Pragma

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I am 100% interested in any empirical citations you can provide. Seriously.

Either the “hypothesis” is supported or it’s not. If it’s not, we should do away with it. The convenience of the lie doesn’t make it true.
Could you entertain the idea that it might be supported for a small number of disorders in certain types of patients, and not for others? It really is not a black and white thing, so I don't understand why you keep coming back to the issue as if it is.

Role of Self-medication in the Development of Comorbid Anxiety and Substance Use Disorders

Mood Disorder Self-Medication article

ETA: Some of the better papers that I have read on this topic.
 
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A paper about how little psychologists are getting trained with regard to SUDs. I read this one a few years back and I don't know if things have improved much, if at all, since then.

Link to article
 
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I agree - one of the big issues with 12-step programs as they've been applied has been their impact on the AVE (although that concept doesn't really apply to a lot of folks either). If you check some of the recent reviews of the evidence for Marlatt's model, not every component is exactly evidence-based. That said, it's a good general framework and jives well with other lifestyle modifications that can help get people through the early stages.

But I disagee with your last statement. Not everyone wants a "treatment team" and given how stigmatizing substance use is, as well as how terrible success rates are for treatment, I wouldn't really push any particular intervention or "treatment team" framework on someone. I'm a psychologist and I think that MI and CBT and medications offer some of the best evidence to help a person out, but addiction is very heterogeneous and not very well-understood - otherwise we'd have even more effective treatments by now. There's a huge group of people that just quit on their own that we don't know a lot about. There's people who do it without any form of "treatment" at all and that rely mostly on community supports and lifestyle changes. I just don't have the hubris to think that we psychologists have it all figured out, particularly (think OP) when many psychologists haven't even taken a class on this.
Oh, yeah, I just said treatment team because I work in the VA and we tend to have those for every patient. What I was trying to say that, if a patient seeks treatment, I would like the ultimate goal of the treatment (abstinence, controlled drinking, or harm reduction) to be in line with what the patient actually wants and what appears to be the most appropriate goal. I do acknowledge that there are patients who don't want to stop drinking and probably should, and in those situations that would be something to eventually be discussed with the patient in terms of recommendations vs. what the patient is willing to do.

I agree with you that sometimes this isn't necessary. I work part time in primary care and have had a lot of success helping people take steps to cut back without the use of a formal protocol.
 
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One thing I also want to add is that California does require a 15 hr substance abuse course for psychologist licensure. I did my post doc in CA so I sat through one of them.
 
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@Pragma , your comment about me never having taken a substance use disorder course is weird to me, as I never said that at all. I’m confused.
I didn't mean that, I was just musing about how psychologists are not routinely educated very much about addiction or the subculture. I know your OP was about credentialing people to be addictions counselors; I guess my point is that just because we are psychologists doesn't mean that we're by default educated much about this either.
 

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One thing I also want to add is that California does require a 15 hr substance abuse course for psychologist licensure. I did my post doc in CA so I sat through one of them.
It wasn't the most engaging and wonderful course in your life? :D
 

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Clearly that’s a Big Five issue for you smalltown!
:)
I was reluctant to engage in this conversation because it tends to not go well. By that I mean that I am not trying to engage in an argument for or against 12 step programs as much as trying to broaden the perspective. I do think that psychology does itself a disservice by taking such a negative stance towards these types of groups. What is surprising is that I don't see such strong resistance from practitioners out here in community settings. Probably because we have all had cases where 12 step programs have been of benefit, and when you are day in and day out dealing with the harmful effects of addiction on the individuals and their families, you tend to be a bit more open to anything that might work. If my patient said snake handling helped them to stop using meth so that they could take care of their kids, then I would be completely on board with that. I think we have a bit more evidence that 12 step programs are more effective than snake handling even though a placebo-controlled head to head comparison hasn't been conducted as of yet. ;)

Anyway, what I see in the community is that clinicians want to know more about how to work with patients in various stages of recovery from substances with or without 12 step involvement and a desire to understand those programs better to be of more help. Some day I will follow my dissertation committee's advice and publish a book on this.
 

