life in recovery

Life In Recovery (Part 3)

Posted on by alcoholicsguide

“This story is only starting to be told.

We have much work to do … to challenge the stereotypes of both the general public and our own professionals.

Addiction may well be a chronic, relapsing condition but people can and do recover.

They can change and that change is not only personal but social and societal.”

COMPARISONS:

US & AUSTRALIAN LIVES IN RECOVERY

In the US, a total of 3,228 people completed the online survey and as in the Australian survey just over half of the sample was female.

The samples were also very similar in that the mean length of the substance using career was 18 years in the US and 18.6 years in Australia. The average ages of recovery initiation were also very similar – 34.8 years in Australia and 36 years in the US.

While 75.2% of the US sample described themselves as being ‘in recovery’ and 13.7% as recovered, this was true for 79.8% and 6.3% respectively in Australia.

In terms of problem profile, primary alcohol was the problem for 29% in the US and 35% in Australia, drugs only for 13% in the US and 11% in Australia, and both alcohol and drugs for 57% in the US and 54% in Australia.

In terms of their pathway to recovery, 70.5% of the US sample had received formal treatment, compared to 69.8% in Australia; 94.6% of the US recovery group had attended 12-step meetings compared to 82.0% of the Australian sample. Although a wide range of other mutual aid groups was reported, there was much less frequent use of mutual aid groups other than 12-step in Australia.

There is a higher rate of lifetime mental health problems in Australia – while 62.4% of the US sample had been treated for a mental health condition, 91.5% of the Australian sample reported lifetime mental health problems and 56.8% reported current involvement with mental health services. In the US, 55.6% had a bachelor or graduate degree, while this was true for 41.4% in Australia. At the time of the survey, 70.8% of the US sample was employed compared to 68.2% of the Australian participants. Thus, it is reasonable to conclude that the histories and careers of the Australian sample were very similar to their American counterparts.

THE IMPACT OF RECOVERY IN THE US AND AUSTRALIA

The most dramatic and powerful findings of the US survey, that addiction involves “many heavy costs … to the individual and to the nation” and that “recovery from alcohol and drug problems is associated with dramatic improvements in all areas of life” (FAVOR, 2013, page 1) are clearly replicated in the Australian context.

As in the US, where 4 out of 10 individuals experienced financial problems while in recovery, this was also the case for around one in 3 in Australia who owed back taxes and / or had bad debts. However, there were dramatic effects in Australia as in the US of family functioning with significant reductions in domestic violence.

The Australian study also successfully replicates the US findings around health and criminal justice – with marked improvements in positive health markers such as regular exercise, registering with a GP and regular dental check-ups and significant reductions in negative health factors such as ED attendance and untreated psychological problems.

As in the US sample just over half of the Australian sample had a lifetime arrest history (although significantly fewer Australians in recovery had been incarcerated following sentence), the reduction in arrests and in any involvement with the criminal justice system was even more dramatic – around 40% of the US sample and 90% of the Australian sample had no criminal justice system involvement while in recovery.

There were similarly positive differences in work and study – showing the same overall pattern of reduced burden to the taxpayer and the same improvement in personal, family and community wellbeing and connectedness.

CONCLUSIONS

Similarly, there is a dramatic reduction in involvement with the criminal justice system from around half to less than one in ten, particularly involving the areas of drink-driving and criminal damage. There is also a dramatic improvement in both employment and education, and in successful engagement and retention of jobs. This is a story of overcoming adversity and transforming lives to make a significant and positive contribution in their families, in their communities and to society. These results are consistent with the findings of the US Life in Recovery Survey (Laudet et al, 2013) in showing dramatic reductions in pathology and improvements in wellbeing from active addiction to recovery. This is the first attempt at undertaking a recovery survey in Australia and the results are unequivocal in showing that there is an accessible population of Australians who will classify themselves as being in recovery or recovered and who are willing to complete a survey about their experiences.

There is a critical message here for policy makers and treatment providers – that people in Australia can and do recover from addiction problems.

However, there are two nuanced factors that are important to emphasise.

The first is that this is a long and challenging journey for many people and that there will still be residual and ongoing problems for many throughout the recovery journey.

However, there are two nuanced factors that are important to emphasise. The first is that this is a long and challenging journey for many people and that there will still be residual and ongoing problems for many throughout the recovery journey

The findings also emphasise the fact that those in recovery are a very diverse population and that there is no single road to recovery, with a proportion of those participating describing themselves as in ‘medication-assisted recovery’ and a much larger population having ongoing contact with specialist services for addiction or mental health issues.

Nonetheless, the transition reported from active addiction to recovery is a dramatic one.

This is particularly striking in key areas around social and family functioning where the rate of involvement in domestic violence decreased from more than 50% to less than 10% and in volunteering where participation increased from less than 20% to more than 50%.

Similarly, there is a dramatic reduction in involvement with the criminal justice system from around half to less than one in ten, particularly involving the areas of drink-driving and criminal damage. There is also a dramatic improvement in both employment and education, and in successful engagement and retention of jobs.

This is a story of overcoming adversity and transforming lives to make a significant and positive contribution in their families, in their communities and to society.

