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CORK Bibliography: Alcoholics Anonymous (AA)

64 citations. January 2006 to present

Prepared: December 2008

Aase DM; Jason LA; Robinson WL. 12-step participation among dually-diagnosed individuals: A review of individual and contextual factors. (review). Clinical Psychology Review 28(7): 1235-1248, 2008. (75 refs.)

The frequent co-occurrence of substance abuse disorders along with psychiatric disorders creates a number of complexities and needs in terms of long-term treatment for individuals. 12-step groups might provide unique mechanisms by which dually-diagnosed individuals can maintain their abstinence and improve their psychological functioning. This paper reviews the literature on outpatient community 12-step participation among dually-diagnosed individuals, and also focuses on individual factors that may interact with treatment: homelessness. legal status, and ethnicity. A total of 59 articles was included in the review. with an emphasis on these individual factors and findings regarding mechanisms of action. Overall, findings from the studies reviewed suggest a general benefit of 12-step participation across these individual factors and some potential for dual-focus 12-step programs for dually-diagnosed individuals via social support and self-efficacy. However, methodological limitations and lack of research in the area of ethnicity limited some of the conclusions that can be made. Suggestions for further research are discussed.

Bodin MC; Romelsjo A. Predictors of 2-year drinking outcomes in a Swedish treatment sample. European Addiction Research 13(3): 136-143, 2007. (50 refs.)

Background: Few studies have investigated predictors of short- and longer-term outcomes in relatively well functioning treatment samples. Methods: Multivariate logistic regression analyses were used to identify predictors of continuous abstinence in 188 individuals during their 2nd year after private 12-step treatment in Sweden, and findings are related to a previous report on 1-year outcomes. Results: Individual baseline characteristics were not directly related to 2nd year outcomes, while a higher 1st-year drinking severity decreased the likelihood of 2nd-year abstinence. Satisfaction with treatment and affiliation with Alcoholics Anonymous, but not program aftercare during the 1st year increased the likelihood of 2nd-year abstinence. Conclusion: Results are consistent with previous studies showing that shorter-term outcomes are likely to be maintained, and that baseline characteristics and treatment factors account less for outcomes over longer terms.

Bogenschutz MP; Tonigan JS; Miller WR. Examining the effects of alcoholism typology and AA attendance on self-efficacy as a mechanism of change. Journal of Studies on Alcohol 67(4): 562-567, 2006. (36 refs.)

Objective: Existing research indicates that increased self-efficacy to sustain abstinence is a strong causal mechanism explaining later reduction of drinking. Little is known about how mechanisms of change may differ among distinct subgroups of alcoholics. The purpose of this study was to evaluate the mediational role of self-efficacy on changes in drinking associated with Alcoholics Anonymous (AA) attendance in Type-A and Type-B alcoholics. Method: Analysis of covariance and structural equation modeling were used to model 6-, 9-, 12-, and 15-month data from Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) participants who were classified as Type-A or Type-B alcoholics (N = 1,284; 72% male). Measures of AA attendance and percent days abstinent were taken from the Form 90. Self-efficacy was assessed with the Alcohol Abstinence Self-Efficacy Scale. Results: Alcoholism typology and AA attendance were independent predictors of later self-efficacy, but there was no interaction between typology and AA attendance. Abstinence self-efficacy mediated a modest proportion of the effect of posttreatment AA attendance on later abstinence in both Type-A and Type-B alcoholics. The strength of this mediation did not differ by typology. Conclusions: Self-efficacy for abstinence has a strong direct relationship to abstinence across treatment conditions and typologies. Increases in self-efficacy mediate some of the beneficial effects of AA for Type-A and Type-B alcoholics. Further work is necessary to determine whether self-efficacy plays a different role in the recovery of Type-A versus Type-B alcoholics.

Borden A. The History of Gay People in Alcoholics Anonymous: From the Beginning. New York: Haworth Press, 2006

This history examines the challenges AA faced as the Fellowship endeavored to become a more inclusive and cohesive community, and explicitly address the needs of gay alcoholics. The author incorporates first-person accounts to narrate events and the work of influential gay and straight AA members that touched upon key events in AA's history. The volume is divided into two historical periods. The first is the period from the founding of AA in 1935 through 1970. This section begins with a description of the recovering gay community. It then turns to the early history, beginning with the story of Barry L and the gay origins of AA's Third Tradition. Also discussed is a brief review of the early treatment of alcoholism and homosexuality. This is followed by examination of the debate in AA over meetings for gay alcoholic and includes material from interviews with members and co-founders of the first gay AA meetings. The second part of the book, entitled "Building Sober Communities" covers the period from 1970-2000. It traces developments across the country, including the history of the AA pamphlet "AA and the Gay/Lesbian Alcoholic", why a parallel AA organization for gay alcoholics formed in southern California, and strategies gay AA members developed to make their meetings simultaneously safe and public.

