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Prison ‘aha’ moment leads to research into mental health and addiction

Stanford researcher finds that inpatient psychiatric care helps long-term recovery rates for people with both mental illness and addiction.

Noel Vest was watching television in a Nevada state prison when he experienced an aha moment that changed his life.

The topic of the show was addiction and recovery, and it struck a chord for Vest, who was serving a seven-year sentence for identity theft.

"It dawned on me that I could become a drug and alcohol counselor," Vest told me. After he was released from prison in 2009, he followed up: He returned to school, trained to be a counselor and eventually earned his PhD.

Now Vest is a postdoctoral scholar in the Systems Neuroscience and Pain Lab at Stanford Medicine, and his experience as a person in recovery from methamphetamine addiction helps inspire his research into addiction and mental health.

In his most recent work, Vest and his colleagues examined long-term recovery rates for people diagnosed with both mental illness and addiction. They found that patients significantly reduced their alcohol use and reported fewer symptoms of depression after inpatient psychiatric care.

They also found that Alcoholics Anonymous and other support groups helped a significant portion of people in the study.

"We saw that 90% of individuals reduced their drinking very, very quickly," Vest said. "I want to drive home the fact that these people are getting better, and from a public health perspective, this is huge. We saw these big reductions in drinking and depression symptoms across time."

Improving long-term recovery

For a study funded by the U.S. Department of Veterans Affairs, Vest and his colleagues examined assessments on 406 people diagnosed with both mental illness and substance use disorder over a 15-month period. Assessments were made when the participants were checked into a psychiatric facility and repeated three months, nine months, and 15 months later. Participants stayed in a facility for an average of a week.

In their analysis, the researchers found that almost 90% of participants had cut their alcohol use by 50% or more and had fewer depression symptoms by the end of the study period. After inpatient psychiatric care, some people recovered from addiction with Alcoholics Anonymous, while others who also showed levels of recovery didn't participate in AA.

"Our results were consistent with what we see in general population studies," Vest said. "For about one-third of the participants, AA worked really well. But there is also recovery without AA."

Vest said he became aware of link between mental illness and substance abuse during his years of incarceration. At AA meetings in prison, he also learned how common the dual diagnosis is, and recognized how his own moderate depression had contributed to his years of addiction.

After his release, he decided to focus his doctoral research on the intersection of mental health and substance use disorder, specifically borderline personality disorder and prescription opioid misuse.

Landing at Stanford as a postdoc was "a long shot," he told me. When he experienced his aha moment in prison, he could never have imagined he'd be where he is today.

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