Article

First-Person Perspectives on Dual Diagnosis Anonymous (DDA): A Qualitative Study

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  • Dual Diagnosis Anonymous
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Abstract

People dually diagnosed with substance abuse and mental illnesses often feel alienated at traditional 12-step meetings, yet they need the peer support provided by such groups. Dual Diagnosis Anonymous (DDA) is a peer-support program specifically for people with co-occurring disorders, which addresses many of the factors that members find alienating about traditional 12-step groups. This study aimed to elicit first-person perspectives on DDA. Occupational therapy students conducted 13 focus groups with 106 DDA members in three settings: the community (6 groups, n = 36), correctional facilities (5 groups, n = 53), and the state psychiatric hospital (2 groups, n = 17). Researchers inductively analyzed focus group transcripts to identify prominent themes. The vast majority of participants were between the ages of 18 and 49 (n = 87, 82.1%) and were non-Hispanic/White (n = 82, 77.4%). Most participants had been using substances for more than 10 years and had been diagnosed with a mental illness for more than 10 years. The most common substance of choice among those in the community and corrections setting was multiple substances, while those in the state hospital identified alcohol most often. Bipolar disorder was the most common mental illness diagnosis among participants in the state hospital, but depression and anxiety were the two most common diagnoses in the community and corrections participants. Four primary themes emerged from the qualitative analysis: (1) feeling accepted by others in the group, (2) acceptance within the group of mental illness and substance abuse together, (3) the structure of DDA meetings compared to other 12-step meetings, and (4) a focus on hope and recovery from both illnesses. DDA provides a helpful alternative for individuals who do not feel comfortable at traditional 12-step groups due to their mental illness. Members value the acceptance, understanding, discussion, and hope in DDA meetings.

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... Previous research on treatment-related factors within the field of co-occurring AOD and mental health problems stresses the importance of the individual's own participation in the recovery process. Thus, the responsibility lies first with the person in focus, and the professional's role is to support individual possibilities and preconditions for recovery, and to give hope (Davidson and White 2007;Cabassa, Nicasio, and Whitley 2013;Mueser and Gingerich 2013;Roush et al. 2015). In order to inspire hope, the practitioner's own hope is crucial when putting strategies for inspiring hope into action (Saelør et al. 2015) but how hope might be inspired cannot be answered in a general way (Herrestad et al. 2014). ...
... In order to inspire hope, the practitioner's own hope is crucial when putting strategies for inspiring hope into action (Saelør et al. 2015) but how hope might be inspired cannot be answered in a general way (Herrestad et al. 2014). Furthermore, the professional's role is to provide knowledge on mental health and AOD problems (Green et al. 2015;Roush et al. 2015;Pallaveshi et al. 2013) and to give non-judgmental support (Green et al. 2015). Having a social network that believes in the person and accepts them as they are, is important (Pallaveshi et al. 2013;Roush et al. 2015) and in this sense self-help groups can be vital (Laudet et al. 2000). ...
... Furthermore, the professional's role is to provide knowledge on mental health and AOD problems (Green et al. 2015;Roush et al. 2015;Pallaveshi et al. 2013) and to give non-judgmental support (Green et al. 2015). Having a social network that believes in the person and accepts them as they are, is important (Pallaveshi et al. 2013;Roush et al. 2015) and in this sense self-help groups can be vital (Laudet et al. 2000). The fundamental importance of relatively decent living conditions in terms of housing and financial security is stressed in some studies (Brekke et al. 2017;Elison et al. 2016) but is surprisingly rarely mentioned within the field of co-occurring AOD and mental health problems, conceivably because of its basic character. ...