Borkman T; Kaskutas LA; Owens P. Contrasting and converging philosophies of three models of alcohol/other drugs treatment: Minnesota model, social model, and addiction therapeutic communities. Alcoholism Treatment Quarterly 25(3): 21-38, 2007

The Institute of Medicine and Project MATCH have promoted the concept that various treatment programs are equally effective. Yet little attention has been paid to common treatment models in current use. This paper compares three dominant models evident in public and private substance abuse treatment today: the Minnesota Model, the California Social Model Programs, and the addiction Therapeutic Community. We explore their common roots in Alcoholics Anonymous (AA), and how each approach selectively borrowed particular AA principles (e.g., abstinence as the goal, reliance on the experiential knowledge of recovery, etc.) while rejecting others (i.e., Therapeutic Communities adapted some of AA's 12 steps, but without spirituality as an ingredient). We then examine the dominant forces that were exerted on these emerging treatment approaches, including the development of the treatment industry (with alcoholics and drug addicts initially treated separately, but later merged), the professionalization of counselor roles (with Social Model Programs most vulnerable), and managed care to achieve cost containment. The current status of each model is presented which indicates that the differences among them had significantly narrowed by the year 2000. Homogeneity among models raises the issue of when a treatment center can legitimately identify itself as using a specific model: How can a policy maker, funder, or researcher be assured that a treatment center operates with its advertised model? Finally, we discuss the common therapeutic ingredient that remains: the peer-group process.

Brown AE; Whitney SN; Schneider MA; Vega CP. Alcohol recovery and spirituality: Strangers, friends, or partners? Southern Medical Journal 99(6): 654-657, 2006. (29 refs.)

Alcoholics Anonymous, with its steady but nonspecific promotion of belief in a higher power and its emphasis on the group process, long held a near-monopoly in the outpatient alcohol recovery field, but its hegemony has now been challenged by two very different perspectives. The first is a nonspiritual approach that emphasizes the individual's capability to find a personal pathway to sobriety, exemplified by Rational Recovery. The second is a faith-based method, built on a religious understanding of alcoholism, of which Celebrate Recovery is a prominent example, based upon Christianity. Most communities offer a variety of approaches, so clinicians who are aware of these differences are in a good position to help patients make intelligent choices among the competing recovery philosophies.

Brown H. Hi, My name is Boris. Forbes 180(8): 82-85, 2007. (0 refs.)

Lou Bantle, a former tobacco executive and alcoholic, battled apathy corruption and the mob to bring Alcoholics Anonymous to Russia.

Butler S; Jordan T. Alcoholics Anonymous in Ireland: AA's first European experience. Addiction 102(6): 879-886, 2007. (37 refs.)

Aim: To trace the evolution of Alcoholics Anonymous in Ireland from its establishment there in 1946, focusing on the efforts of early members to publicize the fellowship and negotiate a role for themselves in relation to existing religious and healthcare institutions. Methods Archival research, drawing mainly on primary sources in AA archives in New York and Dublin. Results: Anticipated tensions between this fellowship, which had its roots in Evangelical Protestantism, and the politically powerful Roman Catholic Church in Ireland were skillfully avoided; initial hostility from the medical profession quickly dissipated; and AA distanced itself from policy debate on the wider topic of alcoholism as disease. Conclusions: The relatively smooth introduction of AA to Ireland, the first European country in which it was established, may be attributed to the essentially pragmatic nature of the fellowship and the strategic abilities of its early members.

Campbell SW; Kelley MJ. Mobile phone use among Alcoholics Anonymous members: New sites for recovery. New Media & Society 10(6): 915-933, 2008. (47 refs.)

This article reports on a line of research exploring mobile phone use in the recovery efforts of Alcoholics Anonymous (AA) members. A preliminary investigation indicated that many individuals in AA have come to rely on the mobile phone for both instrumental and expressive recovery-related interactions. This article reports on follow-up initiatives to assess whether and how these forms of use are linked to its perceived value and explores more deeply how the technology is used in these ways. Using both quantitative and qualitative approaches, the study found that expressive use of the mobile phone made a particularly meaningful contribution to the perceived value of the technology as a tool for recovery. In addition, it uncovered ways that AA members are using mobile communication for social support and to stay connected with others in the program. The discussion offers implications of the findings and directions for future research.

