Can 12-Step Programs Treat Dual Diagnoses?
23 November 2019
August 16, 2019
Effective treatment needs to include both the substance use disorder and the co-occurring disorder in an integrated approach because the two conditions build on each other.
Thirty-three percent of people with mental illness also have a substance use disorder (SUD); that number rises to 50 percent for severe mental illness. Fifty-one percent of people with SUD have a co-occurring mental health disorder. Effective treatment needs to include both the SUD and the co-occurring disorder in an integrated approach because the two conditions build on each other. People with mental illness may turn to substances to alleviate symptoms and severe substance misuse can cause lasting psychological and physiological damage.
12-step programs are free, prolific, and available throughout the world. These mutual-help organizations are designed to facilitate recovery from addiction, but are they suitable for treating the large segment of people with addiction who also have other mental health conditions or psychiatric diagnoses?
A 2018 meta-analysis undertook a literature review on 14 years of studies related to dual diagnosis and Alcoholics Anonymous (AA). This extensive quantitative look into the effiicacy of AA for people with dual diagnosis found that participation in AA and abstinence “were associated significantly and positively.” The research supports the clinically-backed notion that an integrated mental health approach that encourages participation in mutual help programs is the best approach for treating patients with comorbid SUD and mental illness.
Does it Depend on the Dual Diagnosis?
There is enormous variation in mental illnesses, so does the potential effectiveness of 12-step programs change based on the type of disorder or diagnosis? The co-founder of AA, William Wilson (known as Bill W.), was afflicted with a co-occurring disorder. Wilson struggled with “very severe depression symptoms” and today his mental health issue may have been diagnosed as major depressive disorder.
A study published in the Journal of Substance Abuse Treatment followed 300 alcohol-dependent people with and without social anxiety disorder who went through hospital-assisted detox followed by participation in AA. Social anxiety disorder is characterized by an intense fear of being rejected or disliked by other people. This study found that there was no significant difference in relapse or abstinence rates between the two groups and concluded that social anxiety disorder was “not a significant risk factor for alcohol use relapse or for nonadherence to AA or psychotherapy.”
Do Sponsors Matter?
People with dual diagnoses tend to participate in 12-step programs like AA as much as people with just SUD and receive the same benefits in recovery. Those people with co-occurring conditions may actually benefit more from “high levels of active involvement, particularly having a 12-step sponsor.”
In many 12-step mutual help organizations, people enter into an informal agreement with another recovering person who will support their recovery efforts and hold them accountable for continued sobriety. This one-on-one relationship of sponsor and sponsee has been compared to the “therapeutic alliance” that is formed between patients and their clinicians. The therapeutic alliance is positively correlated with treatment outcomes and abstinence.
The therapeutic alliance is one of the most important aspects of effective psychotherapy, as it helps the therapist and the patient to work together. The relationship is based on a strong level of trust. Patients need to feel fully supported, and know that that their therapist is always working towards the best possible outcome for the patient. In the sponsor-sponsee relationship, a similar level of trust and belief is essential if sponsorship is going to be beneficial.
As with therapy, it may take many tries with many different people to find the right fit. Not all people are suitable to be sponsors and not all sponsorships go well. A sponsor is generally expected to be very accessible to their sponsee, and available at any time, day or night. They are supposed to help with completing the 12-steps, and they often provide advice and suggestions from their own experiences. It’s a lot of responsibility.
A strong therapeutic alliance has been found to be an excellent predictor for treatment outcomes. Does that mean a failed therapeutic alliance could derail treatment? In short, the answer is yes. Trust is critical to healing from any mental illness.
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