The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders.

We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers.

This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs.

Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees.

These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery.

Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities.

Research; Galanter M, Dermatis H, Bunt G, Williams C, Trujillo M, Steinke P. Assessment of spirituality and its relevance to addiction treatment. J Subst Abuse Treat. 2007 Oct;33(3):257-64.

See also;

• The Most Effective Form of Harm Reduction
• What About This Spiritual Awakening Thing?

Multiple psychiatric disorder risk for families with alcohol dependence

First-degree relatives of people dependent on alcohol are not only at increased risk of becoming addicted to alcohol and other drugs such as cocaine, but also of developing psychiatric disorders such as depression and panic disorder, study findings indicate.

Noting that alcohol dependence tends to aggregate within families, John Nurnberger (Indiana University School of Medicine, Indianapolis, USA) and colleagues analyzed data from the family collection of the Collaborative Study on the Genetics of Alcoholism to assess whether other psychiatric disorders may be also be more common in families with a history of alcoholism.

Data were available for 8296 relatives of people with alcohol dependence and 1654 individuals with no family history of alcoholism.

The rate of DSM-IV alcohol dependence was 28.8% for relatives of people with the condition, compared with 14.4% for controls.

Overall, relatives of alcoholics were twice as likely to become addicted to alcohol as people without a family history of alcohol dependence.

Relatives of alcohol-dependent individuals were also at an increased risk of becoming addicted to other drugs, including cocaine, marijuana, opiates, sedatives, and stimulants. The greatest risk was for cocaine dependence, with relatives of individuals with alcoholism more than three times as likely as those without a family history of alcoholism to become dependant on the drug.

Moreover, relatives of alcoholics had a higher risk of depression, panic disorder, post-traumatic stress disorder, and antisocial personality disorder than controls.

“The aggregation of antisocial personality disorder, drug dependence, anxiety disorders, and mood disorders, suggests common mechanisms for these disorders and alcohol dependence within some families,” Nurnberger et al write in the Archives of General Psychiatry.

This represents a “shared specific genetic vulnerability,” they say, which puts people at risk of a number of psychiatric disorders if they have a family history of alcohol dependence.

Research Source: Arch Gen Psychiatry 2004; 61: 1246-1256

Assessing sobriety and successful membership of Alcoholics Anonymous

The goal of this study was to identify appropriate measures of successful membership of Alcoholics Anonymous (AA) and to investigate membership patterns and perceptions of sobriety across sociodemographic categories of AA membership.

The study uses a cross-sectional survey design, and participants (n=77) were community-based members of nine individual AA groups. All data were collected using a self-completion questionnaire, which included open-ended and closed questions on understanding of successful AA membership, meeting attendance, 12-stepping activity, and length of membership.

The following results of the study were seen:

• association of successful AA membership with sobriety as well as
• longevity of membership,
• attendance at AA meetings, and
• commitment to 12-step work

Research report; Gabhainn, S.N. Assessing sobriety and successful membership of Alcoholics Anonymous. Journal of Substance Use, 8(1):55-61, 2003.

Brief-TSF is designed to encourage these elements.

Professional Interventions That Facilitate 12-Step Self-Help Group Involvement

Facilitating patients’ involvement with 12-step self-help organizations, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), is often a goal of substance abuse treatment.

Twelve-step-facilitation (TSF) interventions have been found to be more effective than comparison treatments in increasing patients’ 12-step group involvement and in promoting abstinence.

Evaluations of TSF Interventions

One large study, known as Project MATCH, compared a TSF intervention with cognitive-behavioral (CB) therapy and motivational enhancement therapy (MET) among 1,726 patients (76 percent male) diagnosed with either alcohol abuse or dependence, including 774 inpatients who were beginning outpatient aftercare and 952 patients receiving outpatient care as their primary treatment.

• CB therapy focuses on teaching coping skills to reduce alcohol use (i.e., patients who use alcohol to cope with stress learn and practice alternative coping methods).
• In contrast, MET employs motivational strategies to mobilize patients’ internal resources for change.
• The TSF intervention in the Project MATCH study was a form of one-on-one professional counseling explicitly designed to work synergistically with AA and other 12-step groups.

Major Goals of 12-Step Facilitation Therapy

Acceptance

• Acceptance by patients that they suffer from the chronic and progressive illness of alcoholism
• Acceptance by patients that they have lost the ability to control their drinking
• Acceptance by patients that because there is no effective cure for alcoholism, the only viable alternative is complete abstinence from the use of alcohol

Surrender

• Acknowledgment on the part of the patient that hope for recovery (i.e., sustained sobriety) exists, but only by accepting the reality of loss of control and by having faith that some higher power can help the patient, whose own willpower has been defeated by alcoholism
• Acknowledgment by the patient that the fellowship of Alcoholics Anonymous (AA) has helped millions of alcoholics sustain their sobriety and that the patient’s best chances for success are to follow the AA path.

Consistent with AA’s philosophy, TSF therapists presented alcohol dependence as a disease with spiritual, emotional, and physical components and emphasized that the disease could be arrested but not cured through permanent abstinence from alcohol.

Also consistent with AA’s approach, patients were strongly urged, but neither ordered nor forced, to attend AA meetings and to maintain a journal describing their reactions to the meetings.

At both 1- and 3-year follow ups, patients in all three conditions (i.e., CB therapy, MET, and TSF therapy) had improved significantly on drinking related (e.g., number of drinks per day and drinking consequences), psychological (e.g., depressive symptoms), and life-functioning (e.g., days of employment) outcomes.

