Using AA and other 12-step programs more effectively

Correlates of alcoholics anonymous affiliation among justice-involved women

BACKGROUND

Alcohol use disorder (AUD) constitutes a major public health problem and is associated with a substantial amount of disability and premature death worldwide. Several treatment and self-help options including Alcoholics Anonymous (AA) meetings are available. Nevertheless, factors associated with AA affiliation in some disadvantaged groups such as justice-involved women are not well understood. The purpose of this study is to report on previously unexamined correlates of past year AA affiliation among women in pretrial jail detention.

METHODS

The current study used cross-sectional data from 168 women with DSM-5 diagnosis of  AUD in pretrial jail detention. The study examined factors related to women's concept of self and others (i.e., disbelief that others are trustworthy, lack of autonomy to choose who they interact with, experience of violent victimization, low investment in self-care, higher stress levels, and homelessness) as correlates of past-year AA affiliation, controlling for severity of AUD and demographic factors.

RESULTS

Women who believe that others are inherently trustworthy, women who met less AUD criteria, and women who are older reported more past-year AA affiliation in both univariate and multivariate analyses.

CONCLUSION

Introducing AA outreach and alternative interventions for younger, less severely addicted women might improve AUD outcomes. Moreover, designing more individualized treatment plan for women who believe others are not trust worthy might help AUD treatment engagement in this population.

TRIAL REGISTRATION

NCT01970293 , 10/28/2013.

From Self-Help to Professional Care

The process of an enhanced application of the spiritual self-help 12-step program of Alcoholics Anonymous in a professional counseling approach is described. Two integrated enhancements are outlined. The first is the enhancement of the addressed problem as applied by several 12-step self-help groups. Assuming a three-dimensional view of human existence—physical, mental and spiritual—it is argued that a more far-reaching program is obtained when the problem is defined as originating primarily in the mental dimension, but the most inclusive 12-step program may be defined by emphasizing the problem’s definition as originating in the spiritual dimension. Second is the program’s expansion from self-help to professional practice. Although in the past this trend derived mainly from the addiction-treatment field, it is argued that professionals can practice a more inclusive 12-step program called Grace Therapy. Basic assumptions of this program as reflecting a theory of applied spirituality are outlined and supported by clinical illustrations.

Spiritually and Religiously Oriented Health Interventions

Controlled intervention studies offer considerable promise to better understand relationships and possible mechanisms between spiritual and religious factors and health. Studies examining spiritually augmented cognitive–behavioral therapies, forgiveness interventions, different meditation approaches, 12-step fellowships, and prayer have provided some evidence, albeit modest, of efficacy in improving health under specific conditions. Researchers need to describe spiritual and religious factors more clearly and precisely, as well as demonstrate that such factors independently influence treatment efficacy. Inclusion of potential moderating and mediating variables (e.g. extent of religious commitment, intrinsic religiousness, specific religious coping strategy) in intervention designs could help explain relationships and outcomes. Using a variety of research designs (e.g. randomized clinical trials, single-subject experimental designs) and assessment methods (e.g. daily self-monitoring, ambulatory physiological measures, in-depth structured interviews) would avoid current limitations of short-term studies using only questionnaires.

Adolescent substance abuse treatment clinicians' self-help meeting referral practices and adolescent attendance rates

Clinicians in adolescent substance abuse treatment programs often recommend attendance at 12-Step meetings; however, there has been no systematic study of their referral practices or possible influence on attendance rates. Quantitative and qualitative data were used to examine: (a) the self-help referral practices of clinicians employed in adolescent substance abuse treatment programs; and (b) the potential relationship between practices and self-help attendance. Data were analyzed from open-ended interviews with 28 clinicians at eight CSAT-funded SCY sites and from follow-up interviews with over 1,600 adolescents. Results indicated that clinicians referred adolescents almost exclusively to 12-Step groups. Various factors were considered when recommending attendance, including substance use severity and ability to grasp 12-Step concepts. Meeting age composition and availability were common influences when suggesting specific meetings. Clinicians who described their treatment programs as "12-Step based" and actively linked adolescents to groups tended to be employed at sites that had the highest overall rates of self-help attendance. Findings suggest that if clinicians want to facilitate self-help attendance, they might assess the "fit" between individual adolescents and particular meetings. Additionally, programs may want to develop and train staff in standardized referral procedures. Further research is needed to empirically test referral strategies with adolescents.

