Information about Drug Abuse Treatment, 12-Step and Alcoholism for Healthcare Professionals
Most psychologists, social workers and therapists who provide clinical services for mental health recognize that early stage sobriety rarely results from individual, weekly visits in the therapy office. At a minimum, a substance abusing client requires group interaction with a sober support network, disease model education, and cognitive behavioral training to acquire the skills needed to establish a recovery practice.
Twin Town seeks to engage community based therapists in the delivery of a comprehensive treatment plan. Rather than attempt to provide all services to everyone, Twin Town instead sets out to cross-refer and coordinate care between its addiction treatment staff and the mental health professional.
Promoting self-help group involvement appears to improve post-treatment outcomes while reducing the costs of continuing care. Even cost offsets that somewhat diminish over the long term can yield substantial savings. Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.” Keith Humphreys11 Veterans Affairs and Stanford University Medical Centers, Palo Alto, California. and Rudolf H. Moos11Veterans Affairs and Stanford University Medical Centers, Palo Alto, California.
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. Alcoholism: Clinical and Experimental Research; Volume 30 Issue 8 Page 1381 – August 2006; doi:10.1111/j.1530-0277.2006.00165.x Volume 30 Issue 8; John F. Kelly, Robert Stout, William Zywiak, and Robert Schneider
As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) versus CB (37.0%) programs. Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs. In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p=0.01). Encouraging Posttreatment Self-Help Group Involvement to Reduce Demand for Continuing Care Services: Two-Year Clinical and Utilization Outcomes Keith Humphreys11Veterans Affairs and Stanford University Medical Centers, Palo Alto, California. and Rudolf H. Moos11Veterans Affairs and Stanford University Medical Centers, Palo Alto, California
“Patients who stay in treatment longer than 3 months usually have better outcomes than those who stay less time.”
“Patients who go through medically assisted withdrawal to minimize discomfort but do not receive any further treatment, perform about the same in terms of their drug use as those who were never treated.” NIDA
Problem drinking is rarely discussed during medical visits, more so during psychiatric visits. Most people with alcohol problems have their first voluntary contact with health professionals in the context of other health or social problems. Problem and dependent drinkers make heavy use of medical and mental-health services. Doctors and mental-health professionals do not generally use this opportunity to discuss drinking. Weisner, C., Matzger, H. (July 2003). Missed opportunities in addressing drinking behavior in medical and mental health services. Alcoholism: Clinical & Experimental Research, 27(8), 1132 – 1142.
Drug abuse treatment programs can significantly increase the likelihood that patients will stay in treatment and remain abstinent by offering them more groups and individual counseling opportunities and encouraging them to participate in complementary 12-step programs, such as Narcotics Anonymous.
Patients who attended more group and individual counseling sessions had significantly lower levels of drug use during and after treatment than those who participated less frequently. Even among patient who completed the treatment program, those who participated more frequently in counseling had lower rates of relapse than those who participated less.
Patients in the enhanced programs (more frequency of counseling sessions and visits) used drugs forty (40) percent less than did patients in comparison programs in the six (6) months following an initial in-treatment assessment; in the last month, they used drugs sixty (60) percent less. Frequency of patients’ participation in individual and group counseling accounted for virtually all of the differences in post-treatment drug use (rather than patient characteristics).
Patients who attended at least one 12-step meeting per week after completing drug abuse treatment had much lower levels of drug use than those who participated less frequently or not at all. During (a) six (6) month follow-up period, only about twenty-two (22) percent of weekly 12-step participants had used an illicit drug. By contrast, forty-four (44) percent of those who attended 12-step programs less than once a week or not at all during that period had used an illicit drug. The more favorable outcomes of frequent 12-step participants could not be attributed to differences in motivation or to other post-treatment activities, such as attending other aftercare programs.
