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Mauro PM, Kaur N, Askari MS, Keyes KM. Alcohol or Drug Self-Help Use Among Adults in the United States: Age, Period, and Cohort Effects Between 2002 and 2018. Int J Ment Health Addict 2023:1-15. [PMID: 36785551 PMCID: PMC9907883 DOI: 10.1007/s11469-023-01012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/11/2023] Open
Abstract
In the context of an ongoing and worsening drug overdose epidemic in the USA, increases in free support services like self-help groups may be expected. We estimated differences in self-help use by age, period, or cohort among people who may have needed treatment. We included N = 92,002 adults from the 2002-2018 National Surveys on Drug Use and Health who met past-year DSM-IV substance use disorder criteria or received alcohol/drug treatment in any location. We used hierarchical age-period-cohort (HAPC) modeling to estimate average age-period-cohort associations with self-help. Level-1 covariates included age, race and ethnicity, household income, and sex. We quantified level-2 variance components using the median odds ratio (MOR). We found small positive HAPC period effects for alcohol/drug self-help that were driven by alcohol-specific effects. Birth cohort differences were observed starting at age 48. Younger birth cohorts, especially among Black adults, were less likely to report self-help use than older birth cohorts. MOR was consistently elevated for cohort effects (MOR = 1.17; covariance parameter: 0.15; 95% CI [0.11, 0.23]) but not for period effects. Overall, self-help use did not increase in the context of substantial treatment needs and worsening overdose racialized disparities. Instead, cohort effects explained trends in alcohol/drug self-help. Findings could indicate that younger birth cohorts may need additional supports, especially services tailored for Black and Hispanic people. Supplementary Information The online version contains supplementary material available at 10.1007/s11469-023-01012-2.
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Affiliation(s)
- Pia M. Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
| | - Navdep Kaur
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
| | - Melanie S. Askari
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
| | - Katherine M. Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032 USA
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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.
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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
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Kelly JF, Abry A, Ferri M, Humphreys K. Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers. Alcohol Alcohol 2020; 55:641-651. [PMID: 32628263 PMCID: PMC8060988 DOI: 10.1093/alcalc/agaa050] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 01/12/2023] Open
Abstract
AIMS A recently completed Cochrane review assessed the effectiveness and cost-benefits of Alcoholics Anonymous (AA) and clinically delivered 12-Step Facilitation (TSF) interventions for alcohol use disorder (AUD). This paper summarizes key findings and discusses implications for practice and policy. METHODS Cochrane review methods were followed. Searches were conducted across all major databases (e.g. Cochrane Drugs and Alcohol Group Specialized Register, PubMed, Embase, PsycINFO and ClinicalTrials.gov) from inception to 2 August 2019 and included non-English language studies. Randomized controlled trials (RCTs) and quasi-experiments that compared AA/TSF with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants or no treatment, were included. Healthcare cost offset studies were also included. Studies were categorized by design (RCT/quasi-experimental; nonrandomized; economic), degree of manualization (all interventions manualized versus some/none) and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). Random-effects meta-analyses were used to pool effects where possible using standard mean differences (SMD) for continuous outcomes (e.g. percent days abstinent (PDA)) and the relative risk ratios (RRs) for dichotomous. RESULTS A total of 27 studies (21 RCTs/quasi-experiments, 5 nonrandomized and 1 purely economic study) containing 10,565 participants were included. AA/TSF interventions performed at least as well as established active comparison treatments (e.g. CBT) on all outcomes except for abstinence where it often outperformed other treatments. AA/TSF also demonstrated higher health care cost savings than other AUD treatments. CONCLUSIONS AA/TSF interventions produce similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission, where AA/TSF is superior. AA/TSF also reduces healthcare costs. Clinically implementing one of these proven manualized AA/TSF interventions is likely to enhance outcomes for individuals with AUD while producing health economic benefits.