Article
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The study focus on how clients with co-occurring problems describe the importance of treatment factors for the recovery process and how these descriptions relates to professional descriptions. 40 client interviews and 15 interviews with professionals were conducted. Three major themes emerge in the results: medication, methods and the professionals. The amount of contact with psychiatry and social services that these clients often have through the years can lead to a ‘learned passivity’ towards their own recovery process. Thus, an important task for the professionals is to break through passivity and isolation. This can be done by treating the client like an ‘ordinary fellow human’. Besides the actual professional tasks, small things seem to be important; greeting the person, paying respect when entering some one’s home, etc. When a social network is missing, the professional can sometime fill this gap, but if this is to promote recovery, it seem important that the professional social network is used as a bridge to other social networks. The professionals as a group, including the environment, emerge as important. Accordingly, to be supportive as a group, and be able to act like ‘social role models’, the professionals need to have working alliances also between themselves. The environment can also offer tools that can be used for socialization that interfere with the ‘learned passivity’ and instead includes and respects the client. This, together with the results highlighting the importance of creating safe milieus, confident and secure professionals, puts focus on how the professional work is organized.
... Other factors highlighted as important are material circumstances, friends and relatives, the construction of a meaningful explanation of the mental health problems, and the person's own efforts (Topor, 2001;Davidson, 2003;Davidson et al., 2006;Topor et al., 2011). Thus, the importance of the individual's own participation in the recovery process is stressed, while the professionals' role is to support the individual possibilities and preconditions for recovery, to give hope (Davidson and White, 2007;Cabassa et al., 2013;Mueser and Gingerich, 2013;Roush et al., 2015); to provide knowledge about SMI and AOD problems (Pallaveshi et al., 2013;Green et al., 2015;Roush et al., 2015), and to give non-judgemental support (Green et al., 2015). Having a social network that believes in the person and accepts them as they are is important (Pallaveshi et al., 2013;Roush et al., 2015), so self-help groups can be vital in this sense (Laudet et al., 2000). ...
... Other factors highlighted as important are material circumstances, friends and relatives, the construction of a meaningful explanation of the mental health problems, and the person's own efforts (Topor, 2001;Davidson, 2003;Davidson et al., 2006;Topor et al., 2011). Thus, the importance of the individual's own participation in the recovery process is stressed, while the professionals' role is to support the individual possibilities and preconditions for recovery, to give hope (Davidson and White, 2007;Cabassa et al., 2013;Mueser and Gingerich, 2013;Roush et al., 2015); to provide knowledge about SMI and AOD problems (Pallaveshi et al., 2013;Green et al., 2015;Roush et al., 2015), and to give non-judgemental support (Green et al., 2015). Having a social network that believes in the person and accepts them as they are is important (Pallaveshi et al., 2013;Roush et al., 2015), so self-help groups can be vital in this sense (Laudet et al., 2000). ...
... Thus, the importance of the individual's own participation in the recovery process is stressed, while the professionals' role is to support the individual possibilities and preconditions for recovery, to give hope (Davidson and White, 2007;Cabassa et al., 2013;Mueser and Gingerich, 2013;Roush et al., 2015); to provide knowledge about SMI and AOD problems (Pallaveshi et al., 2013;Green et al., 2015;Roush et al., 2015), and to give non-judgemental support (Green et al., 2015). Having a social network that believes in the person and accepts them as they are is important (Pallaveshi et al., 2013;Roush et al., 2015), so self-help groups can be vital in this sense (Laudet et al., 2000). The fundamental importance of having stable housing and financial security is recognised in some studies (Elison et al., 2016;Brekke et al., 2017), but is surprisingly rarely mentioned, conceivably because it may be considered a basic necessity. ...
Article
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Purpose The purpose of this paper is to investigate the internal and social factors that persons with experience from severe mental illness and alcohol and other drugs problems, and who have received treatment for these problems, describe as important for initiating and maintaining a recovery process. Design/methodology/approach In total, 40 persons were interviewed and asked to describe factors they perceived as important for initiating and maintaining recovery. The software Nvivo was used to categorise data in internal and social factors with subcategories. Findings There is significant variation in how recovery emerged but involved in general having a proper social situation and finding meaning in life. Initially, the majority had a marginalised situation with need of assistance with housing, employment, financial and social support. Research limitations/implications The change process in the investigated group is interpreted as related to individual resources rather than belonging to a group defined as having “double trouble”. Practical implications The study implies that in addition to professional help to handle diagnosed problems, the group in focus also need support and interventions that address individual complex needs. Social implications Supporting activities/peer support seem to be important for those lacking support from family. At the same time, it is important to recognise the risk of being forced into a recovery identity which might lead to worsening the situation for those who do not fit into this. Originality/value By using the same design as in previous studies, comparisons with other groups are possible while still keeping the qualitative meaning of the investigated factors.
