Will AA’s 12-Steps Work For Me?
Written By: Brent Lloyd, BSW, MA, Clinical Manager, EHN Calgary Outpatient Clinic
A Touch of Controversy
Questions about the effectiveness of the 12-Step Alcoholics Anonymous and whether it’s a bonifide approach to addressing recovery from addiction still remain. These questions can create uncertainty about whether or not the 12-Steps program is right for you or if it will work.
Authors, such as Dr. Lance Dodes who published a few years ago, “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry” used key studies to support his opinion that AA didn’t work.
In the last couple of years, new research studies demonstrate that the 12-Steps do work and help people remain in recovery. A study published this year in the Journal of Health and Human Services Administration looked at the effectiveness of the 12-Steps in helping someone remain abstinent after they’d been through a substance abuse treatment program at the one year mark and five year mark. The results found that “12-Steps or self-help program have a higher success than cases not in a program for the 1-year follow up… Comparing the percentages we can conclude that the probability that an individual relapses is smaller for those who are part of the 12-Step program.”
My Point of View
Before we get started, let’s first look at how open and willing we are to look at both pros and cons of Alcoholics Anonymous. Easier said than done. I believe we all have biases and that does not have to be a negative thing as long as we are willing to be honest about how and why we came about these biases.
For instance, I have met and had the privilege of hearing how scores of people in recovery from addiction whom now speak highly of AA, but at the beginning were angry, defiant and skeptical about this approach. I was one of them.
I have found that when wanting to get high our drunk I would go to any lengths to make this happen. I learned that I needed to be earnestly willing to put in at least half that energy. That’s where AA became the chief reason that helped not only solve the drinking problem I had, but my emotional, health, spiritual, physical and emotional.
Essentially, you need to participate on a regular basis and “work” the 12-Step program if you want to see results. Recently, in Drug and Alcohol Dependence, a study looked at the recovery benefits of the “therapeutic alliance” among 12-Step mutual-help organization attendees and their sponsors. The results from this study showed that almost 69% of participants that had a sponsor, remained in contact with them and had a strong sponsor alliance were “significantly associated with greater 12-Step participation and abstinence, on average, during follow-up. Interaction results revealed that more sponsor contact was associated with increasingly higher 12-Step participation whereas stronger sponsor alliance was associated with increasingly greater abstinence.” 
Let me be clear. AA is not a cure all. Those words are from the AA big book. I would humbly ask any person struggling with addiction to look at all options, many people who have recovered via the AA route will tell you themselves that they had tried many approaches before going through the doors of an AA meeting.
You Be The Judge
In conclusion, only you can answer the question is AA right for me. However, before you rule it out as an option, please give it an earnest evaluation. Recovery is not for the faint of heart and walking through any recovery program requires one to look within. Not an easy task when we put down our mood altering chemicals. I am bias- yes. However, 19 years of ongoing recovery has inspired me to remember where and why I am sober. I would not be where I am today without this life changing fellowship of AA.
Regards, Brent Lloyd, BSW, MA, Clinical Manager, EHN Calgary Outpatient Clinic
Brent is a registered social worker with a degree from the University of Victoria and a Master of Arts in Leadership from Royal Roads University. With several years of experience as a counsellor in both inpatient and outpatient settings, Brent is passionate about guiding and assisting individuals and their loved ones through the struggles of addiction.
-  Gamble, J., & O’lawrence, H. (2016). An overview of the efficacy of the 12-step group therapy for substance abuse treatment. Journal of Health and Human Services Administration, 39(1), 142.
-  Kelly, J. F., Greene, M. C., & Bergman, B. G. (2016). Recovery benefits of the “therapeutic alliance” among 12-step mutual-help organization attendees and their sponsors. Drug and Alcohol Dependence, 162, 64.
Dependence Vs. Addiction- What’s the difference?
Joshua Montgomery, Director of Operations- Bellwood Health Services
Transcript from video:
When we talk about addiction and when we talk about opiate use, a lot of things come up. There are a lot of questions around: What’s dependence? What’s tolerance? What’s pseudoaddiction? What’s actually addiction? And they are all very great questions.