Cloud RN; Besel K; Bledsoe L; Golder S; McKiernan P; Patterson D et al. Adapting motivational interviewing strategies to increase post-treatment 12-Step meeting attendance. Alcoholism Treatment Quarterly 24(3): 31-53, 2006

Recent twelve-step (TS) program research has suggested a dose threshold consisting of minimum weekly TS meeting attendance that is necessary to derive substantial benefit. Unfortunately, other research has observed the vast majority of patients do not attend meetings or attend sporadically in the period following treatment. As another example of research advancing our understanding of recovery processes, numerous studies have refined adaptations of Motivational Interviewing (MI) into a change theory with proven practice methods. This paper reviews related literature and provides rationale for the use of a brief motivational intervention to increase TS program attendance. The paper concludes by addressing two possible problems to implementing such an intervention: (1) Resistance within the culture of the addiction counseling field and (2) a lack of objective and normative TS program feedback data. We respond to this latter gap in the literature by advancing possible specimen feedback data.

Eaton J. Medicine, spirituality, and Alcoholics Anonymous: A personal story. Southern Medical Journal 100(4): 441-444, 2007. (5 refs.)

This first-person account of alcoholism and recovery, and involvement in Alcoholics Anonymous is one of several articles in a special section, "Spirituality/Medicine Interface Project."

Fenster J. Characteristics of clinicians likely to refer clients to 12-Step programs versus a diversity of post-treatment options. Drug and Alcohol Dependence 83(3): 238-246, 2006. (30 refs.)

Most clients in substance abuse treatment are referred for continuing care. However, post-treatment services vary widely in their approaches to helping individuals achieve better substance use outcomes. This study examined the attitudes of outpatient treatment staff who refer clients exclusively to 12-Step groups (12-Step subgroup) and staff who refer clients both to 12-Step groups and to other continuing care options (Diversity subgroup) toward seven mutual-aid and professional psychosocial post-treatment options: Twelve-Step Programs (12-Step), Cognitive-Behavioral Therapy (CBT), Moderation Management (MM), Smart Recovery(r) (SMART), Psychodynamic-oriented Therapy (PSY), Secular Organizations for Sobriety (SOS), and Women for Sobriety (WFS). A large percentage of clinicians lacked knowledge about the effectiveness of all alternatives to 12-Step programs with the exception of CBT. Clinicians in the 12-Step subgroup were more likely than those in the Diversity subgroup to be unfamiliar with alternatives to 12-Step programs and to believe less strongly in the effectiveness of CBT and PSY. A logistic regression found beliefs about CBT effectiveness and clinician preference for the 12-Step model to be related to the likelihood of referring exclusively to 12-Step groups. Findings suggest that clinicians could benefit from information and training on assessing and referring clients to various options for continuing care.

Ferri M; Amato L; Davoli M. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. (review). Cochrane Database of Systematic Reviews 3(CD005032), 2006. (65 refs.)

Background: Alcoholics Anonymous (AA) is an international organization of recovering alcoholics that offers emotional support through self-help groups and a model of abstinence for people recovering from alcohol dependence, using a 12-step approach. Although it is the most common, AA is not the only 12-step intervention available there are other 12-step approaches (labelled Twelve Step Facilitation (TSF)). Objectives To assess the effectiveness of AA or TSF programmes compared to other psychosocial interventions in reducing alcohol intake, achieving abstinence, maintaining abstinence, improving the quality of life of affected people and their families, and reducing alcohol associated accidents and health problems. Search strategy: We searched the Specialized Register of Trials of the Cochrane Group on Drugs and Alcohol, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE from 1966, EMBASE from 1980, CINAHL from 1982, PsychINFO from 1967. Searches were updated in February 2005. We also inspected lists of references for relevant studies. Selection criteria: Studies involving adults (< 18) of both genders with alcohol dependence attending on a voluntary or coerced basis AA or TSF programmes comparing no treatment, other psychological interventions, 12-step variants. Data collection and analysis One reviewer (MF) assessed studies for inclusion and extracted data using a pre-defined data extraction form. Studies were evaluated for methodological quality and discussed by all reviewers. Main results: Eight trials involving 3417 people were included. AA may help patients to accept treatment and keep patients in treatment more than alternative treatments, though the evidence for this is from one small study that combined AA with other interventions and should not be regarded as conclusive. Other studies reported similar retention rates regardless of treatment group. Three studies compared AA combined with other interventions against other treatments and found few differences in the amount of drinks and percentage of drinking days. Severity of addiction and drinking consequence did not seem to be differentially influenced by TSF versus comparison treatment interventions, and no conclusive differences in treatment drop out rates were reported. Included studies did not allow a conclusive assessment of the effect of TSF in promoting complete abstinence. Authors' conclusions: No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.

