12-step Meetings Research Articles

The Impact of the COVID-19 Pandemic on Recovery From Substance Use Disorder: Findings From a Qualitative Study.

This study considers how the COVID-19 pandemic impacted individuals recovering from a substance use disorder (SUD). Fifty individuals recovering from SUD in Vermont, a rural New England state (U.S.), were recruited for an interview from 12-step recovery meetings (Alcoholics Anonymous, Narcotics Anonymous) as well as via word-of-mouth. Interviews were transcribed and coded, and qualitative analyses were performed. Many of the participants who were in recovery prior to the pandemic starting remained substance-free and in recovery throughout the pandemic period. Some individuals used substances during the pandemic period, although not typically in the context of a relapse caused by negative emotions (eg, distress over a loved one contracting COVID-19). The majority of those individuals indicated that the risk of catching COVID-19 did not alter their substance use. Many individuals already in SUD recovery before COVID-19 remained in recovery despite the challenges of pandemic era. The role of peer support in recovering individuals managing negative emotions caused by COVID-19 is considered.

Giving and Receiving Help Among Persons Entering Sober Living Houses

ABSTRACT Giving and receiving help are integral to creating the social environments necessary to support recovery. However, studies assessing the effects of helping behaviors have focused primarily on the benefits derived from giving help to others in 12-step programs and treatment. The current study examined the frequency of giving and receiving help among 188 persons entering sober living houses (SLHs), a type of recovery home that is common in California. Helping was assessed in three contexts: the SLH, 12-step meetings they attended, and interactions with their family and friends. Residents who gave help to others in one of these contexts tended to also receive help in that context. Residents who reported giving or receiving help in one context tended to report giving and receiving help in other contexts. Study findings suggest helping in recovery occurs in a broader, more reciprocal manner than currently conceptualized. Studies should address how giving and receiving help in different contexts affects recovery outcomes. Research is also needed to describe the determinants of giving and receiving help. Considerations for facilitating help among SLH residents are described.

Recovering Individuals' Feelings About Addict and Alcoholic as Stigmatized Terms: Implications for Treatment.

The current emphasis among addiction treatment providers is to use person-first language, such as "a person with a substance use disorder," as a way to reduce stigma around addiction and resulting barriers to treatment. This study considers how individuals recovering from substance use feel about the terms "alcoholic" and "addict," particularly how they self-identify and whether they believe the terms carry stigma. Thirty-five individuals were interviewed, recruited primarily, but not exclusively, from 12-step meetings (Alcoholics Anonymous, Narcotics Anonymous), from 3 locations throughout a rural New England state. Interviews were transcribed and coded in Atlas Ti qualitative analysis software, and a content analysis of text coded with "stigma" was conducted. Some comments reflected a belief that the terms "addict" and "alcoholic" carry a stigma. However, more comments rejected the notion of these being stigmatized terms; or acknowledged the stigma but reflected the subject's lack of internalizing of any stigma. Comments reflected other themes including a sense of pride, identity and ownership when self-identifying as an addict or alcoholic. Several comments suggested that person-first language is part of a larger movement to "soften everything," without changing the underlying condition (addiction). The findings may reflect the fact that subjects were recruited from 12-step programs, where the convention is to self-identity using the terms "alcoholic" and/or "addict." Some individuals seeking treatment for addiction may prefer self-identifying using old-school terminology (addict, alcoholic) rather than person-first language, for a variety of reasons (eg, they do not internalize the stigma of such terms).

The Experiences of 12-Step Program Attendees Transitioning to Online Meetings during the COVID-19 Pandemic

ABSTRACT When the COVID-19 pandemic began, many 12-step meetings rapidly transitioned from an in-person to an online format. In this qualitative focus group study, 17 attendees of 12-step programs from six U.S. states participated in one of two focus groups on Zoom platform in August 2021 in which their experiences of attending online versus in-person meetings were explored. Respondents praised the accessibility and convenience of online meetings, and the ability to interact with members from different geographic locations. However, they noted the loss of intensive social support found at in-person meetings and technological/procedural challenges that remain unsolved online.

