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Engagement patterns with a digital therapeutic for substance use disorders: Correlations with abstinence outcomes. J Subst Abuse Treat 2021; 132:108585. [PMID: 34366201 DOI: 10.1016/j.jsat.2021.108585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 06/25/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patient engagement may play a key role in the success or failure of treatments for substance use disorder (SUD). This exploratory analysis of data from a large, multisite effectiveness trial (NCT01104805) sought to determine how patient engagement with a digital therapeutic for SUD delivered at clinics was associated with abstinence outcomes. METHODS The study evaluated engagement for 206 participants enrolled in a treatment program for SUDs related to cocaine, alcohol, cannabis, or other stimulants who were randomized to receive treatment as usual (TAU) or reduced TAU plus the digital Therapeutic Education System (TES) for 12 weeks. Participants were eligible for contingency management incentives for module completion (modules cover Community Reinforcement Approach topic areas) and negative urine drug screens. Analyses examined the association of module completion with end-of-treatment abstinence. RESULTS Participants completed a mean of 38.8 (range 0-72) TES modules over 12 weeks of treatment. Study completers (n = 157) completed a mean of 45.5 (range 9-72) TES modules, whereas study noncompleters (n = 49) completed a mean of 17.4 (range 0-45) TES modules. The study observed a strong positive correlation between TES engagement (i.e., total number of modules completed) and the probability of abstinence during weeks 9-12 of treatment among 157 study completers (OR = 1.11; 95% CI 1.08-1.14). Each module completed increased the odds of abstinence during weeks 9-12 by approximately 11% for study completers and 9% for the full sample. The study observed a similar, but weaker, association between engagement and abstinence among 49 patients who did not complete the study (OR = 1.02; 95% CI 0.98-1.07). CONCLUSIONS Greater engagement with a digital therapeutic for patients with SUD (i.e., number of modules completed over time) was strongly associated with the probability of abstinence in the last four weeks of treatment among those who completed the recommended 12-week treatment. TRIALS REGISTRATION ClinicalTrials.gov Identifier: NCT01104805.
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Chen T, Zhong N, Du J, Li Z, Zhao Y, Sun H, Chen Z, Jiang H, Zhao M. Polydrug use patterns and their impact on relapse among heroin-dependent patients in Shanghai, China. Addiction 2019; 114:259-267. [PMID: 30276902 DOI: 10.1111/add.14451] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/15/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022]
Abstract
AIMS To describe the polysubstance use patterns of heroin-dependent patients and to understand the impact of polysubstance use patterns on relapse during the 5 years after completing compulsory rehabilitation programmes. DESIGN In this secondary analysis, the baseline data of 503 heroin-dependent patients were linked with their 5-year follow-up data from official records. SETTING Four compulsory rehabilitation centres in Shanghai, China. PARTICIPANTS A total of 564 heroin-dependent patients who were discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008 were recruited. Among these, 503 patients with available follow-up records were included in this analysis. MEASUREMENTS The baseline measurements included the Addiction Severity Index, the Temperament and Character Inventory and the Medical Outcomes Study Social Support Scale. Relapses after discharge from the compulsory rehabilitation centres were extracted monthly from the official electronic record system. Latent class analysis was used to identify different polysubstance use patterns. Associations between the identified latent classes and heroin use and the factors related to relapse during the 5-year follow-up were analysed with the Cox regression model. FINDINGS Three latent classes were identified in this cohort: (1) alcohol polydrug users (APU; 13.7%), (2) low polydrug users (LPU; 76.5%) and (3) amphetamine-type stimulant polydrug users (ASPU; 9.7%). During the 5-year follow-up, 298 heroin patients relapsed, and the three groups showed different relapse rates (ASPU 69.4 versus LPU 60.5 versus APU 44.9%, P = 0.02). The average durations of abstinence for the three groups differed (ASPU 31.27 ± 3.41 months versus LPU 36.77 ± 1.19 months versus APU 42.46 ± 2.81 months, P = 0.02). Multivariate Cox regression analyses found that the LPU [hazard ratio (HR) = 1.63, 1.06-2.51] and ASPU (HR = 2.10, 1.24-3.56) classes were positively associated with the risk of heroin relapse. CONCLUSION Polydrug use patterns differ among heroin-dependent patients in compulsory rehabilitation programmes in China. A history of polydrug use may predict heroin relapse risk among patients in those compulsory rehabilitation programmes.
