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Psychiatric comorbidity, continuing care and mutual help as predictors of five-year remission from substance use disorders
Abstract
In a cohort of 2,595 male patients in VA intensive treatment programs for substance use disorders (SUD), we tested whether psychiatric comorbidity, outpatient care and mutual help group attendance during the first two follow-up years predicted remission status at Year 5, controlling for covariates.
Logistic regression modeling of longitudinal data was used to test the hypotheses.
Dual diagnosis patients were less likely to be in remission at Year 5 than SUD-only patients. Outpatient care was at best only weakly related to Year 5 remission status. By contrast, mutual help involvement substantially improved the chances of substance use remission at Year 5 for both SUD-only and dual diagnosis patients. Mutual help involvement did not, however, offset the poorer prognosis for dual diagnosis patients.
Because mutual help groups specifically targeted to individuals with comorbid substance use and psychiatric disorders are currently rare, further research is recommended to investigate whether they are more effective than standard SUD mutual help groups in facilitating the recovery of persons with dual diagnoses.
... Non-treatment factors like participation in 12-step fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) might be some of the best prognosticators of future recovery status (Humphreys et al., 2004;Moos & Moos, 2004;Owen et al., 2003). Research studies involving recovering addicts/alcoholics have shown participation in 12-step fellowships to be a significant predictor of decreased stress in early recovery (Laudet & White, 2008) and reduced alcohol/drug use at 2-year (McKellar, Stewart, & Humphreys, 2003), 5-year (Ritsher, McKellar, Finney, Otilingam, & Moos, 2002) and 16-year follow-up (Moos & Moos, 2007). ...
... Participation has been assessed in several ways, including measuring 12-step meeting attendance rates in terms of frequency and duration (Moos & Moos, 2004, 2007Ritsher et al., 2002) and consistency (Weiss et al., 2005). However, participation in 12-step fellowships might be best considered a construct that involves meeting attendance in addition to one's involvement in such fellowships-in other words, one's participation in other 12-step-related activities/behaviors (Tonigan, Connors, & Miller, 1998). ...
The present study examined 12-step involvement categorically, independent of 12-step meeting attendance, and its relation to recovery resources among 100 members of Alcoholics Anonymous and Narcotics Anonymous residing in recovery homes. Participants who were actively involved in 12-step activities reported significantly higher levels of recovery resources compared with those who were less involved, whereas meeting attendance was significantly and negatively related to self-efficacy for abstinence and meaning in life. Findings suggest that categorical involvement in 12-step activities equip recovering alcoholics/addicts with resources for their ongoing recovery. Implications for future research are discussed.
... While previous studies often linked abstinence to the absence of baseline conditions related to relapse, [36][37][38][39][40] we only observed this pattern in the least prevalent configuration for abstinence-specifically, among patients without social disintegration and psychiatric comorbidity. Surprisingly, our study found that the most prevalent configuration for achieving abstinence included the presence of social disintegration. ...
Purpose
Substance use disorder (SUD) can be a chronic relapsing condition with poor treatment outcomes. Studies exploring factors associated with abstinence or relapse after treatment are often quantitative in nature, applying linear statistical approaches, while abstinence and relapse result from non-linear, complex, dynamic and synergistic processes. This study aims to explore these underlying dynamics using qualitative comparative analysis (QCA) as a mixed methods approach to further our understanding of factors contributing to post-treatment abstinence and relapse.
Patients and Methods
In a prospective study, we gathered both qualitative and quantitative data pertaining to post-treatment substance use and the factors linked to substance use outcomes. These factors encompassed psychiatric comorbidity, intellectual disability, social disintegration, post-treatment support, and engagement in activities among patients who had undergone inpatient treatment for severe SUD (n = 58). QCA, a set-theoretic approach that considers the complex interplay of multiple conditions, was applied to discern which factors were necessary or sufficient for the occurrence of either abstinence or relapse.
Results
We found two solutions predicting abstinence, and five for relapse. Post-treatment conditions (support and engagement in activities) were important for retaining abstinence. For relapse, individual baseline characteristics (intellectual disability, social disintegration, psychiatric comorbidity) combined with (post-)treatment factors (post-treatment support, activities) were important.
Conclusion
Although abstinence and relapse represent opposing outcomes, they each exhibit distinct dynamics. To gain a comprehensive understanding of these dynamics, it is advisable to examine them as separate outcomes. For clinical practice, it can be worthwhile to recognize that fostering the conditions conducive to abstinence may differ from preventing the factors that trigger relapse.
... La asistencia prolongada a este tipo de programas es un factor importante para mantener los beneficios logrados en el tratamiento (Fiorentine y Hillhouse, 2000; Moos y Moos, 2006 veces más reuniones de AA que aquellos que no logran la abstinencia en el largo plazo, independientemente de su nivel socioeconómico y otras variables demográficas asociadas al pretratamiento (Etheridge et al., 1999;Weiss et al., 2005). También se destaca que la calidad de las actividades propuestas en los programas de DP influye para que los usuarios permanezcan en rehabilitación por más tiempo, haciendo más probable que completen intervenciones de 24 semanas, además de que influyen en la reducción del consumo de alcohol o de drogas durente dos, cinco y hasta dieciséis años de seguimiento (McKellar et al., 2003;Moos y Moos, 2007;Ritsher et al., 2002). Lo dicho anteriormente significa que la duración de este tipo de tratamiento constituye un predictor significativo, llegándose a estimar que la mitad de los pacientes requieren de trece a dieciocho sesiones para alcanzar un resultado clínico excelente (Hansen et al., 2002;Howard et al., 1986). ...
Los factores relacionados con el tratamiento terapéutico constituyen importantes predictores asociados a la prevención de recaídas durante la recuperación de las drogodependencias. Sin embargo, aún es necesario investigar por qué algunos de los elementos propios del periodo de rehabilitación son lo suficientemente efectivos para elevar significativamente las probabilidades de remisión de los trastornos por abuso de sustancias. Por ello, el objetivo del presente estudio fue analizar la manera en que la interrelación de las variables predictoras agrupadas en el dominio del tratamiento influyen o contrarrestan el retorno al consumo de drogas en usuarios drogodependientes. Para ello, se llevó a cabo una revisión sistemática en las bases de datos EBSCO, Scopus y Science Direct que abarcó el período de 2011 a 2020. Después de aplicar los criterios de inclusión y exclusión, establecidos a partir de la estrategia PICOS, se seleccionó un total de ocho artículos, de los cuales la mayoría tenían diseños aleatorios controlados, con cifras de participantes superiores a mil usuarios, seguimientos longitudinales de más de doce meses y procedimientos estadísticos multivariados. Las principales variables predictoras identificadas fueron la calidad de los programas de autoayuda de doce pasos, el apoyo de pares, los tratamientos grupales, la atención plena, la duración del tratamiento y el tipo de servicios (ambulatorios o residenciales). Los estudios que denotaron tener una mayor consistencia destacan la importancia de la participación comprometida en grupos de autoayuda, la calidad de las actividades propuestas en los programas de doce pasos y el apoyo de pares como componentes clave para prevenir recaídas durante la recuperación de las drogodependencias.
... Despite the mounting evidence to support AA for the treatment of alcohol use disorder (AUD) [for review see (Kelly et al., 2020)], evidence supporting its role as an effective form of continuing care is more limited. Generally, the evidence that does exist suggests involvement in 12-step groups following a period of more intensive treatment (e.g., inpatient), typically operationalized as meeting attendance, is associated with improved substance use outcomes among adults (Bergman et al., 2014(Bergman et al., , 2015Connors et al., 2001;Costello et al., 2019;Gossop et al., 2008;Kelly et al., 2011;Klein and Slaymaker, 2011;Magura et al., 2013;Morgenstern et al., 1997;Ritsher et al., 2002;Ye and Kaskutas, 2009). However, with the exception of a small number of randomized controlled trials (RCTs) (Connors et al., 2001;Kelly et al., 2011;Magura et al., 2013), most studies of 12-step involvement are observational in nature, making it difficult to establish a causal relation between 12-step involvement and the outcome under study. ...
Background
Continuing care following inpatient addiction treatment is an important component in the continuum of clinical services. Mutual help, including 12-step groups like Alcoholics Anonymous, is often recommended as a form of continuing care. However, the effectiveness of 12-step groups is difficult to establish using observational studies due to the risks of selection bias (or confounding).
Objective
To address this limitation, we used both conventional and machine learning-based propensity score (PS) methods to examine the effectiveness of 12-step group involvement following inpatient treatment on substance use over a 12-month period.
Methods
Using data from the Recovery Journey Project – a longitudinal, observational study – we followed an inpatient sample over 12-months post-treatment to assess the effect of 12-step involvement on substance use at 12-months (n = 254). Specifically, PS models were constructed based on 34 unbalanced confounders and four PS-based methods were applied: matching, inverse probability weighting (IPW), doubly robust (DR) with matching, and DR with IPW.
