Publications by Year: 2016

2016
Kelly, J. F., & Renner, J. (2016). Alcohol related disorders. In T. A. Stern, M. Fava, T. Wilens, & J. F. Rosenbaum (Ed.), Massachusetts General Hospital comprehensive clinical psychiatry (2nd ed. pp. 270-290) . Philadelphia: Elsevier.
Kelly, J. F., & Bergman, B. G. (2016). Twelve-step mutual-help organizations and facilitation interventions. In W. Mistral (Ed.), Integrated approaches to drug and alcohol problems: Action on addiction (pp. 169-181) . London, UK: Routledge.
Kaminer, Y., Winters, K., & Kelly, J. F. (2016). Screening, assessment, and treatment options for youths with a substance use disorder. In Y. Kaminer (Ed.), Youth Substance Abuse and Co-Occurring Disorders (pp. 49-80) . Washington (D.C.): American Psychiatric Association.
Kaminer, Y., Winters, K., & Kelly, J. F. (2016). Screening, assessment, and treatment options for youths with a substance use disorder. In Y. Kaminer (Ed.), Youth Substance Abuse and Co-Occurring Disorders (pp. 49-80) . Washington (D.C.): American Psychiatric Association.
Bergman, B. G., Kelly, J. F., Cristello, J. V., Sylvia, E. J., & Kelly, N. W. (2016). Social network sites: A “new wave” of electronic health research in emerging adult substance use disorder treatment and recovery? . The Addictions Newsletter, American Psychological Association, Division 50 , 25 (2), 13-14.
Kelly, J. F., & Humphreys, K. (2016). Recovery: The many paths to wellness. . In: U.S. Department of Health and Human Services (HHS), Office of the Surgeon General: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS.
Kelly, J. F., Greene, M. C., Bergman, B., Hoeppner, B. B., & Slaymaker, V. (2016). The Sponsor Alliance Inventory: Assessing the therapeutic bond between 12-step attendees and their sponsors. Alcohol and Alcoholism , 51 (1), 32-39. Publisher's VersionAbstract

AIMS: Within 12-step mutual-help organizations (MHOs), a sponsor plays a key recovery-specific role analogous to a 'lay therapist', serving as a role model, support and mentor. Research shows that attendees who have a sponsor have higher rates of abstinence and remission from substance use disorder (SUD), yet, while myriad formal psychotherapy studies demonstrate the therapeutic significance of the alliance between patients and professional clinicians on treatment outcomes, very little is known about the influence of the 'therapeutic alliance' between 12-step members and their sponsor. Greater knowledge about this key 12-step relationship could help explain greater degrees of 12-step effects. To bridge this gap, this study sought to develop and test a measure assessing the 12-step sponsee-sponsor therapeutic alliance--the Sponsor Alliance Inventory (SAI).

METHOD: Young adults (N = 302) enrolled in a prospective effectiveness study who reported having a 12-step sponsor during the study (N = 157) were assessed at treatment entry, and 3, 6 and 12 months later on the SAI, their 12-step MHO attendance, involvement and percent days abstinent (PDA).

RESULTS: Principal axis extraction revealed a single, 10-item, internally consistent (α's ≥ 0.95) scale that explained the majority of variance and was largely invariant to primary substance, gender and time. Criterion validity was also supported with higher SAI scores predicting greater proximal 12-step attendance, involvement and PDA.

CONCLUSION: The SAI may serve as a brief, valid measure to assess the degree of sponsee-sponsor 'therapeutic alliance' within 12-step communities and may help augment explanatory models estimating the effects of MHOs on recovery outcomes.

© The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

White, W., Galanter, M., Humphreys, K., & Kelly, J. F. (2016). The paucity of attention to Narcotics Anonymous in current public, professional, and policy responses to rising opioid addiction. Alcohol Treatment Quarterly , 34 (4), 437-462. Publisher's VersionAbstract

 

Increased opioid-related morbidity and mortality in the United States has triggered considerable professional, public, and political alarm and a wide array of community and clinical responses. The potential role of Narcotics Anonymous (NA) as a recovery support resource is rarely noted within recent media and professional reports addressing opioid addiction. In this brief review and commentary, the authors compare public and professional misconceptions about NA with the findings of available scientific studies of NA. The authors conclude that NA is an underutilized resource in contemporary responses to opioid addiction.

