Alcoholics Anonymous and Relapse Prevention as Maintenance Strategies After Conjoint Behavioral Alcohol Treatment for Men: 18-Month Outcomes.

Ninety men with alcohol problems and their female partners were randomly assigned to 1 of 3 outpatient conjoint treatments: alcohol behavioral couples therapy (ABCT), ABCT with relapse prevention techniques (RP/ABCT), or ABCT with interventions encouraging Alcoholics Anonymous (AA) involvement (AA/ABCT). Couples were followed for 18 months after treatment. Across the 3 treatments, drinkers who provided follow-up data maintained abstinence on almost 80% of days during follow-up, with no differences in drinking or marital happiness outcomes between groups. AA/ABCT participants attended AA meetings more often than ABCT or RP/ABCT participants, and their drinking outcomes were more strongly related to concurrent AA attendance. For the entire sample, AA attendance was positively related to abstinence during follow-up in both concurrent and time-lagged analyses. In the RP/ABCT treatment, attendance at posttreatment booster sessions was related to posttreatment abstinence. Across treatment conditions, marital happiness was related positively to abstinence in concurrent but not time-lagged analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcoholics Anonymous involvement and positive alcohol-related outcomes: Cause, consequence, or just a correlate? A prospective 2-year study of 2,319 alcohol-dependent men.

A positive correlation between Alcoholics Anonymous (AA) involvement and better alcohol-related outcomes has been identified in research studies, but whether this correlation reflects a causal relationship remains a subject of meaningful debate. The present study evaluated the question of whether AA affiliation appears causally related to positive alcohol-related outcomes in a sample of 2,319 male alcohol-dependent patients. An initial structural equation model indicated that 1-year posttreatment levels of AA affiliation predicted lower alcohol-related problems at 2-year follow-up, whereas level of alcohol-related problems at 1-year did not predict AA affiliation at 2-year follow-up. Additional models found that these effects were not attributable to motivation or psychopathology. The findings are consistent with the hypothesis that AA participation has a positive effect on alcohol-related outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affiliation with Alcoholics Anonymous after treatment: A study of its therapeutic effects and mechanisms of action.

Relatively little is known about how substance abuse treatment facilitates positive outcomes. This study examined the therapeutic effects and mechanisms of action of affiliation with Alcoholics Anonymous (AA) after treatment. Patients (N?=?100) in intensive 12-step substance abuse treatment were assessed during treatment and at 1- and 6-month follow-ups. Results indicated that increased affiliation with AA predicted better outcomes. The effects of AA affiliation were mediated by a set of common change factors. Affiliation with AA after treatment was related to maintenance of self-efficacy and motivation, as well as to increased active coping efforts. These processes, in turn, were significant predictors of outcome. Findings help to illustrate the value of embedding a test of explanatory models in an evaluation study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcoholics anonymous, other 12-step movements and psychotherapy in the US population, 1990

Based on the 1990 US National Alcohol Survey, this note provides the first available comprehensive findings on self-reported utilization of a variety of sources of personal support and counselling for alcohol and other problems. Respondents were queried about lifetime attendance and number of times they went to identified sources of help in the prior year. Twelve-step groups included Alcoholics Anonymous, Al-Anon, Adult Children of Alcoholics, and other non-alcohol-oriented groups like Gamblers Anonymous, Narcotics Anonymous, and Overeaters Anonymous; additional questions inquired about support or therapy groups and individual counselling for non-alcohol problems. Of the US adult population, 9% have been to an AA meeting at some time, 3.6% in the prior year, only about one-third of these for problems of their own. About half these percentages, mostly women, have attended Al-Anon. Of the same population, 13.3% indicate ever attending a 12-step meeting (including non-alcohol-oriented groups), 5.3% in the last year. During the prior year a further 2.1% used other support/therapy groups and 5.5% sought individual counselling/therapy for personal problems other than alcohol. In contrast to this high reported utilization, only 4.9% (ever) and 2.3% (12-months) reported going to anyone including AA for a problem (of their own) related to drinking.     

Is it beneficial to have an alcoholics anonymous sponsor?

