This research paper is already completed but is in need of a conculsion, also known as a discussion to end the paper. I need a 4 full pages total. I attached my paper, so you can read it and continue writing in my document. I highly reccomd reading some of the sources to get a better undertsanding. I also attached a copy of a sample paper my professor gave us so you can look at the discussion at the bottom of that paper.
Susceptibility and Prevention of Substance Use Disorder and Relapse
Name
King?s College
Abstract
Substance use disorder (SUD) is defined by the American Psychological Association (2013) and DSM-5 as an addictive disorder involving repetitive substance abuse and dependence despite consequences, with a diagnostic range of mild, moderate, and severe. Relapse, a common symptom among individuals with SUD, can be described as the reoccurrence of abusive behavior following a period of abstinence or recovery (APA, 2020). The interactions of specific variables (demographics, drug of abuse, and treatment style) and SUD are evaluated to determine susceptibility and prevalence of SUD and relapse rates. Research findings concerning risk factors for SUD, including age, sex, socioeconomic status, race, comorbidity, and drug of abuse, are discussed in relation to relapse rates and various treatment practices (conventional and alternative). Overall findings suggest that young, Caucasian, low-SES, males, with multiple mental illnesses are at highest risk of SUD and subsequent relapse (Boscarino et al., 2015; Kopak et al., 2017; Tawa et al., 2016). Efficacy of treatment styles and relapse prevention yields mixed findings, however, there is evidence that suggests that any form of treatment proves more effective than no treatment (Ouimette et al., 1997; Bahr et al., 2012). Future research is encouraged to emphasize treatment efficacy, and other psychological factors relation to SUD, such as family dynamics, emotional attachment and parenting styles, and drug of abuse differences.
Susceptibility and Prevention of Substance Use Disorder and Relapse
The American Psychological Association (2013) defines substance use disorder, according to the DSM-5, as a disorder categorized by the combination of substance abuse and substance dependence, with a diagnostic range of mild, moderate, and severe. Substance use disorder can be defined by an uncontrollable use of a substance, in this case, drugs or alcohol, despite the consequences of use (APA, 2021). Individuals with substance use disorder elicit an intense obsession with engaging in substance use daily, resulting in impaired function in everyday life (APA. 2021). Although substance use disorder can be recognized in individuals dependent and abusive of drugs such as nicotine, for the purpose of this review, the focus will remain on alcohol and narcotics (APA, 2013). It should be noted that subgroups of substance use disorder, such as alcohol use disorder and opiate use disorder, fall within the constitutions of substance use disorder and addictive disorders according to the APA (2013) and the DSM-5, and the examination of such subgroups will be evaluated individually and collectively throughout this review. Specifically, the goal of this literature review will be to determine which factors (demographics, drug of abuse, and treatment), if any, are correlated with or increase risks of developing substance use disorder and subsequent relapse, and which preventative steps can be taken through treatment to increase the likelihood of continued sobriety or abstinence with minimal to no relapses.
Brownell, Marlatt, Lichtenstein, and Wilson (1986) define relapse as being dependent on the perception of the individual in question. In other words, according to Brownell et al., (1986) the slip or mistake constitutes a relapse when the individual perceives a loss of control. For example, according to Brownell et al., (1986) an alcoholic?s relapse is determined and defined by their perception of their mistake or loss of control when consuming alcohol after any period of sobriety or abstinence. It is also believed that understanding the processes of relapse among substance use and addictive disorders is of highest priority in an attempt to treat or combat such disorders (Brownell et al., 1986). More recent definitions conclude that relapse is the recurrence of a disorder following a period of improvement or abstinence (APA, 2020). Despite variance among the definitions of relapse throughout the years, it can be inferred from previous research that the presence of relapse in substance use and addictive disorders is essentially the reoccurrence of addictive and abusive behavior in relation to drugs and alcohol.
Aside from relapse, substance use disorders have other consequences related to health, physically and psychologically. Health-related consequences of alcohol use disorder and alcohol dependency are extensive. Alcohol use disorder, a subcategory of substance use disorder, is said to be among the top ten leading causes of psychiatric problems (Mendoza-Sassi & Béria, 2003). Mendoza-Sassi and Béria (2003) also state that alcohol dependence is more life-threatening than tobacco and narcotic usage. According to Delker, Brown, and Hasin (2016), such consequences begin in utero, due to alcohol use during pregnancy, causing fetal alcohol syndrome and other birth defects. Other health-related consequences in adolescents include higher risks of engaging in tobacco use, violence, suicide, and criminal encounters from driving while impaired (Delker et al., 2016). Among adults, alcohol-related deaths were highest among young adults, ranging from ages 18-24 years (Delker et al., 2016).