... In the 16 selected studies, different qualitative research designs were applied: six studies using focus groups (Brooks et al., 2007;Hagler et al., 2015;Hipolito et al., 2011;Matusow et al., 2013;Roush, Monica, Carpenter-Song, & Drake, 2015;Whitley, 2012), eight studies using indepth interviews (Cruce et al., 2012;Green et al., 2015;Kennedy & Horton, 2011;Maybery, Reupert, & Goodyear, 2015;O'Sullivan et al., 2013;Padgett et al., 2008;Staiger et al., 2011;Turton et al., 2011), one study using photo-elicitation interviews (Smith et al., 2015) and one study reviewing the Internet in order to find narratives . Three studies focused on the concept of recovery in relation to a specific treatment program (Hagler et al., 2015;Matusow et al., 2013;Roush et al., 2015). ...
... In the 16 selected studies, different qualitative research designs were applied: six studies using focus groups (Brooks et al., 2007;Hagler et al., 2015;Hipolito et al., 2011;Matusow et al., 2013;Roush, Monica, Carpenter-Song, & Drake, 2015;Whitley, 2012), eight studies using indepth interviews (Cruce et al., 2012;Green et al., 2015;Kennedy & Horton, 2011;Maybery, Reupert, & Goodyear, 2015;O'Sullivan et al., 2013;Padgett et al., 2008;Staiger et al., 2011;Turton et al., 2011), one study using photo-elicitation interviews (Smith et al., 2015) and one study reviewing the Internet in order to find narratives . Three studies focused on the concept of recovery in relation to a specific treatment program (Hagler et al., 2015;Matusow et al., 2013;Roush et al., 2015). Of the 16 selected studies, 8 were conducted in the USA, 3 in Australia, 3 in the UK, 1 in Canada and 1 in Sweden. ...
... Participants stressed the value of self-help groups as 'safe spaces' where they can identify with persons who have dealt with the same struggles and where they feel welcome, accepted and respected. In self-help groups such as DTR (Double Trouble in Recovery), AA (Alcoholics Anonymous) or NA (Narcotics Anonymous), persons with DD can experience an ongoing mutual support and a shared sense of belonging Green et al., 2015;Hagler et al., 2015;Matusow et al., 2013;Roush et al., 2015;Turton et al., 2011). On the other hand, a few studies mentioned that the program requirements of self-help groups such as AA or NA, e.g. ...
Article
Objectives: In recent years, the concept of recovery has gained ground in the treatment of persons with dual diagnosis. Recovery refers to living a meaningful life despite limitations caused by mental illness and substance use disorders. It also implies that support for persons with dual diagnosis should be organized according to the personal needs and wishes of its users. Therefore, it is important to gain insight into the aspects that persons with dual diagnosis deem important for their recovery process. This systematic review aims to summarize existing qualitative research on the meaning of recovery from the perspective of persons with dual diagnosis. Methods: A literature search was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic reviews in the following databases: Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Medline, Embase, and Web of Science. Results: Sixteen studies using a qualitative research design were retained in which four overarching themes could be identified. The first theme focused on feeling supported by family and peers and being able to participate in the community. The second theme focuses on the need for a holistic and individualized treatment approach, seeing the persons "behind the symptoms." The third theme that emerged was having personal beliefs, such as fostering feelings of hope, building a new sense of identity, gaining ownership over one's life, and finding support in spirituality. The last theme identified was the importance of meaningful activities that structure one's life and give one motivation to carry on. Conclusions: In this review, the participants pleaded for "flexibility" in mental health care, i.e., an approach that allows for both successes and failures. However, in order to come to a more comprehensive theoretical model of recovery in persons with dual diagnosis, future research is necessary to gain insight into the underlying mechanisms of recovery processes.
