Serving Substance Abuse Professionals Since 1993

Last Update: 02.10.07

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Self-help Groups

106 citations. January 2004 to present

Prepared: September 2007

Bogenschutz MP; Geppert CMA; George J. The role of twelve-step approaches in dual diagnosis treatment and recovery. American Journal on Addictions 15(1): 50-60, 2006. (97 refs.)

The authors reviewed the empirical literature concerning the use of twelve-step programs and treatments by patients with co-occurring substance use disorders and other psychiatric disorders. Strong evidence was found that dually diagnosed individuals (DDI), with the possible exception of those with psychotic disorders, attend twelve-step programs at rates comparable to non-DDI. Twelve-step involvement is consistently associated with improved substance use outcomes. Although there have been numerous clinical trials involving twelve step-oriented interventions for DDI, most of the studies suffered from substantial methodological limitations. More work is needed to determine what kinds of twelve-step treatments and programs are effective for various types of patients and elucidate the mechanisms by which these approaches facilitate recovery.

Bogenschutz MP; Tonigan JS; Miller WR. Examining the effects of alcoholism typology and AA attendance on self-efficacy as a mechanism of change. Journal of Studies on Alcohol 67(4): 562-567, 2006. (36 refs.)

Objective: Existing research indicates that increased self-efficacy to sustain abstinence is a strong causal mechanism explaining later reduction of drinking. Little is known about how mechanisms of change may differ among distinct subgroups of alcoholics. The purpose of this study was to evaluate the mediational role of self-efficacy on changes in drinking associated with Alcoholics Anonymous (AA) attendance in Type-A and Type-B alcoholics. Method: Analysis of covariance and structural equation modeling were used to model 6-, 9-, 12-, and 15-month data from Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) participants who were classified as Type-A or Type-B alcoholics (N = 1,284; 72% male). Measures of AA attendance and percent days abstinent were taken from the Form 90. Self-efficacy was assessed with the Alcohol Abstinence Self-Efficacy Scale. Results: Alcoholism typology and AA attendance were independent predictors of later self-efficacy, but there was no interaction between typology and AA attendance. Abstinence self-efficacy mediated a modest proportion of the effect of posttreatment AA attendance on later abstinence in both Type-A and Type-B alcoholics. The strength of this mediation did not differ by typology. Conclusions: Self-efficacy for abstinence has a strong direct relationship to abstinence across treatment conditions and typologies. Increases in self-efficacy mediate some of the beneficial effects of AA for Type-A and Type-B alcoholics. Further work is necessary to determine whether self-efficacy plays a different role in the recovery of Type-A versus Type-B alcoholics.

Boyd SJ; Tashkin DP; Huestis MA; Heishman SJ; Dermand JC; Simmons MS et al. Strategies for quitting among non-treatment-seeking marijuana smokers. American Journal on Addictions 14(1): 35-42, 2005. (16 refs.)

This study examines self-reported quitting strategies used by adult, non-treatment-seeking marijuana smokers. Sixty-five subjects rated the use and effectiveness of thirteen strategies on a self-developed instrument, the Marijuana Quit Questionnaire. The strategies clustered into three categories/factors, whether grouped by principal components analysis, mean helpfulness rating, or frequency of endorsement Change Environment, Seeking Organized/Professional Help, and Social Support Changing one's environment was rated as most helpful while seeking help from professionals was the least helpful. Clinicians are likely to see marijuana users in their practice and should be proactive in offering assistance, incorporating the strategies reported here into treatment plans for their marijuana-using patients.

Bridges FS. Correlations for alcohol use, abuse, and treatment with suicide and homicide across 21 nations. Psychological Reports 96(3, Part 1): 783-786, 2005. (12 refs.)

In this study which followed Lester's work of 1998 and 2001 for 27 nations of the world, membership in Alcoholics Anonymous, but not alcohol consumption or cirrhosis mortality as measures of alcohol use, abuse, and treatment, correlated with homicide but not suicide rates. Changes in Alcoholics Anonymous membership were not associated with changes in age-adjusted rates of homicide or suicide.

Cheever S. My Name Is Bill: Bill Wilson -- His Life and the Creation of Alcoholics Anonymous. New York: Simon & Schuster, 2004

This is a biography of Bill Wilson one of the two founders of Alcohlics Anonymous. His story is well known to those within the fellowship of AA. Bill had stayed away from alcohol until the age of 22 because of his family history of drinking problems. Having already suffered from episodes of depression, he took his first drink at 22 and experienced a glow of self-confidence and escape from dysphoria. This was followed by his descent into alcoholism and many failed attempts at detoxifications to curb his compulsive drinking. On June 10, 1935, Bill was traveling on business in Akron, Ohio, and struggling to control the urge to drink. The thought occuured to him, that were he able to sit down and speak with another alcoholic that would be helpful. Indeed, through a series of calls he was put in touch with another alcoholic, a physician. This meeting is counted as the beginning of AA, which drew heavily upon the Oxford movement. This book captures Bill Wilson's charisma, his organizational skills and role in the evolution of Alcoholics Anonymous. In addition to recounting the story of Bill Wilson, this book also captures the importance and role of AA in the life of its members. This book provides information on his early years, including his father's drinking. It also touches upon topics that are not as well known, his womanizing and his use of LSD>

Cloud RN; Ziegler CH; Blondell RD. What is Alcoholics Anonymous affiliation? Substance Use & Misuse 39(7): 1117-1136, 2004. (39 refs.)

An increasing body of research evidence supports the use of 12-step program affiliation as an effective adjunct and aftercare for formal treatment. Recently, three brief (9- or 10-item) measures of affiliation have been developed. However, the brief scales are difficult to interpret, and the question of exactly what is affiliation (or disaffiliation) remains unclear. This analysis examines the question of what is the essence of affiliation vs. disaffiliation. Data from the Project MATCH 1-year posttreatment Alcoholics Anonymous Involvement (AAI) scale (N = 1506) are used to identify the most salient items of Alcoholics Anonymous (AA) affiliation predicting 1-year posttreatment drinking outcomes. Analysis using stepwise regression suggests that a three-item solution can explain a similar amount of variance in the proportion of days abstinent in months 9 through 12 posttreatment, as does using the nine items. These three "core items predicting recovery" include AA attendance, sum of steps completed, and identifying self as an AA member. As an affiliation composite scale, these three items are easier to interpret and administer than the full AAI scale, and when combined, possess adequate reliability (alpha = 0.72).

Cohen PJ. The Dietary Supplement Health and Education Act: Regulation at a crossroads. Science, politics, and the regulation of dietary supplements: It's time to repeal DSHEA. American Journal of Law & Medicine 21: 175-224, 2005. (227 legal refs.)

Since the turn of the century, resourceful entrepreneurs have advertised a wide variety of purportedly simple and painless cures for cancer, including liniments of turpentine, mustard, oil, eggs, and ammonia; peat moss; arrangements of colored floodlamps; pastes made from glycerine and limburger cheese. Conflict between the orthodox medical community and practitioners of alternative therapies has been a recurring motif throughout the history of medicine. Dietary supplements, a major component of complementary and alternative medicine ("CAM"), have become extraordinarily popular in recent years. The Dietary Supplement Health and Education Act ("DSHEA") was enacted with the goal of facilitating the use of dietary supplements by minimizing their regulation. DSHEA raises three major questions concerning policy and politics: (1) Are there essential differences between pharmaceuticals and supplements? (2) If so, do these differences justify the radically different approach under which drugs and supplements are regulated today? (3) To what extent should the government regulate any substance used to treat, ameliorate or prevent disease? DSHEA has several critical weaknesses, three of which are of critical importance for this article. First, DSHEA classifies compounds as dietary supplements based on their source, rather than their pharmacologic and physiologic properties. This article argues that DSHEA's definition of supplement is not based on scientific findings or foundations. Second, it assumes that components of foods cannot cause harm, even when ingested in large amounts, and that therefore supplements should be subject only to regulations dealing with foods rather than with the more stringent regulations applied to drugs. DSHEA also assumes that since herbs and botanicals are "natural," they warrant regulation only to the same extent as food components. This article maintains that both of these assumptions are erroneous. This articles concludes that these and other deficiencies inherent in DSHEA render current dietary supplement regulations inherently misleading. One section examines the role of public health with regard to supplements and drugs. It reviews contrasting philosophies concerning the role of government in regulating an individual's use of drugs. The focus is on the Rutherford case and the Access to Medical Treatment Act. It argues that regulation of both drugs and supplements requires a knowledge base adequate to evaluate their pharmacologic and physiologic effects as well as their risks and benefits. Since most consumers lack this knowledge base, the state has an obligation to act in parens patriae to prevent harm to them. The concluding section proposes that the burdens to society imposed by DSHEA greatly exceed any real or theoretical benefit accruing to the individual, and that Congress abrogated its duty to the public welfare when it ended any meaningful FDA oversight of dietary supplements.

Coleman P. Privilege and confidentiality in 12-step self-help programs: Believing the promises could be hazardous to an addict's freedom. (review). Journal of Legal Medicine 26(4): 435-474, 2005. (199 refs.)

A wide gap exists between perception and reality on the question of whether an individual can prevent others from revealing statements he or she made while dealing with addiction in a 12-step self-help group. The simple but troubling explanation for this disparity is that, although people are routinely assured whatever they say during meetings will not be repeated, neither state nor federal laws support these promises. As a variety of studies demonstrate the advantages associated with participating in peer-run programs, especially when attendance is combined with conventional treatment, researchers encourage physicians to persuade their patients to participate. These recommendations are appropriate as most people in recovery benefit from the support of others who also are struggling with sobriety and from the continual monitoring organizations like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) provide. Traditional lengthy therapy, even if it were as effective, is not a good alternative because it has become too expensive. Thus, physicians should refer their patients to established self-help groups, but only after fully explaining the limitations on confidentiality and privilege. Failure to do so could subject physicians to both disciplinary action and civil liability. This article provides information important for people in these programs as well as their attorneys and therapists. Part I defines addiction and discusses the human and financial costs attributed to this compulsive disorder. Part II explains the law surrounding confidentiality, privilege, and the duty to report certain information. Part III briefly describes the history and evolution of self-help groups in treating people with drug and alcohol problems. It also compares and contrasts such programs to group therapy and substance abuse counseling with an eye toward determining whether the differences justify disparate protections. Part IV analyzes relevant court decisions. Part V canvasses state statutes on group therapy and points out that they do not encompass associations lacking a professional therapist or clergyman to whom confidentiality and privilege might apply. This section also reviews federal and state legislative treatment of substance abuse counselors and suggests these laws could be expanded to include self-help members. Part VI cautions physicians who refer patients to these groups that, to avoid both civil liability and licensure problems, they should alert their patients that, under exceptional circumstances, their statements made in working through the 12 steps might be disclosed. This warning will satisfy the duty to alert patients to potential risks and protect physicians from claims that they failed to obtain informed consent for the recommended treatment--namely, joining a self-help group. Finally, Part VII proposes a uniform statute that grants confidentiality and a qualified privilege to communications between and among self-help participants. The article concludes that the only way to eliminate the problem is to pass legislation that shields these conversations absent either consent to release or clear and convincing evidence of a compelling need for the information.

Coyhis D; Simonelli R. Rebuilding native American communities. Child Welfare 84(2): 323-336, 2005. (11 refs.)

The Wellbriety Movement in Native American communities draws on the wisdom and participation of traditional elders. Beginning with a basic community teaching called the Four Laws of Change and the Healing Forest Model, the Wellbriety Movement blends Medicine Wheel knowledge with the 12 Steps of Alcoholics Anonymous to provide culture-specific addiction recovery help for Native Americans. The four journeys of the Sacred Hoop brought the Wellbriety Movement to Native and non-Native people alike from 1999 to 2003.

