Seeking Safety + 12 Step Facilitation = good outcomes

The Journal of Substance Abuse Treatment looks at Seeking Safety plus twelve step facilitation. Good news:

Objective

The Recovery Management paradigm provides a conceptual framework for the examination of joint impact of a focal treatment and post-treatment service utilization on substance abuse treatment outcomes. We test this framework by examining the interactive effects of a treatment for comorbid PTSD and substance use, Seeking Safety, and post-treatment Twelve-Step Affiliation (TSA) on alcohol and cocaine use.

Method

Data from 353 women in a six-site, randomized controlled effectiveness trial within the NIDA Clinical Trials Network were analyzed under latent class pattern mixture modeling. LCPMM was used to model variation in Seeking Safety by TSA interaction effects on alcohol and cocaine use.

Results

Significant reductions in alcohol use among women in Seeking Safety (compared to health education) were observed; women in the Seeking Safety condition who followed up with TSA had the greatest reductions over time in alcohol use. Reductions in cocaine use over time were also observed but did not differ between treatment conditions nor were there interactions with post-treatment TSA.

Conclusions

Findings advance understanding of the complexities for treatment and continuing recovery processes for women with PTSD and SUDs, and further support the chronic disease model of addiction.

 

Some people say…

Ugh. A pretty visible blogger resorts to the “some people say“ tactic to advance a pet theory that slanders 12-step groups. 

It’s worth noting that he’s acknowledged elsewhere that he’s had next to zero direct exposure to 12-step groups. His knowledge of 12-step groups and theory are based on internet comments. Ugh. Ugh. 

The 12-step approach has been said (by some ex-members) to put a freeze on emotional development. For those who believe that people can develop out of addiction (like me, for one), this is not an optimal solution. Twelve-step groups are notorious for convincing members that, even if they’ve been clean for a while, their addiction is out there waiting for them, waiting to sneak up on them in moments of weakness. So they have to remain constantly vigilant: Any slip, even one drink or one pill, will be the first step on a journey that inevitably leads to full-scale relapse. Twelve-step groups want you to keep coming back, to help gird your loins against the hazards of relapse, and they encourage you to define yourself as an addict – for life. In other words, not only the way you govern your life but your whole self-image is frozen in place. This is what you are, and if any change occurs, be warned: it’s going to be a change backward – back to being out of control.

A reader of my other blog suggested that the net effect of the scare tactics used in some 12-step groups is to induce a kind of PTSD (Post-Traumatic Stress Disorder). People with PTSD live with continuous anxiety, denial and avoidance mechanisms, intrusive thoughts, and more, about what happened to them, whether it was a serious accident, a mugging, physical or sexual abuse, rape, or getting wounded in a war. PTSD is in some ways an adaptive emotional response to trauma. It’s one way to stay clear of danger. After getting mugged or raped, you won’t go strolling through city parks at night, you’ll stay inside when the parade comes by, you’ll avoid people of a certain type, you might avoid eye-contact with strangers altogether, but you’ll continue to see yourself as a victim or a loser. This is a static state; obviously it’s also an unhealthy state, at least compared to normal, flexible, spontaneous functioning. It maintains anxiety rather than relieving it.

According to him, millions of us are voluntarily submitting ourselves to and “unhealthy state” of frozen emotional development, chronic manufactured anxiety, PTSD and a life time of seeing ourselves “as a victim or a loser.” He adds that 12-step groups are a poor choice for “those who do have the capacity to continue growing.”

Hate to say it, but tossing in that this describes “many (surely not all) 12-step programs” does not get you off the hook.

Trauma and Chemical Use and Addiction

From the Dawn Farm Education Series:

a thousand pasts and no future

“Choose [your memories] carefully. Memories are all we end up with … You’ll have a thousand pasts and no future.” –The Secret Behind Their Eyes (film)

forget about the sunshine by whatmegsaid

A friend shared this On Point episode with me and made a connection between it and resentments.

This matter of appropriate, helpful, deliberate forgetting is very fascinating.

We’ve talked before about role of the brain’s memory circuits. I’ve also been very interested in the similarities between PTSD and addiction. Both are characterized by intrusive, powerful, multi-sensory, involuntary memories.

The On Point episode discusses that the capacity this helpful forgetting relies on executive function which we’ve discussed is impaired AND depleted.

So…addicts may have limited capacity for this kind of helpful forgetting. Maybe this explains and supports 12 step recovery’s emphasis on letting go of resentments.

Further, the idea in the quote above may help explain the emphasis on gratitude and the power of gratitude lists. Aren’t gratitude lists really an attempt to choose what to remember?