The high rate of treatment failure is a common problem in the treatment of methamphetamine use. Therefore, the aim of this research is to identify the most common causes of relapse in methamphetamine users.
This is a qualitative study and of content analysis type. Information was collected using purposeful sampling and through semi-structured interviews and focus group discussions. The statistical population consisted of all people with the methamphetamine-use disorder in 2022 who were in the abstinence phase and participated in the meetings of the Narcotics Anonymous (NA) Center of Bojnord. Theoretical sampling continued until data saturation. A total of 10 one-on-one interviews were conducted, each lasting between 45 to 80 min. Additionally, two focus group interviews were conducted with six members in each group, lasting between 95 to 110 min and data saturation was achieved through these interviews. Data analysis was done using the content analysis method (Sterling). Recoding and Holsti\'s method were used to measure reliability; validity was then calculated through content validity assessment.
The results of the thematic analysis showed that laps and relapse factors were identified and categorized into 5 organizing themes, including negative emotional states, positive emotional states, negative physical states, interpersonal factors, and environmental factors, consisting of 39 basic themes.
Identifying the risk factors leading to laps and relapse in methamphetamine users and increasing the knowledge in this field can lay the groundwork for preventive therapeutic interventions in this community.

BACKGROUND: Addiction is a chronic and relapsing disorder characterized by compulsive drug seeking and lasting changes in the brain. Low quality of life may influence the substance craving, which leads to relapsing. Therefore, the present study aimed to investigate the relationship between beliefs in substance craving and quality of life among narcotics anonymous.
METHODS: This cross-sectional study was performed on 202 narcotics anonymous in Kerman, southeastern Iran. Convenience sampling was used to select anonymous patients in the Narcotics Anonymous (NA) association in Kerman city. Narcotics anonymous completed the demographic questionnaire, the Craving Beliefs Questionnaire (CBQ), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Multiple linear regression model was used to determine the predictors of craving beliefs. The data were then analyzed using SPSS 22.
RESULTS: The mean age of the participants was 38.48 ± 11.32 years. The majority of the samples were male (86.1%), married (65.4%), educated (93.6%) and urban (86.1%). The mean scores of craving beliefs and overall Quality of Life (QOL) were 77.58 ± 20.70 and 64.42 ± 23.13, respectively. Forty-two-point 1% had high level of craving beliefs. We found a significant negative and weak correlation between beliefs in substance craving, physical health domain (r = -0.16, p = 0.02), and overall quality of life (r = -0.15, p = 0.03). History of crack use, job, and physical health domain of QOL were predictors of beliefs in substance craving among the NAs.
CONCLUSIONS: Based on the study results, the participants had a high level of substance craving, and some aspects of the quality of life had an impact on the beliefs of addiction. However, it is necessary to conduct more studies in this field; psychological interventions and programs to increase the quality of life may reduce the substance craving.

Face-to-face mutual-aid meetings such as Alcoholics Anonymous shuttered with the onset of COVID-19. Research could not be conducted quickly enough to provide guidance for how to respond. However, two powerful tools could be leveraged: the research on mutual aid conducted before the pandemic and the vast number of virtual resources that proliferated with the onset of the pandemic. This article reviews the existing mutual aid research and its relevance to COVID-19, describes the diverse array of virtual resources, and provides recommendations for successful engagement with virtual mutual aid during COVID-19 and beyond.

Background: Cognitive-behavioral therapy is an umbrella term which encompasses a wide range of distinct, yet related interventions, several of which have been shown to be efficacious in the treatment of substance use disorders. However, 12-Step programs (including Alcoholics Anonymous and Narcotics Anonymous) are traditionally the most widely known and commonly used approaches to managing alcohol and substance abuse. Objectives: Therefore, this paper attempts to offer a summary of the compatibility of CBT-based approaches and 12-Step philosophy, in order to assist clinicians who work with patients with a strong adherence to 12-Step ideology. Results: Specific passages from AA\'s Big Book, NA\'s Basic Text, and ancillary 12-Step literature will be highlighted where appropriate. Moreover, common roadblocks to synthesis (e.g. belief in a \"higher power;\" acceptance of one\'s \"powerlessness\") will also be addressed. Conclusions: Clinicians who are committed to evidence-based, CBT-related practices are ultimately advised to adopt flexibility when working with patients who identify with the cultural values of 12-Step programs.