Similarly, to alcohol use disorder, opiate use disorder also has health-related and neuropsychological consequences (Guber, Silveri, & Yurgelun-Todd, 2007). Overdose, driving while impaired, and use during pregnancy, similarly to alcohol use disorder, also pose threats to individuals with opiate use disorder. Gruber et al., (2007) state that a constitution of opiate use disorder is a disruption of social, recreational, and occupational practices. Cognitive abilities, such as attention deficits, motor function, visuomotor and visuospatial functions, and impulse control were shown to be long-term and chronic effects of opiate use disorder (Gruber et al., 2007). Although legal-related consequences are seen both among addicts and alcoholics, Hasin et al. (2013) state that legal problems related to substance use disorders are not adequate qualifying symptoms and consequences for classification and diagnosis. That is, although many individuals with substance use disorders may experience consequences related to legal issues, it is not a consequence seen in every case, just as other health-related consequences are not universally dependent on alcohol use disorder or opiate use disorder.
Treatments for substance use disorders vary from traditional to alternative and complementary treatment programs and practices. Much research has been done on the effectiveness and expansion of treatment programs and practices for substance use disorder in the recent decades and can be seen to have an effect on maintaining long-term abstinence for many individuals. Cognitive-behavioral therapy (CBT), evidence-based treatments, complementary treatment, and twelve-step programs are known to have effectiveness in treating and managing substance use disorders. Among the most popular treatment programs, in-patient, or ?rehab?, involves admission, detoxification, psychological assessments, cognitive/behavioral therapy, and group therapy sessions (Elkashef et al., 2013). Twelve-step programs such as Alcoholics Anonymous, Narcotics Anonymous, Cocaine Addicts Anonymous, and Gambling Addicts Anonymous, consist of regular, daily to weekly, meetings, in which the anonymous fellowship follow a set of steps through story sharing, sponsorship, and reading to obtain continuous sobriety (Ouimette, Finney, Moos, 1997). Alternative, or complementary, treatments are also employed to combat and treat substance use disorder. Alternative treatments may consist of meditation, yoga, and hypnotism to promote sobriety and treat alcoholism and addiction. Certain facilities offer patients with an array of treatment programs in which patients and counselors can personalize their treatment for optimal outcomes and long-term abstinence.
A multitude of studies have been conducted examining the various populations and demographics affected by substance use disorder. Demographics such as age of onset, length or presence of abstinence or sobriety, socioeconomic status, sex/gender, ethnicity, comorbidity contexts, and occupation have been studied in relation to substance use disorder (Delker et al., 2016; Bush & Lipari, 2013). Studies focusing on comorbidity examined eating disorders, gambling disorders, and other mental illnesses such as depression and anxiety alongside substance use disorders (Angus, Pickering, Keen, & Blaszczynski, 2020; Bahji et al., 2019; Stewart et al., (2014). Through research, associations have been suggested to be present between factors and substance use disorder including demographics, biological influences, and drug of choice (Bush & Lipari, 2013). An important consideration when studying these findings and factors associated with substance use disorder would be the presence and rate of relapse. For example, a study conducted by Nordjaern (2010) found that 150 of 352 participants relapsed within three to twelve months following treatment for substance use disorder, most of which occurred during the most recent months of treatment discharge. It was also found that drug of choice among addicts was also influential in predicting relapse (Nordjaern, 2010).
From the gathered information regarding substance use disorder and relapse, it can be inferred that relapse is a prevalent phenomenon among individuals with substance use disorders such as alcohol use disorder and opiate use disorder. Although the complexity of contextual factors in substance use disorder may seem to suggest a definitive prevalence of the disorder in the human population, associations and susceptibility for substance use disorder and subsequent relapse, may be present. These complexities involving substance use disorder and relapse call for the evaluation and determination of which factors (demographics, drug of abuse, and treatment), if any, are correlated with or increase risks of developing substance use disorder and subsequent relapse, and which preventative steps can be taken to eliminate or minimize relapse.
