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Rodriguez-Morales L. In Your Own Skin: The Experience of Early Recovery from Alcohol-Use Disorder in 12-Step Fellowships. ALCOHOLISM TREATMENT QUARTERLY 2017. [DOI: 10.1080/07347324.2017.1355204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Beck AK, Baker A, Kelly PJ, Deane FP, Shakeshaft A, Hunt D, Forbes E, Kelly JF. Protocol for a systematic review of evaluation research for adults who have participated in the 'SMART recovery' mutual support programme. BMJ Open 2016; 6:e009934. [PMID: 27217279 PMCID: PMC4885378 DOI: 10.1136/bmjopen-2015-009934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Self-Management and Recovery Training (SMART Recovery) offers an alternative to predominant 12-step approaches to mutual aid (eg, alcoholics anonymous). Although the principles (eg, self-efficacy) and therapeutic approaches (eg, motivational interviewing and cognitive behavioural therapy) of SMART Recovery are evidence based, further clarity regarding the direct evidence of its effectiveness as a mutual aid package is needed. Relative to methodologically rigorous reviews supporting the efficacy of 12-step approaches, to date, reviews of SMART Recovery have been descriptive. We aim to address this gap by providing a comprehensive overview of the evidence for SMART Recovery in adults with problematic alcohol, substance and/or behavioural addiction, including a commentary on outcomes assessed, potential mediators, feasibility (including economic outcomes) and a critical evaluation of the methods used. METHODS AND ANALYSIS Methods are informed by the Cochrane Guidelines for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. 6 electronic peer-reviewed and 4 grey literature databases have been identified. Preliminary searches have been conducted for SMART Recovery literature (liberal inclusion criteria, not restricted to randomised controlled trials (RCTs), qualitative-only designs excluded). Eligible 'evaluation' articles will be assessed against standardised criteria and checked by an independent assessor. The searches will be re-run just before final analyses and further studies retrieved for inclusion. A narrative synthesis of the findings will be reported, structured around intervention type and content, population characteristics, and outcomes. Where possible, 'summary of findings' tables will be generated for each comparison. When data are available, we will calculate a risk ratio and its 95% CI (dichotomous outcomes) and/or effect size according to Cohen's formula (continuous outcomes) for the primary outcome of each trial. ETHICS AND DISSEMINATION No ethical issues are foreseen. Findings will be disseminated widely to clinicians and researchers via journal publication and conference presentation(s). PROSPERO REGISTRATION NUMBER CRD42015025574.
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Affiliation(s)
- Alison K Beck
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Amanda Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anthony Shakeshaft
- Department of NDARC, University of New South Wales, Sydney, New South Wales, Australia
| | - David Hunt
- SMART Recovery Australia (Employee), Sydney, New South Wales, Australia
| | - Erin Forbes
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - John F Kelly
- Massachusetts General Hospital, Recovery Research Institute, Harvard Medical School, Boston, Massachusetts, USA
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Validation of the alcohol use item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS). Drug Alcohol Depend 2016; 161:316-22. [PMID: 26936412 PMCID: PMC6032515 DOI: 10.1016/j.drugalcdep.2016.02.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) includes five item banks for alcohol use. There are limited data, however, regarding their validity (e.g., convergent validity, responsiveness to change). To provide such data, we conducted a prospective study with 225 outpatients being treated for substance abuse. METHODS Assessments were completed shortly after intake and at 1-month and 3-month follow-ups. The alcohol item banks were administered as computerized adaptive tests (CATs). Fourteen CATs and one six-item short form were also administered from eight other PROMIS domains to generate a comprehensive health status profile. After modeling treatment outcome for the sample as a whole, correlates of outcome from the PROMIS health status profile were examined. RESULTS For convergent validity, the largest correlation emerged between the PROMIS alcohol use score and the Alcohol Use Disorders Identification Test (r=.79 at intake). Regarding treatment outcome, there were modest changes across the target problem of alcohol use and other domains of the PROMIS health status profile. However, significant heterogeneity was found in initial severity of drinking and in rates of change for both abstinence and severity of drinking during follow-up. This heterogeneity was associated with demographic (e.g., gender) and health-profile (e.g., emotional support, social participation) variables. CONCLUSIONS The results demonstrated the validity of PROMIS CATs, which require only 4-6 items in each domain. This efficiency makes it feasible to use a comprehensive health status profile within the substance use treatment setting, providing important prognostic information regarding abstinence and severity of drinking.