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Affiliation(s)
- Tianzhen Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhibin Li
- Jiading Mental Health Center, Shanghai, China
| | - Yan Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiming Sun
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhikang Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Witkiewitz K, Votaw VR, Vowles KE, Kranzler HR. Opioid Misuse as a Predictor of Alcohol Treatment Outcomes in the COMBINE Study: Mediation by Medication Adherence. Alcohol Clin Exp Res 2018; 42:1249-1259. [PMID: 29873089 PMCID: PMC6063524 DOI: 10.1111/acer.13772] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alcohol is often consumed with opioids and alcohol misuse interferes with treatment for opioid use disorder (OUD). Drug misuse is associated with worse alcohol use disorder (AUD) treatment outcomes, yet no studies have investigated the role of opioid misuse in AUD treatment outcomes. METHODS We conducted secondary analyses of the medication conditions of the COMBINE study (n = 1,226), a randomized clinical trial of medications (acamprosate and/or naltrexone) and behavioral interventions (medication management and/or behavioral intervention) for alcohol dependence. We examined associations between baseline opioid misuse and the use of cannabis and other drugs with time to first drinking day, time to first heavy drinking day, and the frequency and intensity of drinking during treatment and 1 year following treatment, based on latent profile analysis. Opioid misuse was defined as use of illicit or prescription opioids without a prescription or not as directed in the previous 6 months, in the absence of OUD. Self-reported cannabis and other drug use were also examined. Seventy individuals (5.7%) met the opioid misuse definition and 542 (44.2%) reported use of cannabis or other drugs without opioid misuse. We also examined medication adherence as a potential mediator. RESULTS Baseline opioid misuse significantly predicted the time to first heavy drinking day (OR = 1.38 [95% CI: 1.13, 1.64], p = 0.001) and a higher probability of being in a heavier and more frequent drinking profile at the end of treatment (OR = 2.90 [95% CI: 1.43, 5.90], p = 0.003), and at 1 year following treatment (OR = 2.66 [95% CI: 1.26, 5.59], p = 0.01). Cannabis and other drug use also predicted outcomes. Medication adherence partially mediated the association between opioid misuse, cannabis use, other drug use, and treatment outcomes. CONCLUSIONS Opioid misuse and other drug use were associated with poorer AUD treatment outcomes, which was partially mediated by medication adherence. Clinicians and researchers should assess opioid misuse and other drug use in patients undergoing AUD treatment.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Victoria R Votaw
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Henry R Kranzler
- Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Witkiewitz K, Vowles KE. Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review. Alcohol Clin Exp Res 2018; 42:478-488. [PMID: 29314075 PMCID: PMC5832605 DOI: 10.1111/acer.13594] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/29/2017] [Indexed: 12/20/2022]
Abstract
The dramatic increase in opioid misuse, opioid use disorder (OUD), and opioid-related overdose deaths in the United States has led to public outcry, policy statements, and funding initiatives. Meanwhile, alcohol misuse and alcohol use disorder (AUD) are a highly prevalent public health problem associated with considerable individual and societal costs. This study provides a critical review of alcohol and opioid misuse, including issues of prevalence, morbidity, and societal costs. We also review research on interactions between alcohol and opioid use, the influence of opioids and alcohol on AUD and OUD treatment outcomes, respectively, the role of pain in the co-use of alcohol and opioids, and treatment of comorbid OUD and AUD. Heavy drinking, opioid misuse, and chronic pain individually represent significant public health problems. Few studies have examined co-use of alcohol and opioids, but available data suggest that co-use is common and likely contributes to opioid overdose-related morbidity and mortality. Co-use of opioids and alcohol is related to worse outcomes in treatment for either substance. Finally, chronic pain frequently co-occurs with use (and co-use) of alcohol and opioids. Opioid use and alcohol use are also likely to complicate the treatment of chronic pain. Research on the interactions between alcohol and opioids, as well as treatment of the comorbid disorders is lacking. Currently, most alcohol research excludes patients with OUD and there is lack of measurement in both AUD and OUD research in relation to pain-related functioning. Research in those with chronic pain often assesses opioid use, but rarely assesses alcohol use or AUD. New research to examine the nexus of alcohol, opioids, and pain, as well as their treatment, is critically needed.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM
| | - Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, NM