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Affiliation(s)
- John F Kelly
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra Abry
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marica Ferri
- Best Practices, Knowledge Exchange and Economic Issues, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Keith Humphreys
- Veterans Affairs and Stanford University Medical Centers, Stanford University Stanford School of Medicine, Stanford, CA, USA
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Garcia V, Pagano A, Recarte C, Lee JP. La Cultura Cura: Latino Culture, Shared Experiences, and Recovery in Northern Californian Anexos. ALCOHOLISM TREATMENT QUARTERLY 2020; 39:47-62. [PMID: 34305300 PMCID: PMC8294478 DOI: 10.1080/07347324.2020.1803167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article examines the anexo's use of Latino culture and shared experiences to promote recovery and its appeal to 1.5- and second-generation Latinos. Anexos are grassroots recovery groups with origins in Mexico that offer a residential Alcoholics Anonymous program in Latino communities. Data were gathered from a two-year (2014-2016) ethnographic study of anexos in Northern California and were analyzed thematically. Despite having access to publicly funded treatment, many 1.5- and second-generation Latinos accessed anexos based on cultural familiarity, shared experiences, and a desire to recuperate cultural practices lost during their substance use.
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Affiliation(s)
- Victor Garcia
- Department of Anthropology and Mid-Atlantic Research and Training Institute for Community and Behavioral Health (MARTI-CBH), Indiana University of Pennsylvania, Indiana, Pennsylvania, USA
| | - Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
| | - Carlos Recarte
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
| | - Juliet P. Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
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Abstract
BACKGROUND Alcohol use disorder (AUD) confers a prodigious burden of disease, disability, premature mortality, and high economic costs from lost productivity, accidents, violence, incarceration, and increased healthcare utilization. For over 80 years, Alcoholics Anonymous (AA) has been a widespread AUD recovery organization, with millions of members and treatment free at the point of access, but it is only recently that rigorous research on its effectiveness has been conducted. OBJECTIVES To evaluate whether peer-led AA and professionally-delivered treatments that facilitate AA involvement (Twelve-Step Facilitation (TSF) interventions) achieve important outcomes, specifically: abstinence, reduced drinking intensity, reduced alcohol-related consequences, alcohol addiction severity, and healthcare cost offsets. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, CINAHL and PsycINFO from inception to 2 August 2019. We searched for ongoing and unpublished studies via ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 15 November 2018. All searches included non-English language literature. We handsearched references of topic-related systematic reviews and bibliographies of included studies. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs and non-randomized studies that compared AA or TSF (AA/TSF) with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants, or no treatment. We also included healthcare cost offset studies. Participants were non-coerced adults with AUD. DATA COLLECTION AND ANALYSIS We categorized studies by: study design (RCT/quasi-RCT; non-randomized; economic); degree of standardized manualization (all interventions manualized versus some/none); and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). For analyses, we followed Cochrane methodology calculating the standard mean difference (SMD) for continuous variables (e.g. percent days abstinent (PDA)) or the relative risk (risk ratios (RRs)) for dichotomous variables. We conducted random-effects meta-analyses to pool effects wherever possible. MAIN RESULTS We included 27 studies containing 10,565 participants (21 RCTs/quasi-RCTs, 5 non-randomized, and 1 purely economic study). The average age of participants within studies ranged from 34.2 to 51.0 years. AA/TSF was compared with psychological clinical interventions, such as MET and CBT, and other 12-step program variants. We rated selection bias as being at high risk in 11 of the 27 included studies, unclear in three, and as low risk in 13. We rated risk of attrition bias as high risk in nine studies, unclear in 14, and low in four, due to moderate (> 20%) attrition rates in the study overall (8 studies), or in study treatment group (1 study). Risk of bias due to inadequate researcher blinding was high in one study, unclear in 22, and low in four. Risks of bias arising from the remaining domains were predominantly low or unclear. AA/TSF (manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi-randomized evidence) RCTs comparing manualized AA/TSF to other clinical interventions (e.g. CBT), showed AA/TSF improves rates of continuous abstinence at 12 months (risk ratio (RR) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants; high-certainty