Marc Galanter

• Professor
• Professor (Full) at New York University

Background The availability of the fellowships of Alcoholics Anonymous and Narcotics Anonymous in community settings is extensive and patients admitted to treatment programs for substance use disorder may therefore have previously attended meetings of these two Twelve Step (TS) programs. Data on such prior attendance and related clinical findings,...

Background: A Zoom-based website was developed in 2020 that offers continuous access to online Narcotics Anonymous (NA) meetings for the first time. This website provides immediate access for persons with substance use disorder to support abstinence from substance-related addictive disorders.Objectives: This study is designed to characterize attend...

Background: Spirituality is a construct encompassing a diversity of strongly held beliefs and pursuits related to life's meaning and purpose. Empirical studies in key domains of spirituality related to substance use disorder (SUD) can be valuable in guiding research, and potentially clinical care. Objectives: To conduct a scoping review of resea...

Background: The Twelve Steps described by Narcotics Anonymous (NA) and Alcoholics Anonymous denote key aspects of how members can achieve abstinence from alcohol and other drugs. However, there are limited empirical findings on what long-term members rely on to support their ongoing recovery. Method: In order to clarify the members’ reliance on tho...

Background and objectives: Methamphetamine use disorder (MUD) is a major public health problem, but there are no evidence-based, best-practice, pharmacologic, or behavioral treatments for it. Narcotics Anonymous (NA) may provide an option for referral for such patients. Methods: Two waves of surveys were sent to a sample of NA members to evaluat...

Spirituality is a construct that is reflected in a diversity of strongly felt personal commitments in different cultural and national groups. For persons with substance use disorders (SUDs), it can serve as a component of the recovery capital available to them. This position statement reviews empirical research that can shed light on psychological,...

Objectives: Face-to-face meetings are key components of Twelve Step (TS) fellowships' support of members' abstinence. Home confinement during COVID-19 made this less feasible. Our objective was to ascertain whether a transition to virtual online meetings among TS members took place, and whether it was potentially effective. Methods: Two thousand...

Office-based practice for the treatment of patients with substance use disorders is limited in important information obscured by a patient’s denial of illness and lack of support for the patient in the face of potential relapse. This chapter provides a description of the rationale and technique for employing the support of family and close friends...

This chapter is directed at defining the nature of spirituality and its relationship to empirical research and clinical practice. An understanding of the spiritual experience can be achieved on the basis of diverse theoretical and empirically grounded sources. Furthermore, the impact of spirituality on addiction in different cultural and clinical s...

Background: The term God, included in 5 of the 12 Steps of Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), self-designated spiritual fellowships, has not been studied empirically relative to members' experiences. A greater understanding of this can be clinically useful and can shed light on the 12 Step process of recovery. Objectives: To...

Objective: Mentorship for Addiction Problems (MAP) is a new behavioral treatment formalizing client-to-client mentorship relationships as an adjunct to standard outpatient substance use disorder treatment. We tested the preliminary efficacy of MAP in reducing substance use and associated barriers to successful treatment outcomes. Method: A total...

Background and objectives: Variables contributing to the outcome of buprenorphine treatment for opiate use disorder have been studied, including patient characteristics and the treatment approach applied. It is also valuable to study the types of clinical facilities that can affect outcome. Methods: We evaluated patients (N = 20 993) in 573 faci...

Objective: Narcotics Anonymous (NA), a nonprofessional 12-step fellowship for people seeking recovery from addiction, reports 27,677 meetings in the USA, where it was founded, but there is limited literature on its adaptability cross-culturally. We studied NA within the Islamic Republic of Iran to ascertain its relative adaptation in a different c...

Background: People with severe substance use disorders require long-term rehabilitative care after the initial treatment. There is, however, a deficit in the availability of such care. This may be due both to inadequate medical coverage and insufficient use of community-based Twelve-Step programs in many treatment facilities. In order to address t...