 

Kelly, J. F., Saitz, R., & Wakeman, S. (2016). Language, substance use disorders, and policy: The need to reach consensus on an “addiction-ary” . Alcohol Treatment Quarterly , 34 (1), 116-123. Publisher's VersionAbstract

 

The language used to describe health conditions reflects and influences our attitudes and approaches to addressing them, even to the extent of suggesting that a health condition is a moral, social, or criminal issue. The language and terminology we use is particularly important when it comes to highly stigmatized and life-threatening conditions, such as those relating to alcohol and other drugs. Scientific research has demonstrated that, whether we are aware of it, the use of certain terms implicitly generates biases that can influence the formation and effectiveness of our social and public health policies in addressing them. Such research has made it difficult to trivialize or dismiss the terminology debate as merely “semantics” or a linguistic preference for “political correctness.” Furthermore, given that alcohol and other drug-related conditions are among the top public health concerns in the United States and in most English speaking countries globally (e.g., United Kingdom, Australia, Ireland), this is no trivial matter. In this article, the authors detail the conceptual and empirical basis for the need to avoid using certain terms and to reach consensus on an “addiction-ary.” The authors conclude that consistent use of agreed-upon terminology will aid precise and unambiguous clinical and scientific communication and help reduce stigmatizing and discriminatory public health and social policies.

 

Bergman, B. G., Kelly, J. F., Nargiso, J., & McKowen, J. (2016). “The age of feeling in-between”: Addressing challenges in the treatment of emerging adults with substance use disorders. Cognitive and Behavioral Practice , 23 (3), 270-288. Publisher's VersionAbstract

 

Substance use and substance-related disorders are among the most prodigious public health problems in the United States. Emerging adults (ages 18–25) appear to carry a disproportionately large share of this societal burden, as they are more than twice as likely as adolescents and older adults to be diagnosed with substance use disorders (SUDs), and comprise more than 20% of SUD treatment seekers. Described as the "age of feeling in-between," emerging adulthood is associated with a biopsychosocial profile distinct from both adolescence and older adulthood, making members of this age group unique and challenging clinical cases. Data suggest that although emerging adults can benefit from cognitive-behavioral (CB) and other psychosocial treatments for SUD, they are likely to have poorer treatment response than their younger and older counterparts. Therefore, we propose several theoretically and empirically-grounded treatment modifications for this vulnerable group, such as parent counseling (or "coaching") to facilitate better treatment engagement and benefit via contingency management. A case example is used to illustrate challenges typical in SUD treatment for emerging adults and how a CB practitioner might choose to modify his/her approach based on the proposed modifications. We also offer several recommendations for practitioners who wish to address their patients' SUD or harmful substance use when it is not the primary focus of treatment.

 

Beck, A. K., Baker, A., Kelly, P. J., Deane, F. P., Shakeshaft, A., Hunt, D., Forbes, E., et al. (2016). Protocol for a systematic review of evaluation research for adults who have participated in the 'SMART recovery' mutual support programme. BMJ Open , 6 (5).Abstract

 

Introduction: Self-Management and Recovery Training (SMART Recovery) offers an alternative to predominant 12-step approaches to mutual aid (eg, alcoholics anonymous). Although the principles (eg, self-efficacy) and therapeutic approaches (eg, motivational interviewing and cognitive behavioural therapy) of SMART Recovery are evidence based, further clarity regarding the direct evidence of its effectiveness as a mutual aid package is needed. Relative to methodologically rigorous reviews supporting the efficacy of 12-step approaches, to date, reviews of SMART Recovery have been descriptive. We aim to address this gap by providing a comprehensive overview of the evidence for SMART Recovery in adults with problematic alcohol, substance and/or behavioural addiction, including a commentary on outcomes assessed, potential mediators, feasibility (including economic outcomes) and a critical evaluation of the methods used.