Demographics
Age
Studies of background demographics in relation to substance use disorder prevalence, treatment, and relapse have been conducted numerously in the most recent several decades. Demographics such as age, gender, sex, education, employment, and marital status have been studied and suggest associations and correlations with substance use disorders (Kopak, Proctor, & Hoffmann, 2017; Mueser et al., 2000). Age, specifically younger ages, for example, was found to be associated with cocaine and cannabis use disorder, but not associated with alcohol use disorder in a study conducted by Meuser et al (2000). Kopak et al (2017) also found that individuals, ages 25 years and younger, are at greater risk of developing substance use disorders and higher clinical severity of the disorders, legal encounters, such as arrests, and multiple forms of substance dependency.
Age of onset has also been shown to be associated with psychological and social problems such as social incompetence, mental illnesses, severity of substance use disorder, academic, social, and employment performance issues, and behavioral issues (Poudel & Gautam, 2017). Specifically, early onset substance use was found by Poudel and Gautam (2017) to be significantly associated with overall problems in individual?s health and psychosocial capabilities. Late onset age groups were reported to have fewer overall problems in familial, peer, behavioral, and psychological contexts compared to early onset individuals, however, it was also found that substance use disorder presence, social competence, and health condition had no significant differences from that of the early onset group (Poudel & Gautam, 2017). Another significant finding was that older populations of individuals with substance use disorders reported fewer familial, drug, and psychiatric problems compared to younger patients in treatment, and older patients were less likely to view treatment as important or necessary than younger patients (Brennan, Nichol, & Moos, 2003).
SES, Education, & Race
Conflicting findings have been reported regarding substance use disorder and correlations with socioeconomic status. Contrary to previous research and assumptions concerning socioeconomic status and substance use, Humensky (2010) found that higher socioeconomic status was associated with higher levels of adolescents and young adults engaging in substance use including alcohol bingeing, cannabis, and cocaine usage. In support of Humensky?s (2010) findings, Martin (2019) found that high-socioeconomic undergraduate students engage in substance use to cope with the stressors of academia, whereas low-socioeconomic students engage in substance use to cope with pessimism and academic related stress. Although substance use and engagement were found to be present among both high and low socioeconomic status among undergraduate students, frequency and intensity of use may lead to developing substance use disorder, and results indicated that race and culture were better demographic predictors of students developing problems due to substance use, and subsequently, the development of substance use disorders (Martin, 2019).
Meuser et al (2000) provided findings that suggest that among individuals hospitalized for mental illness, and among those with substance use disorder, 318 of 352 participants were caucasian and suffered from alcohol use disorder. These findings, however, differed when concerning cocaine and cannabis use disorder, stating that non-white individuals were reported to have a higher population percentage of cocaine and cannabis use disorders compared to white individuals (Meuser et al, 2000). Although these findings may be skewed due to demographic and geographical location of the hospital and study setting, these findings are also congruent with those of Martin (2019), in which substance use and abuse was most common among high-SES white individuals with a moderately high educational level.
Comorbidity Contexts
A common finding in research regarding comorbidity is that presence of one disorder increases predisposition to other disorders (Meuser & Drake, 2007). A study of hospitalized mental patients recorded that schizophrenia and bipolar disorders are at higher risk of substance use disorder compared to the general population (Meuser et al., 2000). Due to findings of comorbidity and substance use disorders, it has been deemed important to determine which psychological illnesses predispose individuals to substance use disorders, or, in other words, which individuals with other psychological disorders are most vulnerable to developing substance use disorders (Meuser et al., 2000). According to Swendsen (2000), the presence of both depression and substance use disorders are not only prevalent, but are commonly present within an individual, known as comorbidity. Swendsen (2000) also states that the presence of both depression and substance use disorder may have origins due to a causal relationship, or etiology, from biological and contextual factors. This study found that substance use disorder and depression are risk factors for each other, and found that more commonly, substance use disorder, specifically alcohol use disorder, is a predictive and casual factor for depression (Swendsen, 2000).
The comorbidity of anxiety disorders and substance use disorders is described by Pasche (2012) as a primary or secondary phenomenon. For example, Pasche (2012) states that individuals with anxiety disorder may engage in substance use to self-medicate and treat their anxiety, and others may suffer from anxiety disorders due to side effects of engaging in substance abuse. Pasche?s (2012) study also mentions that the risk for developing anxiety disorders is almost 3 times as likely when currently suffering from substance use disorder, and that individuals with anxiety disorders were almost 3 times as likely to develop alcohol dependency. The comorbidity of anxiety and substance use disorder has also been found to complicate treatment processes and progresses due to inaccurate diagnoses, prognoses, and can result in increased risk of suicide in anxious and depressive individuals suffering from substance use disorders (Pasche, 2012).
