AnnouncementsStudy guide will be released Friday nightHandouts have been posted to Learn@UW for prior lecturesTwo handouts have been updated: Public health and health disparities, stigmaWalk-in office hoursTuesday (today) 11am-1pmWednesday 8-11am, 12:40-4:30pmMutual help groups for addictionPeer-led meetings in the community to help people overcome their addictionCommon features of mutual help groups:Obtain practical advice from people who have been where you have beenSense of belonging, fellowshipA change to use your personal experience to help othersFreeAlcoholics Anonymous and Narcotics Anonymous“12-step programs”Fellowship working towards a fundamental shift in lifeA lifelong spiritual journey“The only requirement for membership is the desire to stop using”There is a distinction between a closed and open meeting. A closed meeting means that everyone who shows up has to be committed to becoming an AA member. That makes it a little less stigmatizing, if you show up you won’t be the odd one out. The open meetings give people who are not in recovery themselves, or who don’t want to join can see what a group is like.Several of the 12-steps (heavily paraphrased)1. Admit we were powerless, and our lives have become unmanageable2. Belief in a higher power…5. Admit our wrongdoings…9. Make amends wherever possible…12. Help othersSome people don’t feel comfortable “believing in higher power”, but others do.Sponsors develop relationship with new member and help them along. If they feel like they want to use they can call you and get helpIClickerWhy is Alcoholics Anonymous (AA) so hard to study?a. It’s free and accessible, so it’s hard to successfully randomize people to use it or notb. Many people don’t like AA and drop outc. AA tends to retain people who have “already hit rock bottom”d. People who enroll in AA tend to already be committed to sobrietye. All of the aboveWhy is it so hard to study AA to understand how much it actually works and how it works?If you randomize people to not use AA the assumption is that they won’t use it. Since it is anonymous there is no way of knowing whether people use it or not.People who drop out may complicate a research study because they are like the control group who don’t receive AA. The people who drop out will be in the same set of people who didn’t receive intervention which makes the comparison between people who go to AA and don’t difficult.The people who stay in AA “hit rock bottom” which is when you have struggled with substance use problems throughout your life and want to do something about it but don’t. When you hit rock bottom you’re at the worst place you’ve ever been in your life and the only choice you have is to stop using. This can create a selection bias. Those people may find it easier to go to AA, there may not be complications they have no other choice but to get better.Also people tend to be committed to sobriety, this may or may not have to do with AA. So this is hard to study.What we know today is that AA does work and it tends to work for a specific set of people. The set of people have life circumstances that match up with AA principles.IclickerWhich of the following pre-treatment factors were predictive of dropout in 12-step groups?a. Lacking insurance and other financial barriersb. Less attendance at religious servicesc. Having friends with substance use problemsd. Meeting criteria for both alcohol use disorder and drug use disorderCould actually have financial barriers like transportation, childcare, etc.For religious services, a main principle of AA believes in a higher power. There could be a group of people who aren’t religious and they don’t like talking about the higher power and they are more likely to dropout. Or it could be attractive to some people. Some people might have a religion that they might be private about. This could definitely be a predictive dropout factor.Having friends who have problems the peer pressure may make you want to use. If you have an established group of friends doing something, it will overpower the group aspect of AA. Whether or not your friends use doesn’t really affect dropout. AA is successful in making new friendships and new connections.There is a lot of overlap in addiction to alcohol and drugs. When it comes down to a choice they may prefer to go to AA or NA. There is a mixed group, so people are welcoming because the concepts behind addiction are pretty much the same. It doesn’t seem to influence dropout.Spirituality and religion90% of people in U.S. report religious affiliationIn adolescents, involvement in organized religion is strongly protective against developing addictionHow might incorporating spirituality make mutual help groups work better?A lot of religions have rules similar like 10 Commandments. There is already a role base and clear path. People may be used to following a clear path.If you submit to a higher power in some respect it can take some accountability off you. This could either make it more difficult to get better, not up to you. Or it could be easier if less responsibility is on you. Maybe will give addicts more hope.Helps foster a sense of communityWhat are the disadvantages of incorporating spirituality in a mutual help program?A lot of people think God has a specific plan for them so being an addict maybe part of that planReligion could turn people off from AACould be increased guilt, if you don’t go to church in some religions you feel bad about it.Overall for people who are spiritual, the spirituality factor of AA seems to help.How much can we attribute someone’s success in achieving abstinence to changes in life that occur during AA?Some people stop using in AA and some people don’t.This graph is saying what about going through AA or changes in life from AA result in abstinence?This pie graph shows how changes from AA contribute to abstinence. They study looked at multiple factors that changed throughout AA when someone is in the program.And then how much of becoming abstinent can be attributed to changes in spirituality in religion?This graph says it is 6%. Changes in spirituality in AA do explain some success in abstinence.What really seems to help is the way that AA changes your social network.33% is attributed to changes in pro-drinking social contacts. Or decreasing contact in your social network of people who are partiers.Changes in pro-abstinence social contacts, how many new