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Dennis CB, Roland BD, Loneck BM. Strengthening the working alliance through a clinician's familiarity with the 12-step approach. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:378-385. [PMID: 29048974 DOI: 10.1080/00952990.2017.1378892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/09/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The working alliance plays an important role in the substance use disorder treatment process. Many substance use disorder treatment providers incorporate the 12-Step approach to recovery into treatment. With the 12-Step approach known among many clients and clinicians, it may well factor into the therapeutic relationship. OBJECTIVE We investigated how, from the perspective of clients, a clinician's level of familiarity with and in-session time spent on the 12-Step approach might affect the working alliance between clients and clinicians, including possible differences based on a clinician's recovery status. METHOD We conducted a secondary study using data from 180 clients and 31 clinicians. Approximately 81% of client participants were male, and approximately 65% of clinician participants were female. We analyzed data with Stata using a population-averaged model. RESULTS From the perspective of clients with a substance use disorder, clinicians' familiarity with the 12-Step approach has a positive relationship with the working alliance. The client-estimated amount of in-session time spent on the 12-Step approach did not have a statistically significant effect on ratings of the working alliance. A clinician's recovery status did not moderate the relationship between 12-Step familiarity and the working alliance. CONCLUSION These results suggest that clinicians can influence, in part, how their clients perceive the working alliance by being familiar with the 12-Step approach. This might be particularly salient for clinicians who provide substance use disorder treatment at agencies that incorporate, on some level, the 12-Step approach to recovery.
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Affiliation(s)
- Cory B Dennis
- a School of Social Work, Brigham Young University , Provo , UT , USA
| | - Brian D Roland
- b Department of Behavioral Sciences , Indiana Wesleyan University , Marion , IN , USA
| | - Barry M Loneck
- c School of Social Welfare, University at Albany, State University of New York , Albany , NY , USA
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Hatch-Maillette M, Wells EA, Doyle SR, Brigham GS, Daley D, DiCenzo J, Donovan D, Garrett S, Horigian VE, Jenkins L, Killeen T, Owens M, Perl HI. Predictors of 12-Step Attendance and Participation for Individuals With Stimulant Use Disorders. J Subst Abuse Treat 2016; 68:74-82. [PMID: 27431050 DOI: 10.1016/j.jsat.2016.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/22/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Few studies have examined the effectiveness of 12-step peer recovery support programs with drug use disorders, especially stimulant use, and it is difficult to know how outcomes related to 12-step attendance and participation generalize to individuals with non-alcohol substance use disorders (SUDs). METHOD A clinical trial of 12-step facilitation (N=471) focusing on individuals with cocaine or methamphetamine use disorders allowed examination of four questions: Q1) To what extent do treatment-seeking stimulant users use 12-step programs and, which ones? Q2) Do factors previously found to predict 12-step participation among those with alcohol use disorders also predict participation among stimulant users? Q3) What specific baseline "12-step readiness" factors predict subsequent 12-step participation and attendance? And Q4) Does stimulant drug of choice differentially predict 12-step participation and attendance? RESULTS The four outcomes variables, attendance, speaking, duties at 12-step meetings, and other peer recovery support activities, were not related to baseline demographic or substance problem history or severity. Drug of choice was associated with differential days of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) attendance among those who reported attending, and cocaine users reported more days of attending AA or NA at 1-, 3- and 6-month follow-ups than did methamphetamine users. Pre-randomization measures of perceived benefit of 12-step groups predicted 12-step attendance at 3- and 6-month follow-ups. Pre-randomization 12-step attendance significantly predicted number of other self-help activities at end-of-treatment, 3- and 6-month follow-ups. Pre-randomization perceived benefit and problem severity both predicted number of self-help activities at end-of-treatment and 3-month follow-up. Pre-randomization perceived barriers to 12-step groups were negatively associated with self-help activities at end-of-treatment and 3-month follow-up. Whether or not one participated in any duties was predicted at all time points by pre-randomization involvement in self-help activities. CONCLUSIONS The primary finding of this study is one of continuity: prior attendance and active involvement with 12-step programs were the main signs pointing to future involvement. Limitations and recommendations are discussed.
