The purpose of this study was to measure;

• spiritual well-being (SWB),
• private religious practices (PRP),
• positive religious coping,
• abstinence self-efficacy (AASE),
• affiliation with AA (AAA), and
• their associations with alcoholics in treatment.

Seventy-four adults in a three-week outpatient addiction treatment program were assessed at admission and discharge.

Wilcoxon signed rank and t tests demonstrated significant increases in all variables. Spearman correlation coefficients detected significant associations between the spiritual variables, SWB and AASE, as well as PRP and AAA.

Findings suggest that spiritual variables can change during treatment and that there may be connections between spiritual variables and variables associated with longer-term recovery.

Research; Piderman KM, Schneekloth TD, Pankratz VS, Maloney SD, Altchuler SI. Spirituality in alcoholics during treatment. Am J Addict. 2007 May-Jun;16(3):232-7.

See also;

• Twelve Step Facilitation
• Relapse Prevention

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…

The marriage of drug abuse treatment and twelve-step strategies

Research supports the idea that involvement with 12-step fellowships is a very good way to achieve and maintain recovery, but it is not for everyone.

Some research has indicated that although 12-step and other treatment approaches are compatible, patients’ level of commitment or engagement in prescribed behaviors is very low.

They stress that some way must be found to get patients engaged and committed and that the 12-step affiliation needs to be considered an important, rather than a casual, part of treatment.

Patients, many of whom have already been attending meetings before entering treatment, must recognize that 12-step organizations, including Alcoholics Anonymous (AA), are social organizations with a way of living with a program and a fellowship.

At the end of formal treatment, patients must become engaged in and committed to the processes of 12-step programs.

Research report; Forman, R.F.; Humphreys, K.; Tonigan, J.S. Response: The marriage of drug abuse treatment and twelve-step strategies. Science and Practice Perspectives, 2(1):52-54, 2003.

Brief-TSF is designed to increase levels of commitment to recovery.

Or how to avoid burnout

1. We admitted difficulty living as a health-care professional only, that our problems arise from this single focus in life.
2. We came to believe that accepting help and support from everything life has to offer could restore our physical, mental, emotional, social and spiritual health.
3. We made a decision to turn our will and our lives over to the care of our fellows who have learned these lessons and a Higher Power as we understand one.
4. We made a searching and fearless personal inventory of our problems, strengths, goals and dreams.
5. We shared our list with trusted others, including our Higher Power, acknowledging our character weaknesses, virtues and humanity.
6. We became entirely ready to accept the help available to address our basic human needs.
7. With humility and an open mind we sought to correct the shortcomings in our lives.
8. We made a list of all persons and institutions we resented or harmed and became willing to address these issues.
9. We made direct amends where necessary and took any action required to relieve these tensions, except when to do so would harm others.
10. We continue to monitor internal feelings and needs, promptly admitting when we had a problem.
11. We remained open and responsive to the help, guidance and love we can receive from others who care about us, including our Higher Power.
12. Having achieved personal revitalisation as the result of these steps, we try to carry this message to the others in our lives and to practice these principles in all our affairs.

After Kaufman M. (1999) The Twelve-Steps for physicians who seek rehumanising. Ontario Medical Review. November.

Resilient Practitioner, The: Burnout Prevention and Self-Care Strategies for Counselors, Therapists, Teachers, and Health Professionals by Thomas M. Skovholt Read more about this title…

Concise TSF and Brief-TSF Research Summary

All the elements of TSF have moderate to strong research support, most of which has been replicated.

NB: AA does not participate in research but individual members do. The huge volume of peripheral research supports a strong case for recommending AA participation by alcoholics.

