title: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Findings reported in previous studies on the association between exposure to DTR and reductions in substance use were partially supported in this efficacy trial.
authors.affiliation: Institute for Treatment and Services Research, National Development and Research Institutes, New York, NY 10010, USA. Electronic address: Rosenblum@ndri.org.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rosenblum
authors.affiliation: Institute for Treatment and Services Research, National Development and Research Institutes, New York, NY 10010, USA.
authors.forename: Harlan
authors.initials: H
authors.lastname: Matusow
authors.affiliation: Institute for Treatment and Services Research, National Development and Research Institutes, New York, NY 10010, USA.
authors.forename: Chunki
authors.initials: C
authors.lastname: Fong
authors.affiliation: Double Trouble in Recovery, Inc, West Palm Beach, FL 33411, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Vogel
authors.affiliation: Weill-Cornell Medical College, New York, NY 10065, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Uttaro
authors.affiliation: Cherry Street Health Services, Grand Rapids, MI 49503, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Moore
authors.affiliation: The Evaluation Center, Western Michigan University, Kalamazoo, MI 49008, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Magura
mesh_terms: D000328:Adult; D017831:Diagnosis, Dual (Psychiatry) / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D012657:Self-Help Groups; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
keywords: 12-Step groups; Co-occurring disorders; Dual diagnosis; Mutual aid; Recovery