These results are consistent with the findings of the US Life in Recovery Survey (Laudet et al, 2013) in showing dramatic reductions in pathology and improvements in wellbeing from active addiction to recovery

Those in recovery for the longest term report markedly higher levels of psychological wellbeing and quality of life and much lower levels of need for professional support for emotional or mental health issues.

The other more surprising domain of consistency with the US results is around the demographics and career factors of those who took part. Average age at time of survey completion, average duration of recovery and average length of addiction career are all markedly similar across two countries with differing cultures, treatment systems and philosophies around addiction and recovery.

RECOMMENDATIONS

POLICY RECOMMENDATIONS

It is critical that the implications from the Australian Life in Recovery survey are acknowledged and addressed at a federal, state and local level to ensure that the achievement of recovery is extended across families, communities and professional settings (such as health and legal systems).

As such, the following policy recommendations are suggested for consideration:

1. Policy makers should acknowledge and recognise in drug and alcohol commissioning the key role that recovery organisations play in the initiation and sustaining of recovery journeys that benefit wider society and challenge stereotypes and stigma around addiction

2. Greater policy and funding commitment to recovery support services to ensure that those who initiate recovery journeys are supported to maximise their own wellbeing and their contributions to family and community

3. That greater funding is provided for alumni and aftercare organisations to enable the informal community support that is essential to build recovery capital and recovery communities

This story is only starting to be told.

We have much work to do – and we hope to do this through academic publications and presentations – to challenge the stereotypes of both the general public and our own professionals.

There is one core message that the data presented here in Australia and by FAVOR in the US

Addiction may well be a chronic, relapsing condition but people can and do recover.

They can change and that change is not only personal but social and societal.

The next step on this journey is to repeat and augment this work. At the date of publication this survey has already been approved and will be conducted in the UK and we we await the survey outcomes with great interest.

This survey has already followed in the footsteps of the FAVOR survey with almost no resources and supports and we should aim both to do this in more countries and to continue to repeat the surveying to allow us to map global changes and implications in recovery pathways (see final recommendations below).

LIFE IN RECOVERY SURVEY RECOMMENDATIONS

1. That the ‘Life in Recovery survey’ is undertaken in other countries to increase the comparability and so that a shared evidence base can be generated.

2. That repeat surveys are undertaken in Australia to assess change in the nature of the recovering population and in the journeys and stories they provide.

3. That the results from this survey are widely distributed and used to contribute to the policy debate about recovery in Australia.

4. That the results from the current survey are used for academic journal publications to augment the empirical evidence base around recovery.

http://www.southpacificprivate.com.au/sites/default/files/2015%20Australian%20Life%20In%20Recovery%20Survey.pdf

 

Life In Recovery – Australia (Part 2)

Posted on by alcoholicsguide

“After over five years of intermittent relapses and struggling to re-invent myself, I can safely say that I feel at ease in my own company for the first time in my life. I trust that I will do the right thing by myself and my family”.

 

“…all levels of government need to stop focusing on the policing of drug use and distribution, and invest more in recovery services.

That would slash health care, child care and criminal justice system costs racked up by addicts, while drastically cutting crime rates and creating more valuable contributors to society, the Life in Recovery report says.

The survey, by the South Pacific Private and Turning Point treatment centres, suggests addicts in recovery are 75 per cent less likely to drive while under the influence, 50 per cent less likely to get arrested and 40 per cent less likely to perpetrate or be a victim of family violence.

They’re also 40 per cent more likely to volunteer in a community group, and tend to make more significant contributions to the community than the average person, according to the report’s author, Associate Professor David Best.

Government funding is provided for detox services but virtually no money is spent on the difficult recovery process that follows, despite relapse rates of between 50 and 70 per cent in the first year of recovery, he said.

The focus needs to switch to funding support groups and programs that help addicts get back on their feet, like finding jobs and accommodation, he said.

“None of the treatment services are sufficiently well-funded but the complete neglect of after care and recovery services is both inconsistent with the evidence and counter-productive, because it just puts people into this spiral of relapse,” Prof Best said.

from

http://www.sbs.com.au/news/article/2015/05/05/govt-policy-addicts-wrong-report

reported in

http://www.southpacificprivate.com.au/Life-in-Recovery-Survey-first-of-its-kind

Infographic  of some of the Survey Findings

 

 

 

RECOVERY STATUS There was considerable variation in how people described their recovery:

• 79.8% described themselves as ‘in recovery’

• 6.3% described themselves as ‘recovered’

• 4.5% described themselves as in ‘medication-assisted recovery’

• 3.7% reported that ‘they used to have an AOD problem but don’t any more’

• 5.7% used other ways of describing themselves

Thus, for the vast majority of participants, recovery is seen as an ongoing process.

The majority (69.8%) reported that they had accessed alcohol and other drug (AOD) treatment services meaning that 30.2% had never done so. Of those who had, 36.6% had taken medications prescribed by a health care professional to help them deal with their drug and alcohol problems.

At the time of the survey, 41 individuals (7.2% of the total sample), were currently receiving prescribed medication to deal with their drug and alcohol problems.

A higher proportion (82.0%) had attended a 12-step meeting, with 68.8% attending 12-step meetings at the time of the survey. Current 12-step group attendance involved Alcoholics Anonymous for 57.1% of the sample, Narcotics Anonymous for 24.6%, Gamblers Anonymous for 2.3% and Crystal Meth Anonymous for 1.0%.