Flores P. Group Psychotherapy with Addicted Populations: An Integration of Twelve-Step and Psychodynamic Theory, Third Edition. London: Routledge, 2007

This is the third edition of a primer on group therapy with drug abuse troubled clients. It describes different types of groups, the use of groups in different settings, the dynamics of group work. It is organized into two major sections. The first deal with theoretical models and addresses core constructs such as attachment theory, the disease model, psychodynamic theory, and relational models. Of note it also discusses Alcoholics Anonymous, and how it might be viewed from these different theoretical perspectives. The second section deals with the application of different models and also deals with clinical concerns such as preparing clients for participation in groups, the nature of the therapeutic alliance, increasing group retention and reducing dropout, the use of contracts, basic tasks within groups, the role of procedural norms and anti-therapeutic norms, the use of "the here and now," and stages of group development.

Forcehimes AA; Feldstein SW; Miller WR. Glatt's curve revisited: A pilot study investigating the progression of recovery in Alcoholics Anonymous. Alcoholism Treatment Quarterly 26(3): 241-258, 2008

Glatt's 1958 curve is used in AA to illustrate the nature of alcohol dependence and recovery, and spiritual gains are considered an important point in the recovery progression. Sixteen AA members, who had experienced transformational changes, were interviewed regarding the progression of recovery surrounding their transformation. Their progressions were compared with Glatt's hypothetical curve. For most, the transformation was located in the middle of the recovery progression and was positively correlated with Glatt's progression. For this sample, the working of the 4th step of AA appeared to be an important catalyst for transformational change. In addition, the experience of transformation often resulted in a rebirth of ideals and a new set of enduring moral values.

Galanter M. Spirituality in Alcoholics Anonymous: A valuable adjunct to psychiatric services. (editorial). Psychiatric Services 57(3): 307-309, 2006. (15 refs.)

Alcoholics Anonymous ( AA) is described as a spiritual fellowship by many of its members, but its spiritual orientation needs to be better understood by clinicians and researchers. Spirituality is a latent construct, one that is inferred from multiple component dimensions, such as social psychology, neurophysiology, and treatment outcome research. Mechanisms related to its role in promotion of recovery in AA are discussed from the perspective of these findings, along with related options for professionally grounded treatment, such as Twelve-Step Facilitation. This discussion illustrates the importance of further research on AA and spirituality and of employing them in the provision of psychiatric services.

Galanter M. Spirituality and addiction: A research and clinical perspective. American Journal on Addictions 15(4): 286-292, 2006. (71 refs.)

Spirituality is a construct that has recently gained currency among clinicians because of its close association with twelve-step modalities and its perceived role in the promotion of meaningfulness in recovery from addiction. This article draws on studies from physiology, psychology, and cross-cultural sources to examine its nature and its relationship to substance use disorders. Illustrations of its potential and limitations as a component of treatment in spiritually oriented recovery movements like Alcoholics Anonymous, meditative practices, and treatment systems for the dually diagnosed are given.

Galanter MM. Spirituality and recovery in 12-step programs: An empirical model. Journal of Substance Abuse Treatment 33(3): 265-272, 2007. (65 refs.)

Alcoholics Anonymous (AA) and other 12-step programs are widely employed in the addiction rehabilitation community. It is therefore important for researchers and clinicians to have a better understanding of how recovery from addiction takes place, in terms of psychological mechanisms associated with spiritual renewal. A program like AA is described here as a spiritual recovery movement, that is, one that effects compliance with its behavioral norms by engaging recruits in a social system that promotes new and transcendent meaning in their lives. The mechanisms underlying the attribution of new meaning in AA are considered by recourse to the models of positive psychology and social network support; both models have been found to be associated with constructive health outcomes in a variety of contexts. By drawing on available empirical research, it is possible to define the diagnosis of addiction and the criteria for recovery in spiritually oriented terms.

Gossop M; Stewart D; Marsden J. Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study. Addiction 103(1): 119-125, 2008. (44 refs.)