 

Methods and analysis: Methods are informed by the Cochrane Guidelines for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. 6 electronic peer-reviewed and 4 grey literature databases have been identified. Preliminary searches have been conducted for SMART Recovery literature (liberal inclusion criteria, not restricted to randomised controlled trials (RCTs), qualitative-only designs excluded). Eligible ‘evaluation’ articles will be assessed against standardised criteria and checked by an independent assessor. The searches will be re-run just before final analyses and further studies retrieved for inclusion. A narrative synthesis of the findings will be reported, structured around intervention type and content, population characteristics, and outcomes. Where possible, ‘summary of findings’ tables will be generated for each comparison. When data are available, we will calculate a risk ratio and its 95% CI (dichotomous outcomes) and/or effect size according to Cohen's formula (continuous outcomes) for the primary outcome of each trial.

 

Hoeppner, B. B., Hoeppner, S. S., Seaboyer, L., Schick, M. R., Wu, G. W. Y., Bergman, B. G., & Kelly, J. F. (2016). How smart are smartphone apps for smoking cessation? A content analysis. Niccotine & Tobacco Research , 18 (5), 1025-1031. Publisher's VersionAbstract

 

Introduction: Smartphone technology is ideally suited to provide tailored smoking cessation support, yet it is unclear to what extent currently existing smartphone “apps” use tailoring, and if tailoring is related to app popularity and user-rated quality.

Methods: We conducted a content analysis of Android smoking cessation apps ( n = 225), downloaded between October 1, 2013 to May 31, 2014. We recorded app popularity (>10 000 downloads) and user-rated quality (number of stars) from Google Play, and coded the existence of tailoring features in the apps within the context of using the 5As (“ask,” “advise,” “assess,” “assist,” and “arrange follow-up”), as recommended by national clinical practice guidelines.

Results: Apps largely provided simplistic tools (eg, calculators, trackers), and used tailoring sparingly: on average, apps addressed 2.1±0.9 of the 5As and used tailoring for 0.7±0.9 of the 5As. Tailoring was positively related to app popularity and user-rated quality: apps that used two-way interactions (odds ratio [ OR ] = 5.56 [2.45–12.62]), proactive alerts ( OR = 3.80 [1.54–9.38]), responsiveness to quit status ( OR = 5.28 [2.18–12.79]), addressed more of the 5As ( OR = 1.53 [1.10–2.14]), used tailoring for more As ( OR = 1.67 [1.21–2.30]), and/or used more ways of tailoring 5As content ( OR = 1.35 [1.13–1.62]) were more likely to be frequently downloaded. Higher star ratings were associated with a higher number of 5As addressed ( b = 0.16 [0.03–0.30]), a higher number of 5As with any level of tailoring ( b = 0.14 [0.01–0.27]), and a higher number of ways of tailoring 5As content ( b = 0.08 [0.002–0.15]).

Conclusions: Publically available smartphone smoking cessation apps are not particularly “smart”: they commonly fall short of providing tailored feedback, despite users’ preference for these features.

 

Kelly, J. F., Greene, C. M., Bergman, B. G., Hoeppner, B. B., & Slaymaker, V. (2016). The Sponsor Alliance Inventory: Assessing the therapeutic bond between 12-step attendees and their sponsors. Alcohol and Alcoholism , 51 (1), 32-39. Publisher's VersionAbstract

 

AIMS: Within 12-step mutual-help organizations (MHOs), a sponsor plays a key recovery-specific role analogous to a 'lay therapist', serving as a role model, support and mentor. Research shows that attendees who have a sponsor have higher rates of abstinence and remission from substance use disorder (SUD), yet, while myriad formal psychotherapy studies demonstrate the therapeutic significance of the alliance between patients and professional clinicians on treatment outcomes, very little is known about the influence of the 'therapeutic alliance' between 12-step members and their sponsor. Greater knowledge about this key 12-step relationship could help explain greater degrees of 12-step effects. To bridge this gap, this study sought to develop and test a measure assessing the 12-step sponsee-sponsor therapeutic alliance--the Sponsor Alliance Inventory (SAI).

METHOD: Young adults (N = 302) enrolled in a prospective effectiveness study who reported having a 12-step sponsor during the study (N = 157) were assessed at treatment entry, and 3, 6 and 12 months later on the SAI, their 12-step MHO attendance, involvement and percent days abstinent (PDA).

