AA and a social model of treatment

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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Screening for Alcohol Problems

Screening for Alcohol Problems in Primary Care; A Systematic Review.

Background; Primary care physicians can play a unique role in recognizing and treating patients with alcohol problems.

Objective; To evaluate the accuracy of screening methods for alcohol problems in primary care.

Methods; We performed a search of MEDLINE for years 1966 through 1998. We included studies that were in English, were performed in primary care, and reported the performance characteristics of screening methods for alcohol problems against a criterion standard. Two reviewers appraised all articles for methodological content and results.

Results; Thirty-eight studies were identified. Eleven screened for at-risk, hazardous, or harmful drinking; 27 screened for alcohol abuse and dependence. A variety of screening methods were evaluated.

The Alcohol Use Disorders Identification Test (AUDIT) was most effective in identifying subjects with at-risk, hazardous, or harmful drinking (sensitivity, 51%-97%; specificity, 78%-96%),

while the CAGE questions proved superior for detecting alcohol abuse and dependence (sensitivity, 43%-94%; specificity, 70%-97%).

These 2 formal screening instruments consistently performed better than other methods, including quantity-frequency questions. The studies inconsistently adhered to methodological standards for diagnostic test research: 3 (8%) provided a full description of patient spectrum (demographics and comorbidity), 30 (79%) avoided workup bias, 12 (of 34 studies [35%]) avoided review bias, and 21 (55%) performed an analysis in pertinent clinical subgroups.

Conclusions; Despite methodological limitations, the literature supports the use of formal screening instruments over other clinical measures to increase the recognition of alcohol problems in primary care. Future research in this field will benefit from increased adherence to methodological standards for diagnostic tests.

Research report; David A. Fiellin; M. Carrington Reid, MD; Patrick G. O’Connor. Screening for Alcohol Problems in Primary Care; A Systematic Review. Arch Intern Med. 2000;160.

Brief-TSF uses the CAGE and the AUDIT to identify alcohol use disorders.

Prevention of relapse in the recovery of Arizona health care providers

This project gathered survey information from physicians, physician assistants, dentists and pharmacists in Arizona who, while enrolled or following a completion of a monitored aftercare program, had relapsed back to active chemical dependency.

In general, survey respondents were male, averaged 52 years of age, had relapsed several times and started abusing illicit drugs and alcohol in high school or college.

The findings suggest several subjective factors that contributed to the subjects’ relapse included;

dishonesty to self,
not working a 12 step program, and
denial of the problem.

Factors reported to be helpful for future relapse prevention were

abstinence from substance use,
working a 12 step program, and
having spiritual beliefs.

By identifying the specific causes of relapse, future studies may attempt to decrease the percentage of health care providers who relapse by recognizing signs of problematic behavior before they occur.

Long MW, Cassidy BA, Sucher M, Stoehr JD. Prevention of relapse in the recovery of Arizona health care providers. J Addict Dis. 2006;25(1):65-72.

A Sponsorship Guide for 12-Step Programs
by M. T.

Alcoholics Anonymous and church involvement

Alcoholics Anonymous and church involvement as predictors of sobriety among three ethnic treatment populations

This study examines the impact of spirituality and religiousness, and involvement in Alcoholics Anonymous (AA) on sobriety among three ethnic groups, African Americans, Caucasians, and Hispanics.

Participants (African Americans: n = 253; Hispanics: n = 60, and Caucasians: n = 538) completed survey questionnaires upon entry into public, private, and health maintenance treatment programs.

Results indicated that among the three groups, African Americans, who described themselves as more religious, were less likely to substitute church attendance for participation in Alcoholics Anonymous.

African Americans reporting high AA attendance at the end of one year, in addition to church attendance, were more likely to report sobriety over the past 30 days than were those African Americans reporting only high church attendance.

Among Caucasians and Hispanics, participants reporting primarily high AA attendance were more likely to report past 30 day sobriety.

Research report; Roland, E.J.; Kaskutas, L.A. Alcoholics anonymous and church involvement as predictors of sobriety among three ethnic treatment populations. Alcoholism Treatment Quarterly, 20(1):61-77, 2002.

Drinking and Harm Continuum in Britain

Patterns of Alcohol Consumption and Related Behaviour in Great Britain:

A Latent Class Analysis of the Alcohol Use Disorder Identification Test (AUDIT).

AIMS: Attempts have been made to develop typologies to classify different types of alcoholism. However, limited research has focused on classifications to describe general patterns of alcohol use in general population samples.

METHODS: Latent class analysis was used to create empirically derived behaviour clusters of alcohol consumption and related problems from the Alcohol Use Disorder Identification Test (AUDIT) based on data from a large stratified multi-stage random sample of the population of Great Britain. Multinomial logistic regression was performed to describe these resultant classes using both demographic variables and mental health outcomes.

RESULTS: Six classes best described responses in the sample data.

Three were heavy consumption groups,

one with multiple negative consequences,
one experiencing alcohol-related injury and social pressures to cut down and
an additional class with memory loss.

There was one moderate class with few negative consequences.
There were two mild consumption groups,

one with alcohol-related injury and social pressure to cut down and
one with no associated problems.

CONCLUSIONS: Alcohol use in Great Britain can be hypothesized as reflecting six distinct classes, four of which follow a continuum of increased consumption leading to increased dependence and related problems and two that do not.

Differences between alcohol use classes are apparent with;

reduced risk of depressive episode in moderate classes and
an increased risk of anxiety disorders for the highest consumers of alcohol.

