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Timko C, Mericle A, Vest N, Delk J, Zemore SE. Mode of mutual-help group attendance: Predictors and outcomes in a US national longitudinal survey of adults with lifetime alcohol use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209395. [PMID: 38740188 PMCID: PMC11300150 DOI: 10.1016/j.josat.2024.209395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/23/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Although attending substance use-focused mutual-help meetings online may reduce attendance barriers, associations of attendance mode with group participation and outcomes are unknown. Using longitudinal data from mutual-help group attendees, this study, after identifying differences in baseline characteristics by attendance mode, examined associations of attendance mode with mutual-help participation (number of meetings attended, involvement) and outcomes (alcohol abstinence, heavy drinking, alcohol problems). METHODS The Peer Alternatives for Addiction Study 2021 Cohort sampled attendees of 12-step groups (e.g., Alcoholics Anonymous), Women for Sobriety, LifeRing Secular Recovery, and/or SMART Recovery in-person and/or online within 30 days before baseline. The baseline sample, recruited in fall 2021, was 531 adults with lifetime alcohol use disorder, followed at 6 (88 %) and 12 months (85 %). Differences in baseline characteristics by attendance mode were tested using Chi-squares and ANOVAs. GEE models examined associations of attendance mode, time, and their interactions with mutual-help group participation and alcohol outcomes. The in-person only mode was compared to the online-only, and to the in-person plus online, modes. RESULTS At baseline, 53.7 % of participants had attended only online meetings in the past 30 days, 33.7 % had attended both in-person and online meetings, and 12.6 % had attended only in-person meetings. Online meeting attendees were less likely to endorse lifetime abstinence as an alcohol recovery goal than in-person-only meeting attendees. In adjusted models (including for recovery goal), those attending online meetings only, or both online and in-person meetings, attended a greater number of meetings compared to those attending only in-person meetings. However, online-only attendance was associated with less involvement than in-person-only attendance. In adjusted models, compared to baseline, involvement increased and outcomes improved at follow-ups. Adjusted models examining alcohol outcomes found that no attendance at mutual-help groups at follow-ups was associated with more heavy drinking compared to in-person-only attendance. CONCLUSIONS Findings inform efforts to ascertain benefits of mutual-help group participation by suggesting that online attendance is associated with attending more meetings, less involvement, and lower endorsement of abstinence as a recovery goal, and is comparable to in-person attendance on alcohol outcomes. In-person attendance may be more beneficial for less heavy drinking than terminating attendance.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation, VA Health Care System, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA.
| | - Amy Mericle
- Alcohol Research Group, Emeryville, CA 94608, USA
| | - Noel Vest
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA
| | - Joanne Delk
- Alcohol Research Group, Emeryville, CA 94608, USA
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Beck AK, Waks S, Argent A, Deane FP, Larance B, Manning V, Baker AL, Hides L, Kelly PJ. The benefits and challenges of virtual SMART recovery mutual-help groups: Participant and facilitator perspectives. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104174. [PMID: 37659377 DOI: 10.1016/j.drugpo.2023.104174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND COVID-19 prompted widespread transition of face-to-face mutual-help groups to virtual delivery. Current understanding of the experience of virtual mutual-help groups is limited to 12-step approaches or asynchronous groups (e.g., forums). This paper explores participant and facilitator perspectives regarding the benefits and challenges of accessing SMART Recovery mutual-help groups virtually via videoconference. METHODS A self-selected convenience sample of participants (n = 29) and facilitators (n = 15) from SMART Recovery mutual-help groups in Australia were enrolled. Participants and facilitators were sampled to reflect experience of virtual groups delivered via videoconference ('online'), face-to-face groups ('face-to-face') or both types of groups ('both'). Telephone qualitative interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed, and analysed using iterative categorisation. RESULTS Participant and facilitators discussed their experience across eight interconnected themes benefits were typically discussed with regard to the (1) availability, (2) ease of access and (3) value add of the chat feature in online groups. Challenges largely pertained to (1) in-group engagement, (2) group size, (3) non-verbal cues, (4) social interaction and (5) technology problems. The impact of these challenges on participant and facilitator experience varied, and neither modality was consistently identified as superior. CONCLUSIONS SMART Recovery mutual-help groups provided participants with another option for accessing mutual-help and appealed to different people under different circumstances. Depending on the needs and preferences of the individual, online SMART Recovery mutual-help groups may help to mitigate a range of barriers to help seeking and may also engage people otherwise unable or reluctant to engage in treatment. To inform training, practice and policy, improved understanding of the individual and contextual factors that enhance participant engagement, experience and outcomes is needed.
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Affiliation(s)
- Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia.
| | - Shifra Waks
- Discipline of Occupational Therapy, The University of Sydney, NSW, Australia
| | | | - Frank P Deane
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Briony Larance
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, NSW, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, QLD, Australia
| | - Peter J Kelly
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
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Manning V, Roxburgh AD, Savic M. Piloting the integration of SMART Recovery into outpatient alcohol and other drug treatment programs. Addict Sci Clin Pract 2023; 18:52. [PMID: 37674227 PMCID: PMC10481580 DOI: 10.1186/s13722-023-00406-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/15/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Research suggests peer support groups can amplify and extend treatment effects and enhance long-term recovery from Alcohol and Other Drug (AOD) problems. However, they are rarely integrated into outpatient treatment programs, resulting in a missed opportunity for peer-to-peer learning, and increased connection to others social networks where people want to reduce or cease substance use. METHOD In this mixed-methods study, we examined the uptake, participant experiences and impacts of Self-Management and Recovery Training (SMART) when embedded in three public AOD treatment programs in a pilot program in Australia. Groups were delivered initially in-person but transitioned online during the COVID-19 pandemic. RESULTS A total of 75 SMART Recovery groups were run by the pilot sites, with an average attendance of 6.5 people per meeting. Among Participants (N = 31) who completed the survey, 94% reported benefits relating to substance use (i.e., reduction/ successful maintenance of abstinence), 71% reported improvements in their mental health and wellbeing, 74% reported improvements in their physical health, and 81% reported feeling better connected with others. In-depth qualitative interviews were conducted with 10 participants to explore their experiences. Thematic analysis revealed four themes: motivation to attend, active ingredients, views on the integration of SMART into formal AOD, and the advantages and disadvantages of online groups. CONCLUSION Taken together, these findings suggest embedding SMART Recovery in AOD treatment is a worthwhile endeavour. This was indicated by a good uptake and evidence of multiple and unique benefits to participants over and above their usual care, notably, better management of their AOD use, health, wellbeing, and sense of connection with others.
