(Press-News.org) Contact: Brandon G. Bergman, Ph.D.
bgbergman@partners.org
617-643-7563
Massachusetts General Hospital
Christine Timko, Ph.D.
ctimko@stanford.edu
650-617-2746
Department of Veterans Affairs
Alcoholism: Clinical & Experimental Research
Individuals with a dual diagnosis can benefit from 12-step programs too
Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) can play an important role in addiction recovery.
A new study examines the suitability of 12-step organizations for young adults with co-occurring substance use and psychiatric disorders, referred to as dual diagnosis (DD).
Findings indicate that young adult DD patients show similar benefits compared with those diagnosed only with a substance use disorder.
Studies and testimonials have shown that 12-step mutual-help organizations such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) can play an important role in addiction recovery among young adults with substance use disorders (SUDs). However, concerns exist regarding the suitability of 12-step programs for clinical subgroups such as those with co-occurring substance use and psychiatric disorders, called dual diagnosis (DD). A study of the influence of a DD or SUD-only diagnostic status on post-treatment attendance, active involvement in, and derived benefits from 12-step programs has found that young adult DD patients and SUD-only patients benefitted similarly from program attendance and involvement.
Results will be published in the February 2014 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
"There are two major clinical concerns about purely addiction-focused 12-step groups for DD patients" said Brandon Bergman, a postdoctoral fellow at the Massachusetts General Hospital Center for Addiction Medicine as well as corresponding author for the study. "First, some think a DD will make it difficult for patients to attend and connect with others; for example, depressed patients may not see potential positives in attending, or struggle with the social aspects of the meetings. Second, anecdotal reports suggest some AA/NA members may be anti-medication and in some cases, anti-psychotherapy. However, research suggests the majority of members are in favor of psychotropic and anti-relapse/anti-craving medication use, though there may be a vocal minority of members who oppose it. Also anecdotally, there are concerns that DD patients will be told, if they are feeling depressed or anxious, they are simply not 'working their program.'"
"Understanding the role of 12-step mutual-help groups in recovery is extremely important, especially given the widespread use of these groups and their easy accessibility as a long-term, ongoing source of help," added Christine Timko, a senior research career scientist at the Department of Veterans Affairs, and consulting professor in the Department of Psychiatry and Behavioral Sciences at Stanford University. "The field has moved on from examining whether mutual-help groups are beneficial – they are – to examining the mechanisms by which they are effective. For example: 'what are the mediators explaining their effectiveness?' 'What are the moderators?' 'For whom are they more or less effective?'"
"Because studies suggest patients with co-occurring psychiatric disorders typically comprise somewhere between 50 and 75 percent of SUD treatment seekers," noted Bergman, "it's a clinical subgroup that has garnered empirical attention. And because their rates of SUD are about three times higher than other cohorts, young adults are another group of patients the field has begun to examine in more detail."
Bergman and his colleagues followed 296 young adults (218 men, 78 women), aged 18 to 24 years and primarily Caucasian, who attended a private not-for-profit residential SUD treatment program in the upper Midwestern United States between October 2006 and April 2008. All participants were assessed at intake, and three, six, and 12 months post-treatment on 12-step attendance, active involvement (having a sponsor, social interaction with other members, completing step work, etc.), and percent days abstinent.
"We found that young adults in SUD treatment with at least one comorbid psychiatric disorder – mostly depressive and anxiety disorders – had more severe problems when coming into treatment and were a bit more motivated to change their substance use," said Bergman. "In the year following treatment discharge, [DD patients] showed about the same rates of participation in 12-step groups compared with their SUD-only peers. This included both attendance and active involvement. However, DD patients had worse abstinence rates than SUD-only patients."
Neither Bergman nor Timko could firmly speak to 'why' DD patients had worse abstinence rates, however, Bergman noted that having a co-occurring psychiatric disorder compounds challenges in recovery. "Specifically, added emotional and cognitive stress of the psychiatric disorder, in addition to addiction-specific recovery tasks, may make it tougher for DD young adults to maintain abstinence," he said.
"In addition," said Timko, "greater severity of substance use problems earlier on is a predictor of continued greater severity later on.