Results
Each PS-based method minimized the potential of confounding from unbalanced variables and demonstrated a significant effect (p < 0.001) between high 12-step involvement (i.e., defined as having a home group; having a sponsor; attending at least one meeting per week; and, being involved in service work) and a reduced likelihood of using substances over the 12-month period (odds ratios 0.11 to 0.32).
Conclusions
PS-based methods effectively reduced potential confounding influences and provided robust evidence of a significant effect. Nonetheless, results should be considered in light of the relatively high attrition rate, potentially limiting their generalizability.
... Furthermore, those affected by high levels of psychiatric severity are exposed to higher risk levels, and experience greater impairment in functioning and negative health, emotional, psychological, and social outcomes (Drake et al., 1998;Morisano et al., 2014). For instance, studies have found that individuals with SUD comorbidities were less likely to have their disorder in remission at a 2-year follow-up (Ouimette et al., 1999;Ritsher et al., 2002). In addition, this population tends to seek health services and have legal issues at greater rates than those without a comorbidity (Enez-Darcin et al., 2015), while those who require inpatient, residential treatment tend to have persistent problems with severe symptomology and mood dysregulation (Shand et al., 2003). ...
It is estimated that nearly 20 million adults in the United States have a substance use disorder (SUD), and 8.4 million of those adults have a comorbid mental disorder. Roughly half of those adults with a SUD and a psychiatric comorbidity fail to receive adequate treatment for either the SUD or the mental disorder (combined or separately). However, this sub-population has shown positive treatment outcomes (e.g., improved quality of life and increased length of stay in a recovery home) when allotted the proper resources to treat the overlapping symptomologies associated with their multiple diagnoses. Many individuals with SUD and psychiatric comorbidity receive community-based support from recovery residences, a ubiquitous form of aftercare treatment in the United States. The aim of the present study was to investigate the relationship between psychiatric severity index scores (a proxy for psychiatric comorbidity that measures social functioning, impairment, symptoms, and behavior), length of stay in Oxford Houses (OHs), and quality of life. The present study found a significant negative relationship between length of stay and psychiatric severity scores, and between psychiatric severity scores and quality of life scores. Psychiatric severity was observed to predict decreased quality of life, while length of stay predicted decreased psychiatric severity. Psychiatric severity mediated the relationship between length of stay and quality of life based on house composition.
... The role of psychiatric comorbidity is of great interest and impact on substance use treatments; however, studies conducted in outpatient settings have been scarcely published. It has been found that US veteran patients with dual diagnoses are less likely to be in remission than SUD patients without comorbidities (Ritsher et al., 2002;Compton et al., 2003). Several studies describe that depression is one of the most prevalent disorders among SUD patients (Grant et al., 2004;Herrero et al., 2008), and it has been associated with an increased risk of post-discharge consumption (Hasin et al., 2002;Compton et al., 2003;Samet et al., 2013). ...
Introduction
The impact of psychiatric comorbidity and addiction features throughout the course of addiction has been widely studied. This is a naturalistic study conducted in an outpatient unit, where treatment follow-up studies are scarce compared to studies including inpatients or those under experimental conditions. Therefore, this follow-up study aims to analyze the treatment adherence and abstinence of outpatients with SUD (Substance Use Disorders) according to addiction severity and psychiatric comorbidity.
Methods
The current six-month follow-up study examined 404 SUD outpatients. Psychiatric comorbidity, addiction severity, substance consumption and treatment adherence were systematically evaluated using semistructured interviews. Survival analyses were conducted to compare the time of treatment adherence and abstinence in a bivariate and multivariate level.
Results
A progressive dropout was observed, reaching 32.2% of dropouts at the six-month follow-up. More than 50% achieved abstinence during the first month and similar percentages were found until the six-month follow-up.
At the multivariate level, treatment adherence, cannabis use disorder and polyconsumption were independently associated with earlier dropout. ADHD was the only mental disorder significantly related with dropout. Regarding substance consumption, the time of abstinence was independently associated with months of treatment adherence and the achievement of abstinence before starting treatment. In general, dual diagnosis was associated with less time of abstinence, but only depressive disorder across the lifespan was related to less time of abstinence in the multivariate model.
Conclusion
These findings highlight the importance of an accurate diagnosis at the beginning of treatment, especially in an outpatient setting, addressing the treatment needs and promoting strategies that improve treatment adherence and reduce the risk of relapses.
... Several studies show that people with substance dependence, with or without co-occurring disorders, are stigmatized and discriminated against. [41][42][43] They are often seen as immoral or dangerous. 44 Some authors have concluded that stigmatization inflicts greater psychological pain than the mental disorder or addiction itself 45,46 and poses a key barrier to rehabilitation. ...
... In addition, depressive and anxiety symptoms across diagnostic groups may play a role in predicting abstinence (Bradizza et al., 2006;Dodge et al., 2005), which indicates that treatment addressing depressive and anxiety symptoms quickly after achieving abstinence may reduce the risk of relapse. Given the low rates of positive treatment outcomes in DD patients in both this study and other studies (Riper et al., 2014;Ritsher, McKellar, et al., 2002), more research should be conducted on factors influencing treatment success in DD patients. To our knowledge, this is the first study to examine a wide set of predictors of abstinence in a heterogeneous sample of dual diagnosis patients; therefore, replication of our study is necessary. ...
Objective: Patients with both a substance use disorder and comorbid mental disorder, or dual diagnosis, form a heterogeneous group with complex treatment needs. Dual diagnosis patients have worse treatment outcomes compared to patients with substance use disorders alone. There is a lack of research focusing on predictors of treatment outcome in dual diagnosis patients. The aim of this study was to identify patient characteristics associated with abstinence in dual diagnosis patients. Methods: In a cohort design, we examined associations between baseline demographic and clinical patient characteristics and abstinence at 14-month follow-up in 102 dual diagnosis patients undergoing treatment in an addiction-psychiatry service in Amsterdam. Immigration, employment, housing, age, emotion regulation, psychiatric symptoms, and frequency and nature of substance abuse were examined as possible predictors of abstinence. Patients were considered abstinent if they had refrained from any substance use in the 30 days prior to the follow-up assessment, as measured with the Timeline Follow Back method. Results: In a multiple logistic regression analysis corrected for treatment utilization, being a first- or second-generation immigrant was associated with lower odds of abstinence (OR = 5.13; 95% CI [1.63, 18.18]), as well as higher levels of depressive and anxiety symptoms at baseline (OR = 0.90; 95% CI [0.81, 0.99]). Gender, age, housing, employment, emotion regulation, frequency and nature of substance abuse, and the psychiatric symptoms positive symptoms, negative symptoms, and manic excitement and disorganization did not show a significant relationship with abstinence. Conclusions: The results indicate that being a first- or second-generation immigrant and experiencing more symptoms of depression and anxiety are predictive of non-abstinence. Attention for linguistic and cultural congruence of dual diagnosis treatments may enhance abstinence in immigrants. Additionally, addressing symptoms of depression and anxiety in dual diagnosis treatment may be beneficial for the maintenance of abstinence. More research is needed on factors influencing treatment success in dual diagnosis patients.
... Successful approaches to improving long-term addiction recovery have included expanding continuity of care beyond an acute treatment episode, monitoring and early reconnection with treatment, and providing other recovery supports such as twelve-step groups (Ritsher et al., 2002). As a result, the focus is slowly shifting from a single acute treatment episode to a longer-term recovery orientation in which relapse is no longer viewed as an indicator of treatment failure. ...
Care-giver substance abuse (SA) represents one of the most common reasons for entering the child welfare system in the USA with families and children for whom substance abuse is an issue fairing worse at every stage of the child welfare process from investigation to removal to reunification. In this conceptual article, we assert that a paradigm clash between a framework for SA that understands treatment and recovery to be a linear process and a framework that views relapse as normative underlies many of the reasons that SA represents a seemingly intractable issue within child welfare. We identify this mismatch as a mechanism for more severe trajectories of SA cases and then suggest new models for child welfare policy and practice that anticipate relapse and which respond to the often chronic nature of substance use disorders. © 2017 The Author. Published by Oxford University Press on behalf of The British Association of Social Workers. All rights reserved.
... Previous studies have found that greater levels of positive interpersonal relationships and social support have anticipated better drinking outcomes for recovery patients (Longabaugh et al., 1995). Therefore, some approaches to improving continuing care interventions include integrating increased relationships between social networks and utilizing social media innovations to enhance treatment outcomes (Ritsher, Mckellar, Finney, Otilingam, & Moos, 2002). ...
... Previous studies have found that greater levels of positive interpersonal relationships and social support have anticipated better drinking outcomes for recovery patients (Longabaugh et al., 1995). Therefore, some approaches to improving continuing care interventions include integrating increased relationships between social networks and utilizing social media innovations to enhance treatment outcomes (Ritsher, Mckellar, Finney, Otilingam, & Moos, 2002). ...