Exploring the impact of COVID-19 on older adults in 12-step programs

ABSTRACT The purpose of this study was to understand how older adults in recovery from substance use disorders experienced the transition from in-person to virtual 12-step meetings. We interviewed 11 older adults (age 50+) who self-identified as being members of 12-step programs. Participants completed an online survey including standardized measures assessing depression, anxiety, social isolation, and quality of life. Three themes emerged from interviews: Importance of the program; Promises and Limits of Technology; and Concern for Others. Participants’ high level of commitment to their groups enabled them to adapt quickly to virtual meetings. Participants described their concerns about members of their groups who were unable to make this transition. Older adults in this study adapted quickly to virtual recovery groups. The social support participants received during groups, whether virtual or in person, may have acted as a buffer protecting them from the isolative effects of the pandemic.

Post–residential treatment outpatient care preferences: Perspectives of youth with opioid use disorder

IntroductionWe know little about what youth with opioid use disorders (OUD) think about outpatient substance use treatment and 12-step meetings following discharge from residential substance use treatment. This study explores youths' preferences between intensive outpatient treatment (IOP) and community-based 12-step groups. MethodThe study recruited youth (n = 35) from a larger randomized trial (N = 288) that examined the effectiveness of extended-release naltrexone versus treatment-as-usual. This study asked the youth to participate in semi-structured qualitative interviews at baseline, 3 months, and 6 months post-residential treatment discharge. Qualitative interviews probed youths' key decision points during the six-months following residential treatment for OUD, including medication and counseling, and 12-step continuation in the community. ResultsQualitative analyses revealed three overarching themes related to youths' preferences for either IOP or 12-step meetings: structure of recovery support, mechanisms of accountability, and relationships. ConclusionDespite varying preferences, this analysis highlights the complexity of benefits that youth report receiving from each approach. Research has yet to determine the degree to which these approaches are complementary or supplementary for this population.

Feeling Supported in Addiction Recovery: Comparing Face-to-Face and Videoconferencing 12-Step Meetings

We surveyed ninety-seven 12-step community members from IntheRooms.com – a recovery social networking site – to investigate the relationship between 12-step meeting format (face-to-face or videoconferencing) and members’ perceptions of meeting effectiveness, social support quality, recovery network quality, and meeting accessibility. Findings suggest 12-step members perceive more challenges than advantages to be associated with VC 12-step meetings. Moreover, FtF 12-step meetings are associated with significantly higher perceptions of (a) meeting effectiveness, (b) support quality, and (c) recovery network quality, yet not perceived as (d) more accessible than VC meetings. Our findings suggest that VC is a valuable supplemental tool for 12-step group communication, but it should not replace FtF meetings—which are more productive in facilitating the achievement of 12-step groups’ health goals.

In their own words: language preferences of individuals who use heroin.

Use of non-judgmental, respectful and uniform language to describe individuals with substance use disorders (SUD) is recommended to reduce stigma. However, existing research concerning the use of labels for substance use has largely focused on perspectives of treatment providers and the general public, and to a lesser degree of those in long-term recovery. This study aimed to examine and compare labels that individuals who use heroin and are initiating SUD treatment (1) use to describe themselves and when speaking with others who use drugs, with family and with treatment providers, and (2) prefer to be called and never want to be called. Design and Setting This was a cross-sectional survey study using a convenience sample of individuals initiating an in-patient managed withdrawal program in Massachusetts, USA. Between October 2017 and May 2018, 263 participants were enrolled. Participants completed a survey about (1) what labels they used to refer to self and when talking with others who use drugs, with providers, families and at 12-Step meetings and (2) to identify which label they preferred least and most for others to use when referring to them. More than 70% of participants used the term 'addict' to describe themselves and when speaking with others. However, use of 'addict' varied by context, and was most common at 12-Step programs. Fewer than 15% reported using 'user' or slang terms, most commonly 'junkie', in any communications. The most-preferred label for others to call them was 'person who uses drugs', while the most common label that participants never wanted to be called was 'heroin misuser' or 'heroin-dependent'. Label preferences by individuals who use heroin and are in early recovery are consistent with general guidelines about use of first-person language and suggest avoidance of language indicative of drug misuse or dependence.

Smartphone Apps Targeting Alcohol and Illicit Substance Use: Systematic Search in in Commercial App Stores and Critical Content Analysis.