evidence). This effect remained consistent at both 24 and 36 months. For percentage days abstinent (PDA), AA/TSF appears to perform as well as other clinical interventions at 12 months (mean difference (MD) 3.03, 95% CI -4.36 to 10.43; 4 studies, 1999 participants; very low-certainty evidence), and better at 24 months (MD 12.91, 95% CI 7.55 to 18.29; 2 studies, 302 participants; low-certainty evidence) and 36 months (MD 6.64, 95% CI 1.54 to 11.75; 1 study, 806 participants; low-certainty evidence). For longest period of abstinence (LPA), AA/TSF may perform as well as comparison interventions at six months (MD 0.60, 95% CI -0.30 to 1.50; 2 studies, 136 participants; low-certainty evidence). For drinking intensity, AA/TSF may perform as well as other clinical interventions at 12 months, as measured by drinks per drinking day (DDD) (MD -0.17, 95% CI -1.11 to 0.77; 1 study, 1516 participants; moderate-certainty evidence) and percentage days heavy drinking (PDHD) (MD -5.51, 95% CI -14.15 to 3.13; 1 study, 91 participants; low-certainty evidence). For alcohol-related consequences, AA/TSF probably performs as well as other clinical interventions at 12 months (MD -2.88, 95% CI -6.81 to 1.04; 3 studies, 1762 participants; moderate-certainty evidence). For alcohol addiction severity, one study found evidence of a difference in favor of AA/TSF at 12 months (P < 0.05; low-certainty evidence). AA/TSF (non-manualized) compared to treatments with a different theoretical orientation (e.g. CBT) (randomized/quasi-randomized evidence) For the proportion of participants completely abstinent, non-manualized AA/TSF may perform as well as other clinical interventions at three to nine months follow-up (RR 1.71, 95% CI 0.70 to 4.18; 1 study, 93 participants; low-certainty evidence). Non-manualized AA/TSF may also perform slightly better than other clinical interventions for PDA (MD 3.00, 95% CI 0.31 to 5.69; 1 study, 93 participants; low-certainty evidence). For drinking intensity, AA/TSF may perform as well as other clinical interventions at nine months, as measured by DDD (MD -1.76, 95% CI -2.23 to -1.29; 1 study, 93 participants; very low-certainty evidence) and PDHD (MD 2.09, 95% CI -1.24 to 5.42; 1 study, 286 participants; low-certainty evidence). None of the RCTs comparing non-manualized AA/TSF to other clinical interventions assessed LPA, alcohol-related consequences, or alcohol addiction severity. Cost-effectiveness studies In three studies, AA/TSF had higher healthcare cost savings than outpatient treatment, CBT, and no AA/TSF treatment. The fourth study found that total medical care costs decreased for participants attending CBT, MET, and AA/TSF treatment, but that among participants with worse prognostic characteristics AA/TSF had higher potential cost savings than MET (moderate-certainty evidence). AUTHORS' CONCLUSIONS There is high quality evidence that manualized AA/TSF interventions are more effective than other established treatments, such as CBT, for increasing abstinence. Non-manualized AA/TSF may perform as well as these other established treatments. AA/TSF interventions, both manualized and non-manualized, may be at least as effective as other treatments for other alcohol-related outcomes. AA/TSF probably produces substantial healthcare cost savings among people with alcohol use disorder.
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Affiliation(s)
- John F Kelly
- Massachusetts General Hospital and Harvard Medical School, Recovery Research Institute, Center for Addiction Medicine, 151 Merrimac Street, 6th Floor, Boston, Massachusetts, USA, 02114
| | - Keith Humphreys
- Stanford University Stanford School of Medicine, Veterans Affairs and Stanford University Medical Centers, 401 North Quarry Road, Stanford, CA, USA
| | - Marica Ferri
- European Monitoring Centre for Drugs and Drug Addiction, Best practices, knowledge exchange and economic issues, Cais do Sodre' 1249-289 Lisbon, Lisbon, Portugal
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Cuadrado M. Roman Catholic Priests as Referral Sources and Treatment Aides for Hispanics with Substance Misuse/Abuse Problems. JOURNAL OF RELIGION AND HEALTH 2018; 57:609-621. [PMID: 28766248 DOI: 10.1007/s10943-017-0464-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This self-administered mail survey study, conducted along the USA-Mexico border, examines Roman Catholic Priests' involvement in aiding Hispanic individuals with substance abuse problems. The Priests were found to be highly involved or willing to be involved in: (1) participating in juramentos (pledge usually to Virgin of Guadalupe, with Priest as witness, to temporarily abstain from substance use), (2) providing referrals, and (3) working with family and/or treatment resources in the community in order to help the person seeking their help. Fluency in Spanish, regardless of Hispanic ethnicity, was found to positively impact involvement in juramentos, providing referrals, and willingness to work with community resources.
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Affiliation(s)
- Mary Cuadrado
- School of Social and Behavioral Sciences, Mercy College, 555 Broadway, Dobbs Ferry, NY, 10522, USA.
