The Role of Twelve‐Step Approaches in Dual Diagnosis Treatment and Recovery

Abstract

The authors reviewed the empirical literature concerning the use of twelve-step programs and treatments by patients with co-occurring substance use disorders and other psychiatric disorders. Strong evidence was found that dually diagnosed individuals (DDI), with the possible exception of those with psychotic disorders, attend twelve-step programs at rates comparable to non-DDI. Twelve-step involvement is consistently associated with improved substance use outcomes. Although there have been numerous clinical trials involving twelve step-oriented interventions for DDI, most of the studies suffered from substantial methodological limitations. More work is needed to determine what kinds of twelve-step treatments and programs are effective for various types of patients and elucidate the mechanisms by which these approaches facilitate recovery.

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

“…The above literature indicates that, although traditional 12 step attendance rates are sometimes similar for persons with co-occurring and substance abuse disorders only, the benefits of such participation tend to be less for the former, and problems remain with their being fully accepted and involved in traditional 12 step groups The documented lower participation of persons with schizophrenia and schizoaffective disorder, who are a substantial proportion of the SMI, is especially noteworthy (Bogenschutz et al, 2006;Jordan et al, 2002;). Thus, some of the inconsistency among studies may be attributable to differences in diagnoses and/or severity of psychiatric disorders.…”

Recovery From Comorbidity

“…An avenue for exploration is comparing 12-step-and other peer-based approaches (Bogenschutz et al, 2006). One notable study found little difference in directly comparing the 12-step approach with the secular Self-ManagementAnd-Recovery-Training (SMART) in comorbidity recovery (Brooks & Penn, 2003).…”

“…Persons with comorbidity are less likely to participate in 12-step-based peer-support programs (Powel & Kurtz, 1996).Complex social networks in recovery are poorly understood and peer support is highly valued by consumers, providing "insights that may not be available to professionals" (Lawrence-Jones, 2010, p. 124). There has been some exploration of (and support for) the helper-role and reciprocal-learning process as being key elements of successful recovery (Bogenschutz, Geppert, & George, 2006).…”

“…Relevant research in comorbidity is limited in quantity, external validity, and methodological clarity and conflicting in outcomes for and inclusiveness of people with comorbidity (Bogenschutz et al, 2006;Chappel & DuPont, 1999;Powel & Kurtz, 1996;Ward, 2011). …”

Dual Diagnosis, Mutual-Help Use, and Outcomes: A Naturalistic Follow-Up

“…Research shows that mutual-help groups are beneficial to individuals with dual diagnoses (Bogenschutz, Geppert, & George, 2006;Magura et al, 2003;Moos, Schaefer, Andrassy, & Moos, 2001). For example, attending more mutual-help group meetings is associated with higher rates of abstinence and remission from drugs and alcohol (Gossup, Stewart, & Marsen, 2008;Weiss et al, 2005).…”