BackgroundSmartphone apps promise to enhance the reach of evidence-based interventions (cognitive behavior therapy, contingency management and therapeutic education system) for populations with substance use disorders, with minimal disruption to health systems. However, further studies are needed to systematically evaluate smartphone apps targeting alcohol and illicit substances.ObjectiveThe aim of this study was to evaluate the functionality, aesthetics, and quality of information of free or low-cost apps claiming to target alcohol, benzodiazepine, cocaine, crack/cocaine, crystal methamphetamine, and heroin use using the validated Mobile App Rating Scale (MARS) and critical content analysis.MethodsA systematic search of iTunes and Google Play app stores for free or low-cost apps facilitating recovery was conducted in March 2018 and yielded 904 apps using the keywords described in previous studies (eg, recovery, sobriety, sober, alcohol, and heroin). An interdisciplinary team of clinicians, behavioral informatics, and public health reviewers trained in substance use disorders conducted a descriptive analysis of 74 apps categorized as reducing use. In addition to the MARS scale, a descriptive analysis of relevant apps was conducted by the study team to assess for quality indicators emphasized by expert guidelines and review articles.ResultsMost apps (n=74) claimed to reduce use or promote abstinence and yielded an overall low median MARS score of 2.82 (0.55) and a wide range of scores (1.64, 4.20). Ratings were also low for engagement (2.75 (0.72)), functionality (3.64 (0.78)), aesthetics (3.03 (0.87)), information (2.82 (0.62)), and satisfaction (1.76 (0.67)) subdomains. Innovative design and content features elicited in the review included initial assessments of substance use following app download, tracking substance use, and related consequences (eg, cost or calorie intake), remote and proximate peer support per geospatial positioning, and allowing users and family members of individuals with substance use disorders to locate 12-step meetings, treatment programs, and mental health services. Few apps integrated evidence-based psychotherapeutic (eg, cognitive behavioral therapy [CBT] or motivational interviewing) and pharmacologic interventions (eg, naloxone or buprenorphine).ConclusionsFew commercially available apps yielded in our search integrated evidence-based interventions (eg, extended-release naltrexone, buprenorphine, naloxone, Self-Management and Recovery Training recovery, or CBT), and a concerning number of apps promoted harmful drinking and illicit substance use.

Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders

Background Psychiatry inpatients frequently have co-occurring substance use and mental health disorders, which are related to poor post-discharge outcomes. Telephone monitoring is effective in specialty substance use disorder treatment settings in increasing continuing care and 12-step program utilization and improving substance use outcomes. This study examined the effectiveness of telephone monitoring among psychiatry inpatients with co-occurring substance use and mental health disorders.Methods This randomized controlled trial (n = 406) compared usual care to usual care plus telephone monitoring (one in-person session during the inpatient stay, followed by weekly telephone contact for three months post-discharge). Follow-ups were conducted at end-of-intervention (three months post-baseline) and nine and 15 months post-baseline (73% followed). Primary outcomes were number of days out of the past 30 of drinking alcohol, using drugs, and experiencing psychological problems. Secondary outcomes were outpatient substance use treatment, and 12-step group, utilization.Results Longitudinal modeling found that patients in both conditions improved over time on each primary outcome. Improvement was comparable between conditions on alcohol and drug use and psychological problems. Receipt of outpatient treatment decreased over the follow-up period and was not related to condition. Likelihood of attending 12-step group meetings did not change over follow-ups, and was not related to condition.Conclusions Improvement over time was evident regardless of condition assignment. Patients maintained attendance at 12-step groups from pre- to post-discharge. Short-term telephone monitoring in addition to usual care for patients with co-occurring substance use and mental health disorders may not be sufficiently intensive to achieve additional improvements on outcomes.