As well as studies examining the comorbidity of anxiety, depression, and substance use disorders, studies have also examined the comorbidity of substance use disorder and posttraumatic stress disorder (Simpson et al., 2020). Simpson et al (2020) found that individuals with substance use disorder and lifetime posttraumatic stress disorder were likely to have sought and received treatment for mental health and/or substance use disorder at one point in time, with a significant preference for mental health treatment more so than treatment for substance use disorders. Findings from this study also suggest that despite treatment, many individuals elicit complex clinical profiles, suggesting that treatment was ineffective for either substance use disorder, posttraumatic stress disorder, and other mental health issues, or both (Simpson et al., 2020).
Despite findings suggesting predispositions, risks, correlations, and associations of demographics (age, SES, education, race, and comorbidity contexts), it should be noted that the complexity of these contexts suggest constant interaction between the environment, behavior, and biological and genetic influences (Meuser et al., 2000). Although the reported findings previously mentioned suggest risk factors and associations of developing substance use disorders, more research should be conducted to assess the replicability, reliability, and validity of these findings in today?s society. Specifically, a focus on newer drugs such as opiates and synthetic narcotics that have become more prevalent and popular among substance use disordered individuals.
Drug of Abuse
Alcohol
According to the Center for Disease Control and Prevention regarding prevalence of substance use disorders, alcohol use disorder is the cause of approximately 88,000 annual deaths in the United States (Tawa, Hall, & Lahoff, 2016). As previously mentioned, comorbidity in substance use disorders have significant findings and support for increased risks and severity of disorders and have recently been found to become an increasing psychological phenomenon in the United States (Tawa et al., 2016). Prevalence of alcohol use disorder, according to Tawa and colleagues (2016), represents approximately 37% of individuals ages 30-44 years, with men representing approximately 21% more than women.
Susceptibility of developing alcohol use disorder can be determined by several factors which are suggested to increase risk and predict the development of the disorder. Environmental factors such as stress, physical, sexual, and psychological abuse are known to increase an individual?s risk of developing alcohol use disorder (Tawa et al., 2016; Enoch, 2010). Family history of alcohol use disorder and genetic factors contribute approximately 50% of the susceptibility of developing alcohol use disorder (Tawa et al., 2016). Although genetics and biological factors greatly influence one?s susceptibility of developing alcohol use disorder, gene-environment interactions may constitute the remaining percentage of casual factors (Tawa et al., 2016). For example, a study conducted by Novo-Veleiro and colleagues (2014) found that miRNAs alleles, small non-coding RNAs responsible for gene expression, are associated with, and may possibly be predictors of alcohol use disorder due to presence and functioning of genetic variants. It should be noted, however, that limited research has been conducted regarding microRNA and alcohol use disorder susceptibility (Novo-Veleiro et al., 2014).
Concerning relapse in alcohol use disorder, individuals with alcohol use disorder and comorbidity are more likely to experience relapses throughout life (Sliedrecht et al., 2019). Although gender, and/or sex, was not a significant determinant of susceptibility for relapse within substance use disorder, Sliedrecht and colleagues (2019) found that age, cognitive dysfunctions, health issues, sleep disturbances, severity of alcohol use disorder, craving levels, emotion/affect, self-efficacy, impulsivity, stress, and psychiatric comorbidity were significant determinants of relapse. It was found that older age of onset of alcohol use disorder is significantly associated with the greater likelihood for continued sobriety and remission with minimal to no relapses (Sliedrecht et al., 2019). Surprisingly, number of prior detoxification treatments and impulsivity were inconclusive in their results, suggesting no significant effect on susceptibility of relapse, most likely due to lack of research abundance (Sliedrecht et al., 2019). An important finding to note would be that of treatment history, cognitive deficits, and coping, which are also said to be significantly associated with risk for relapse (Sliedrecht et al., 2019).
Social factors in relation to relapse in alcohol use disorder prove to be significant. According to Sliedrecht and colleagues (2019), positive social contexts, or non-drinking/scarce-drinking social groups, have a positive impact on individuals with alcohol use disorder in that the social support protects individuals to a certain extent. However, heavy drinking social networks are significantly associated with higher risks for relapse (Sliedrecht et al., 2019). Spiritual factors were found to be significant in protection against relapse in limited studies (Sliedrech et al., 2019), which may be attributed to the anonymity of specific 12-step programs that center treatment around spirituality.