Alcoholics Anonymous (AA) attendance is predictive of increased abstinence for many problem drinkers and treatment referral to AA is common. Strong encouragement to acquire an AA sponsor is likewise typical, and findings about the benefits associated with social support for abstinence in AA support this practice, at least indirectly. Despite this widespread practice, however, prospective tests of the unique contribution of having an AA sponsor are lacking. This prospective study investigated the contribution of acquiring an AA sponsor using a methodologically rigorous design that isolated the specific effects of AA sponsorship. Participants were recruited from AA and outpatient treatment. Intake and follow-up assessments included questionnaires, semi-structured interviews, and urine toxicology screens. Eligibility criteria limited prior treatment and AA histories to clarify the relationship of interest while, for generalizability purposes, broad substance abuse criteria were used. Of the 253 participants, 182 (72%) provided complete data on measures central to the aims of this study. Overall reductions in alcohol, marijuana, and cocaine use were found over 12-months and lagged analyses indicated that AA attendance significantly predicted increased abstinence. During early AA affiliation but not later logistic regressions showed that having an AA sponsor predicted increased alcohol-abstinence and abstinence from marijuana and cocaine after first controlling for a host of AA-related, treatment, and motivational measures that are associated with AA exposure or are generally prognostic of outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reaction to Cummings on addiction.

Argues that there is an assumption in N. A. Cummings's (see record 1980-08234-001) article that is unfortunate for psychologists who work with addiction and for their patients. Cummings devotes only a short paragraph to Alcoholics Anonymous (AA) and speaks in a way that dismisses AA as not worthy of serious consideration in the treatment of addictions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development and initial evaluation of the Survey of Readiness for Alcoholics Anonymous Participation.

This article presents 5 studies related to the development and initial evaluation of the Survey of Readiness for Alcoholics Anonymous Participation (SYRAAP). The SYRAAP is a brief, multidimensional, self-administered instrument that assesses beliefs associated with Alcoholics Anonymous (AA) participation. Study 1 generated 239 candidate items for potential inclusion in the instrument. Study 2 assessed the content validity of these items according to 3 criteria and identified a subset of 60 with the highest values on the criteria for further consideration. Study 3 produced a shorter version of the SYRAAP and evaluated its structure, internal reliability, and validity. Study 4 reevaluated the structure and internal reliability of the SYRAAP and yielded findings that were generally consistent with those from Study 3. Study 5 established stability reliability for the instrument. The collective findings indicated the SYRAAP can reliably and validly assess individual-level beliefs associated with AA participation. The potential use of the SYRAAP for researchers and clinicians, along with limitations of the work presented here, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing network support for drinking: Initial findings from the Network Support Project.

The aim of this study was to determine whether a socially focused treatment can effect change in the patient's social network from one that reinforces drinking to one that reinforces sobriety. Alcohol dependent men and women (N = 210) recruited from the community were randomly assigned to 1 of 3 outpatient treatment conditions: network support (NS), network support + contingency management (NS + CM), or case management (CaseM; a control condition). Analysis of drinking rates for 186 participants at 15 months indicated a significant interaction effect of Treatment × Time, with both NS conditions yielding better outcomes than the CaseM condition. Analyses of social network variables at posttreatment indicated that the NS conditions did not reduce social support for drinking relative to the CaseM condition but did increase behavioral and attitudinal support for abstinence as well as Alcoholics Anonymous (AA) involvement. Both the NS variables and AA involvement variables were significantly correlated with drinking outcomes. These findings indicate that drinkers' social networks can be changed by a treatment that is specifically designed to do so, and that these changes contribute to improved drinking outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Optimal EMG signal bandwidth and interelectrode distance for the recording of acoustic, electrocutaneous, and photic blink reflexes

OBJECTIVE: The purpose of this research was to control for self-selection bias in the evaluation of Alcoholics Anonymous (AA) as aftercare treatment. Observational studies of alcoholism aftercare treatment are subject to selection bias whenever the self-selection process results in important differences in unobserved casemix dimensions between treatment groups. METHOD: The sample included 118 male veterans discharged from inpatient alcohol treatment, 85% of whom were followed-up at 3 months. Drinking outcomes were measured by self-reported abstinence in the third month after discharge. The aftercare treatment effect of AA was estimated using standard logistic regression analysis and instrumental variables analysis. Instruments included the subject's ability to drive oneself to AA meetings and the presence/absence of an AA meeting in the subject's town of residence. A Hausman exogeniety test was used to determine whether the standard logistic regression results were subject to self-selection bias. RESULTS: Estimates from the standard logistic regression yielded a positive (OR = 3.7) and significant (p = .018) treatment effect for AA attendance. However, the instrumental variables analysis yielded a smaller (OR* = 1.7) and insignificant treatment effect estimate (p = .782). The Hausman exogeniety test indicated that the treatment effect estimate from the standard logistic regression was subject to significant self-selection bias (chi2 = 83.9, 1 df, p <.01). CONCLUSIONS: The AA aftercare treatment effect observed in this sample was due to differences in unobserved casemix factors between the treatment groups. Results suggest that previous AA aftercare research may have also been subject to self-selection bias. Researchers of substance abuse outcomes should consider analyzing nonexperimental data using instrumental variables methodologies.     