Improving recovery outcomes among MSM: The potential role of recovery housing

ABSTRACTBackground: Gay, bisexual, and other men who have sex with men (MSM) face unique recovery challenges. Recovery housing may play an important role in improving outcomes among MSM, but little is known about their experiences in these settings. Methods: This study examined 3-month outcomes among MSM (N = 22) living in a group of recovery residences in Texas, one of which is a home specifically designated for gay and bisexual men. Upon intake, adult MSM were recruited to participate in the study, which involved a baseline and 3-month phone interview and allowing study staff to access records maintained by the program about their stay. Results: At follow-up, only two (9.1%) reported used of any substances in the past 30 days. The vast majority (73%) had attended outpatient substance use treatment in the past three months, and 86% reported working for pay during the past 30 days. All participants reported attending four or more 12-step meetings in the past 30 days. Use of dysfunctional coping strategies significantly decreased, however, so did scores on health-related quality of life. Conclusions: MSM have complex treatment needs. Recovery housing may help improve outcomes among MSM by bridging formal substance use treatment with community-based recovery support.

An Interview With Addiction Psychiatrist Dr. Christoffel Le Roux

An Interview With Addiction Psychiatrist Dr. Christoffel Le Roux

Study protocol: Community Links to Establish Alcohol Recovery (CLEAR) for women leaving jail

PurposeThis article describes the protocol for a randomized effectiveness trial of a method to link alcohol use disordered women who are in pretrial jail detention with post-release 12-step mutual help groups. BackgroundJails serve 15 times more people per year than do prisons and have very short stays, posing few opportunities for treatment or treatment planning. Alcohol use is associated with poor post-jail psychosocial and health outcomes including sexually transmitted diseases and HIV, especially for women. At least weekly 12-step self-help group attendance in the months after release from jail has been associated with improvements in alcohol use and alcohol-related consequences. Linkage strategies improve 12-step attendance and alcohol outcomes among outpatients, but have not previously been tested in criminal justice populations. DesignIn the intervention condition, a 12-step volunteer meets once individually with an incarcerated woman while she is in jail and arranges to be in contact after release to accompany her to 12-step meetings. The control condition provides schedules for local 12-step meetings. Outcomes include percent days abstinent from alcohol (primary), 12-step meeting involvement, and fewer unprotected sexual occasions (secondary) after release from jail. We hypothesize that (Minton, 2015) 12-step involvement will mediate the intervention's effect on alcohol use, and (O'Brien, 2001) percent days abstinent will mediate the intervention's effect on STI/HIV risk-taking outcomes. Research methods accommodate logistical and philosophical hurdles including rapid turnover of commitments and unpredictable release times at the jail, possible post-randomization ineligibility due to sentencing, 12-step principles such as Nonaffiliation, and use of volunteers as interventionists.

Predictors of 12-Step Attendance and Participation for Individuals With Stimulant Use Disorders

ObjectiveFew studies have examined the effectiveness of 12-step peer recovery support programs with drug use disorders, especially stimulant use, and it is difficult to know how outcomes related to 12-step attendance and participation generalize to individuals with non-alcohol substance use disorders (SUDs). MethodA clinical trial of 12-step facilitation (N=471) focusing on individuals with cocaine or methamphetamine use disorders allowed examination of four questions: Q1) To what extent do treatment-seeking stimulant users use 12-step programs and, which ones? Q2) Do factors previously found to predict 12-step participation among those with alcohol use disorders also predict participation among stimulant users? Q3) What specific baseline “12-step readiness” factors predict subsequent 12-step participation and attendance? And Q4) Does stimulant drug of choice differentially predict 12-step participation and attendance? ResultsThe four outcomes variables, attendance, speaking, duties at 12-step meetings, and other peer recovery support activities, were not related to baseline demographic or substance problem history or severity. Drug of choice was associated with differential days of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) attendance among those who reported attending, and cocaine users reported more days of attending AA or NA at 1-, 3- and 6-month follow-ups than did methamphetamine users. Pre-randomization measures of perceived benefit of 12-step groups predicted 12-step attendance at 3- and 6-month follow-ups. Pre-randomization 12-step attendance significantly predicted number of other self-help activities at end-of-treatment, 3- and 6-month follow-ups. Pre-randomization perceived benefit and problem severity both predicted number of self-help activities at end-of-treatment and 3-month follow-up. Pre-randomization perceived barriers to 12-step groups were negatively associated with self-help activities at end-of-treatment and 3-month follow-up. Whether or not one participated in any duties was predicted at all time points by pre-randomization involvement in self-help activities. ConclusionsThe primary finding of this study is one of continuity: prior attendance and active involvement with 12-step programs were the main signs pointing to future involvement. Limitations and recommendations are discussed.