Addiction is a neurobiological disease that has genetic, psychosocial and environmental factors. It’s characterized by poor impulse control, compulsive drug use, continued use of the drug despite any consequences to their finances, their mental or social well-being and there’s a craving for the drug.
People question about addiction versus physical dependence and so we see physical dependence in individuals who are chronic pain sufferers. We also physical dependence on things like anti-depressants and so forth.
The physical dependence is the body’s adaptation to a particular medication and what happens is the body becomes so use to it that without it, it kind of has a negative reaction, so the body needs that medication. Therefore, it creates dependence and a tolerance as well. Some individuals question well, I’m taking an opiate, I may be physically dependent, will that progress into an addiction? And that’s not always the case. A lot of individuals, who take opiates as prescribed, may be dependent. And chances that they are- will never acquire an addiction. Where we see individuals that shift from dependence to addiction are individuals that often have some concurrent mental health disorder, maybe there are some stressors going on in their life, maybe it’s provided some sort of secondary relief.
The best thing that you can do is reach out, reach out to a family member, a friend, your physician. If you don’t feel comfortable with that, reach out to a professional.Certainly, looking to resources in the community.
At the Edgewood Health Network, we’re a national organization, so we do have outpatient offices throughout Canada. We have residential facilities. We’re a good start. What’s nice about when you call a facility like ours, a facility that’s comparable, is the fact that they should have a continuum of care as we do. And that allows the client to recognize, ‘Do I have an addiction? Am I abusing? Is this a pseudoaddiction? We can really help to determine where you kind of fit on that spectrum of abstinence to addiction.
So, again just to wrap up: You gotta reach out, you gotta seek help, and there’s a lot of help out there.
Joshua Montgomery RN, joined Bellwood as the Clinical Manager of Intake and Assessment in 2014. Joshua graduated from Conestoga College’s Nursing Program and received his Registered Nursing certification in 2004. He began his nursing career at Grand River Hospital working in the area of pediatrics. While working in this area, he accepted a position with the hospital’s acute mental health and addictions services. Throughout his career, Joshua has gained experience working in a variety of roles, the majority of which has been acquired in acute mental health and addictions at Grand River Hospital. Roles included front-line nurse, prime nurse, patient flow coordinator, and patient relations coordinator.
While working in the area of mental health, Joshua developed many departmental processes designed to enhance the hospital’s care delivery systems, one of which was adopted by the entire organization. Following his time with acute mental health, he coordinated the opening and operations of Mount Hope Day Hospital, a facility focusing on mental health, in 2010.
One of Joshua’s greatest passions, second to helping others, is optimizing people’s abilities to help others.
Should My Addiction Treatment Program Be Gender-Specific?
‘Should my addiction treatment program be gender-specific?’ It’s one of the questions you might ask if you’re looking at addiction treatment programs or support options for substance use disorder. As addiction treatment providers, we always want to offer the best treatment programs for our clients’ recovery. It’s important that we look at what works and what we can do better.
Research published in the Journal of Substance Abuse Treatment states that “greater effectiveness has been demonstrated by treatment programs that address problems and issues common among substance-abusing women, such as childcare issues, services for pregnant or postpartum women, or histories of trauma and/ or domestic violence.” While research in the Journal of Psychoactive Drugs concludes that appropriate methodologies need to be developed to properly analyze the effectiveness of gender-responsive treatment. So, the question remains: Will it make a difference if my addiction treatment program or substance abuse support program is gender-specific?
What Does Gender-Specific Treatment Look Like?
Gender-specific treatment programs are created to treat only males or females in a specific program. Some reasons why centres state that they use this style is to remove distractions from the opposite sex, it allows patients to feel more comfortable discussing certain issues and experiences. Essentially, the treatment program allows males or females to focus on certain factors or experiences that they share during their treatment program.
Socioeconomic factors related to their male and female genders have an effect on treatment completion rates and duration. It seems women are more vulnerable to stigma than men when seeking treatment because of socioeconomic factors such as being a parent of young children. Women’s addictions are often associated with violence and sexual abuse and/ or risky sexual behaviour. On the other hand men’s addictions are usually associated with legal problems.
