Double trouble in recovery: Self-help for people with dual diagnoses.

2008

Substance Use & Misuse

Self Cite

Over five million adults in the U.S. have a co-occurring substance use disorder and serious psychological distress. Mutual aid ("self-help") can usefully complement treatment, but people with co-occurring substance use and psychiatric disorders often encounter a lack of empathy and acceptance in traditional mutual aid groups. Double Trouble in Recovery (DTR) is a dual focus fellowship whose mission is to bring the benefits of mutual aid to persons recovering from cooccurring disorders. An evaluation of DTR was conducted by interviewing 310 persons attending 24 DTR meetings in New York City in 1998 and following them up for two years, in 1999 and 2000. The evaluation produced 13 articles in 12 peer reviewed journals, the main results of which are summarized here. The sample's characteristics were: mean age, 40 years; women, 28%; black, 59%; white, 25%; Hispanic, 14%; never married, 63%; live in supported community residence, 53%; high school graduate or GED, 60%; arrested as adult, 63%; diagnoses of: schizophrenia, 39%; major depression, 21%; or bipolar disorder; 20%; currently prescribed psychiatric medication, 92%; primary substance used, current or past: cocaine/crack, 42%; alcohol 34%; or heroin, 11%. Overall, the findings indicate that DTR participation has both direct and indirect effects on several important components of recovery: drug/alcohol abstinence, psychiatric medication adherence, self-efficacy for recovery, and quality of life. The study also identified several "common" therapeutic factors (e.g., internal motivation, social support) and unique mutual aid processes (helper-therapy, reciprocal learning) that mediate the influence of DTR participation on recovery. For clinicians, these results underline the importance of fostering stable affiliation with specialized dual focus 12-step groups for their patients with co-occurring disorders, as part of a comprehensive recovery-oriented treatment approach.

Section: "Traditional" Mutual Aid and Dually Diagnosed Personsmentioning

confidence: 99%

Section: "Traditional" Mutual Aid and Dually Diagnosed Personsmentioning

confidence: 99%

Section: Description Of Double Trouble In Recoverymentioning

confidence: 99%

See 1 more Smart Citation

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

2008

Substance Use & Misuse

Self Cite

“…DTR adapts the original 12 Steps of A.A. to dual diagnosis in Step One ("We admitted we were powerless over our mental disorders and substance abuse and that lives had become unmanageable") and in Step Twelve ("Having had a spiritual awakening as a result of these steps, we tried to carry this message to other dually-diagnosed people and to practice these principles in all our affairs"). DTR emphasizes active personalized outreach to severely affected people with co-morbid disorders in settings (e.g., institutions, day treatment) where they ordinarily lack opportunities to participate in consumer-led mutual aid groups that are non-judgmental about medication issues (www.doubletroubleinrecovery.org; Vogel et al, 1998). DTR has been studied through unique community-based participatory research, consisting of a team co-led by both researchers and consumers with dual diagnoses.…”

Section: Introductionmentioning

confidence: 99%

Effects of “Dual Focus” Mutual Aid on Self-Efficacy for Recovery and Quality of Life

Cleland

Vogel³

et al. 2006

Adm Policy Ment Health

Self Cite

Four million adults in the U.S. have co-occurring serious mental illness and a substance use disorder. Mutual aid can usefully complement treatment, but people with co-occurring disorders often encounter a lack of empathy and acceptance in traditional mutual aid groups. Double Trouble in Recovery (DTR) is a dual focus fellowship whose mission is to bring the benefits of mutual aid to persons with dual diagnoses. Three hundred and ten persons attending 24 DTR groups in New York City during 1998 were interviewed and followed-up for two years. A mediational model was specified and results across time were summarized with generalized estimating equations (GEE). Degree of DTR affiliation (attendance and involvement) was significantly associated with Self-efficacy for Recovery and three quality of life measures: Leisure Time Activities, Feelings of Well-Being and Social Relationships. Self-efficacy fully mediated the effects of DTR Affiliation on Leisure Time and Feelings and partially mediated DTR's effect on Social Relationships. The association of DTR involvement with self-efficacy is consistent with the processes inherent in mutual aid, although the observational nature of these data preclude causal inference. To improve outcomes, clinicians should facilitate affiliation with dual focus groups among persons with dual diagnoses as part of a comprehensive treatment approach.

“…The DTR group is a dual-focus self-help program adapted from the 12-step program [see (58)]. Members were recruited at 25 meeting sites throughout New York City.…”

Section: Setting and Samplementioning

confidence: 99%

Interest in and Obstacles to Pursuing Work Among Unemployed Dually Diagnosed Individuals

Laudet

Vogel

et al. 2002

Substance Use & Misuse

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Employment status is commonly used as a sign of stability in recovery and an outcome variable for substance abuse treatment and research. However, there has been little attention in the literature on the topic of work for the dually diagnosed (i.e., persons diagnosed with both substance use and mental health disorders). Data collected in 1999 are presented on expressed interest in and perceived barriers to pursuing work and on the utilization of vocational rehabilitation (voc-rehab) services among unemployed members of a dual recovery self-help fellowship (N = 130). While members generally expressed high interest in working, they also cited multiple obstacles to attaining and maintaining employment. A path model was specified and tested. Significant contributors to interest in working were substance use status and physical health rating. Consistent with our hypotheses, mental health symptoms and greater perceived obstacles (e.g., stigma, fear of failure, and insufficient skills) were significant contributors to perceived difficulty in pursuing work, whereas substance use, physical health, and recency of employment were not. Finally, those who perceived less difficulty in pursuing work were more likely to utilize voc-rehab services, and men were more likely than women to use these facilities; interest in work was not significantly associated with utilizing voc-rehab services. The roles of mental health disorders and substance use in relation to pursuit of employment are discussed, as well as that of perceived obstacles such as stigma. The paper addresses the setting of realistic vocational goals and possible strategies to mitigate barriers to increased employment of dually diagnosed individuals.