A comparison of African American and Caucasian stimulant users in 12-step facilitation treatment

ABSTRACTEngagement in 12-step meetings and activities has been shown to be a powerful aid to recovery from substance use disorders. However, only limited attention has been given to ethnic and racial differences in attitudes toward 12-step and involvement. This study utilized data from a large multisite trial testing the effectiveness of a 12-step facilitation therapy with stimulant-dependent treatment seekers. We compared baseline differences and treatment outcomes between African American and Caucasian participants. A select few baseline differences were found (i.e., African Americans reported higher levels of spirituality than Caucasians; African American participants indicated more perceived benefits of 12-step involvement; Caucasians were more likely to endorse future involvement in 12-step). There were no outcome differences (e.g., substance use outcomes, 12-step meeting attendance). The tested intervention produced similar outcomes for both groups, indicating that it may be useful across racial categories.

Co-Occurring Conditions Clients and Counselors Compare 12-Step and Smart Recovery Mutual Help

ABSTRACTThere are few published accounts describing the perspectives of persons with co-occurring conditions (CC) of serious mental illness and substance use disorders, despite the high prevalence of CC. Two focus groups were conducted with CC clients (n = 12) and counselors (n = 7) who had experience with two common types of mutual-help meetings: 12-step meetings and Self-Management and Recovery Training (SMART) Recovery®. In both groups, there were positive comments about both modalities, but there were relatively more negative comments about 12-step programs. Many positive comments related to the experience of being in a meeting, regardless of modality. The results suggest that persons with CC who are currently in treatment generally respond better to SMART Recovery than to 12-step mutual-help meetings.

Crush

Crush Dana Roeser (bio) Why do they call it "crush"?The man strapped in horizontal on the hydraulic lift, then tipped vertical,bellowing, I am standing up. The nurses trying to cantileverhim into the bathroom so he can brush his teeth.Greg described my dad's menu as "mechanically softened."They actually take the entire rib-eye steak, or chicken parmigiana,and put it through a meat grinder. On Irish night, my father, uncharacteristically,screamed, "This is revolting! I won't eat it." Imagine corned beef and cabbagein a paste. I heard later that the patrons in the main dining room werereimbursed the price [End Page 104] of their dinners. That's how unsavorythe entrees were even before pulverization. I had Irishcream shrimp. And a soaking baked potato. ________ Crush. Coup de foudre. Blow tothe head, lightning strike. It's annoying to fall for a garden varietywomanizer with whom I have nothing in common. And I'm not theonly one. Whole 12-step meetings filled with women who have washedtheir hair. I feel like giving that thing a blow to its head. But it keepssashaying up to me when I'm shaking my pelvis to some pining, thrusting love song inZumba class—like a Cat Five hurricane in the Wall of Wind simulator. ________ My father begs me, I mean begs,for red grapes. Red grapes, he says, or a sip of water—his hand in a pinch—just one. No, I want real water. "Thickener" is put in every drink he ingests. [End Page 105] ________ What if he breaks your heart?my friend Cicily says, her inquiring, open face tilted up to mine.A moment before, when I was extolling his charms,"And have you seen the other side of that?" I had to sayI had. "Yes, he is very wound up." ________ Sally was lit up like a sparkler,her thinning gray hair every which way, getting stupendously drunkbut still strikingly aware. She told us how her first bone marrow transplantdidn't take and she needed to get another one. Each time sobering up the onlymatch, her alcoholic brother. Sally was holding a snifter of ginand then glass after glass of white wine. It had been a hard day, she said. As I wasstanding to leave, she told us about her crush (as was the case the night beforewhen I started in at the restaurant [End Page 106] with Anna and Rose, out came the crushes).She said it had gotten so bad she avoided going into the relevant establishmentwhen she saw her guy's license plate in a parking spot. Forty years married,and devoted to his wife. Flirting like crazy. She was married to oneof those flirts, but somehow she focused him. His fifth wife, twentyyears. He adored her until his ailments— the last straw was he, a NationalBook Award winner, couldn't read the computer screen—got to himand he shot himself on a visit home from the assisted living placewhere he had been living, basically, without a hip. Sally was in theother room. ________ Sally was on prednisone for years.Between that and the forced menopause, she had several compression fracturesin her spine. Crush. Use this word in a sentence:her spine was crushed. [End Page 107] ________ In my father's roomI eat bites from a piece of fake "coffee cake" fromhis tray. They've upgraded his diet somewhat (from"pulverized" to "smashed," I say in the "Care" meeting—which makeseveryone laugh). But it's too late. He eats almost nothing.I'm going to offer him the sip of the waterhe's not allowed to have— today he starts Hospiceso why not start breaking the rules right away?—but he forgetshe asked. I've been assured Hospice is going to give "pleasurefoods" and a "comfort tray" (I can't get a clear read of what's on thistray, besides morphine and Ativan.) ________ Grief suffuses Hoy CenterFloor 2 A especially at night. From [End Page 108...