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Affiliation(s)
- Mary Hatch-Maillette
- University of Washington Alcohol and Drug Abuse Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105; University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St., Seattle, WA 98105.
| | - Elizabeth A Wells
- University of Washington Alcohol and Drug Abuse Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105; University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105
| | - Suzanne R Doyle
- University of Washington Alcohol and Drug Abuse Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105
| | | | - Dennis Daley
- University of Pittsburgh School of Medicine, Department of Psychiatry, Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213
| | - Jessica DiCenzo
- San Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA 98110
| | - Dennis Donovan
- University of Washington Alcohol and Drug Abuse Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105; University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific St., Seattle, WA 98105
| | - Sharon Garrett
- University of Washington Alcohol and Drug Abuse Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105
| | - Viviana E Horigian
- University of Miami Department of Public Health Sciences, Miller School of Medicine, 1120 NW 14th St., Miami, FL 33136
| | - Lindsay Jenkins
- Multnomah County Health Department, 426 SW Stark St, Portland, OR 97204
| | - Therese Killeen
- Medical University of South Carolina Department of Psychiatry and Behavioral Sciences, 67 President St., Charleston, SC 29425
| | - Mandy Owens
- University of New Mexico Center on Alcoholism, Substance Abuse and Addictions, 2650 Yale Blvd SE, Albuquerque, NM 87106
| | - Harold I Perl
- Independent Consultant, P.O. Box 169, Arroyo Seco, NM 87514
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Parkman TJ, Lloyd C, Splisbury K. Self-Help Groups for Alcohol Dependency: A Scoping Review. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/1556035x.2015.1034824] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Short NA, Cronkite R, Moos R, Timko C. Men and women who attend Al-Anon: gender differences in reasons for attendance, health status and personal functioning, and drinker characteristics. Subst Use Misuse 2015; 50:53-61. [PMID: 25245105 DOI: 10.3109/10826084.2014.957772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although Al-Anon Family Groups (Al-Anon) is the most common source of help for people concerned about someone else's drinking, only 16% of members are men. To identify gender differences, we compared demographics, reasons for attendance, health status, and personal functioning, and drinker characteristics of 174 men and women attending Al-Anon. Men and women were similar in most areas; however, some key differences emerged. Men reported better overall mental health than women, and described some differing concerns and drinker characteristics. With this information, healthcare providers may facilitate men's participation in Al-Anon by addressing their unique concerns and possible barriers to attendance.
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Affiliation(s)
- Nicole A Short
- 1Department of Psychology, Florida State University , Tallahassee, Florida , USA
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Rice SL, Hagler KJ, Tonigan JS. Longitudinal trajectories of readiness to change: alcohol use and help-seeking behavior. J Stud Alcohol Drugs 2014; 75:486-95. [PMID: 24766761 DOI: 10.15288/jsad.2014.75.486] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Pre-post changes in readiness for change (RC) are commonly assessed in treatment outcome studies, often with contradictory results. Little is known about 12-month RC trajectories among those initiating change or about the association between RC and either within- or between-person alcohol use or time-lagged help-seeking behavior. METHOD This observational longitudinal study measured RC as ambivalence, problem recognition, and taking steps. Participants (N = 253; 66.4% male) diagnosed with alcohol use disorders were recruited from treatment sites, Alcoholics Anonymous (AA) groups, and other community sources when first initiating change and assessed at baseline and 3, 6, 9, and 12 months. RESULTS Support for significant participant heterogeneity as well as linear and quadratic change in RC trajectories was found, although results differed across the three aspects of RC. Independent associations of both within- and between-person percentage of days abstinent were found for ambivalence and taking steps. Lagged, time-specific fluctuations in prior help-seeking behaviors within an individual predicting subsequent RC showed that both AA (B = -1.650, p < .05) and treatment attendance (B = 2.914, p < .01) were associated with subsequent ambivalence. Prior increases in taking steps within individuals were predictive of subsequent AA but not treatment attendance. CONCLUSIONS Results inform treatment providers about how RC trajectories vary depending on alcohol use, both within and between individuals, and how individuals may mobilize change attitudes and behaviors, especially in relation to AA attendance. Future research should investigate additional predictors of RC trajectories and the causal direction between RC and help seeking.
