An empirical study on the construct of "God" in the Twelve Step process.

Background: The term God, included in 5 of the 12 Steps of Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), self-designated spiritual fellowships, has not been studied empirically relative to members' experiences. A greater understanding of this can be clinically useful and can shed light on the 12 Step process of recovery. Objectives: To determine how NA members understand the 12-step concept "God as we understood Him" and the relationship between their understanding of God and the intensity of their craving and depressive symptoms." Methods: 450 (59% male) NA members completed a survey related to their experiences relative to their relationship with "God." The relationship among these variables and comparisons to the general population was analyzed. Craving and depressive symptoms were assessed by self-report. Results: 98% of the NA participants believe in God explicitly or some other higher power (vs 89% of a probability sample of the US population), 67% believe that God determines what happens to them some or all of the time (vs 48%), 78% (vs 28%) report hearing God talking to them "in their mind"; and 37% report that God talks to them "out loud." Acceptance of 12 Step God-related variables inversely predicted a significant portion of the variance of scores on craving (7.5%) and depression (13.5%). Conclusions: Respondents' understanding of God in NA varied considerably and was predictive of their depressive symptoms and craving intensity. These findings can serve as a basis for research into mechanisms underlying NA/AA recovery experiences and can also aid clinicians in how to employ these programs.

Addiction in older women: American health care's best-kept secret.

Older women are not immune from alcohol and drug dependence. In fact, substance use disorders are becoming more common in women over 60 and will become a larger public health issue as the baby boomers reach retirement age. Addicted women in their senior years present special challenges in identification and intervention, and have special needs in treatment. Incidence of co-occurring medical and psychiatric problems is increased. They respond best to a compassionate, nonjudgmental counseling approach.

Addiction and the treatment of pain.

Persons experiencing pain, whether acute or chronic, seek and deserve relief from their discomfort and loss of function. However, opioid analgesics have the capacity to induce tolerance, physical dependence, and addiction. Furthermore, persons with a history of opioid use disorders or other substance misuse problems are at "high risk" when they acquire painful conditions requiring aggressive treatment. Prescription of opioids could trigger a relapse to the original drug of choice or could initiate a new bout of addiction with the prescribed drug. This article explores the relationship between addiction and pain, including signs of developing addiction and approaches to managing pain in those with addiction.