Aims This study investigates the relationship between frequency of attendance at Narcotics Anonymous and Alcoholics Anonymous (NA/AA) meetings and substance use outcomes after residential treatment of drug dependence. It was predicted that post-treatment NA/AA attendance would be related to improved substance use outcomes. Methods Using a longitudinal, prospective cohort design, interviews were conducted with drug-dependent clients (n = 142) at intake to residential treatment, and at 1 year, 2 years and 4-5 years follow-up. Data were collected by structured interviews. All follow-up interviews were carried out by independent professional interviewers. Findings Abstinence from opiates was increased throughout the 5-year follow-up period compared to pre-treatment levels. Clients who attended NA/AA after treatment were more likely to be abstinent from opiates at follow-up. Abstinence from stimulants increased at follow-up but (except at 1-year follow-up) no additional benefit was found for NA/AA attendance. There was no overall change in alcohol abstinence after treatment but clients who attended NA/AA were more likely to be abstinent from alcohol at all follow-up points. More frequent NA/AA attenders were more likely to be abstinent from opiates and alcohol when compared both to non-attenders and to infrequent (less than weekly) attenders. Conclusions: NA/AA can support and supplement residential addiction treatment as an aftercare resource. In view of the generally poor alcohol use outcomes achieved by drug-dependent patients after treatment, the improved alcohol outcomes of NA/AA attenders suggests that the effectiveness of existing treatment services may be improved by initiatives that lead to increased involvement and engagement with such groups.

Groh DR; Jason LA; Keys CB. Social network variables in Alcoholics Anonymous: A literature review. (review). Clinical Psychology Review 28(3): 430-450, 2008. (104 refs.)

Alcoholics Anonymous (AA) is the most commonly used program for substance abuse recovery and one of the few models to demonstrate positive abstinence outcomes. Although little is known regarding the underlying mechanisms that make this program effective, one frequently cited aspect is social support. In order to gain insight into the processes at work in AA, this paper reviewed 24 papers examining the relationship between AA and social network variables. Various types of social support were included in the review such as structural support, functional support, general support, alcohol-specific support, and recovery helping. Overall, this review found that AA involvement is related to a variety of positive qualitative and quantitative changes in social support networks. Although AA had the greatest impact on friend networks, it had less influence on networks consisting of family members or others. In addition, support from others in AA was found to be of great value to recovery, and individuals with harmful social networks supportive of drinking actually benefited the most from AA involvement. Furthermore, social support variables consistently mediated AA's impact on abstinence, suggesting that social support is a mechanism in the effectiveness of AA in promoting a sober lifestyle. Recommendations are made for future research and clinical practice.

Hedblom JB. Last Call: Alcoholism and Recovery. Baltimore: Johns Hopkins University Press, 2008

The journey from active alcoholism to sobriety, and the pivotal role of Alcoholics Anonymous (AA) in navigating that transition, is the focus of this book. It is directed to those in the professional community unfamiliar with AA. It incorporates first-person accounts. The author, a psychotherapist, covers the process of getting sober, from diagnosis to detox to sobriety. The book relates the history of Alcoholics Anonymous, and then describes the process of affiliation, the role of sponsors, the importance of spiritual development in recovery. In elaborating the Twelve Steps of AA, there is also discussion of how they meet the psychological needs and mindset of the alcoholic individual.

Hoffmann HC. Criticism as deviance and social control in Alcoholics Anonymous. Journal of Contemporary Ethnography 35(6): 669-695, 2006. (52 refs.)

Emile Durkheim recognized many years ago that all groups -- even a "society of saints" -- produce deviants. Group members must then come to terms with how to respond to and control those who violate the group's moral order. The Alcoholics Anonymous (AA) meeting offers an interesting context to explore this process. AA members, by their own admission, are far from being "saints," some admitting to adultery, theft, and assault during their active alcoholism. In this article, the author describes the moral order of AA that functions to prevent and create deviant behavior, focusing on AA members' use of criticism as both a method of social control and a violation of AA's normative system. This seeming contradiction is explained by showing that criticism is a social control strategy available primarily to high-status members, used primarily against lower-status members.

Humphreys K. The trials of Alcoholics Anonymous. (editorial). Addiction 101(5): 617-618, 2006. (15 refs.)

Kahler CW; Kelly JF; Strong DR; Stuart GL; Brown RA. Development and initial validation of a 12-step participation expectancies questionnaire. Journal of Studies on Alcohol 67(4): 538-542, 2006. (15 refs.)