Patients who attended 12-step meetings regularly before entering drug abuse treatment stayed in treatment longer and were more likely to complete the treatment program and participate in post-treatment 12-step programs. Eight (8) months after the initial intake interview showed that patients who attended 12-step meetings at least once a week while they were participating in conventional drug abuse treatment had significantly higher rates of abstinence than patients who participated in only one or the other of those programs.
These findings suggest an “additive effect” on the recovery process from concurrent participation in drug abuse treatment and 12-step programs. Dr. Fiorentine says, “You get a better outcome with both than if you do either alone.” Fiorentine, R., et.al., “After treatment: Are 12 Step Programs effective in maintaining abstinence?”, “Does increasing the opportunity for counseling increase the effectiveness of outpatient drug treatment”, “Counseling participation and the effectiveness of outpatient drug treatment”, “Drug treatment and twelve-step program participation: The additive effects of integrated recovery activities”. American J. Drug and Alcohol Abuse, 1997/9; J. Substance Abuse Treatment 1996, 2003
Immediate response to requests for help, assessment readiness and aggressive follow-up, result in better patient rates of enrollment, engagement in recovery, and treatment outcome. Leigh, Ogburne, Cleland. Factor associated with patient dropout from an outpatient alcoholism treatment service. J. Stud Alcohol. 1984l 45:359-362, Stark, Campbell. Personality drug use and early attrition from substance abuse treatment. Am J Drug Alcohol Abuse. 1988; 14: 475-485, Stark, Campbell, Brinkerhoff. “Hello, may we help you?”: a study of attrition prevention at the time of the first phone contact with substance-abusing clients. Am J Drug Alcohol Abuse. 1990; 16: 67-76, Fehr, Weinstein, Sterling Gottheil. “As soon as possible:” An initial treatment engagement strategy. Subst. Abuse. 1991; 4: 183-189, Gainey, Wells, Hawkins, Catalano. Predicting treatment retention among cocaine users. Int. J Addict. 1993; 28: 487-505
“Patients in programs surveyed for DATOS (the Drug Abuse Treatment Outcome Study- NIDA,’93) showed a marked reduction in drug use after treatment regardless of the type of treatment program (residential, outpatient, etc.) they participated.” National Institute on Drug Abuse (NIDA)
“Alcohol abuse/ dependence is the most prevalent mental disorder in the workforce and is associated with the third highest productivity loss.” “Alcohol abuse/ dependence, the mental disorder with the highest prevalence at 9%, also has the highest rate of non-recognition, with nearly 3 out of 4 employees with this condition never having sought help.”
“… most individuals with alcohol problems have their first voluntary contact with health professionals in the context of other health or social problems. Yet a study in the July issue of Alcoholism: Clinical & Experimental Research has found that, despite heavy use of medical and mental-health services by problem and dependent drinkers, doctors and mental-health professionals often do not address alcohol consumption during visits. “We found that the problem and dependent drinkers we interviewed were using medical and mental health services at fairly high rates,” said Constance Weisner, MD … This is a missed opportunity to address alcohol problems and refer people to counseling and treatment if needed.” Weisner, C., Matzger, H. (July 2003). Missed opportunities in addressing drinking behavior in medical and mental health services. Alcoholism: Clinical & Experimental Research, 27(8), 1132 – 1142.