12-step participation as a pathway to recovery: the Maryhaven experience and implications for treatment and research

Maryhaven, a comprehensive, community-based drug abuse treatment facility, combines a core commitment to 12-step principles and practices with the use of scientifically derived treatment interventions. Treatment goals at Maryhaven include abstinence from substance abuse, patient engagement and progress in 12-step activities, and strong patient affiliation with 12-step organizations within the community. The author discusses the reasons why Maryhaven takes this approach, describes the program’s use of empirically derived treatment tools to further 12-step objectives, argues that there are natural affinities between 12-step and some empirical treatment tools such as the Stages of Change model, and suggests research projects that he believes can improve treatment and illuminate the mechanisms by which 12-step activities help patients overcome addiction.

An exploration of the effect of on-site 12-step meetings on post-treatment outcomes among polysubstance-dependent outpatient clients

Rates of return to active substance use after addiction treatment tend to be high; participation in 12-step fellowships (e.g., Alcoholics Anonymous) reduces relapse rates but many clients do not attend or attend for a short period only. This quasi-experimental study uses repeated measurement to explore the role of presence/absence of on-site 12-step meetings during treatment on post-treatment outcomes. Polysubstance-dependent clients (N = 219) recruited at a program with and one without 12-step on-site, were followed for one year post-treatment. On-site 12-step enhanced 12-step attendance, especially during treatment, and predicted continuous abstinence for the post-treatment year. Holding 12-step meetings on-site is a low-cost strategy that programs should consider to foster post-treatment remission maintenance.

Impaired healthcare professional

OBJECTIVE

The objective of the article is to present the available data from the literature on substance use disorders in healthcare professionals. Prevalence, risk factors, treatment options, and reentry into clinical practice are discussed.

INTRODUCTION

Impairment of a healthcare professional is the inability or impending inability to practice according to accepted standards as a result of substance use, abuse, or dependency (addiction). The term substance use disorder can be divided into substance abuse and dependence (addiction). Substance abuse results in adverse social and professional consequences. Addiction manifests as physiologic and behavioral symptoms related to a maladaptive pattern of substance use.

MAIN RESULTS

It is estimated that approximately 10% to 15% of all healthcare professionals will misuse drugs or alcohol at some time during their career. Although the rates of substance abuse and dependence are similar to those of the general population, the prevalence is disturbing because healthcare professionals are the caregivers responsible for the general health and well-being of the general population. Healthcare professionals have higher rates of abuse with benzodiazepines and opiates. Specialties such as anesthesia, emergency medicine, and psychiatry have higher rates of drug abuse, probably related to the high-risk environment associated with these specialties, the baseline personalities of these healthcare providers, and easy access to drugs in these areas. Drugs and alcohol are mostly used for "recreational" purposes by medical students. Residents and attending physicians use drugs of abuse for performance enhancement and as self-treatment for various reasons, such as, pain, anxiety, or depression.

CONCLUSIONS

Institutional, local, and statewide impaired-physician programs are now available for the active treatment and rehabilitation of impaired healthcare professionals. Many of these programs are also designed to assist the clinician with reentry into clinical practice. Rarely is punitive action taken when the healthcare provider undergoes successful treatment and ongoing follow-up management. Overall recovery rates for impaired healthcare professionals seem to be higher compared with other groups, particularly with intensive inpatient management and subsequent follow-up care.

Participation in treatment and Alcoholics Anonymous: a 16-year follow-up of initially untreated individuals

This study focused on the duration of participation in professional treatment and Alcoholics Anonymous (AA) for previously untreated individuals with alcohol use disorders. These individuals were surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. Compared with individuals who remained untreated, individuals who obtained 27 weeks or more of treatment in the first year after seeking help had better 16-year alcohol-related outcomes. Similarly, individuals who participated in AA for 27 weeks or more had better 16-year outcomes. Subsequent AA involvement was also associated with better 16-year outcomes, but this was not true of subsequent treatment. Some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA.