... The present paper elaborate on these findings; patients that remained abstinent were more likely to show lower levels of mental distress than patients that relapsed at 6 month follow-up.. In accordance with other studies [53,54], our findings implied that patients that actively used drugs were less likely to retain the improvement in mental distress achieved with treatment; this finding highlighted the complex nature of mental distress in patients with SUDs. Epidemiological studies on the general population have shown that there are bidirectional influences between SUDs and psychiatric . ...
Background
Treatment services to patients with substance use disorders (SUDs), including those mandated to treatment, needs to be evaluated and evidence based. The Norwegian Municipal Health Care Act (NMHCA) calls for compulsory treatment for persons with “severe and life-threatening substance use disorder” if these individuals are not otherwise willing to be voluntarily treated and consequently risk their lives over drug use. Mental distress is known to be high among SUD patients admitted to inpatient treatment. The purpose of this study is to describe changes in mental distress from admission to a 6-month follow-up in patients with SUDs, which underwent either voluntary or compulsory treatment.
Method
This prospective study followed 202 hospitalized patients with SUDs who were admitted voluntarily (VA; n = 137) or compulsorily (CA; n = 65). Levels of mental distress were assessed with SCL-90-R. Of 123 patients followed-up at 6 months, 97 (62 VA and 35 CA) had rated their mental distress at admission, discharge and follow-up. Sociodemographics and substance use severity were recorded with the use of The European Addiction Severity Index (EuropASI). We performed a regression analysis to examine factors associated with changes in psychiatric distress at the 6-month follow-up.
Results
The VA group exhibited higher mental distress than the CA group at admission, but both groups improved significantly during treatment. At the 6-month follow-up, the VA group continued to show reduced distress, but the CA group showed increases in mental distress to the levels observed before treatment. The deterioration appeared to be associated with higher scores that reflected paranoid ideas, somatization, obsessive-compulsive symptoms, interpersonal sensitivity, and depression. Active substance use during follow-up was significantly associated with increased mental distress.
Conclusion
In-patient treatment reduces mental distress for both CA and VA patients. The time after discharge seems critical especially for CA patients regarding active substance use and severe mental distress. A greater focus on continuing care initiatives to assist the CA patients after discharge is needed to maintain the reduction in mental distress during treatment. Continuing-care initiatives after discharge should be intensified to assist patients in maintaining the reduced mental distress achieved with treatment.
Trial registration
ClinicalTrials.gov NCT 00970372 December 02, 2016.
... Nonetheless, after controlling for all the significant variables, the effect of mental health symptoms was no longer significant; these findings are congruent with previous studies that reported a significant association between mental health and risky sexual behaviors-an association that should be further explored to determine which mental health disorders increase the risks of engaging in risky sexual behaviors [3]. Our results may support ongoing efforts to reduce substance misuse by addressing mental disorders among adult Latinas [98]. ...
Few studies have examined the sociocultural determinants of risky sexual behavior trajectories among adult Latinas. To longitudinally examine the link between sociocultural determinants of risky sexual behaviors, we followed a sample of adult Latina mother-daughter dyads (n = 267) across a 10-year span through four waves of data collection. The present study investigates how risky sexual behavior (operationalized as sex under the influence of alcohol or other drugs, sex without a condom, or multiple sex partners) is affected by: (a) socioeconomic conditions; (b) mental health; (c) medical health; (d) acculturation to U.S. culture; (e) interpersonal support; (f) relationship stress; (g) mother-daughter attachment; (h) intimate partner violence; (i) religious involvement; and (j) criminal justice involvement. Results indicate the following factors are negatively associated with risky sexual behavior: drug and alcohol use, treating a physical problem with prescription drugs, religious involvement, and mother–daughter attachment. The following factors are positively associated with risky sexual behavior: higher number of mental health symptoms, being U.S.-born, and criminal justice involvement. We discuss implications for the future development of culturally relevant interventions based on the study findings.
... Other studies have demonstrated the effectiveness of 12-step groups for the treatment of substance abuse following treatment, [37][38][39] and prior research of 12-step groups has shown reductions in alcohol and drug use. [40][41][42] ...
Objective
Peer support can be defined as the process of giving and receiving nonprofessional, nonclinical assistance from individuals with similar conditions or circumstances to achieve long-term recovery from psychiatric, alcohol, and/or other drug-related problems. Recently, there has been a dramatic rise in the adoption of alternative forms of peer support services to assist recovery from substance use disorders; however, often peer support has not been separated out as a formalized intervention component and rigorously empirically tested, making it difficult to determine its effects. This article reports the results of a literature review that was undertaken to assess the effects of peer support groups, one aspect of peer support services, in the treatment of addiction.
Methods
The authors of this article searched electronic databases of relevant peer-reviewed research literature including PubMed and MedLINE.
Results
Ten studies met our minimum inclusion criteria, including randomized controlled trials or pre-/post-data studies, adult participants, inclusion of group format, substance use-related, and US-conducted studies published in 1999 or later. Studies demonstrated associated benefits in the following areas: 1) substance use, 2) treatment engagement, 3) human immunodeficiency virus/hepatitis C virus risk behaviors, and 4) secondary substance-related behaviors such as craving and self-efficacy. Limitations were noted on the relative lack of rigorously tested empirical studies within the literature and inability to disentangle the effects of the group treatment that is often included as a component of other services.
Conclusion
Peer support groups included in addiction treatment shows much promise; however, the limited data relevant to this topic diminish the ability to draw definitive conclusions. More rigorous research is needed in this area to further expand on this important line of research.
... These results suggest that more symptoms of mental disorder are associated with an increased risk of drug misuse, a finding that is in line with previous studies (Amaro et al., 1999;Brook et al., 2011;Vega, Sribney, & Achara-Abrahams, 2003) that found that some individuals take nonprescribed sedatives to cope with problems such as major depressive disorder. Results support ongoing efforts to reduce substance misuse through addressing mental disorders among adult Latinas (Ritsher, McKellar, Finney, Otilingam, & Moos, 2002). ...
Few studies have examined the socio-cultural determinants of alcohol and drug misuse trajectories among adult Latinas. To assess the associations between socio-cultural determinants and alcohol and drug misuse, we used a longitudinal design to follow a sample of adult Latina mother-daughter-dyads (N = 267) for ten years, and collected four waves of data. They were adult Latinas of Caribbean, South and Central American descent. Specifically, this study investigated the effects of the following factors: (1) Individual Determinants (e.g., socioeconomic conditions, mental health, and medical status); (2) Cultural Determinants (e.g., acculturation to US culture); (3) Interpersonal Determinants (e.g., interpersonal support, relationship stress, mother-daughter attachment, intimate partner violence); (4) Community Determinants (e.g., neighborhood related stress); and (5) Institutional Determinants (e.g., religious involvement, involvement with the criminal justice system). Using hierarchical modeling, we found that taking prescribed medication on a regular basis for a physical problem, religious involvement, and mother-daughter attachment were negatively associated with drug misuse, while involvement in criminal activity was positively associated with drug misuse. Regarding alcohol misuse, results showed that age at arrival in the United States, number of years in the United States, and religious involvement were negatively associated with alcohol misuse, while involvement in criminal activity was positively associated with alcohol misuse. Based on our findings, explicit implications are provided for culturally relevant interventions.
... However, it would be inappropriate in armed force scenario as it would adversely affect the service, promotion and pension prospects of the individual. In a suspected case of alcoholism a false positive test due to lower specificity can have adverse social and stigmatizing consequences [23][24][25]. ...
Introduction: The development of reliable diagnostic tool for
assessing alcoholism is an utmost necessity in treating and
preventing damage due to alcoholism to both individual and armed
forces as alcoholism represents a serious health issue with major
socioeconomic consequences.
Aim: To observe, gamma glutamyl transferase (GGT) can serve
the practical utility of firmly establishing alcohol dependence /
relapse in Armed Forces patients and aid in fair disposals.
Materials and Methods: Fifty two consecutive cases of alcohol
dependence syndrome admitted to a peripheral hospital were
evaluated for the biological marker gamma glutamyl transferase
(GGT) and compared against the gold standard of psychiatrist
assessment. The cases were followed up for one year at three
months, six months, nine months and 12 months interval. The
GGT value of the cases was correlated with the abstinent /relapse
status to find the cutoff levels of the GGT as a biological marker.
Results: At cutoff level of 50 IU/lit GGT exhibited specificity of
100% and sensitivity varying from 56% to 100%. At lower cut off
levels chances of false positive cases with adverse consequences
on service prospects of the individuals are high. The mean
difference in GGT levels across relapse and abstinent group
reached significant statistical proportion at admission and during
follow-up at 3 months /6 months/9 months and 12 months.
Conclusion: GGT can serve the practical utility of firmly
establishing alcohol dependence syndrome in armed forces
to aid in fair disposal of cases. It helps in providing motivational
inputs to patients. Clinician should pay due consideration to
clinical profile, ward observation and unit report as the diagnosis of
alcohol dependence syndrome has serious implications towards
service prospects of a soldier.