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Conrad KM, Conrad KJ, Passetti LL, Funk RR, Dennis ML. Validation of the Full and Short-Form Self-Help Involvement Scale Against the Rasch Measurement Model. EVALUATION REVIEW 2015; 39:395-427. [PMID: 26275980 PMCID: PMC4591028 DOI: 10.1177/0193841x15599645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Substance use disorders (SUDs) are one of the nation's most costly problems in terms of dollars, disability, and death. Self-help programs are among the varied recovery support options available to address SUD, and evaluation of these programs depends on good measurement. There exists an unmet need for a psychometrically sound, brief, efficient measure of self-help involvement for individuals with SUD that is valid across different substances and age-groups. METHODS Using data from 2,101 persons presenting for SUD treatment, the full 21-item Global Appraisal of Individual Needs Self-Help Involvement Scale (SHIS) and a newly developed 11-item short-form version were validated against the Rasch measurement model and each other. Differential item functioning (DIF) was assessed by primary substance and age. RESULTS Both versions met Rasch psychometric criteria. The full scale had minor misfit with no DIF for alcohol, marijuana, or opioids but a few instances of DIF for amphetamine and cocaine users as well as for age, in that youth tended to endorse several easier items more frequently than did adults. The 11-item short form had neither misfit nor DIF by substance and only minor DIF by age was highly correlated with the full version and was relatively more efficient. Criterion-related validity was supported for both. CONCLUSIONS Both the long and short versions of SHIS are psychometrically sound measures of a more comprehensive conceptualization of self-help involvement for SUDs that can be used as part of an in-depth assessment or as a short measure that lessens respondent burden.
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Affiliation(s)
- Karen M Conrad
- University of Illinois at Chicago School of Public Health, Chicago, IL USA Program Metrics, LLC, Oak Park, IL, USA
| | - Kendon J Conrad
- University of Illinois at Chicago School of Public Health, Chicago, IL USA Program Metrics, LLC, Oak Park, IL, USA
| | - Lora L Passetti
- Chestnut Health Systems Lighthouse Institute, Normal, IL, USA
| | - Rodney R Funk
- Chestnut Health Systems Lighthouse Institute, Normal, IL, USA
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Schultz NR, Blonigen D, Finlay A, Timko C. Criminal typology of veterans entering substance abuse treatment. J Subst Abuse Treat 2015; 54:56-62. [PMID: 25661518 PMCID: PMC5754024 DOI: 10.1016/j.jsat.2015.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/13/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
Criminal justice involvement among veterans is a critical and timely concern, yet little is known about criminal histories and clinical characteristics among veterans seeking treatment for substance use disorders (SUDs). The present study examined criminal typology, clinical characteristics, treatment utilization, and 12-step mutual-help group (MHG) participation among veterans (N = 332) at intake to SUD treatment at the Department of Veterans Affairs (VA), and 6 months and 1 year post-intake. Cluster analysis yielded three types of criminal histories mild-(78.9%), moderate (13.6%), and severe (7.5%)-distinguished by type of offense, number of convictions, and number of months incarcerated. At intake, participants with mild criminal histories reported more alcohol problems and fewer legal and employment problems than participants with moderate and severe criminal histories. Participants with severe criminal histories were most likely to attend a 12-step MHG meeting in the year post-intake, but all groups had high attendance. When only participants who had attended at least one meeting in the year post-intake were compared, participants with mild criminal histories worked more steps and were more involved in 12-step practices. All groups improved between baseline and follow-up and did not differ at follow-ups on substance use or other clinical outcomes. Multiple regressions identified treatment utilization and MHG attendance, but not baseline criminal history, as significant predictors of improved substance use problem severity at follow-up. Outpatient treatment and 12-step MHG attendance appear to be important components of recovery for veterans with varying criminal histories. Clinicians in SUD treatment programs should screen for criminal histories at treatment intake to ensure appropriate treatment planning.
