Consumer Evaluation of Dual Focus Mutual Aid

Efficacy of 12-step mutual-help groups other than Alcoholics Anonymous: a systematic review and meta-analysis

This paper offers a systematic review of quantitative and qualitative studies on the main twelve-step mutual-help (TSMH) groups (excluding Alcoholics Anonymous) and four meta-analyses exploring the correlation between (i) duration or involvement in TSMH groups and; (ii) severity of symptoms or quality of life. Systematic review was conducted following PRISMA guidelines. Searches of databases (MEDLINE, PsychInfo), a register (ClinicalTrials) and citations were conducted, from inception through November 01 2022. Fifty five articles were included (24 quantitative, 27 qualitative, 4 mixed-methods), corresponding to 47 distinctive studies. 68% of these studies were conducted in North America, 17% in Middle East, 11% in the European Union and 4% in Australia. The most studied TSMH group were Gamblers Anonymous (28% of the 47 studies), Narcotics Anonymous (26%), Double Trouble in Recovery (15%), Overeaters Anonymous (19%) and TSMH groups for compulsive sexual behaviors (11%). The four meta-analyses pooled data from 9 studies. Pooled mean age ranged from 36.5 to 40.5. 80-81% of participants were male. TSMH attendance and involvement were negatively correlated with severity of symptoms (high and medium levels of evidence) and positively correlated with quality of life (low levels of evidence). Twenty-one qualitative papers reported factors influencing recovery: Social (n = 15), emotional (n = 9), spiritual (n = 8), self-identification or psychological (n = 6) factors. Review provides characteristics of TSMH groups others than Alcoholics Anonymous, with implications for both research and healthcare practice. The perspective to implement TSMH groups targeting ontological addiction, at the root of all addiction, is discussed.Protocol registration: Prospero registration number: CRD42022342605.

“My actual mind and body is in a better place, I just feel better since coming here”: recovery and mental wellbeing

Purpose

– An increasing literature points to the efficacy and importance of mutual aid groups for people recovering from substance dependency. However, there is a paucity of qualitative evidence into the experiences and perceptions of service users attending UK-based mutual aid groups, and the implications they could have for recovery and mental wellbeing. The paper aims to discuss this issue.

Design/methodology/approach

– A phenomenological approach was chosen to explore the experiences and perceptions of service users and mentors at a mutual aid group in Leeds. Semi-structured interviews were conducted with service users and mentors (ex-service users) involved with the project. Thematic analysis was used to analyse the data.

Findings

– This paper focuses on the influence of mutual aid attendance on mental wellbeing. It was found that attendance seemed to have positive influences on providing structure, reducing stress and boredom, “broadening the mind” and providing service users with a social network that supported their recovery and mental wellbeing. However, it was also found that for those that have little outside the project, dependency on the group could develop, resulting in negative consequences on mental wellbeing.

Originality/value

– This paper provides an increased understanding of why mutual attendance has influences on mental wellbeing, as well as the implications such impacts have on recovery trajectories.

Efficacy of dual focus mutual aid for persons with mental illness and substance misuse

BACKGROUND

Previous studies have indicated that persons with co-occurring mental health and substance use problems can benefit by attending dual-focus mutual aid groups. However, to date, a trial to test the efficacy of these groups has not been published.

METHOD

This study randomly assigned 203 substance misusing clients attending a mental health or dual-diagnosis facility to either a dual-focus 12-step group (Double Trouble in Recovery; DTR) or a waiting list control group. Participants were followed for 3-6 months. The primary outcome was substance use (days used in the past 30 with saliva testing to detect under-reporting); secondary outcomes included psychiatric medication adherence, attendance at traditional (single-focus) 12-step meetings (e.g., AA/NA); and improvement in mental health and substance use problems (quality of life). Multilevel model (MLM) regression was used to analyze the nested effect of participants within 8 facilities (7 in New York City and 1 in Michigan). Regression imputation was used to adjust for drug use under-reporting.

RESULTS

At follow-up 79% of the subjects were interviewed. In intent to treat analysis, DTR subjects compared with control subjects used alcohol (p=.03) and any substances (p=.02) on fewer days. DTR compared with control subjects were also more likely to rate themselves as experiencing better mental health and fewer substance use problems (p=.001). There were no effects for DTR on drug use only, medication adherence or NA/AA attendance.

CONCLUSION

Findings reported in previous studies on the association between exposure to DTR and reductions in substance use were partially supported in this efficacy trial.

12-step facilitation for the dually diagnosed: a randomized clinical trial

There are few clinical trials of 12-step treatments for individuals with serious mental illness and alcohol or drug dependence. This randomized trial assessed the effects of adding a 12-session 12-step facilitation therapy (TSF), adapted from that used in Project MATCH, to treatment as usual in an outpatient dual diagnosis program. Participants were 121 individuals dually diagnosed with alcohol dependence and a serious mental disorder, followed during 12 weeks of treatment and 36 weeks post-treatment. Participants receiving TSF had greater participation in 12-step programs, but did not demonstrate greater improvement in alcohol and drug use. However, considered dimensionally, greater participation in TSF was associated with greater improvement in substance use, and greater 12-step participation predicted decreases in frequency and intensity of drinking. Findings suggest that future work with TSF in this population should focus on maximizing exposure to TSF, and maximizing the effect of TSF on 12-step participation.