Mutual aid organizations, such as Narcotics Anonymous (NA), can provide support in substance use disorder (SUD) recovery processes. However, research on NA and its recovery-supportive elements is scarce and perspectives of NA-members remain understudied, in particular outside the US. Therefore, this study aims to gain insight into recovery-supportive elements of NA, as experienced by its members.
To explore the perspectives on and experiences with recovery-supportive elements in NA, 11 in-depth interviews with NA-members were conducted in Flanders (Belgium). Interviews were audio-taped, transcribed verbatim and analyzed by using CHIME-D, a personal recovery framework (Connectedness, Hope, Identity, Meaning in life, Empowerment, Difficulties) developed by Leamy and colleagues in 2011.
Various recovery-supportive elements of NA were highlighted, with Connectedness as a key component including opportunities for building up a social network and for providing a safety net or sounding board. Elements that enabled Connectedness were 1) a non-judgemental approach, and 2) mutual understanding through sharing in NA. Other elements of the CHIME-D framework were less frequently mentioned, although these were inextricably linked to Connectedness.
Connectedness appeared to be the crucial recovery-supportive element in NA, emphasizing the relational character of SUD recovery. Although other elements of the CHIME-D framework were identified, these were closely related to and intertwined with the concept of connectedness.

For persons with substance use disorders (SUDs), 12-step groups (TSGs) are the most available and used peer-based recovery resource, worldwide. However, disengagement is common, and attrition may partly be due to practices and procedures within these groups that are unacceptable to a portion of the population with SUDs. Our overall aim was to identify problematic issues related to Narcotics Anonymous (NA) participation in Norway, to inform addiction professionals\' strategies when referring persons to addiction-related self-help groups (SHGs).
In this qualitative study, we interviewed ten individuals who had previously participated regularly in NA for at least 6 months, to examine their reasons for disengagement. We interpreted the interviews using thematic analysis.
We identified three themes: (1) \'The model did not fit\', either the strategies utilized in NA (e.g., meeting format and step working) or NA\'s explanatory model of addiction, (2) \'Negative experiences spurred frustration\', and (3) \'The safe place can become a cage\'. The respondents believed that a main aim of recovery was reintegration into society, such that SHG participation should not be an end goal, but rather a platform for normalization back into society. Despite their negative experiences and strong critique, respondents still regarded NA as a valuable recovery resource, but pointed out that one size does not fit all.
Addiction professionals should recognize possible problems related to TSG participation, to help prevent negative experiences and possible harms to individuals. Professionals should also inform individuals about alternative support groups, to help them find the recovery resource best suited to them.

This article focuses on the ways in which members of Alcoholics Anonymous and Narcotics Anonymous construct themselves as being in recovery from addiction. In this original study, data were taken from 19 participants. They were analysed using Willig\'s six-stage Foucauldian discourse analytic method. This method is suited to enabling the analyst to locate discourse resources used by participants within broader, dominant, discourses, and for exploration of the implications of these constructions for subjectivity and practice. This article presents a discussion of analytic findings. Mainstream academia has often constructed 12-Step recovery as a largely totalising discourse. This is likely to have negatively prejudiced health professionals and may help explain relatively low referral rates into 12-Step resources for addicted clients. However, our analysis suggested that participants constructed themselves not as subjected by Alcoholics Anonymous and Narcotics Anonymous discourse, but as drawing on it in ways aligned with agency, in order to practice care of the self in pursuit of various ethical goals. This implies 12-Step recovery to be less antithetical to, and indeed more aligned with, humanistic practitioner values than is perhaps often assumed to be the case. This finding suggests that practitioners may need to consider reappraising their view of 12-Step recovery. The discussion will therefore focus on the agency-structure dialectic that seemed to be at the heart of participant constructions of addiction and recovery. It is also a finding which points to an urgent need for more qualitative studies in the currently under-researched, and hence perhaps poorly understood, area of 12-Step recovery from addiction.

OBJECTIVE: Empirical evidence indicates that, in general, treatments which systematically engage adults with freely available twelve-step mutual-help organizations (TSMHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) often enhance treatment outcomes while reducing health care costs. Also evident is that TSMHOs facilitate recovery through mechanisms similar to those mobilized by professional interventions, such as increased abstinence self-efficacy and motivation, as well changing social networks. Much less is known, however, regarding the utility of these resources specifically for young adults and whether the TSMHO mechanisms are similar or different for young adults. This article provides a narrative review of the clinical and public health utility of TSMHOs for young adults, and summarizes theory and empirical research regarding how young adults benefit from TSMHOs.
RESULTS: Results indicate that, compared to older adults, young adults are less likely to attend TSMHOs and attend less frequently, but derive similar benefit. The mechanisms, however, by which TSMHOs help, differ in nature and magnitude. Also, young adults appear to derive greater benefit initially from meetings attended by similar aged peers, but this benefit diminishes over time.
CONCLUSIONS: Findings offer developmentally specific insights into TSMHO dynamics for young adults and inform knowledge of broader recovery needs and challenges.

