Faculty Bibliography

This case study of the development and implementation of an opioid overdose prevention program is based on an actual clinic's experience, but information about the clinic, including details of implementation and outcome measures, has been changed. Four experts reflect on the medical, administrative, peer-support, community, and evaluation aspects of this case. This discussion highlights challenges and important considerations in the creation of programs to address the ever-increasing risk for opioid overdose.

BACKGROUND: In the course of achieving abstinence from alcohol, longstanding members of Alcoholics Anonymous (AA) typically experience a change in their addiction-related attitudes and behaviors. These changes are reflective of physiologically grounded mechanisms which can be investigated within the disciplines of social and cognitive neuroscience. OBJECTIVE: This article is designed to examine recent findings associated with these disciplines that may shed light on the mechanisms underlying this change. METHOD: Literature review and hypothesis development. RESULTS: Pertinent aspects of the neural impact of drugs of abuse are summarized. After this, research regarding specific brain sites, elucidated primarily by imaging techniques, is reviewed relative to the following: Mirroring and mentalizing are described in relation to experimentally modeled studies on empathy and mutuality, which may parallel the experiences of social interaction and influence on AA members. Integration and retrieval of memories acquired in a setting like AA are described, and are related to studies on storytelling, models of self-schema development, and value formation. A model for ascription to a Higher Power is presented. CONCLUSION: The phenomena associated with AA reflect greater complexity than the empirical studies on which this article is based, and certainly require further elucidation. Despite this substantial limitation in currently available findings, there is heuristic value in considering the relationship between the brain-based and clinical phenomena described here. SCIENTIFIC SIGNIFICANCE: There are opportunities for the study of neuroscientific correlates of Twelve-Step-based recovery, and these can potentially enhance our understanding of related clinical phenomena. (Am J Addict 2014;23:300-307).

Clinicians' understanding of Alcoholics Anonymous (AA) is generally based on their subjective response to encounters with patients, rather than on empirical research. In an effort to improve on this, this article presents a model of AA's operation that draws on diverse, scientifically grounded disciplines: social psychology, cognitive psychology, neuroscience, sociobiology, and sociology. Findings from these respective disciplines are presented to clarify how social support initially influences an individual's induction into the program, and how the social structure of the fellowship can be framed from an empirical perspective. Integration of a model of AA along these lines can help in framing how it succeeds in stabilizing long-term recovery in its adherents, and how its psychological and sociologic underpinnings have assured its continuity over time.

Alcoholics Anonymous (AA) provides an experience of fulfillment and lifesaving recovery for its committed members. For the research community, however, it serves as an example of how social and spiritual forces are orchestrated to achieve changes in cognition and behavior. We undertook organizing the material provided here as an emerging body of research and clinical science that sheds light on this process of change and redemption. This current body of research findings begins with two overview articles that we prepared to frame this publication. The first, by Marc Galanter, deals with an approach to applying diverse scientific perspectives to understanding AA's function. Clearly, more research and related explanation will be needed to further build on our understanding of this remarkable, spiritually grounded fellowship, but we see the current effort as one contribution to this ongoing process.

Spiritual awakening, a key aspect of 12-Step recovery, is designated in the 12th Step of Alcoholics Anonymous (AA). The authors applied a psychiatric survey instrument to 161 long-term AA members who reported having had such an awakening. Sixty-seven percent of respondents reported no craving for alcohol or drugs at the time of this survey. Their awakening had most often taken place gradually (60%), while they were working the Steps (52%), and right after bottoming out (57%). Their responses reflected a major experiential transformation, including highly significant changes: decreases in craving and depression and increases in service to other AA members. A factor analysis of descriptors of the awakening revealed the following six dimensions of the experience, with variability across respondents: positive mood, abstinence, interpersonally related, a sensory experience, God-related, and related to personal meaning. Findings showed that it is feasible to characterize commonalities in the nature of a spiritual awakening as a major transformative event across many long-term AA members, though the specific character of the experience differs across individuals.

Abstract Substance use disorder, often comorbid with post-traumatic stress disorder, is a problem confronted by many veterans. In order to determine the potential utility of Narcotics Anonymous for veterans, 508 NA attendees were studied. Veterans (N = 172) were more likely to have been referred by a professional than were non-veterans (77% vs. 27%); 70% had been hospitalized for alcohol or drug problems, and 51% had been treated for non-substance psychological problems. The 70% of veterans who responded at least one of 3 service-related stressful experiences were more likely to report PTSD-related symptoms. NA apparently can serve as a recovery resource for certain veterans with SUD, with or without PTSD.