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If you wanted to live a long and healthy life, what measures could you take to achieve your goals? Stop smoking? Lose weight? Exercise? Drop your blood pressure? We have evidence that all of these make a difference, but a recent analysis of 148 studies on the subject found two things that made more of a difference to mortality than anything else. What were they?
Well, having strong social relationships and being integrated socially seem to protect against death. This analysis was not specifically about addiction, but suffering from addiction is strongly associated with increased death rates and it seems very likely that if we could promote strong social links in those seeking help it will reduce the risk of relapse and ultimately of early death.
We already know that those who stick aorund drinking buddies in early recovery have a greater risk of relapse than those who don’t. And the other side of the coin is that if we encourage folk to make new relationships with those who are sober and drug-free, they have a greater chance of maintaining recovery. In this sense, recovery acts like an infectious agent. Hang around those who have it and you might just catch it.
These findings will come as no surprise to those of us in recovery for it is the experience of many that friends and family, mutual aid and other resources are keystones in facilitating the process of starting and maintaining recovery.
It gets me to wondering if those of us involved in treatment are really that aware of the power of recovery communities, like the virtual community on Wired In and the thousands of mutual aid groups meeting every week in Britain.
What if we started to think about these communities as the heart of recovery rather than focussing so much on treatment? What, as Bill White has suggested, if we saw treatment as a support and “add-on” to mutual aid and community recovery resources rather than the other way around? How would that work and how easy would it be to achieve?
In preparing to do a presentation on the state of mutual aid in the UK, I discovered something very interesting. Mutual aid is not only alive and well, it is exceedingly healthy. The findings below are based on the best evidence I could find (including counting hundreds of meetings on websites!) If there are corrections to be made, I’m happy to make them if you leave a comment
There are many roads to recovery and each one is individual. However many travel the roads together, at least for a period and for many their paths will intersect in mutual aid groups.
Keith Humphreys summarises common components of mutual aid groups clearly in his book “Circles of Recovery”.
• Members share some problem or status that results in suffering/distress
• Groups are organised and facilitated by members themselves
• Experiential knowledge is the basis of expertise
• All members are both “helpers” and “helpees”
• No fees are charged, save “pass the hat” contributions
The UK has a solid tradition of mutual aid with Alcoholics Anonymous, the world’s largest mutual aid group for addiction, arriving here in 1949. There are more than four and a half thousand meetings every week in the UK. In the last two years alone, AA members have opened 600 new meetings.
Alanon, support for families and friends of those affected by alcoholism started in Belfast in 1951 and spread rapidly to the mainland. There are now more than 800 meetings a week nationally.
In 1980, Narcotics Anonymous hit these shores with a single weekly meeting in London. Today there are almost a thousand meetings a week and it is growing rapidly too.
In 1992, Cocaine Anonymous held its first meeting in London. Today there are 230 meetings in the country. In Scotland meetings have increased from 10 a week in the central belt to 26 meetings weekly in just two years.
SMART Recovery began operating in 1994 in the USA. I’d be grateful for any information members here might have about where and when SMART held its first UK recovery meeting. Currently 23 meetings are listed nationally with 12 of these in Scotland and ten of the twelve in the north east of the country. I predict significant growth over the next while.
Women for Sobriety has UK meetings, but these are not listed and it would be good to have an idea of how many and where they are.
There is still a fair amount of suspicion and prejudice out there about mutual aid. A couple of fairly recent British studies have evidenced this with less than half of professionals expressing positive attitudes and in one study only a third saying they would refer to mutual aid.
This is so out of kilter with the evidence base that it needs to be challenged. However it is probably true to say that the influence of mutual aid groups is increasing. Their size and membership certainly are in the United Kingdom.
Here’s my current tally of mutual aid organisations related to substance dependence in the UK. If you know of others, I’d like to add them to my list.
Number of meetings:
Alcoholics Anonymous_____________4,600
Narcotics Anonymous ______________ 962
Alanon___________________________820
Cocaine Anonymous________________ 220
Families Anonymous_________________45
SMART Recovery____________________23
British Doctors & Dentists Group _______17
Secular Organisations for Sobriety______12
Marijuana Anonymous_________________9
Adult Children of Alcoholics____________7
Whether we sign up to the disease model of addiction or not, there are plenty of advantages to understanding what the science is telling us. We know so much more about what happens in the brain in addiction than we ever did before and soon we’ll know more about the recovering brain too. I’ve blogged about this before here. Theres another interesting discussion going on which touches on the issue of choice in another blog.
I’m asked a lot by patients and by professionals about aspects of the neuroscience of addiction. Sometimes people who dismiss the science and hate the idea of framing addiction as a disease haven’t actually got an understanding of current knowledge. That’s not really a criticism or a surprise, for not only is there so much out there that it is overwhelming. but it’s also hard to get your head around the detail. I want to share some of the resources that have helped me and that may help those who want to know more.
Dr Kevin McCauley is an addiction physician and an educator. He is also an advocate for the rights of addicts. As I’ve said elsewhere here, my understanding of the biology of addiction has been greatly enhanced by his understanding and teaching. He’s just released a DVD on the subject of addiction, disease and choice called Pleasure Unwoven This is an exploration of addiction science, starting with genes and ending with choice, theorising that addiction is a disorder of our pleasure sense modified by stress and resulting in impairment of choice. Kevin adeptly uses the breathtaking backdrop of the Utah national parks to communicate the evidence and manages to translate the science into easy to understand concepts. I have not seen anything of this quality on the subject before and it is well worth seeing.