Cunningham J. Is level of interest among cannabis users in self-help materials and other services aimed at reducing problem use? (letter). Addiction 100(4): 561-562, 2005. (7 refs.)

Cunningham JA; Humphreys K; Koski-Jannes A; Cordingley J. Internet and paper self-help materials for problem drinking: Is there an additive effect? Addictive Behaviors 30(8): 1517-1523, 2005. (21 refs.)

The objective of this study was to conduct a preliminary evaluation of an Internet-based intervention for problem drinkers, comparing changes in drinking between respondents who only received the intervention to those who also received a self-help book. After receiving a personalized feedback summary on the Internet, 83 respondents provided complete baseline information and volunteered to participate in a 3-month follow-up survey. Half of the respondents were randomized to receive an additional self-help book. The follow-up was returned by 48 respondents (69% female). Repeated measures ANOVAs were conducted to compare drinking levels at baseline and 3-month follow-up among respondents who only received the Internet-based intervention. There was minimal support for an impact of the Internet intervention alone. In addition, hierarchical regression analyses were conducted to compare respondents in the two intervention conditions on their drinking at follow-up, controlling for baseline consumption. Respondents who received the additional self-help book reported drinking less and experiencing fewer consequences at follow-up as compared to respondents who received only the Internet-based intervention. While the results are promising, they cannot be taken as evidence of the efficacy of Internet-based personalized feedback as a stand-alone intervention because of the absence of a control group that did not receive the intervention. Further research on this topic should be a priority because of the potential for Internet-based interventions to reach problem drinkers underserved by traditional treatment.

Daigle J. Commentary on ''Self-help organizations for alcohol and drug problems: Towards evidence-based practice and policy''. Journal of Substance Abuse Treatment 26(3): 159-160, 2004. (0 refs.)

At the outset the author notes that the report of the work group provides a comprehensive, succinct, and well-organized review of the literature and research on the role of self-help organizations in the substance abuse treatment and recovery process. Attention is then directed to the implications for clinician and policymakers. This article presents a series of recommendations for consideration by policymakers that offer opportunity for significant and positive change at a systems level. As the authors report, both policymakers and practitioners have important roles to play fostering the growth of self-help organizations.

Davis MI; Jason LA. Sex differences in social support and self-efficacy within a recovery community. American Journal of Community Psychology 36(3-4): 259-274, 2005. (62 refs.)

This study examined similarities and differences in social support and self-efficacy for abstinence between women and men recovering from substance addiction. The sample consisted of 87 residents of Oxford House (OH) self-run, community-based recovery homes. Analyses revealed similarities between women and men in terms of the composition and utilization of support networks and abstinence self-efficacy. Also, for both sexes, length of residency in OH was significantly related to decreased social support for alcohol and drug use and increased self-efficacy for abstinence. However, multiple-group SEM analyses demonstrated that social support for alcohol/drug use fully mediated the link between length of residency and abstinence self-efficacy for women, but not for men. Findings suggest that the process of gaining self-efficacy to remain abstinent is distinct for women and men, and that social support plays a different role in women's recovery than it does in men's.

Dawson DA; Grant BF; Stinson FS; Chou PS. Estimating the effect of help-seeking on achieving recovery from alcohol dependence. Addiction 101(6): 824-834, 2006. (38 refs.)

Aims: To investigate the effect of help-seeking on the likelihood of recovery from Diagnostic and Statistical Manual version IV (DSM-IV) alcohol dependence, specifically examining the impact of model selection, factors that moderate the effect of help-seeking and distinctions between the effects of 12-Step participation and formal treatment. Methods This analysis is based on data from the Wave 1 2001-02 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional, retrospective survey of a nationally representative sample of US adults 18 years of age and over. The analytical sample consisted of 4422 individuals with prior-to-past-year (PPY) onset of DSM-IV alcohol dependence. Findings: Logistic regression, proportional hazards and time-dependent proportional hazards models were used to estimate the effects of help-seeking on three outcomes: (1) any recovery from alcohol dependence, which required full remission of all symptoms of alcohol abuse and dependence and excluded asymptomatic drinkers whose alcohol consumption exceeded low-risk drinking guidelines; (2) non-abstinent recovery (NR), representing low-risk asymptomatic drinkers; and (3) abstinent recovery (AR), representing abstainers. Findings Only one-quarter of individuals with PPY-onset alcohol dependence had ever sought help for alcohol problems, including 3.1% who had participated in 12-Step programs only, 5.4% who had received formal treatment only and 17.0% with both 12-Step and formal treatment. Based on the most appropriate model, help-seeking increased the likelihood of any recovery [hazard rate ratio (HRR) = 2.38], NR (HRR = 1.50) and AR (HRR = 4.01). The impact of help-seeking on AR did not show any significant variation across the exposure period but was modified by severity among other factors. Individuals who participated in 12-Step programs in addition to formal treatment had almost twice the chance of recovery and more than more than twice the chance of AR compared with those who received formal treatment alone. Conclusions: Help-seeking plays a significant role in the achievement of abstinent recovery from alcohol dependence, with 12-Step participation playing a major role. Appropriate model selection is critical to assessing the impact of help-seeking.

Day E; Gaston RL; Furlong E; Murali V; Alex Copello. United Kingdom substance misuse treatment workers' attitudes toward 12-step self-help groups. Journal of Substance Abuse Treatment 29(4): 321-327, 2005. (22 refs.)

Research has highlighted the benefits of professional substance misuse treatment workers facilitating their clients' involvement in 12-step self-help groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). This study used a cross-sectional survey design to explore the attitudes of substance misuse treatment staff working in the English West Midlands region toward AA and NA and the 12-step philosophy. A total of 346 treatment workers responded (71%). Fewer than 10% used the 12-step model in their treatment work, and only a third felt that their clients were generally suited to AA or NA. Fewer than half (46%) said that they were likely to recommend that their clients attend a self-help group meeting. Staff with nursing qualifications were more likely to have a positive attitude toward AA/NA than their non-nursing colleagues, and there was a statistically significant association between the level of reported spirituality of the workers and the likelihood of them recommending to clients that they attend AA or NA meetings. These results highlight differences in the role of AA/NA within the substance misuse treatment system in the United Kingdom and that in the United States; possible explanations are discussed.

De Leon G. Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. (commentary). Journal of Substance Abuse Treatment 26(3): 163-165, 2004. (5 refs.)

Following an introduction, the author considers that nature of self-help organizations, self-help approaches and the differences between. This is followed up the nature of self-help approaches and whether they are primary, secondary or ancillary to treatment. The roles in recovery, support, management, and the objectives. The perception of 'Once a junkie always a junkie' as well as characterizing addiction as a "chronic relapsing disease" are considered, and the implications of public pereption and public policy. The commentary concludes with the role of mutual self help in an integrated treatment system.

Denning P; Little J; Glickman A. Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol. New York: Guilford Press, 2004. (chapter refs.)

This self-help volume is directed to drug users and their family members. From a harm reduction perspective, it deals initially with the drug's benefits, real or imagined, from the user's perspective, and then the other side of the equation, i.e., the difficulties encountered, spelling out ways to reduce the dangers associated with use. The book is organized in 10 chapters. Chapter 1 deals with the question: "Addiction. Is it all or nothing?" Chapter 2 is entitiled, "So if we aren't addicts, what's the harm?" which presents the principles of harm reduction while also introducing the notion of hidden harm. Chapter 3, "How much is too much?" focuses upon the harm associated with drug use. Chapter 4 considers the question "So why do I keep using?" by addressing the ways in which drugs are seen as beneficial, psychological theories of drug use, as well as some of the basic biology on drugs' effects on the brain. Chapter 5 addresses the issue "To change or not to change?", by speaking to the dilemma of making choices, the normal difficulties associted with making changes, and describing the stages of change process, and concludes with consideration of the matter of "what" to change. Chapter 6 describes the major drug classes: alcohol, sedative/hypnotics, opiates, major stimulants; nicotine, caffeine, marijuana, hallucinogens, ecstasy, the dissociative anesthetics, and inhalants. Chapter 7 discusses the kind of changes that might be considered in substance use management, e.g., changing the amount, changing the number/types of drugs that are used together; changing the frequency of use, changing the route of administration, changing the situation/circumstances of use, planning use, drug substitution, overdose prevention, and what to do if you want to quit. Chapter 8 addresses practicing harm reduction, how to take care of yourself while still using. Chapter 9 deals with finding the right help, what to expect if considering treatment, how to shop for drug treatment, and "training" your therapist. Chapter 10 provides a summary, suggesting ways to deal with the question, "Is harm reduction working?", including thinking about the relationship with drugs, setting goals, and knowing what you want, and making changes.

Dermatis H; Guschwan MT; Galanter M; Bunt G. Orientation toward spirituality and self-help approaches in the therapeutic community. Journal of Addictive Diseases 23(1): 39-54, 2004. (26 refs.)

Although Alcoholics Anonymous and other Twelve-Step interventions are among the most widely utilized self-help options by persons with chemical dependency, little is known concerning whether this approach should be integrated with non-spirituality based self-help approaches. The purpose of this study was to assess the extent to which clients receiving inpatient treatment in a residential therapeutic community (TC) felt that spirituality based interventions should be featured in TC treatment. Three hundred twenty-two members of the Daytop TC completed a survey assessing personal orientation to spirituality and attitudes towards spirituality based treatments. The majority of clients believed that the TC program should feature spirituality more in treatment. Nearly half agreed that the Twelve-Step (AA) approach should be more a part of TC treatment. Preference for Twelve-Step meeting interventions was positively correlated with past attendance at Twelve-Step meetings. Personal spiritual orientation to life was positively correlated with endorsement of spirituality based interventions in TC treatment. These findings highlight the importance of integrating treatment approaches which address the spiritual needs of TC residents.

Dubiel RM. The Road to Fellowship: The Role of the Emmanuel Movement and the Jacoby Club in the Development of Alcoholics Anonymous. New York: IUniverse, 2004

The United States saw the growth of a variety of self-help recovery efforts in the latter half of the 18th century -- recovery houses, mutual aid societies. With the collapse of this network, there was a void until the mid 20th century. The bridge between these groups was a system of lay alcoholism therapy that grew out of a clinic and social club operated by Emmanuel Episcopal church of Boston. The Emmanuel movement Clinic and its influence on the birth of Alcoholics Anonymous and the rise of modern alcohol treatment has been the subject of growing interest. This volume is the most complete history of the movement. It describes the birth of this clinical movement. It integrated religion, psychology and medicine. The Emanuel movement spawned lay clinicians and a mutual aid society, the Jacoby Club. This volume draws upon primary sources and establishes some of the early connections to Alcoholics Anonymous.

Durant A. African-American alcoholics: An interpretive/constructivist model of affiliation with Alcoholics Anonymous (AA). Journal of Ethnicity in Substance Abuse 4(1): 5-21, 2005. (45 refs.)

It is estimated that two million African-Americans suffer directly and indirectly from alcoholism and its related problems. Yet, because of their cultural background, African-American alcoholics do not readily accept that alcoholism is a disease. This study explores how African-American alcoholics modify the steps and traditions of AA to affiliate with the organization. Data was collected from intensive and semi-structured interviews and participant observation. Procedures and analysis generic to grounded theory were used in the context of an interpretive/constructivist paradigm.

Erbas B; Bui QA; Huggins R; Harper T; White V. Investigating the relation between placement of Quit antismoking advertisements and number of telephone calls to Quitline: a semiparametric modelling approach. Journal of Epidemiology and Community Health 60(2): 180-182, 2006. (13 refs.)