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Garcia V, Pagano A, Recarte C, Lee JP. The Anexo in Northern California: An Alcoholics Anonymous-Based Recovery Residence in Latino Communities. JOURNAL OF GROUPS IN ADDICTION & RECOVERY 2017; 12:158-176. [PMID: 28819349 PMCID: PMC5555670 DOI: 10.1080/1556035x.2017.1313147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Our ethnographic study on help-seeking pathways of Latino immigrants in northern California reveals that they turn to anexos in their treatment and recovery quest. Anexos are linguistically- and culturally-specific recovery houses with origins in Mexico and Alcoholics Anonymous and a long history in Latino communities across the United States. Drawing on the findings of our study, we characterize the anexos and compare them to other recovery residences using National Alliance for Recovery Residences (NARR) criteria. The description and comparison reveal that anexos cannot be placed into a single NARR residence category. We discuss why this is the case.
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Affiliation(s)
- Victor Garcia
- Department of Anthropology and Mid-Atlantic Research and Training Institute for Community and Behavioral Health (MARTI-CBH), Indiana University of Pennsylvania, Indiana, Pennsylvania, USA
| | - Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California USA
| | - Carlos Recarte
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California USA
| | - Juliet P. Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California USA
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8
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Su KC, Nguyen L, Rogers C. Deaths in Unlicensed Alcohol Rehabilitation Facilities<sup/>. J Forensic Sci 2016; 62:103-106. [PMID: 27864953 DOI: 10.1111/1556-4029.13253] [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: 07/24/2015] [Revised: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 12/01/2022]
Abstract
Non-English-speaking people do not always seek medical care through established institutions. This paper reports a series of deaths in unlicensed alcohol rehabilitation facilities serving Spanish-speaking men. These facilities are informal groups of alcohol abusing men who live together. New members receive various treatments, including administration of ethanol or isopropanol, restraint, and seclusion. We reviewed 42 deaths in unlicensed alcohol rehabilitation facilities in Los Angeles County during the years 2003-2014. Data gathered included age, length of time spent in the facility, blood alcohol and drugs at autopsy, and cause and manner of death. Causes of death included acute alcohol poisoning, alcohol withdrawal, and a variety of other causes. Three cases were considered homicides from restraint asphyxia. The Department of Medical Examiner-Coroner has worked with the police, district attorney, and State Department of Health Services to try to prevent additional deaths in unlicensed alcohol rehabilitation facilities. Nevertheless, prevention has been difficult.
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Affiliation(s)
- Keng-Chih Su
- Department of Medical Examiner-Coroner, 1104 North Mission Road, Los Angeles, CA, 90033
| | - Lawrence Nguyen
- Department of Medical Examiner-Coroner, 1104 North Mission Road, Los Angeles, CA, 90033
| | - Christopher Rogers
- Department of Medical Examiner-Coroner, 1104 North Mission Road, Los Angeles, CA, 90033
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9
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Frings D, Collins M, Long G, Pinto IR, Albery IP. A test of the Social Identity Model of Cessation Maintenance: The content and role of social control. Addict Behav Rep 2016. [PMID: 29532003 PMCID: PMC5845948 DOI: 10.1016/j.abrep.2016.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Engagement with self-help groups is a predictor of positive outcomes for those attempting to control their addictive behaviours. In common with other groups, self-help groups have to manage non-normative (‘deviant’) behaviour to ensure the social values of the group remain preserved, and the group can fulfil its aims. These processes may protect group members from relapse. Drawing on the Social Identity Model of Cessation Maintenance, the current study asked a number (n = 44) of attendees of fellowship (AA/NA/CA) and of SMART groups to list behaviours they saw as normative and deviant, and rate a variety of responses to deviant behaviours. Costs of relapse to both the self and the group were also measured alongside self-efficacy regarding cessation and identity as both an active addict and as a member of a self-help group. Results suggest that social control responses to deviance grouped into education, punishment and avoidant type responses. More social control was perceived by highly identifying self-help group members. Educational responses were seen as used by groups more extensively than other responses. Punishment responses were mediated by the perceived costs an individual's relapse incurred on the rest of the group. These findings inform our understanding of what standards of normative and deviant behaviour self-help groups hold, and how they react to violations of such norms. They also have a number of implications for practitioners and facilitators in regard to using social identities as part of the treatment process. Self-help groups are a prevalent and often effective aid to addiction cessation. Social Identity Model of Cessation Maintenance describes related social processes. Current study explored such mechanisms in instances members violated group norms. Social control mechanisms comprised education, punishment and avoidant responses. Punishment responses influenced by identity, and mediated by actions cost to group
