Circles of Recovery: Self-help Organizations for Addictions (International Research Monographs in the Addictions) PDF
Preview Circles of Recovery: Self-help Organizations for Addictions (International Research Monographs in the Addictions)
This page intentionally left blank CIRCLES OF RECOVERY Self-HelpOrganizationsforAddictions Self-helporganizationsacrosstheworld,suchasAlcoholicsAnonymous,Croixd’Or, TheLinks,ModerationManagement,NarcoticsAnonymous,andSMART Recovery, haveattractedtensofmillionsofindividualsseekingtoaddressaddictionproblemswith drugsoralcohol.Forthefirsttime,thisbookprovidesanintegrative,internationalreview ofresearchontheseorganizations,focusinginparticularonthecriticalquestionsasto howtheyaffectindividualmembersandwhetherself-helpgroupsandformalhealthcare systemscanworktogethertocombatsubstanceabuse.KeithHumphreysreviewsover 500studiesintotheefficacyofself-helpgroupsasanalternativeandvoluntaryformof treatment.Inadditiontoofferingacritical,state-of-the-artreviewoftheinternational bodyofresearchinthisarea,heprovidespracticalstrategiesforindividualclinicians andtreatmentsystemstointeractwithself-helporganizationsinawaythatimproves outcomesforpatientsandforcommunitiesasawhole. keith humphreys isAssociateProfessorofPsychiatryattheStanfordUniversity SchoolofMedicine,andDirectoroftheProgramEvaluationandResourceCenter.He hasreceivednationalandinternationalawardsforhiswork,andhasservedonexpert consultantpanelsfortheCenterforMentalHealthServices,theNationalInstituteof AlcoholAbuseandAlcoholism,theOfficeofBehavioralandSocialScienceResearch, theDepartmentofVeteransAffairs,andtheOfficeofJuvenileJusticeandDelinquency Prevention. international research monographs in the addictions (irma) SeriesEditor ProfessorGriffithEdwards NationalAddictionCentre InstituteofPsychiatry,London This is a series of volumes presenting important research from major centers around the world on the basic sciences, both biological and behavioral, that haveabearingontheaddictions.Italsoaddressestheclinicalandpublichealth applicationsofsuchresearch.Theserieswillcoveralcohol,illicitdrugs,psy- chotropics,andtobacco.Itisanimportantresourceforclinicians,researchers, andpolicymakers. Alsointhisseries CannabisandCognitiveFunctioning NadiaSolowij ISBN05211591147 AlcoholandtheCommunity:ASystemsApproachtoPrevention HaroldD.Holder ISBN0521591872 ACommunityReinforcementApproachtoAddictionTreatment RobertJ.MeyersandWilliamR.Miller ISBN0521771072 TreatmentMatchinginAlcoholism ThomasF.BaborandFrancesK.DelBoca ISBN0521651123 CIRCLES OF RECOVERY Self-Help Organizations for Addictions KEITH HUMPHREYS DepartmentofPsychiatry StanfordUniversitySchoolofMedicine Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge , United Kingdom Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521792776 © Cambridge University Press 2004 This book is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2003 - isbn-13 978-0-511-06946-8 eBook (EBL) - isbn-10 0-511-06946-4 eBook (EBL) - isbn-13 978-0-521-79277-6 hardback - isbn-10 0-521-79277-0 hardback Cambridge University Press has no responsibility for the persistence or accuracy of s for external or third-party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publisher therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. Contents Acknowledgements x 1 Definitions,scope,andoriginofthehealth-relatedself-helpgroup movement 1 Pointsofdeparture 1 Goalsofthisbook 2 Goal1:todescribeaddiction-relatedself-helporganizations 2 Goal2:toevaluatehowself-helpgroupinvolvementaffectsmembers 3 Goal3:toprovideguidelinesforclinicalandpolicyinteractionwith self-helpgroups 4 Goal4:tobringsciencetobearoncontroversialissuesinthefield 5 Thescopeofthisbook 7 Rangeofsocietiesexamined 8 Benefitsandchallengesofaninternationalscope 9 Rangeofaddiction-relatedandnon-addiction-relatedself-help organizationsaddressed 11 Rangeofdisciplinescovered 12 Whatself-helporganizationsareandwhattheyarenot 12 Nomenclature 12 Essentialcharacteristicsofself-helporganizations 13 Optionalfeaturesofself-helporganizations 17 Differentiatingself-helporganizationsfromotherinterventions 