Study objectives: Quitline - an antismoking advertising and a telephone helpline service - is an effective public health intervention strategy for tobacco control. The objective of this short report is to model the relation between placement of antismoking advertisements and calls to Quitline on a given day. Methods/design: Data on daily Quitline antismoking advertisements, television target audience rating points (TARPS), and calls to Quitline Victoria were studied for the period 1 August 2000 and 31 July 2001. The outcome - calls to Quitline - is a count and thus assumed to follow a Poisson distribution. Generalised partial linear models were used to model the logarithm of mean daily calls as a non-parametric function of time and a linear parametric function of the day of week, number of advertisements, and TARPS. Main results: Peak calls to Quitline Victoria occurred during Monday to Wednesday with around three times as many calls compared with Sunday. Both placement of Quitline advertisements (p < 0.001) and an increase in TARPS (p < 0.001) on a given day significantly increased the number of calls made to Quitline Victoria. The model adequately captured fluctuations in call volume and diagnostics showed no model inadequacy. Conclusions: In this short report the emphasis is on modelling the parametric components - day of week, placement of advertisements, and TARPS on call volume. The dynamics of the underlying time trend in call volume is captured in a non-parametric component. Future analysis of hourly data would provide additional information to assess different media buying strategies that might increase call volume.

Fenster J. Characteristics of clinicians likely to refer clients to 12-Step programs versus a diversity of post-treatment options. Drug and Alcohol Dependence 83(3): 238-246, 2006. (30 refs.)

Most clients in substance abuse treatment are referred for continuing care. However, post-treatment services vary widely in their approaches to helping individuals achieve better substance use outcomes. This study examined the attitudes of outpatient treatment staff who refer clients exclusively to 12-Step groups (12-Step subgroup) and staff who refer clients both to 12-Step groups and to other continuing care options (Diversity subgroup) toward seven mutual-aid and professional psychosocial post-treatment options: Twelve-Step Programs (12-Step), Cognitive-Behavioral Therapy (CBT), Moderation Management (MM), Smart Recovery(r) (SMART), Psychodynamic-oriented Therapy (PSY), Secular Organizations for Sobriety (SOS), and Women for Sobriety (WFS). A large percentage of clinicians lacked knowledge about the effectiveness of all alternatives to 12-Step programs with the exception of CBT. Clinicians in the 12-Step subgroup were more likely than those in the Diversity subgroup to be unfamiliar with alternatives to 12-Step programs and to believe less strongly in the effectiveness of CBT and PSY. A logistic regression found beliefs about CBT effectiveness and clinician preference for the 12-Step model to be related to the likelihood of referring exclusively to 12-Step groups. Findings suggest that clinicians could benefit from information and training on assessing and referring clients to various options for continuing care.

Ferri M; Amato L; Davoli M. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. (review). Cochrane Database of Systematic Reviews 3(CD005032), 2006. (65 refs.)

Background: Alcoholics Anonymous (AA) is an international organization of recovering alcoholics that offers emotional support through self-help groups and a model of abstinence for people recovering from alcohol dependence, using a 12-step approach. Although it is the most common, AA is not the only 12-step intervention available there are other 12-step approaches (labelled Twelve Step Facilitation (TSF)). Objectives To assess the effectiveness of AA or TSF programmes compared to other psychosocial interventions in reducing alcohol intake, achieving abstinence, maintaining abstinence, improving the quality of life of affected people and their families, and reducing alcohol associated accidents and health problems. Search strategy: We searched the Specialized Register of Trials of the Cochrane Group on Drugs and Alcohol, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE from 1966, EMBASE from 1980, CINAHL from 1982, PsychINFO from 1967. Searches were updated in February 2005. We also inspected lists of references for relevant studies. Selection criteria: Studies involving adults (< 18) of both genders with alcohol dependence attending on a voluntary or coerced basis AA or TSF programmes comparing no treatment, other psychological interventions, 12-step variants. Data collection and analysis One reviewer (MF) assessed studies for inclusion and extracted data using a pre-defined data extraction form. Studies were evaluated for methodological quality and discussed by all reviewers. Main results: Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence. Authors' conclusions: No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.

Finley JR. Integrating the 12 Steps into Addiction Therapy: A Resource Collection and Guide for Promoting Recovery. New York: Wiley Publishing, 2004

This workbook is directed to therapists, counselors, social workers and clinicians. It is intended for use in a traditional therapy setting to introduce clients to and promote their involvement in 12 Step programs. The volume includes eight lesson plans, twenty-seven assignments, and client handouts.

2004, Wiley Publishing

Fisher GL; Harrison TC. Substance Abuse: information for School Counselors, Social Workers, Therapists, and Counselors, 3rd edition. Boston: Pearson/Allyn and Bacon, 2005. (650 book refs.)

This volume is directed not to those who work in the substance abuse field, but to the range of mental health professionals who while not exclusively involved with substance abuse can anticipate a significant proportion of their clients to have substance abuse problems. The first chapter provides an overview of the book, and considers the need for generalist training. Chapter 2 deals with the major drug classes, the acute and chronic effects, with sections on central nervous system depressants, central nervous system stimulants, opioids, hallucinogens, cannabis, inhalants, steroids, and club drugs. Chapter 3 focuses upon different models of addiction: the moral model, sociocultural and psychological models, the disease concept, and the biopsychosocial model. Chapter 4 considers the major cultural and ethnic groups in the US -- Native Americans and Alaska natives, Asian Americans, African Americans, Latino and Hispanics -- and general principles in working with culturally and ethnically diverse populations. Chapter 5 addresses assessment and diagnosis; Chapter 6, engaging the client and brief interventions; and Chapter 7 treatment approaches and settings, principles of effective treatment, and client-treatment matching. Chapter 8 focuses upon relapse prevention and the process of recovery. Chapter 9 deals with Twelve-Step programs as well as other types of support groups. Chapters 10 and 11 consider the family and children in the family, and adult children. Chapter 12 focuses upon HIV/AIDS. Chapter 13 provides an overview of a variety of other addictions including gambling. The final chapters deal with prevention and confidentiality and ethical concerns.

Galanter M. Spirituality in Alcoholics Anonymous: A valuable adjunct to psychiatric services. (editorial). Psychiatric Services 57(3): 307-309, 2006. (15 refs.)

Alcoholics Anonymous ( AA) is described as a spiritual fellowship by many of its members, but its spiritual orientation needs to be better understood by clinicians and researchers. Spirituality is a latent construct, one that is inferred from multiple component dimensions, such as social psychology, neurophysiology, and treatment outcome research. Mechanisms related to its role in promotion of recovery in AA are discussed from the perspective of these findings, along with related options for professionally grounded treatment, such as Twelve-Step Facilitation. This discussion illustrates the importance of further research on AA and spirituality and of employing them in the provision of psychiatric services.

Galanter M. Spirituality and addiction: A research and clinical perspective. American Journal on Addictions 15(4): 286-292, 2006. (71 refs.)

Spirituality is a construct that has recently gained currency among clinicians because of its close association with twelve-step modalities and its perceived role in the promotion of meaningfulness in recovery from addiction. This article draws on studies from physiology, psychology, and cross-cultural sources to examine its nature and its relationship to substance use disorders. Illustrations of its potential and limitations as a component of treatment in spiritually oriented recovery movements like Alcoholics Anonymous, meditative practices, and treatment systems for the dually diagnosed are given.

Galanter M; Hayden F; Castaneda R; Franco H. Group therapy, self-help groups, and network therapy. IN: Frances RJ; Miller SI; Mack AH, eds. Clinical Textbook of Addictive Disorders, 3rd edition. New York: Guilford Press, 2005. pp. 502-527. (78 refs.)

The common denominator of these treatment approaches is the use of social networks in treatment. It explores the impact of group treatments in a variety of settings. It considers the role of the clinician in relation to each of these. Aspects of treatment discussed include the process of referral, leadership styles, and describes some representative group models. The relationship of group therapy to individual treatment and management of group members who do not remain abstinent are considered. In the context of considering self-help groups treatment outcome as well as 12-step facilitation are discussed. Network therapy is briefly outlined, including steps to adapt individual therapy to network treatment and training therapists.

Grella CE; Scott CK; Foss MA. Gender differences in long-term drug treatment outcomes in Chicago PETS. Journal of Substance Abuse Treatment 28(2. Supplement 1): S3-S12, 2005. (77 refs.)

Few long-term follow-up studies of substance abusers have examined gender differences. In the current study, gender differences were examined at 36 months following residential or outpatient drug-free treatment among 951 participants in the Chicago Target Cities Project, the majority of whom were female (62%) and African American (93%). There were no differences in the proportion of men and women who reported any alcohol or drug use at the 36-month follow-up, with an overall reduction of 41% from intake. Greater proportions of men were incarcerated or employed, whereas greater proportions of women had returned to treatment, lived with their children, lived with a substance user, or had interpersonal problems. Women, as a group, had greater increases over time in self-help participation, free time spent with family, non-using family/friends, and employment. Although both men and women showed significant improvements following treatment, gender differences persisted in several areas of psychosocial functioning related to recovery.

Griffiths M. Online therapy for addictive behaviors. Cyberpsychology & Behavior 8(6): 555-561, 2005. (23 refs.)

Clinicians working in the field of addictive behaviors cannot afford to ignore the Internet. Psychological advice, help, and treatment for addicts are no exceptions, with both counseling and psychotherapy entering the computer age. This paper reviews the main issues in the area and approaches the discussion acknowledging that online therapy has to be incorporated within the overall framework of the need for clinical assistance. The paper also provides brief overviews of some websites as illustrative examples of what types of online therapy are available.

Humphreys K. The trials of Alcoholics Anonymous. (editorial). Addiction 101(5): 617-618, 2006. (15 refs.)

Humphreys K; Wing S; McCarty D; Chappel J; Gallant L; Haberle B et al. Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. Journal of Substance Abuse Treatment 26(3): 151-158, 2004. (25 refs.)

This expert consensus statement reviews evidence on the effectiveness of drug and alcohol self-help groups and presents potential implications for clinicians, treatment program managers and policymakers. Because longitudinal studies associate self-help group involvement with reduced substance use, improved psychosocial functioning, and lessened health care costs, there are humane and practical reasons to develop self-help group supportive policies. Policies described here that could be implemented by clinicians and program managers include making greater use of empirically-validated self-help group referral methods in both specialty and non-specialty treatment settings and developing a menu of locally available self-help group options that are responsive to client's needs, preferences, and cultural background. The workgroup also offered possible self-help supportive policy options (e.g., supporting self-help clearinghouses) for state and federal decision makers. Implementing such policies could strengthen alcohol and drug self-help organizations, and thereby enhance the national response to the serious public health problem of substance abuse.

Jhirwal OP. Involvement of Alcoholics Anonymous and other self-help groups in professional treatment of substance abusers: An Indian perspective. (letter). Journal of Substance Abuse Treatment 29(1): 65-65, 2005. (3 refs.)

Johnson JE; Finney JW; Moos RH. End-of-treatment outcomes in cognitive-behavioral treatment and 12-step substance use treatment programs: Do they differ and do they predict 1-year outcomes? Journal of Substance Abuse Treatment 31(1): 41-50, 2006. (21 refs.)

This study examined changes in treatment-related proximal outcomes from intake to follow-up, associations between continuing care and maintenance of proximal outcome gains, correlations between specific proximal outcomes and substance use outcomes, and potential mediators of treatment effects for 12-step versus cognitive-behavioral (CB) substance use disorder (SUD) treatment. The participants were 1,873 male veterans seeking SUD treatment at five CB-oriented and five 12-step-oriented VA inpatient/residential SUD programs. Patterns of change in proximal outcomes were similar across the two program types. After discharge, attendance at 12-step groups, but not outpatient treatment, was associated with greater maintenance on most proximal outcomes. Only a few proximal outcomes at discharge were associated with 1-year substance use; most 1-year proximal outcomes were associated with 1-year substance use. Having a sponsor, reading 12-step materials, attending 12-step meetings, and having an abstinence goal appeared to mediate the greater effects of 12-step programs (relative to CB programs) on abstinence.