Risk factors for medication non-adherence among psychiatric patients with substance misuse histories

Medication non-adherence among psychiatric patients is known to be associated with poorer treatment outcomes. The study examined a comprehensive set of modifiable risk factors for non-adherence in a theoretical framework among a diverse, high risk sample of psychiatric patients with substance misuse histories (N=299). Medication side effects and excessive alcohol use were related to lower medication adherence and higher motivation for mental health treatment and recovery support were related to greater adherence. The results suggest that a multifaceted model for intervention to increase psychiatric medication adherence should be developed and tested.

Consumers' Experiences in Dual Focus Mutual Aid for Co-occurring Substance Use and Mental Health Disorders

Mutual aid fellowships have been shown to improve outcomes for those with co-occurring substance use and mental illness disorders. Processes associated with usefulness include helper therapy (the assumption of a helping role to foster commitment) and reciprocal learning (the sharing of problems and solutions among members). The present qualitative investigation used focus groups comprised a subset of participants in Double Trouble in Recovery (DTR), a 12-step mutual aid group for those with co-occurring disorders, to gather their subjective perceptions of the groups. Participants emphasized that in linking them to others with similar problems, the DTR groups played a vital emotional role in their lives and provided a needed venue for information sharing that might have been otherwise unavailable.

Factors associated with medication adherence among psychiatric outpatients at substance abuse risk

Substance misuse is usually associated with poorer psychiatric medication adherence among psychiatric patients. Identifying predictors of medication adherence among patients with dual psychiatric and substance misuse problems is important because poor adherence is associated with relapse and re-hospitalization. The subjects were patients newly admitted to a psychiatric outpatient program who were prescribed psychiatric medication from different providers during the six months prior to admission; all also had substance misuse histories (N=131). Confidential research interviews were conducted that included a modified Medication Adherence Rating Scale (MARS) and drug toxicologies. Age (mean): 39 y; male 61%; Black 41%; Hispanic 38%; White 21%; completed high school/GED 41%; DSM-IV diagnoses: major depression 26%, schizoaffective 21%, bipolar 16%, schizophrenia 13%, other 24%; positive drug toxiology 55%. Potentially malleable factors correlated with lower adherence were: lower friends' support for drug/alcohol abstinence, more recovery-promoting behaviors, lower satisfaction with medication, more medication side effects, lower self-efficacy for drug avoidance, and lower social support for recovery. In multivariate regression analysis, only the last three factors remained as significant predictors of adherence. Low adherence is not attributable to simply forgetting to take medication. Strengthening adherence should also include better education about side effects and the importance of adherence to sustain the benefits of medication. Psychiatrists and other medical providers should also be encouraged to address patients' adherence strategies, since the time devoted to addressing that during treatment may prevent serious adverse events such as relapse to substance abuse, treatment drop-out and re-hospitalization.

Dual diagnosis clients' treatment satisfaction - a systematic review

BACKGROUND

The aim of this systematic review is to synthesize existing evidence about treatment satisfaction among clients with substance misuse and mental health co-morbidity (dual diagnoses, DD).

METHODS

We examined satisfaction with treatment received, variations in satisfaction levels by type of treatment intervention and by diagnosis (i.e. DD clients vs. single diagnosis clients), and the influence of factors other than treatment type on satisfaction. Peer-reviewed studies published in English since 1970 were identified by searching electronic databases using pre-defined search strings.

RESULTS

Across the 27 studies that met inclusion criteria, high average satisfaction scores were found. In most studies, integrated DD treatment yielded greater client satisfaction than standard treatment without explicit DD focus. In standard treatment without DD focus, DD clients tended to be less satisfied than single diagnosis clients. Whilst the evidence base on client and treatment variables related to satisfaction is small, it suggested client demographics and symptom severity to be unrelated to treatment satisfaction. However, satisfaction tended to be linked to other treatment process and outcome variables. Findings are limited in that many studies had very small sample sizes, did not use validated satisfaction instruments and may not have controlled for potential confounders. A framework for further research in this important area is discussed.

CONCLUSIONS

High satisfaction levels with current treatment provision, especially among those in integrated treatment, should enhance therapeutic optimism among practitioners dealing with DD clients.

Dual-focus mutual aid for co-occurring disorders: a quasi-experimental outcome evaluation study

Previous observational research has indicated the effectiveness of a 12-step, dual-focus mutual aid group, Double Trouble in Recovery (DTR), for assisting individuals to recover from co-occurring substance use and psychiatric disorders. The current study extends this line of research by evaluating DTR with a quasi-experimental design; controlled designs are rare in studies of mutual aid. Patient outcomes in the same psychiatric day treatment program were compared for two consecutive admission cohorts characterized by high rates of co-occurring disorders. The first cohort did not have DTR available while the second cohort was exposed to DTR after it was established at the program. Both cohorts were assessed at program admission and at a six-month follow-up. Using intent to treat analysis, the Post-DTR cohort as compared with the Pre-DTR cohort had significantly fewer days of alcohol and drug use, more frequent traditional 12-step groups outside of the program and higher psychiatric medication adherence. There were no differences in psychiatric symptoms or program retention, however. This study helps demonstrate the benefits of introducing 12-step, dual-focus mutual aid into psychiatric treatment programs that serve patients with co-occurring disorders.