?

A number of meta-analyses have demonstrated the modest efficacy of brief interventions (BI) for nondependent unhealthy alcohol use in primary care settings.

Whether this level of efficacy can be expected when BIs are delivered outside of research studies in not known.

This systematic review identified 22 randomized trials including over 5800 patients. Investigators classified the trials on a spectrum from tightly controlled (efficacy design) to real world (effectiveness design) studies.

The scale considered whether patients presented to health care with a range of conditions, whether practices delivered a full range of medical services, whether practitioners routinely worked in the service rather than being funded by the trial, and whether the intervention could be delivered within standard visit times.

• Participants who received BI drank approximately 3 standard drinks per week less than those who did not.
• Longer duration of intervention was not significantly associated with a larger effect.
• The effect of BI on drinking was similar in studies regardless of whether they were tightly controlled or had more real world characteristics.

Comments by Michael Levy, PhD

This meta-analytic study showed the benefit of BI in reducing alcohol consumption in both controlled and real world primary care settings.

It seems logical to assume similar results could be achieved in community treatment programs.

Since BI in the studies reviewed was designed to achieve a reduction in alcohol consumption, treatment programs could consider implementing BI for patients who are not interested in achieving abstinence but who want to reduce their intake.

Reference: Kaner EF, Dickinson HO, Beyer F, et al. The effectiveness of brief alcohol intervention in primary care settings: a systematic review. Drug Alcohol Rev. 2009;28(3):301–323.

From; Join Together Online

Medical students’ knowledge about alcohol and drug problems: results of the medical council of Canada examination.

PURPOSE: To determine knowledge of a national sample of medical students about substance withdrawal, screening and early intervention, medical and psychiatric complications of addiction, and treatment options.

METHODS: Based on learning objectives developed by medical faculty, twenty-two questions on addictions were included in the 1998 Canadian licensing examination.

RESULTS: The exam was written by 858 medical students. The average score on the addiction questions was 64%.

• Students showed strong knowledge of the clinical features of medical complications.

Specific knowledge gaps were identified for

• withdrawal treatment protocols,
• low-risk drinking guidelines,
• taking an alcohol history,
• substance-induced psychiatric disorders, and
• Alcoholics Anonymous.

CONCLUSION: Medical students are knowledge-deficient around key learning objectives in addictions. The deficiencies were in areas of basic knowledge that could be learnt with little difficulty.

Research report; Kahan M, Midmer D, Wilson L, Borsoi D. Medical students’ knowledge about alcohol and drug problems: results of the medical council of Canada examination. Subst Abus. 2006 Dec;27(4):1-7.

Brief-TSF includes training, as well as other matters, in taking an alcohol inventory and knowledge of Alcoholics Anonymous.

 Study Examines Link Between Stress RelapseA new animal study finds that a stress-related gene and brain chemical may play a role in addiction relapse, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).Researchers from NIAAA and Camerino University in Italy found that rats that showed a preference for alcohol were more sensitive to stress. Those more prone to relapse under stress were examined for genetic patterns that might offer clues to this trait. Researchers found that these rats had higher expression levels of Crhr1, a gene that encodes the stress-related corticotropin-releasing hormone receptor 1 (CRH-R1).”Our findings demonstrate that the Crhr1 genotype and its expression interact with environmental stress to reinstate alcohol-seeking behavior in this animal model of excessive drinking,” said study leader Anita Hansson, Ph.D., a fellow at NIAAA’s Laboratory of Clinical and Translational Studies.”This finding helps untangle the complex interplay of genetic and environmental factors that influence relapse,” added NIAAA Director T-K Li, M.D. “It also points to potential approaches for treating individuals at risk for relapse.”The research appears in the online edition of the Proceedings of the National Academy of Sciences. 

Research Reference: Hansson, A.C., et al. (2006) Variation at the rat Crhr1 locus and sensitivity to relapse into alcohol seeking induced by environmental stress. Proc. Natl. Acad. Sci.

From Join Together