Transcript Slide 1
Double Trouble Recovery
SELF HELP FOR THE DUALLY DIAGNOSED
Presenter: Howard Vogel 2005
Acknowledgements
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Thanks to all of the consumers who are made this presentation possible by sharing their experiences,
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And thanks to the service providers for their cooperation.
Background
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High prevalence of comorbidity with many far reaching treatment implications: More severe and chronic than single, “pure” psychiatric disorders Associated with a variety of negative consequences including clinically, therapeutically, psychologically as well as socially and economically.
Predictor of negative treatment outcomes for drug users.
AND Interaction between street drugs and medication.
Self-Help Programs
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A group of individuals who share a common problem behavior.
They learn to accept their problem, share their experiences, strengths, and hopes.
Only requirement for attending is the desire to abstain from the problem behavior.
No “professional” involvement.
Most are based on some adaptation of the 12-step model.
Self-Help Programs (continued)
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Recognized as a potentially cost-effective treatment modality.
Often included in aftercare planning and used as a complement to formal treatment.
Little research on self-help.
Conducted with AA groups.
Evidence that involvement self-help group has a positive effect on recovery.
How Self-Help Works
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Self-help contributes to the reduction of mental health symptoms in five ways: 1. Provides a social network based on commonly shared experience.
2. Facilitates move from help-recipient to helper 3. Specific ways of coping based on experience are shared.
4. Those who cope successfully serve as role models.
5. Provides meaningful structure which is self generated rather than imposed from the outside.
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Traditional Self-Help and the Dually-Diagnosed
“ONE DISEASE-ONE RECOVERY.” Recovery needs which fall within that single parameter are ignored, misunderstood, or stigmatized.
DOUBLE STIGMA = DANGER OF MINIMIZING, OR IGNORING THE “OTHER HALF” of recovery needs.
MISGUIDED ADVICE ABOUT MENTAL DISORDERS AND MEDICATION can lead to non-compliance with medication, increased psychiatric symptoms, and substance abuse relapse.
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Traditional Self-Help and the Dually-Diagnosed
Lack of identification = NO SOCIAL/EMOTIONAL SUPPORT, NO LEARNING/SKILLS DEVELOPMENT, NO DIRECTION OR PERSONAL GUIDANCE
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Individuals with dual recovery needs cannot typically find the HONESTY, ACCEPTANCE, EMOTIONAL SUPPORT AND SHARED EXPERIENCES which are critical elements of mutual aid process in traditional self-help groups
Double Trouble in Recovery (DTR)
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A fellowship of men and women who share their experience, strength, and hope with each other so they may solve their common problems and help others to recover from their particular addiction(s) and mental disorders.
A mutual aid program adapted from 12 step programs Primary purpose is to maintain freedom from addiction(s) and to maintain well-being.
DTR also addresses the problems and benefits of psychiatric medication, thus recognizing that for many, having addiction and mental disorders represents Double Trouble in Recovery.
Double Trouble in Recovery (DTR)
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No dues or fees for DTR membership; DTR is self-supporting through members’ own contributions.
Not affiliated with any sect, denomination, political group, organization or institution.
From the first group in NYC in 1989, DTR is now a nationwide movement. Currently, there are over 100 DTR groups in the US, 40+ in NYC alone.
An average of 15 new groups start each year.
About the Study
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A 3.5 year effectiveness study.
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Funded by the National Institute on Drug Abuse (NIDA).
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Using a 12-month prospective longitudinal cohort of 310 members in 25 peer-led DTR groups in NYC.
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Semi-structured interview protocol
Sociodemographics
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Male Median Age African-American Hispanic Caucasian Other Primary Income:
– Government Assistance – Job – Other
72% 39 years (SD+8.6) 58% 16% 25% 1% 95% 3% 2%
Sociodemographics
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Less than grad/GED HS grad/GED Some college or more Living Arrangements: Own apt/house Community residence/Apt program SRO W/friends/relatives 41% 32% 27% 21% 52% 16% 11%
Other Characteristics
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Ever physically abused Ever sexually abused Legal status: No involvement Probation/parole/pending Seropositive for HIV 91% 48% 36% 7% 6%
Mental Health History
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Age 1st emotional/MH problems Age 1st sought/received help for MH Age 1st diagnosed PRIMARY DIAGNOSIS:
– Schizophrenia – Unipolar (major) depression – Bipolar Disorder – Schizoaffective – Mood Disorder – PTSD
*median 18 yrs* 22 yrs* 30 yrs* 43% 26% 25% 7% 5% 5%
Mental Health: Past Year
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Symptoms past year 70%
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Emotional/mental health past month:
– Very Troubled – Moderately
10% 28%
– Somewhat Troubled – Not at all
38% 24%
Mental Health Treatment
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Ever hospitalized for MH Ever in outpatient treatment Ever on medication for MH
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Median age started medication Currently in outpatient MH/MICA
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Length of current enrollment Currently taking medications for MH *median 89% 97% 100% 24 yrs* 91% 8 mos.
92%
Substance Use History
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Age 1st used drugs/alcohol 1st Substance used:
– Alcohol – Marijuana – Heroin – Crack/cocaine
Why started: Peer pressure/to fit in Primary substance (lifetime):
– Crack/cocaine – Alcohol – Heroin – Marijuana – Other
14 yrs.