Table one; Posttreatment 12-step self-help group involvement of 2,045 substance-dependent veterans treated by 12-step or cognitive-behavioral programs.

As predicted, TSF therapy was significantly more effective than either CB therapy or MET in increasing AA involvement, as indicated by the frequency of such patient behaviors as attending meetings, having and serving as a sponsor, following the 12 steps, and considering oneself an AA member.

In addition, TSF therapy was more effective than the other two treatments in promoting abstinence. For example, at the 3-year follow up, 36 percent of TSF patients in the outpatient group reported being abstinent for the previous 3 months, compared with about 25 percent of outpatients in the CB therapy and MET treatment conditions. This result is consistent with the goals of TSF therapy and with AA, neither of which views moderate drinking as an acceptable or attainable goal for alcohol dependent people.

Research report; Keith Humphreys. Professional Interventions That Facilitate 12-Step Self-Help Group Involvement Alcohol Research & Health, Vol. 23, No. 2, 1999

A qualitative study of Alcoholics Anonymous members and South Asian men.

The spiritual aspect of recovery for people with drinking problems was explored in a comparative analysis of South Asian men recovering from drink problems and white members of Alcoholics Anonymous (AA).

In-depth semi-structured interviews were carried out with participants to explore significant factors that assisted recovery. Interviews were analyzed using grounded theory. Ten participants in total were interviewed; 5 were South Asian men receiving individual and/or group counseling with South Asian therapists either in an NHS or non-statutory specialist alcohol treatment service, and 5 were white members of AA.

Models of recovery for the two groups were developed and are presented.

Spirituality and religion played an important role in the experiences of recovery described by AA and South Asian participants respectively.

For AA participants their experiences reflected those described in AA’s Big Book although concepts such as that of a Higher Power were complex and multilayered, with spirituality just one, albeit significant, aspect.

South Asian participants generally underwent a re-affirmation of existing beliefs rather than the conversion type of experience described by AA participants.

The findings are discussed in relation to implications for service delivery and development and directions for future research.

Morjaria, A.; Orford, J. Role of religion and spirituality in recovery from drink problems: A qualitative study of alcoholics anonymous members and South Asian men. Addiction Research and Theory, 10(3):225-256, 2002.

The Spirituality of Imperfection: Storytelling and the Search for Meaning by Ernest Kurtz, Katherine Ketcham Read more about this title…

Cannabis use and risk of psychotic or affective mental health outcomes

Background; Whether cannabis can cause psychotic or affective symptoms that persist beyond transient intoxication is unclear. We systematically reviewed the evidence pertaining to cannabis use and occurrence of psychotic or affective mental health outcomes.

Methods; We searched databases from their inception to September, 2006, searched reference lists of studies selected for inclusion, and contacted experts. Studies were included if longitudinal and population based. 35 studies from 4804 references were included. Data extraction and quality assessment were done independently and in duplicate.

"we conclude that there is now sufficient evidence to warn young people
that using cannabis could increase their risk of developing a psychotic illness later in life."

Findings; There was an increased risk of any psychotic outcome in individuals who had ever used cannabis (pooled adjusted odds ratio=1·41, 95% CI 1·20-1·65). Findings were consistent with a dose-response effect, with greater risk in people who used cannabis most frequently (2·09, 1·54-2·84). Results of analyses restricted to studies of more clinically relevant psychotic disorders were similar. Depression, suicidal thoughts, and anxiety outcomes were examined separately. Findings for these outcomes were less consistent, and fewer attempts were made to address non-causal explanations, than for psychosis. A substantial confounding effect was present for both psychotic and affective outcomes.

Interpretation; The evidence is consistent with the view that cannabis increases risk of psychotic outcomes independently of confounding and transient intoxication effects, although evidence for affective outcomes is less strong. The uncertainty about whether cannabis causes psychosis is unlikely to be resolved by further longitudinal studies such as those reviewed here. However, we conclude that there is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life.

Theresa HM Moore, Stanley Zammit, Anne Lingford-Hughes, Thomas RE Barnes, Peter B Jones, Margaret Burke and Glyn Lewis. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. The Lancet 2007; 370:319-328

Life With Hope: A Return to Living Through the Twelve Steps and Twelve Traditions of Marijuana Anonymous

Experiences of alcohol dependence: a qualitative 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.

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.

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 GPs 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.

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

A comparative evaluation of substance abuse treatment

This article first explains the conceptual framework and plan of a naturalistic, multisite evaluation of Department of Veterans Affairs (VA) substance abuse treatment programs. It then examines the effectiveness of an index episode of inpatient treatment and the effectiveness of continuing outpatient care and participation in self-help groups.

The study was conducted among 3018 patients from 15 VA programs that emphasized 12-Step, cognitive-behavioral (CB), or eclectic treatment.

Casemix-adjusted 1-year outcomes showed that patients in 12-Step programs were the most likely to be abstinent, free of substance abuse problems, and employed at the 1-year follow-up.

Patients who obtained more regular and more intensive outpatient mental health care, and those who participated more in 12-Step self-help groups, were more likely to be abstinent and free of substance use problems at the 1-year follow-up.

These findings support the effectiveness of 12-Step treatment and show that patients with substance use disorders who become more involved in outpatient care and self-help groups tend to experience better short-term substance use outcomes.

Moos RH, Finney JW, Ouimette PC, Suchinsky RT. A comparative evaluation of substance abuse treatment. Alcohol Clin Exp Res. 1999 Mar;23(3):529-36.

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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