1
|
Oser CB, Moody MD, Hansen AC, Stevens-Watkins D, Staton M, Bunting AM. Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: A latent class approach. Drug Alcohol Depend 2024; 260:111326. [PMID: 38733734 DOI: 10.1016/j.drugalcdep.2024.111326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/01/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND The purpose of this study includes: 1) identifying classes of substance-related needs among Black women, and 2) examining the effect of substance-related need classes and culturally-relevant factors on Black women's use of substance use disorder (SUD) treatment and mutual support groups. METHODS As part of a longitudinal cohort study, Black women were recruited in prison nearing release, on probation, and in the community without involvement in the criminal legal system (CLS, n=565) and followed-up at 18-months. We conducted a baseline latent class analysis of substance-related needs among Black women. Logistic regression models adjusted for culturally-relevant factors to predict the use of treatment and frequency of mutual support group participation over 18-months among Black women who use drugs. RESULTS Four classes by level of needs were found: low, daily marijuana use, high mental health, and high comorbidity. During the 18-month follow-up, women characterized by the high comorbidity need class and with higher scores of religious well-being were more likely to frequently participate in mutual support groups. Non-CLS-involved women were less likely to engage with both treatment and mutual support groups than women from the prison sample at 18-months. CONCLUSIONS This study highlights four distinct classes of substance-related needs among Black women, highlighting the complex patterns of behavior and within-racial group differences among Black women. Black women with high comorbidity needs were more likely to participate in mutual support groups, but the latent classes did not predict SUD treatment indicating other non-medical and social contextual need factors may be at play.
Collapse
Affiliation(s)
- Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY 40506, United States.
| | - Myles D Moody
- Department of Sociology, The University of Alabama at Birmingham, Heritage Hall, Room 460, 1401 University Blvd, Birmingham, AL 35233, United States
| | - Anna C Hansen
- Department of Sociology, College of Medicine, University of Kentucky, 1519 Patterson Office Tower, Lexington, KY 40506, United States
| | - Danelle Stevens-Watkins
- Department of Counseling Psychology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 251c Dickey Hall, Lexington, KY 40506, United States
| | - Michele Staton
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, 117 Medical Behavioral Science Building, Lexington, KY 40506, United States
| | - Amanda M Bunting
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, United States
| |
Collapse
|
2
|
Stenersen MR, Thomas K, Struble C, Moore KE, Burke C, McKee S. The impact of self-help groups on successful substance use treatment completion for opioid use: An intersectional analysis of race/ethnicity and sex. J Subst Abuse Treat 2021; 136:108662. [PMID: 34840040 PMCID: PMC8940633 DOI: 10.1016/j.jsat.2021.108662] [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: 02/03/2021] [Revised: 10/04/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Race/ethnicity and sex disparities in substance use and substance use treatment completion are well documented in the literature. Previous literature has shown that participation in self-help groups is associated with higher rates of substance use treatment completion. While most of this research has focused on the completion of treatment for alcohol and stimulant use, research examining this relationship using an intersectional approach for individuals in treatment for opioid use is limited. METHODS Thus, the current study utilized responses from the Treatment Episodes Data Set-Discharges, 2015-2017 to examine disparities in the relationship between participation in self-help groups and substance use treatment completion for individuals undergoing treatment for opioid use based on sex, race, and ethnicity. RESULTS Results revealed a positive association between participation in self-help groups and treatment completion among those in treatment for opioid use across race, ethnicity, and sex. Further, the study found several differences in this association based on one's race, ethnicity, and sex. When compared to men of other races/ethnicities, the association between self-help group participation and treatment completion was highest among Black men. CONCLUSIONS The results of the current study extend the knowledge-base about self-help participation's role in promoting successful substance use treatment completion to individuals in treatment for opioid use. Results also highlight the need to examine treatment outcomes with an intersectional lens.
Collapse
Affiliation(s)
| | - Kathryn Thomas
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA.
| | - Cara Struble
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA.
| | - Kelly E Moore
- Department of Psychology, East Tennessee States University, Johnson City, TN 37614, USA.
