Recovery Plus 16 Feb 2016 Scientifically-informed recovery: what’s new? Over the past 80 years, Alcoholics Anonymous has grown from two members to over 2million members. AA and similar organisations such as Narcotics Anonymous are among the mostsought sources of help for substance-related problems. But it is only relatively recently that the scientific community conducted rigorous studies on the clinical utility and healthcare cost-offset potential of mutual-help groups, and developed and tested professional treatments to facilitate their use. Professionally delivered interventions designed to facilitate the use of AA and NA – Twelve-Step Facilitation – are now “empirically supported treatments” as defined by US federal agencies and the American Psychological Association. The World Health Organisation and the UK’s NHSguidance body NICE recommend their use. So let’s look at six lessons learned during the past 15-20 years on how mutual-help organisations can help individuals suffering from substance use disorders (SUDs) while cutting healthcare costs. Substance use and related disorders confer a massive health, social and economic burden. Globally, alcohol kills 3.3 million people annually. It is the leading risk factor for death among males aged 15-59 and it is the third leading risk factor for disease burden around the world. In the US, alcohol use is the third-leading cause of preventable death and the financial impact of SUD is estimated to approach $600billion per year, stemming mostly from lost productivity, criminal justice and healthcare costs. In most developed nations, the societal response to these endemic public health problems has been multipronged, including prohibiting certain substances; attempts to reduce consumption through price controls, taxation and licensing of sales outlets (in the case of alcohol); federal, state and community prevention initiatives; and professional treatment. In addition to these considerable formal efforts, peer-led mutual-help organisations have flourished in most communities in the past 80 years, perhaps stemming from recognition at the grassroots level of the need for more flexible, rapidly accessible and ongoing support that can mitigate relapse risk at little to no cost. Mutual-help organisations help offset this burden and can be studied empirically. By far the largest and most researched of these peer-led mutual-help organisations is AA. Sophisticated scientific evidence supports the role of AA and similar groups in helping people to achieve abstinence and maintain recovery. We now have a strong evidence base in support of professionally delivered interventions (TSF) to effectively engage individuals with these community resources. AA purports that the primary mechanism through which recovery from alcohol addiction is achieved is through a “spiritual awakening” which is realised by following a sequential 12-step programme. Such spiritual processes might seem antithetical to empirical study. But research over the past 20 years has shown that there are many aspects of AA and its mechanisms of action which are amenable to empirical study, including spirituality and spiritual practices. Six lessons from the past 15-20 years: 1) Substance use and related disorders are a massive health, social and economic burden 2) Mutual-help organisations help offset this burden and can be studied empirically 3) Mutual-help groups confer clinically-meaningful benefits for many different types of people over and above formal treatment 4) Mutual-help groups work through mechanisms similar to those in formal treatment 5) Mutual-help groups can reduce healthcare costs by reducing patients’ reliance on professional services without detriment to, and might enhance, outcomes 6) Empirically-supported clinical interventions increase patient participation in mutual-help groups and enhance treatment outcomes.
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