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I believe that the "resistance" is more dismay that AA has a sort of hegemony in the area, and that it likely limits the offering/construction of more efficacious actual treatment options. Whether that be through direct, or indirect methods, is really irrelevant. I just happen to believe we shouldn't be peddling pseudoscience, or misinformation, in any case. I'm happy to leave people their placebo effects, But, for example, if a patient asks me about whether or not Aricept or Prevagen is going to do anything for their memory, I give them the honest answer based on what the data actually says. Not what I want the data to say to make them feel better.
 
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Pragma

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I believe that the "resistance" is more dismay that AA has a sort of hegemony in the area, and that it likely limits the offering/construction of more efficacious actual treatment options. Whether that be through direct, or indirect methods, is really irrelevant. I just happen to believe we shouldn't be peddling pseudoscience, or misinformation, in any case. I'm happy to leave people their placebo effects, But, for example, if a patient asks me about whether or not Aricept or Prevagen is going to do anything for their memory, I give them the honest answer based on what the data actually says. Not what I want the data to say to make them feel better.
You do realize that there are official clinician's guides from NIAAA/NIDA that tell physicians and other clinicians to refer to mutual support groups, right? I'm assuming they are basing that on TSF studies (12-Step Facilitation Therapy (Alcohol, Stimulants, Opiates)) and other work that has found that participation in mutual help groups, in conjunction with other actual treatments, is associated with good outcomes?

https://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf

Check out the bottom of page 20.

I usually tell patients that some people find 12-step groups to be helpful, some people don't, and that there are a number of different types of community support that someone could access if they choose to.
 

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I do realize that. But, the ideal world of clinician's guides and the real world rarely overlap. In many areas, it's either the only option, or the only referred option. Luckily, I have access to a comprehensive in/outpatient treatment program in my hospital, but haven't been as lucky in the past. I'm fine with giving patients the options available and giving them adequate information about the efficacy/costs/benefits, but that's generally not how this is approached in any meaningful way in a majority of encounters. Although I can see the argument that some of us are toeing the line of "throwing the baby out with the bathwater, I feel that we run the same type of risk of assuming the ideal is the actual real world application of things.
 

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I do realize that. But, the ideal world of clinician's guides and the real world rarely overlap. In many areas, it's either the only option, or the only referred option. Luckily, I have access to a comprehensive in/outpatient treatment program in my hospital, but haven't been as lucky in the past. I'm fine with giving patients the options available and giving them adequate information about the efficacy/costs/benefits, but that's generally not how this is approached in any meaningful way in a majority of encounters. Although I can see the argument that some of us are toeing the line of "throwing the baby out with the bathwater, I feel that we run the same type of risk of assuming the ideal is the actual real world application of things.
Hot off the press for your consideration:
https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.14268
(Meta-analysis of 12-step and dual diagnosis)

You also might be interested to know that there is a new Cochrane Review happening: Alcoholics Anonymous and other 12‐step programs for alcohol use disorder

Because Alcoholics Anonymous is not controlled or standardized by professionals, it has historically been harder to study than professionally designed and delivered treatments for which manuals are written, doses can be randomly assigned, and length of contact can be standardized and predetermined (Humphreys 2004; Kelly 2017). However, over the past two decades, Alcoholics Anonymous researchers have become increasingly sophisticated at finding methods to study Alcoholics Anonymous in a rigorous fashion. Reviews of this research have been conducted, including a prior Cochrane Review (Ferri 2006a; Ferri 2006b; Kaskutas 2009; Kelly 2009), but a flurry of additional empirical investigations since these reviews were conducted signifies a need for major update. Consequently, an additional rigorous, high-quality systematic review is needed that includes more recent studies to inform the field of the clinical and public health utility, and effectiveness and cost-effectiveness of, AA and TSF. Consequently, this review updates and supercedes the previously conducted Cochrane Review, on which one of the present coauthors participated (Ferri 2006b).

There's a lot of reputable scholars out there exploring AA and other mutual help interventions. I'd encourage folks to check out the work of Jim Kelly at Harvard, Tonigan at UNM, Humphries at Stanford, etc - lots of interesting findings that have come out. In fact, those are the folks doing the new Cochrane Review.
 
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I look forward to the new Cochrane review. I also wonder how things may change as we become an increasingly secularized society.
 