Objective: There are no available instruments that assess expectancies for participation in 12-step mutual-help groups despite the impact such expectancies may have on actual participation. The purpose of the present study was to develop a measure of attitudes and expectancies regarding 12-step participation, to conduct preliminary analyses on its psychometric properties, and to explore its concurrent and predictive validity. Method: Alcohol-dependent patients (N = 48) undergoing inpatient detoxification completed a questionnaire that included subscales assessing expected benefits of, concerns about, and barriers to 12-step participation. Participants also completed measures of 12-step group participation and drinking outcomes at 1, 3, and 6 months following discharge. Results: After examining the internal consistency of the items within each subscale and refining the questionnaire accordingly, an exploratory factor analysis showed that the scales could be combined into a higher-order total score. This total score correlated significantly with prior 12-step experience and goals for attending future 12-step meetings. In addition, the Expectancies Total Score at baseline significantly predicted 12-step group participation during follow-up. Conclusions: The measure of attitudes and expectancies regarding 12-step group participation demonstrated good internal consistency, concurrent validity, and predictive validity. The measure may have clinical utility in highlighting patients' expectancies regarding 12-step participation, allowing treatment providers to explore with patients the benefits, concerns, and barriers to involvement that they have endorsed.

Kaskutas LA. Comments on the Cochrane review on Alcoholics Anonymous effectiveness. (letter). Addiction 103(8): 1402-1403, 2008. (8 refs.)

Kaskutas LA; Ammon LN; Oberste E; Polcin DL. A brief scale for measuring helping activities in recovery: The Brief Helper Therapy Scale. Substance Use & Misuse 42(11): 1767-1781, 2007. (37 refs.)

Background: Helping others is evident in the philosophy of Alcoholics Anonymous, and is emphasized in formal treatment. However, helping among recovering alcoholics has not been studied, in part because of a lack of helping measures. Methods: This study developed a Brief Helper Therapy Scale to capture helping among individuals with varying lengths of recovery. The 26-item long version of the Helper Therapy Scale was developed from qualitative interviews (n = 21) and item analysis of responses from 200 recovering alcoholics with differing lengths of recovery. Three subscales assessed Recovery, Life, and Community Helping. This brief version was created using an iterative process of item analysis designed to yield good internal consistency and representation of different types of helping. Helping was assessed as a continuous measure of how much time had been spent on each activity in the past week. Results: The resulting 9-item Brief Helper Therapy Scale demonstrated strong internal consistency (alpha = 0.83), but did not correlate well with psychological and spirituality measures used to assess construct validity. The Brief Helper Therapy Scale can be completed in about 5 minutes. Those in early recovery reported move involvement in recovery helping, with service in AA a notable exception. Those with the longest recovery focused more on community helping. Conclusions: Findings suggest that persons more stable in recovery move beyond a singular focus on recovery helping and demonstrate that people in recovery do contribute to society -- potentially dispelling some of the stigma associated with alcoholism.

Kelly JF; Myers MG. Adolescents' participation in Alcoholics Anonymous and Narcotics Anonymous: Review, implications and future directions. Journal of Psychoactive Drugs 39(3): 259-269, 2007. (73 refs.)

Youth treatment programs frequently employ 12-Step concepts and encourage participation in Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). Since AA/NA groups are easily accessible at no charge and provide flexible support at times of high relapse risk they hold promise as a treatment adjunct in an increasingly cost-constricting economic climate. Yet, due to concerns related to adolescents' developmental status, skepticism exists regarding the utility of AA/NA for youth. This review evaluates the empirical evidence in this regard, identifies and discusses knowledge gaps, and recommends areas for future research. Searches were conducted in PsychINFO, Medline, relevant literature and by personal correspondence. Findings suggest youth may benefit from AA/NA participation following treatment, but conclusions are limited by four important factors: (1) a small number of studies; (2) no studies with outpatients; (3) existing evidence is solely observational; and ( 4) only partial measurement of the 12-Step construct. While surveys of adolescent SUD treatment programs indicate widespread clinical interest and application of adult-derived 12-Step approaches this level of enthusiasm has not been reflected in the research community. Qualitative research is needed to improve our understanding of youth-specific AA/NA barriers, and efficacy, comparative effectiveness, and process studies are still needed to inform clinical practice guidelines for youth providers.

Kingree JB; Simpson A; Thompson M; McCrady B; Tonigan JS; Lautenschlager G. The development and initial evaluation of the Survey of Readiness for Alcoholics Anonymous Participation. Psychology of Addictive Behaviors 20(4): 453-462, 2006. (43 refs.)

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.