Increased opioid-related morbidity and mortality in the United States has triggered considerable professional, public, and political alarm and a wide array of community and clinical responses. The potential role of Narcotics Anonymous (NA) as a recovery support resource is rarely noted within recent media and professional reports addressing opioid...

Background: Many individuals with alcohol-use disorders who had experienced alcohol craving before joining Alcoholics Anonymous (AA) report little or no craving after becoming long-term members. Their use of AA prayers may contribute to this. Neural mechanisms underlying this process have not been delineated. Objective: To define experiential an...

This chapter is directed at defining the nature of spirituality and its relationship to empirical research and clinical practice. A preliminary understanding of the spiritual experience can be achieved on the basis of diverse theoretical and empirically grounded sources, which will be delineated. Furthermore, the impact of spirituality on addiction...

Over the past 30 years, numerous empirically tested behavioral approaches to substance use disorders (SUDs) have been adopted by treatment settings. A key focus of many of these approaches is the retention of patients in treatment. This Introduction provides an overview of the chapters in this section on behavioral approaches to SUDs, including psy...

Individual therapists in office practice are often considered to have limited effectiveness in treating alcohol and drug dependence. In this chapter, the author describes network therapy, an approach developed to assure greater success in such treatment. A cognitive-behavioral model of addiction related to securing abstinence is reviewed by the rol...

This paper reviews empirical studies conducted on the role of spirituality and religiosity (S/R) characteristics in 12-step recovery among program members followed up after substance abuse treatment and those assessed independent of formal treatment. Aspects of spiritual functioning that change in relation to program participation and those S/R cha...

This Viewpoint discusses the differences between patients experiencing denial and those exhibiting lack of insight and addresses interventions that may improve care for patients exhibiting lack of insight. Vexing challenges arise in clinical care when patient preferences are at odds with the standard of care. In the hospital setting, such patients...

Abstract Substance use disorder, often comorbid with post-traumatic stress disorder, is a problem confronted by many veterans. In order to determine the potential utility of Narcotics Anonymous for veterans, 508 NA attendees were studied. Veterans (N = 172) were more likely to have been referred by a professional than were non-veterans (77% vs. 27%...

Spiritual awakening, a key aspect of 12-Step recovery, is designated in the 12th Step of Alcoholics Anonymous (AA). The authors applied a psychiatric survey instrument to 161 long-term AA members who reported having had such an awakening. Sixty-seven percent of respondents reported no craving for alcohol or drugs at the time of this survey. Their a...

Clinicians' understanding of Alcoholics Anonymous (AA) is generally based on their subjective response to encounters with patients, rather than on empirical research. In an effort to improve on this, this article presents a model of AA's operation that draws on diverse, scientifically grounded disciplines: social psychology, cognitive psychology, n...

In the course of achieving abstinence from alcohol, longstanding members of Alcoholics Anonymous (AA) typically experience a change in their addiction-related attitudes and behaviors. These changes are reflective of physiologically grounded mechanisms which can be investigated within the disciplines of social and cognitive neuroscience. This articl...

This case study of the development and implementation of an opioid overdose prevention program is based on an actual clinic's experience, but information about the clinic, including details of implementation and outcome measures, has been changed. Four experts reflect on the medical, administrative, peer-support, community, and evaluation aspects o...

There is little empirical literature on the experience in sobriety of long-term, committed members of Alcoholics Anonymous (AA). Studies on the experience of long-term members, however, can yield a better understanding of the role of spirituality in AA membership, and how the program helps stabilize abstinence. We studied 144 physicians at a confer...

Background: Narcotics Anonymous is a worldwide fellowship that employs the Twelve-Step model for members dependent on drugs of abuse. The spiritual orientation of its program of abstinence has not been subjected to empirical study. Methods: Responses of 527 American Narcotics Anonymous meeting attendees to a structured questionnaire were evaluat...