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Affiliation(s)
- Samara L Rice
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Kylee J Hagler
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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Tonigan JS, Rynes K, Toscova R, Hagler K. Do changes in selfishness explain 12-step benefit? A prospective lagged analysis. Subst Abus 2014; 34:13-9. [PMID: 23327500 DOI: 10.1080/08897077.2012.691453] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
12-Step attendance is associated with increased abstinence. A strong claim made in 12-step literature is that alcoholics are pathologically selfish and that working the 12 steps reduces this selfishness, which, in turn, leads to sustained alcohol abstinence. This study tested this assumption by investigating the linkages between 12-step attendance, pathological narcissism, and drinking. One hundred thirty early Alcohol Anonymous (AA) affiliates with limited AA and treatment histories were recruited from treatment and community-based AA. A majority of the sample was alcohol dependent and reported illicit drug use before recruitment. Participants were interviewed at intake and at 3, 6, and 9 months. A majority of participants attended AA meetings throughout follow-up and such attendance predicted increased abstinence and reduced drinking intensity. 12-Step affiliates were significantly higher on pathological narcissism (PN) relative to general population samples and their PN remained elevated. Contrary to predictions, PN was unrelated to 12-step meeting attendance and did not predict later abstinence or drinking intensity. The findings did not support the hypothesis that reductions in PN explain 12-step benefit. An alternative function for the emphasis placed on pathological selfishness in 12-step programs is discussed and a recommendation is made to use unobtrusive measures of selfishness in future research.
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Affiliation(s)
- J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM87106, USA.
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Decker KP, Peglow SL, Samples CR. Participation in a novel treatment component during residential substance use treatment is associated with improved outcome: a pilot study. Addict Sci Clin Pract 2014; 9:7. [PMID: 24886745 PMCID: PMC4047771 DOI: 10.1186/1940-0640-9-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A person-centered substance use treatment component, the Natural Recovery Program, was developed. The Natural Recovery Program is comprised of small group therapy combined with pursuit of hobbies. METHODS This was a pilot study of the program and was not randomized. A retrospective record review of 643 veterans in an inpatient mental health recovery and rehabilitation program was analyzed to determine if participants of Natural Recovery had a different rate of treatment completion than those who elected to participate in the core program alone. Univariate and multivariate analyses were conducted on: participation in the Natural Recovery Program; co-morbid psychiatric disorders; and legal, medical, and psychiatric issues. RESULTS Participation in Natural Recovery was significantly associated with successful treatment completion when analyzed by univariate analysis (p = 0.01). Other significant variables associated with successful completion included: no co-morbid psychiatric diagnosis, fewer prior suicide attempts, and no homelessness prior to admission. Binary logistic regression demonstrated that participation in Natural Recovery was associated with improved treatment completion, even when other variables were considered (p = 0.01). Treatment retention was longer for patients who participated in Natural Recovery, even if they did not complete treatment. CONCLUSIONS The Natural Recovery Program was associated with improved outcomes, as measured by treatment retention in the first 60 days and by treatment completion. Participants of Natural Recovery with co-morbid psychiatric disorders completed treatment at a higher rate than those with co-morbid psychiatric disorders who participated in the core program. Patients reported high satisfaction with the program. This program may be a valuable adjunct to residential treatment.
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Affiliation(s)
- Kathleen P Decker
- Hampton Veterans Affairs Medical Center, MS/18, Hampton VAMC, Hampton, VA 23667, USA
- Eastern Virginia Medical School, 711 Southampton Avenue, Norfolk, VA 23510, USA
| | - Stephanie L Peglow
- Eastern Virginia Medical School, 711 Southampton Avenue, Norfolk, VA 23510, USA
| | - Carl R Samples
- Hampton Veterans Affairs Medical Center, MS/18, Hampton VAMC, Hampton, VA 23667, USA
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Timko C, Cronkite R, Laudet A, Kaskutas LA, Roth J, Moos RH. Al-Anon family groups' newcomers and members: Concerns about the drinkers in their lives. Am J Addict 2014; 23:329-36. [PMID: 24628725 DOI: 10.1111/j.1521-0391.2014.12122.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 08/13/2013] [Accepted: 09/21/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite Al-Anon's widespread availability and use, knowledge is lacking about the drinkers in attendees' lives. We filled this gap by describing and comparing Al-Anon newcomers' and members' reports about their "main drinker" (main person prompting initial attendance). METHODS Al-Anon's World Service Office mailed a random sample of groups, yielding completed surveys from newcomers (N = 362) and stable members (N = 265). RESULTS Newcomers' and members' drinkers generally were comparable. They had known their drinker for an average of 22 years and been concerned about his or her's drinking for 9 years; about 50% had daily contact with the drinker. Most reported negative relationship aspects (drinker gets on your nerves; you disagree about important things). Newcomers had more concern about the drinker's alcohol use than members did, and were more likely to report their drinkers' driving under the influence. Drinkers' most frequent problem due to drinking was family arguments, and most common source of help was 12-step groups, with lower rates among drinkers of newcomers. Concerns spurring initial Al-Anon attendance were the drinker's poor quality of life, relationships, and psychological status; goals for initial attendance reflected these concerns. DISCUSSION AND CONCLUSIONS The drinker's alcohol use was of less concern in prompting initial Al-Anon attendance, and, accordingly, the drinker's reduced drinking was a less frequently endorsed goal of attendance. SCIENTIFIC SIGNIFICANCE Family treatments for substance use problems might expand interventions and outcome domains beyond abstinence and relationship satisfaction to include the drinker's quality of life and psychological symptoms and in turn relieve concerns of family members.
