Comparing Treatments for Dual Diagnosis: Twelve-Step and Self-Management and Recovery Training

Abstract

The purpose of this study was to compare the effectiveness of 12-step and cognitive-behavioral (Self-Management and Recovery Training [SMART]) approaches for persons with a dual diagnosis of serious mental illness and substance use disorder in an intensive outpatient/partial hospitalization setting. Participants (n = 112) were alternately assigned to the two treatment conditions, with 50 participants completing the 6-month treatment program. Assessments occurred at baseline, 3 months, and 6 months during treatment, and at 3- and 12-month follow-ups. Analyses were conducted on participants who had completed 3 months of treatment (n = 70). The 12-step intervention was more effective in decreasing alcohol use and increasing social interactions. However, a worsening of medical problems, health status, employment status, and psychiatric hospitalization were associated with the 12-step intervention. SMART was more effective in improving health and employment status, but marijuana use was greater for SMART participants. Improvements in alcohol use and life satisfaction occurred in both approaches. Covariates associated with treatment outcome were identified, with greater attendance being positively related to outcome. Involvement with the criminal justice system was positively related to treatment completion but negatively associated with medical problems. Less alcohol use, fewer medical problems, and better financial well-being at baseline were associated with better attendance.

Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness

“…Our findings regarding the absence of effects of substance abuse/dependence on vocational outcomes were not surprising, given that prior studies of individuals receiving return-to-work services reached similar conclusions [16][17][18][19]. In a logistic regression analysis of data from 275 individuals with psychiatric disabilities in three vocational rehabilitation programs, Rogers et al found that current substance abuse did not predict employment status at 3, 6, or 12 months after program entry [19].…”

“…However, findings are also inconsistent regarding the relationship of substance use to employment outcomes in this population [11][12]. While some studies suggest that substance use has deleterious effects on employment outcomes [13][14][15], others have found that clients with this comorbidity do as well as or better in vocational programs than those without comorbidity [16][17][18][19].…”

Theory-based active ingredients of effective treatments for substance use disorders

“…Moreover, 12-step-oriented drug counseling appears to be as effective as cognitive therapy and supportive expressive therapy in reducing cocaine use (Crits-Cristoph et al, 1999). In addition, TSF and 12-step recovery support do as well in preventing patients' relapse to alcohol and drug use as does CB relapse prevention (Brooks and Penn, 2003;Brown et al, 2002;Wells et al, 1994). …”

Effectiveness of Dual Focus Mutual Aid for Co-Occurring Substance Use and Mental Health Disorders: A Review and Synthesis of the “Double Trouble” in Recovery Evaluation

“…Although specialized 12 step facilitation (TSF) models for persons with co-occurring disorders have been developed and are valuable (Bogenschutz, 2005;Brooks and Penn, 2003), these are professionally-led therapies designed to prepare patients for peer-led dual focus 12 step groups. The research summarized in this paper is the first study of the effectiveness of participation in a specialized dual focus 12 step fellowship, including an examination of the mechanisms of attitudinal and behavioral change in such groups.…”