Kahler CW; Kelly JF; Strong DR; Stuart GL; Brown RA. Development and initial validation of a 12-step participation expectancies questionnaire. Journal of Studies on Alcohol 67(4): 538-542, 2006. (15 refs.)

Objective: There are no available instruments that assess expectancies for participation in 12-step mutual-help groups despite the impact such expectancies may have on actual participation. The purpose of the present study was to develop a measure of attitudes and expectancies regarding 12-step participation, to conduct preliminary analyses on its psychometric properties, and to explore its concurrent and predictive validity. Method: Alcohol-dependent patients (N = 48) undergoing inpatient detoxification completed a questionnaire that included subscales assessing expected benefits of, concerns about, and barriers to 12-step participation. Participants also completed measures of 12-step group participation and drinking outcomes at 1, 3, and 6 months following discharge. Results: After examining the internal consistency of the items within each subscale and refining the questionnaire accordingly, an exploratory factor analysis showed that the scales could be combined into a higher-order total score. This total score correlated significantly with prior 12-step experience and goals for attending future 12-step meetings. In addition, the Expectancies Total Score at baseline significantly predicted 12-step group participation during follow-up. Conclusions: The measure of attitudes and expectancies regarding 12-step group participation demonstrated good internal consistency, concurrent validity, and predictive validity. The measure may have clinical utility in highlighting patients' expectancies regarding 12-step participation, allowing treatment providers to explore with patients the benefits, concerns, and barriers to involvement that they have endorsed.

Karno MP; Longabaugh R. What do we know? Process analysis and the search for a better understanding of Project MATCH's anger-by-treatment matching effect. Journal of Studies on Alcohol 65(4): 501-512, 2004. (20 refs.)

Objective: A consistent matching result from Project MATCH was the impact of patient trait anger on the effectiveness of alcohol treatments. Despite that finding, subsequent work failed to identify mechanisms underlying the effect. The present study examined a potential mediator, therapist directiveness, to determine its relationship with patient anger, treatment modality and drinking outcomes. Method: Observers rated therapist directiveness for 140 patients (70% men) at one MATCH aftercare site. ANOVA was used to test for the interaction between directiveness and patient anger, treatment differences in level of directiveness, the interaction between treatment modality and anger, and directiveness as a mediator of treatment modality effects. Results: A disordinal interaction was found between patient anger and therapist directiveness. Directiveness was associated with worse drinking outcomes among high anger patients and associated with less frequent drinking among low anger patients. Patient anger also interacted with treatment modality. Motivational enhancement therapy (MET) was more effective than cognitive behavioral therapy (CBT) for patients high in anger, whereas the reverse was true for patients low in anger. A lower level of therapist directiveness in MET mediated its superiority over CBT for high anger patients. Twelve-step facilitation therapy (TSF) was comparably effective to MET for high anger patients; it is interesting to note that TSF and MET did not differ in directiveness. Conclusions: Therapist directiveness is important to consider when working with patients at varying levels of trait anger. Analysis of the therapy process and tests for mediation are critical to further understand active ingredients of psychosocial treatment.

Kaskutas LA; Ammon L; Delucchi K; Room R; Bond J; Weisner C. Alcoholics Anonymous careers: Patterns of AA involvement five years after treatment entry. Alcoholism: Clinical and Experimental Research 29(11): 1983-1990, 2005. (50 refs.)

Background: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of aftercare, but we know very little about treatment seekers' patterns of AA involvement over time and how these relate to abstinence. Method: This paper applies latent class growth curve modeling to longitudinal data from 349 dependent drinkers recruited when they were entering treatment and were re-interviewed at one or more follow-up interviews one, three and five years later, and who reported having attended AA at least once. Results: Four classes of AA "careers" of meeting attendance emerged: The low AA group mainly just attended AA during the 12 months following treatment entry. The medium and high AA groups were characterized by stable attendance at the second and third follow-ups-at about 60 meetings a year for the medium group and over 200 meetings per year for the high group, followed by slight increases for the medium group and slight decreases for the high group by year five. The declining AA group doubled its meeting attendance postbaseline, to almost 200 meetings during the year following treatment entry, but by year five they were only attending about six meetings on average. Decreases in AA meetings did not necessarily signal disengagement from AA; at the five-year follow-up, a third of the low AA group and over half of the declining AA group said they felt like a member of AA. Activities other than meeting attendance, such as having a sponsor, otherwise paralleled the meeting careers, but social networks were similar by year five. Rates of abstinence by year five (for the past 30 days) were 43% for the low AA group, 73% for the medium group, 79% for the high group and 61% for the declining group. Rates of dependence symptoms and social consequences of drinking did not differ between the groups at year five. Conclusions: The prototypical AA careers derived empirically are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable (and sometimes quite high) rates of AA attendance. However, contrary to AA lore, many who connect only for a while do well afterwards.

Kaskutas L; Room R; Ammon L; Bond J; Delucchi K; Weisner C. AA careers in the 5 years after alcohol treatment. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 195A-195A, 2004. (0 refs.)

Kauffman E; Yosioka MRM. Substance Abuse Treatment and Family Therapy. Treatment Improvement Protocol (TIP) Series No. 39. Rockville MD: Center for Substance Abuse Treatment, 2004. (456 report refs.)

This TIP is organized into six chapters. Chapter 1 provides an introduction to substance abuse treatment and family therapy. It introduces the changing definition of "family," explores the evolution of the field of family therapy and the primary models of family therapy, presents concepts from the substance abuse treatment field, and discusses the effectiveness and cost benefits of family therapy. Chapter 2 explores the impact of substance abuse on families. The chapter includes a description of social issues that coexist with substance abuse in families and recommendations for ways to address these issues. Chapter 3 discusses approaches to therapy in both substance abuse treatment and family therapy. One section, directed at substance abuse treatment counselors, provides basic information about the models, approaches, and concepts in family therapy. Another section for family therapists provides basic information about theory, treatment modalities, and the role of 12 -Step programs in substance abuse treatment. Chapter 4 presents a discussion of integrated models for substance abuse treatment and family therapy. These models can serve as a guide for conjoint treatment approaches. Chapter 5 provides background information about substance abuse treatment for various populations and applications to family therapy for each population. Chapter 6, aimed at administrators and trainers, presents information about the importance of improving services to families and some policy implications to consider for effectively joining family therapy and substance abuse treatment. In addition, the chapter discusses program planning models developed by the consensus panel that provide a framework for including family therapy in substance abuse treatment.

Kelly JF; Myers MG; Brown SA. The effects of age composition of 12-step groups on adolescent 12-step participation and substance use outcome. Journal of Child & Adolescent Substance Abuse 15(1): 63-72, 2005. (21 refs.)

Youth substance use disorder treatment programs frequently advocate integration into 12-Step fellowships to help prevent relapse. However, the effects of the predominantly adult composition of 12-step groups on adolescent involvement and substance use outcome remain unstudied. Greater knowledge could enhance the specificity of treatment recommendations for youth. To this end, adolescents (N = 74; M age = 15.9, 62% female) were recruited during inpatient treatment and followed Lip 3 and 6 months later. Greater age similarity was found to positively influence attendance rates and the perceived importance of attendance, and was marginally related to increased step-work and less substance use. These preliminary findings suggest locating and directing youth to meetings where other youth are present may improve 12-step attendance, involvement, and substance use outcomes.

Kelly JF; Stout R; Zywiak W; Schneider R. A 3-year study of addiction mutual-help group participation following intensive outpatient treatment. Alcoholism: Clinical and Experimental Research 30(8): 1381-1392, 2006. (86 refs.)

Addiction-focused mutual-help group participation is associated with better substance use disorder (SUD) treatment outcomes. However, little has been documented regarding which types of mutual-help organizations patients attend, what levels of participation may be beneficial, and which patients, in particular, are more or less likely to participate. Furthermore, much of the evidence supporting the use of these organizations comes from studies examining participation and outcomes concurrently, raising doubts about cause-effect connections, and little is known about influences that may moderate the degree of any general benefit. Alcohol-dependent outpatients (N=227; 27% female; M age=42) enrolled in a randomized-controlled telephone case monitoring trial were assessed at treatment intake and at 1, 2, and 3 years postdischarge. Lagged-panel, hierarchical linear models tested whether mutual-help group participation in the first and second year following treatment predicted subsequent outcomes and whether these effects were moderated by gender, concurrent axis I diagnosis, religious preference, and prior mutual-help experience. Robust regression curve analysis was used to examine dose-response relationships between mutual-help and outcomes. Mutual-help participation was associated with both greater abstinence and fewer drinks per drinking day and this relationship was not found to be influenced by gender, Axis I diagnosis, religious preference, or prior mutual-help participation. Mutual-help participants attended predominantly Alcoholics Anonymous and tended to be Caucasian, be more educated, have prior mutual-help experience, and have more severe alcohol involvement. Dose-response curve analyses suggested that even small amounts of participation may be helpful in increasing abstinence, whereas higher doses may be needed to reduce relapse intensity. Use of mutual-help groups following intensive outpatient SUD treatment appears to be beneficial for many different types of patients and even modest levels of participation may be helpful. Future emphasis should be placed on ways to engage individuals with these cost-effective resources over time and to gather and disseminate evidence regarding additional mutual-help organizations.

Kirby MW. ''Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy'' (commentary). Journal of Substance Abuse Treatment 26(3): 161-162, 2004. (0 refs.)

The subject of the article "Self-Help Organizations for Alcohol and Drug Problems: Toward Evidence-Based Practice and Policy" -- the respective roles of substance abuse treatment and self-help organizations in addressing substance dependence -- is both important and timely. The emphasis on the access offered by self-help organizations -- particularly Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) -- underscores the availability of an invaluable resource that is insufficiently recognized and frequently undervalued by treatment practitioners and policymakers. When one considers that there are AA and NA meetings in virtually every community in this country (and in countless other countries as well) and that these meetings are open and available at all hours of the day and evening with no fees or attendance requirements, the accessibility of addiction-related self-help organizations can best be characterized as extraordinary. One simply could not design a more accessible system. Thus, a key issue raised by this article is the failure of treatment practitioners to maximize the advantages offered by this highly accessible support system. The availability of a community resource capable of providing long-term support raises questions about the very structure of substance abuse treatment. Should the formal treatment system be placing greater emphasis on brief, comparatively inexpensive interventions designed, in part, to transition patients to appropriate self-help groups immediately following treatment? In this model, formal treatment would be recognized as acute treatment, not sufficient in itself to meet the demands of a chronic condition. It is in this context that the authors assert that no treatment intervention can be wholly effective in achieving complete and permanent abstinence for the majority of patients seen. Moreover, the authors make an important contribution for our understanding of the issues involved in assessing treatment outcomes. Thus the following statement is made: "Financial resources for addiction treatment are always constrained, such that any judgment about whether an intervention is valuable needs to consider its costs as well as its effectiveness." This perspective is critical because it suggests that for treatment research to inform policy, it must address issues of resource allocation. It also suggests that the focus of treatment research might beneficially be shifted away from treatment effectiveness alone to an increasing emphasis on treatment cost-effectiveness. The authors raise a further point that may also merit additional study. They state that "Self-help groups are best viewed as a form of continuing care rather than as a substitute for acute treatment services." However, research in this area is limited. It is conceivable that some number of substance users can derive significant benefit from self-help organizations alone. If so, it may be useful to identify those individuals whose effective treatment need not involve demands on the overburdened formal treatment system.