What the Edgewood Health Network Offers
Bill Caldwell, Extended Care Supervisor & Chemical Dependency Counsellor at the Edgewood Treatment Centre shares why and how Edgewood provides a co-ed or mixed-gender program for clients. “The decision to make Edgewood a coed program was made very early in the planning stages and is one of the things that makes us a little bit different than many of the other treatment providers. We do this for a variety of reasons, not least of which is the decision that addiction does not discriminate between genders, so neither do we. It also affords some options for therapy and growth that otherwise might not be available. As an example many of our patients have never learned how to have healthy platonic relationships with the opposite sex, and now have a chance to do that in a supportive setting.”
Bill Caldwell shares that there are challenges that come with a mixed gender addiction treatment program. “Coed treatment comes with its own set of challenges. Inappropriate relationships are the obvious shortfall: when we first opened our extended care program. We found quickly that some distance between the male and female residences was a very good idea, especially at night. It also creates some interesting dichotomies: while we do want to encourage our patients to learn more about healthy interactions, we also know that there is a different connection that happens when seeking support and assistance from same-sex peers.”
Finding a Healthy Balance
So the question now is what’s the best choice for treatment? Bill Caldwell believes a balanced approach works best. “We have found that combining the best of both worlds seems to be the winning approach, and we accomplish this by running a variety of gender specific groups alongside our coed programming and groups. These include groups focusing on sexual addiction, trauma, and general men’s/women’s group therapy, but it can also mean that we adapt existing groups to tailor to the needs of the patients. Sometimes we have men or women tell their patient story just to peers of the same gender, especially if their story includes details that would best be supported by same-sex groups.”
According to Bill Caldwell, Edgewood’s balanced approach creates the best possibilities for our clients to recover from drug and alcohol addictions and sexual compulsive behaviour, “There has been a lot of research done about the similarities and differences between men and women in treatment and recovery and the corresponding importance of respecting those similarities and differences. We believe that we have struck a balance that works very well for our patient’s growth and healing, and we will continue to develop new ways of individualizing our treatment process to create the best possible outcomes.”
At the Edgewood Health Network, we support customized treatment and evidence-based research. It’s important to us that you have all the information to make an educated decision about what program to choose. Whether you prefer a mixed program or gender-specific, the Edgewood Health Network has a range of options for you to choose from across Canada. To learn more about our programs visit our website or call us 1-800-683-0111.
Brady, K. T., & Randall, C. L. (1999). Gender differences in substance use disorders. Psychiatr Clin North Am, 22(2), 241-252.
Fattore, L., Melis, M., Fadda, P., & Fratta, W. (2014). Sex differences in addictive disorders. Front Neuroendocrinol, 35(3), 272-284. doi: 10.1016/j.yfrne.2014.04.003
 Prendergast, M. L., Messina, N. P., Hall, E. A., & Warda, U. S. (2011). The relative effectiveness of women-only and mixed-gender treatment for substance-abusing women. Journal of Substance Abuse Treatment, 40(4), 336-348. doi:10.1016/j.jsat.2010.12.001
 Grella, C. E. (2008). From generic to gender-responsive treatment: Changes in social policies, treatment services, and outcomes of women in substance abuse treatment. Journal of Psychoactive Drugs, 40(sup5), 327-343. doi:10.1080/02791072.2008.10400661
 Grella, C. E. (2008). From generic to gender-responsive treatment: Changes in social policies, treatment services, and outcomes of women in substance abuse treatment. Journal of Psychoactive Drugs, 40(sup5), 327-343. doi:10.1080/02791072.2008.10400661
Is There a Relationship Between ADHD and Substance Use Disorder?
Written by: Dr. Charles Whelton, MD, FRCP(C ), ABAM
During their initial psychiatric evaluation at Edgewood, patients often describe a lifelong history of poor attention, hyperactivity and distractibility. Many patients wonder if they have attention-deficit/hyperactivity disorder (ADHD), and ask if this could be tested for, and treated if it is present, while they are at Edgewood.
The relationship between ADHD and substance use disorder (SUD) is one that has significant clinical importance.