11.3% were currently attending Al-Anon (as a loved one or family member) and 6.8% reported that they were currently attending other 12-step groups that included Sex and Love Addicts Anonymous, Overeaters Anonymous, GROW (for co-morbid alcohol and mental health problems) and Adult Children of Alcoholics. SMART Recovery was being attended by 0.5% of the survey participants.

 

1. FINANCES

Changes in financial situation from active addiction to recovery There were marked improvements in paying bills on time, in having your own place to live, in having a good credit rating and paying taxes from when participants were in active addiction to when they were in recovery.

WELLBEING & LIFE

2. FAMILY AND SOCIAL LIFE

…  there were marked reductions in the experience of family violence from around half of the participants during active addiction to less than 10% in recovery, that were accompanied by positive improvements in participation in family activities and planning for the future. There was also a clear improvement in children returning from care and a massive increase in participation of community and civic groups.

3. HEALTH

There are marked differences in health functioning as reported by participants with clear improvements in a range of self-care activities – improved engagement with GPs, regular dental check-ups, improved diet and nutrition and regular exercise. At the same time there is a clear reduction in health service utilisation indicated by marked reductions in the frequency of use of healthcare services and emergency department attendance and improvements in the rate of smoking. There is also a significant reduction in experiencing mental health side effects.

4. LEGAL ISSUES

Changes from active addiction to recovery in offending and criminal justice system involvement There are very striking transitions in involvement with the criminal justice system and overall offending with the most marked transition from 82.9% reporting driving under the influence while in active addiction to fewer than 5% while in recovery. Likewise, while more than half of the sample had been arrested in active addiction, this dropped to around 2% in recovery, leading to significant reductions in family disruption as well as significantly reduced costs to society. This is also reflected in the more than 90% reduction in imprisonment from active addiction to recovery, while there were considerable improvements in re-obtaining both professional registration and the right to drive once in recovery.

5. WORK AND STUDY

Missing work and being fired or suspended, which had been frequent occurrences in active addiction, were extremely uncommon in recovery, as was dropping out of school and university. In contrast, there were clear improvements in positive job appraisals, in further education and in remaining in steady employment.

 

THE SOCIAL NETWORKS AND SOCIAL IDENTITIES OF ACTIVE ADDICTS AND PEOPLE IN RECOVERY

Here the position is even more dramatic with the vast majority of participants reporting no contact with people in recovery while they were active addicts, but that this situation is reversed to the extent that 36% of people in recovery have a social network made up only of people in recovery.

This is reflected in ‘qualitative social capital’ – in other words the number of people individuals can rely on. At the peak of their addiction, 38.3% of participants reported that they had nobody they could discuss important things with compared to 2.0% who reported the same in their recovery. By contrast, while 8.6% of participants reported that they had four or more people they could discuss important things with in active addiction, this increased to 65.9% in their recovery. This is reflected in changes in social group membership – a proxy for connectedness and wellbeing.

…our participants’ social identification with addiction had not diminished but their social identification with recovery had grown enormously.

 

PERSONAL ACCOUNTS OF RECOVERY

THE EXPERIENCE OF ADDICTION

he pain and trauma of addiction is clearly illustrated in the reports of participants. Active addiction is seen as having destroyed the person’s own lives and taken many of the lives of their peers.

“Active addiction completely destroyed any semblance of normality in my life. Everything was reduced to absolutes: the need to get drugs so I could not feel sick, and the use of drugs to numb any emotional or physical pain”.

“Ruined my life in all areas, physically, mentally, emotionally and spiritually”

“I am alive, none of my peers from that time are alive. Only 5 of the 33 people I was in rehab with are still alive”.

THE JOURNEY TO RECOVERY

This journey is not perceived as a quick or easy journey by most of the participants. Many recognised that they have had persistent problems long into their abstinence. However, for most people it is a generally positive transition.

“After over five years of intermittent relapses and struggling to re-invent myself, I can safely say that I feel at ease in my own company for the first time in my life. I trust that I will do the right thing by myself and my family”.

 

“Addiction was part of my journey, I don’t regret it but recovery is so much more comfortable”.

THE EXPERIENCE OF BEING IN RECOVERY

Building on the previous section, this was generally very positive and the following examples illustrate the perceived benefits. Many people spoke of what they had achieved since starting their recovery journey.

“I am a productive member of society today: a good partner, parent, employee, daughter, sibling and friend, and I was not any of those things before”

“I experience long periods of peace of mind. I can manage problems really well. I am less inclined to react negatively to adverse events. I have recovered from Hepatitis C. I have deep and meaningful relationships with friends and family. I feel a wide range of emotions and can (mostly) sit with them. I have experienced 15 years of being engaged with and liked by the community instead of being a pest to society and that is absolute gold”.

POSITIVE ROLE OF TREATMENT OR MUTUAL AID

There were a striking number of comments supportive of 12-step groups, as illustrated by the following:

“AA saved my life because I gradually changed and got my self-respect back”

“AA saved my life; I would be dead without AA”

“I have a brand new life thanks to AA. For me, my children and my grandchildren. I am responsible at work and pay my bills”

“In nearly 30 years I have literally witnessed many hundreds of people turn their lives around from chaos and mayhem to lead similarly fruitful lives to the one I live today, overwhelmingly through the agency of their involvement in 12 step programs”

“I could not stop drinking on my own. AA has shown me a new way of living. Life is not perfect but I can now live like a ‘normal’ person. I have self-respect and dignity and I am a good worker and mother”

COMBINED APPROACHES Furthermore, as is consistent with the literature, a number of respondents talked about the benefits of bespoke and blended support from both mutual aid groups and professional treatment services.