... In the treatment of comorbid disorders, there is increasing evidence that integrated care consistently produces the most favorable outcomes (Drake et al., 2007;Fantuzzi & Mezzina, 2020), however, the current standard of mental health care emphasizes "primary need first" and individuals are often denied psychiatric care until their substance misuse is resolved (Ducharme et al., 2007). Additionally, mutual aid programs aimed at the treatment of AUD and SUD discourage the discussion of mental illness or psychotropic medication-preventing people with dual diagnosis from fully receiving the benefits of the identification process (Roush et al. 2015;Milani et al. 2020). As such, vulnerable individuals suffering from dual diagnosis are often left unsupported and isolated (Public Health England, 2017). ...
... Research suggests peer support groups rely on social ties to aid in recovery from alcohol and substance misuse (Dingle et al., 2019). The process of identification has been found to promote sustained recovery, including within mutual aid groups (Buckingham et al., 2013;Roush et al. 2015;Milani et al. 2020). As such, the researchers were interested in examining the social ties present within DDA through the lens of inclusion. ...
Article
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The COVID-19 pandemic has been particularly challenging for individuals with concurrent mental health and addiction problems. Like other mutual aid groups, Dual Diagnosis Anonymous (DDA) of Oregon in the US and DDA-UK were forced to suspend face to face meetings during the pandemic. To continue to support its members, DDA began offering online meetings. Objectives: this study explored attendees' perceived effectiveness, strengths, and limitations of online support within the context of the pandemic. Methods: A total of 92 DDA members from the US (n = 71) and the UK (n = 18) completed an online survey, which included quantitative scales and open questions. Feelings of inclusion in online versus in-person meetings were assessed using an adaptation of the Work Group Inclusion Test (Chung et al., 2020). A supplementary interview was conducted with a DDA facilitator. The open survey questions and the interview were independently thematically analyzed by two investigators. Results: Attendance of meetings significantly increased after the introduction of online meetings (p < 0.001). Approximately half of the participants (51.09%) indicated that DDA online support was the most helpful form of support they received during lockdown; 98.77% of participants agreed that online support should continue after the lockdown. There was no significant difference regarding feelings of inclusion in online versus in-person meetings. Conclusions: Online meetings allowed DDA to go global and provided effective support to people with complex needs during the COVID-19 lockdown. Participants experienced a continuity of inclusion and accessibility due to the online provision. Implications: It is suggested that going forward, online support should continue alongside traditional face to face meetings due to its potential to increase convenience, accessibility, and inclusivity.
... Studies on the importance of social relationships and social support for recovery frequently are qualitative studies in the form of in-depth interviews with people who struggle with drug and/or mental health challenges (see for instance Biringer et al., 2017;Greiff et al., 2020). Other qualitative studies reflect the perspective of their professional helpers (Harris & Panozzo, 2019;Roush et al., 2015;Saelør et al., 2015). A recent qualitative study by Hansen et al. (2020), showed that relationships and support from family and friends play an important role in the process of personal recovery. ...
Article
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To study the prospective associations between social factors and recovery in patients with psychotic disorders in mental health specialist services. In this prospective observational cohort study, analyzes were based on baseline- and follow-up data after 18 months from 108 patients with psychosis. Personal recovery was assessed by the Questionnaire about the Process of Recovery (QPR). Linear regression models were used to test the prospective associations between social predictor variables and QPR. An association was found between experienced quality of interpersonal relationships at baseline and change in QPR score over the next 18 months. Stratified analyzes showed that the effect of experienced quality of interpersonal relationships on recovery was due to an association among persons living with others. Patients’ experience of quality of interpersonal relationships are prospectively associated with recovery. Findings indicate that interpersonal relationships and social interaction as central drivers of recovery in patients with psychotic disorders.
... The need for shelter can be interrelated with alcoholism, influencing the path for homeless people living with addiction (Burlingham et al., 2010;Collins et al., 2016). For mentally ill persons with addiction, it has been found that Dual Diagnosis Anonymous (DDA) is a good alternative to AA, as DDA creates a space for acceptance and understanding for people struggling with similar issues, providing hope of overcoming both illnesses (Roush et al., 2015). Others have argued that the psychological state is influenced by whether the person stops drinking or reduce his or her intake (Green et al., 2015), and that self-help strategies have an important influence on obtaining sobriety (Luciano et al., 2014). ...