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Affiliation(s)
- V Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Clayton, Australia
- Turning Point, Eastern Health, Box Hill, Australia
| | - A D Roxburgh
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Clayton, Australia.
- Turning Point, Eastern Health, Box Hill, Australia.
| | - M Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Clayton, Australia
- Turning Point, Eastern Health, Box Hill, Australia
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Beck AK, Larance B, Baker AL, Deane FP, Manning V, Hides L, Kelly PJ. Supporting people affected by problematic alcohol, substance use and other behaviours under pandemic conditions: A pragmatic evaluation of how SMART recovery Australia responded to COVID-19. Addict Behav 2023; 139:107577. [PMID: 36528964 PMCID: PMC9741494 DOI: 10.1016/j.addbeh.2022.107577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic prompted rapid, reflexive transition from face-to-face to online healthcare. For group-based addiction services, evidence for the impact on service delivery and participant experience is limited. METHODS A 12-month (plus 2-month follow-up) pragmatic evaluation of the upscaling of online mutual-help groups by SMART Recovery Australia (SRAU) was conducted using The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Data captured by SRAU between 1st July 2020 and 31st August 2021 included participant questionnaires, Zoom Data Analytics and administrative logs. RESULTS Reach: The number of online groups increased from just 6 pre-COVID-19 to 132. These groups were delivered on 2786 (M = 232.16, SD = 42.34 per month) occasions, to 41,752 (M = 3479.33, SD = 576.34) attendees. EFFECTIVENESS Participants (n = 1052) reported finding the online group meetings highly engaging and a positive, recovery supportive experience. 91 % of people with experience of face-to-face group meetings rated their online experience as equivalent or better. Adoption: Eleven services (including SRAU) and five volunteers delivered group meetings for the entire 12-months. IMPLEMENTATION SRAU surpassed their goal of establishing 100 groups. Maintenance: The average number of meetings delivered [t(11.14) = -1.45, p = 0.1737] and attendees [t(1.95) = -3.28, p = 0.1880] per month were maintained across a two-month follow-up period. CONCLUSIONS SRAU scaled-up the delivery of online mutual-help groups in response to the COVID-19 pandemic. Findings support the accessibility, acceptability and sustainability of delivering SMART Recovery mutual-help groups online. Not only are these findings important in light of the global pandemic and public safety, but they demonstrate the potential for reaching and supporting difficult and under-served populations.
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Affiliation(s)
- Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia.
| | - Briony Larance
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Australia.
| | - Frank P Deane
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Australia.
| | - Peter J Kelly
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
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Al-Hakeim HK, Altufaili MF, Almulla AF, Moustafa SR, Maes M. Increased Lipid Peroxidation and Lowered Antioxidant Defenses Predict Methamphetamine Induced Psychosis. Cells 2022; 11:3694. [PMID: 36429122 PMCID: PMC9688750 DOI: 10.3390/cells11223694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND a significant percentage of methamphetamine (MA) dependent patients develop psychosis. The associations between oxidative pathways and MA-induced psychosis (MIP) are not well delineated. OBJECTIVE the aim of this study is to delineate whether acute MA intoxication in MA dependent patients is accompanied by increased nitro-oxidative stress and whether the latter is associated with MIP. METHOD we recruited 30 healthy younger males and 60 acutely intoxicated males with MA dependence and assessed severity of MA use and dependence and psychotic symptoms during intoxication, and serum oxidative toxicity (OSTOX) biomarkers including oxidized high (oxHDL) and low (oxLDL)-density lipoprotein, myeloperoxidase (MPO), malondialdehyde (MDA), and nitric oxide (NO), and antioxidant defenses (ANTIOX) including HDL-cholesterol, zinc, glutathione peroxidase (GPx), total antioxidant capacity (TAC), and catalase-1. RESULTS a large part (50%, n = 30) of patients with MA dependence could be allocated to a cluster characterized by high psychosis ratings including delusions, suspiciousness, conceptual disorganization and difficulties abstract thinking and an increased OSTOX/ANTIOX ratio. Partial Least Squares analysis showed that 29.9% of the variance in MIP severity (a first factor extracted from psychosis, hostility, excitation, mannerism, and formal thought disorder scores) was explained by HDL, TAC and zinc (all inversely) and oxLDL (positively). MA dependence and dosing explained together 44.7% of the variance in the OSTOX/ANTIOX ratio. CONCLUSIONS MA dependence and intoxication are associated with increased oxidative stress and lowered antioxidant defenses, both of which increase risk of MIP during acute intoxication. MA dependence is accompanied by increased atherogenicity due to lowered HDL and increased oxLDL and oxHDL.
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Affiliation(s)
| | | | - Abbas F. Almulla
- Department of Psychiatry, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf 54001, Iraq
| | - Shatha Rouf Moustafa
- Clinical Analysis Department, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Psychiatry, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
- School of Medicine, Barwon Health, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong VIC 3216, Australia
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