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Affiliation(s)
- Daniel Frings
- Division of Psychology, London South Bank University, United Kingdom
- Corresponding author at: London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom.London South Bank University103 Borough RoadLondonSE1 0AAUnited Kingdom
| | - Michael Collins
- Division of Psychology, London South Bank University, United Kingdom
| | - Gavin Long
- Division of Psychology, London South Bank University, United Kingdom
| | - Isabel R. Pinto
- University of Porto, Portugal
- Institute of Social Sciences - University of Lisbon, Portugal
| | - Ian P. Albery
- Division of Psychology, London South Bank University, United Kingdom
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Anderson BT, Garcia A. 'Spirituality' and 'cultural adaptation' in a Latino mutual aid group for substance misuse and mental health. BJPsych Bull 2015; 39:191-5. [PMID: 26755953 PMCID: PMC4706138 DOI: 10.1192/pb.bp.114.048322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A previously unknown Spanish-language mutual aid resource for substance use and mental health concerns is available in Latino communities across the USA and much of Latin America. This kind of '4th and 5th step' group is a 'culturally adapted' version of the 12-step programme and provides empirical grounds on which to re-theorise the importance of spirituality and culture in mutual aid recovery groups. This article presents ethnographic data on this organisation.
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Cuadrado M. Hispanic Use of Juramentos and Roman Catholic Priests as Auxiliaries to Abstaining from Alcohol Use/Misuse. Ment Health Relig Cult 2015; 17:1015-1022. [PMID: 25685052 DOI: 10.1080/13674676.2014.995074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This self-administered mail survey study conducted along the US-Mexico border replicates and expands on research conducted in Florida regarding the prevalence of juramento use as an intervention technique for alcohol misuse. Juramentos are pledges to abstain from alcohol use for a time determined by the user. The pledge is usually to the Virgin of Guadalupe and is often done in the presence of a Roman Catholic Priest. As in Florida, the majority of Priests along the border reported they were familiar with the practice of juramentos and had already witnessed at least one. The majority of Priests who had done juramentos viewed them as effective. Since the vast majority of Priest indicated that they would begin or continue witnessing juramentos, this makes juramentos and Roman Catholic Priests a viable culturally sensitive aide for treatment among Hispanics, in particular those of Mexican descent.
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Affiliation(s)
- Mary Cuadrado
- University of Texas at El Paso, Criminal Justice, 500 W. University Avenue, El Paso, 79968 United States
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12
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Cuadrado M, Lieberman L. The Virgin of Guadalupe as an ancillary modality for treating Hispanic substance abusers: Juramentos in the United States. JOURNAL OF RELIGION AND HEALTH 2011; 50:922-930. [PMID: 19937121 DOI: 10.1007/s10943-009-9304-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
During a 6-month research study of substance abuse outreach and retention methods in Mexico, the authors learned about the common practice of a self-control mechanism to abstain from substance abuse: Juramentos. Juramentos are pledges usually made to the Virgin of Guadalupe in the presence of a Catholic priest. The Jurado promises not to drink during a specified period of time. The authors discuss the dynamics of Juramentos and present data from an exploratory study indicating that Juramentos are being used among Mexican migrants in Florida and may provide a culturally sensitive adjunct for treatment of Mexican and other Hispanic clients in the United States.
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Affiliation(s)
- Mary Cuadrado
- Institute for Policy and Economic Development, University of Texas at El Paso, 500 West University Ave, Kelly Hall #407, El Paso, TX 79968, USA.
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13
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Humphreys K, Kaskutas LA. World Views of Alcoholics Anonymous, Women for Sobriety, and Adult Children of Alcoholics/ Al-Anon Mutual Help Groups. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/16066359509005240] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Alvarez J, Jason LA, Davis MI, Olson BD, Ferrari JR. Latinos and Latinas in communal settings: a grounded theory of recovery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:1317-34. [PMID: 19440520 PMCID: PMC2681194 DOI: 10.3390/ijerph6041317] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 03/26/2009] [Indexed: 11/16/2022]
Abstract
Semi-structured interviews were conducted with 12 Latino/a residents of a mutual help residential recovery program (Oxford House) in order to elicit their experiences of the program's therapeutic elements. A model of recovery emerged from the analysis including several themes supported by existing literature: personal motivation and readiness to change, mutual help, sober environment, social support, and accountability. Consistent with a broad conceptualization of recovery, outcomes included abstinence, new life skills, and increased self-esteem/sense of purpose. Most participants were the only Latino/a in their Houses; however, cultural differences did not emerge as salient issues. The study's findings highlight potential therapeutic aspects of mutual-help communal recovery programs and suggest that English-speaking, bicultural Latinos/as have positive experiences and may benefit from participating in these programs.