“I am an active participant in the AA program – the 12 steps are my program for recovery. Putting the 12 steps in my life and putting the skills I learned at South Pacific Private into my life have given me a life that is full of understanding, patience, great relationships and love”.

“Detox set me on the path to recovery and AA helped me to sustain my recovery”, while a third respondent reported that “recovery through detox, rehab clinic, 12 step program with AA has completely changed my life and my attitude to life. I feel free and have choices and I am happy for the first time in years”

The overall conclusion by the majority of participants is that recovery is experienced as liberation and is an opportunity not just for a normal life but a meaningful and fulfilling one. That does not mean recovery is without regrets or without problems :

“My addiction was hell, my recovery has been amazing. I will be forever grateful for the second chance I was given. It took a long time to feel a part of the world when coming out of addiction. It was so hard to fit in with a world I felt so uncomfortable in. But now I love every day. I suffer with depression, and it has been harder than active addiction was but it is in remission and I have learned to live with it. My children are my greatest blessing and I have been able to break the cycle”.

 

Life in Recovery Survey for the UK

Posted on by alcoholicsguide

UNDERSTANDING RECOVERY GREATLY HELPS WITH REDUCING THE STIGMA ATTACHED WITH SUFFERING FROM AN ADDICTIVE DISORDER. PLEASE HELP?

If you live in the UK, are in recovery and have 20 minutes to fill in this very worthwhile survey you can make a difference to how we, as a society, perceive recovery and help reduce the stigma surrounding addiction at the same time.

The survey will be open until the 30th June 2015.

The first ever survey in the UK into Life in Recovery is in process – please click this link and contribute if you can?

https://www.surveymonkey.com/r/?sm=XAVi2JPeWMQ%2fNYEBCJ%2bVdFpgF4FXHFDp%2fkW51R%2bLCKA%3d

 

Life in Recovery Survey UK 2015

Again, the survey will be open until the 30th June 2015.

Understanding recovery and the process of recovery greatly helps with reducing the stigma attached with suffering from an addictive disorder. It also instills hope that you too can recover!

Please help?

We do recover!!

Let’s show the world how?

 

Life In Recovery Surveys – Australia, USA and the UK

Posted on by alcoholicsguide

“Recovery introduced me to myself. The hardest but most rewarding journey I have ever undertaken.”

Recovery from alcohol and drug addiction is now widely recognised as a journey that takes place over time and in a multitude of ways that reflect personal circumstances, supports and resources.”

interior

The Australian Life in Recovery Survey, conducted by Professor David Best of Sheffield Hallam University and Turning Point in partnership with South Pacific Private, is the largest survey of its kind in Australia.

This survey provides an important first glimpse into the lives of people in recovery through comparisons of key domains of life and wellbeing during active addiction and after seeking recovery.

Additionally, comparisons are drawn to the U.S. version of the survey sponsored by Faces & Voices of Recovery. Just click image below for the findings.

 

The first ever survey in the UK into Life in Recovery is also in the process – please click this link and contribute if you can?

http://www.sheffieldalcoholsupportservice.org.uk/sass/news-and-features/item/283-life-in-recovery-survey-uk-2015

 

Understanding recovery greatly helps with reducing the stigma attached with suffering from an addictive disorder. Please help?

The survey will be open until the 30th June 2015.

 

Life in Recovery Survey UK 2015

 

Please click to refer to the infographic of and the introduction to the survey results from the Australian survey.

https://magic.piktochart.com/embed/6227462-rri-life-in-recovery-australia?wmode=transparent

and click here for the findings and report –

http://www.recoveryanswers.org/blog/life-in-recovery-a-survey-from-australia/

Part 1

WHO WERE THE PARTICIPANTS?

Just over half of those who participated were female (54.6%), and the average age of participants was 43.6 years (although the range was from 15 to 76 years). The vast majority of participants lived in Australia (97.3%) although small numbers of participants completed the survey who lived in the US, Europe, Indonesia and South Africa.

Participants were educated to varying degrees – just over 40% had a university qualification. Occupational status varied markedly across the group with just under half (44.6%) employed full time, 19.8% employed part-time, 5.8% self-employed and 5.4% students. In other words, 75.6% were involved in employment or education with the remainder retired (5.6%), involved in home duties (3.2%) and unemployed or on disability support pension (15.7%).

 

LIFE HISTORIES

Participants were asked about their primary addiction – for 35.3% this was alcohol only

for 11.1% it was drugs only

and for 53.6% it was both drugs and alcohol.

Nonetheless, the primary problem substance was predominantly alcohol (for 66.0% of participants)

followed by heroin and other opiates (14.1%),

methamphetamines (4.2%),

cannabis (3.7%),

cocaine (2.9%),

other amphetamine type substances (1.9%)

and pharmaceutical opioids (1.9%).

