Recovery Plus your library’s essential reference Feb 2016 17 About the author John Kelly BS Psychology (Summa Cum Laude) PhD is Harvard University’s first professor in addiction medicine, president of the American Psychological Association Society of Addiction Psychology and associate editor for the journals Addiction and the Journal of Substance Abuse Treatment. He is also founder and director of the Recovery Research Institute at Massachusetts General Hospital, programme director of the Addiction Recovery Management Service and associate director of the Center for Addiction Medicine at MGH. He has served as a consultant to US federal agencies such as the White House Office of National Drug Control Policy, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institutes of Health (NIH); to non-profits such as the Hazelden Betty Ford Foundation; and to foreign governments. Dr Kelly has published over 100 peer-reviewed articles, reviews, and chapters in the field of addiction. Harvard’s first professor of addiction medicine, John Kelly, summarises rigorous studies by the scientific community on the clinical utility and cost offsets of mutual-help groups. Studying AA empirically is not without its challenges, particularly in terms of the gold standard of treatment research: the randomised controlled trial. The tightly controlled and highly insulated context of an RCT runs counter to the way real-world AA groups are conducted. AA is attended anonymously, usually voluntarily. No records are kept about who attends and what is said. Groups vary widely in their size and content. Because AA is freely accessible in the community, it can seem unethical to randomly assign some RCT participants to attend and prohibit the attendance of others. These issues have led researchers to examine AA through other methods, such as through naturalistic, prospective, effectiveness studies which use sophisticated methods to account for selfselection biases (eg, statistical controls, propensity scores, instrumental variable analyses). Researchers have also examined the efficacy of professionally delivered TSF treatments, which systematically encourage and facilitate 12-step meeting attendance, relative to other treatments that neither encourage nor forbid attendance. Together, these types of research show the benefits of AA attendance in a way that has both scientific integrity and real-world relevance. Meaningful benefits for many different types of people, over and above formal treatment. There have been hundreds of empirical studies on AA, summarised in several meta-analyses and one Cochrane review. These reviews indicate that AA is associated with a moderate effect on alcohol and other drug use that is on par with professional treatment. For some people, mutualhelp group participation alone is an effective intervention for substance-use disorder. Questions can arise as to whether AA is less suitable for certain groups of people, particularly dually diagnosed people, those taking psychotropic or anti-relapse medications, atheists or agnostics, women and youth. But the available empirical evidence suggests that, for the most part, such people benefit from participation in regular AA meetings. One exception might be people with severe impairments in psychosocial functioning and reality testing – such as SUD with schizophrenia – who might benefit more from dual-diagnosis mutual-help groups such as Double Trouble in Recovery. Similarly, although young people can benefit from attendance at AA and NA meetings, benefits can be enhanced at meetings with at least some same-aged peers. Mutual-help groups work through mechanisms similar to those in formal treatment. Over 20 years ago, the Institute of Medicine called for more research on how AA works. A recent review of the research on the mechanisms of change in AA revealed that AA helps people to attain and maintain recovery through multiple mechanisms, many of which are also activated by formal treatment. Most consistently and strongly, AA appears to work through mobilising adaptive changes in the social networks of attendees – for instance, decreasing pro-drinking social ties and increasing proabstinence social ties – and enhancing coping skills and self efficacy for abstinence in high-risk social situations.
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