Article
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Aim: The aim of this study is to illuminate the experience of living with alcohol addiction from the perspective of socially excluded people outside the healthcare system. It presents the results from a qualitative study of five personal narratives from socially excluded men living with alcohol addiction in Denmark. The group is rarely heard and often underprioritised in the Danish healthcare system, contributing to the social inequality in public health. Therefore, giving them a voice will contribute important insight into the individuals' own experiences and understandings of their situations. Design: Five semi-structured interviews were conducted with socially excluded people living with alcohol addiction. Positioned in a narrative methodology, the focus of the study was on the construction of meaning on a structural, performative and thematic level of the narratives of addiction, as told by the person with addiction. Results: Social identities as "alcoholics" were constructed across the narratives; however, there was a distinct difference between the different informants' own positions. Some constructed meaning in their addiction by including an identity as a stereotypical "drunk" defined as a certain type of unhealthy, unkempt, low-income addict. Others distanced themselves from this identity. Furthermore, alcohol was presented with a double meaning, being associated with positive memories and relationships as well as negative consequences and bad experiences, complicating a potential wish for sobriety. Conclusions: The study illuminates the individual perspectives in the identity construction of socially excluded people with alcohol addiction. When relating to the characteristics of the stereotypical "drunk", the individuals' self-perspectives may differ from the common understanding. The constructed identities reflected the participants' lived experience with addiction, with alcohol as an unavoidable life companion, consequently creating individual meaning in one's addiction.
... In three independent focus group studies investigating the subjective perceptions of participants in 12-step mutual aid groups for COD, participants reported that AA/NA groups had a judgmental atmosphere regarding medication that was negative to their recovery process, and that they appreciated adapted self-help groups for COD because medications for mental health problems were accepted (Hagler et al., 2015;Matusow et al., 2013;Roush, Monica, Carpenter-Song, & Drake, 2015). In a quantitative, prospective questionnaire study of support, mutual aid and recovery in COD, an association was found between mutual aid groups and recovery, but only for COD mutual aid groups and not for single-focus mutual aid groups (e.g. ...
Thesis
Full-text available
People with co-occurring mental health and substance use disorders (COD) face challenges related to living conditions, community participation, and a lack of tailored and integrated health and social services. Recovery and person-centred approaches allow for an understanding of COD that is grounded in each individual person and his or her context, where lived experience is seen as a valued source of knowledge. There is a need for knowledge of how recovery and professional help are experienced by people with COD in different contexts. While recovery-oriented practice is recommended through national guidelines, there is little knowledge of how such practice works at the service delivery level. Knowledge is also needed on how practitioners experience recovery-oriented practice to support people with COD. This thesis has sought to contribute to the scientific knowledge on recovery and recovery-oriented practice in COD, with a particular focus on community services, by describing and exploring the lived experiences of people with COD and practitioners who work to support recovery in this group. An overarching purpose of the project was to make these lived experiences visible to decision makers in the field. The first aim was to explore and describe experiences of recovery among people with COD. The second aim was to explore and describe behaviour and attributes of professional helpers that support recovery, as experienced by people with COD. The third aim was to explore and describe practitioners’ experiences with dilemmas in recovery-oriented practice to support people with COD. This project is influenced by phenomenological and collaborative methodology and consists of two qualitative studies. Study 1 consisted of eight individual, in-depth, interviews with people with COD, which were analysed with systematic text condensation. Study 2 consisted of three focus group interviews with practitioners in a municipal mental health and addictions team that was committed to developing recovery-oriented practice. The interviews in Study 2 were analysed using thematic analysis. Both studies were conducted in the same local authority area in Norway. An advisory group with people from the community with lived experience of COD, experience as family members, and professional experience has been involved in the project throughout. Results from this project support findings from other qualitative studies which indicate that control over symptoms may be a pathway to, but not the essence of, recovery. Systematic