Participants had typically experienced lengthy addiction careers – reporting an average of 18.6 years of AOD use (ranging from 1 to 47 years) and an average of 12.5 years of active addiction (ranging from 1 to 47 years).

There was a significant rate of adverse life events reported across the participants with 91.5% reporting life time mental health challenges and 56.8% reporting some current involvement in mental health treatment.

In contrast, current wellbeing was rated positively on the three wellbeing scales…

What this means is that participants were generally in a positive space although some participants had poor wellbeing across all three indicators.

At the time of the interview, 298 participants (52.0% of the overall sample) were receiving help or treatment for mental health problems.

What is clear is that this diminishes over time – while 86.1% of those in the first three years of recovery are receiving some form of help or treatment for emotional or mental health problems, this is the case for 58.0% of those between three and ten years in recovery and 33.5% of those more than ten years into their recovery journeys.”

To be continued…

Impulsivity is an Independent Predictor of 15-Year Mortality Risk among Individuals Seeking Help for Alcohol-Related Problems

Posted on by alcoholicsguide

In yesterday’s blog we looked at how AA membership and the 12 step program of recovery helped reduce impulsivity in recovering alcoholics.

We mentioned also that impulsivity was present as a pathomechanism of alcoholism from vulnerability in “at risk” children from families, were there was a history of alcoholism, right the way through to recovering alcoholics in long term recovery (i.e. many years of recovery).

We cited and used excerpts from a study written by the same authors as the study we cite now (1).

This study shows and highlights how, if untreated, by recovery programs such as AA’s 12 steps, that “trait” impulsivity can lead to increased mortality in alcoholics.

This study interestingly shows there is a difference from “state-like” impulsivity in early recovery when recovering people are still distressed and “trait-like” which is after Year 1 of recovery when some of the severity of withdrawal from alcohol has long since abated and some recovery tools have been learnt.

The fact that this impulsivity continues to contribute to relapse and mortality may suggest it is a trait state in alcoholics and possibly a vulnerability to later alcoholism also.

In effect, it illustrates the role impulsivity plays as a pathomechanism in alcoholism, i.e. it is a psychological mechanism that drives addiction and alcoholism forward to it’s chronic endpoint.

Again research shows us how we can learn about a pathology from the recovery from it!

 

impulse control.preview

“Abstract

Background

Although past research has found impulsivity to be a significant predictor of mortality, no studies have tested this association in samples of individuals with alcohol-related problems or examined moderation of this effect via socio-contextual processes. The current study addressed these issues in a mixed-gender sample of individuals seeking help for alcohol-related problems.

Results

…higher impulsivity at baseline was associated with an increased risk of mortality from Years 1 to 16; higher impulsivity at Year 1 was associated with an increased risk of mortality from Years 1 to 16, and remained significant when accounting for the severity of alcohol use, as well as physical health problems, emotional discharge coping, and interpersonal stress and support at Year 1. In addition, the association between Year 1 impulsivity and 15-year mortality risk was moderated by interpersonal support at Year 1, such that individuals high on impulsivity had a lower mortality risk when peer/friend support was high than when it was low.

Conclusions

The findings highlight impulsivity as a robust and independent predictor of mortality.

Introduction

…personality traits related to impulsivity (e.g., low conscientiousness) have been identified as significant predictors of poor health-related outcomes including mortality (Bogg and Roberts, 2004; Roberts et al., 2007). Although there is a well-established association between disinhibitory traits and alcohol use disorders (AUDs) (Labouvie and McGee, 1986; McGue et al., 1999;Sher et al., 2000), to our knowledge, no studies have tested these traits as predictors of mortality among individuals with alcohol-related problems or examined moderation of this effect via socio-contextual processes.

Predictors of Mortality Risk among Individuals with Alcohol Use Disorders

Relative to the general population, individuals with AUDs are more likely to die prematurely (Finney et al., 1999; Johnson et al., 2005; Valliant, 1996). Accordingly, several longitudinal studies have aimed to identify the most salient risk factors for mortality in this population (for a review, see Liskow et al., 2000)

…more reliance on avoidance coping, less social support, and more stress from interpersonal relationships increase the risk of mortality among individuals with AUDs (Finney and Moos, 1992; Holahan et al., 2010; Mertens et al., 1996; Moos et al., 1990).

Impulsivity and Risk for Mortality: Relevance for Individuals with Alcohol Use Disorders

Despite the litany of variables that have been examined as predictors of mortality among individuals with AUDs, tests of the significance of individual differences in personality are noticeably absent from this literature. In the clinical and health psychology literatures, however, personality traits have long been identified as possible risk factors for mortality (Friedman and Rosenman, 1959), with low conscientiousness emerging as one of the most consistent, trait-based predictors of poor health and reduced longevity (Kern and Friedman, 2008; Roberts et al., 2007). Conscientiousness is a broad domain of personality reflecting individual differences in the propensity to control one’s impulses, be planful, and adhere to socially-prescribed norms (John et al., 2008).

(previously) no studies in this literature have tested impulsivity as an independent predictor of mortality in a sample of individuals with alcohol-related problems. This is a surprising omission, given that impulsivity is a well-established risk factor for alcohol misuse (Elkins et al., 2006; McGue et al., 1999; Sher et al., 2000) and therefore may be an especially potent predictor of mortality among individuals with AUDs. Furthermore, the role of impulsivity as an independent predictor of mortality risk among individuals with AUDs is relevant from the standpoint of the stage of the alcohol recovery process.