Kingree JB; Simpson A; Thompson M; McCrady B; Tonigan JS. The predictive validity of the Survey of Readiness for Alcoholics Anonymous Participation. Journal of Studies on Alcohol and Drugs 68(1): 141-148, 2007. (33 refs.)

Objective: This study evaluated the predictive validity of the Survey of Readiness for Alcoholics Anonymous Participation (SYRAAP), which is a 15-item, self-administered instrument. Method: Bivariate and multivariate analyses examined whether responses to the SYRAAP within I week of entering substance-use treatment (T1) were associated with posttreatment Alcoholics Anonymous (AA) participation at 3-month (T2) and 6-month (T3) follow-up assessments. The T I assessment was completed by 268 respondents; the T2 and T3 assessments were completed by 232 (86%) and 217 (81%) respondents, respectively. Results: Results revealed that responses to the SYRAAP at T1 predicted AA participation at T2 and T3. Conclusions: The findings indicate the SYRAAP is a valid measure for assessing readiness for participating in AA. Future research in relation to the SYRAAP and limitations of the current study are discussed.

Kuruvilla PK; Jacob KS. Five-year follow up for sobriety in a cohort of men who had attended an Alcoholics Anonymous programme in India. National Medical Journal of India 20(5): 234-236, 2007. (12 refs.)

Background. There are little data from India on the long term follow up of patients with alcohol dependence who have undergone a de-addiction programme. A cohort of patients who completed a detoxification and de-addiction programme based on the Alcoholics Anonymous model were followed up for a period of 5 years. Methods. A cohort design was used. A community outreach programme of a de-addiction centre was the setting for the study. One hundred and eighty-two patients who completed a detoxification and de-addiction programme based on the Alcoholics Anonymous model were followed up. Sobriety at 5 years' of follow up was the outcome measure. Results. One hundred and fifty-one (83%) patients were followed up at 5 years. The majority (90; 59.6%) did not change their alcohol consumption and a small minority (25; 16.5%) remained completely sober over the 5-year period. Sobriety at I year was significantly associated with complete abstinence at 5 years (chi(2) = 53.8; df = 1; p < 0.00 1). More patients coming from distant places (RR 0.84; 95% Cl: 0.71, 0.98; p<0.03) and those with health workers in their localities (RR 0.81; 95% Cl: 0.68, 0.96; p<0.01) were completely abstinent. These variables were also significantly associated with sobriety even after adjusting for other confounders using logistic regression. Conclusion. The results of the 5-year outcome are modest. More patients coming from distant places and those with health workers in their localities remained completely abstinent suggesting the possible role of the individual's motivation and the need for continued community support in maintaining sobriety.

Laffaye C; McKellar JD; Ilgen MA; Moos RH. Predictors of 4-year outcome of community residential treatment for patients with substance use disorders. Addiction 103(4): 671-680, 2008. (61 refs.)

Aims: This study examined systematically how predictors of substance use disorder (SUD) treatment outcome worked together over time and identified mediators and moderators of outcome. Design: The MacArthur model was applied in this naturalistic study to identify how baseline, discharge and 1-year follow-up factors worked together to predict 4-year improvement in substance-related problems. Setting Eighty-eight community residential facilities were selected based on geographic representativeness, number of patient referrals and type of treatment orientation. Participants Of 2796 male patients who completed intake assessments, 2324 were assessed at the 1-year follow-up and 2023 at the 4-year follow-up. Measurements: Self-report measures of symptom severity, functioning, social resources and coping, treatment and involvement in Alcoholics Anonymous (AA) were collected at baseline and at 1- and 4-year follow-ups. Provider-rated treatment participation measures were obtained at discharge. Findings Greater substance use severity, more psychiatric symptoms, more prior arrests and stronger belief in AA-related philosophy at treatment entry predicted improvement significantly in substance-related problems 4 years later. At the 1-year follow-up, being employed and greater use of AA-related coping predicted outcome significantly. AA-related coping at 1 year mediated the relationship partially between belief in AA philosophy at treatment entry and 4-year outcome. Conclusions The findings highlight the unique and positive impact of AA involvement on long-term SUD treatment outcome and extend understanding of why AA is beneficial for patients.

Laudet A; Stanick V; Sands B. An exploration of the effect of on-site 12-step meetings on post-treatment outcomes among polysubstance-dependent outpatient clients. Evaluation Review 31(6): 613-646, 2007. (92 refs.)