Opiates
Opiate use disorders are reported to have increased significantly in the most recent decade in the United States (Boscarino, Hoffman, & Han, 2015). Prevalence of opioid-use disorder can now be viewed as an epidemic due to mortality rates, despite recent decreases in dispensing and prescription of opiates (Boscarino et al., 2015). Similarly, to alcohol use disorder, Boscarino and colleagues (2015) found that comorbidity and opioid use disorders have significant associations. Specifically, PTSD, anxiety, depression, psychological trauma, antisocial personality disorder, and alcohol use disorder are significantly associated with opioid use disorder (Boscarino et al., 2015). Wang et al (2019) state that opioid addiction susceptibility has environmental and heritable factors, suggesting similar findings to that of alcohol use disorder.
A recent study by John and Wu (2019) found that the majority of individuals with prescription opioid use disorder were white males, aged 18-25 years, and that approximately 60% of individuals with prescription opioid use disorder reported visiting the emergency department within the past year (John & Wu, 2019). John and Wu (2019) also state that susceptibility and predisposing variables included demographics such as, sex, age, and race/ethnicity, similarly to alcohol use disorder and other substance use disorders. Other indicative factors of prescription opioid use disorder were psychological distress, nicotine dependence, and sedative and tranquilizer usage (John & Wu, 2019).
Mortality associations with opioid use disorders, concerning heroin, increased by 26% from the year 2000 to 2014 (Martins et al., 2017). Within the most recent decades, heroin use has predominantly increased among white individuals (Martins et al., 2017). It was also noted by Martins and colleagues (2017) that despite an overall nondiscrimination of heroin use and addiction among all socioeconomic statuses, increases in heroin use and opioid use disorder have been found in lower SES and lower educated individuals. In sum, heroin use has greatly increased and affected young, white, low SES, and lower educated men (Martins et al., 2017).
Concerning relapse in opioid use disorders, Naji and colleagues (2016) found that among individuals receiving methadone maintenance treatment (MMT) for opioid use disorder, delivery method (IV or nasal inhalation), age of onset, and other illicit drug consumption (benzodiazepines) were significant predictors of accelerated relapse. The study of individuals in MMT programs also states that comorbidities associated with IV opioid use predispose these individuals for risky behavior, overdose, and development of communicable diseases such as HIV and Hepatitis, which significantly raises health and mortality risks for older onset individuals (Naji et al., 2016). Risk for death is especially high among individuals with opioid use disorder due to the effectiveness of maintenance treatments such as methadone (Nunes et al., 2018). Once on maintenance drugs, individuals with opioid use disorder lose high tolerance levels, and upon relapse, overdose is not only common, but more commonly, results in death (Nunes, 2018). Treatment type and length has also been found to be associated with relapse rates according to Nunes and colleagues (2018), suggesting that the shorter the treatment period, the higher risk for relapse.
The research mentioned points to an unsettling suggestion that despite maintenance treatment programs effectiveness short-term, the less likely individuals with opioid use disorder will remain abstinent. This is also suggested to be true among individuals receiving typical in-patient treatment and typical length of stay (Nunes, 2018). Unfortunately, due to the intense addiction effects of opiates, specifically heroin and prescription opiates, relapse is still highly prevalent among most populations, and only a minority of individuals prove to remain abstinent following MMT (Nunes, 2018). These finding suggest that despite optimal treatment efforts, environmental, genetic, and psychological factors may be the most predictive indicators of relapse or long-term abstinence in opioid use disorder contexts. Although similarities in susceptibility are found among alcohol use disorder and opioid use disorder in demographics (age, SES, sex, race, and comorbidity), differing treatment practices seem to have an influence on susceptibility of, and prevalence, to relapse.
Treatment
12-step programs
Similar to the treatment of other mental illnesses, substance abuse treatment can be offered through inpatient, outpatient, semi-intensive outpatient, maintenance drug programs (methadone and suboxone), and alternative forms, such as yoga, meditation, practicing mindfulness, self-help groups (AA, NA), and traditional therapy sessions with a licensed counselor. Bahr et al (2012) mention that despite 12-step programs, such as AA and NA, being widely known, used, and one of the oldest forms of treatment for substance abuse, there is little empirical evidence of its effectiveness. This could be attributed to the anonymity-based standards and practices of such 12-step programs, or also due to singular-based treatment for substance use while lacking outside resources like outpatient therapy and regular counseling, possibly resulting in relapse. For example, it was also found that approximately 50% of individuals participating in AA obtain longer than 3 months of sobriety (Bahr et al., 2012).