Thus, we sought to examine the impulsivity-mortality link at baseline and one year after participants had initiated help-seeking for their alcohol use problems. At baseline, participants were in a state of distress due to their problematic alcohol use, whereas at Year 1 most participants had obtained help for their alcohol-related problems and reduced their drinking (Finney and Moos, 1995).

Given prior research on acute clinical states and self-report assessments of personality (e.g., Brown et al., 1991; Peselow et al., 1994;Reich et al., 1987), we hypothesized that individuals’ self-reports of impulsivity at Year 1 would be less a reflection of their alcohol problems – and therefore more likely to be independently linked to mortality risk – than their reports at baseline, which may be more closely associated with concurrent alcohol use and problems (i.e., state effects).

Discussion

…impulsivity at baseline was a significant predictor of mortality risk from Years 1 to 16; however, this effect was accounted for by the severity of alcohol use at baseline. In contrast, impulsivity at Year 1 was associated with an increased risk of mortality over the subsequent 15 years…

In addition, a significant interaction was observed between impulsivity and peer/friend support at Year 1, which suggested that, among individuals high on impulsivity, the mortality risk may be reduced for those high on support from peers/friends. Collectively, these findings highlight impulsivity as an independent risk factor for mortality in AUD samples…

…It is also conceivable that, given participants were in a state of crisis at baseline, their reports of their impulsive tendencies at that time partly captured “state” effects (e.g., psychiatric distress from concurrent substance use; withdrawal symptoms) and therefore were less an indication of their typical or “characterological” pattern of impulsivity, independent of alcohol use. However, at Year 1, most participants had reduced their drinking and were not in a state of crisis; thus, their reports at that time may have been a better reflection of their “trait-like” pattern of impulsivity, which in turn may be a more robust independent predictor of long-term outcomes such as mortality. Accordingly, future studies that seek to test impulsivity as an independent predictor of mortality among individuals with AUDs should consider the stage of the alcohol recovery process.

Moderation of the Impulsivity-Mortality Link via the Social Context

The results of the moderator analyses suggest that the effects of impulsivity on mortality may become manifest through interactions between traits and socio-contextual process (Friedman, 2000). That is, the dire effects of impulsivity on risk for mortality may not reach fruition for individuals who are able to maintain a strong peer support network. Conceivably, by virtue of their strong bond with a high-risk individual, such peers may have sufficient leverage to discourage expression of the individual’s impulsive tendencies and encourage consideration of the long-term consequences of his/her actions.

Such a perspective is consistent with evidence from the AUD treatment-outcome literature that social support networks are a key mechanism by which Alcoholics Anonymous (AA) and other psychosocial treatments can improve long-term drinking-related outcomes (Humphreys and Noke, 1997; Kaskutas et al., 2002).

Furthermore, from the standpoint of treatment, the present findings suggest that interventions for AUDs may benefit from an ecological perspective that considers the contexts in which dispositional tendencies, such as impulsivity, become expressed in individuals’ everyday lives. Notably, based on prior work with this sample, longer duration in AA and alcohol treatment was associated with a decline in impulsivity (Blonigen et al., 2009). In combination with the present findings, it appears that formal and informal help for AUDs may include “active ingredients” that can help curtail expression of impulsive tendencies (e.g., social integration, peer bonding; Moos, 2007,2008) and buffer the otherwise deleterious impact of such tendencies on health and longevity.

References

1. Blonigen, D. M., Timko, C., Moos, B. S., & Moos, R. H. (2011). Impulsivity is an Independent Predictor of 15-Year Mortality Risk among Individuals Seeking Help for Alcohol-Related Problems. Alcoholism, Clinical and Experimental Research, 35(11), 2082–2092. doi:10.1111/j.1530-0277.2011.01560.x

Alcoholics Anonymous and Reduced Impulsivity: A Novel Mechanism of Change

Posted on by alcoholicsguide

Impulsivity or lack of behaviour inhibition, especially when distressed, is one psychological mechanisms which is implicated in all addictive behaviour from substance addiction to behaviour addiction.

It is, in my view, linked to the impaired emotion processing as I have elucidated upon in various blogs on this site.

This impulsivity is present for example in those vulnerable to later alcoholism, i.e. sons and daughters of alcoholic parents or children  from a family that has a relatively high or concentrated density of alcoholics in the family history, right through to old timers, people who have decades of recovery from alcoholism.

It is an ever present and as a result part of a pathomechanism of alcoholism, that is it is fundamental to driving alcoholism to it’s chronic endpoint.

It partly drives addiction via it’s impact on decision making – research shows people of varying addictive behaviours choose now over later, even if it is a smaller short term gain over a greater long term gain. We seem to react to relieve a distress signal in the brain rather than in response to considering and evaluating the long term consequences of a decision or act.

No doubt this improves in recovery as it has with me. Nonetheless, this tendency for rash action with limited consideration of long term consequence is clearly a part of the addictive profile. Not only do we choose now over then, we appear to have an intolerance of uncertainty, which means we have difficulties coping with uncertain outcomes. In other words we struggle with things in the future particularly if they are worrying or concerning things, like a day in court etc. The future can continually intrude into the present. A thought becomes a near certain action, again similar to the though-action fusion of obsessive compulsive disorder. It is as if the thought and possible future action are almost fused, as if they are happening in unison.