... [1][2][3] Participation in 12-Step programs predicts beneficial substance related outcomes measured in a variety of ways: longterm abstinence, percent days abstinent and decreased substance related problems. [4][5][6][7][8][9][10][11] This beneficial effect has been supported by a variety of methodological approaches: populationbased epidemiology studies, longitudinal studies of individuals who have enrolled in formal substance abuse treatment and Project MATCH, an efficacy trial comparing three different substance use disorder treatment methods. [12][13][14][15][16][17][18] Substance use disorder treatment approaches that result in increased 12-Step participation have been related to better substance use outcomes and lower costs than those that do not. ...
Given the limited research on young adults' reactions to 12-Step programs the purpose of this study was to explore young adults' views of Alcoholics Anonymous and Narcotics Anonymous. Qualitative interviews with 26 young adults who had attended AA or NA were conducted. Most participants viewed 12-Step programs favorably reporting that the programs provided hope and emotional support. Participants who rejected the programs often refused to accept the concepts of powerlessness and a higher power. Many participants who rejected AA and NA were unaware of some of the key tenets of the programs suggesting that 12-Step facilitation would benefit this population.
... Studies targeting the impact of psychiatric problems on outcome have typically been limited to assessment of psychiatric severity at baseline. 11,12 Our design was different in that we studied how changes in psychiatric severity over a 2-month period were associated with changes in frequency of MA and other drug use and severity of problems experienced as a result of use. We also examined whether relationships among these variables continued at 4and 6-month follow-up. ...
Few studies have examined how changes in psychiatric symptoms over time are associated with changes in drug use and severity of drug problems. No studies have examined these relationships among methamphetamine (MA) dependent person receiving motivational interviewing within the context of standard outpatient treatment.
Two hundred seventeen individuals with MA dependence were randomly assigned to a standard single session of motivational interviewing (MI) or an intensive 9-session model of MI. Both groups received standard outpatient group treatment. The Addiction Severity Index (ASI) and time-line-follow-back (TLFB) for MA use were administered at treatment entry and 2-, 4- and 6-month follow-up.
Changes in ASI psychiatric severity between baseline and 2 months predicted changes in ASI drug severity during the same time-period, but not changes on measures of MA use. Item analysis of the ASI drug scale showed psychiatric severity predicted how troubled or bothered participants were by their drug us, how important they felt it was for them to get treatment, and the number of days they experienced drug problems. However, it did not predict the number days they used drugs the past 30 days. These associations did not differ between study conditions and they persisted when we compared psychiatric severity and outcomes across 4- and 6-month time periods.
Results are among the first to track how changes in psychiatric severity over time are associated with changes in MA use and severity of drug problems. Treatment efforts targeting reduction of psychiatric symptoms among MA dependent persons might be helpful in reducing the level of distress and problems associated with MA use but not how often it is used. There is a need for additional research describing the circumstances under which the experiences and perceptions of drug related problems diverge from frequency of consumption.
... 33 Comorbid disorders generally predict worse prognoses. [34][35][36] Among youth who had 3 or more types of disorder at baseline, almost all males and three-quarters of females had 1 or more disorders 5 years later. These patterns are of concern. ...
Psychiatric disorders and comorbidity are prevalent among incarcerated juveniles. To date, no large-scale study has examined the comorbidity and continuity of psychiatric disorders after youth leave detention.
To determine the comorbidity and continuity of psychiatric disorders among youth 5 years after detention.
Prospective longitudinal study of a stratified random sample of 1829 youth (1172 male and 657 female; 1005 African American, 296 non-Hispanic white, 524 Hispanic, and 4 other race/ethnicity) recruited from the Cook County Juvenile Temporary Detention Center, Chicago, Illinois, between November 20, 1995, and June 14, 1998, and who received their time 2 follow-up interview between May 22, 2000, and April 3, 2004.
At baseline, the Diagnostic Interview Schedule for Children Version 2.3. At follow-ups, the Diagnostic Interview Schedule for Children Version IV (child and young adult versions) and the Diagnostic Interview Schedule Version IV (substance use disorders and antisocial personality disorder).
Five years after detention, when participants were 14 to 24 years old, almost 27% of males and 14% of females had comorbid psychiatric disorders. Although females had significantly higher rates of comorbidity when in detention (odds ratio, 1.3; 95% CI, 1.0-1.7), males had significantly higher rates than females at follow-up (odds ratio, 2.3; 95% CI, 1.6-3.3). Substance use plus behavioral disorders was the most common comorbid profile among males, affecting 1 in 6. Participants with more disorders at baseline were more likely to have a disorder approximately 5 years after detention, even after adjusting for demographic characteristics. We found substantial continuity of disorder. However, some baseline disorders predicted alcohol and drug use disorders at follow-up.
Although prevalence rates of comorbidity decreased in youth after detention, rates remained substantial and were higher than rates in the most comparable studies of the general population. Youth with multiple disorders at baseline are at highest risk for disorder 5 years later. Because many psychiatric disorders first appear in childhood and adolescence, primary and secondary prevention of psychiatric disorders offers the greatest opportunity to reduce costs to individuals, families, and society. Only a concerted effort to address the many needs of delinquent youth will help them thrive in adulthood.
... These results suggest that more symptoms of mental disorder are associated with an increased risk of drug misuse, a finding that is in line with previous studies (Amaro et al., 1999;Brook et al., 2011;Vega, Sribney, & Achara-Abrahams, 2003) that found that some individuals take nonprescribed sedatives to cope with problems such as major depressive disorder. Results support ongoing efforts to reduce substance misuse through addressing mental disorders among adult Latinas (Ritsher, McKellar, Finney, Otilingam, & Moos, 2002). ...
Background and Purpose: Religiosity is a salient cultural value within the Latino population. Studies suggest Latinos use religious coping mechanisms more frequently than Non-Latino Whites. Given the tendency of Latinos to apply religious coping skills during stressful life situations, it appears that religiosity may serve as a protective factor against risky health behaviors such as illicit drug use. The present study examines whether religiosity moderates the relationship between chronic stress and illicit drug use among Latina mothers and their daughters. We expect that the association between chronic stress and illicit drug use will be moderated by religiosity, after controlling for socioeconomic status and an acculturation proxy (Spanish language proficiency). Specifically, chronic stress will be positively associated with illicit drug use only among Latina women with low levels of religiosity (and not among Latinas with high levels of religiosity). Thus, religiosity will buffer the effects of chronic stress on illicit drug use.
Methods: The analyses were conducted with data from a study of intergenerational drug use among Latina mothers and daughters. The sample consisted of 316 women that were predominantly first-generation immigrants. Participants were administered a single, face-to-face interview in their language of preference (English or Spanish) that included the measures used in the current study. Participants were asked to report demographic data such as their nativity, current personal income during the year prior to assessment, education level, and their employment status. A measure of Chronic Stress from a survey of adult health risk behaviors (Life Course and Health Research Center, 1997) was used to assess mother and daughter stress levels. Religiosity was assessed by items from the Santa Clara Strength of Religious Faith Questionnaire. Spanish language proficiency was measured using the Spanish Language Proficiency scale of the Multidimensional Measure of Cultural Identity Scales for Latinos. The Drug Use Frequency measure was used to assess the frequency of illicit drug use among the participants during the 3 months prior to assessment.
Results: Regression analyses were conducted examining the frequency of marijuana and non-medical sedative use across mother and daughter samples. U.S. born mothers reported more marijuana use. Daughters reporting lower level of Spanish Language Proficiency also reported using marijuana more frequently. Mothers reporting more religiosity reported less marijuana use. Mothers and daughters with high levels of chronic stress and low levels of religiosity reported more marijuana use than participants reporting high levels of chronic stress and high levels of religiosity. The only hypothesized predictor of sedative use was chronic stress in the daughter sample. Daughters reporting more chronic stress reported more sedative use.
Implications: Findings indicate the significant role that religiosity plays in the Latino culture as a potential protective factor from engaging in certain illicit drug use. These results are an important contribution to the field of social work practice and towards the enhancement of culturally congruent substance abuse prevention and intervention services with adult Latinas.
... The finding that alcohol and drug problems were more severe among the high psychiatric group is consistent with a variety of reports in the alcohol and drug treatment literature (Broome, Flynn, & Simpson, 1999;McLellan, et al., 1983;Ritsher, McKeller, Finney, Otilingam, & Moos, 2002). However, our study adds to the literature by accounting for psychiatric symptoms over time rather than at treatment entry only. ...
Background:
Studies show residents of sober living recovery houses (SLHs) make improvements in a variety of areas including alcohol and drug use, arrests, and employment. Longitudinal measures of motivation (assessed as costs and benefits of continuing sobriety) have been shown to be associated with alcohol and drug outcomes in SLHs. However, how motivation interacts with other potentially important factors, such as psychiatric severity, is unclear.
Objective:
The present study aimed to assess how perceived costs and benefits of sobriety among residents of SLHs differed by psychiatric severity. The study also aimed to assess how costs and benefits interacted with psychiatric severity to influence outcome.
Methods:
Two hundred forty-five residents of SLHs were assessed at baseline and 6, 12, and 18 months.