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA.
| | - Sherry McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA.
| |
Collapse
|
3
|
Zemore SE, Gilbert PA, Pinedo M, Tsutsumi S, McGeough B, Dickerson DL. Racial/Ethnic Disparities in Mutual Help Group Participation for Substance Use Problems. Alcohol Res 2021; 41:03. [PMID: 33717774 PMCID: PMC7934641 DOI: 10.35946/arcr.v41.1.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Mutual help groups are a ubiquitous component of the substance abuse treatment system in the United States, showing demonstrated effectiveness as a treatment adjunct; so, it is paramount to understand whether they are as appealing to, and as effective for, racial or ethnic minority groups as they are for Whites. Nonetheless, no known comprehensive reviews have examined whether there are racial/ethnic disparities in mutual help group participation. Accordingly, this study comprehensively reviewed the U.S. literature on racial/ethnic disparities in mutual help participation among adults and adolescents with substance use disorder treatment need. The study identified 19 articles comparing mutual help participation across specific racial/ethnic minority groups and Whites, including eight national epidemiological studies and 11 treatment/community studies. Most compared Latinx and/or Black adults to White adults, and all but two analyzed 12-step participation, with others examining "self-help" attendance. Across studies, racial/ethnic comparisons yielded mostly null (N = 17) and mixed (N = 9) effects, though some findings were consistent with a racial/ethnic disparity (N = 6) or minority advantage (N = 3). Findings were weakly suggestive of disparities for Latinx populations (especially immigrants, women, and adolescents) as well as for Black women and adolescents. Overall, data were sparse, inconsistent, and dated, highlighting the need for additional studies in this area.
Collapse
Affiliation(s)
| | - Paul A Gilbert
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa
| | - Miguel Pinedo
- Center for Health and Social Policy, College of Education-Kinesiology and Health Education, University of Texas, Austin, Texas
| | - Shiori Tsutsumi
- School of Environment and Society, Department of Social and Human Sciences, Tokyo Institute of Technology, Tokyo, Japan
| | - Briana McGeough
- Cofrin Logan Center for Addiction Research and Treatment, School of Social Welfare, University of Kansas, Lawrence, Kansas
| | - Daniel L Dickerson
- Integrated Substance Abuse Programs, University of California, Los Angeles, California
| |
Collapse
|
4
|
Jordan A, Babuscio T, Nich C, Carroll KM. A feasibility study providing substance use treatment in the Black church. J Subst Abuse Treat 2020; 124:108218. [PMID: 33771290 DOI: 10.1016/j.jsat.2020.108218] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 10/02/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Black adults with substance use disorders (SUDs) experience health care disparities, including access to and retention in treatment. The Black church is a trusted institution in the Black community and could be a novel setting for providing SUD treatment. METHOD We conducted a nonrandomized feasibility study evaluating (1) whether it was possible to conduct a clinical trial of SUD treatment in this setting, (2) whether an adequate number of individuals with SUDs would participate in technology-based treatment in this setting, and (3) whether an adequate number of individuals would be retained in this setting. We evaluated computer-based training for cognitive behavioral therapy (CBT4CBT), with modifications that the church-based health advisors (CHAs), who delivered the intervention within the church, made. RESULTS Participants were 40 Black adults, all of whom met DSM-5 criteria for a current SUD, (55% severe). The mean number of sessions completed was 6.8 and 31 completed all 7 sessions of CBT4CBT. Both self-reports and weekly urine toxicology screens indicated reduction in substance use over time. CONCLUSION We demonstrated feasibility, as we were able to (1) collect weekly data and protect participant confidentiality, (2) recruit an adequate number of individuals with SUD, with (3) high uptake and retention of an adapted CBT4CBT in the Black church. If demonstrated to be effective in a future randomized clinical trial, delivery of technology-based treatments in the Black church may prove a promising, easily disseminable strategy to provide evidence-based interventions to an underserved and undertreated population.