Although simple, less worrying events can also make me struggle with leaving the future to the future instead of endless and fruitlessly ruminating about it in the now. In early recovery  especially I found that I had real difficulty dealing with the uncertainty of future events and always thought they would turn out bad. It is akin to catastrophic thinking.

If a thought of a drink entered into my head it was so distressing, almost as if I was being dragged by some invisible magnet to the nearest bar. It was horrendous. Fortunately I created my own thought action fusion to oppose this.

Any time I felt this distressing lure of the bar like some unavoidable siren call of alcohol I would turn that thought into the action of ringing my sponsor. This is why sponsees should ring sponsors about whatever, whenever in order to habitualize these responses to counteract the automatic responses of the addicted brain.

I think it is again based on an inherent emotion dysregulation. Obsessive thoughts are linked to emotion dysregulation.

My emotions can still sometimes control me and not the other way around.

Apparently we need to recruit the frontal part of the brain to regulate these emotions and this is the area most damaged by chronic alcohol consumption.

As a result we find it difficult to recruit this brain area which not only helps regulate emotion but is instrumental in making reflective, evaluative decisions about future, more long term consequence. As a result addicts of all types appear to use a “bottom up” sub-cortical part of the brain centred on the amgydala region to make responses to decisions instead of a “top down” more cortical part of the brain to make evaluative decisions.

We thus react, and rashly act to relieve the distress of undifferentiated emotions, the result of unprocessed emotion rather than using processed emotions to recruit the more cortical parts of the brain.

Who would have though emotions were so instrumental in us making decisions? Two parts of the brain that hold emotions in check so that they can be used to serve goal directed behaviour are the orbitofrontal cortex and the ventromedial prefrontal cortex.

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These areas also keep amgydaloid responding in check. Unfortunately these two areas are impaired in alcoholics and other addictive behaviours so their influence on and regulation of the amgydala is also impaired.

This means the sub cortical areas of the amgydala and related regions are over active and prompt not a goal directed response to decision making but a “fight or flight” response to alleviate distress and not facilitate goal directed behaviour.

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Sorry for so much detail. I have read so much about medication recently which does this or that to reduce craving or to control  drinking but what about the underlying conditions of alcoholism and addictive behaviour? These are rarely mentioned or considered at all.

 

We always in recovery have to deal with alcoholism not just it’s symptomatic manifestation of that which is chronic alcohol consumption. This is a relatively simple point and observation that somehow alludes academics, researchers and so-called commentators on this fascinating subject.

Anyway that is some background to this study which demonstrates that long term AA membership can reduce this impulsivity and perhaps adds validity to the above arguments that improved behaviour inhibition and reducing impulsivity is a very possible mechanism of change brought about by AA membership and the 12 step recovery program.

It shows how we can learn about a pathology from the recovery from it!

Indeed when one looks back at one’s step 4 and 5 how many times was this distress based impulsivity the real reason for “stepping on the toes of others” and for their retaliation?

Were we not partly dominated by the world because we could not keep ourselves in check? Didn’t all our decisions get us to AA because they were inherently based on a decision making weakness? Isn’t this why it is always useful to have a sponsor, someone to discuss possible decisions with?

Weren’t we out of control, regardless of alcohol or substance or behaviour addiction? Isn’t this at the heart of our unmanageability?

I think we can all see how we still are effected by a tendency not to think things through and to act rashly.

The trouble it has caused is quite staggeringly really?

Again we cite a study (1) which has Rudolf H. Moos as a co-author. Moos has authored and co-authored a numbered of fine papers on the effectiveness of AA and is a rationale beacon in a sea of sometimes quite controversial and ignorant studies on AA, and alcoholism in general.

“Abstract

Reduced impulsivity is a novel, yet plausible, mechanism of change associated with the salutary effects of Alcoholics Anonymous (AA). Here, we review our work on links between AA attendance and reduced impulsivity using a 16-year prospective study of men and women with alcohol use disorders (AUD) who were initially untreated for their drinking problems. Across the study period, there were significant mean-level decreases in impulsivity, and longer AA duration was associated with reductions in impulsivity…

Among individuals with alcohol use disorders (AUD), Alcoholics Anonymous (AA) is linked to improved functioning across a number of domains [1, 2]. As the evidence for the effectiveness of AA has accumulated, so too have efforts to identify the mechanisms of change associated with participation in this mutual-help group [3]. To our knowledge, however, there have been no efforts to examine links between AA and reductions in impulsivity-a dimension of personality marked by deficits in self-control and self-regulation, and tendencies to take risks and respond to stimuli with minimal forethought.

In this article, we discuss the conceptual rationale for reduced impulsivity as a mechanism of change associated with AA, review our research on links between AA and reduced impulsivity, and discuss potential implications of the findings for future research on AA and, more broadly, interventions for individuals with AUD.

