BOOKS & ELETRONIC MEDIA
Circles of recovery: self-help organizations for addictions
Isidore Obot; Shekhar Saxena1
Department of Mental Health and Substance Abuse, World Health Organization, 1211 Geneva 27, Switzerland
Author: Keith Humphreys
Series: International Research Monographs in the Addiction
Publisher: Cambridge: Cambridge University Press; 2004
ISBN: 0521792770; 228 pages;
price: UK£ 55.00
The volumes of the International Research Monographs in the Addictions, edited by Griffith Edwards of the National Addiction Centre, London, are useful resources for professionals in the field of addictions. The inclusion of the present book in this prestigious series is entirely justified.
Circles of recovery is the first attempt to document the wide variety of self-help organizations for addiction problems found in many parts of the world. It is written for both experts and general readers, though the latter might find some chapters of little interest. Because the self-help movement remains an area that has been consistently ignored by professionals, caregivers and researchers, the book is an especially welcome addition.
The author discusses the nature of self-help organizations and explores why they have thrived in many societies. There follows a very informative discussion of the types of organizations and movements that exist in different parts of the world their origins, philosophy and membership. This comprehensive analysis also makes clear the significant influence of Alcoholics Anonymous (AA) on the majority of all other self-help organizations.
In what is probably the most important chapter for people who are already familiar with the subject, the author presents a detailed analysis of available evaluation studies that examine the effectiveness of self-help organizations for addiction problems. The findings confirm what many would have expected: where studies exist, they show positive outcomes for the organization most often studied AA but the chapter also reveals that little is known about how effective other organizations are. Not only are many of them not evaluated in any rigorous manner, but also the designs used in the studies are often weak, resulting in the lack of unequivocal findings. Especially useful (for the scientific reader) is the section on suitable methods for generating scientific evidence of effectiveness in this difficult area of self-help interventions. One hopes that these methods will be used by researchers to accumulate more evidence in the future.
Even if many self-help organizations are not demonstrated to be effective for problems of addiction, their popularity with the people who use them remains high. In part, this might be attributable to what the author treats as more subjective outcomes than those that can easily be measured by researchers. Among such aspects are reports of spiritual and identity change, development of new friendships, and involvement in political action in the community, all of which are likely to improve the quality of life of persons in recovery and contribute to valid positive outcomes.
The author is a well-known figure in the fields of evaluation research and the treatment of substance dependence. He has effectively focused the attention of an international audience on responses to a problem of global dimension.
Addiction to psychoactive substances and related problems have become a serious threat to health and welfare in many parts of the world. Data from WHO show that the abuse of tobacco and alcohol products is a major contributor to the global burden of disease not only in western countries but also in low-mortality developing countries. In spite of this growing burden, there is a dearth of resources and services for managing alcohol and other drug problems in most countries. Even where treatment services are available they are often not accessible, mainly because of an inability to pay for them. Therefore, many people who need help for their substance use problems have come to depend on self-help organizations fortreatment and the prevention of relapse.
It emerges clearly that most of the self-help movement is confined to the western world, and the rest of the world is still cautiously experimenting with these models. The best service this book can render is to open the way for the adoption of the self-help philosophy as an option everywhere and to stimulate an ongoing scientific evaluation of its effectiveness. 
1 Correspondence should be sent to Dr Saxena (email: saxenas@who.int).
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