Collapse
Affiliation(s)
- Ayana Jordan
- Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA.
| | - Theresa Babuscio
- Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA.
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA.
| | - Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, 300 George St, Suite 901, New Haven, CT 06511, USA.
| |
Collapse
|
5
|
Peavy KM, Garrett S, Doyle S, Donovan D. A comparison of African American and Caucasian stimulant users in 12-step facilitation treatment. J Ethn Subst Abuse 2016; 16:380-399. [PMID: 27294812 DOI: 10.1080/15332640.2016.1185657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Engagement in 12-step meetings and activities has been shown to be a powerful aid to recovery from substance use disorders. However, only limited attention has been given to ethnic and racial differences in attitudes toward 12-step and involvement. This study utilized data from a large multisite trial testing the effectiveness of a 12-step facilitation therapy with stimulant-dependent treatment seekers. We compared baseline differences and treatment outcomes between African American and Caucasian participants. A select few baseline differences were found (i.e., African Americans reported higher levels of spirituality than Caucasians; African American participants indicated more perceived benefits of 12-step involvement; Caucasians were more likely to endorse future involvement in 12-step). There were no outcome differences (e.g., substance use outcomes, 12-step meeting attendance). The tested intervention produced similar outcomes for both groups, indicating that it may be useful across racial categories.
Collapse
Affiliation(s)
- K Michelle Peavy
- a Alcohol & Drug Abuse Institute , University of Washington , Seattle , Washington.,b Evergreen Treatment Services , Seattle , Washington
| | - Sharon Garrett
- a Alcohol & Drug Abuse Institute , University of Washington , Seattle , Washington
| | - Suzanne Doyle
- a Alcohol & Drug Abuse Institute , University of Washington , Seattle , Washington
| | - Dennis Donovan
- a Alcohol & Drug Abuse Institute , University of Washington , Seattle , Washington
| |
Collapse
|
6
|
Feigenbaum JC. A Historical Review of Perceptions of Key Aspects of Spirituality and Religion Within Alcoholics Anonymous. J Addict Nurs 2013; 24:229-36. [DOI: 10.1097/jan.0000000000000004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Matthews CR, Lorah P. An Examination of Addiction Treatment Completion by Gender and Ethnicity. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2011. [DOI: 10.1002/j.2161-1874.2005.tb00197.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
8
|
Chen G. The Meaning of Suffering in Drug Addiction and Recovery from the Perspective of Existentialism, Buddhism and the 12-Step Program. J Psychoactive Drugs 2011; 42:363-75. [DOI: 10.1080/02791072.2010.10400699] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Gila Chen
- a Criminology Department , Ashkelon Academic College and Bar-Ilan University , Israel
| |
Collapse
|
9
|
|
10
|
Magura S. The relationship between substance user treatment and 12-step fellowships: current knowledge and research questions. Subst Use Misuse 2007; 42:343-60. [PMID: 17558934 DOI: 10.1080/10826080601142071] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article reviews and synthesizes information about the relationship between two distinct approaches to helping substance users, formal "addiction treatment" and 12-step mutual aid. The following issues are addressed: Extent of formal treatment and 12-step fellowship participation for persons with substance use-related problems; overlap between treatment and 12-step participation; early attempts to "integrate" treatment and 12-step mutual aid; differences and similarities between the 12-step program and treatment; issues of spirituality in the 12-step program; effectiveness of 12-step participation as treatment aftercare; and whether help-seekers can be "matched" to 12-step. The article poses pertinent questions that could answered by additional research, including life cycle patterns of usage of treatment and 12-step, outcomes of such episodes, reasons for using different interventions at different times, feasibility of 12-step participation as a primary intervention, the relative contributions of striving for spiritual values vs. social support factors to the effectiveness of 12-step, and the comparative effectiveness of secular vs. 12-step mutual aid. The article concludes with a proposed reconceptualization of the relationship between formal treatment and 12-step mutual aid that may help in structuring future research.