ADHD is an illness characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity, beginning in childhood, and causing functional impairment in social, academic or occupational settings. Difficulty in sustaining attention is often the cardinal feature, but patients may also display disorganization, distractibility, forgetfulness, or failure to complete tasks. Hyperactivity may be manifested by fidgetiness, restlessness, difficulty in remaining seated, excessive talking, or simply always being ‘on the go’, as if ‘driven by a motor’. Impulsivity may present as impatience, interrupting others excessively, or engaging in activities without consideration of possible consequences. Persons with ADHD may get bored easily, and consequently may frequently look for new experiences. Paradoxically, individuals with ADHD may focus well or even hyperfocus, when the task is something that they are interested in. Longitudinal data suggest that childhood ADHD persists in 50% of cases into adulthood.
Higher than expected rates of ADHD are found in populations with SUD. Although ADHD affects 6-9% of children, and up to 5% of adults worldwide, fully 25% of adults with SUD have ADHD, with an earlier onset and more severe SUD associated with the presence of ADHD. Conversely, approximately 20-40% of individuals with ADHD have a lifetime history of an SUD. Prospective studies of ADHD children have provided evidence that ADHD itself is a risk factor for SUD. Children with ADHD who also have co-occurring conduct disorder or bipolar disorder seem to have the poorest outcome with respect to developing SUD.
There is some controversy about the effects of early ADHD treatment on the development of SUD. An aggregate of the literature suggests that early stimulant treatment of ADHD reduces or delays the onset of SUD; however, the protective effect is lost in adulthood. This may be due in part to adolescents stopping their ADHD treatment in later adolescence and young adulthood, and therefore losing the protective effect of this treatment.
The precise reason why individuals with ADHD develop SUD remains unclear. It has been proposed that some people with ADHD ‘self-medicate’ with substances, to treat their ADHD. When substance abusing adolescents with and without ADHD were compared, adolescents with ADHD reported using substances more frequently to attenuate their mood and to help them sleep. No overall differences in types of substance used emerged between these groups however.
Symptoms need to be assessed carefully before making a diagnosis of ADHD, particularly in persons with SUD. Some ADHD symptoms are similar to symptoms that can be associated with SUD. Attention problems can occur in some substance withdrawal syndromes, for instance. Furthermore, some individuals may want to be diagnosed with ADHD in order to obtain a prescription for stimulants, and may feign ADHD symptoms. A thorough assessment is required.
The Canadian ADHD Resource Alliance (CADDRA) has designed a useful evaluation package, included in the Canadian ADHD Practice Guidelines. This includes an evaluation of current symptoms and related functional impairment, as well as retrospective evaluations of childhood symptoms, by both the patient and by an independent observer such as a parent. Collateral information can be very useful if available, such as past educational records and psychological assessments. There are many conditions that can mimic aspects of ADHD including anxiety and mood disorders, conduct disorder and oppositional defiant disorder, personality disorders including borderline and antisocial personality disorder, and substance abuse itself. When in doubt, neuropsychological testing can be helpful.
The treatment needs of individuals with SUD and ADHD need to be considered simultaneously, however, in general, the SUD should be addressed and stabilized first. Addiction stabilization may require inpatient treatment. Intervention for ADHD could then be considered in tandem with an addiction treatment program.
Not all patients with ADHD require medication. Many adults with ADHD have learned ways of coping with their ADHD symptoms, and would prefer to not use medication. Cognitive and behavioral therapies for both ADHD and SUD have been shown to be effective. Adults with ADHD may benefit from psychoeducation, coaching or skills training. However for others, medication can serve an important role in reducing the symptoms of ADHD and in improving functioning.
ADHD adults with SUD, noradrenergic agents (e.g. Atomoxetine) and antidepressants (e.g. Bupropion) should be considered first, to reduce the risks associated with using stimulants in this population. If this approach is ineffective, extended-release or longer acting stimulants (Concerta or Vyvanse) with lower abuse liability and diversion potential are preferable to the short acting stimulants (Ritalin or Dexedrine), which can be more easily abused.
Regardless of the pharmacotherapy being used, patients with ADHD and SUD should be monitored carefully. Treatment compliance should be evaluated regularly, and random drug screens performed as indicated. If stimulants are used, care should be taken to monitor for abuse of the stimulant. Treatment should be coordinated between all care providers, including family doctors, therapists and addiction counsellors.