Other useful resources to enhance understanding include Addiction Inbox where Dirk Hanson keeps readers up to date with scientific and medical studies on addiction. Hanson’s book, The Chemical Carousel is a good read.
Addiction and Recovery News is edited by Jason Schwarz of Dawn Farm and covers, amongst other things, research on addiction and recovery. I highly recommend it.
Finally the National Institute on Drug Abuse (sorry, it’s that word again) or NIDA has an amazing amount of resources on its website including a booklet called The Science of Addiction which although a little out of date now, is still a good introduction.
I’d be interested to know what others think of these resources..
Recently, when I was working on a research project as part of a university course looking at how doctors recover from dependent drug use, my fellow students were incredulous. “Addicted doctors? You’re having us on”.
I had to tell them that having a medical degree does not protect you from alcoholism and other drug addiction. Believe me on that one. I had no problem finding volunteers to take part in the research. Sometime I’ll blog on its findings.
This week, the Practitioner Health Programme reported on its first year of operation. A pilot project to address unmet health needs of doctors and dentists living within the M25 area, it has just reported on its first year of operation.
One hundred and eighty four people sought help in that time. Thirty six percent were addicted to alcohol or drugs. They got fast access to high quality treatment. The recovery rate for the period? Eighty percent became and remained abstinent. I know some of these doctors and the turn around in individual lives is breathtaking and moving.
Studies around the world show that doctors get addicted to substances at pretty much the same rates of the general population. What is astonishingly different is that doctors recovery rates are very much higher than the general population. I am always asking myself why that it, and I’m not satisfied with the easy answers. I want to know what we can learn from this success.
No doubt, part of the high success rates is down to high “recovery capital”, or the internal and external resources that doctors can draw on to aid recovery. Not everyone is starting out from the same place.
I’ve already mentioned the quality of treatment the doctors in PHP got, but there’s more. For these addicted doctors there was hope and aspiration from the outset that they would recover. Not in a year or two or a few years, but starting now, with a clear and early goal of abstinence.
For the opiate addicts in the programme, the port of first call was not automatically maintenance methadone as most of their patients would get, but something quite different. The crucial value of mutual aid through Alcoholics Anonymous, Cocaine Anonymous, Narcotics Anonymous and the support organisation, the British Doctors and Dentists Group is understood by PHP and active referral made.
Having worked with substance dependent people for some time now, I’ve seen the impossible happen and “hopeless” cases recover. In truth, nobody is hopeless.
What would it be like If we offered all addicts access to high quality and intensity treatment focussed on abstinence? If the treatment environment was underpinned by hope and aspiration? What if that treatment were of sufficient duration and had aftercare and “recovery checkups” built in? What if the service actively linked people into recovery communities as a routine measure, not with a leaflet, but by taking or getting someone else to take the person to a meeting?
If we offered all that to those seeking help, would we see higher recovery rates for alcoholics and addicts generally?
What comes first the chicken or the egg?
In alcohol dependence, the question becomes; what comes first, the depression or alcoholism? And, I suppose what needs to be tackled first?
Alcohol through its effect on neurotransmitters and behaviours can cause depression, but surely depression can cause heavy drinking or relapse as a person tries to attempt to escape the dark feelings.
There are dozens of studies now giving positive associations between AA membership and improved drinking outcomes. AA itself addresses the importance of managing mood and feelings in its literature.
In a paper about to be published in the journal Addiction (you can catch it in early view at the moment), Dr Kelly and colleagues take a look at whether AA membership helps with depression.
They used data from the massive Project Match study in the US to test this out, analysing data from over 1700 folk. They assessed depression in this group and compared it to rates in the general population, then they monitored how the study group did in terms of depression over 15 months of follow up.
Next they monitored what the relationship was between depression and AA attendance over time and whether reductions in depression affected AA related reductions in drinking.
Finally they really wanted to know whether AA was associated with reductions in depression over and above what might be expected just from reducing alcohol.
I can tell you that these are quite complex questions and unfortunately need quite complicated statistical tools and methods. This section of the paper is hard going. The authors are also quick to point out that the study has limitations, so caution is required.
The first thing they found was that alcoholic clients were a lot more depressed than the average population. No surprises there.
Then something many studies have found: AA attendance was robustly associated with reductions in alcohol consumption. Going to meetings more frequently was associated with reductions in depression.
However the authors reckon that this improvement was mostly explained because of the AA effect on drinking rather than a primary direct effect on depression. Put simply sorting out the drinking through AA seemed to be fundamental to sorting out the depression.
Although women in the sample were more depressed than men at the start of the study, their depression lifted to the same degree. I thought of the recent DDN article about Women and AA (see the contentious blog discussion here). The women in this sample did very well in AA which is reassuring given the concerns that have been expressed. The authors postulate that women are more sensitive to alcohol’s depressing effect than men. This fits in with the observation that they are more sensitive to its other harmful effects too.
I’ll finish with a paragraph from the discussion section of the paper:
“AA’s association with reduced drinking and reduced depression is encouraging, as AA’s emphases on ‘powerlessness’, ‘surrender’ and ‘character defects’ could be conceived as perpetuating a pessimistic world-view cultivated by subjugation of will. On the contrary, in keeping with AA’s emphasis on reducing negative affect and increasing subjective wellbeing, attending AA appears to relate not only to improved drinking outcomes, but also to improved psychological adjustment. It is possible that AA attendance alleviates depression through the group therapy principles of instilling hope, universality, group cohesiveness and catharsis”.
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