We know: -

• that Twelve Step Facilitation reduces alcohol abuse , improves related consequences, and improves employment prospects.
• that Alcoholics Anonymous has good efficacy, and that Peer Sponsoring/social support is an essential element in AA’s success.
• that recovering people who help recovering people maintain better sobriety and have greater involvement in the general community.
• that men, women, adolescence, African-Americans, Hispanics and gay men benefit from AA. That all socio-demographic groups are represented.
• that AA is suitable for head trauma victims, and methadone patients.
• that AA has wide acceptance and is readily available in almost all communities. The current global membership of AA is approximately 2.06 million.
• that participation in Alcoholics Anonymous improves medication compliance for mental health patients, improves psychological functioning, Improves coping, reduces child abuse and domestic violence, reduces healthcare usage, reduces hospitalisation, reduces medical symptoms, reduces subsequent treatment demand, reduces mortality, and reduces associated costs.
• that healthcare workers have good success rates for substance abuse treatment and recovery from alcoholism that can be improved with AA participation.
• that alcoholics with social networks supportive of drinking have better outcomes if they initiate AA attendance while in treatment.
• that affiliation with AA is enhanced if prospects gain an awareness of the culture and methods used by AA and that sobriety is better than drinking prior to attending AA.
• that 80% of Australian, 87% of USA, and 65% of UK doctors believe that Alcoholics Anonymous is the treatment of choice for alcoholism, but overall they do not understand how AA works.
• that more than 80% of specialist alcohol and drug treatment staff support Alcoholics Anonymous treatment referral and 92% of another specialist A & D service requested training in 12 Step approaches.
• that AA Peer Sponsor contact at the healthcare worker office/institution increases initiation and sustained attendance at AA meetings.
• that active and regular AA participation is one of the more effective ways to effect lifestyle changes for alcoholics.
• that routinely engaging patients in continuing outpatient care is likely to yield better outcomes..
• that most people in the early stages of alcoholism seek help from GP’s or Community Health Centres.
• that individuals with substance abuse medical conditions benefit from integrated medical and substance abuse treatment, and approaches such as TSF can be cost-effective.
• that for every $1.00 invested in intervention $4.30 is saved in future healthcare costs.

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

RSS feed keeps you up to date with all research on TSF.

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. Read more about this title…

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)

A 3-year study of addiction mutual-help group participation following intensive outpatient treatment

BACKGROUND: Addiction-focused mutual-help group participation is associated with better substance use disorder (SUD) treatment outcomes. However, little has been documented regarding which types of mutual-help organizations patients attend, what levels of participation may be beneficial, and which patients, in particular, are more or less likely to participate.

Furthermore, much of the evidence supporting the use of these organizations comes from studies examining participation and outcomes concurrently, raising doubts about cause-effect connections, and little is known about influences that may moderate the degree of any general benefit.

METHOD: Alcohol-dependent outpatients (N=227; 27% female; Mean age=42) enrolled in a randomized-controlled telephone case monitoring trial were assessed at treatment intake and at 1, 2, and 3 years post discharge.

Lagged-panel, hierarchical linear models tested whether mutual-help group participation in the first and second year following treatment predicted subsequent outcomes and whether these effects were moderated by gender, concurrent axis I diagnosis, religious preference, and prior mutual-help experience.

Robust regression curve analysis was used to examine dose-response relationships between mutual-help and outcomes.

RESULTS: Mutual-help participation was associated with both greater abstinence and fewer drinks per drinking day and this relationship was not found to be influenced by gender, Axis I diagnosis, religious preference, or prior mutual-help participation.

Mutual-help participants attended predominantly Alcoholics Anonymous and tended to be Caucasian, be more educated, have prior mutual-help experience, and have more severe alcohol involvement.

Dose-response curve analyses suggested that even small amounts of participation may be helpful in increasing abstinence, whereas higher doses may be needed to reduce relapse intensity.

CONCLUSIONS: Use of mutual-help groups following intensive outpatient SUD treatment appears to be beneficial for many different types of patients and even modest levels of participation may be helpful.

Future emphasis should be placed on ways to engage individuals with these cost-effective resources over time and to gather and disseminate evidence regarding additional mutual-help organizations.

Kelly JF, Stout R, Zywiak W, Schneider R. A 3-year study of addiction mutual-help group participation following intensive outpatient treatment. Alcohol Clin Exp Res. 2006 Aug;30(8):1381-92.

Brief-TSF is designed to engage alcoholics in supportive therapy while attending Alcoholics Anonymous.