Results:
High psychiatric severity was associated with higher severity of alcohol and drug problems and higher perceived costs of sobriety at all data collection time points. Perceived costs and benefits of sobriety were strong predictors of alcohol and drug problems for participants with low psychiatric severity. Perceived costs, but not perceived benefits, predicted outcomes for residents with high psychiatric severity. CONCLUSIONS/IMPORTANCE: High psychiatric severity is a serious impediment for some residents in SLHs. These individuals perceive sobriety as difficult and that perception is associated with worse outcome. Finding ways to decrease perceived costs and challenges to sustained sobriety among these individuals is essential as is collaboration with local mental health services. SLHs should consider whether additional onsite services or modifications of SLH operations might help this population.
... sociated with better substance use outcomes when treatment amount was controlled, whereas amount of outpatient care was not independently associated with outcomes (Moos et al., 2001;Ouimette, Moos, & Finney, 1998). These and other studies (Ritsher, McKellar, Finney, Otilingam, & Moos, 2002) suggest that, among individuals with substance use disorders only, attending more mutual-help group meetings is beneficial for substance use outcomes, above and beyond the influence of treatment utilization. ...
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... In terms of treatment planning, SASSI-3 results could be used to mandate attendance at support groups such as Alcoholics Anonymous as a condition of clients' conditional release. Ritsher, McKellar, Finney, Otilingam, and Moos (2002) found that such support groups were beneficial to individuals dually diagnosed with substance use disorders and other psychiatric diagnoses. Likewise, Wiederanders and Choate (1994) referred to anecdotal reports by clients who suggested that weekly drug testing helped them to avoid using drugs and alcohol. ...
Previous studies have shown the Substance Abuse Subtle Screening Inventory-3 (G. Miller, 1999) to be valid in classifying substance use disorders in forensic and mentally ill populations. The authors found that it also correctly classified substance use disorders in the understudied not guilty by reason of insanity population.
... Several studies show that people with substance dependence, with or without co-occurring disorders, are stigmatized and discriminated against. [41][42][43] They are often seen as immoral or dangerous. 44 Some authors have concluded that stigmatization inflicts greater psychological pain than the mental disorder or addiction itself 45,46 and poses a key barrier to rehabilitation. ...
Objective:
Our study sought to identify sociodemographic, clinical, life perception, and service use characteristics that distinguish new cases of people dependent on substances from the general population; and to determine predictors of substance dependence over a 2-year period. Variables that differentiate people dependent on substances according to sex and age were also assessed.
Methods:
Among 2434 people who took part in an epidemiologic catchment area health survey at baseline, 2.2% were identified with substance dependence at the second measurement time only. Using a comprehensive framework, various aspects were considered as predictors for multivariate statistics.
Results:
Participants with substance dependence at time 2 only showed worse clinical conditions, life events, life and health perception, and neighbourhood characteristics than other participants, but only 2.5% used health care services. Male sex, younger age, stigmatization, and impulsiveness were predictors of substance dependence. Regarding sex, females with dependence were only more likely to suffer from social phobia than males. In terms of age categories, participants over 50 with substance dependence were more likely to have a lower household income and less social support than younger people.
Conclusion:
Stigmatization was the strongest predictor of substance dependence. Our study also confirmed that males and younger people were more likely to have substance dependence. Anti-stigmatization, prevention, and outreach programs are needed to overcome the reluctance of this clientele to use health care services. Health professionals should also pay more attention to life and health perception and neighbourhood characteristics of newly identified drug users.
... Effects on treatment have been studied in many mental health disorders by mostly US and European researchers. Examples include: depression (Bagby et al., 2002), bipolar disorder (Frangou, 2002), schizophrenia (Green et al., 2003), substance use disorders (Ritsher et al., 2002), obsessive -compulsive disorder (Abramowitz, 2004), generalized anxiety disorder (Bruce et al., 2005;Noyes, 2001), post-traumatic stress disorder (Breslau, 2001), social phobia (Bruce et al., 2005) and panic disorder (Bruce et al., 2005;Mennin and Heimberg, 2000). In general, the presence of a co-occurring disorder can increase treatment failure, require more treatment attempts, or necessitate longer treatment depending on the specific interaction effects. ...
A substantial portion of gamblers in treatment may have co-occurring mental health disorders including substance use disorders, especially alcohol dependency, personality disorders, affective disorders, anxiety disorders and impulse control disorders. Co-occurring mental health disorders affect treatment seeking, the treatment process and its outcome, quality of life and functioning in many mental health disorders. Participants in this study were 78 adults enrolled in state-supported out-patient services for pathological gambling and current Gamblers Anonymous attendees. The majority of participants (76.6%) had co-occurring behaviours; 55.8% had multiple co-occurring behaviours. Participants with multiple co-occurring behaviours were more likely to report that a co-occurring behaviour increased the severity of their gambling symptoms. A dose/response relationship between number of co-occurring behaviours and severity of gambling problems was found. Co-occurring behaviours can interact with gambling behaviour. Brief, validated screening instruments are available for screening and diagnosing co-occurring behaviours among gamblers presenting for treatment.
... Author manuscript; available in PMC 2012 November 05. than single disorders (Hagnell & Grasbeck, 1990; Hirschfeld, Hasin, Keller, Endicott, & Wunder, 1990; Kessler, 1995; Murphy, 1990) and tend to predict of negative treatment outcomes (Ritsher,, McKellar, Finney, Otilingam, & Moos, 2002; Gonzalez and Rosenheck, 2002; McLellan, Luborsky, Woody, O'Brien, & Druley, 1983; Rounsaville, Kosten, Weissman, & Kelber, 1986), although not in all studies (for a review, see Bogenschutz Geppert, & George, 2006). Mutual aid refers to people helping each other address a shared problem in living, usually in a group context, without mediation by professional treatment or service providers. ...
Double Trouble in Recovery (DTR) is a "dual focus," 12 step-based mutual aid program tailored to assist recovery from co-occurring substance use and psychiatric disorders. OBJECTIVE: To determine consumers' perceptions of DTR's usefulness for their recoveries and the relationships between perceived DTR usefulness and self-help processes, self-efficacy to cope with problems in recovery, and changes in behaviors conducive to dual recovery. METHODS: Consumers attending DTR groups, located within a psychiatric day-treatment program, completed anonymous surveys 8 months (N=19) and 20 months (N=61) after DTR was implemented. RESULTS: DTR participants rated DTR favorably and length of DTR attendance was significantly associated with increased self-efficacy for recovery and positive changes in recovery-oriented behaviors. Perceived DTR usefulness was significantly associated with greater engagement in three specific self-help processes and increased self-efficacy for recovery; notably, these associations were independent of consumers' overall satisfaction with the treatment program. CONCLUSION: This study is the first to document consumers' perceived usefulness of DTR in relation to indicators of recovery. Overall, the study provides additional evidence for the benefits of implementing consumer-led dual focus groups in treatment programs.
... Furthermore, research on addiction treatment also has shown consistently that roughly 50% of adults who receive addiction treatment resume their drug use within 6 months of ending treatment, regardless of their substance of choice (Anglin, Hser, & Grella, 1997;Institute of Medicine, 1998;McKay et al., 1999;McKay et al., 2004), with many of these individuals relapsing within 90 days of discharge (Hubbard, Flynn, Craddock, & Fletcher, 2001). Although longer treatment episodes, especially residential treatment, and posttreatment continuing care are associated with better outcome at 5-year follow-up (Hubbard, Craddock, & Anderson, 2003;Ray, Weisner, & Mertens, 2005;Ritsher, McKellar, Finney, Otilingam, & Moos, 2002), the last decade has seen a significant shift toward briefer and briefer treatment and away from residential settings to outpatient care, where nearly 90% of addiction treatment now occurs (Mclellan, Carise, & Kleber, 2003;SAMHSA, 2002a). ...
Recovery capital—the quantity and quality of internal and external resources to initiate and maintain recovery—is explored with suggestions for how recovery support services (RSS) (nontraditional, and often nonprofessional support) can be utilized within a context of comprehensive addiction services. This article includes a brief history of RSS, conceptual and operational definitions of RSS, a framework for evaluating RSS, along with a review of recent empirical evidence that suggests that rather than enabling continued addiction, recovery supports are effective at engaging people into care, especially those who have little recovery capital, and/or who otherwise would likely have little to no “access to recovery.”
... In particular, it was found that regular attendance at two or more aftercare programs was associated with the largest proportion of clients in high recovery. These findings are not surprising, as previous research has consistently demonstrated the importance of attending post-treatment aftercare to improve relapse prevention (Gossop et al., 2003 & Ritsher, McKellar, Finney, Otilingam & Moos, 2002). By engaging in a form of organized support, it appears that clients in aftercare are not resuming the maladaptive coping patterns sustained by their chemical dependence and instead are preventing a return to active addiction by turning to others in times of need. ...