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I believe that the "resistance" is more dismay that AA has a sort of hegemony in the area, and that it likely limits the offering/construction of more efficacious actual treatment options. Whether that be through direct, or indirect methods, is really irrelevant. I just happen to believe we shouldn't be peddling pseudoscience, or misinformation, in any case. I'm happy to leave people their placebo effects, But, for example, if a patient asks me about whether or not Aricept or Prevagen is going to do anything for their memory, I give them the honest answer based on what the data actually says. Not what I want the data to say to make them feel better.
Probably shouldn't have used the resistance as I didn't mean it in the defense mechanism sense. ;) I do agree with the problem with it being problematic how AA has had so much influence, but some of that is due to some historical factors and that is changing. I do know that there is some research evidence that AA involvement has benefit for people and I think it has more to do with maintenance of change as opposed to initial phases of change. I'll leave it to @Pragma to keep posting that as I have my 3:00 waiting. :)
 
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A paper about how little psychologists are getting trained with regard to SUDs. I read this one a few years back and I don't know if things have improved much, if at all, since then.
Yeah this is really an interesting point. I actually really WANTED substance use treatment experience on internship. My program didn't have this experience because SUD cases are often too high risk for department clinics (true of my current position as well, we often don't take SUD cases). We actually had a student here try to get SUD experience at the VA a few years ago and it fell through because there was no psychologist on the team to supervise. Something similar happened to me on internship, there was only ONE psychologist on the SUD team and she was too overworked/overwhelmed to take an intern when I started, so I never got the experience. Compare this to the many psychologists who were on the PTSD team, and even 2-3 doing couples treatment.

My research area is at least sort of in the area of substance use, so I have a general understanding of the processes at work. But if I actually *wanted* experience and couldn't get it, I have to imagine there are plenty of people who aren't really interested and thus are never trained even with so many people out there using/abusing/dependent on substances.
 

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One thing I also want to add is that California does require a 15 hr substance abuse course for psychologist licensure. I did my post doc in CA so I sat through one of them.
Was it a useful course?

I’m serious about my request bc I have my own bias, but i’m curious about other ppl’s experiences.
 

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Was it a useful course?

I’m serious about my request bc I have my own bias, but i’m curious about other ppl’s experiences.
Based on the content? Not sure if you are saying the content is not useful. Hopefully they would cover a lot of basic stuff like etiology/epidemiology, screening/assessment, brief interventions, treatments/modalities, ROSC, relapse prevention, etc. Like any course, I’d imagine the instructor matters a lot.
 

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I look forward to the new Cochrane review. I also wonder how things may change as we become an increasingly secularized society.
Not sure how much secularizing matters. There are atheist AA groups, and growing secular alternatives. Society seems to trend a lot towards spirituality, which AA taps into a bit. Marlatt’s focus on mindfulness-based relapse prevention prior to his death seems to indicate a heavy shift towards the integration/utilization of mutual help interventions as a key component to long-term recovery even within a CBT relapse prevention framework. Talk to a Division 50 psychologist sometime. None of this is considered extreme or even particularly controversial when you are talking to psychologists that work in this space.

There are plenty of bad treatment centers that follow only one ideology and ignore evidence, but there’s been a huge shift towards evidence-based practice and the block grants these places relied upon before are disappearing.

Bill Miller had a good 2006 article about the research/practice gap and the state of the addictions field and what the holdup is for some places/providers. Lots of implementation science work going on since then.
 
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Pragma

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Yeah this is really an interesting point. I actually really WANTED substance use treatment experience on internship. My program didn't have this experience because SUD cases are often too high risk for department clinics (true of my current position as well, we often don't take SUD cases). We actually had a student here try to get SUD experience at the VA a few years ago and it fell through because there was no psychologist on the team to supervise. Something similar happened to me on internship, there was only ONE psychologist on the SUD team and she was too overworked/overwhelmed to take an intern when I started, so I never got the experience. Compare this to the many psychologists who were on the PTSD team, and even 2-3 doing couples treatment.

My research area is at least sort of in the area of substance use, so I have a general understanding of the processes at work. But if I actually *wanted* experience and couldn't get it, I have to imagine there are plenty of people who aren't really interested and thus are never trained even with so many people out there using/abusing/dependent on substances.
Yes, lack of training opps in some areas might have to do with how siloed the systems have been historically. There’s change happening there, but I can’t think of a ton of places that would give a psychology extern excellent supervision (with video review) of MI interventions, for example.
 