Kissman K; Torres OA. Incarcerated mothers: Mutual support groups aimed at reducing substance abuse relapse and recidivism. Contemporary Family Therapy 26(2): 217-228, 2004. (22 refs.)

Interventions to reduce relapse and recidivism for the increasing number of mothers incarcerated for illicit drug use are needed to prevent maternal/child separation and high public expenditures. This paper describes mutual support groups for women inmates aimed at strengthening family coping skills, especially communication, anger management, and parenting skills. Qualitative data collected during the group sessions indicated that the healing support of shared experiences, stories, poetry, and staying in the present were identified as spiritually uplifting. Problem solving and improved family interactions constituted additional themes extracted from the qualitative data. Future plans include including quantitative outcome measures of success.

Kuruvilla PK; Vijayakumar N; Jacob KS. A cohort study of male subjects attending an Alcoholics Anonymous program in India: One-year follow-up for sobriety. Journal of Studies on Alcohol 65(4): 546-549, 2004. (10 refs.)

Objective: The objective of this study was to follow up a cohort of subjects who completed detoxification treatment and a deaddiction program based on the Alcoholics Anonymous (AA) model. The factors associated with complete abstinence were investigated. Method: Patients (187 men) admitted consecutively to an addiction facility, who fulfilled the DSM-IV criteria for alcohol dependence, were recruited for the study. Patients with major psychopathology were excluded from the cohort. The program was based on the principles of AA. The final outcome at 1 year was determined by visiting the patient and talking to the family and members of the local AA group. Results: Of the 187 initially recruited, five were excluded due to the presence of major psychopathology, one committed suicide and seven could not be traced. Of the 174 patients followed up, 58 (33.3%) remained sober (complete abstinence for the past year) at 1 year. Patients coming from distant places and those with follow-up workers in their localities fared better than those from the local area and those from towns where there was no one to motivate them to continue with AA meetings. These variables were significantly associated with sobriety even after adjusted for other confounders using multivariate techniques. Conclusions: A third of the cohort remained sober at 1-year follow-up. The patients' initial motivation and continued support once they returned to their communities were associated with being sober at follow-up.

Lancaster T; Stead LF. Self-help interventions for smoking cessation. (review). Cochrane Database of Systemic Reviews (3): CD001118.pub2, 2005. (151 refs.)

Background: Many smokers give up smoking on their own, but materials giving advice and information may help them and increase the number who quit successfully. Objectives: The aims of this review were to determine the effectiveness of different forms of self-help materials, compared with no treatment and with other minimal contact strategies; the effectiveness of adjuncts to self help, such as computer-generated feedback, telephone hotlines and pharmacotherapy; and the effectiveness of approaches tailored to the individual compared with non-tailored materials. Selection criteria: We included randomized trials of smoking cessation with follow up of at least six months, where at least one arm tested a self-help intervention. Main results: We identified sixty trials. Thirty-three compared self-help materials to no intervention or tested materials used in addition to advice. In 11 trials in which self help was compared to no intervention there was a pooled effect that just reached statistical significance. The analysis excluded two trials with strongly positive outcomes that introduced significant heterogeneity. Four further trials in which the control group received alternative written materials did not show evidence for an effect of the smoking self-help materials. Authors' conclusions: Standard self-help materials may increase quit rates compared to no intervention, but the effect is likely to be small. We failed to find evidence that they have an additional benefit when used alongside other interventions such as advice from a healthcare professional, or nicotine replacement therapy. There is evidence that materials that are tailored for individual smokers are effective, and are more effective than untailored materials, although the absolute size of effect is still small.

Laudet AB; Cleland CM; Magura S; Vogel HS; Knight EL. Social support mediates the effects of dual-focus mutual aid groups on abstinence from substance use. American Journal of Community Psychology 34(3-4): 175-185, 2004. (62 refs.)

Background: Specialized 12-step based groups have emerged to address the needs of persons recovering from both substance abuse and psychiatric illness. Objective: This study investigates the role of social support in mediating the association between mutual aid participation and subsequent substance use for dually diagnosed persons. Method: A cohort of Double Trouble in Recovery (DTR) members in New York City were studied prospectively over a two-year period. Findings: Longer DTR participation during the first year of the study was associated with lower substance use in the second year; that effect was partially explained by the maintenance of high level of social support. Conclusion: These findings speak of the enduring influence of 12-step attendance on reducing substance use, and underline the importance of both 12-step attendance and supportive networks for dually diagnosed persons.

Laudet AB; Magura S; Cleland CM; Vogel HS; Knight EL; Rosenblum A. The effect of 12-step based fellowship participation on abstinence among dually diagnosed persons: A two-year longitudinal study. Journal of Psychoactive Drugs 36(2): 207-216, 2004. (35 refs.)

A large percentage of individuals are dually-diagnosed with a psychiatric disorder and a substance use disorder. Such persons typically face more difficulties and have poorer outcomes than do single disorder substance users. Among noncomorbid substance users, treatment and participation in 12-Step groups have been shown to enhance the likelihood of abstinence from substance misuse. Specialized 12-Step based fellowships have recently emerged to address the recovery needs of dually-diagnosed persons. The present study is a longitudinal investigation of the effect of such 12-Step based groups on abstinence among dually-diagnosed persons. Participants were members of Double Trouble in Recovery (DTR) who were recruited at community-based meetings in New York City and reinterviewed twice at yearly intervals. Generalized estimating equation analysis indicated that, over the two-year study period, ongoing DTR attendance was significantly associated with a greater likelihood of abstinence after controlling for other pertinent variables, such as mental health symptoms. For clinicians, these findings underline the importance of fostering stable affiliation with specialized 12-Step based groups among their clients.

Ledgerwood DM; McCaul ME; Petry NM. Psychotherapy and pharmacotherapy in treatment of substance use disorders. IN: Kranzler HR; Ciraulo DA, eds. Clinical Manual of Addiction Psychopharmacology. Washington DC: American Psychiatric Press, 2005. pp. 339-356. (112 refs.)

This concluding chapter, following 8 chapters dealing with specific drug classes, addresses the general role of psychotherapy and pharmacotherapy in treating substance use disorders. Specific treatment approaches discussed are brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, behavioral couples therapy, and 12-step treatments. The interaction between these psychotherapies and drug therapies is reviewed.

Lieberman DZ. Clinical characteristics of individuals using an online alcohol evaluation program. American Journal on Addictions 14(2): 155-165, 2005. (26 refs.)

Access to treatment for substance abuse disorders is limited, and practical strategies are needed to expand opportunities for individuals to receive effective interventions. Automated or semi-automated treatments have shown promise in other disorders. Identifying the characteristics of patients who will be able to benefit from this unconventional approach will increase the likelihood of success. The current study examined 9,297 individuals using an online alcohol evaluation program. Subjects had high scores on the Alcohol Use Disorders Identification Test (AUDIT) and a substantial amount of ambivalence about the possible harm that their drinking caused, but they also had very low levels of self-identification as actual problem drinkers.

Lobdell JC. This Strange Illness: Alcoholism and Bill W.. New York: Walter de Gruyter, Inc.,, 2004

This work considers the impact of Bill Wilson in the formation of Alcoholics Anonymous and its conceptualiztion of the disesase as an illness of the mind, body, and spirit. It considers the evolving definitions of alcoholism, including theoretical formulations, statistically derived typologies and the changing definitions used by the medical community. The first chapters set forth the historical context and a historical perspective of AA, tracing its origins through Bill Wilson. and Dr Bob Smith. Several chapters are devoted to providing a biological and genetic perspective of alcoholism, presenting studies related to behavioral genetic, biochemical and genetic aspects of alcoholism. The final chapters endeavor to integrate the psychology and biology of alcoholism with the philosophy, theology and traditions of AA to provide a unified paradigm to support future research.

Magura S; Fong C; Staines GL; Cleland C; Foote J; Rosenblum A et al. The combined effects of treatment intensity, self-help groups and patient attributes on drinking outcomes. Journal of Psychoactive Drugs 37(1): 85-92, 2005. (36 refs.)

Better understanding of the diverse factors that predict alcoholism treatment outcomes is essential to improving treatment strategies. Patients accepted for treatment at a multimodality program were inter-viewed and followed-up at three months and one year after admission. The study tested a set of hypotheses relating to the effects on drinking outcomes of treatment modality, modality matching, treatment retention, aftercare, self-help group participation and patient attributes at admission. Drinking frequency diminished substantially between baseline and the two follow-ups. Outcomes for inpatient were better than for outpatient treatment in bivariate analysis, but outcomes for these modalities were equal after adjusting for the effect of patient-treatment mismatching. Aftercare treatment, time in treatment for outpatients, community 12-Step group participation, and several patient attributes such as motivation for change and psychiatric severity significantly predicted drinking outcomes at one or both follow-ups. Clinical implications of the results are discussed.

Mann RE; Smart RG; Rush BR; Zalcman RF; Suurvali H. Cirrhosis mortality in Ontario: Effects of alcohol consumption and Alcoholics Anonymous participation. Addiction 100(11): 1669-1679, 2005. (62 refs.)

We test the hypotheses that cirrhosis mortality rates are positively associated with per capita alcohol consumption and negatively associated with Alcoholics Anonymous (AA) membership rates. The impact of alcohol consumption levels and AA membership rates on cirrhosis mortality rates in Ontario from 1968 to 1989 were examined. Time-series analyses with ARIMA modelling were applied to male and female cirrhosis mortality rates in three age groups: 15-44, 45-64 and 65 + years. Missing AA membership data were interpolated using two methods: linear splines and cubic splines. In general, cirrhosis mortality rates were positively associated with alcohol consumption and negatively associated with AA membership. For some age and gender combinations, these effects were not statistically significant. The limits of this study include restrictions in the length of series available and in the ability to infer causality. Despite these limitations, these findings are consistent with previous research demonstrating that per capita consumption is a strong determinant of cirrhosis mortality rates, and also that higher levels of AA membership can reduce cirrhosis mortality rates.

Masudomi I; Isse K; Uchiyama M; Watanabe H. Self-help groups reduce mortality risk: A 5-year follow-up study of alcoholics in the Tokyo metropolitan area. Psychiatry and Clinical Neurosciences 58(5): 551 -557, 2004. (32 refs.)

The present study aimed to determine whether alcoholics who attend self-help groups experience fewer deaths than those who do not. Subjects were patients from the Alcoholism Treatment Program (ATP) of Matsuzawa hospital. A cohort of alcoholic patients recruited into a prospective study was followed from April 1994 to March 1999. A total of 469 alcoholic patients met the International Classification of Diseases (10th edition) criteria for alcohol dependency. Of these, 94 patients refused to participate in the study, leaving a total of 375 participants. After discharge from the ATP and a complete explanation of the present study, subjects decided whether to attend a self-help group (SHG) or not. The SHG comprised 208 subjects, and the non-self-help group (NSHG) comprised 167 subjects. Outcomes were evaluated with regard to death during follow-up for a mean of 2.4 years. Death was ascertained through the records of the Setagaya Department of Health and Welfare center, Matsuzawa hospital and other hospitals, and through personal contact with informants, relatives, and significant others of subjects. Deaths were confirmed for 47 NSHG subjects and only five SHG subjects. NSHG displayed a significantly decreased cumulative survival compared with SHG (P < 0.0001). Cox proportion hazard analysis was used to examine variables that may help to predict mortality among alcoholics. Alcoholics who attended self-help groups differed from those who did not, with regard to mortality experience. Attending a self-help group represented the most important predictor of prognosis for alcoholics.

Matzger H; Delucchi K; Weisner C. Alcoholics Anonymous social networks and formal services' impact on alcohol consumption in a 5-year study of problem and dependent drinkers. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 195A-195A, 2004. (0 refs.)