21 Genericfactorsbehindthedevelopmentoftheself-helpgroupmovement inthemodernworld 24 Fiveinter-relatedforcesthathavefosteredthemodernself-helpgroup movement 26 Improvedpublichealthandwealth 26 Weakeningoffamilialties 27 v vi Contents Limitsofprofessionalassistance 28 Theriseofconsumerisminhealthcare 30 Benefitsofparticipation 31 2 Aninternationaltourofaddiction-relatedmutual-helporganizations 33 Backgroundandcontext 33 Origins,philosophy,andmembershipofaddiction-relatedself-help organizations 35 AlcoholicsAnonymous 35 AbstainersClubs 43 Al-AnonFamilyGroups 46 AllNipponSobrietyAssociation/theSobrietyFriendsSociety (Danshukai) 51 BlueCross(CroixBleue) 54 ClubsofTreatedAlcoholics 57 DoubleTroubleinRecovery 60 FreeLife(VieLibre) 63 JewishAlcoholics,ChemicallyDependentPersons,andSignificant Others 65 TheLinks 67 ModerationManagement 70 NarcoticsAnonymous 74 NicotineAnonymous 77 OxfordHouses 78 PuiHongSelf-HelpAssociation 80 RationalRecovery 82 SMART Recovery 84 SOS/LifeRingSecularRecovery 86 WomenforSobriety 88 Comparisonsandcontrasts 90 3 Doesself-helpgroupparticipationleadtopositiveaddiction-related, psychiatric,andmedicaloutcomes? 94 Conceptualbackground 94 Thecaseforevaluatingwhetheraddictionself-helpgroups “reallywork” 94 Evaluatingself-helpgroupsasanalogoustoprofessionalhealthcare interventions 95 Contents vii Randomizedclinicaltrialsasaregulatingidealintreatmentresearch 96 Randomizedtrialsarenotnecessarilythebestguidetouseful knowledge 96 Randomizedtrialshaveadditionalshortcomingsspecifictoself-help groupevaluation 97 Correlationalstudiesandquasi-experimentsarenopanaceaeither 98 Outcomestudiesofspecificaddiction-relatedmutual-help organizations 99 Al-AnonFamilyGroups 100 AllNipponSobrietyAssociationandtheSobrietyFriends Society(Danshukai) 102 ClubsofTreatedAlcoholics 103 DoubleTroubleinRecovery 103 ModerationManagement 104 NarcoticsAnonymous 104 NicotineAnonymous 106 OxfordHouses 107 PuiHongSelf-HelpAssociation 108 RationalRecovery 108 SecularOrganizationforSobriety 109 WomenforSobriety 109 OutcomestudiesofAA 109 Experimentalandquasi-experimentalstudiesofAAasasole intervention 111 LongitudinalstudiesofAA’seffectivenessincombinationwith treatment 115 SummaryofAAeffectivenessstudies 119 ThreeintriguingquestionsaboutAA’seffectiveness 119 MediatorsofAA’sinfluenceondrinkingoutcomes 119 AA’spotentialforpopulation-levelbenefits 123 WeaknessesandpossibleharmsofAA 125 Summary 126 4 Adifferentperspectiveonchangeinself-helporganizations: spirituality,identity,lifestories,friendshipnetworks,and politicization 128 Movingbeyondthetreatment-outcomeperspective 128 Scopeandbackground 130 viii Contents Domain1:spiritualchange 131 Understandingspiritualchangeinsubstance-abuse-relatedself-help organizations 137 Domain2:identityandlife-storytransformation 141 Domain3:friendship-networkcomposition 144 Domain4:politicizationandempowerment 146 Summary 148 5 Howshouldgovernmentagencies,healthcareorganizations,and cliniciansinteractwithself-helporganizations? 149 Externalsupportofself-helporganizations:benefitsandrisks 149 Directhealthbenefits 149 Healthcarecostreductions 150 Challengestocollaboration 152 Summary:movingcarefullyforward 154 Strategiesforgovernmentalsupportofaddiction-relatedself-help organizations 154 Legitimatingrhetoric 155 Directfinancialsupportofself-helporganizations 156 In-kindresourceprovision 156 Investmentsinself-helpsupportorganizations 157 Mediaandinformationcampaigns 159 Trainingandeducationforprofessionalhelpers 160 Researchsupport 161 Self-helpgroupsasparticipantsinrelevantpolicyarenas 163 Strategiesforindividualcliniciansandtreatmentagencies 163 Theneedforacollaborativemindset 164 Avenuesforcollaboration 166 Makingeffectivereferrals 167 Empiricallysupportedreferralstrategies 167 Consultationandanexperimentalattitudeoverapriorimatching 168 Commonworriesaboutreferral 169 Helpingtostartself-helpgroups 174 Technicalassistance,lectures,researchhelp,andmediareferral person 174 Attendingself-helpgroupsasaprofessional 175 Epilogue:summingup,movingforward 177 SomeanswersfortheMartian 177
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