The present study examined the impact of an in-patient addiction treatment program and whether client-related treatment outcomes were moderated by addiction type: (1) alcohol only; (2) cocaine only or with alcohol; (3) cocaine with other substances; and (4) prescription drugs and/or cannabis. Clients completed self-reports of their substance use and quality of life during their first week in treatment and at 6-months post-discharge. Pre-treatment motivation and post-treatment aftercare attendance were also assessed. Overall, a positive impact of the addiction treatment programme was noted as clients reported a significant reduction in substance use and improvement in quality of life. Results also demonstrated that drug of choice impacted recovery status such that compared with cocaine poly substance clients, alcohol clients obtained significantly higher scores on quality of life measures at both pre- and 6-months post-treatment. However, cocaine poly substance clients were also significantly younger than alcohol only clients and were less likely to be married or employed. In general, substance use clients responded well to treatment. Some variability was noted among substance use groups—namely that cocaine poly-drug users obtained lowest levels of post-treatment reduction in substance use. The implications of such findings are discussed.
... 72,73 A small literature that suggests that engagement in AA may have beneficial mood effects for depressed members; however, it is unclear if this effect is due to reductions in alcohol use. 74 Moreover, in a heterogeneous dually-diagnosed population, data suggest a positive correlation between twelve step group participation and rates of abstinence, 75 and levels of general distress. 76 Engaging a patient in a self-help program may create unexpected challenges for alcoholic patients with co-occurring psychiatric illness. ...
Alcohol use disorders (AUDs) and depressive illnesses are highly prevalent, frequently co-occur, and are associated with worse outcomes when paired. The assessment and treatment of patients with co-occurring alcohol use disorders and depressive illnesses is wrought with many significant challenges. When it comes to advocating treatment guidelines for this dually-diagnosed population, the data are limited, but, nonetheless, do suggest that an integrated approach to patients presenting with co-occurring AUD and depressive symptoms can be efficacious. In this approach, ongoing evaluation and treatment are provided under one roof according to the evolving needs of each patient. Utilizing antidepressant medications in conjunction with psychosocial therapies may augment overall treatment efficacy; data also suggest that combining and tailoring psychosocial therapies, such as motivational enhancement therapies, cognitive therapies, and twelve-step facilitation may further improve treatment outcomes for patients with co-occurring depressive and alcohol use disorders.
... Accordingly, the American Psychiatric Association (1995), the American Society for Addiction Medicine (ASAM; 2001), and Department of Veterans' Affairs Office of Quality and Managing Chronic Addiction -8 Performance (2004) have issued clinical practice guidelines recommending that patients being discharged from intensive levels of addiction treatment be transferred to outpatient treatment for a period of time before being discharged from the addiction treatment systems. A number of studies demonstrate that patients who did so were more likely to remain abstinent and avoid arrest than those who did not (e.g., Brown et al., 1994; Donovan, 1998; Gilbert, 1988; Godley et al., in press; Higgins, Badger, & Budney, 2000; Ito & Donovan, 1986; Kosten et al., 1992; McKay, 2001; McKay et al., 1998; Moos, Schaefer, Andrassy, & Moos, 2001; Moos & Moos, 2003; Ouimette, Moos, & Finney, 1998; Peterson et al., 1994; Ritsher, McKellar, Finney, Otilingam, & Moos, 2002; Sannibale et al., 2003; Walker, Donovan, Kivlahan, & O'Leary, 1983). Conversely, in one of the few economic evaluations of long-term management of chronic SUD, French and colleagues (2000) found that while the outlay to provide a full continuum of inpatient and outpatient care was greater than that for outpatient treatment alone ($2,530 vs. $1,138; p<.05), the cost differential was offset by significantly greater reductions in societal costs over the subsequent 9 months (savings of $17,833 vs. $11,173; p<.05). ...
... Effects on treatment by co-occurring disorders have been documented in many mental health disorders, including depression (Bagby, Ryder, & Cristi, 2002), bipolar disorder (Frangou, 2002), schizophrenia (Green, Canuso, Brenner, & Wojcik, 2003), substance use disorders (Ritsher, McKellar, Finney, Otilingam, & Moos, 2002), obsessive-compulsive disorder (Abramowitz, 2004), generalized anxiety disorder (Noyes, 2001), posttraumatic stress disorder (Breslau, 2001), social phobia (Bruce et al., 2005), and panic disorder (Mennin & Heimberg, 2000;Bruce et al., 2005). Several modalities of treatment including cognitive-behavioral therapies (Mennin & Heimberg, 2000), behavioral therapy (Steketee, Chambless, & Tran, 2001), inpatient treatment (Haettenschwiler, Rueesch, & Modestin, 2001), and pharmacotherapy (Bagby et al., 2002) have studies that document effects by cooccurring disorders. ...
Introduction
Recent reviews found problem gamblers are heterogeneous and recommended subtyping gamblers in treatment studies.
Objective
Review factors (stage of change, preferred gambling activity, co-occurring disorder, and temporal instability of symptoms) for subtyping by evaluating the evidence for their effects on gambling treatment.
Methods
Literature review, evidence grading.
Results
Evidence is limited that any of the reviewed factors affects gambling treatment. Substantial evidence from prospective studies and other evidence from cross-sectional studies and the strong placebo response among pathological gamblers support the temporal instability of gambling symptoms.
Conclusions
Multiple studies are needed to develop the evidence base needed to subtype gamblers in treatment. Changes in the diagnostic criteria of pathological gambling may be necessary, especially to specify the persistence of gambling-related symptoms.
... For instance, persons recovering from alcohol and substance use disorders typically utilize social support through their involvement in self/mutual-help programs such as those found in twelve-step fellowships (Humphreys 2004; Humphreys et al. 1999). Involvement in twelve-step fellowships (e.g., Alcoholics Anonymous, Narcotics Anonymous) has been related to improvements in remission rates among persons with substance use disorders and psychiatric comorbidity (Ritsher et al. 2002). Research data from an 8-year outcome study (Moos and Moos 2004) suggest that continued involvement in self-help programs might produce additional desirable health outcomes. ...
A longitudinal analysis of psychiatric severity was conducted with a national sample of recovering substance abusers living
in Oxford Houses, which are self-run, self-help settings. Outcomes related to residents’ psychiatric severity were examined
at three follow-up intervals over one year. Over time, Oxford House residents with high versus low baseline psychiatric severity
reported significantly more days using psychiatric medication, decreased outpatient psychiatric treatment, yet no significant
differences for number of days abstinent and time living in an Oxford House. These findings suggest that a high level of psychiatric
severity is not an impediment to residing in self-run, self-help settings such as Oxford House among persons with psychiatric
comorbid substance use disorders.
This study aimed to explore whether there are differences between Oxford House recovery home residents with psychiatric comorbidity in their ability to form, maintain, and dissolve loaning ties and seek advice, when compared to Oxford House residents without comorbidity, and if differences do exist, are those ties mono- or bi-directional. Findings indicated unique interdependencies among individuals with psychiatric comorbidity for advice seeking, loaning, and recovery factor scores. The results of this investigation are consistent with the dynamic systems theory conceptions of community-based recovery. Recovery homes provide access to social capital, via the residents’ social network, by facilitating recovery-oriented social exchanges, which can lead to changes to the recovery home social dynamics. Upon interpreting the results of this study, components from a dynamic systems theory emerged (e.g. explaining the processes that preserve or undermine the development, maintenance, and dissolution of a network); and provided a framework for interpreting the loaning, advice-seeking, and the latent recovery factor networks and their relationship with psychiatric comorbidity. A deeper understanding of the interplay among these dynamics is described providing an understanding of how Oxford House recovery homes promote long-term recovery in a shared community setting for those with high psychiatric comorbidity.
Introduction
The successful retention of individuals with substance use disorders in treatment remains a challenge but is an important indicator of positive post-treatment outcomes. The aim of this study is to advance understanding of pre-admission factors associated with substance use treatment completion in Rhode Island.
Methods
Data for this longitudinal analysis are from the RI Behavioral Health On-Line Database (RI-BHOLD). The primary outcome of interest was substance use treatment completion defined as any planned discharge from treatment, including transfers to other facilities. Associations were assessed using generalized estimating equations (GEE) to account for the potential of repeated measures for the same individuals.
Results
Among the 7,351 clients discharged from a substance use treatment program in RI in 2018, the treatment completion rate was 58.1%. There was a positive relationship between the frequency of attendance of voluntary self-help groups and odds of treatment completion. Treatment completion rates were lower among those who reported use of opioids (AOR: 0.59; 95% CI: 0.52-0.66) and other drugs (AOR: 0.52; 95% CI: 0.44-0.62), compared to alcohol and for those with co-occurring mental health conditions (AOR: 0.85; 95% CI: 0.76-0.94).
Conclusions
This study highlights the importance of social connectedness in substance use disorder treatment completion. Future research is needed to identify the characteristics of persons who are most likely to benefit from self-help groups and the optimal combination of treatment participation and attendance of self-help groups across a spectrum of disorder severity and community resources.