Research report; Alcohol Alcohol. 2008 May 22; Patterns of Alcohol Consumption and Related Behaviour in Great Britain: A Latent Class Analysis of the Alcohol Use Disorder Identification Test (AUDIT). Smith GW, Shevlin M.

Dual Disorders, Dual Diagnosis

Dual Disorders – Third Edition

Depression. Schizophrenia. Post-traumatic stress disorder. Bipolar disorder.

Millions of individuals diagnosed with psychiatric or emotional disorders must battle an equally menacing and powerful disease–chemical dependency–alcoholism, drug addiction, medication addiction.

First published in 1993, Dual Disorders is the leading text on the biological and psychological relationship between mental illness and addiction.

The third edition of this Hazelden best-seller has been updated to include the latest research, information about new medications, and an explanation of new diagnostic criteria.

Key features and benefits

outlines the relationship between chemical dependency and psychiatric disorders

contains important resources for chemically dependent individuals and their families

presents practical relapse prevention strategies

pharmacotherapy

Dual Disorders – Buy 3rd Ed today!

Lesbian Alcoholics were Unloved

Lesbian Alcoholics were Unloved, Unwanted and Alcoholic had Parents; Social Supports and Lesbian Alcoholics

The purpose of this study was to investigate the relationship between social support and alcoholism among lesbians.

Fifteen lesbian alcoholics and 15 lesbian non-alcoholics were administered a questionnaire covering their childhood and adolescent history, social support systems, history of drinking, and demographic information.

The findings suggested that the alcoholic lesbiansâ€™ current support systems were not as disrupted as had been anticipated.

However, the alcoholic lesbians more often reported;

having had a less supportive childhood and adolescence,
feeling unloved and unwanted,
experiencing conflict with adults in their families, and
having had a parent with a drinking problem.

Social Supports and Lesbian Alcoholics. Rebecca Schilit, W. Mark Clark, and Elizabeth Ann Shallenberger. Affilia 1988; 3; 27.

Alcohol intervention may help.

Spirituality Enables Adaptive Coping

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.

Conversations with God : An Uncommon Dialogue (Book 1)

AA Works, Long Term

Predictors of 4 year outcome of community residential treatment for patients with substance use disorders.

Aims This study examined systematically how predictors of substance use disorder (SUD) treatment outcome worked together over time and identified mediators and moderators of outcome.

Design The MacArthur model was applied in this naturalistic study to identify how baseline, discharge and 1-year follow-up factors worked together to predict 4-year improvement in substance-related problems.

Setting Eighty-eight community residential facilities were selected based on geographic representativeness, number of patient referrals and type of treatment orientation.

Participants Of 2796 male patients who completed intake assessments, 2324 were assessed at the 1-year follow-up and 2023 at the 4-year follow-up.

Measurements Self-report measures of

symptom severity,
functioning,
social resources and coping,
treatment and
involvement in Alcoholics Anonymous (AA) were collected at baseline and at 1- and 4-year follow-ups.

Provider-rated treatment participation measures were obtained at discharge.

Findings

Greater substance use severity,
more psychiatric symptoms,
more prior arrests and
stronger belief in AA-related philosophy at treatment entry

predicted improvement significantly in substance-related problems 4 years later.

At the 1-year follow-up,

being employed and
greater use of AA-related coping
predicted outcome significantly.

AA-related coping at 1 year mediated the relationship partially between belief in AA philosophy at treatment entry and 4-year outcome.

Conclusions

The findings highlight the unique and positive impact of AA involvement on long-term SUD treatment outcome and extend understanding of why AA is beneficial for patients.

Research report; Predictors of 4 year outcome of community residential treatment for patients with substance use disorders. Addiction. 2008 Apr;103(4):671-80. Laffaye C, McKellar JD, Ilgen MA, Moos RH.

Beyond Codependency

Beyond Codependency: And Getting Better All the Time

By Melody Beattie

Review By Neal J. Pollock (VA USA)

While I have not read Melody Beattie’s other works, I thought this a very valuable book in and of itself. It sheds much light on the topic and helped me to become sensitized to the obvious signs of codependency in people. By doing this, it enabled me to avoid situations where I could become codependent in a relationship.

I think that, as in the Diagnostic and Statistical Manual, there are levels of psychological situations and/or problems. Thus, there may be people inherently inclined towards codependency, but there may also be people who are thrust into it due to the demands of others. The latter may find this book incredibly helpful in avoiding such relationships and in helping their dependent person seek real help vs. codependency from another person. There are also a number of great quotes by the author in this book. A few are:

p. 70: “It’s hard to feel compassion for someone while that person is using or victimizing us.”

p. 71: “If everything looks black, we’ve probably got our eyes shut.”

p. 164: “Who we’re in a relationship with says as much about us as it does about them.” Earnie Tucker (quoted by Melody Beattie)

Codependency is not something to make light of, it’s as much (if not more) the codependent’s problem as the dependent’s. As Caroline Casey humorously noted in “Making the Gods Work for You” (Harmony Books NY 1998), on page 72:
“What do codependents see when they die? Someone else’s life flashes before their eyes.”

This is literally a life-changing book for codependents.

Reviewer: A reader

Once Melody Beattie’s Codependent No More has been “digested”, Beyond Codependency helps to move the recovering codependent past the hurt and on to the business of literally changing behaviors and making a better life. I absolutely recommend this book above any others to recovering codependents.