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Yes, lack of training opps in some areas might have to do with how siloed the systems have been historically. There’s change happening there, but I can’t think of a ton of places that would give a psychology extern excellent supervision (with video review) of MI interventions, for example.
I consider it super fortunate that my first clinical training was very intensive MI training with a mandated population of people referred for substance misuse. It gave me opportunity to develop those skills really well very early on.
 
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Pragma

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I am 100% interested in any empirical citations you can provide. Seriously.

Either the “hypothesis” is supported or it’s not. If it’s not, we should do away with it. The convenience of the lie doesn’t make it true.
Could you entertain the idea that it might be supported for a small number of disorders in certain types of patients, and not for others? It really is not a black and white thing, so I don't understand why you keep coming back to the issue as if it is.

Role of Self-medication in the Development of Comorbid Anxiety and Substance Use Disorders

Mood Disorder Self-Medication article

ETA: Some of the better papers that I have read on this topic.
It's been a few days, so I thought I would check in.
 

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It's been a few days, so I thought I would check in.
There are multiple other models for how/why substance abuse develops.

1) In regards to these articles
a) The authors redefine "self medication" however they want. This "hypothesis" is a specific thing.
b) The surveyors are asking people who have a substance use disorder to begin with, if their use is self medication. As you mentioned, there is a high degree of social bias which is for some reason mitigated by the self medication explanation.
c) First they propose self medication is considered a separate variable. Some people self medicate, some don't. Some do it before onset of psychiatric symptoms (which who the hell knows how one medicates against something before it starts). If "self medicating" behaviors are not directly attributable to a psychiatric disorder, then these behaviors are not self medicating.
d) lumping "drugs" into a homogeneous group completely redefines self medication. Again self medication is the use of a substance which has a property in the opposite direction of the affective disorder. Methamphetamine is not the same as benzodiazepines.
e) I didn't see where they addressed how the affective disorder starts and then the substance use starts.
f) The self medication hypothesis specifically states that once the underlying affective disorder is treated, the substance abuse will go away. This is clearly contradicted by this evidence.
g) Self medicating against a specific phobia, in many if not most instances, contradicts the idea of a specific phobia. And developing alcohol dependence from a specific phobia is evidence for alternative models, not the self medication hypothesis.

2) If substance abuse is self medication, we would expect the affective disorder to start first. If we look at the same data, we can see that based upon mean age of onset alcohol dependence begins before the other affective disorder aside from social phobia and specific phobia. This would contraindicate the self medication hypothesis and support the substance induced anxiety model (e.g., Cohen, 1995; Katerndahl, 1999; Breese, 2005; etc). This data is similar to those found in the original Khantzian validation study.

3) Goodwin, 2004 shows that when extraneous factors are accounted for, anxiety is not a predictor for alcohol abuse.

4) IIRC, it was either the Grant or Helzer study from the 1980s using the national survey that contradicted the self medication hypothesis which led to Khantzian redefining his hypothesis. Because hypothesis can mean whatever now.
 
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Pragma

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There are multiple other models for how/why substance abuse develops.

1) In regards to these articles
a) The authors redefine "self medication" however they want. This "hypothesis" is a specific thing.
b) The surveyors are asking people who have a substance use disorder to begin with, if their use is self medication. As you mentioned, there is a high degree of social bias which is for some reason mitigated by the self medication explanation.
c) First they propose self medication is considered a separate variable. Some people self medicate, some don't. Some do it before onset of psychiatric symptoms (which who the hell knows how one medicates against something before it starts). If "self medicating" behaviors are not directly attributable to a psychiatric disorder, then these behaviors are not self medicating.
d) lumping "drugs" into a homogeneous group completely redefines self medication. Again self medication is the use of a substance which has a property in the opposite direction of the affective disorder. Methamphetamine is not the same as benzodiazepines.
e) I didn't see where they addressed how the affective disorder starts and then the substance use starts.
f) The self medication hypothesis specifically states that once the underlying affective disorder is treated, the substance abuse will go away. This is clearly contradicted by this evidence.
g) Self medicating against a specific phobia, in many if not most instances, contradicts the idea of a specific phobia. And developing alcohol dependence from a specific phobia is evidence for alternative models, not the self medication hypothesis.