Long-term influence of duration and frequency of participation in alcoholics anonymous on individuals with alcohol use disorders

This study examined the influence of the duration and frequency of a baseline episode of participation in Alcoholics Anonymous (AA) among 473 individuals with alcohol use disorders on 1-year and 8-year outcomes and the effect of additional participation and delayed participation on outcomes. Compared with individuals who did not participate, individuals who affiliated with AA relatively quickly, and who participated longer, had better 1-year and 8-year alcohol-related outcomes. Individuals who continued to participate, and those who continued longer, had better alcohol-related outcomes than did individuals who discontinued participation, but individuals who delayed participation in AA had no better outcomes than those who never participated. In general, the frequency of participation was independently associated only with a higher likelihood of abstinence.

The effects of sponsorship in 12-step treatment of injection drug users

What contributes to sustained abstinence from injection drug use by those who participate in community-based Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) is not well understood. We know that sponsorship is a central element in these programs. To investigate the relationship between sponsorship and abstinence, we evaluated NA/AA sponsorship over a 1-year period in a longitudinal study of 500 former and current injection drug users in inner-city Baltimore recruited from the community-at-large, independent of treatment center affiliation. The findings indicated that having a sponsor in NA/AA for this population was not associated with any improvement in 1-year sustained abstinence rates than a non-sponsored group. However, being a sponsor over the same time period was strongly associated with substantial improvements in sustained abstinence rates for the sponsors, controlling for involvement with community organizations, NA/AA meeting attendance, marital status, employment, participation in drug and alcohol treatment centers and HIV status. Involvement in community organizations was also strongly associated with successful abstinence, controlling for the same variables. Of those participants involved with community organizations, more than half reported involvement in church activities. Our investigation suggests that, for NA/AA sponsors in this study population, providing direction and support to other addicts is associated with improved success in sustained abstinence for the sponsors but does little to improve the short-term success of the persons being sponsored.

Factors associated with frequency of 12-Step attendance by drug abuse clients

Comparison was made of treatment clients attending Narcotics Anonymous and/or Alcoholics Anonymous meetings less than weekly (n = 41) with treatment clients attending meetings at least three times a week (n = 30). The frequent attenders (attending an average of 30.6 meetings monthly) differed from non- and infrequent attenders (attending an average of 0.4 meetings monthly) in terms of histories of greater lifetime drug use, more arrests and treatment experiences, and an earlier age of first use of alcohol. Although the frequent attender was also older, age was not found to influence the differences found between groups. Measures of religiosity, use of community services, and support from others for recovery and psychological functioning, other than ratings of the helpfulness of 12-Step, were not differentiated among groups. The findings suggest that 12-Step groups are more likely to be selected by clients with more severe histories of drug use and criminal activity, i.e., those most in need of the support to behavior change those groups provide. The role of treatment programs in facilitating the use of 12-Step groups is discussed.

12-Step Program Participation and Effectiveness: Do Gender and Ethnic Differences Exist?

Although 12-Step is increasingly utilized as a recovery resource and is viewed by many addiction specialists as an integral component of treatment and long-term recovery, questions regarding participation and effectiveness of 12-Step programs for women and ethnic minorities have been raised. Utilizing data from the Los Angeles Target Cites Evaluation Project (n = 356), participants in adult outpatient alcohol and drug treatment were followed for 24 months and rates of 12-Step participation and effectiveness were assessed for all gender and ethnic groups. Contrary to reports that 12-Step is more appropriate for European-American males, statistical analyses reveals that women and ethnic minorities are equally likely to attend 12-Step programs, and to recover In conjunction with such participation as European-American males. Although 12-Step may not appeal to all seeking to cease alcohol and drug use, the clinical implications for treatment providers and other addiction specialists points to the benefits of Integrating 12-Step components into traditional treatment programs and recommending 12-Step participation for clients of all gender and ethnic groups.

Exploring the additive effects of drug misuse treatment and Twelve-Step involvement: does Twelve-Step ideology matter?