Contrasting evidence was found by Miller (2008) which promoted that 12-step programs, such as AA, were ineffective in treating substance use disorder in alcoholics and drug addicts due to the nature of 12-step programs counteracting traditional therapeutic processes like CBT. For example, 12-step programs promote the avoidance of drugs and alcohol entirely and fail to promote the reduction of harmful and hazardous behaviors involving alcohol and drug use, differing from that of CBT practices (Miller, 2008). According to Miller (2008) this avoidance and lack of integration of CBT practices within 12-step programs could account for elevated prevalence of relapse within the first year of the program. Although Miller?s (2008) findings suggest that 12-step programs are more ineffective than receiving no treatment for substance use disorders, limitations in this study can be found in the self-reported evidence, problems with validity, and contrasting research findings from other studies. Further research of 12-step program effectiveness is encouraged, specifically in inpatient contexts to combat the anonymity dilemma of researching 12-step groups outside of treatment centers.
Traditional Treatment Programs
Seen in inpatient and outpatient treatment practice services, cognitive-behavioral therapy (CBT), is a widely recognized and popular method of treating substance use disorders (Magill, Kiluk, Hoadley, et al., 2019). CBT interventions for treatment of substance use disorder involve motivational interventions, targeting the ambivalence and desire to obtain sobriety, contingency management, the introduction of positive reinforcements following periods of sobriety or abstinence, and a combination of treatment interventions and practices (McHugh, Hearon, & Otto, 2010). It was found that among 760 participants were less likely to engage in drug or alcohol abuse following a 6-month CBT program, compared to those who did not receive CBT (Bahr et al., 2012). Although widely used and practice, empirical evidence regarding the effectiveness of CBT in treating substance use disorders has mixed findings (Bahr et al., 2012; McHugh et al., 2010). An important note would be that of court-mandated treatment. Specifically, among DUI convicted individuals, court-mandated treatment proved to be effective when both psychological counseling, therapy and legal follow-ups, such as probation, suspended license, and educational DUI courses, were used (Dill & Wells-Parker, 2006). It should be taken into account that these findings, however, were not solely aimed at abstinence and addiction improvement, but more towards legal recidivism (Dill & Wells-Parker, 2006).
Research findings supporting the efficacy of CBT for substance use disorders have been conducted in the most optimal of settings, and according to McHugh et al (2010), this does not account for the unfortunate majority of contexts in which underfunded, underexperienced, and overworked counselors and therapists are not given or do not have optimal treatment settings or conditions. Despite mixed findings, Magill et al (2019) suggest that although CBT has been shown to vary in effectiveness, CBT has proven to be more effective in treating substance use disorders compared to no treatment, and just as effective as other specific treatment processes.
Alternative Treatment Programs
Non-conventional, or alternative, forms of treatment have grown more popular in the most recent decades (Behere, Muralidharan, & Benegal, 2009). In 2002, the National Health Interview Survey reported that approximately 62% of the United States population engaged in or used alternative treatment practices (Behere et al., 2009). Homeopathy, including homeopathic remedies, acupuncture, herbal medicines (magnesium and melatonin), bioelectromagnetic-based therapy, yoga, meditation, massage therapy, and spirituality are considered the modern forms of non-conventional and alternative therapies in treating substance use disorders (Behere et al., 2009).
Similarly, to that of 12-step programs and CBT treatment for substance use disorders, alternative therapy practices also yield mixed findings. For example, in a meta-analysis conducted by Behere et al (2009), acupuncture was found to be ineffective, or have no significant effect on abstinence rates or provide additional benefits compared to traditional treatments in samples of alcohol-dependent participants. Other studies mentioned in the meta-analysis, however, did provide findings that alcohol and cocaine dependent participants obtained sobriety of up to 6 months (during follow-up), and that there were benefits and improvements in abstinence rates (Beher et al., 2009). As for yoga, meditation, and spirituality, it was found that 60% of participants disengaged in alcohol use after 24-36 months of practicing mind-body therapies (