Abstract
Background: Women with alcohol disorders have more severe problems related to their drinking than men. They have higher mortality from alcohol-related accidents and enter treatment with more serious medical, psychiatric, and social consequences. Objective: This study assessed the effects of Intensive Motivational Interviewing (IMI), a new, 9-session counseling intervention for women with drinking problems. Methods: A randomized clinical trial was conducted with 215 women. Most were white (83%), college educated (61%), and older (mean age 51). Half received IMI and half a standard single session of MI (SMI) along with an attention control (nutritional education). Results: Generalized estimating equations models showed women who were heavy drinkers at baseline in the IMI condition reduced heavy drinking more than those in the SMI condition at 2-, 6-, and 12-month follow-up. Analyses of disaggregated subgroups showed IMI was most effective for women with low psychiatric severity, more severe physical and impulse control consequences associated with drinking, and higher motivation. However, formal 3-way interaction models (condition by moderator by time) showed significant effects primarily at 2 months. Conclusions: Improvements associated with IMI were limited to heavy drinking and varied among subgroups of women. Studies of women with more diverse characteristics are needed.
Social support and psychiatric severity are known to influence substance abuse. However, little is known about how their influences vary under different conditions. We aimed to study how different types of social support were associated with substance abuse outcomes among persons with low and moderate psychiatric severity who entered Sober Living Houses (SLHs). Two hundred forty-five individuals entering 16 SLHs were interviewed at baseline and 6, 12, and 18 months. The Brief Symptom Inventory assessed psychiatric symptoms and the Important People Instrument and a modified AA Affiliation Scale assessed social support. Social support variables predicted substance abuse outcomes for persons with low and moderate psychiatric severity. However, they were the strongest and most consistent predictors for the low severity group.
Abstract
Social support and psychiatric severity are known to influence substance abuse. However, little is known about how their influences vary under different conditions. We aimed to study how different types of social support were associated with substance abuse outcomes among persons with low and moderate psychiatric severity who entered Sober Living Houses (SLHs). Two hundred forty-five individuals entering 16 SLHs were interviewed at baseline and 6, 12, and 18 months. The Brief Symptom Inventory assessed psychiatric symptoms and the Important People Instrument and a modified AA Affiliation Scale assessed social support. Social support variables predicted substance abuse outcomes for persons with low and moderate psychiatric severity. However, they were the strongest and most consistent predictors for the low severity group.
Background:
Although studies of co-occurring psychiatric disorders among methamphetamine (MA)-dependent persons have been conducted in treatment programs, none have examined them in service settings used to sustain long-term recovery, such as sober living houses (SLHs).
Methods:
Residents entering SLHs (N = 243) were interviewed within two weeks and at 6-, 12-, and 18-month follow-up. Measures assessed psychiatric symptoms using the Brief Symptom Inventory (BSI), past-year drug and alcohol dependence, and abstinence over six-month time periods.
Results:
Overall, severity of psychiatric symptoms on the BSI was similar among MA-dependent and other dependent residents. Global psychiatric severity, depression, and somatization scales on the BSI predicted abstinence for both groups. However, phobic anxiety and hostility scales were associated with abstinence for MA-dependent residents but not for those dependent on other substances.
Conclusion:
The similarity of psychiatric symptoms among persons with and without MA dependence in SLHs is different from what studies have found in treatment programs. The association between psychiatric symptoms and abstinence for both groups suggests SLHs should consider provision of on- or off-site mental health services. Additional research is needed to understand why phobic anxiety and hostility are associated with abstinence among MA-dependent residents but not those dependent on other substances.
IntroductionThe Course of Addictive DisordersScreening and Initial Referral of PatientsDescriptions of Psychosocial Treatments for SudSelf-Help for Substance Use DisorderRole of Referring Physician During Self-Help and/or Professional Sud TreatmentContinuing CareManaging Treatment-Resistant PatientsConclusions
AcknowledgmentReferences
IntroductionStress Coping and Self-Medication ModelsTreatment in the Community12-Step ApproachesCognitive and Behavioral TherapiesConclusions
AcknowledgmentReferences
Introduction
Social factors play vital role in unfolding of alcohol use disorders in any given population. Several factors beyond the confines of treatment settings influence treatment outcome in alcohol dependence syndrome. Social support has positive effect in treatment outcome of alcohol dependence syndrome. This has not been much studied in India in past. Therefore we decided to study the perception of social support in cases of alcohol dependence syndrome admitted in a busy hospital in armed forces.
This study sought to identify profiles associated with substance dependence only, mental disorders only and co-occurring disorder respectively, using a broad range of socio-demographic, socio-economic, health beliefs, clinical and health services utilization variables concurrently. Based on a broad analytic framework, 423 participants diagnosed with substance dependence only, mental disorders only or co-occurring disorders within a 12-months period were studied. The study used comparison analysis, and a multinomial logistic regression model. Participants with dependence only and mental disorders only were in contrast in terms of gender, age, marital status, self-perception of physical health, perception of the physical conditions of their neighbourhood, impulsiveness, psychological distress and visit with a family physician in previous 12-months, while those with co-occurring disorders were in an intermediary position between the other two groups. Public authorities should especially promote strategies that could increase the capacity of family physicians to take care of individuals with substance dependence only.
The present study examined 12-step involvement categorically and its relation to coping strategies and self-efficacy for abstinence among 42 members of Alcoholics Anonymous and Narcotics Anonymous and 42 recovering addicts/alcoholics residing in democratically operated recovery homes (Oxford Houses). Participants who were categorically involved in a set of 12-step activities reported significantly lower levels of emotion-focused coping strategies and significantly higher levels of social-support coping strategies and self-efficacy for abstinence compared with those who were less involved. Twelve-step meeting attendance was not significantly related to outcomes. Findings suggest that categorical involvement in 12-step activities equips recovering alcoholics/addicts with active coping strategies for their ongoing recovery. Implications for future research are discussed.
The present study examined self-regulation, unemployment, and substance use outcomes for individuals with and without posttraumatic stress disorder (PTSD) who had transitioned from substance use treatment centers to the community. Participants, recruited from substance abuse treatment centers, were randomly assigned to an Oxford House self-help communal living environment (n = 75) or received usual aftercare (n = 75). Among these 150 individuals, 32 participants (27 women, 5 men) were diagnosed with lifetime PTSD. At a two year follow-up, individuals with PTSD in the usual aftercare condition showed significantly lower levels of self-regulation than those in the Oxford House condition with or without PTSD. These findings highlight the importance of abstinence supportive settings following substance use treatment, especially for individuals with PTSD.
ABSTRACT This study investigates the 10-year course and impact of Alcoholics Anonymous (AA)-related helping (AAH), step-work, and meeting attendance on long-term outcomes. Data were derived from 226 treatment-seeking alcoholics recruited from an outpatient site in Project MATCH and followed for 10 years post treatment. Alcohol consumption, AA participation, and other-oriented behavior were assessed at baseline, end of the 3-month treatment period, and 1, 3, and 10 years post treatment. Controlling for explanatory baseline and time-varying variables, results showed significant direct effects of AAH and meeting attendance on reduced alcohol outcomes and a direct effect of AAH on improved other-oriented interest.
The majority of drug abusing offenders who need substance abuse treatment do not receive it. Although interventions like drug court increase the probability of offender success, little is known about how co-occurring psychological symptoms impact drug court treatment outcomes. Based on previous research, we hypothesized that co-occurring psychological symptoms would have a significant relationship with successful drug court completion. Using a sample of suburban drug court enrollees (n = 122), multivariate logistic regression was conducted with successful drug court completion as the outcome variable. Predictor variables included symptom counts of depression, post-traumatic stress, obsessive-compulsive disorder, panic disorder, psychosis, generalized anxiety, and social phobia. Results indicated that participants with fewer symptoms of depression were more likely to successfully complete drug court than participants with more symptoms. The present study extends previous research by demonstrating that symptoms of depression are related to poorer outcomes for drug court enrollees. Accordingly, drug courts need to address participants' symptoms of depression to maximize success.
This article examines the academic sources and origins of the „recovery movement” in the drugs field in the United Kingdom and considers a series of disparate evidence sources that have been applied and used in this regard. Only two of these originate in traditional addictions materials—treatment outcome and cohort studies—with the remaining studies reviewed coming from a range of other areas. In particular, the sources include a switch in focus from the specialist treatment clinic to the community, and from the therapeutic to the more broadly social. The framework for this approach is explicitly developmental and attends to the published research around crime careers and addiction careers. The final sections of the article review recent UK addiction recovery research and assess where we are and what we currently know—and as a consequence the key gaps and the methodological questions that need to be addressed.
Studies have shown that eating disorders and substance use disorders often co-occur and share common clinical and biological substrates. Given the high prevalence of co-occurring eating and substance use disorders, it is important to explore the impact of the dual-diagnosis on treatment outcomes. The present study compared individuals with an eating disorder only (ED) to those with a comorbid eating and substance use disorder (ED-SUD) on several factors related to 6-month post-treatment outcomes in eating attitudes and behavior and quality of life. Results show that both ED and ED-SUD clients experience significant improvements in self-reported eating disorder symptoms and concerns, as well as quality of life functioning. There were no significant differences in outcomes between ED and ED-SUD clients, which suggests that the two conditions can be successfully treated together.