RESULTS: Principal axis extraction revealed a single, 10-item, internally consistent (α's ≥ 0.95) scale that explained the majority of variance and was largely invariant to primary substance, gender and time. Criterion validity was also supported with higher SAI scores predicting greater proximal 12-step attendance, involvement and PDA.

CONCLUSION: The SAI may serve as a brief, valid measure to assess the degree of sponsee-sponsor 'therapeutic alliance' within 12-step communities and may help augment explanatory models estimating the effects of MHOs on recovery outcomes.

 

Kelly, J. F., Yeterian, J. D., Cristello, J. V., Kaminer, Y., Kahler, C. W., & Timko, C. (2016). Developing and testing twelve-step facilitation for adolescents with substance use disorder: Manual development and preliminary outcomes. Substance Abuse , 10, 55-64. Publisher's VersionAbstract

 

Adolescent substance use disorder treatment programs are often based on the 12-step philosophy of Alcoholics Anonymous and/or link adolescents to these free resources. Despite this, no studies have developed and rigorously tested a twelve-step facilitation (TSF) intervention for young people, leaving a significant evidence gap. This study describes the first systematic development of an outpatient adolescent TSF treatment. An integrated twelve-step facilitation (iTSF) treatment incorporated TSF, motivational enhancement therapy, and cognitive behavioral therapy elements and was developed in an iterative manner with weekly feedback provided by 36 adolescents (M age 17 years [SD = 1.4]; 52.8% white) with DSM-IV substance use disorder recruited from the community. Assessments were conducted at baseline and at three and six months. Participants completed 6 of 10 sessions on average (8 participants completed all 10). Notable treatment developments were the inclusion of "in-services" led by Marijuana Anonymous members, including parents in a portion of individual sessions to provide a rationale for TSF, and use of a Socratic therapeutic interaction style. Acceptability and feasibility of the treatment were excellent (treatment satisfaction was 4.29 [SD = 0.59] out of 5). In keeping with TSF theory, the intervention substantially increased 12-step participation, and greater participation related to greater abstinence. iTSF is a replicable manualized treatment that can be implemented and tested in outpatient settings. Given the widespread compatibility of iTSF with the current adolescent treatment, if found efficacious, iTSF could be relatively easily adopted, implemented, and sustained and could provide an evidence-based option that could undergird current practice.

 

Kelly, J. F., Greene, C. M., & Bergman, B. G. (2016). Recovery benefits of the "therapeutic alliance" among 12-step mutual-help organization attendees and their sponsors. Drug and Alcohol Dependence , 162, 64-71. Publisher's VersionAbstract

 

Background: The “therapeutic alliance” between clinicians and patients has been associated with treatment response and outcomes in professionally-delivered psychotherapies. Although 12-step mutual help organizations (MHOs), such as Alcoholics Anonymous, are the most commonly sought source of support for individuals with substance use disorder (SUD), little is known about whether a stronger alliance in comparable MHO relationships between 12-step sponsors and those they help (“sponsees”) confers benefits similar to those observed in professional contexts. Greater knowledge could inform clinical recommendations and enhance models that explain how individuals benefit from 12-step MHOs.

Method: Young adults (N = 302) enrolled in a prospective, clinical effectiveness study of residential SUD treatment were assessed at treatment entry, and 3, 6, and 12 months after discharge on whether they had a sponsor, contact with a sponsor, and degree of sponsor alliance. Hierarchical linear models (HLM) tested their effects on 12-step MHO attendance, involvement, and percent days abstinent (PDA).

Results: Approximately two-thirds of the sample (n = 208, 68.87%) reported having a sponsor at one or more follow-up time points. Both having sponsor contact and stronger sponsor alliance were significantly associated with greater 12-step participation and abstinence, on average, during follow-up. Interaction results revealed that more sponsor contact was associated with increasingly higher 12-step participation whereas stronger sponsor alliance was associated with increasingly greater abstinence.

Conclusions: Similar to the professional-clinical realm, the “therapeutic alliance” among sponsees and their sponsors predicts better substance use outcomes and may help augment explanatory models estimating effects of MHOs in SUD recovery.