65% 23% 4% 3% 63% 42% 34% 11% 10% 3%
Substance Use Past Year
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Past year any drug/alcohol Any drugs Any alcohol Past month any drug/alcohol Any drugs Any alcohol 47% 36% 34% 9% 5% 6%
Substance Abuse Treatment
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Age 1st D&A treatment Ever hospitalized for D&A Ever in outpatient for D&A
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Currently in outpatient for D&A
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Length of current enrollment *median 28 yrs.* 75% 96% 77% 8 mos.*
Association between Mental Health and Substance Abuse
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“Overall, what has caused you the most problems?”
– Substance abuse 29%
− Mental Health 17%
– Both Equally
49% − Not sure 6%
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“When you have symptoms, how much do you feel like using?”
– Very much
44% − A little 14%
– Moderately
17% − Not at all 25%
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When/if using...
– Symptoms get worse – Symptoms get better
69% 16%
– Symptoms stay the same 15%
Self-Help: DTR Attendance
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“Overall, what has caused you the most problems?”
– 1-3 months
12%
– 4-12 months – 1 year or more
25% 64% “When/If you have symptoms, how much do you feel like using?”
– Through a therapist
41%
– Through a friend/assoc – At drug treatment prog.
19% 16% “When/If using...
– Twice a week or more – Once a week – Less than once a week
37% 60% 3%
Self-Help: DTR Attendance
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Length of attendance:
– 1-3 months – 4-12 months – 1 year or more
Frequency of attendance
– Twice a week or more – Once a week – Less than once a week
7% 60% 3% “How did you first hear about DTR?” (Top 3)
– Through a therapist – Through a friend/assoc – At a drug treatment prog.
41% 19% 16%
Self-Help: DTR and Recovery
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Importance of DTR in recovery
– Very important – Moderately – A little/not at all
85% 13% 3%
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Importance of other DTR members in recovery
– Very important – Moderately – A little/not at all
79% 15% 6%
Self-Help: Other 12-Step Groups
• – Currently attending Alcoholics Anonymous – Currently attending Narcotics Anonymous – Speak about MH in AA or NA
73% 64% 49% Reasons for attending other 12-step groups (Top 2)
• – To stay clean and sober/deal w/drug issues51% – To hear other’s stories
18% Reasons for not attending other 12-step meetings (Top 2)
– DTR meets my needs, don’t miss groups. – Don’t feel accepted/comfortable.
32% 17%
Findings: In their own words...
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“Why do you come to DTR?”
– To identify with, relate to other dually diagnosed people 38% – To stay clean and sober 22% – For help, support, acceptance, understanding, and respect
20% “How has coming to DTR affected your life and your recovery?”
– Give me hope, support, encouragement, a new outlook on life
20%
– Better understanding of self, issues, dual-diagnosis 20% – I don’t use, I stay clean and sober, I am restored to sanity
19%
Findings: In their own words..
(Cont)
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“How would your life be different now if you hadn’t come to DTR?”
– I would be using/getting high 32% – I would be confused, lonely, searching for help 16%
“Overall, what has changed in your life since you started attending DTR?”
– Greater self-esteem, respect, acceptance, understand for self
and others 21% Goals and hopes for the next year:
– Vocational/job mentions????
47%
– Housing
30%
– Stay clean and sober – Educational
20% 29%
Recovery Challenges
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As part of it’s effort to educate about dual diagnosis, DTR organized dialogues where consumers and service providers exchange ideas and concerns outside of the therapeutic environment.
One question is: “What has been your most difficult struggle in your recovery from dual-diagnosis?” Proceeds from ten dialogues held in New York State in 1996 and 1997 representing over 200 participants were combined to eliminate redundancy.
The resulting list of 36 items was incorporated into the baseline questionnaire of the study. Specifically, the question was: “Following are issues and situations that people may struggle with during their experience dealing with these issues in recovery.” The answer categories were on a 4 point Likert-type scale: Very difficult to deal with/to do, moderately difficult, a little difficult to deal with, and not at all difficult.
Recovery Challenges: Most Difficult
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Working, finding/keeping job:
– Very difficult • • • •
Dealing with feelings (anger, pain, shame, guilt) Fear of picking up Having money problems Dealing with inner conflicts 46% 46% 44% 41% 39%
Recovery Challenges: Least Difficult
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Accepting a Higher Power Very Difficult
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Following a program such as the 12-steps Not being accepted at other 12-step groups Being open minded, listening Asking/accepting help and support 13% 16% 19% 20% 22%
Conclusion
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Interest in self-help is growing rapidly in the context of managed care health service delivery The single focus (one disease-one recovery) of traditional self help groups is an important part of their appeal to members. However, it often falls short of meeting the needs of those with multiple recovery needs Self-help groups designed to embrace the dually-diagnosed, such as DTR, provides a safe forum where the combination of mutual support and acceptance, honesty, and role modeling creates a feeling of self-confidence and empowerment that is helpful in the struggle for staying clean and taking one’s medications DTR members credit DTR for giving them the ability to stay on the path of their double recovery. “For me, coming to DTR was like coming home.”