McCrady BS; Epstein EE; Kahler CW. Alcoholics Anonymous and relapse prevention as maintenance strategies after conjoint behavioral alcohol treatment for men: 18-month outcomes. Journal of Consulting and Clinical Psychology 72(5): 870 -878, 2004. (40 refs.)

Ninety men with alcohol problems and their female partners were randomly assigned to I of 3 outpatient conjoint treatments: alcohol behavioral couples therapy (ABCT), ABCT with relapse prevention techniques (RP/ABCT), or ABCT with interventions encouraging Alcoholics Anonymous (AA) involvement (AA/ABCT). Couples were followed for 18 months after treatment. Across the 3 treatments, drinkers who provided follow-up data maintained abstinence on almost 80% of days during follow-up, with no differences in drinking or marital happiness outcomes between groups. AA/ABCT participants attended AA meetings more often than ABCT or RP/ABCT participants, and their drinking outcomes were more strongly related to concurrent AA attendance. For the entire sample, AA attendance was positively related to abstinence during follow-up in both concurrent and time-lagged analyses. In the RP/ABCT treatment, attendance at posttreatment booster sessions was related to posttreatment abstinence. Across treatment conditions, marital happiness was related positively to abstinence in concurrent but not time-lagged analyses.

McGovern MP; Fox TS; Xie H; Drake RE. A survey of clinical practices and readiness to adopt evidence-based practices: Dissemination research in an addiction treatment system. Journal of Substance Abuse Treatment 26(4): 305-312, 2004. (51 refs.)

Addiction research is challenged to disseminate evidence-based practices into routine clinical settings. The successful adoption of innovation must consider issues of fit, such as the characteristics, readiness, and attitudes of clinicians in the community. We constructed a survey to assess clinical practices and readiness to adopt certain evidence-based practices in addiction treatment programs. The instrument was administered to directors (n = 21) and clinicians (n = 89) from 24 public addiction treatment programs in New Hampshire (USA). Clinicians are more motivated to adopt some evidence-based practices (twelve-step facilitation, cognitive behavioral therapy, motivational interviewing, relapse prevention therapy) than others (contingency management, behavioral couples therapy, pharmacotherapies). Translational strategies for treatment development and research dissemination are discussed.

McKay JR; Foltz C; Stephens RC; Leahy PJ; Crowley EM; Kissin W. Predictors of alcohol and crack cocaine use outcomes over a 3-year follow-up in treatment seekers. Journal of Substance Abuse Treatment 28(2. Supplement 1): S73-S82, 2005. (42 refs.)

This study identified predictors of long-term alcohol and crack cocaine use outcomes in individuals participating in the Persistent Effects of Treatment Study. The domains that were assessed included motivation, self-efficacy, social support, psychiatric severity, employment, housing status, and self-help group attendance at baseline and 6, 12, 24, and 30 month follow-ups. In alcohol users, higher perceived seriousness of substance use problems, self-efficacy, and self-help group attendance, as well as lower social support for substance use, consistently predicted better alcohol use outcomes in the subsequent assessment period. In crack cocaine users, only self-efficacy consistently predicted cocaine use outcomes. Higher self-efficacy during follow-up was predicted by lower perceived seriousness of substance use and lower alcohol use frequency in the prior assessment period, whereas greater self-help group attendance was predicted by greater perceived seriousness of substance use, and lower substance use frequency.

Moos RH; Moos BS. Help-seeking careers: Connections between participation in professional treatment and Alcoholics Anonymous. Journal of Substance Abuse Treatment 26(3): 167-173, 2004. (25 refs.)

This study examined the relationships between participation in professional treatment and Alcoholics Anonymous (AA) among 473 initially untreated individuals with alcohol use disorders. These individuals were assessed at baseline and at 1-year, 3-year, and 8-year followups. There were moderate positive concurrent associations between the duration of participation in professional treatment and in AA. More important, a longer duration of treatment in year 1 was associated with more sustained participation in AA in years 2 and 3, which was associated with less time in treatment in years 4 through 8. The strength of these findings varied somewhat in relation to whether individuals chose to enter treatment or AA first. The findings suggest that referral and alliance processes contribute to a positive association between the duration of an initial episode of treatment and subsequent AA, and then extended participation in AA contributes to better alcohol-related outcomes and reduced need for subsequent treatment.

Moos RH; Moos BS. Long-term Influence of duration and frequency of participation in Alcoholics Anonymous on individuals with alcohol use disorders. Journal of Consulting and Clinical Psychology 72(1): 81-90, 2004. (46 refs.)

This study examined the influence of the duration and frequency of a baseline episode of participation in Alcoholics Anonymous (AA) among 473 individuals with alcohol use disorders on 1-year and 8-year outcomes and the effect of additional participation and delayed participation on outcomes. Compared with individuals who did not participate, individuals who affiliated with AA relatively quickly, and who participated longer, had better 1-year and 8-year alcohol-related outcomes. Individuals who continued to participate, and those who continued longer, had better alcohol-related outcomes than did individuals who discontinued participation, but individuals who delayed participation in AA had no better outcomes than those who never participated. In general, the frequency of participation was independently associated only with a higher likelihood of abstinence

Moos RH; Moos BS. Participation in treatment and Alcoholics Anonymous: A 16-year follow-up of initially untreated individuals. Journal of Clinical Psychology 62(6): 735-750, 2006. (51 refs.)

This study focused on the duration of participation in professional treatment and Alcoholics Anonymous (AA) for previously untreated individuals with alcohol use disorders. These individuals were surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. Compared with individuals who remained untreated, individuals who obtained 27 weeks or more of treatment in the first year after seeking help had better 16-year alcohol-related outcomes. Similarly, individuals who participated in AA for 27 weeks or more had better 1 6-year outcomes. Subsequent AA involvement was also associated with better 1 6-year outcomes, but this was not true of subsequent treatment. Some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA.

Moos RH; Moos BS. Paths of entry into Alcoholics Anonymous: Consequences for participation and remission. Alcoholism: Clinical and Experimental Research 29(10): 1858-1868, 2005. (42 refs.)

Background: This study compared individuals with alcohol use disorders who, in the first year after initiating help-seeking, entered Alcoholics Anonymous (AA) only, entered professional treatment and AA together, or entered professional treatment only Methods: A sample of initially untreated individuals (N = 362) was surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. At each contact point, participants described their participation in AA and treatment and their current alcohol-related functioning. They also described their reasons for entering AA and/or treatment and the perceived benefits of these sources of help Results: Compared with individuals who initially participated only in treatment but later entered AA, those who entered treatment and AA together participated in AA longer and more frequently and were more likely to achieve remission. Among individuals who initially participated only in AA, those who later entered treatment had poorer remission outcomes than those who did not enter treatment. Longer duration of participation in AA was associated with a higher likelihood of remission at all four follow-ups; individuals who dropped out of AA were more likely to relapse or remain nonremitted. Conclusions: Compared with individuals who participated only in professional treatment in the first year after they initiated help-seeking, individuals who participated in both treatment and AA were more likely to achieve remission. Individuals who entered treatment but delayed participation in AA did not appear to obtain any additional benefit from AA.

Moos RH; Moos BS. The interplay between help-seeking and alcohol-related outcomes: Divergent processes for professional treatment and self-help groups. Drug and Alcohol Dependence 75(2): 155-164, 2004. (45 refs.)

This study examined the influence of self-selection, as reflected in alcohol-related functioning, on the duration of professional treatment and Alcoholics Anonymous (AA), and the influence of social causation, as reflected in the duration of treatment and AA, on alcohol-related outcomes. A sample of alcoholic individuals was surveyed at baseline and 1, 3, and 8 years later. At each point, participants completed an inventory that assessed participation in treatment and AA since the last assessment and alcohol-related functioning. There were divergent processes of self-selection and social causation with respect to the duration of participation in professional treatment and AA. Individuals with more severe alcohol-related problems obtained longer episodes of professional treatment, but this self-selection process was much less evident for AA. Longer participation in professional treatment in the first year predicted better alcohol-related outcomes; however, the duration of subsequent treatment was not associated with better subsequent outcomes. In contrast, longer participation in AA consistently predicted better subsequent alcohol-related outcomes. These findings are consistent with a need-based model of professional treatment, in which more treatment is selected by and allocated to individuals with more severe problems, and an egalitarian model of self-help, in which need factors play little or no role in continued participation.

O'Halloran S. Symmetry in interaction in meetings of Alcoholics Anonymous: The management of conflict. Discourse & Society 16(4): 535-560, 2005. (50 refs.)

This is a study of the interactive order of participants in meetings of Alcoholics Anonymous (AA). It explores, through a detailed examination of one instance of conflict, the turn-taking system of AA meetings and the discursive alignment of members to each other. It aims to demonstrate that the non-hierarchical, egalitarian nature of AA is reflected in and constituted through the way symmetrical interaction is managed. It is proposed that this symmetry is institutional and is constitutive of the aims of AA; demonstrating that discursive symmetry is constituted by members' access to and employment of a similar range of discursive practices which reflects and constitutes non-differentiated roles among members, mitigating against conflict. It is further proposed that the symmetry in AA discursive practices is exceptional in that, unlike the symmetry of mundane conversation between equals, it is institutional and that symmetry is displayed to a higher degree, i.e. that AA discourse is both institutional and highly symmetrical and that this has a particular bearing on conflict management within AA meetings.

Pagano ME; Friend KB; Tonigan JS; Stout RL. Helping other alcoholics in Alcoholics Anonymous and drinking outcomes: Findings from Project MATCH. Journal of Studies on Alcohol 65(6): 766-773, 2004. (63 refs.)

Objective: Although Alcoholics Anonymous (AA) is the largest mutual-help organization for alcoholics in the world, its specific mechanisms that mobilize and sustain behavior change are poorly understood. The purpose of this study is to examine prospectively the relationship between helping other alcoholics and relapse in the year following treatment for alcohol use disorders. Method: Data were derived from Project MATCH, a longitudinal prospective investigation of the efficacy of three behavioral treatments for alcohol abuse and dependence. Kaplan-Meier survival estimates were used to calculate probabilities of time to alcohol relapse. To identify the unique value of helping other alcoholics when controlling for the number of AA meetings attended, proportional hazards regressions were conducted to determine whether the likelihood of relapse was lower for those who were helping other alcoholics. Results: There were no demographic differences that distinguished participants in regard to involvement in helping other alcoholics, with the exception of age; those who were helping other alcoholics were, on average, 3 years older than those who were not helping alcoholics. Those who were helping were significantly less likely to relapse in the year following treatment, independent of the number of AA meetings attended. Conclusions: These findings provide compelling evidence that recovering alcoholics who help other alcoholics maintain long-term sobriety following formal treatment are themselves better able to maintain their own sobriety. Clinicians who treat persons with substance abuse disorders should encourage their clients to help other recovering alcoholics to stay sober.

Pagano J; Graham NA; Frost-Pineda K; Gold MS. The physician's role in recognition and treatment of alcohol dependence and comorbid conditions. Psychiatric Annals 35(6): 473-481, 2005. (44 refs.)

Alcohol abuse and dependence are the cause of significant morbidity and morality. Comorbid psychiatric disorders and polysubstance use are the rule rather than the exception. Physicians are ideally positioned to educate, prevent, diagnose, intervene and treat or refer patients with substance use problems. Twelve-step recovery is a mainstay of treatment and should be encouraged in all persons regardless of the treatment plan. This article, part of the journal's CME feature, addresses the following topics: associated morbidity; neurological effects, withdrawal; epidemiology including risk factors; consequences of alcohol use; beneficial effects of alcohol; the diagnostic process; screening approaches and screening tools; comorbidity in terms of psychiatric diseases and other drug use; office-based interventions; general features of treatment including the use of 12-step programs and drug therapies such as naltrexone and acamprosate.