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Affiliation(s)
- Josefina Alvarez
- Adler School of Professional Psychology, 65 E. Wacker Place, Suite 2100, Chicago, IL 60601, USA
| | - Leonard A. Jason
- DePaul University, Center for Community Research, 990 Fullerton Avenue, Suite 3100, Chicago, Illinois 60614, USA
- Author to whom correspondence should be addressed; E-Mail:
; Tel.: +1-773-325-2018
| | - Margaret I. Davis
- DePaul University, Center for Community Research, 990 Fullerton Avenue, Suite 3100, Chicago, Illinois 60614, USA
| | - Bradley D. Olson
- Northwestern University, School of Education and Social Policy 2120 Campus Drive Evanston, IL 60208, USA
| | - Joseph R. Ferrari
- DePaul University, Department of Psychology, 2219 N. Kenmore Ave., Chicago, Il. 60614, USA
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White WL, Sanders M. Recovery Management and People of Color: Redesigning Addiction Treatment for Historically Disempowered Communities. ALCOHOLISM TREATMENT QUARTERLY 2008. [DOI: 10.1080/07347320802072198] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Mark Sanders
- b Great Lakes Addiction Technology Transfer Center , N. Sheridan Road, Suite 618, Chicago, IL, 60640
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Alvarez J, Jason LA, Olson BD, Ferrari JR, Davis MI. Substance abuse prevalence and treatment among Latinos and Latinas. J Ethn Subst Abuse 2007; 6:115-41. [PMID: 18192207 PMCID: PMC3059600 DOI: 10.1300/j233v06n02_08] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Substance abuse prevalence rates for Latinos/as generally mirror those of the general U.S. population; however, a number of indicators of assimilation to U.S. culture as well as sociodemographic variables predict substance use and abuse among this group. Latinos/as have poorer outcomes in substance abuse treatment programs. Yet there is little empirical evidence that explains the problems these individuals experience in treatment, and there are few studies on the use and effectiveness of mutual help groups among this population. New developments in the conceptualization and measurement of acculturation will lead to a greater understanding of the role of culture in the prevalence and treatment of substance-related problems.
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Affiliation(s)
- Josefina Alvarez
- Center for Community Research, De Paul University, 990 West Fullerton Ave, Suite 3100, Chicago, IL 60614-2458, USA.
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Amaro H, Arévalo S, Gonzalez G, Szapocznik J, Iguchi MY. Needs and scientific opportunities for research on substance abuse treatment among Hispanic adults. Drug Alcohol Depend 2006; 84 Suppl 1:S64-75. [PMID: 16766137 DOI: 10.1016/j.drugalcdep.2006.05.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The results of a focused search of the literature on empirical studies of substance abuse treatment outcomes with Hispanic adults are reviewed. Also provided are key research opportunities and recommendations on substance abuse treatment for Hispanics. The paper is divided into two major sections: the first focuses on behavioral drug treatment studies on Hispanic adults, and the second identifies published original articles in pharmacotherapy, namely that more empirical research is needed to determine which treatments are efficacious with Hispanic populations. For treatment modalities not associated with promising effect sizes with Hispanic samples, cultural modifications may be needed to improve the compatibility of the treatment with Hispanic culture. For those treatments found to have promising effect sizes with various Hispanic subgroups, with Hispanics at different levels of acculturation, and with Hispanics from various socioeconomic backgrounds. The authors stress the need for theory-driven interventions to be developed specifically for well-characterized Hispanic subgroups (e.g., suburban middle-income Puerto Ricans living in the Northeast).
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Affiliation(s)
- Hortensia Amaro
- Institute on Urban Health Research, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02215, USA.