When ADHD co-occurs with SUD, treatment for ADHD can help patients to focus and to complete tasks, and to be less restless and impulsive. This may in turn help with the treatment of the SUD. Not all problems with attention are due to ADHD however, and careful assessment is required. Furthermore, if ADHD is present in an individual with SUD, careful consideration of management options is essential.
(The following paper was the source of much of the information used in the preparation of this manuscript: Wilens, TE and Morrison, NR. The intersection of attention-deficit/hyperactivity disorder and substance abuse. Curr Opin Psychiatry, 2011 Jul: 24(4): 280-285.)
End the Impact of Addiction: How You Can Help Your Children Start Their Own Healing
Written By: Nicole Sartore-Babuin, BSW, CDP, Family Programs
Many of us can probably relate to watching the fame of baseball, either live or on television. These days as a busy mom, I find myself racing to the ball fields after work to watch my kids play the all American game. As they come up to bat, I get butterflies in my stomach. Will they hit the ball? Will the ball hit them? What if they strike out? As the parents in the stands cheer, I find myself growing more and more anxious. What if they strike out?
This is a question I would like to focus on. What if they DO strike out?
I look at parenting similar to the game of baseball. Sometimes we get a hit. We run the bases and sometimes we have fans cheering for us. Some days we don’t come near to making contact with the ball. We can feel that there are hundred pound weights around our ankles, and the bleachers are empty. Ultimately all any of us can do, is our best.
I am a parent, and I am also a practicing counselor working with families who have been impacted by substance use disorder. I have been working with kids and families for the past twenty two years to help break the cycle and stigma of substance use disorder. Addiction affects all family members, and I often tell families who have a member struggling with addiction, that when they get involved in their own healing process it greatly increases the chance of successful recovery for their loved one. With education and information they can become the “cheering section” that supports and encourages their loved one’s recovery, and within those families, it is the youngest, most vulnerable members who can benefit most from this type of intervention.
Children often don’t have ways to talk and express conflicting feelings, may internalize their feelings resulting in guilt, anxiety, confusion, anger and depression. By offering a safe and supportive environment where children can learn ways to express uncomfortable feelings, learn a definition of substance use disorder, understand they can’t ‘catch’ it, (like a cold or flu) and most of all that they are not alone we are beginning to break the cycle of addiction.
In Bounce Back our definition of addiction is ‘Hooked, Stuck and Trapped’. The goal of the program is to help children develop the skills and resources they will need to meet the emotional challenges they face, and for them to know that there is a safe place they can come or talk, and that it is not their fault.
As parents, it is our job and responsibility to provide children tools they’ll need to deal with life’s challenges and stressors. When children are living in homes where substance use is an issue, parents can be the stressors. If these children never receive support and the opportunity to learn about the nature of substance use disorder and learn coping strategies, the repercussions can be severs: problems in school, the law, elevated rates of Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Disorder (DOD), truancy, runaways, as well as increased chance of developing a substance use disorder in their adulthood.
As a parent, if you knew you could greatly decrease the odds of your child having to attend an inpatient treatment for addiction, wouldn’t you seek it out? Wouldn’t you want him or her to know where to go for help and support if they ever developed a substance use disorder?
Often parents need support too. Early intervention programs like Bounce Back provide the support to help you learn how to help your kids so that as parents- you can be the one cheering them on or better yet, hitting a home run. Through our extensive family addiction programs at Edgewood Health Network we can help families and children recover. Over the next few months I will be writing about the Bounce Back and Family Programs we offer and how they are helping make a difference.
Nicole Sartore-Babuin, BSW, CDP, Family Programs
Nicole Sartore-Babuin completed her Bachelor of Social Work at the University of Victoria and worked as both inpatient and family counselor at the Edgewood Treatment Center in Nanaimo, BC Canada. In 2004 Nicole relocated to the Seattle, where she pioneered Edgewood’s children’s program Bounce Back. She specializes in working with family members who have been affected by the devastation of addiction and truly believes that everyone deserves a chance to recover.