OBJECTIVE: The integration of 12-Step philosophy and practices is common in adolescent substance use disorder (SUD) treatment programs, particularly in North America. However, although numerous experimental studies have tested 12-Step facilitation (TSF) treatments among adults, no studies have tested TSF-specific treatments for adolescents. We tested the efficacy of a novel integrated TSF.
METHODS: Explanatory, parallel-group, randomized clinical trial comparing 10 sessions of either motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT; n = 30) or a novel integrated TSF (iTSF; n = 29), with follow-up assessments at 3, 6 and 9 months following treatment entry.
METHODS: Out-patient addiction clinic in the United States.
METHODS: Adolescents [n = 59; mean age = 16.8 (1.7) years; range = 14-21; 27% female; 78% white].
UNASSIGNED: The iTSF integrated 12-Step with motivational and cognitive-behavioral strategies, and was compared with state-of-the-art MET/CBT for SUD.
METHODS: Primary outcome: percentage days abstinent (PDA); secondary outcomes: 12-Step attendance, substance-related consequences, longest period of abstinence, proportion abstinent/mostly abstinent, psychiatric symptoms.
RESULTS: Primary outcome: PDA was not significantly different across treatments [b = 0.08, 95% confidence interval (CI) = -0.08 to 0.24, P = 0.33; Bayes\' factor = 0.28).
RESULTS: during treatment, iTSF patients had substantially greater 12-Step attendance, but this advantage declined thereafter (b = -0.87; 95% CI = -1.67 to 0.07, P = 0.03). iTSF did show a significant advantage at all follow-up points for substance-related consequences (b = -0.42; 95% CI = -0.80 to -0.04, P < 0.05; effect size range d = 0.26-0.71). Other secondary outcomes did not differ significantly between treatments, but effect sizes tended to favor iTSF. Throughout the entire sample, greater 12-Step meeting attendance was associated significantly with longer abstinence during (r = 0.39, P = 0.008), and early following (r = 0.30, P = 0.049), treatment.
CONCLUSIONS: Compared with motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), in terms of abstinence, a novel integrated 12-Step facilitation treatment for adolescent substance use disorder (iTSF) showed no greater benefits, but showed benefits in terms of 12-Step attendance and consequences. Given widespread use of combinations of 12-Step, MET and CBT in adolescent community out-patient settings in North America, iTSF may provide an integrated evidence-based option that is compatible with existing practices.

Adolescent substance use disorder treatment programs are often based on the 12-step philosophy of Alcoholics Anonymous and/or link adolescents to these free resources. Despite this, no studies have developed and rigorously tested a twelve-step facilitation (TSF) intervention for young people, leaving a significant evidence gap. This study describes the first systematic development of an outpatient adolescent TSF treatment. An integrated twelve-step facilitation (iTSF) treatment incorporated TSF, motivational enhancement therapy, and cognitive behavioral therapy elements and was developed in an iterative manner with weekly feedback provided by 36 adolescents (M age 17 years [SD = 1.4]; 52.8% white) with DSM-IV substance use disorder recruited from the community. Assessments were conducted at baseline and at three and six months. Participants completed 6 of 10 sessions on average (8 participants completed all 10). Notable treatment developments were the inclusion of \"in-services\" led by Marijuana Anonymous members, including parents in a portion of individual sessions to provide a rationale for TSF, and use of a Socratic therapeutic interaction style. Acceptability and feasibility of the treatment were excellent (treatment satisfaction was 4.29 [SD = 0.59] out of 5). In keeping with TSF theory, the intervention substantially increased 12-step participation, and greater participation related to greater abstinence. iTSF is a replicable manualized treatment that can be implemented and tested in outpatient settings. Given the widespread compatibility of iTSF with the current adolescent treatment, if found efficacious, iTSF could be relatively easily adopted, implemented, and sustained and could provide an evidence-based option that could undergird current practice.