Perkinson RR. Treating Alcoholism: Helping your Clients Find the Road to Recovery. Hoboken NJ: John Wiley & Sons, 2004. (182 book refs.)

This volume is directed to general clinicians. It is organized into ten chapters that deal with identification and assessment; core concepts; treatment planning; recovery tools; Alcoholics Anonymous steps; psychiatric co-morbidity; adolescent treatment; aftercare and relapse prevention; and the recovery community. Emphasis is placed upon explaining basic components of Alcoholics Anonymous, and efforts which can promote clients affiliation with AA. As part of this, there is discussion of the spiritual aspects of AA and how to utilize a "Higher Power" in treatment, use by the client and the therapist. Case vignettes are provided.

Poage ED; Ketzenberger KE; Olson J. Spirituality, contentment, and stress in recovering alcoholics. [rapid communication]. Addictive Behaviors 29(9): 1857-1862, 2004. (22 refs.)

The relationships among length of sobriety, spirituality, contentment, and stress were examined in a sample of recovering alcoholics attending Alcoholics Anonymous meetings. Length of sobriety was significantly associated with spirituality but not with contentment or stress. Spirituality and contentment were also positively related. There were significant gender differences in the relationships among spirituality, contentment, and stress level. Spirituality was significantly correlated with lower stress for women but not for men. Men's contentment was significantly related to lower stress levels, but contentment and stress was nonsignificant for women.

Polcin DL; Zemore S. Psychiatric severity and spirituality, helping, and participation in Alcoholics Anonymous during recovery. American Journal of Drug and Alcohol Abuse 30(3): 577-592, 2004. (39 refs.)

Although helping others is a critical part of Alcoholics Anonymous (AA) and many treatment programs, measures for assessing helping and describing its relationship with sobriety are lacking. A sample of 200 subjects completed a Helper Therapy Scale including three subscales: Recovery Helping (alpha = 0.78), Life Helping (alpha = 0.62), and Community Helping (alpha = 0.60). A previous analysis using structural equation modeling found that length of sobriety predicted measures of spirituality, helping, and AA participation. The analysis reported here examined whether psychiatric severity was associated with these variables. Results indicated significant relationships between psychiatric severity and measures of spirituality (Self Transcendence, Forgiveness, Positive Coping, and Negative Coping) and AA Achievement (defined as completing the 12 steps and serving as a sponsor). However, no relationships were found between psychiatric severity and length of sobriety, the three Helper Therapy subscales, or AA involvement. The findings suggest that individuals with higher psychiatric severity may need assistance from their peers or professional service providers to develop a spiritual life, serve as a sponsor for others, or complete the steps of AA.

Pull CB. Self-help Internet interventions for mental disorders. (editorial). Current Opinion in Psychiatry 19(1): 50-53, 2006. (13 refs.)

Purpose of review: In recent years a considerable number of publications has appeared on various aspects of Internet interventions for mental health care. The purpose of the present article is to review the current scientific status of Internet interventions for the treatment of mental disorders. Recent findings: Randomized controlled studies on the use Internet interventions for the treatment of mental disorders are still scarce. Most studies in the field have been on Internet interventions for the treatment of depressive disorders and anxiety disorders, using cognitive behavioural therapy. In addition, a few studies have been published on the use of Internet interventions in the treatment of substance use disorders (smoking, problem drinking), insomnia and tinnitus. Summary: Recent studies provide provisional evidence that Internet interventions may be a promising tool for the treatment of some mental disorders.

Rassool GH; Rassool GH. The self-help movement in the addiction field: Revisited. Journal of Addictions Nursing 17(1): 47-52, 2006. (26 refs.)

The self-help principle has witnessed a recent upsurge in popularity in response to popular movements towards self-care and individual responsibility. It was power-to-the-people social movements in the 1960s that provided avenues for the development of the self-help group movement. Self-help groups in the treatment of addiction provide a non-judgmental caring and supportive focus, are based in the community, and are freely available to anyone who wishes to attend. Self-help groups in the addiction field are not explicitly used by the recovering drug-user or problem-drinker. Family self-help groups also have emerged and are good examples of sources of empowerment for those people who have become victims of circumstances. The aims of this paper are to examine the nature, ideologies, beliefs, benefits, and limitations of self-help groups and their role in advocacy and in complementing professional help in the addiction field.

Saladin ME; Santa Ana EJ. Controlled drinking: More than just a controversy. Current Opinion in Psychiatry 17(3): 175-187, 2004. (96 refs.)

Purpose of review: We intend to provide clinicians and clinical scientists with an overview of developments in the controlled-drinking literature, primarily since 2000. A brief description of the controversy surrounding controlled drinking provides a context for a discussion of various approaches to controlled drinking intervention as well as relevant clinical research.Recent findings Consistent with previous research, behavioral self-control training continues to be the most empirically validated controlled-drinking intervention. Recent research has focused on increasing both the accessibility/availability and efficacy of behavioral self-control training. Moderation-oriented cue exposure is a recent development in behaviorally oriented controlled drinking that yields treatment outcomes comparable to behavioral self-control training. The relative efficacy of mode ration-oriented cue exposure versus behavioral self-control training may vary depending on the format of treatment delivery (group versus individual) and level of drinking severity. In general, the efficacy of both techniques does not appear to vary as a function of drinking severity but may vary as a function of drinking-related self-efficacy. Guided-self change is a relatively new and brief cognitive-behavioral intervention that has demonstrated efficacy with problem drinkers. Interventions based on harm reduction principles have decreased alcohol use in various student populations. Finally, Moderation Management is the only self-help program that supports non-abstinence goals, a feature that makes it popular with problem drinkers who are avoidant of traditional treatment services. Summary: The controversial past of controlled drinking is slowly giving way to a hopeful future in which individuals are less likely to be forced into an abstinence-only treatment scenario. The enhanced accessibility of effective controlled-drinking interventions should significantly expand the treatment options of individuals within the full spectrum of alcohol-related problems.

Schonbrun B. In the light of reason and experience: The scope of evidentiary privilege in the self-help setting. Alcoholics Anonymous examined. Cardozo Law Review 25: 1203-1242, 2004. (195 refs.)

... Cox cleaned the crime scene before departing, disposed of his bloodied clothes in an incinerator, and threw the murder weapon into a nearby body of water. ... This specifically addresses the issue that the Second Circuit left unanswered in Cox - "whether to protect the confidentiality of communications among members of AA," either by invoking the cleric-congregant privilege or by creating a distinct evidentiary privilege to protect communications in the self-help setting. ... Generally, the creation of an evidentiary privilege requires that it serve the public interest and also protect relationships where confidentiality is considered essential to the nature of the association. ... With this exposition the court attempted to elucidate the legislative intent behind the statute by extending the cleric-congregant privilege to "ministers of all religions," as "New York's test for the privilege's applicability distills to a single inquiry: whether the communication in question was made in confidence and for the purpose of obtaining spiritual guidance. ... If the privacy interest of AA members warranted the extension of a self-help privilege to AA, the brutal murder of the Chervus would have likely remained unsolved. ... Simply stated, AA is a support group of laymen that does not merit the protection of the cleric-congregant privilege or the creation of a distinct evidentiary privilege to shield its communications. ...

Stead LF; Lancaster T. Group behaviour therapy programmes for smoking cessation. (review). Cochrane Database of Systematic Reviews 2: CD001007.pub2, 2005. (125 refs.)

Background: Group therapy offers individuals the opportunity to learn behavioural techniques for smoking cessation, and to provide each other with mutual support. Objectives: We aimed to determine the effects of smoking cessation programmes delivered in a group format compared to self-help materials, or to no intervention; to compare the effectiveness of group therapy and individual counselling; and to determine the effect of adding group therapy to advice from a health professional or to nicotine replacement. We also aimed to determine whether specific components increased the effectiveness of group therapy. We aimed to determine the rate at which offers of group therapy are taken up. Search strategy We searched the Cochrane Tobacco Addiction Group Trials Register, with additional searches of MEDLINE and PsycINFO, including the terms behavior therapy, cognitive therapy, psychotherapy or group therapy, in January 2005. Selection criteria We considered randomized trials that compared group therapy with self help, individual counselling, another intervention or no intervention (including usual care or a waiting list control). We also considered trials that compared more than one group programme. We included those trials with a minimum of two group meetings, and follow up of smoking status at least six months after the start of the programme. We excluded trials in which group therapy was provided to both active therapy and placebo arms of trials of pharmacotherapies, unless they had a factorial design. Data collection and analysis We extracted data in duplicate on the participants, the interventions provided to the groups and the controls, including programme length, intensity and main components, the outcome measures, method of randomization, and completeness of follow up. The main outcome measure was abstinence from smoking after at least six months follow up in patients smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow up were analyzed as continuing smokers. Where possible, we performed meta-analysis using a fixed-effects (Mantel-Haenszel) model. Main results A total of 55 trials met inclusion criteria for one or more of the comparisons in the review. Sixteen studies compared a group programme with a self-help programme. There was an increase in cessation with the use of a group programme (N = 4395, odds ratio (OR) 2.04, 95% confidence interval (CI) 1.60 to 2.60). Group programmes were more effective than no intervention controls (seven trials, N = 815, OR 2.17, 95% CI 1.37 to 3.45). There was no evidence that group therapy was more effective than a similar intensity of individual counselling. There was limited evidence that the addition of group therapy to other forms of treatment, such as advice from a health professional or nicotine replacement, produced extra benefit. There was variation in the extent to which those offered group therapy accepted the treatment. There was limited evidence that programmes which included components for increasing cognitive and behavioural skills and avoiding relapse were more effective than same length or shorter programmes without these components. This analysis was sensitive to the way in which one study with multiple conditions was included. We did not find an effect of manipulating the social interactions between participants in a group programme on outcome. Authors' conclusions: Group therapy is better for helping people stop smoking than self help, and other less intensive interventions. There is not enough evidence to evaluate whether groups are more effective, or cost-effective, than intensive individual counselling. There is not enough evidence to support the use of particular psychological components in a programme beyond the support and skills training normally included.

Tangenberg KM. Twelve-step programs and faith-based recovery: Research controverseries, provider perspectives, and practice implications. IN: Hilarski C, ed. Addiction, Assessment, and Treatment with Adolescents, Adults, and Families. New York: Haworth Social Work Practice Press, 2005. pp. 19-40. (44 refs.)

This paper draws upon empirical research literature and faith-related challenges posed by 12-step and other spiritually oriented treatment approaches. The paper is organized to provide clarification of relevant terminology, review research literature and controversies surrounding the effectiveness of 12-step recovery approaches and other treatment models, present faith-related provider narratives, and discuss the implications of existing research and faith-related treatment ideologies for evidence-based practice.

Timko C; Billow R; DeBenedetti A. Determinants of 12-step group affiliation and moderators of the affiliation-abstinence relationship. Drug and Alcohol Dependence 83(2): 111-121, 2006. (80 refs.)

This study examined characteristics of substance use disorder (SUD) outpatients at intake to treatment (N=345) that were associated with more 12-step group attendance and involvement, Steps worked, and acceptance of 12-step philosophy at a 6-month follow-up (N=281, 81.4%). Patient characteristics covered the domains of sociodemographics, SUD severity, personal functioning, and previous help received. Distinguishing baseline characteristics of patients who attended more 12-step group meetings during follow-up were being less-educated, more engaged in religious practices, and more extroverted and interpersonally competent, and having had more previous 12-step group exposure. These patient characteristics were generally similar to those associated with more 12-step meeting involvement and philosophy acceptance. More 12-step meeting attendance and involvement were related to abstinence at 6 months. Associations of attendance with abstinence were stronger among patients who were younger, white, less-educated, unstably employed, less religious, and less interpersonally skilled. These patients may have had fewer available social resources and so benefitted more from the fellowship and support for abstinence that 12-step group members often provide. We suggest methods by which treatment providers may encourage 12-step group affiliation among patients likely to benefit from it on substance use outcomes.

