12-step facilitation for the dually diagnosed: a randomized clinical trial.

There are few clinical trials of 12-step treatments for individuals with serious mental illness and alcohol or drug dependence. This randomized trial assessed the effects of adding a 12-session 12-step facilitation therapy (TSF), adapted from that used in Project MATCH, to treatment as usual in an outpatient dual diagnosis program. Participants were 121 individuals dually diagnosed with alcohol dependence and a serious mental disorder, followed during 12 weeks of treatment and 36 weeks post-treatment. Participants receiving TSF had greater participation in 12-step programs, but did not demonstrate greater improvement in alcohol and drug use. However, considered dimensionally, greater participation in TSF was associated with greater improvement in substance use, and greater 12-step participation predicted decreases in frequency and intensity of drinking. Findings suggest that future work with TSF in this population should focus on maximizing exposure to TSF, and maximizing the effect of TSF on 12-step participation.

Evil by default: the origins of dark visions.

The growing body of literature on transformational change reflects an increasing interest among professionals in understanding epiphany and visionary change. However, we typically assume that such quantum changes are positive and pro-social ones. It is equally possible for an individual to lead a life that is organized around a motivating vision that is destructive to self, others, or both. The author examines the phenomenon of "dark visions," offering some hypotheses as to their origins. The article also offers strategies to minimize the number of individuals who choose dark visions, with all their unfortunate consequences.