investigation of first-person experiences in this project has painted a broader picture of recovery in COD, which includes community participation, living conditions, and existential phenomena. Community participation, particularly feeling useful, may be a central facilitator in recovery. Adverse living conditions and loneliness may be important barriers to recovery in COD. There were individual differences in how participants related to substance use, but control over substance use seemed necessary in the process of coming to love oneself and emerging as a person. Professional helpers may play a central role in the recovery process once a trusting relationship has been established. Professional helpers’ ability to understand and act on people’s everyday struggles, and to address substance use in a competent and straightforward way, appear as specific valued attributes in professional helpers by people with COD. Practitioners described dilemmas in recovery-oriented practice to support people with co-occurring disorders; these involved how to relate to substance use in a recoveryoriented way, how to give enough help and still facilitate empowerment, and how to relate to people’s own life goals with neither moralism nor indifference. People with COD were described as expecting too little from services and tolerating unacceptable living conditions, which elicited directiveness from practitioners. This thesis concludes that a better life is possible for people with COD. While perceptions of a good life are similar to, and equally diverse as, perceptions in the general population, the degree of adverse living conditions and the amount of barriers in solving them seem particular to this group of citizens. In order for professional helpers to support recovery for people with COD, a trusting relationship is fundamental. Practitioners may experience dilemmas in recovery-oriented practice to support people with COD. Different traditions of understanding substance use may lead to different understandings of what it means to address substance use in a recovery-oriented way. Results from this thesis suggest that services to people with COD need to be flexible, integrated and allow for continuity. Professional helpers and services should be able to address living conditions and loneliness, and increase opportunities for genuine community participation for people with COD. Services should be able to address substance use in competent and individualised ways.
... Cost-effective (Humphreys et al., 2007) • Uniqueness of DDA in line with results found in Oregon (Roush et al., 2015) (1) feeling accepted by others in the group (2) understanding the interactive nature of dual disorders, ...
Presentation
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Individuals with co-occurring mental and addictive disorders (or “Dual Diagnosis”) are one of the most vulnerable groups in society, yet often mental health and addiction services fail to meet their needs. Founded by Corbett Monica, the Dual Diagnosis Anonymous programme (DDA) utilises a peer-led 12 + five step approach to offer continuous support in the community and has been running successfully in Oregon since 2005. The five extra steps enable individuals with “dual diagnosis” to concomitantly address their mental health issues as well as their addictive disorders. The aim of the present study is to evaluate the first UK DDA pilot using both questionnaires and qualitative in-depth interviews. This presentation will focus on the qualitative interviews gathered at two different time points in the recovery process of 8 DDA members. Interviews addressed whether and how they thought that DDA was helping them and how the programme could be improved. Data were transcribed, coded and analysed thematically using the software NVivo. Emerging themes suggest that DDA plays a role in positive changes regarding social interaction, mental and physical health, self-development and acceptance. Identification with other members of the group was one of the key factors that enabled positive change. In conclusion, preliminary findings suggest that DDA could prove to be a cost-effective aid to recovery for individuals with co-occurring mental and addictive disorders.
Chapter
Dual diagnosis is a leading contributor of disease burden worldwide. Whilst integrated treatment is recommended, there are considerable barriers that may inhibit access to integrated care, including a lack of training and resources. Digital interventions may enable access to support, providing a space for people to engage in treatment when they need it most. This chapter reviews the current literature on the efficacy of digital interventions for dual diagnosis. Computer-based interventions were effective at improving dual diagnosis outcomes; however, the combined effect of computer-based interventions and therapist support was found to be more effective than the effects of computer-based interventions alone. The evidence-base around smartphone applications is lacking, and there are perceived difficulties with this technology in addressing the complexity of issues faced by people with dual diagnosis. Future research should include standardised terminology to describe techniques used within interventions and consider a variety of research methods to understand implementation.