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Affiliation(s)
- Christine Timko
- Department of Veterans Affairs Health Care System, Center for Health Care Evaluation, Stanford University Medical Center, Palo Alto, California
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Tonigan JS, Rynes KN, McCrady BS. Spirituality as a change mechanism in 12-step programs: a replication, extension, and refinement. Subst Use Misuse 2013; 48:1161-73. [PMID: 24041178 PMCID: PMC4768745 DOI: 10.3109/10826084.2013.808540] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This National Institutes of Health funded study investigated spiritual growth as a change mechanism in 12-step programs. A total of 130 people, early 12-step affiliates with limited Alcoholics Anonymous (AA) histories, were recruited from 2007 to 2008 from AA, treatment, and community centers in a Southwestern city in the United States. A majority of the sample was alcohol dependent. Participants were interviewed at baseline and at 3, 6, and 9 months. Lagged General Linear Modeling analyses indicated that spiritual change as measured by the Religious Background and Behavior (RBB) self-report questionnaire were predictive of increased abstinence and decreased drinking intensity, and that the magnitude of this effect varied across different RBB scoring algorithms. Future research should address study limitations by recruiting participants with more extensive AA histories and by including assessments of commitment to, and practice of, AA prescribed activities. The study's limitations are noted.
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Affiliation(s)
- J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico , Albuquerque, New Mexico , USA
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Tonigan JS, Rynes K, Toscova R, Hagler K. Do changes in selfishness explain 12-step benefit? A prospective lagged analysis. Subst Abus 2013. [PMID: 23327500 DOI: 10.1080/08897077.2012.691453.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
12-Step attendance is associated with increased abstinence. A strong claim made in 12-step literature is that alcoholics are pathologically selfish and that working the 12 steps reduces this selfishness, which, in turn, leads to sustained alcohol abstinence. This study tested this assumption by investigating the linkages between 12-step attendance, pathological narcissism, and drinking. One hundred thirty early Alcohol Anonymous (AA) affiliates with limited AA and treatment histories were recruited from treatment and community-based AA. A majority of the sample was alcohol dependent and reported illicit drug use before recruitment. Participants were interviewed at intake and at 3, 6, and 9 months. A majority of participants attended AA meetings throughout follow-up and such attendance predicted increased abstinence and reduced drinking intensity. 12-Step affiliates were significantly higher on pathological narcissism (PN) relative to general population samples and their PN remained elevated. Contrary to predictions, PN was unrelated to 12-step meeting attendance and did not predict later abstinence or drinking intensity. The findings did not support the hypothesis that reductions in PN explain 12-step benefit. An alternative function for the emphasis placed on pathological selfishness in 12-step programs is discussed and a recommendation is made to use unobtrusive measures of selfishness in future research.
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Affiliation(s)
- J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM87106, USA.