Long-Term Influence of Duration and Frequency of Participation in Alcoholics Anonymous on Individuals With Alcohol Use Disorders.

This study examined the influence of the duration and frequency of a baseline episode of participation in Alcoholics Anonymous (AA) among 473 individuals with alcohol use disorders on 1-year and 8-year outcomes and the effect of additional participation and delayed participation on outcomes. Compared with individuals who did not participate, individuals who affiliated with AA relatively quickly, and who participated longer, had better 1-year and 8-year alcohol-related outcomes. Individuals who continued to participate, and those who continued longer, had better alcohol-related outcomes than did individuals who discontinued participation, but individuals who delayed participation in AA had no better outcomes than those who never participated. In general, the frequency of participation was independently associated only with a higher likelihood of abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Molar environmental contexts surrounding recovery from alcohol problems by treated and untreated problem drinkers.

The relation between event occurrences and recovery from drinking problems was investigated in abstinent problem drinkers with different help-seeking histories: no assistance (n?=?18), Alcoholics Anonymous (AA) only (n?=?18), or alcohol treatment plus AA (n?=?21). Events were assessed retrospectively for a 4-year period that spanned the 2 years before and 2 years after subjects initiated stable abstinence (M?=?6.8 years abstinent). Collaterals verified subjects' reports. Events common to recovery across the 3 help-seeking groups included decreases from the pre- through the postresolution period in events reflecting health, legal, intimate relations, and family problems and increases during the year following initial abstinence in events reflecting positive changes in health habits, finances, social activities, and intimate relations. The changes in legal and social events and in positive events generally were due largely to the 2 groups who had received assistance. Results suggest similarities in the molar environmental contexts that surround recoveries achieved with and without assistance, whereas differences in event occurrences due to help-seeking status were more circumscribed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reduced substance-abuse-related health care costs among voluntary participants in Alcoholics Anonymous

OBJECTIVE: This study examined differences in outcomes, alcoholism treatment utilization, and costs between alcoholic individuals with no previous treatment history who chose to attend Alcoholics Anonymous (AA) or to seek help from a professional outpatient alcoholism treatment provider. METHODS: Participants in this three-year prospective study were recruited at alcoholism information and referral services and at detoxification units in the San Francisco Bay Area. Chi square and t tests and repeated-measures analyses of variance were used to examine data gathered from interviews with 201 participants at baseline and at one and three years. RESULTS: At baseline, participants who chose to attend AA meetings (N = 135) were not significantly different from those who chose professional outpatient treatment (N = 66) in sex, marital status, employment, race, and symptoms of alcohol dependence and depression. However, AA attendees had lower incomes and less education and experienced more adverse consequences of drinking at baseline than did those who sought outpatient care, suggesting somewhat worse prognoses for the AA group. Over the three-year study, per-person treatment costs for the AA group were 45 percent (or $1,826) lower than costs for the outpatient treatment group. Despite the lower costs, outcomes for the AA group at both one and three years were similar to those of the outpatient treatment group. CONCLUSIONS: Voluntary AA participation may significantly reduce professional treatment costs. Clinicians, researchers, and policymakers should recognize the potential health care cost offsets offered by AA and other self-help organizations.     

Network support for drinking, Alcoholics Anonymous and long-term matching effects

AIMS: (1) To examine the matching hypothesis that Twelve Step Facilitation Therapy (TSF) is more effective than Motivational Enhancement Therapy (MET) for alcohol-dependent clients with networks highly supportive of drinking 3 years following treatment; (2) to test a causal chain providing the rationale for this effect. DESIGN: Outpatients were re-interviewed 3 years following treatment. ANCOVAs tested the matching hypothesis. SETTING: Outpatients from five clinical research units distributed across the United States. Participants: Eight hundred and six alcohol-dependent clients. INTERVENTION: Clients were randomly assigned to one of three 12-week, manually-guided, individual treatments: TSF, MET or Cognitive Behavioral Coping Skills Therapy (CBT). MEASUREMENTS: Network support for drinking prior to treatment, Alcoholics Anonymous (AA) involvement during and following treatment, percentage of days abstinent and drinks per drinking day during months 37-39. FINDINGS: (1) The a priori matching hypothesis that TSF is more effective than MET for clients with networks supportive of drinking was supported at the 3 year follow-up; (2) AA involvement was a partial mediator of this effect; clients with networks supportive of drinking assigned to TSF were more likely to be involved in AA; AA involvement was associated with better 3-year drinking outcomes for such clients. CONCLUSIONS: (1) In the long-term TSF may be the treatment of choice for alcohol-dependent clients with networks supportive of drinking; (2) involvement in AA should be given special consideration for clients with networks supportive of drinking, irrespective of the therapy they will receive.     