2) If substance abuse is self medication, we would expect the affective disorder to start first. If we look at the same data, we can see that based upon mean age of onset alcohol dependence begins before the other affective disorder aside from social phobia and specific phobia. This would contraindicate the self medication hypothesis and support the substance induced anxiety model (e.g., Cohen, 1995; Katerndahl, 1999; Breese, 2005; etc). This data is similar to those found in the original Khantzian validation study.

3) Goodwin, 2004 shows that when extraneous factors are accounted for, anxiety is not a predictor for alcohol abuse.

4) IIRC, it was either the Grant or Helzer study from the 1980s using the national survey that contradicted the self medication hypothesis which led to Khantzian redefining his hypothesis. Because hypothesis can mean whatever now.
@PSYDR, thanks for the detailed reply. I'll look it over more soon, but certainly I agree there are operationalization problems. It is nice when data are longitudinal to explore some of these factors.

I think that most of us would agree that substance use is multifactorially determined. To me that isn't even really up for debate anymore. The extent to which certain factors influence use seems to be heterogeneous based on what we do know. That was my entire point in posting some other papers for consideration. You posted reference to an unsystematic literature review and a study of undergraduate students. I felt it was important to share the different perspectives that are out there in the literature, as the concept of self-medication has been looked at in some more detail than you seemed to be letting on. Again, I don't see any of this as a dichotomous issue. Any "hypothesis" claiming to explain addiction entirely is of course wrong (not much convincing evidence in personality theory either). But what about weighting different factors for different types of patients?
 

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@PSYDR, thanks for the detailed reply. I'll look it over more soon, but certainly I agree there are operationalization problems. It is nice when data are longitudinal to explore some of these factors.

I think that most of us would agree that substance use is multifactorially determined. To me that isn't even really up for debate anymore. The extent to which certain factors influence use seems to be heterogeneous based on what we do know. That was my entire point in posting some other papers for consideration. You posted reference to an unsystematic literature review and a study of undergraduate students. I felt it was important to share the different perspectives that are out there in the literature, as the concept of self-medication has been looked at in some more detail than you seemed to be letting on. Again, I don't see any of this as a dichotomous issue. Any "hypothesis" claiming to explain addiction entirely is of course wrong (not much convincing evidence in personality theory either). But what about weighting different factors for different types of patients?
That's fair. I was never attempting to sum up the research base, so I apologize if it came across that way. I am trying to provoke others to at least look into the history of the prevailing theory that guides most substance abuse treatment, and consider that maybe the emperor has no clothes.

The self medication hypothesis states that the affective disorder would always preceded the substance abuse, and the substance abuse would always resolve after the affective disorder was treated. This is simply not supported by the research base.


There are several other theories of substance abuse out there. IMO, most are better (e.g., Common Factors Model, Mutual Maintenance Model). There is a wide range of evidence that there is a strong biological to such conditions as pathological gambling and alcohol dependence (e.g., dopamine agonists causing pathological gambling, Kluver Bucy causing hypersexuality, why bupropion helps with smoking cessatoin while other antidepressants do not, ADH polymorphisms associated with less risk of alcohol dependence, etc).

If we treat a false etiology, we will rarely help anyone. Didn't work for refrigerator mothers, won't work for substance abusers.

p.s. if you're really interested in this, look at the odds ratios for SUDs in OCD.
 

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@PSYDR There are lots of other models too - role theory, other psychological models, contextual models. I don’t think treatment is centered around self-medication most of the time - where are you seeing this? The prevailing theory is the disease model in treatment settings.

Also, not everyone exploring that concept follows Khantzian’s framework, which is my beef with your comments. As I said from the get go, I’m not a big fan of self medication as an etiological explanation in most cases. It’s a mixture of biology, psychology, and environment/context.
 