"Nevertheless," said Bergman, "we found that all patients benefitted from participation, whether or not they also had a psychiatric disorder. If anything, clinicians should make a concerted attempt to foster active 12-step involvement among their DD young adult patients because, despite overall worse abstinence rates in the DD group, those involved at the highest levels had rates similar to their SUD-only counterparts. It's important to remember, however, that our DD group had primarily depressive and anxiety disorders, so our findings may not apply to young adults with more severe psychiatric conditions, like psychotic disorders."
"These findings also suggest that 12-step group facilitation efforts for DD patients might focus on how to obtain and work with a sponsor," said Timko. "More generally, facilitation efforts may have to incorporate particular sensitivity to DD patients' more frequent discomfort with social interactions and with personal disclosures, especially regarding their mental health-related issues. Stigma may be especially salient and need addressing in 12-step facilitation for DD clients."
"Young adulthood is a crucial developmental period for clinical researchers because prevalence rates of SUD and psychiatric disorders are at their peak," said Bergman. "An important implication of the findings here is that as health care organizations, both publically and privately funded, keep a close eye on health care spending, free and widely accessible 12-step organizations can be a powerful recovery resource for young adults – including those with co-occurring psychiatric disorders. Participation is very likely to bolster abstinence and remission, which helps keep people out of the emergency room and hospital beds."
"SUD treatment programs should use evidence-based mutual-help group facilitation practices with clients, including those who are dually diagnosed," Timko recommended. "These methods should emphasize not only group attendance, but also involvement. Because DD patients benefit from AA, which is widely available, facilitation can focus on AA and does not need to focus on dual-focused groups, which are quite limited in availability in most regions. Future research should also look at specific groups of DD patients to see if there are differences in their benefits from mutual-help groups, such as depressed alcoholics versus those with PTSD using opiates for pain. In addition, research needs to broaden its focus from substance use and psychiatric outcomes to include true, comprehensive recovery such as quality of life and well-being."
###
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Psychiatric Comorbidity and 12-Step Participation: A Longitudinal Investigation of Treated Young Adults," were: M. Claire Greene of the Center for Addiction Medicine at Massachusetts General Hospital; Bettina B. Hoeppner and John F. Kelly of the of the Center for Addiction Medicine at Massachusetts General Hospital, and Harvard Medical School; and Valerie Slaymaker of Hazelden Foundation, Center City. The study was funded by the National Institute on Alcohol Abuse and Alcoholism, and the Hazelden Foundation. This release is supported by the Addiction Technology Transfer Center Network at http://www.ATTCnetwork.org.
Individuals with a dual diagnosis can benefit from 12-step programs too
2013-09-13
ELSE PRESS RELEASES FROM THIS DATE:
Better verbal development during childhood linked to later drinking and intoxication
2013-09-13
Contact: Antti Latvala, Ph.D.
antti.latvala@helsinki.fi
358-9-19127224
University of Helsinki
Michael Windle, Ph.D.
e-mwindle@emory.edu
404-727-9868
Emory University
Alcoholism: Clinical & Experimental Research
Better verbal development during childhood linked to later drinking and intoxication
Previous research has found contradictory linkages among cognition, verbal skills, and later alcohol use.
A new study has found that better verbal development during childhood predicts more frequent drinking and intoxication during adolescence and young ...
Genetic variant linked with kidney failure in diabetic women but not men
2013-09-13
Washington, DC (September 12, 2013) — A genetic variant on chromosome 2 is strongly linked with kidney failure in diabetic women but not in men, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings may help explain gender-specific differences in kidney failure, as well as why some diabetic women are prone to develop kidney failure.
Worldwide, more than 370 million people have diabetes, which is the leading cause of kidney failure, or end stage renal disease. Within the non-diabetic population, women ...
Younger women with type 2 diabetes face higher risk of heart disease
2013-09-13
Type 2 diabetes independently increases the risk of heart disease in premenopausal women, according to a study presented at the American Heart AssociationHigh Blood Pressure Research Scientific Sessions 2013.