Collapse
Affiliation(s)
- Stephen Magura
- National Development and Research Institutes, Inc.. New York, Ny 10010, USA.
| |
Collapse
|
11
|
Chen G. Social support, spiritual program, and addiction recovery. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2006; 50:306-23. [PMID: 16648385 DOI: 10.1177/0306624x05279038] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This study compared personal and emotional modifications of inmates who were recovering addicts and who participated in one of two year-long therapeutic intervention programs, one including social support and experiential spiritual program components (Narcotics Anonymous, NA, meetings and the 12-step course), the other including primarily social support (NA meetings only, without the 12-step program). The hypothesis was that supplementing social support programs with a concrete spiritual program would result in more positive personal and emotional changes. The results seem to support the hypothesis: Inmates participating in the 12-step program demonstrated a higher sense of coherence and meaning in life and a gradual reduction in the intensity of negative emotions (anxiety, depression, and hostility) than those participating in NA meetings without the 12-step program. The research findings demonstrate the importance of the 12-step program as part of a rehabilitation process for drug addicts.
Collapse
|
12
|
Sowers W. Transforming systems of care: the American Association of Community Psychiatrists Guidelines for Recovery Oriented Services. Community Ment Health J 2005; 41:757-74. [PMID: 16328588 DOI: 10.1007/s10597-005-6433-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Thinking about recovery has grown significantly over the last 70 years, and particularly in the past fifteen. Promotion of recovery has recently been recognized as an organizing principle for the transformation of behavioral health services. Recovery is a personal process of growth and change which typically embraces hope, autonomy and affiliation as elements of establishing satisfying and productive lives in spite of disabling conditions or experiences. Recovery oriented services replace paternalistic, illness oriented perspectives with collaborative, autonomy enhancing approaches and represent a major cultural shift in service delivery. Recovery oriented services replace the myth of chronicity and dependence with a message of individualism, empowerment and choice in the context of collaborative relationships with service providers. The American Association of Community Psychiatrists has developed Guidelines for Recovery Oriented Services to facilitate the transformation of services to this new paradigm. The guidelines are divided into three domains: administration, treatment, and supports, each consisting of several elements for which recovery enhancing characteristics are defined. Several example indicators are also provided for each element. This paper presents these guidelines and discusses their application.
Collapse
Affiliation(s)
- Wesley Sowers
- Allegheny County Office of Behavioral Health, 304 Wood Street, 5th Floor, Pittsburgh, PA 15222, USA.
| |
Collapse
|
13
|
Abstract
Culturally appropriate strategies have been deemed necessary for the treatment of substance abuse among African American women. This qualitative study was conducted utilizing a grounded theory methodology within a womanist theoretical framework to explore the process by which parenting African American women participate in formal substance abuse treatment programs. Study findings yielded significant insights into this process and support the notion that culturally appropriate frameworks are necessary to help substance-abusing African American women enter into treatment programs and remain in recovery. In addition, specific interventions for treating substance-abusing African American women within a culturally relevant framework are discussed.
Collapse
Affiliation(s)
- Lisa M Lewis
- Teachers College, Columbia University, New York, New York 10027, USA.
| |
Collapse
|
14
|
Laudet AB. Attitudes and beliefs about 12-step groups among addiction treatment clients and clinicians: toward identifying obstacles to participation. Subst Use Misuse 2003; 38:2017-47. [PMID: 14677780 PMCID: PMC1855195 DOI: 10.1081/ja-120025124] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Participation in 12-step groups (12SG) during and after formal treatment has been associated with positive outcome among substance users. However, the effectiveness of 12SG may be limited by high attrition rates and by low participation, areas on which there has been little research. Clinicians play an important role in fostering 12-step participation, and the insights which they develop in their practice can greatly contribute to informing the research process. Yet, little is known about clinicians' attitudes about 12-step groups or about their experiences in referring clients. This study surveyed clients (N = 101) and clinicians (N = 102) in outpatient treatment programs to examine 12-step-related attitudes and to identify potential obstacles to participation. Data collection was conducted between May, 2001 and January, 2002 in New York City. Both client and clinician samples were primarily African-American and Hispanic; 32% of clients reported substance use in the previous month, with crack and marijuana cited most frequently as the primary drug problem. On average, clinicians had worked in the treatment field for 8 years. Both staff and clients viewed 12SG as a helpful recovery resource. Major obstacles to participation centered on motivation and readiness for change and on perceived need for help, rather than on aspects of the 12-step program often cited as points of resistance (e.g., religious aspect and emphasis on powerlessness). Clinicians also frequently cited convenience and scheduling issues as possible obstacles to attending 12SG. Clinical implications of these findings are discussed, including the importance of fostering motivation for change, the need to assess clients' beliefs about and experiences with 12SG on a case-by-case basis, and to find a good fit between clients' needs and inclinations on the one hand, and the tools and support available within 12-step groups on the other.