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f) The self medication hypothesis specifically states that once the underlying affective disorder is treated, the substance abuse will go away. This is clearly contradicted by this evidence.
This aspect of the self-medication hypothesis is the one that causes the most problems. The evidence that I have seen, which is consistent with my own clinical observations, is that both the mental illness and the substance use should be treated simultaneously for best results. One has to be careful in this to not need collude into patients unhealthy rationalizations and justifications for continued use and the self-medication hypothesis has a built-in setup for that.
 
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This aspect of the self-medication hypothesis is the one that causes the most problems. The evidence that I have seen, which is consistent with my own clinical observations, is that both the mental illness and the substance use should be treated simultaneously for best results. One has to be careful in this to not need collude into patients unhealthy rationalizations and justifications for continued use and the self-medication hypothesis has a built-in setup for that.
Yeah, so that is either the mutual maintenance model or the substance induced model. It is NOT the self medication hypothesis model.
 
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It’s astounding how many clinicians downplay or outright reject the “drugs can be fun” reasoning. There are positives from the user’s perspective that shouldn't be ignored. I’m not saying there isn’t maladaptive behaviors mixed in, but there are often clear reasons for use above dependence and poor coping.
 
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It’s astounding how many clinicians downplay or outright reject the “drugs can be fun” reasoning. There are positives from the user’s perspective that shouldn't be ignored. I’m not saying there isn’t maladaptive behaviors mixed in, but there are often clear reasons for use above dependence and poor coping.
If I didn't broach the issue of marijuana use with my chronically psychotic patients in this way, they would simply stop ever speaking to me about it.
 

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The new Cochrane review came out if you need some social distancing reading.

Also, this is a trying time for folks in AA. Online meetings have been around for awhile but a significant portion of that group may not have easy means to do it this way. Support your neighbors and members of your community, folks!
 

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The new Cochrane review came out if you need some social distancing reading.

Also, this is a trying time for folks in AA. Online meetings have been around for awhile but a significant portion of that group may not have easy means to do it this way. Support your neighbors and members of your community, folks!
I saw that, I haven't read the study or methodology of it yet, but if it checks out, I may have to change my view of AA type programs.
 

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I'll be interested to see what folks think after we've read it. Cochrane reviews can run the gamut of quality. Remember, Cochrane reviews also said donepezil is efficacious for AD...
 

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Oh, yeah, I just said treatment team because I work in the VA and we tend to have those for every patient. What I was trying to say that, if a patient seeks treatment, I would like the ultimate goal of the treatment (abstinence, controlled drinking, or harm reduction) to be in line with what the patient actually wants and what appears to be the most appropriate goal. I do acknowledge that there are patients who don't want to stop drinking and probably should, and in those situations that would be something to eventually be discussed with the patient in terms of recommendations vs. what the patient is willing to do.

I agree with you that sometimes this isn't necessary. I work part time in primary care and have had a lot of success helping people take steps to cut back without the use of a formal protocol.
Right on.

It also baffles me how--if you read it--the AA 'big book' Alcoholics Anonymous is FAR closer to the spirit of motivational interviewing than it is to the hard line doctrinaire fire and brimstone '12 step program (Minnesota Model?)' approach that unfortunately pervades a lot of the SUDs treatment programs.

If you read the 'Working With Others' chapter (basically laying out the approach to sponsorship), you'll discover that there's a good bit of motivational interviewing (and even collaborative empiricism) advocated--not fire and brimstone invectives.
 

Fan_of_Meehl

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Not sure how much secularizing matters. There are atheist AA groups, and growing secular alternatives. Society seems to trend a lot towards spirituality, which AA taps into a bit. Marlatt’s focus on mindfulness-based relapse prevention prior to his death seems to indicate a heavy shift towards the integration/utilization of mutual help interventions as a key component to long-term recovery even within a CBT relapse prevention framework. Talk to a Division 50 psychologist sometime. None of this is considered extreme or even particularly controversial when you are talking to psychologists that work in this space.

There are plenty of bad treatment centers that follow only one ideology and ignore evidence, but there’s been a huge shift towards evidence-based practice and the block grants these places relied upon before are disappearing.

Bill Miller had a good 2006 article about the research/practice gap and the state of the addictions field and what the holdup is for some places/providers. Lots of implementation science work going on since then.
The chaper 'We Agnostics' would be a useful read for a lot of the folks who think AA is (or should be) a rabid fundamentalist bible-thumping off-putting organization (in general).

