Efficacy of dual focus mutual aid for persons with mental illness and substance misuse

Abstract

Background: Previous studies have indicated that persons with co-occurring mental health and substance use problems can benefit by attending dual-focus mutual aid groups. However, to date, a trial to test the efficacy of these groups has not been published.

Method: This study randomly assigned 203 substance misusing clients attending a mental health or dual-diagnosis facility to either a dual-focus 12-step group (Double Trouble in Recovery; DTR) or a waiting list control group. Participants were followed for 3-6 months. The primary outcome was substance use (days used in the past 30 with saliva testing to detect under-reporting); secondary outcomes included psychiatric medication adherence, attendance at traditional (single-focus) 12-step meetings (e.g., AA/NA); and improvement in mental health and substance use problems (quality of life). Multilevel model (MLM) regression was used to analyze the nested effect of participants within 8 facilities (7 in New York City and 1 in Michigan). Regression imputation was used to adjust for drug use under-reporting.

Results: At follow-up 79% of the subjects were interviewed. In intent to treat analysis, DTR subjects compared with control subjects used alcohol (p=.03) and any substances (p=.02) on fewer days. DTR compared with control subjects were also more likely to rate themselves as experiencing better mental health and fewer substance use problems (p=.001). There were no effects for DTR on drug use only, medication adherence or NA/AA attendance.

Conclusion: Findings reported in previous studies on the association between exposure to DTR and reductions in substance use were partially supported in this efficacy trial.

Keywords: 12-Step groups; Co-occurring disorders; Dual diagnosis; Mutual aid; Recovery.

Conflict of interest statement

Conflicts of interest

Mr. Vogel is the founder and executive director of Double Trouble in Recovery, Inc; a non-profit organization that has disseminated the DTR model throughout the United States. He also receives royalties from Hazelden Foundation for the sale of DTR documents and CDs. The other authors have no conflicts of interest to disclose.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Figures

Fig. 1

Flowchart of participants’ progress through the study.