Kelly, J. F., Worley, M. J., & Yeterian, J. (2019). Twelve-Step Approaches. In S. A. Brown & R. Zucker (Ed.), The Oxford Handbook of Adolescent Substance Abuse (pp. 731-748) . Oxford University Press.Abstract
Twelve-step approaches to addressing substance use disorder (SUD) are unique in the treatment field in that they encompass professionally led, as well as peer-led, intervention methods. Also, in contrast to most professional treatments that have emerged from scientific theories and empirical data (e.g., cognitive-behavioral treatments), 12-step approaches have been derived, in large part, from the collective addiction and recovery experiences of laymen. Despite this, 12-step approaches have become influential in tackling SUD, with research demonstrating the clinical utility of employing such approaches among adults, and increasingly, among youth. Findings among adolescent samples indicate community 12-step mutual-help organizations, in particular, may provide a beneficial recovery-supportive social context during a life stage where such support is rare.
INTRODUCTION: Smoking cessation interventions for nondaily smokers are needed. The current study explores the fit of the text-messaging intervention SmokefreeTXT for nondaily smokers.
METHODS: Adult nondaily smokers (N = 32; mean age = 35 ± 12, 64% female, 53% non-Hispanic White) were enrolled in SmokefreeTXT. SmokefreeTXT usage data were recorded passively, theorized mechanisms of change were assessed at baseline and 2, 6, and 12 weeks after the chosen quit day, and EMA protocols captured real-time cigarette reports at baseline, and during the first two weeks after the quit day.
RESULTS: Most participants completed the SmokefreeTXT program and responded to system-initiated inquiries, but just-in-time interaction with the program was limited. In retrospective recall at treatment end, content of the text-messages was rated as "neutral" to "helpful." Within-person change was observed in theorized mechanisms, with less craving (p < 0.01), increased abstinence self-efficacy (external: p < 0.01; internal: p < 0.01), and poorer perceptions of pros of smoking (psychoactive benefits: p < 0.01, pleasure p < 0.01; and pros: p < 0.01) reported after SmokefreeTXT initiation compared to baseline. Exploratory analyses of real-time reports of smoking (225 cigarette reports in N = 17 who relapsed) indicated that cigarettes smoked in the first two weeks after quitting were more likely to occur to reduce craving (OR = 2.21[1.21-3.72]), and less likely to occur to socialize (OR = 0.06[0.01-0.24]), between 19:00 and 23:00 (OR = 0.34[0.17-0.66]), and on Saturdays (OR = 0.59[0.35-0.99]) than prior to quitting.
CONCLUSIONS: While well accepted by nondaily smokers, SmokefreeTXT could potentially be improved by targeting cons of smoking, enhancing engagement with the just-in-time component of SmokefreeTXT, and tweaking the timing of text-messages.
KEYWORDS: Smoking cessation; mHealth; mechanisms of change; mobile health; text-messaging
BACKGROUND: Due to shame and fear of discrimination, individuals in, or seeking, recovery from alcohol and other drug (AOD) problems often struggle with whether, when, and to whom to disclose information regarding their AOD histories and recovery status. This can serve as a barrier to obtaining needed recovery support. Consequently, disclosure may have important implications for recovery trajectories, yet is poorly understood.
DESIGN AND SAMPLE: Cross-sectional, U.S. nationally-representative survey conducted in 2016 among individuals with resolved AOD problems (N = 1987) investigated disclosure comfort and whether disclosure comfort differed by time since problem resolution, disclosure recipient (i.e., with interpersonal intimacy), or primary substance (i.e., alcohol [51%], cannabis [11%], opioids [5%], or "other" [33%]). Predictors of disclosure comfort were also examined. Data were analyzed using LOWESS analyses, analyses of variance, and regression.
RESULTS: Overall, longer time since problem resolution was associated with greater disclosure comfort. In general, participants reported greater comfort with disclosure to family and friends, and less comfort with disclosure to co-workers, to first-time acquaintances, in public settings, and in the media, but these effects varied by primary drug with participants who had problems with alcohol and "other" drugs having significantly more disclosure comfort than those who had problems with opioids.
CONCLUSION: Dimensions of time since AOD problem resolution, interpersonal intimacy, and primary drug are significantly associated with disclosure comfort. Individuals seeking recovery may benefit from more formal coaching around disclosure, particularly those with primary opioid problems, but further research is needed to determine the desire for and effects of such coaching among those seeking recovery.
KEYWORDS: Disclosure; Recovery; Remission; Substance use disorder
BACKGROUND: The meaning of unconscious dreaming has been assigned varying degrees of historical significance throughout the ages and across different cultures including in major psychological theories of psychopathology. While dreams' meaning and implications have remained controversial, not disputed is the occurrence of drinking/drug-using dreams (DDUD) when people enter recovery from a significant alcohol and other drug (AOD) problem. Typically taking the form of a relapse scenario followed by relief on awakening, such dreams can be profoundly unnerving. Beyond common anecdotal reports of these phenomena, however, very little is known about the prevalence, predictors, and decay of such dreams with time in recovery. Greater knowledge could help inform patients and providers about what to anticipate in recovery.
METHOD: Nationally-representative cross-sectional study of US adults (N = 39,093) who had resolved a significant AOD problem (weighted n = 2002).
MEASURES: DDUD prevalence/time since last DDUD; demographics; measures of clinical history.
RESULTS: Approximately one third (31.9%) reported experiencing DDUD which were predicted by more severe clinical history variables (earlier age of onset; prior treatment/mutual-help participation). A significant linear decay of DDUD occurrence was observed with time in recovery.
CONCLUSIONS: DDUD appear to occur among a substantial minority of US adults resolving significant AOD problems and are related to a more pronounced and deleterious AOD history. DDUD attenuate in frequency over time in recovery which plausibly may be indicative of increased biopsychosocial stability that reduces neurocognitive reverberation and psychological angst regarding relapse risk. Further prospective research is needed to understand the frequency, topography, content variability, and influence such dreams may have on intermediate (e.g., abstinence self-efficacy) and ultimate (substance use) outcomes.
When the President's Commission on Combating the Opioid Crisis declares “addiction [a] chronic relapsing disease of the brain”1 and calls for expanded access to care, within those statements is recognition of the influx of patients with addiction into general medicine settings for chronic disease management. The initial conversations that can shape a patient's understanding of addiction will occur more and more within primary care offices or at the bedside in the general medicine wards. The stakes are high: how patients understand their addiction may shape their health behaviors, relationship with their care team, and willingness to accept treatment.
A major emphasis in addiction treatment is to implement interventions that improve patients' outcomes and quality of life. Despite this worthy goal, the field has been beset by numerous challenges: immense variation in the uptake and implementation of evidence-based practices; large variability in quality care—even when evidence-based practices are adopted; and inadequate demonstration of improved patient outcomes when programs actually do deliver evidence-based practices with high fidelity. Together with the overselling of addiction treatment effectiveness by some sectors of the treatment field, these observations have led to calls for much greater accountability, including a move toward systematic measuring and reporting of patients' treatment outcomes or measurement-based practice (MBP). This chapter describes the rationale and preliminary evidence for MBP and discusses the clinical and public health implications for its widespread adoption and implementation across the addiction treatment field.