One of most useful recovery concepts that I've seen is: "The most important thing for me to believe about God is that *I* am not God" (and should therefore stop trying to play God in my life.

Some people get a lot of mileage out of considering their 'conscience' to be their higher power.

And I think there's been some empirical substantiation of the antidepressant effect of gratitude. And humility would seem to be a helpful spirit to cultivate for patients who may have an excess of narcissistic and solipsistic thinking holding them back from listening to others, changing their behavior and/or making social connections.
 
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Mar 24, 2014
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Haven't posted for awhile as I am deeply invested in my new job running a treatment program and teaching a bunch of new MA graduates how to do therapy with a fairly severe population. :eek: Social distancing is playing hell with my patients' ability to integrate into the community and the AA closure is one part of that. As a result, our residents just started their own group and I got to attend the other day and it brought tears to my eyes. There is a powerful need that is being met by these groups that is quite compelling to the folks in recovery. Our population tends to be highly resistant to all of our groups and often will not attend despite consequences, but when it comes to AA, they make it happen themselves.
 

futureapppsy2

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Haven't posted for awhile as I am deeply invested in my new job running a treatment program and teaching a bunch of new MA graduates how to do therapy with a fairly severe population. :eek: Social distancing is playing hell with my patients' ability to integrate into the community and the AA closure is one part of that. As a result, our residents just started their own group and I got to attend the other day and it brought tears to my eyes. There is a powerful need that is being met by these groups that is quite compelling to the folks in recovery. Our population tends to be highly resistant to all of our groups and often will not attend despite consequences, but when it comes to AA, they make it happen themselves.
Welcome back! I've really missed your posts! :)

Also, TEPP just published a special issue on addiction/substance use disorder training in psychology:
 
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DynamicDidactic

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So, I just read the results section. Looks like AA is mostly similarly effective to other treatments. The advantages seem to be two fold:
- Slightly higher abstinence rate at 12 months (risk ratio (RR) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants). This is not surprising since abstinence is likely to be a lower priority goal in other treatments (as opposed to risk reduction).
- More cost effective and this one is relatively obvious since peer-led groups don't require a facilitator to be paid.

Unfortunately, outcomes such as quality of life, functioning, or psychological well‐being were not included in any of the studies.
 

futureapppsy2

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So, I just read the results section. Looks like AA is mostly similarly effective to other treatments. The advantages seem to be two fold:
- Slightly higher abstinence rate at 12 months (risk ratio (RR) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants). This is not surprising since abstinence is likely to be a lower priority goal in other treatments (as opposed to risk reduction).
- More cost effective and this one is relatively obvious since peer-led groups don't require a facilitator to be paid.

Unfortunately, outcomes such as quality of life, functioning, or psychological well‐being were not included in any of the studies.
For the Cochrane systematic review, you mean?
 

WisNeuro

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So, I just read the results section. Looks like AA is mostly similarly effective to other treatments. The advantages seem to be two fold:
- Slightly higher abstinence rate at 12 months (risk ratio (RR) 1.21, 95% confidence interval (CI) 1.03 to 1.42; 2 studies, 1936 participants). This is not surprising since abstinence is likely to be a lower priority goal in other treatments (as opposed to risk reduction).
- More cost effective and this one is relatively obvious since peer-led groups don't require a facilitator to be paid.

Unfortunately, outcomes such as quality of life, functioning, or psychological well‐being were not included in any of the studies.
One of the past critiques was that AA orgs generally do not partner with independent researchers, and do not share data for review. For this data, was it independent, or still done all in house?
 

DynamicDidactic

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One of the past critiques was that AA orgs generally do not partner with independent researchers, and do not share data for review. For this data, was it independent, or still done all in house?
These are mostly controlled (not all RCTs) large scale studies. I assume they are not overly biased.
 
Mar 24, 2014
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Welcome back! I've really missed your posts! :)

Also, TEPP just published a special issue on addiction/substance use disorder training in psychology:
Thanks. I miss being involved in this forum too. During my outpatient therapy gig in a remote Montana location, I really needed this community to stay grounded and connected. Not as much of a need now and I don't have the down time either. Really no such thing as missed appointments in a residential setting. :D
 
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