Collapse
Affiliation(s)
- Alexandre B Laudet
- National Development and Research Institutes, Inc., New York, New York 10010, USA.
| |
Collapse
|
15
|
Hyun MS, Kools S, Kim SA. A model of recovery from substance abuse and dependence for Korean adolescents. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2003; 16:25-34. [PMID: 12790305 DOI: 10.1111/j.1744-6171.2003.tb00343.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PROBLEM There is a need for a model that illuminates the recovery process from substance abuse and dependence for Korean adolescents, identifies the stages and strategies of recovery, and directs interventions to specific stages. METHODS The model was developed from content analysis focused on the experiences during the recovery process of 8 Korean adolescents with substance abuse and dependence. CONCLUSIONS The stages in recovery include retracing, accepting, surrendering, and turning to change. The strategies of recovery involve a variety of activities and multidimensional domains. The model integrates the stages and strategies of recovery, and suggests nursing interventions to promote recovery of adolescents with a substance-related disorder.
Collapse
Affiliation(s)
- Myung Sun Hyun
- Ajou University, School of Medicine, Division of Nursing Science, Suwon, Korea.
| | | | | |
Collapse
|
16
|
Hogue CJR. Toward a systematic approach to understanding--and ultimately eliminating--African American women's health disparities. Womens Health Issues 2002; 12:222-37. [PMID: 12225686 DOI: 10.1016/s1049-3867(02)00144-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
17
|
Hillhouse MP, Fiorentine R. 12-Step Program Participation and Effectiveness: Do Gender and Ethnic Differences Exist? JOURNAL OF DRUG ISSUES 2001. [DOI: 10.1177/002204260103100313] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
Collapse
|
18
|
Ehrmin JT. Cultural Implications of the 12-Step Approach in Addictions Treatment and Recovery. J Addict Nurs 2000. [DOI: 10.3109/10884600009040636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
19
|
Fiorentine R. After drug treatment: are 12-step programs effective in maintaining abstinence? THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 1999; 25:93-116. [PMID: 10078980 DOI: 10.1081/ada-100101848] [Citation(s) in RCA: 177] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Although participation in 12-step programs is now widely utilized as a treatment aftercare resource by individuals with drug and alcohol problems, little is known about the effectiveness of such a practice. This paper identifies gaps in the existing literature and articulates methodological concerns that may compromise investigations of 12-step programs. It highlights the need for additional after-treatment studies, and it presents findings from a 24-month longitudinal after-treatment study that suggests the effectiveness of 12-step programs. Rather than a behavioral indicator of recovery motivation or a spurious relationship confounded by additional treatment, aftercare, or alumni activities that occur simultaneously with 12-step participation, the findings suggest that weekly or more frequent 12-step participation is associated with drug and alcohol abstinence. Less-than-weekly participation is not associated with favorable drug and alcohol use outcomes, and participation in 12-step programs seems to be equally useful in maintaining abstinence from both illicit drug and alcohol use. These findings point to the wisdom of a general policy that recommends weekly or more frequent participation in a 12-step program as a useful and inexpensive aftercare resource for many clients.
