A qualitative longitudinal study of the first UK Dual Diagnosis Anonymous (DDA), an integrated peer-support programme for concurrent disorders

Abstract

Purpose Dual Diagnosis Anonymous (DDA) is a peer-led programme developed in the USA, which aims to address mental and addictive disorders in an integrated manner. This study is part of a mixed-methods evaluation of the first DDA pilot in the UK, and the purpose of this study is to explore the impact and mechanism of change of the programme through the perspective of DDA attendees, facilitators and the funding commissioners. Design/methodology/approach Six DDA members were interviewed three times over a period of 12 months, the facilitators were interviewed twice and the commissioner was interviewed once. The qualitative longitudinal data were analysed using a trajectory thematic analysis. Findings DDA attendance was perceived to have had a positive impact on five main areas: acceptance of self, of others and from others; social functioning; self-development; recovery progression; and feeling of hope. The possibility of addressing both mental health and addiction at the same time was a key factor in the recovery process. The facilitators observed that DDA had contributed to integrate members into employment and education, while the commissioner stressed the importance of joint commissioning and sustainability. Originality/value The longitudinal approach provided a unique insight into the recovery process of DDA members. Being able to address the mental health as well as the substance use problems was considered to be a fundamental strength of DDA in comparison to the single purpose peer-support fellowships.

Dual Diagnosis Anonymous (DDA) and the Transition to Online Support During COVID-19

“…Previous research found that sense of belongingness predicts attendance and success within 12-step programs (Rice et al, 2012), while "uniqueness" shares operational features with group acceptance, which is considered an important factor for recovery in peer support programs (Repper et al, 2011). Lastly, in a previous study, DDA members reported that acceptance, social identification, and social interaction-which can be conceptualized as uniqueness, belongingness, and inclusion-were key features of the program, and facilitated their recovery (Milani et al, 2020).…”

“…Research suggests peer support groups rely on social ties to aid in recovery from alcohol and substance misuse (Dingle et al, 2019). The process of identification has been found to promote sustained recovery, including within mutual aid groups (Buckingham et al, 2013;Roush et al 2015;Milani et al 2020). As such, the researchers were interested in examining the social ties present within DDA through the lens of inclusion.…”

“…Notably, when asked to report potential benefits to being in lockdown the primary advantage was attendance of online meetings. In fact, a previous study about DDA (Milani et al, 2020) found that the program was instrumental in helping members break out from isolation and introduce a routine in their lives. Therefore, the present study suggests that moving to online meetings did not affect these two functions of the DDA program.…”

“…In the treatment of comorbid disorders, there is increasing evidence that integrated care consistently produces the most favorable outcomes (Drake et al, 2007;Fantuzzi & Mezzina, 2020), however, the current standard of mental health care emphasizes "primary need first" and individuals are often denied psychiatric care until their substance misuse is resolved (Ducharme et al, 2007). Additionally, mutual aid programs aimed at the treatment of AUD and SUD discourage the discussion of mental illness or psychotropic medication-preventing people with dual diagnosis from fully receiving the benefits of the identification process (Roush et al 2015;Milani et al 2020). As such, vulnerable individuals suffering from dual diagnosis are often left unsupported and isolated (Public Health England, 2017).…”

What kind of science for dual diagnosis? A pragmatic examination of the enactive approach to psychiatry

“…The same goes for psychosocial interventions and the theories that come with it. In an ontological sense, both substance use and mental disorders are phenomena of such richness that they can be engaged with (potentially effectively) in various ways - through biological intervention, through psychotherapies, through environmental interventions, through social networks as Marijuana Anonymous, Dual Diagnosis Anonymous ( Milani et al, 2020 ) and through policy changes, etc.…”