“Clients in every program identified similar factors that played a role in their prior relapse. The most common factors were the following: Wanting to get high Believing that they could use again without getting re-addicted Loneliness Boredom and not knowing what to do when no longer using Dealing with painful feelings such as anxiety and depression.” “Building a System to Prevent Addiction Relapse”, Levy, PhD, Behavioral Healthcare Tomorrow, 12-01 • Although 28% of Americans have a behavioral health disorder at sometime during any given year, less than a third of adults with mental health problems and less than half of those with substance abuse problems receive treatment. Community Voices: Healthcare for the Underserved
Relapse prevention approaches often incorporate some of the principles of cognitive -behavioral therapy. In alcoholism treatment, this approach helps the patient recognize the cues that lead to drinking so as to be better prepared to deal with them when encountered. Patients develop the skills and self-confidence to cope with high-risk situations such as negative emotional states, interpersonal conflict, and social pressure to drink. The informal use of similar coping strategies may contribute to the success of 12-step self-help programs. “Alcohol Alert”, National Institute on Alcohol Abuse and Alcoholism, ’01, “Does urge to drink predict relapse after treatment?”, Rohsenow and Monti, Alcohol Research & Health, ’99, “Relapse Prevention”, Marlatt, Barrett, Daley, American Psychiatric Press Textbook of Substance Abuse Treatment, ’99, “Evaluating Substance Abuse Treatment Process Models: I. Changes on Proximal Outcome Variables during 12-step and Cognitive Behavioral Treatment”, Finney, Moyes, Coutts, Moos, Journal of Studies on Alcohol, ’98
Clients who require follow-up and prompting to enter into treatment show no difference in succeeding in treatment and a personal recovery program. The shorter period of time between a client’s initial call and their first session, the greater is the success in the client engaging in treatment. “Pretreatment Dropouts: Characteristics and Outcomes”, Gottheil, Sterling, Weinstein, Haworth Press, 1997
Persons who drop out of treatment, when compared to clients accepting treatment for addiction, have a much higher likelihood of the following: Continued use of their drug of choice Higher rates of drug and psychological problems Higher rates of inpatient hospitalization Higher rates of incarceration Lower rates of continued education “Pretreatment Dropouts: Characteristics and Outcomes”, Gottheil, Sterling, Weinstein, Haworth Press, 1997
Persons who remain in and become successful in outpatient treatment tend to have better histories of employment and have more emotional or physical distress at the time of admission than those who drop out. “Pretreatment Dropouts: Characteristics and Outcomes”, Gottheil, Sterling, Weinstein, Haworth Press, 1997, “Evaluation of Residential Program Using the Addiction Severity Index and Stages of Change”, Campbell, Haworth Press, 1997
Persons who are treated in Intensive Outpatient Drug Abuse Treatment demonstrate significant improvement in functioning (per ASI scale). There is an interaction between time and scale with successful outcome.
There is minimal interaction between psychiatric diagnosis and outcome. “Efficacy of Outpatient Intensive Treatment for Drug Abuse”, Campbell, Gabrielli, Laster, Liskow, Haworth Press, 1997 • “Stage of change was of no value in forecasting which individuals would or would not remain alcohol/ drug free at three months (post treatment enrollment).” “Evaluation of Residential Program Using the Addiction Severity Index and Stages of Change”, Campbell, Haworth Press, 1997
The longer a person is in treatment, the greater is the likelihood of successful outcome- the intensity of treatment does not appear to directly influence outcome. “Randomized Comparison of Intensive Outpatient vs. Individual Therapy for Cocaine Abusers”, Weinstein, PhD, Gottheil, Sterling, Haworth Press, 1997
Intensive outpatient treatment programs appear to influence better client engagement in mid and long-term recovery than do traditional outpatient services, once the client enrolls and engages in such treatment. “Randomized Comparison of Intensive Outpatient vs. Individual Therapy for Cocaine Abusers”, Weinstein, PhD, Gottheil, Sterling, Haworth Press, 1997
Personal health, social and occupational education, counseling and support services coordinated with Intensive Outpatient Treatment substance abuse counseling enables better long-lasting rehabilitation than does a single focus counseling or therapy approach. “Similarity of Outcome Predictors Across Opiate, Cocaine and Alcohol Treatments: McLellan, Alterman, Metzger, Grissom, Woody, Luborsky, O’Brien, Role of Treatment Services, J. Clin. Consult. Psychol., 1994
Though full cognitive function may not be restored through abstinence from methamphetamine, brain cells damaged by the use of the drug may recover after lengthy abstinence. Volkow, Chang, Journal of Neuroscience, American Journal of Psychiatry, 2001