Objective: Narcotics Anonymous (NA) is an abstinence-based fellowship with more than 58,000 groups worldwide. There has, however, been little research reported on its members. This study was designed to clarify the nature of the participants in NA who are primarily abstinent, long-term members. Method: A protocol was implemented to survey member...

Empirical findings characterizing long-term, committed Alcoholics Anonymous (AA) members are limited, particularly among younger members. The authors studied a sample of 266 highly committed attendees (mean age, 27 years) at an annual conference of Young People in Alcoholics Anonymous (YPAA), whose first encounter with AA was 6 years previously. Mo...

This is a Stage I open pilot to develop a new intervention, Mentorship for Alcohol Problems (MAP), for individuals with alcohol-use disorders in community treatment programs. Ten mentors participated for 6 months until 30 mentees received MAP for 12 weeks. Behavioral and biological measures were conducted in addition to fidelity measures. Four focu...

This study was undertaken to provide an initial characterization of the current status of patients admitted to an alcoholism treatment program in Iceland. Consistent with the Minnesota Model, 12-step facilitation has been a central component of the program since its inception. Of the 94 patients assessed in this study, 67% were male and 40% had att...

We tested the hypothesis that there is a mediational pathway from parental alcohol use during the participants' adolescence to the participants' psychological symptoms in young adulthood. This pathway includes the participants' alcohol use and their psychological symptoms, both during adolescence. The participants are inner city African American an...

Every day, people who want to overcome their problems with addiction walk into one of the 200 000 Alcoholics Anonymous (AA) meetings held worldwide. If you look in on any of these meetings, you will find a tone of earnestness and mutual concern among members who have been successful, and you will also find others who still struggle with the demons...

The purpose of this study was to determine the extent to which spiritual orientation was associated with adaptation to therapeutic community treatment. Spiritual orientation was assessed by the Spirituality Self-Rating Scale, a measure consistent with the conceptualization of spirituality typically reflected in Alcoholics Anonymous members' views....

This paper reviews a body of findings in order to define the nature of spirituality from a biopsychosocial perspective and to illustrate its relevance to the field of psychiatry. The emergence of spirituality within the common culture is described, after which a number of sociobiologically related studies are presented to illustrate how its compone...

The authors prepared a course in addiction psychiatry for the Internet that combines a psychosocial and a medication modality for alcoholism; namely, network therapy and naltrexone. Responses of those who accessed the course revealed 679 counts (visits) at the Web Site. A group of 210 unique respondents, of whom 154 were psychiatrists, answered a d...

This is the first study comparing community-based and hospitalized homeless dually diagnosed men to assess correlates of psychiatric hospitalization. A retrospective review was carried out comparing housing, substance abuse, and psychiatric histories of three cohorts: 53 previously homeless men interviewed while hospitalized for dual psychiatric an...

The aim of this study was to assess patterns of alcohol consumption and alcohol related problems in a sample of lesbian and gay NYC residents. There were no differences between lesbian (n = 93) and gay (n = 90) subgroups with regard to alcohol use and health related variables. The average number of drinking days reported for the previous 30 day per...

Introduction: V62.89Religious or Spiritual Problem [10]: Use of Religious or Spiritual Problem V CodePersonality Disorders [43]PTSD [49]Substance use Disorders [53]Psychotic Disorders [54]Summary and Conclusions [56]References

Spirituality is important to many psychiatric patients, and these patients may be moved toward recovery more effectively if their spiritual needs are addressed in treatment. This, however, is rarely given expression in the psychiatric services of teaching hospitals. In order to develop this potential area of improved care, we (1) evaluated the diff...

Relapse among patients in substance abuse treatment has generated interest in identifying attitudinal factors that sustain recovery. To assess the relationship of attitudes toward approaches to motivation for treatment and Twelve Step beliefs. Dually diagnosed patients (N = 100) completed a survey assessing treatment attitudes, motivation, and Twel...