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Worley MJ, Tate SR, Brown SA. Mediational relations between 12-Step attendance, depression and substance use in patients with comorbid substance dependence and major depression. Addiction 2012; 107:1974-83. [PMID: 22578037 PMCID: PMC3466338 DOI: 10.1111/j.1360-0443.2012.03943.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/09/2012] [Accepted: 05/04/2012] [Indexed: 11/28/2022]
Abstract
AIMS Among patients with substance dependence and comorbid major depressive disorder (MDD) receiving treatment in a controlled trial, we examined if group differences in depression were mediated by 12-Step involvement, and if the effects of 12-Step involvement on future alcohol and drug use were mediated by reductions in depression. DESIGN Controlled trial of Twelve-Step facilitation (TSF) and integrated cognitive-behavioral therapy (ICBT), delivered in out-patient groups for 6 months with adjunct pharmacotherapy. SETTING Out-patient dual diagnosis clinic in Veteran's Affairs Healthcare Center. PARTICIPANTS Veterans (n = 209) diagnosed with alcohol, stimulant or marijuana dependence and substance-independent MDD. MEASUREMENTS Twelve-Step attendance and affiliation, depression severity, percentage of days drinking and percentage of days using drugs assessed at baseline and months 3, 6 and 9. FINDINGS In multi-level analyses greater 12-Step meeting attendance predicted lower depression and mediated the superior depression outcomes of the TSF group, explaining 24.3% of the group difference in depression. Independent of treatment group, lower depression severity predicted lower future alcohol use and mediated the effects of 12-Step meetings, explaining 15.7% of their effects on future drinking. Controlled, lagged models indicated these effects were not confounded by current substance use, suggesting that depression had unique associations with 12-Step meeting attendance and future drinking. CONCLUSIONS For patients with substance dependence and major depressive disorder, attendance at 12-Step meetings is associated with mental health benefits that extend beyond substance use, and reduced depression could be a key mechanism whereby 12-Step meetings reduce future drinking in this population.
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Affiliation(s)
- Matthew J Worley
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92093-0043, USA
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Greenfield BL, Tonigan JS. The general alcoholics anonymous tools of recovery: the adoption of 12-step practices and beliefs. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 27:553-61. [PMID: 22867293 DOI: 10.1037/a0029268] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Working the 12 steps is widely prescribed for Alcoholics Anonymous (AA) members although the relative merits of different methods for measuring step work have received minimal attention and even less is known about how step work predicts later substance use. The current study (1) compared endorsements of step work on an face-valid or direct measure, the Alcoholics Anonymous Inventory (AAI), with an indirect measure of step work, the General Alcoholics Anonymous Tools of Recovery (GAATOR); (2) evaluated the underlying factor structure of the GAATOR and changes in step work over time; (3) examined changes in the endorsement of step work over time; and (4) investigated how, if at all, 12-step work predicted later substance use. New AA affiliates (N = 130) completed assessments at intake, 3, 6, and 9 months. Significantly more participants endorsed step work on the GAATOR than on the AAI for nine of the 12 steps. An exploratory factor analysis revealed a two-factor structure for the GAATOR comprising behavioral step work and spiritual step work. Behavioral step work did not change over time, but was predicted by having a sponsor, while Spiritual step work decreased over time and increases were predicted by attending 12-step meetings or treatment. Behavioral step work did not prospectively predict substance use. In contrast, spiritual step work predicted percent days abstinent. Behavioral step work and spiritual step work appear to be conceptually distinct components of step work that have distinct predictors and unique impacts on outcomes.
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Rynes KN, Tonigan JS. Does Pathway into 12-Step Programs Influence 12-Step-Related Benefit? ALCOHOLISM TREATMENT QUARTERLY 2012; 30:179-189. [PMID: 29056819 DOI: 10.1080/07347324.2012.663308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Most 12-step research recruits participants who are seeking treatment (cf. Kaskutas, Turk, Bond, & Weisner, 2003; Robinson, Cranford, Webb, & Brower, 2007), leaving open the question of how non-treatment-seeking individuals respond to 12-step involvement. The current study examined whether participants recruited from community-based Alcoholics Anonymous (AA) clubs or via advertisement/word-of-mouth differed in their 12-step attendance rates, substance use, and the association between these constructs compared to participants recruited from substance abuse treatment. Multilevel analyses showed that while associations between 12-step attendance and improved substance use did not differ by recruitment group, participants recruited from community-based AA clubs had higher 12-step attendance rates and a higher proportion of alcohol abstinent days than did all other participants. Results indicate that using diverse recruitment strategies may be necessary to obtain samples that are representative of the actual population of 12-step affiliates and to achieve results that estimate the true magnitude of 12-step effects.
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Affiliation(s)
- Kristina N Rynes
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Albuquerque, NM
| | - J Scott Tonigan
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA), Albuquerque, NM
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