Petersen, T. J., Sprich, S., Wilhelm, S., Yeterian, J. D., Labbe, A., & Kelly, J. F. (2015). Substance use disorders. In The Massachusetts General Hospital Handbook of Cognitive Behavioral Therapy (pp. 197-210) . New York: Springer.
Kelly, J. F., & Yeterian, J. D. (2015). Outcomes research on 12-step programs. In M. Galanter, H. Kleber, & K. Brady (Ed.), Textbook of Substance Abuse Treatment (5th ed. pp. 579-593) . Washington (D.C.): American Psychiatric Publishing, Inc.
BACKGROUND: Professional continuing care services enhance recovery rates among adults and adolescents, though less is known about emerging adults (18-25 years old). Despite benefit shown from emerging adults' participation in 12-step mutual-help organizations (MHOs), it is unclear whether participation offers benefit independent of professional continuing care services. Greater knowledge in this area would inform clinical referral and linkage efforts.
METHODS: Emerging adults (N=284; 74% male; 95% Caucasian) were assessed during the year after residential treatment on outpatient sessions per week, percent days in residential treatment and residing in a sober living environment, substance use disorder (SUD) medication use, active 12-step MHO involvement (e.g., having a sponsor, completing step work, contact with members outside meetings), and continuous abstinence (dichotomized yes/no). One generalized estimating equation (GEE) model tested the unique effect of each professional service on abstinence, and, in a separate GEE model, the unique effect of 12-step MHO involvement on abstinence over and above professional services, independent of individual covariates.
RESULTS: Apart from SUD medication, all professional continuing care services were significantly associated with abstinence over and above individual factors. In the more comprehensive model, relative to zero 12-step MHO activities, odds of abstinence were 1.3 times greater if patients were involved in one activity, and 3.2 times greater if involved in five activities (lowest mean number of activities in the sample across all follow-ups).
CONCLUSIONS: Both active involvement in 12-step MHOs and recovery-supportive, professional services that link patients with these community-based resources may enhance outcomes for emerging adults after residential treatment.
BACKGROUND: A growing body of research on adults with substance use disorders (SUDs) suggests that higher levels of religiosity and/or spirituality are associated with better treatment outcomes. However, investigation into the role of religiosity and spirituality in adolescent SUD treatment response remains scarce. The present study examines religiosity as a predictor of treatment outcomes in an adolescent sample, with alcohol/other drug problem recognition as a hypothesized moderator of this relationship. Problem recognition was selected as a moderator in an attempt to identify a subset of adolescents who would be more likely to use religious resources when attempting to change their substance use.
METHODS: One hundred twenty-seven outpatient adolescents aged 14 to 19 (Mage=16.7, SD=1.2, 24% female) were followed for 1 year after treatment intake. Growth curve analyses were used to assess the impact of baseline religiosity and problem recognition on subsequent abstinence rates, drug-related consequences, and psychological distress.
RESULTS: On average, abstinence did not change significantly during the follow-up period, whereas drug-related consequences and psychological distress decreased significantly. Religiosity did not predict changes in abstinence or psychological distress over time. Religiosity did predict reductions in drug-related consequences over time (b=-0.20, t=-2.18, P=.03). However, when problem recognition was added to the model, the impact of religiosity on consequences became nonsignificant, and there was no interaction between religiosity and problem recognition on consequences.
CONCLUSIONS: The main hypothesis was largely unsupported. Possible explanations include that the sample was low in religiosity and few participants were actively seeking sobriety at treatment intake. Findings suggest adolescent outpatients with SUD may differ from their adult counterparts in the role that religiosity plays in recovery.
The term “recovery” in the substance use disorder (SUD) field has been used generally and non-technically to describe global improvements in health and functioning typically following successful abstinence. More recently, however, in an attempt to reduce the stigma and negative public and clinical perceptions regarding remission potential for individuals suffering from SUD, “recovery” has been used more strategically to instil hope and to serve as an organizing paradigm that has inspired a growing recovery movement. In addition, with “recovery” gaining momentum internationally within governments' national health care agencies, there is increasing pressure to operationalise this construct as without it, it is difficult to develop, commission, and deliver the tailored packages of recovery support services needed to help individuals suffering from SUD. Initial attempts to define recovery and delineate its constituent parts have agreed on major elements, but differ on important subtleties; generally lacking has been a conceptual grounding of these definitions. The goal of this article is to promote further thought and debate by offering a conceptual basis for, and description of, the recovery construct that we hope enhances clarity and measurability. To accomplish this, we review existing definitions of recovery and offer a simplified bi-axial formulation and definition, reciprocal in nature, and grounded in stress and coping theory, which mirrors conceptually original formulations of the addiction syndrome.