Clinically, the treatment of substance abuse has relied on the Twelve Steps model, which is heavily focused on issues of spirituality. Adolescents may have cognitive and developmental issues that preclude them from taking advantage of the Alcoholics Anonymous (AA) model. To this end, we examined the spiritual orientation and spiritual behaviors amo...

Background: Buprenorphine, an opiate replacement treatment for opiate dependence prescribed by generalist physicians in their offices, is a novel approach which promises to increase access to treatment, to reduce stigma, and pose less risk of abuse than methadone due to its combination with opiate antagonist naloxone. However its dissemination has...

Hopelessness is a clinically important state relative to morbidity and suicide risk among university students. We examined its role in relation to presenting concerns, diagnosis, psychopharmacologic treatment and spiritual orientation among students seeking treatment at a university counseling center. The most commonly identified concern was anxiet...

Co-occurring mental illness and addiction is very common and results in worse treatment outcomes compared to singly diagnosed addicted individuals. Integrated treatment for co-occurring disorders is associated with better treatment outcomes; however there is a wide range of what is included in integrated treatment. Due to patient and staff interest...

This study assesses medical students' use of and attitudes towards club drugs, classified as "Generation I" (i.e., cocaine and lysergic acid diethylamide), and "Generation II" (i.e., methylenedioxymethamphetamine [MDMA], ketamine, gamma hydroxybutyrate, methamphetamine, rohypnol, dextromethorphan) club drugs based on their initial widespread use in...

This chapter is directed at defining the nature of spirituality and its relationship to empirical research and clinical practice. A preliminary understanding of the spiritual experience can be achieved on the basis of diverse theoretical and empirically grounded sources, which will be delineated: namely, physiology, psychology, and cross-cultural s...

Co-occurring mental illness and addiction is very common and results in worse treatment outcomes compared to singly diagnosed addicted individuals. Integrated treatment for co-occurring disorders is associated with better treatment outcomes; however there is a wide range of what is included in integrated treatment. Due to patient and staff interest...

Coerced or involuntary treatment comprises an integral, often positive component of treatment for addictive disorders. By the same token, coercion in health care raises numerous ethical, clinical, legal, political, cultural, and philosophical issues. In order to apply coerced care effectively, health care professionals should appreciate the indicat...

Recent Developments in Alcoholism Volume 18: Research on Alcoholics Anonymous and Spirituality in Addiction Recovery Edited by Marc Galanter, NYU School of Medicine, and Lee Kaskutas, UC Berkely School of Public Health It was once taken for granted that peer-assisted groups such as Alcoholics Anonymous had no "real" value in recovery from addict...

Alcoholics Anonymous (AA) and other 12-step programs are widely employed in the addiction rehabilitation community. It is therefore important for researchers and clinicians to have a better understanding of how recovery from addiction takes place, in terms of psychological mechanisms associated with spiritual renewal. A program like AA is described...

The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders. We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abuser...

The purpose of the present study was to assess the relationship of history of gang involvement to engagement in Therapeutic Community (TC) treatment. Residents (N = 222) at two Daytop facilities completed a survey assessing sociodemographic characteristics, prior gang involvement and multiple aspects of TC functioning. Residents with prior gang inv...

This paper reviews the literature on ambulatory substance abuse treatment for adolescents, including brief intervention, Twelve-Step-based outpatient treatment, family-based treatment, cognitive behavioral therapy, and pharmacologic treatment. An overview of socially and culturally specific strategies is also included. The diversity of settings and...

High levels of serum Cortisol or abnormal dexamethasone suppression tests may be helpful in diagnosing major depressive disorder. However, a controversy exists as to whether abnormal Hver function associated with alcohol abuse may negate the diagnostic value of the dexamethasone suppression test in alcoholics. We investigated the value of the dexam...

Disorders Abstract: In this review, we highlight recent developments in the pharmacological treatment of alcohol and other substance use disorders and in programs designed for those with dual diagnosis disorders. The depot formulation of naltrexone, which recently received U.S. Food and Drug Administration approval, presents a more effective altern...