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Affiliation(s)
- Nicole R Schultz
- Center for Innovation to Implementation (Ci2i), Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Daniel Blonigen
- Center for Innovation to Implementation (Ci2i), Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA
| | - Andrea Finlay
- Center for Innovation to Implementation (Ci2i), Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA; Substance Use Disorder Quality Enhancement Research Initiative, Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA
| | - Christine Timko
- Center for Innovation to Implementation (Ci2i), Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Carter J, Sharon E, Stern TA. The management of alcohol use disorders: the impact of pharmacologic, affective, behavioral, and cognitive approaches. Prim Care Companion CNS Disord 2015; 16:14f01683. [PMID: 25664205 DOI: 10.4088/pcc.14f01683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/25/2014] [Indexed: 12/11/2022] Open
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Najavits LM, de Haan H, Kok T. How Do Females With PTSD and Substance Abuse View 12-Step Groups? An Empirical Study of Attitudes and Attendance Patterns. Subst Use Misuse 2015; 50:1786-94. [PMID: 26606541 DOI: 10.3109/10826084.2015.1050111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Self-help groups are beneficial for many people with addiction, predominantly through 12-step models. Yet obstacles to attendance also occur. OBJECTIVES We explored attendance patterns and attitudes toward self-help groups by 165 outpatient females with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD), the first study of its kind. METHODS Cross-sectional self-report data compared adults versus adolescents, and those currently attending self-help versus not attending. We also explored attendance in relation to perceptions of the PTSD/SUD relationship and symptom severity. RESULTS Adults reported higher attendance at self-help than adolescents, both lifetime and currently. Among current attendees, adults also attended more weekly groups than adolescents. Yet only a minority of both age cohorts attended any self-help in the past week. Adults perceived a stronger relationship between PTSD and SUD than adolescents, but both age groups gave low ratings to the fact that self-help groups do not address PTSD. That item also had low ratings by both those currently attending and not attending self-help. Analysis of those not currently attending identified additional negative attitudes toward self-help (spirituality, addiction as a life-long illness, sayings, and the fellowship). Symptom severity was not associated with attendance, but may reflect a floor effect. Finally, a surprising finding was that all-female groups were not preferred by any subsample. Conclusions/Importance. Creative solutions are needed to address obstacles to self-help among this population. Addressing trauma and PTSD, not just SUD, was valued by females we surveyed, and may be more helpful than all-female groups per se.
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Affiliation(s)
- Lisa M Najavits
- a 1 Boston University School of Medicine , Boston , Massachusetts , USA
| | - Hein de Haan
- b 2 Tactus Addiction Treatment , Deventer , Netherlands
| | - Tim Kok
- b 2 Tactus Addiction Treatment , Deventer , Netherlands
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Abstract
Scientific advances in the past 15 years have clearly highlighted the need for recovery management approaches to help individuals sustain recovery from chronic substance use disorders. This article reviews some of the recent findings related to recovery management: (1) continuing care, (2) recovery management checkups, (3) 12-step or mutual aid, and (4) technology-based interventions. The core assumption underlying these approaches is that earlier detection and re-intervention will improve long-term outcomes by minimizing the harmful consequences of the condition and maximizing or promoting opportunities for maintaining healthy levels of functioning in related life domains. Economic analysis is important because it can take a year or longer for such interventions to offset their costs. The article also examines the potential of smartphones and other recent technological developments to facilitate more cost-effective recovery management options.
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Affiliation(s)
- Michael L Dennis
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA,
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