Article
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Purpose Dual Diagnosis Anonymous (DDA) is a peer-led programme developed in the USA, which aims to address mental and addictive disorders in an integrated manner. This study is part of a mixed-methods evaluation of the first DDA pilot in the UK, and the purpose of this study is to explore the impact and mechanism of change of the programme through the perspective of DDA attendees, facilitators and the funding commissioners. Design/methodology/approach Six DDA members were interviewed three times over a period of 12 months, the facilitators were interviewed twice and the commissioner was interviewed once. The qualitative longitudinal data were analysed using a trajectory thematic analysis. Findings DDA attendance was perceived to have had a positive impact on five main areas: acceptance of self, of others and from others; social functioning; self-development; recovery progression; and feeling of hope. The possibility of addressing both mental health and addiction at the same time was a key factor in the recovery process. The facilitators observed that DDA had contributed to
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Over the past decade, focus groups and group interviews have reemerged as a popular technique for gathering qualitative data, both among sociologists and across a wide range of academic and applied research areas. Focus groups are currently used as both a self-contained method and in combination with surveys and other research methods, most notably individual, in-depth interviews. Comparisons between focus groups and both surveys and individual interviews help to show the specific advantages and disadvantages of group interviews, concentrating on the role of the group in producing interaction and the role of the moderator in guiding this interaction. The advantages of focus groups can be maximized through careful attention to research design issues at both the project and the group level. Important future directions include: the development of standards for reporting focus group research, more methodological research on focus groups, more attention to data analysis issues, and more engagement with the con...
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We compared outpatients (regional facility) with substance use and psychiatric (N = 199) or only substance use (N = 146) disorders on baseline and one-year symptoms (93% follow-up), and treatment and 12-step group participation over the year (2005). We examined whether diagnostic status moderated associations between participation and outcomes (Addiction Severity Index) with regressions. At follow-up, dual diagnosis patients had more severe symptoms, despite comparable treatment. The groups were comparable on 12-step participation, which was associated with better outcomes. However, associations of participation with better outcomes were weaker for dual diagnosis patients. Study (VA HSR&D-funded) implications and limitations are noted and research suggested.
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Many people with addictions report that support from peer groups fosters recovery. For people with co-occurring mental illnesses, dual-diagnosis peer support groups are considered helpful, but they are often unavailable. Recently, Dual Diagnosis Anonymous peer support groups have spread widely throughout Oregon as a complement to integrated dual diagnosis treatments. This column describes Dual Diagnosis Anonymous and its rapid implementation in Oregon. (Psychiatric Services 61:738-740, 2010)
Article
Over the past decade, focus groups and group interviews have reemerged as a popular technique for gathering qualitative data, both among sociologists and across a wide range of academic and applied research areas. Focus groups are currently used as both a self-contained method and in combination with surveys and other research methods, most notably individual, in-depth interviews. Comparisons between focus groups and both surveys and individual interviews help to show the specific advantages and disadvantages of group interviews, concentrating on the role of the group in producing interaction and the role of the moderator in guiding this interaction. The advantages of focus groups can be maximized through careful attention to research design issues at both the project and the group level. Important future directions include: the development of standards for reporting focus group research, more methodological research on focus groups, more attention to data analysis issues, and more engagement with the concerns of the research participants.
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Previous studies have indicated that persons with co-occurring mental health and substance use problems can benefit by attending dual-focus mutual aid groups. However, to date, a trial to test the efficacy of these groups has not been published. This study randomly assigned 203 substance misusing clients attending a mental health or dual-diagnosis facility to either a dual-focus 12-step group (Double Trouble in Recovery; DTR) or a waiting list control group. Participants were followed for 3-6 months. The primary outcome was substance use (days used in the past 30 with saliva testing to detect under-reporting); secondary outcomes included psychiatric medication adherence, attendance at traditional (single-focus) 12-step meetings (e.g., AA/NA); and improvement in mental health and substance use problems (quality of life). Multilevel model (MLM) regression was used to analyze the nested effect of participants within 8 facilities (7 in New York City and 1 in Michigan). Regression imputation was used to adjust for drug use under-reporting. At follow-up 79% of the subjects were interviewed. In intent to treat analysis, DTR subjects compared with control subjects used alcohol (p=.03) and any substances (p=.02) on fewer days. DTR compared with control subjects were also more likely to rate themselves as experiencing better mental health and fewer substance use problems (p=.001). There were no effects for DTR on drug use only, medication adherence or NA/AA attendance. Findings reported in previous studies on the association between exposure to DTR and reductions in substance use were partially supported in this efficacy trial.