Picolinic acid modulates kainic acid-evoked glutamate release from the striatum in vitro

This paper examines the proposition that increased treatment for alcohol abuse and Alcoholics Anonymous (AA) membership can account for a large part of the recent declines in cirrhosis mortality and morbidity. Data on treatment and AA membership in the USA between 1979 and 1987 and in Ontario between 1975 and 1986 are used, together with estimates of cirrhosis risk and the likely impact of treatment and AA membership. The results show that increased treatment levels and AA membership could account for all of the reductions in cirrhosis deaths and hospital admissions in Ontario. In the USA all of the deaths and about 40% of the admissions could be accounted for by these factors.     

Alcoholics anonymous and behavior therapy: Can habits be treated as diseases? Can diseases be treated as habits?

Alcoholics Anonymous (AA) and behavior therapy have often been characterized as having opposing views of the nature and treatment of alcohol problems. This article describes the theoretical foundations, view of the change process, and treatment practices of AA and behavior therapy. Theoretical and practice perspectives on integration of the two models are examined, and advantages and disadvantages of integration are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tyrosinase transfection produces melanin synthesis and growth retardation in glioma cells

Therapists working in the addictions field and practicing from a psychoanalytic psychodynamic framework are often confronted with the patient's need to know, the demand for therapist self-disclosure. Consistent with Alcoholics Anonymous (AA) principles, many patients state that they cannot be helped unless the therapist is revealing of their personal background. This paper discusses the theoretical roots of therapist self-disclosure and the AA philosophy and offers suggestions for how the two might be reconciled.     

Psychoanalytic approaches to alcoholism and addiction: Treatment and research.

Discusses modified psychoanalysis as a treatment for addiction and reviews the outcome research for such therapy. Modifications to traditional psychoanalysis that may be made for addicts or alcoholics include an initial phase of treatment that is supportive and didactic, followed by more psychoanalytically oriented treatment; a therapist who is active rather than passive; the forestalling of transference; and the recommendation for participation in Alcoholics Anonymous. Two of 3 studies in which modified psychoanalysis was used with addicts or alcoholics found that those Ss derived significant benefit from the therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verification of C. G. Jung's Analysis of Rowland Hazard and the History of Alcoholics Anonymous.

Extant historical scholarship in the Jungian literature and the Alcoholics Anonymous (AA) literature does not provide a complete picture of the treatment of Rowland Hazard by C. G. Jung, an analysis that AA co-founder Bill Wilson claimed was integral to the foundation of AA in theory and practice. Wilson's original report resulted in archivists and historians incorrectly calibrating their searches to the wrong date. The current work definitively solves the mystery of the timing of Hazard's treatment with Jung by placing his preliminary analysis with Jung in the year 1926, rather than 1930 or 1931. Previously unexamined correspondence originating from Jung, Hazard, his cousin Leonard Bacon, his uncle Irving Fisher, and his aunt Margaret Hazard Fisher is supplemented by relevant primary and secondary source material. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy and Alcoholics Anonymous: An integrated approach.

This article provides a rationale for, and a method of, combining a nonprofessional self-help addiction recovery program, Alcoholics Anonymous (AA), and a professional treatment approach, psychotherapy. The two approaches share a common goal, target similar issues, and work toward similar outcomes. A psychotherapy approach that integrates the two approaches can be quite powerful. Treating a patient in psychotherapy who is also working in the AA program without a good understanding of AA can result in the two approaches working at cross-purposes, diminishing the effectiveness of both interventions. After a brief discussion of psychotherapy integration, the AA program is examined in detail, focusing on the philosophy and change strategies that are compatible with psychodynamic and cognitive–behavioral models of psychotherapy. A method for integrating these techniques into a psychotherapy directed at treating addiction is presented. Guidelines are provided to manage the implementation of this integrated approach throughout the process of recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of carl Jung and William james on the origin of Alcoholic Anonymous.

Alcoholics Anonymous is probably the most influential self-help organization in the world, with a current worldwide membership approaching 2 million. The origin of the organization has ties to Carl Gustav Jung and William James, 2 very prominent figures in the history of psychology. A brief history of the events that led to the formation of Alcoholics Anonymous is presented, with particular emphasis on the influence of Jung and James. An account of relevant life events of both Jung and James is provided, in addition to a summary of their views on alcoholism and its treatment. Speculation is offered on how the 2 men might view their unsolicited association with the organization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)