Faculty Bibliography

Alcoholics Anonymous (AA) and other 12-step programs are widely employed in the addiction rehabilitation community. It is therefore important for researchers and clinicians to have a better understanding of how recovery from addiction takes place, in terms of psychological mechanisms associated with spiritual renewal. A program like AA is described here as a spiritual recovery movement, that is, one that effects compliance with its behavioral norms by engaging recruits in a social system that promotes new and transcendent meaning in their lives. The mechanisms underlying the attribution of new meaning in AA are considered by recourse to the models of positive psychology and social network support; both models have been found to be associated with constructive health outcomes in a variety of contexts. By drawing on available empirical research, it is possible to define the diagnosis of addiction and the criteria for recovery in spiritually oriented terms

The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders. We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers. This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs. Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees. These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery. Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities

This paper reviews the literature on ambulatory substance abuse treatment for adolescents, including brief intervention, Twelve-Step-based outpatient treatment, family-based treatment, cognitive behavioral therapy, and pharmacologic treatment. An overview of socially and culturally specific strategies is also included. The diversity of settings and approaches and combinations of approaches in the treatment of adolescents is emphasized as are adaptations of Twelve-Step and other group based interventions. Family-based and multisystem therapy, adapted for substance using adolescents, is highlighted as a promising future direction of effective treatment

The purpose of the present study was to assess the relationship of history of gang involvement to engagement in Therapeutic Community (TC) treatment. Residents (N = 222) at two Daytop facilities completed a survey assessing sociodemographic characteristics, prior gang involvement and multiple aspects of TC functioning. Residents with prior gang involvement (21%) were younger and less educated than those without prior gang involvement. Although gang involved residents were more likely to achieve a high work role status in the program they scored lower on multiple indicators of engagement in treatment including acceptance of Daytop philosophy and TC clinical progress

This study was designed to provide an independent evaluation of the oversight and rehabilitation of substance-impaired physicians. Records of 104 physicians who had completed their monitoring period by the New York State Committee on Physicians' Health were selected at random from CPH files. They had been followed for an average of 41.3 months. Practice characteristics and substance use before admission, as well as workplace monitoring, twelve-step attendance, urine toxicologies, and relapse incidence after admission are reported. Significant intercorrelations among these variables were ascertained by logistic regression. The utility of twelve-step-based rehabilitation as part of a treatment plan for sustaining abstinence and averting relapse is discussed

Coercion as a strategy for treatment of addiction is an effective but often negatively perceived approach. The authors review current policies for involuntary commitments and explore coercive dimensions of treating alcohol and drug dependence in the workplace, sports, and through professional licensure. Gender-specific issues in coercion are considered, including evidence for improved treatment retention among pregnant and parenting women coerced via the criminal justice system. Social security disability benefits represent an area where an opportunity for constructive coercion was missed in the treatment of primary or comorbid substance use disorders. The availability of third-party funding for the voluntary treatment of individuals with substance use disorders has decreased. This unmet need, coupled with the evidence for positive clinical outcomes, highlights the call for implementing socially sanctioned mechanisms of coercion

This analysis of five recovery narratives from leaders of a peer-led, 12-Step-based self- help group in a methadone treatment program highlights the importance of spiritually-mediated role transformation in the recovery process. For these men and women in their forties and fifties, their progression to a leadership role helping others with their recovery validated the spiritual transformation they regarded as underlying their own recovery process. Assumption of this new leadership/helper role marked a tangible sign that their deepened spirituality allowed them to assume a new, higher function in a struggle with the addiction that had plagued their lives. For these peer leaders, methadone was at the core of the group experience and an aid to spiritual transformation