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Alarcón GS, Rodríguez JL, Benavides G, Brooks K, Kurusz H, Reveille JD. Systemic lupus erythematosus in three ethnic groups. V. Acculturation, health-related attitudes and behaviors, and disease activity in Hispanic patients from the LUMINA cohort. LUMINA Study Group. Lupus in Minority Populations, Nature versus Nurture. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1999; 12:267-76. [PMID: 10689991 DOI: 10.1002/1529-0131(199908)12:4<267::aid-art5>3.0.co;2-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the relationship between acculturation and clinical, socioeconomic-demographic, and behavioral/psychosocial features in Hispanic patients with systemic lupus erythematosus (SLE) from the LUMINA (Lupus in Minority Populations, Nature versus Nurture) cohort. METHODS An empirically derived questionnaire was administered to 67 Mexican American SLE patients participating in a longitudinal study of outcome. This questionnaire inquired about place of birth, upbringing and length of stay in the United States, language (proficiency, usage, and preferences; English/bilingual versus Spanish), type of neighborhood, self-identity, and social interactions. Responses to this questionnaire and an informal interaction with a single bilingual, bicultural Mexican American research assistant were used to generate a score on a 10-cm anchored visual analog scale (VAS) (0 = no acculturation and 10 = maximum acculturation). The responses to the questionnaire were then quantified and scored by a physician who was unaware of the VAS. A composite score was then obtained utilizing 4 of the 6 components of the instrument. The VAS was found to have adequate sensitivity (91%), specificity (88%), and overall predictive value (89%) when the composite score was used as the validity criterion. Therefore, the VAS was used in all subsequent analyses; the median in this VAS separated patients into high and low acculturation groups. The relationship between acculturation and sociodemographic, behavioral/psychosocial (social support, abnormal illness-related behaviors, and helplessness) and clinical variables (disease duration, onset type, number of American College of Rheumatology criteria met, disease activity, and damage) at study entry was then explored. RESULTS Patients in the low acculturation group had fewer years of education, were less likely to have private health insurance, and had less social support as compared with those in the high acculturation group; they also exhibited less disease activity as determined by the overall physician and patient global assessments of the Systemic Lupus Activity Measure. Abnormal illness-related behaviors and helplessness were not increased in the low acculturation group. CONCLUSIONS Low levels of acculturation were associated with indicators of low socioeconomic status, but also with less disease activity at enrollment into LUMINA; they were, however, not associated with more abnormal illness-related behaviors or with helplessness, as measured in this study. The possible impact of acculturation and of its mediators in the course and outcome of SLE among Hispanic patients needs to be determined longitudinally.
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Affiliation(s)
- G S Alarcón
- Department of Medicine (Division of Clinical Immunology and Rheumatology), the University of Alabama at Birmingham 35294, USA
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20
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Petrikas R, Schumann L. Altered mental status: hypoglycemia. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 1998; 10:175-80; quiz 181-3. [PMID: 9801552 DOI: 10.1111/j.1745-7599.1998.tb01287.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
This paper uses data abstracted from 465 client records randomly selected from the current files of a downtown medical clinic in Chicago, Illinois to examine substance use among 85 immigrant and 380 nonimmigrant homeless and "at-risk" homeless adults. Immigrants to the United States reported lower levels of current cigarette, alcohol, and drug use compared to nonimmigrants in the sample. Immigrants were also less likely to report potential substance user treatment needs. Immigrants, however, did not differ from nonimmigrants in the reported quantity or frequency of cigarette and alcohol use. Drug use among homeless immigrants was also higher than estimates of misuse in the general population. The literally homeless in the sample reported higher levels of substance use compared to "at-risk" homeless. The literally homeless were also more likely to report higher levels of consumption and were more likely to have potential substance user treatment needs. The role of stress in the etiology of substance misuse among homeless immigrants and nonimmigrants is discussed. Implications for the treatment of these diverse populations are also addressed.
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Affiliation(s)
- J B VanGeest
- Survey Research Laboratory, College of Urban Planning and Public Affairs, University of Illinois at Chicago 60607, USA
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Abstract
This paper provides a brief introduction to current research concerned with alcohol and drug use, misuse, and treatment among displaced persons, including immigrants, refugees, and homeless individuals. Among the topics examined are theoretical issues related to our understanding of substance use processes among displaced populations, methodological considerations, and directions for future research. The review is followed by an annotated bibliography of recent work related to this topic.
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Affiliation(s)
- T P Johnson
- Survey Research Laboratory, University of Illinois, Chicago 60607, USA
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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.
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