Evaluating an alcohol and drug treatment program for the homeless: An econometric approach

Devine, Joel A.; Brody, Charles J.; Wright, James

doi:10.1016/s0149-7189(96)00054-7

Cited by 39 publications

(26 citation statements)

References 10 publications

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“…Many mutual aid groups follow some version of the 12-step model of recovery originally developed by the founders of Alcoholics Anonymous (AA) (Alcoholics Anonymous, 1939/2001/1952. Growing evidence indicates that 12-step groups are useful in maintaining abstinence from "substances of abuse" (e.g., Devine et al, 1997;Humphreys et al, 1994;Timko et al, 2000;Timko et al, 2006;Thurstin et al, 1987;Tonigan et al, 2002;;Humphreys and Moos, 2007;Kaskutas et al, 2005;Kelly et al, 2006;McCrady & Miller, 1993), especially for those who attend regularly or become affiliated (e.g., Fiorentine et al, 1999;Kingree, 1995;McKay et al, 1994;Montgomery et al, 1991;Watson et al, 1997). For example, Moos et al, (1999) found that increased attendance in 12-step groups was associated with a higher proportion of abstinence from drugs and alcohol, less severe distress and psychiatric symptoms, and a higher likelihood of being employed at one-year follow-up.…”

Section: Effectiveness Of Mutual Aidmentioning

confidence: 99%

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

Magura

2008

Substance Use & Misuse

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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.

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Section: Effectiveness Of Mutual Aidmentioning

confidence: 99%

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

Magura

2008

Substance Use & Misuse

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“…Cooccurring disorders (COD) are more severe and chronic than single disorders (2,3,4,5) and are highly predictive of poor treatment outcomes (6,7,8). Evidence indicates that 12-step groups, using the principles articulated by Alcoholics Anonymous [AA] (9), are useful in maintaining abstinence from substances of abuse (10,11,12,13,14) and in promoting recovery from mental illness (15,16,17,18,19,20). But historically, traditional "single focus" 12-step groups have been underutilized by individuals with co-occurring disorders (21,22,23,24).…”

Section: Introductionmentioning

confidence: 99%

Dual-Focus Mutual Aid for Co-Occurring Disorders: A Quasi-Experimental Outcome Evaluation Study

Magura

Rosenblum

Villano

et al. 2008

The American Journal of Drug and Alcohol Abuse

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Previous observational research has indicated the effectiveness of a 12-step, dual-focus mutual aid group, Double Trouble in Recovery (DTR), for assisting individuals to recover from co-occurring substance use and psychiatric disorders. The current study extends this line of research by evaluating DTR with a quasi-experimental design; controlled designs are rare in studies of mutual aid. Patient outcomes in the same psychiatric day treatment program were compared for two consecutive admission cohorts characterized by high rates of co-occurring disorders. The first cohort did not have DTR available while the second cohort was exposed to DTR after it was established at the program. Both cohorts were assessed at program admission and at a six month follow-up. Using intent to treat analysis, the Post-DTR cohort as compared with the Pre-DTR cohort had significantly fewer days of alcohol and drug use, more frequent traditional 12-step groups outside of the program and higher psychiatric medication adherence. There were no differences in psychiatric symptoms or program retention, however. This study helps demonstrate the benefits of introducing 12-step, dual-focus mutual aid into psychiatric treatment programs that serve patients with co-occurring disorders.

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“…Self-help groups, often based on the 12-step philosophy, have played an important role in furthering the recovery of persons who have addictive disorders as well as persons with mental illness (16)(17)(18)(19)(20)(21)(22). However, some members of 12-step groups who have dual diagnoses report receiving misguided advice about psychiatric illness and the use of psychiatric medications, which are seen as "drugs" (23), although this is not the official view of Alcoholics Anonymous or Narcotics Anonymous (24,25).…”

mentioning

confidence: 99%

Adherence to Medication Regimens and Participation in Dual-Focus Self-Help Groups

Magura¹,

Laudet²,

Mahmood³

et al. 2002

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Objective-The authors examined the associations between attendance at self-help meetings, adherence to psychiatric medication regimens, and mental health outcomes among members of a 12-step self-help organization specifically designed for persons with both chronic mental illness and a substance use disorder.Methods-A sample of members of Double Trouble in Recovery (DTR) was interviewed at baseline and one year later. Correlates of adherence to psychiatric medication regimens at the followup interview were identified for 240 attendees who had received a prescription for a psychiatric medication.Results-Consistent attendance at DTR meetings was associated with better adherence to medication regimens after baseline variables that were independently associated with adherence were controlled for. Three baseline variables were associated with adherence: living in supported housing, having fewer stressful life events, and having a lower severity of psychiatric symptoms. In addition, better adherence was associated with a lower severity of symptoms at one year and no psychiatric hospitalization during the follow-up period.Conclusions-Treatment programs and clinicians should encourage patients who have both mental illness and a substance use disorder to participate in dual-focus self-help groups that encourage the responsible use of effective psychiatric medication, particularly after discharge to community living. Clinicians also should be sensitive to stressful life events and discuss with patients how such events might affect their motivation or ability to continue taking medication.Poor adherence to psychiatric medication regimens is a major obstacle to the effective care of persons who have chronic mental illness. A recent review reported that patients who were receiving antipsychotics or antidepressants took an average of 58 percent and 65 percent,

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Evaluating an alcohol and drug treatment program for the homeless: An econometric approach

Cited by 39 publications

References 10 publications

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

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

Dual-Focus Mutual Aid for Co-Occurring Disorders: A Quasi-Experimental Outcome Evaluation Study

Adherence to Medication Regimens and Participation in Dual-Focus Self-Help Groups

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