This study was designed to provide an independent evaluation of the oversight and rehabilitation of substance-impaired physicians. Records of 104 physicians who had completed their monitoring period by the New York State Committee on Physicians' Health were selected at random from CPH files. They had been followed for an average of 41.3 months. Pra...

Coercion as a strategy for treatment of addiction is an effective but often negatively perceived approach. The authors review current policies for involuntary commitments and explore coercive dimensions of treating alcohol and drug dependence in the workplace, sports, and through professional licensure. Gender-specific issues in coercion are consid...

This analysis of five recovery narratives from leaders of a peer-led, 12-Step-based self- help group in a methadone treatment program highlights the importance of spiritually-mediated role transformation in the recovery process. For these men and women in their forties and fifties, their progression to a leadership role helping others with their re...

Spirituality is a construct that has recently gained currency among clinicians because of its close association with twelve-step modalities and its perceived role in the promotion of meaningfulness in recovery from addiction. This article draws on studies from physiology, psychology, and cross-cultural sources to examine its nature and its relation...

Alcoholics Anonymous (AA) is described as a spiritual fellowship by many of its members, but its spiritual orientation needs to be better understood by clinicians and researchers. Spirituality is a latent construct, one that is inferred from multiple component dimensions, such as social psychology, neurophysiology, and treatment outcome research. M...

The present study evaluated a model program at Bellevue Hospital Center incorporating a peer-led self-help (PLSH) approach which can be applied to bring about systems-level change in a variety of settings where persons with dual diagnosis are encountered. A total of 461 consecutive MICA inpatient admissions were evaluated to compare the PLSH unit w...

This study sought to determine which adolescents being treated for substance use in a residential Therapeutic Community (TC) would endorse spirituality and Twelve Step oriented approaches as part of their treatment. By identifying individual difference characteristics associated with preference for spirituality and Twelve Step oriented approaches,...

Patients with combined general psychiatric and addictive disorders are a major public health problem in the US, and are being increasingly recognized as such world-wide. The authors describe a model treatment system for such patients in one municipal hospital in New York. It is composed of three complementary units: a locked ward, a halfway house a...

Pathways to Recovery is a peerled, 12-step-based, self-help group with spiritual underpinnings that was developed to meet the needs of clients in a Methadone Treatment Program (MTP) based in a large municipal hospital. Pathways is facilitated by staff, but groups are patient-run. Pathways was adapted for the MTP population from our original Methado...

Childhood and adolescence represent a critical period for the potential initiation of substance use, and thus it is important that child and adolescent psychiatry (CAP) residents learn to screen, assess, refer, and/or treat children and adolescents who have substance abuse diagnoses. The authors conducted a survey by mail of directors from all accr...

Alcoholics Anonymous is not yet fully employed by the medical community as a means to enhance patient outcome. The purpose of this study was to evaluate visitors' use of an Internet course on Alcoholics Anonymous, and to compare how various disciplines learned about, gained access to and participated in the course. Demographic information was colle...

Network therapy (NT) employs family members and/or friends to support compliance with an addiction treatment carried out in office practice. This study was designed to ascertain whether NT is a useful psychosocial adjunct, relative to a control treatment, for achieving diminished illicit heroin use for patients on buprenorphine maintenance. Patient...

Although Alcoholics Anonymous and other Twelve-Step interventions are among the most widely utilized self-help options by persons with chemical dependency, little is known concerning whether this approach should be integrated with non-spirituality based self-help approaches. The purpose of this study was to assess the extent to which clients receiv...

This is a two-phase study on attitudes of medical students toward Alcoholics Anonymous. The first phase compares views of addiction faculty to third-year medical students on the importance of spirituality in addiction treatment. We administered a questionnaire to assess attitudes toward spiritual, biological, and psychosocial approaches to addictio...