Previous research revealed an additive effect of recovery activities in that those who attended Twelve-Step meetings on a weekly basis during and after outpatient drug-user treatment had higher rates of abstinence compared to those who participated in either treatment or Twelve-Step programs alone. The current investigation extends the previous research by examining the possible effects of Twelve-Step ideology on participation in Twelve-Step programs and abstinence from drug use. The findings from this treatment outcomes study indicate that the acceptance of Twelve-Step ideology, particularly strong agreement with the need for frequent, lifelong attendance at Twelve-Step meetings, and the need to surrender to a "higher power" are significant predictors of weekly or more frequent attendance at Twelve-Step meetings independent from other potentially mediating variables. Twelve-Step ideology, specifically the notion that controlled or nonproblematic drug use is not possible, predicted abstinence independent from Twelve-Step participation and other potentially mediating variables. These findings often a number of implications concerning group process and recovery from drug misuse which are addressed in the Discussion section under the following topics: 1) spirituality and group cohesion, 2) spiritual transcendence, social transcendence, and recovery; 3) spirituality and the obstruction of recovery; 4) Twelve-Step ideology and learning; 5) perceived control of drug use, self-efficacy theory, and recovery; and 7) perceived control of drug use and optimistic illusions. Directions for future research are discussed.

Drug treatment and 12-step program participation: the additive effects of integrated recovery activities

The dramatic rise in the number of 12-step programs and participants raises questions concerning client participation in drug treatment and 12-step programs, and their separate and combined effects on recovery. The results of a treatment outcomes study indicate that rather than recovery alternatives, drug treatment and 12-step programs are utilized by the client as integrated recovery activities. Treatment participants with pretreatment 12-step involvement stayed in treatment longer, and were more likely to complete the 24-week program. Both pretreatment 12-step involvement and duration of participation in drug treatment are associated with subsequent 12-step involvement. Most importantly, there is an additive effect of these recovery activities in that those who participated concurrently in both drug treatment and 12-step programs had higher rates of abstinence than those who participated only in treatment or in 12-step programs.

Cognitive restructuring and the 12-step program of alcoholics anonymous

Alcohol addiction affects many clients that enter the offices of traditional mental health professionals. Their recovery is impacted by what goes on inside the office, in treatment, as well as by involvement outside the office, in 12-step programs as Alcoholics Anonymous (AA). This article examines alcoholism as a thought disorder and cognitive restructuring as an effective model of treatment. Cognitive restructuring occurs in therapy and in AA. It can, therefore, be the bridge that encourages understanding and cooperation between the two factors influencing recovery.

Fostering client connections with Alcoholics Anonymous: a framework for social workers in various practice settings

Alcohol abuse is common among clients in human service agencies, but most never seek help for their drinking problems, either in professional treatment or self-help (mutual aid) groups such as Alcoholics Anonymous (A.A.). A.A. is a widely-available resource, but it is not always introduced to clients in a manner that fosters acceptance of A.A. Social workers in various practice settings can facilitate A.A. affiliation by working collaboratively with clients, seeking a goodness-of-fit between client needs and the resources available within A.A. This article offers a pragmatic approach to initial A.A. involvement, intended to help professionals utilize barriers to affiliation as opportunities for furthering both counseling goals and the connection to A.A.

Alcoholics Anonymous affiliation during early recovery

This study analyzed the Alcoholics Anonymous (AA) participation of 55 patients during the 3 months after their discharge from structured treatment, when dropout is high. Three levels of meeting attendance were discerned: low, mid-level, and "90 meetings in 90 days." Of greatest interest, the mid-level group showed mixed interest in AA practices despite substantial meeting attendance, that is, they admitted powerlessness, but had less enthusiasm for the higher power concept, and relapsed significantly; they were likely to have a sponsor, but were less involved with other AA members; and they reported working the 12 Steps, but were less interested in the AA literature. Findings suggest that individuals who are attending AA but having difficulty embracing key aspects of the program need professional assistance that focuses more on AA practices and tenets and less on meeting attendance. Barriers to affiliation can also serve as opportunities for furthering both counseling goals and affiliation.