Collapse
Affiliation(s)
- R Fiorentine
- UCLA Drug Abuse Research Center, Neuropsychiatric Institute, University of California, Los Angeles 90025, USA
| |
Collapse
|
20
|
Waitzfelder BE, Engel CC, Gilbert FI. Substance Abuse in Hawaii: Perspectives of Key Local Human Service Organizations. Subst Abus 1998; 19:7-22. [PMID: 12511803 DOI: 10.1080/08897079809511369] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Available evidence suggests that substance abuse in Hawaii is a substantial problem. The three major objectives of this study were to determine qualitatively Hawaii's human service organizations' perspective regarding (1) the magnitude of the statewide substance abuse problem, (2) the unmet needs of the state's substance abuse treatment system, and (3) the features of the problem unique to Hawaii's many ethnic and other subgroups. The study targeted those human service organizations most burdened by the substance abuse problem. Respondents from 55 human service organizations were interviewed using a series of 21 open-ended questions. Respondents perceived the magnitude of the Hawaii substance abuse problem to be at least comparable to that of the mainland United States. Although most respondents viewed the problem using a medical model, the problem was generally thought to be exacerbated by a community context in which substance abuse is accepted, excused, or denied. Increasing use of crystal methamphetamine and heroin were cited as the most worrisome trends. Systems issues identified were unstable funding, insufficient detoxification services, and limited availability of residential treatment and supportive services following treatment, such as housing and aftercare. Service delivery problems frequently associated with rural areas were identified, such as transportation, staff development, outreach, and difficulty providing a full range of services, particularly on neighbor islands. Cultural alienation, exacerbated by the state's prevailing multiculturalism, was thought to contribute to the substance abuse problem among all ethnic groups, but especially among Native Hawaiians. Cultural factors were thought to have a major impact on seeking care and subsequent acceptance of such care. Further study is needed to understand better the content of care, therapeutic elements, and efficacy of culturally specific treatment and prevention programs. To initiate change, concerted efforts are needed to inform Hawaii residents about the statewide substance abuse problem and local treatment system needs. Future studies should compare human service organization perceptions to those of individuals abusing substances and using these services.
Collapse
Affiliation(s)
- Beth E. Waitzfelder
- Pacific Health Research Institute, Hawaii MEDTEP Research Center, Thomas Square Centre, 846 South Hotel Street, Honolulu, Hawaii 96813
| | | | | |
Collapse
|
21
|
Abstract
Many drug user treatment programs have difficulty recruiting, retaining, and successfully treating minority clients. Coupled with the fact that cultural diversity among clients is likely to increase, this consideration makes it critical that programs take steps to increase their responsiveness to minority clients. Among the steps which administrators and clinicians recommend that programs take are conducting a needs assessment; implementing special outreach approaches; hiring additional minority staff; providing staff training and education in cultural sensitivity; and identifying client cultural characteristics at intake.
Collapse
Affiliation(s)
- P Finn
- Abt Associates Inc., Cambridge, Massachusetts 02138-1168, USA
| |
Collapse
|
22
|
Saulnier CF. Images of the Twelve-Step Model, and Sex and Love Addiction in an Alcohol Intervention Group for Black Women. JOURNAL OF DRUG ISSUES 1996. [DOI: 10.1177/002204269602600107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Alcoholics Anonymous twelve-step model was developed to help a specific population of white, middle-class, heterosexual men with a specific problem: alcoholism. As the program is applied to a wider variety of issues, with diverse populations, the model's generalizability has been called into question. Its applicability to outgroups is, at best, uncertain. At worst, the addiction model and its notion of powerlessness could have serious negative consequences. Until now, there has been scant research on the effect of using the program with marginalized people. Because of difficulties accessing these populations, the present study used innovative qualitative research methods to answer questions about the consequences of membership in twelve-step programs for a marginalized group: African-American women. This paper documents some of the problems that can occur when a program designed to solve a specific problem among a hegemonic group is used to address everyday activities of marginalized people.
Collapse
|
23
|
Affiliation(s)
- D E Smith
- Haight-Ashbury Free Clinics, Inc., San Francisco, CA 94117
| |
Collapse
|