Buprenorphine Treatment and 12-step Meeting Attendance: Conflicts, Compatibilities, and Patient Outcomes

This analysis examines patient experiences and outcomes with 12-step recovery group attendance during buprenorphine maintenance treatment (BMT), two approaches with traditionally divergent philosophies regarding opioid medications for treatment of opioid use disorder. Using quantitative (n=300) and qualitative (n=20) data collected during a randomized trial of counseling services in buprenorphine treatment, this mixed-methods analysis of African Americans in BMT finds the number of NA meetings attended in the prior 6months was associated with a higher rate of retention in BMT (p<.001) and heroin/cocaine abstinence at 6month follow-up (p=.005). However, patients whose counselors required them to attend 12-step meetings did not have better outcomes than patients not required to attend such meetings. Qualitative narratives highlighted patients' strategies for managing dissonant viewpoints on BMT and disclosing BMT status in community 12-step meetings. Twelve-step meeting attendance is associated with better outcomes for BMT patients over the first 6months of treatment. However, there is no benefit to requiring meeting attendance as a condition of treatment, and clinicians should be aware of potential philosophical conflicts between 12-step and BMT approaches.

Child Support Conviction and Recidivism: A Statistical Interaction Pattern by Race

An estimated 50,000 parents are behind bars on average daily for child support nonpayment, but information about these fathers and their recidivism rates are lacking. Using a jail sample (N = 16,382), multinomial logistics regression method was utilized; subgroup analysis was used to investigate differential beta weights of predictor variables. Informed by Critical Race Theory, findings showed that fathers incarcerated for arrears had significantly higher rates of recidivism than other jailed men, but had an interaction effect with race. After controlling for age, education, and prior attendance at 12-step meetings, Black fathers but NOT White fathers showed significant post-release recidivism. Implications are discussed.

First-Person Perspectives on Dual Diagnosis Anonymous (DDA): A Qualitative Study

Objective: People with dually diagnosed substance abuse and mental illnesses often feel alienated at traditional 12-step meetings, yet they need the peer support provided by such groups. Dual Diagnosis Anonymous (DDA) is a peer-support program specifically for people with co-occurring disorders, which addresses many of the factors that members find alienating about traditional 12-step groups. This study aimed to elicit first-person perspectives on DDA. Methods: Occupational therapy students conducted 13 focus groups with 106 DDA members in three settings: the community (6 groups, n = 36), correctional facilities (5 groups, n = 53), and the state psychiatric hospital (2 groups, n = 17). Researchers inductively analyzed focus group transcripts to identify prominent themes. Results: The vast majority of participants were between the ages of 18 and 49 (n = 87, 82.1%) and were non-Hispanic/White (n = 82, 77.4%). Most participants had been using substances for more than 10 years and had a diagnosed mental illness for more than 10 years. The most common substance of choice among those in the community and corrections setting was multiple substances, while those in the state hospital identified alcohol most often. Bipolar disorder was the most common mental illness diagnosis among participants in the state hospital, but depression and anxiety were the two most common diagnoses in the community and corrections participants. Four primary themes emerged from the qualitative analysis: (1) feeling accepted by others in the group, (2) understanding the interactive nature of dual disorders, (3) the open discussions in DDA meetings, and (4) a focus on hope and recovery from both illnesses. Conclusions: DDA provides a helpful alternative for individuals who do not feel comfortable at traditional 12-step groups due to their mental illness. Members value the acceptance, understanding, discussion, and hope in DDA meetings.