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Many people with addictions report that support from peer groups fosters recovery. For people with co-occurring mental illnesses, dual-diagnosis peer support groups are considered helpful, but they are often unavailable. Recently, Dual Diagnosis Anonymous peer support groups have spread widely throughout Oregon as a complement to integrated dual diagnosis treatments. This column describes Dual Diagnosis Anonymous and its rapid implementation in Oregon.
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Over 5 million adults in the United States have a co-occurring substance use disorder and serious psychological distress. Mutual aid (self-help) can usefully complement treatment, but people with co-occurring substance use and psychiatric disorders often encounter a lack of empathy and acceptance in traditional mutual aid groups. Double Trouble in Recovery (DTR) is a dual focus fellowship whose mission is to bring the benefits of mutual aid to persons recovering from co-occurring disorders. An evaluation of DTR was conducted by interviewing 310 persons attending 24 DTR meetings in New York City (NYC) in 1998 and following them up for 2 years, in 1999 and 2000. The evaluation produced 13 articles in 12 peer-reviewed journals, the main results of which are summarized here. The sample's characteristics were as follows: mean age, 40 years; women, 28%; black, 59%; white, 25%; Hispanic, 14%; never married, 63%; live in supported community residence, 53%; high school graduate or GED, 60%; arrested as adult, 63%; diagnoses of: schizophrenia, 39%; major depression, 21%; or bipolar disorder, 20%; currently prescribed psychiatric medication, 92%; primary substance used, current or past: cocaine/crack, 42%; alcohol 34%; or heroin, 11%. Overall, the findings indicate that DTR participation has both direct and indirect effects on several important components of recovery: drug/alcohol abstinence, psychiatric medication adherence, self-efficacy for recovery, and quality of life. The study also identified several "common" therapeutic factors (e.g., internal motivation and social support) and unique mutual aid processes (helper-therapy and reciprocal learning) that mediate the influence of DTR participation on recovery. For clinicians, these results underline the importance of fostering stable affiliation with specialized dual focus 12-step groups for their patients with co-occurring disorders, as part of a comprehensive recovery-oriented treatment approach.
Article
Previous observational research has indicated the effectiveness of a 12-step, dual-focus mutual aid group, Double Trouble in Recovery (DTR), for assisting individuals to recover from co-occurring substance use and psychiatric disorders. The current study extends this line of research by evaluating DTR with a quasi-experimental design; controlled designs are rare in studies of mutual aid. Patient outcomes in the same psychiatric day treatment program were compared for two consecutive admission cohorts characterized by high rates of co-occurring disorders. The first cohort did not have DTR available while the second cohort was exposed to DTR after it was established at the program. Both cohorts were assessed at program admission and at a six-month follow-up. Using intent to treat analysis, the Post-DTR cohort as compared with the Pre-DTR cohort had significantly fewer days of alcohol and drug use, more frequent traditional 12-step groups outside of the program and higher psychiatric medication adherence. There were no differences in psychiatric symptoms or program retention, however. This study helps demonstrate the benefits of introducing 12-step, dual-focus mutual aid into psychiatric treatment programs that serve patients with co-occurring disorders.
Article
The frequent co-occurrence of substance abuse disorders along with psychiatric disorders creates a number of complexities and needs in terms of long-term treatment for individuals. 12-step groups might provide unique mechanisms by which dually-diagnosed individuals can maintain their abstinence and improve their psychological functioning. This paper reviews the literature on outpatient community 12-step participation among dually-diagnosed individuals, and also focuses on individual factors that may interact with treatment: homelessness, legal status, and ethnicity. A total of 59 articles was included in the review, with an emphasis on these individual factors and findings regarding mechanisms of action. Overall, findings from the studies reviewed suggest a general benefit of 12-step participation across these individual factors and some potential for dual-focus 12-step programs for dually-diagnosed individuals via social support and self-efficacy. However, methodological limitations and lack of research in the area of ethnicity limited some of the conclusions that can be made. Suggestions for further research are discussed.