Impulsivity and related traits of disinhibition are core risk factors for AUD [5, 6]. In cross-sectional research, impulsivity is typically higher among individuals in AUD treatment than among those in the general population [7] and, in prospective studies, impulse control deficits tend to predate the onset of drinking problems [8–11]

Although traditionally viewed as static variables, contemporary research has revealed that traits such as impulsivity can change over time [17]. For example, traits related to impulsivity exhibit significant mean- and individual-level decreases over the lifespan [18], as do symptoms of personality disorders that include impulsivity as an essential feature [21, 22]. Moreover, entry into social roles that press for increased responsibility and self-control predict decreases in impulsivity [16, 23, 24]. Hence, individual levels of impulsivity can be modified by systematic changes in one’s life circumstances [25].

Substance use-focused mutual-help groups may promote such changes, given that they seek to bolster self-efficacy and coping skills aimed at controlling substance use, encourage members to be more structured in their daily lives, and target deficits in self-regulation [26]. Such “active ingredients” may curb the immediate self-gratification characteristic of disinhibition and provide the conceptual grounds to expect that AA participation can press for a reduction in impulsive inclinations.

…the idea of reduced impulsivity as a mechanism of change…it is consistent with contemporary definitions of recovery from substance use disorders that emphasize improved citizenship and global health [31], AA’s vision of recovery as a broad transformation of character [32], and efforts to explore individual differences in emotional and behavioral functioning as potential mechanisms of change (e.g., negative affect [33,34]).

Several findings are notable from our research on associations between AA attendance and reduced impulsivity. First, consistent with the idea of impulsivity as a dynamic construct [18, 19], mean-levels of impulsivity decreased significantly in our AUD sample. Second, consistent with the notion that impulsivity can be modified by contextual factors [25], individuals who participated in AA longer tended to show larger decreases in impulsivity across all assessment intervals.

References

Blonigen, D. M., Timko, C., & Moos, R. H. (2013). Alcoholics anonymous and reduced impulsivity: a novel mechanism of change. Substance abuse, 34(1), 4-12.

Life in Recovery

Posted on by alcoholicsguide

The cost of addiction and the benefits of recovery are clearly illustrated in this survey from last year.

“Faces & Voices first-ever nationwide survey of persons in recovery from addiction to alcohol and other drugs was conducted by Alexandre Laudet, PhD.  The survey documented dramatic improvements in all areas of life for people in recovery from addiction and documents the heavy costs of addiction.

During their active addiction, 50 percent of respondents had been fired or suspended once or more from jobs, 50 percent had been arrested at least once and a third had been incarcerated at least once…

The dramatic improvements associated with recovery affected all areas of life including a 50 percent increase in participation in family activities and in paying taxes compared with their lives in active addiction.

Well the many costs of active addition are well documented, very little is known about the changes in key life areas as a function of entering and sustaining recovery, or when they occur. The survey measures and quantifies the recovery experience over time — less than 3 years; 3 to 10 years; and 10 years or more.

ADDICTION RECOVERY IS ASSOCIATED WITH DRAMATIC IMPROVEMENTS IN ALL AREAS OF LIFE

  • Involvement in illegal acts and involvement with the criminal justice system (e.g., arrests, incarceration ) decreases by about ten-fold
  • Steady employment in addiction recovery increases by over 50% greater relative to active addiction
  • Frequent use of costly Emergency Room departments decreases ten-fold
  • Paying bills on time and paying back personal debt doubles
  • Planning for the future (e.g., saving for retirement) increases nearly three-fold
  • Involvement in domestic violence (as victim or perpetrator) decreases dramatically
  • Participation in family activities increases by 50%
  • Volunteering in the community increases nearly three-fold compared to in active addiction
  • Voting increases significantly
  • Reports of untreated emotional/mental health problems decrease over four-fold
  • Twice as many participants further their education or training than in active addiction

 

THE BENEFITS OF ADDICTION RECOVERY OVER TIME

  • The percentage of people owing back taxes decreases as recovery gets longer while a greater number of people in longer recovery report paying taxes, having good credit, making financial plans for the future and paying back debts.
  • Civic involvement increases dramatically as recovery progresses in such areas as voting and volunteering in the community
  • People increasingly engage in healthy behaviors such as taking care of their health, having a healthy diet, getting regular exercise and dental checkups, as recovery progresses
  • As recovery duration increases, a greater number of people go back to school or get additional job training
  • Rates of steady employment increase gradually as recovery duration increases
  • More and more people start their own business as recovery duration increases
  • Participation in family activities increases from 68% to 95%.

ABOUT THE SURVEY

The online survey was developed, conducted and analyzed in collaboration with Alexandre Laudet, Ph.D., Director of the Center for the Study of Addictions and Recovery at the National Development and Research Institutes, Inc.  It was conducted between November 1 and December 31, 2012 and collected information on 3,228 participants’ sociodemographics, physical/mental health, substance use, and recovery history, and 44 items representing experiences and indices of functioning in work, finances, legal, family, social and citizenship domains…”

This survey help us see that recovery studies help us a societies to look beyond the illness to the recovery of the illness. It helps change our views.There is active addiction and recovery from addiction. We need to keep doing research into this wonderful new world of recovery.

It all helps de-stigmatise this condition so that many more can join us on the road to recovery.

I am not just the disease of addiction, I am the recovery from it.  

Reference

http://www.facesandvoicesofrecovery.org/resources/life-recovery-survey