A randomized experimental design was used to assign participants to an integrated mental health and substance use treatment program or to standard hospital treatment. A multilevel, nonlinear model was used to estimate hospital treatment effects on days of alcohol use for persons with serious mental illness and substance use disorders over 18 months. The integrated treatment program had a significant effect on the rate of alcohol use at 2 months postdischarge, reducing the rate of use by 54%. Motivation for sobriety at hospital discharge, posttreatment self-help attendance, and social support for sobriety were also found to reduce the rate of use during the follow-up period. Implications for mental health treatment and aftercare support are discussed.
The authors examined whether continuing outpatient mental health care, the orientation of the treatment program (12-step, cognitive-behavioral, or eclectic), and involvement in self-help groups were linked to substance abuse patients' remission status two years after discharge.
The data were from a cohort of 2,805 male patients who were treated through one of 15 Department of Veterans Affairs substance abuse programs. Remission was defined as abstinence from illicit drug use and abstinence from or nonproblem use of alcohol during the previous three months. The relationships of the three variables to remission were tested with regression models that controlled for baseline characteristics.
About a quarter of the study participants (28 percent) were in remission two years after discharge. Intake characteristics that predicted remission at two years included less severe substance use and psychiatric problems, lower expected disadvantages and costs of discontinuing substance use, and having abstinence as a treatment goal. No significant relationship emerged between treatment orientation and remission status two years later. Involvement in outpatient mental health care during the first follow-up year and participation in self-help groups during the last three months of that year were associated with a greater likelihood of remission at the two-year follow-up.
The results extend previously published one-year outcome findings showing that cognitive-behavioral and 12-step treatment programs result in similar remission rates. Patients who enter intensive substance abuse treatment with polysubstance use, psychiatric symptoms, or significant emotional distress have more difficulty achieving remission. Routinely engaging patients in continuing outpatient care is likely to yield better outcomes. The duration of such care is probably more important than the number of sessions.
A bstract A im s. To study prospectively the type and extent of aftercare sought by patients following their admission for alcohol and other substance abuse treatment as a function of psychiatric co-morbidity . D esign. Prospective cohort study with follow-up after 16 months . Setting and participants. A nationwide sample of alcoholics discharged from inpatient treatment ( N = 351) in Iceland . M easurem ents. The Diagnostic Interview Schedule was used to assign psychiatric diagnoses at the time of index admission. A questionnaire on the type and number of aftercare attendances was mailed to all participants to obtain information about aftercare . Findings. A combination of attendance at Alcoholics Anonymous (AA) and professional care was the most common aftercare (49%); while only 8% received no aftercare whatsoever. The mean number of AA attendances was over 24 while it was less than 3 for the various professional appointments. Patients with a diagnosis of schizophrenia had a lower rate of attendance at AA. Other types of co-morbidity did not affect AA attendance but did increase rates of professional help-seeking . C onclusions. Better professional treatment attendance might be gained by integrating AA concepts while AA might benefit from professional input to address the prevalent co-morbid psychiatric disorders.
To examine the association between the duration and amount of outpatient mental health care, participation in self-help groups, and patients' casemix-adjusted one-year outcomes.
A total of 2,376 patients with substance use disorders, 35% of whom also had psychiatric disorders, were assessed at entry to treatment and at a one-year follow-up. Information about the duration and amount of outpatient mental health care was obtained from a centralized health services utilization database.
Patients who obtained regular outpatient mental health care over a longer interval and patients who attended more self-help group meetings had better one-year substance use and social functioning outcomes than did patients who were less involved in formal and informal care. The amount of outpatient mental health care did not independently predict one-year outcomes.
The duration of outpatient mental health care and the level of self-help involvement are independently associated with less substance use and more positive social functioning. The provision of low intensity treatment for a longer time interval may be a cost-effective way to enhance substance abuse and psychiatric patients' long-term outcomes.
The influence of psychiatric comorbidity on the course and outcome in a nationwide representative sample (n = 351) of treatment-seeking substance users over a 28-month period was studied prospectively. The patients were administered
the Diagnostic Interview Schedule and a questionnaire on drinking history. At 16 and 28 months after admission the patients
returned a questionnaire on drinking history and mental health. In cases of those lacking information on either follow-up
(45%), details on drinking status was obtained from informants. Completely abstinent were 16%. Generalized anxiety disorder
and/or social phobia at the index admission predicted abstinence during the follow-up [odds ratio (OR) = 0.25], whereas onset
of alcoholism among these patients after age 25 years predicted a worse prognosis (OR = 13.5). Also increasing number of social
consequences related to abuse (OR = 1.3) and drinking more than the median (OR = 2.1) predicted a poor outcome. The abstinent
group had significantly better mental health at follow-up. The patients with comorbid psychiatric disorders at admission were
worse at follow-up. Although substance use disorders and comorbid psychiatric disorders have to a certain degree separate
courses, there is nevertheless significant interaction between them. Early treatment and recognition of comorbid psychiatric
disorders among substance abusers is necessary.
Relatively little is known about how substance abuse treatment facilitates positive outcomes. This study examined the therapeutic effects and mechanisms of action of affiliation with Alcoholics Anonymous (AA) after treatment. Patients (N = 100) in intensive 12-step substance abuse treatment were assessed during treatment and at 1- and 6-month follow-ups. Results indicated that increased affiliation with AA predicted better outcomes. The effects of AA affiliation were mediated by a set of common change factors. Affiliation with AA after treatment was related to maintenance of self-efficacy and motivation, as well as to increased active coping efforts. These processes, in turn, were significant predictors of outcome. Findings help to illustrate the value of embedding a test of explanatory models in an evaluation study.
This article first explains the conceptual framework and plan of a naturalistic, multisite evaluation of Department of Veterans Affairs (VA) substance abuse treatment programs. It then examines the effectiveness of an index episode of inpatient treatment and the effectiveness of continuing outpatient care and participation in self-help groups. The study was conducted among 3018 patients from 15 VA programs that emphasized 12-Step, cognitive-behavioral (CB), or eclectic treatment. Casemix-adjusted 1-year outcomes showed that patients in 12-Step programs were the most likely to be abstinent, free of substance abuse problems, and employed at the 1-year follow-up. Patients who obtained more regular and more intensive outpatient mental health care, and those who participated more in 12-Step self-help groups, were more likely to be abstinent and free of substance use problems at the 1-year follow-up. These findings support the effectiveness of 12-Step treatment and show that patients with substance use disorders who become more involved in outpatient care and self-help groups tend to experience better short-term substance use outcomes. Subsequent papers in this section focus on the proximal outcomes of treatment, patients with psychiatric as well as substance use disorders, patient-treatment matching effects, and the link between program treatment orientation and patients' involvement in and the influence of 12-Step self-help groups.
The association between additional co-morbid axis I disorders and the following 28-month course of drinking and mental distress was explored in a nation-wide representative sample (N = 100) of treatment-seeking alcoholics with antisocial personality disorder (ASPD). Diagnoses at admission were assessed with the Diagnostic Interview Schedule and follow-up status was assessed with a questionnaire and from informants. Only 24% had no additional diagnoses, 39% had an affective disorder, 43% panic/agoraphobia, 61% other anxiety disorders, and 47% were polysubstance abusers. Polysubstance abusers had more prior admissions, and were more often involved in fights, while additional anxiety disorder was associated with lower prevalence of drunken driving arrests. Relapse (87%) was best predicted by the number of prior admissions (odds ratio [OR] = 1.3), while affective disorders reduced the risk of relapse (OR = 0.2). Readmissions (55%) were least common among those with affective disorders (44%). Identifying axis I diagnoses, and in particular affective disorders among treatment-seeking ASPD alcoholics, is of substantial importance both in research and clinical practice.
Drawing on ecological and narrative theories of self-help groups, this study tests a multilevel model predicting self-help group involvement among male veterans who received inpatient substance abuse treatment. Following K. Maton (1993), the study moves beyond the individual-level of analysis to encompass variables in the treatment and post-treatment social ecology. Surveys administered to patients (N = 3,018) and treatment staff (N = 329) assessed these predictor domains and self-help group involvement 1 year after discharge. A hierarchical linear model fit to the data indicates that greater involvement in 12-step groups after discharge is predicted by the compatibility between personal and treatment belief systems. The implications of these findings for efforts to facilitate transitions between inpatient professional treatment and community-based self-help groups are discussed.
Self-help groups are the most commonly sought source of help for substance abuse problems, but few studies have evaluated the mechanisms through which they exert their effects on members. The present project evaluates mediators of the effects of self-help groups in a sample of 2,337 male veterans who were treated for substance abuse. The majority of participants became involved in self-help groups after inpatient treatment, and this involvement predicted reduced substance use at 1-year follow-up. Both enhanced friendship networks and increased active coping responses appeared to mediate these effects. Implications for self-help groups and professional treatments are discussed.