Researchers studied 1,256 Argentine premenopausal and menopausal women with and without type 2 diabetes, ages 19 to 84, who underwent ultrasound imaging to measure plaque in their carotid arteries, the major artery running down the neck. Regardless of their age, family history, smoking history, having high blood pressure or menopausal status, plaque buildup was more ...
Testing child's urine may help doctors identify risk for high blood pressure
2013-09-13
Measuring sodium in a child's urine may help doctors identify those at risk for having high blood pressure later in life, according to a study presented at the American Heart Association High Blood Pressure Research Scientific Sessions 2013.
In a small study, researchers used a new protocol to quickly screen 19 children who were 10-19-year-olds. Researchers found that of the eight who retained sodium seven had high blood pressure.
The inability to properly excrete sodium in the body can occur during stress, such as when kids get nervous while in a doctor's office, so ...
High blood pressure reading in kids linked to triple risk for condition as adults
2013-09-13
Children with one or more high blood pressure readings were about three times more likely to develop the condition as adults, in a study presented at the American Heart Association High Blood Pressure Research Scientific Sessions 2013.
After accounting for age, gender and weight, researchers found a direct link between high blood pressure readings during childhood and high blood pressure in adulthood:
The rate of high blood pressure during adulthood was 8.6 percent among those who didn't have high readings as children.
The rate rose to 18 percent among those who ...
Childhood obesity may quadruple high blood pressure risk in adulthood
2013-09-13
Obese children quadruple their risk and overweight children double their risk of developing high blood pressure in adulthood, according to a study presented at the American Heart Association High Blood Pressure Research Scientific Sessions 2013.
Researchers tracked the growth and blood pressure of 1,117 healthy adolescents from Indianapolis for 27 years, starting in 1986, and found:
During childhood, 68 percent of the kids were a normal weight, 16 percent were overweight and 16 percent were obese. As adults, 119 of the participants were diagnosed with high blood pressure.
Six ...
Molecular structure reveals how HIV infects cells
2013-09-13
SHANGHAI, CHINA, AND LA JOLLA, CA – In a long-awaited finding, a team of Chinese and US scientists has determined the high-resolution atomic structure of a cell-surface receptor that most strains of HIV use to get into human immune cells. The researchers also showed where maraviroc, an HIV drug, attaches to cells and blocks HIV's entry.
"These structural details should help us understand more precisely how HIV infects cells, and how we can do better at blocking that process with next-generation drugs," said Beili Wu, PhD, professor at the Shanghai Institute of Materia ...
Ready for its close-up: 1 of HIV's entrance points
2013-09-13
Scientists have gotten the first close look at one of two co-receptors HIV uses to get its foot in the door of the immune system, a new study reports. Their insights could lead to better HIV drugs.
CCR5, a receptor on the surface of human cells, is one of two main entry points the HIV virus uses to initiate its attack on the human immune system; by binding to it, an HIV protein can fuse to the cell membrane beneath, ultimately digging its way inside the cell.
The other receptor that HIV uses to perform this feat is CXCR4.
Both CCR5 and CXCR4 belong to a family of ...
Local animals' role in human drug-resistant Salmonella may previously have been overstated
2013-09-13
A new study has shown that, contrary to popular belief, local domestic animals are unlikely to be the major source of antibiotic resistant Salmonella in humans. The result comes from a detailed study of DNA from more than 370 Salmonella samples collected over a 22-year period.
By studying the genetic variation in the Salmonella bacteria and their drug resistance genes, researchers found that distinguishable bacterial populations exist in human and animal populations living side by side. Antibiotic resistance is considered to be one of the most important dangers to human ...
International structures needed for equitable access to DNA identification after disaster
2013-09-13
PITTSBURGH— The April 2013 collapse of the Rana Plaza Factory Building in Bangladesh, in which more than 1,130 people were killed, is only the latest in a long line of events that has made plain the plight of the families whose loved ones go missing after conflict and disaster.
In a new paper published in "Science," Carnegie Mellon University and the University of Pittsburgh ethics, policy and human rights experts argue that international structures are needed to promote more equal access to forensic identification technologies, ensure their fair and efficient use, ...