Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 Feb 1:135:78-87.
doi: 10.1016/j.drugalcdep.2013.11.012. Epub 2013 Nov 18.

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

Andrew Rosenblum  1 , Harlan Matusow  2 , Chunki Fong  2 , Howard Vogel  3 , Thomas Uttaro  4 , Thomas L Moore  5 , Stephen Magura  6
Affiliations
Randomized Controlled Trial

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

Andrew Rosenblum et al. Drug Alcohol Depend. .

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.

PubMed Disclaimer

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.

Figures

Fig. 1
Fig. 1
Flowchart of participants’ progress through the study.
See this image and copyright information in PMC

References

    1. Alcoholics Anonymous. Alcoholics Anonymous World Services, Inc; New York: 2013. [accessed 10/3/2013]. Twelve Steps and Twelve Traditions. http://www.aa.org/twelveandtwelve/
    1. Alcoholics Anonymous. Comments on AA’s Triennial Surveys. Alcoholics Anonymous World Services, Inc; New York: 1998.
    1. Bogenschutz MP. 12-step approaches for the dually diagnosed: mechanisms of change. Alcohol Clin Exp Res. 2007;31:64–66. - PubMed
    1. Breslin FC, Sobell LC, Sobell MB, Agrawal S. A comparison of a brief and long version of the Situational Confidence Questionnaire. Behav Res Therapy. 2000;38:1211–1220. - PubMed
    1. Carpinello SE, Knight EL, Markowitz FE, Pease EA. The development of the Mental Health Confidence Scale: a measure of self-efficacy in individuals diagnosed with mental disorders. Psychiatr Rehab J. 2000;23:236–243.

Publication types