Timko C; DeBenedetti A; Billow R. Intensive referral to 12-Step self-help groups and 6-month substance use disorder outcomes. Addiction 101(5): 678-688, 2006. (60 refs.)

Aims: This study implemented and evaluated procedures to help clinicians make effective referrals to 12-Step self-help groups. Design Randomized controlled trial. Setting: Out-patient substance use disorder treatment. Participants Individuals with substance use disorders (SUDs) entering a new treatment episode (n = 345) who were assigned randomly to a standard referral- or an intensive referral-to-self-help condition. Measurements: Self-reports of 12-Step group attendance and involvement and substance use at baseline and a 6-month follow-up. Intervention: The intensive referral intervention focused on encouraging patients to attend 12-Step meetings by connecting them to 12-Step volunteers. Findings: Among patients with relatively less previous 12-Step meeting attendance, intensive referral was associated with more meeting attendance during follow-up than was standard referral. Among all patients, compared with those who received standard referral, those who received intensive referral were more likely to be involved with 12-Step groups during the 6-month follow-up (i.e. had provided service, had a spiritual awakening and currently had a sponsor). Intensive referral patients also had better alcohol and drug use outcomes at 6 months. Twelve-Step involvement mediated part of the association between referral condition and alcohol outcomes. Conclusions: The brief intensive referral intervention was associated with improved 12-Step group involvement and substance use outcomes even among patients with considerable previous 12-Step group exposure and formal treatment. Future 12-Step intensive referral procedures should focus on encouraging 12-Step group involvement in addition to attendance to benefit patients most effectively.

Timko C; Finney JW; Moos RH. The 8-year course of alcohol abuse: Gender differences in social context and coping. Alcoholism: Clinical and Experimental Research 29(4): 612-621, 2005. (74 refs.)

Background: The aim of this study was to compare women (n = 230) and men (n = 236) who had alcohol use disorders in terms of social context and coping methods and in terms of changes in these indices associated with participation in professional treatment and Alcoholics Anonymous (AA). Methods: Initially untreated problem drinkers were followed up for 8 years. Results: Women and men did not differ in regard to the type of help received, but women had longer professional treatment. At baseline, women had more stressors and fewer resources from family and relied more on avoidance coping and drinking to cope. During the next 8 years, women, more so than men, increased on approach coping and reduced their use of avoidance coping and drinking to cope. When baseline status was controlled, women had better social resource, coping, and drinking outcomes than men did at 1 year and 8 years. A longer duration of professional treatment during year 1 was associated with improved approach coping among men but not women. A longer duration of AA attendance during year 1 and the full 8 years was associated with more resources from friends, more use of approach coping, and less drinking to cope. In turn, more friends resources and approach coping and less drinking to cope were associated with better drinking outcomes. Decreases in avoidance coping and drinking to cope were more strongly associated with better drinking outcomes among men than among women. Conclusions: It may be important to target men for formal services or self-help to increase their use of approach coping in efforts to maintain abstinence. Women's strategies for improving their social context need further explication to be adapted for transfer to male problem drinkers.

Timko C; Sempel JM. Intensity of acute services, self-help attendance and one-year outcomes among dual diagnosis patients. Journal of Studies on Alcohol 65(2): 274-282, 2004. (52 refs.)

Objective: This study of dual diagnosis patients examined the associations of the intensity of acute care services and 12-step self-help group attendance with substance use and mental health outcomes. Method: Participants (n = 230; 96% men) received treatment in one of 14 residential programs and were evaluated with the Addiction Severity Index at discharge (98%) and at 1-year follow-up (80%). Results: High service intensity in acute treatment was associated with better substance use and family/social outcomes both at discharge and at I year when patients' intake status was controlled. More attendance at 12-step self-help groups was also associated with better patient substance use and psychiatric outcomes, both during and following treatment. The benefits of more 12-step group attendance, however, depended on whether acute treatment was of low or high service intensity. More 12-step group attendance during treatment was associated with better alcohol and drug outcomes at discharge only among patients treated in low-service-intensity programs; and more attendance postdischarge was associated with better psychiatric and family/social functioning at I year only among patients receiving low-service-intensity care. Conclusions: We suggest potential means by which high-service-intensity acute care programs might better facilitate patients' postdischarge use of 12-step self-help groups to benefit outcomes.

Tonigan JS; Bogenschutz MP; Miller WR. Is alcoholism typology a predictor of both Alcoholics Anonymous affiliation and disaffillation after treatment? Journal of Substance Abuse Treatment 30(4): 323-330, 2006. (32 refs.)

Twelve Steps (TS) has demonstrated effectiveness; induction into Alcoholics Anonymous (AA) is a primary objective of TS and is a pivotal mechanism explaining its effectiveness. However, evidence suggests that, after treatment, dropout from AA is high. This study investigated whether alcohol problem severity predicted both AA affiliation and disaffiliation among clients receiving TS. This study of a Project MATCH sample included 453 alcohol-dependent clients randomly assigned to TS who reported AA attendance during treatment. Greater alcohol problem severity predicted AA attendance; opposite to prediction, less alcohol-impaired clients were more than twice as likely to discontinue AA attendance after treatment. When sustained AA attendance is desired, the evaluation of client pretreatment alcohol involvement may be useful for identifying potential AA dropout after TS treatment. Findings also indicate that, among treatment-seeking problem drinkers, AA dropout and disaffiliation are distinct, albeit correlated, constructs that require future investigation.

Tucker JA; Vuchinich RE; Rippens PD. Different variables are associated with help-seeking patterns and long-term outcomes among problem drinkers. Addictive Behaviors 29(2): 433-439, 2004. (10 refs.)

This study investigated variables associated with help-seeking for drinking problems and with long-term drinking outcomes. In a 3x2 design, problem drinkers (N=167) were selected according to their help-seeking history [no assistance (NA), Alcoholics Anonymous (AA) only, or treatment plus AA (TxAA)] and current drinking status [resolved abstinent (RA) for >2 years or nonresolved (NR) active drinkers]. Drinking practices and problems, influences on help-seeking, and life events were assessed retrospectively during structured interviews. Participant reports were verified through collateral or reliability interviews. Stable resolution was associated with heavier drinking and greater negative life events before resolution. Seeking help, especially from treatment, was associated with greater psychosocial problems and higher dependence levels. The results indicate that different dimensions of drinking problems are associated with help-seeking and drinking outcomes, and suggest ways to increase help-seeking.

Tucker J; Vuchinich R; Rippens P. A factor analytic study of influences on patterns of help-seeking among treated and untreated alcohol dependent persons. Journal of Substance Abuse Treatment 26(3): 237-242, 2004. (21 refs.)

Influences on seeking help from professional alcohol treatment and from Alcoholics Anonymous (AA) were investigated using problem drinkers (N = 167) with different help-seeking experiences (no assistance, AA only, or treatment plus AA) and current drinking statuses (sustained abstinence for > 2 years or active problem drinking). Depending on their help-seeking experiences, participants rated barriers to or reasons for seeking help from treatment and AA, which were factor analyzed. Common impediments to help-seeking included privacy concerns and participants' beliefs that they could solve their problem on their own and that it was not serious enough to seek help. Common reasons for help-seeking included social and other functional problems related to drinking. There were also influences unique to treatment (e.g., cost) and to AA (e.g., group format). Help-seeking factors did not vary by drinking status. The implications for increasing help-seeking among problem drinkers are discussed.

Vaillant GE. Alcoholics Anonymous: Cult or cure? Australian and New Zealand Journal of Psychiatry 39(6): 431-436, 2005. (36 refs.)

Objective: To discuss the mechanism of action, the efficacy and the safety of Alcoholics Anonymous (AA) in the treatment of alcoholism. Method: The published works on effective treatments for alcoholism is briefly reviewed and a prospective multidisciplinary follow-up of recovery from alcoholism in two community cohorts of adolescent males followed from 1940 until the present day is reviewed. Conclusions: The suggested mechanism of action of AA is that it employs four factors widely shown to be effective in relapse prevention in addictions: external supervision, substitute dependency, new caring relationships and increased spirituality. In addition, AA serendipitously follows the principles of cognitive behaviour therapy in relapse prevention. Alcoholics Anonymous appears equal to or superior to conventional treatments for alcoholism, and the skepticism of some professionals regarding AA as a first rank treatment for alcoholism would appear to be unwarranted. Alcoholics Anonymous is probably without serious side-effects.

Vigilant LG. "I don't have another run left with it": Ontological security in illness narratives of recovering on methadone maintenance. Deviant Behavior 26(5): 399-416, 2005. (35 refs.)

This study examines the accounts of 45 opiate-addicted individuals in recovery with methadone maintenance treatment (MMT). In-depth interviews assess these individuals' meanings and practices of recovery. Results show that methadone patients, in forming their own recovery models, vacillate between competing definitions of recovery: from the strict program established by methadone clinicians and enforced through frequent urinalyses, to the ideal that Narcotics and Alcoholics Anonymous ascribe. The findings suggest that despite apparent vacillations between competing recovery-paragons, the unifying theme in their illness narratives on recovery is the need for ontological security. The results imply that opiate-addicted individuals might benefit most from programs modeled on a harm reduction approach.

Weiss RD; Griffin ML; Gallop RJ; Najavits LM; Frank A; Crits-Christoph P et al. The effect of 12-step self-help group attendance and participation on drug use outcomes among cocaine-dependent patients. Drug and Alcohol Dependence 77(2): 177-184, 2005. (41 refs.)

Objective: Although cocaine-dependent patients are frequently referred to 12-step self-help groups, little research has examined the benefits of 12-step group attendance in this population. Moreover, the distinction between attending meetings and actively participating in 12-step activities has not typically been examined. Method: In the National Institute on Drug Abuse Collaborative Cocaine Treatment Study, 487 cocaine-dependent outpatients were recruited at five sites for a randomized controlled trial of 24-week behavioral treatments. Study data were examined to see whether self-help attendance or active participation were related to subsequent drug use. Results: Twelve-step group attendance did not predict subsequent drug use. However, active 12-step participation in a given month predicted less cocaine use in the next month. Moreover, patients who increased their 12-step participation during the first 3 months of treatment had significantly less cocaine use and lower ASI Drug Use Composite scores in the subsequent 3 months. Finally, Individual Drug Counseling, based on a 12-step model, and increasing levels of 12-step participation each offered discrete benefits. Conclusions: Results suggest that active 12-step participation by cocaine-dependent patients is more important than meeting attendance, and that a combination of Individual Drug Counseling and active 12-step participation is effective for these patients.

Wild TC; Roberts AB; Cunningham J; Schopflocher D; Pazderka-Robinson H. Alcohol problems and interest in self-help: A population study of Alberta adults. Canadian Journal of Public Health 95(2): 127-132, 2004. (35 refs.)

Background: We quantified the prevalence of alcohol problems among Alberta adults and determined relationships between sociodemographic characteristics, problem drinking status, and interest in self-help materials to reduce alcohol use. Methods: A computer-aided telephone interview was administered to a stratified random sample of 10,014 Albertans, 18 years of age or older (5,621 women and 4,393 men; M age = 43.3 years, SD = 16.0), with a response rate of 65.4%. Measures included: 1) current drinking status, 2) prior alcohol treatment, 3) problem drinking status (using the Alcohol Use Disorders Identification Test; AUDIT), and 4) interest in receiving free self-help materials to encourage safe drinking. Data were weighted to reflect age, sex, and regional Alberta population. Resu