Rates of return to active substance use after addiction treatment tend to be high; participation in 12-step fellowships (e.g., Alcoholics Anonymous) reduces relapse rates but many clients do not attend or attend for a short period only. This quasi-experimental study uses repeated measurement to explore the role of presence/absence of on-site 12-step meetings during treatment on posttreatment outcomes. Polysubstance-dependent clients (N = 219) recruited at a program with and one without 12-step on-site, were followed for one year post-treatment. On-site 12-step enhanced 12-step attendance, especially during treatment, and predicted continuous abstinence for the post-treatment year. Holding 12-step meetings on-site is a low-cost strategy that programs should consider to foster post-treatment remission maintenance.

Litt MD; Kadden RM; Kabela-Cormier E; Petry N. Changing network support for drinking: Initial findings from the network support project. Journal of Consulting and Clinical Psychology 75(4): 542-555, 2007. (49 refs.)

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 X 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.

Mann RE; Zalcman RF; Smart RG; Rush BR; Suurvali H. Alcohol consumption, Alcoholics Anonymous membership, and suicide mortality rates, Ontario, 1968-1991. Journal of Studies on Alcohol 67(3): 445-453, 2006. (46 refs.)

Objective: The goal of this study is to identify alcohol-related factors that influence mortality rates from suicide. Specifically, we examine the impact of per capita consumption of total alcohol, distilled spirits, and beer and wine; unemployment rate; and Alcoholics Anonymous (AA) membership rate on total and male and female suicide mortality rates in Ontario between 1968 and 1991. Method: We studied the impact of alcohol consumption levels, AA membership rates, and unemployment rates on suicide mortality rates in Ontario from 1968 to 1991. Time series analyses with Auto Regressive Integrated Moving Average (ARIMA) modeling were applied to total and male and female suicide rates. The analyses performed included total alcohol consumption, distilled spirits consumption, beer consumption, and wine consumption. Missing AA membership data were interpolated with cubic splines. Results: Total alcohol consumption and consumption of each of beer, distilled spirits, and wine were significantly and positively related to total and female suicide mortality rates. AA membership rates were negatively related to total and female suicide rates. Although data for males did not reach significance (except for the relationship between wine consumption and suicide rate), the direction of effects was consistent with that observed for female and total suicide rates. Unemployment rates were positively related to male and total suicide rates in some models. Conclusions: These data confirm the important relationships between per capita consumption measures and suicide mortality rates seen by previous investigators. Additionally, the results for AA membership rates are consistent with the hypothesis that AA membership and treatment for misuse of alcohol can exert beneficial effects observable at the population level.

Mann RE; Zalcman RF; Smart RG; Rush BR; Suurvali H. Alcohol consumption, Alcoholics Anonymous membership, and homicide mortality rates in Ontario 1968 to 1991. Alcoholism: Clinical and Experimental Research 30(10): 1743-1751, 2006. (51 refs.)

Background: Research has shown a strong link between alcohol use and a variety of problems, including violence. Parker and colleagues have presented a selective disinhibition theory for the link between alcohol use and homicide (and other violence) that posits a causal relationship that is also influenced by other situational and contextual factors. This model is particularly well suited for aggregate-level investigations. In this study, we examine the impact of alcohol factors, including consumption measures and Alcoholics Anonymous (AA) membership rates, on homicide mortality rates in Ontario, and test predictions derived from the selective disinhibition model. Methods: Time series analyses with ARIMA modeling were applied to total, male, and female homicide rates in Ontario between 1968 and 1991. The analyses performed included total alcohol consumption, spirits consumption, beer consumption, and wine consumption. Missing AA membership data were interpolated with cubic splines. Results: For the total population and males, homicide rates were significantly and positively related to total alcohol consumption and to the consumption of beer and spirits. They were also negatively related to AA membership rates in the analyses involving spirits and wine and positively related to unemployment rates in the analyses involving beer, wine, and total alcohol. Among females, none of the measures were significant predictors of homicide mortality rates. Conclusions: These data provide important support for the selective disinhibition model and confirm important relationships between per capita consumption measures and homicide mortality rates, especially among males, seen in other studies. Additionally, the results for AA membership rates are consistent with the hypothesis that AA membership and treatment for misuse of alcohol can exert beneficial effects observable at the population level.

Matheson JL; Mccollum EE. Using metaphors to explore the experiences of powerlessness among women in 12-step recovery. Substance Use & Misuse 43(8/9): 1027-1044, 2008. (22 refs.)

12-Step programs of substance abuse recovery are the most utilized mutual-help models in the United States. A pivotal aspect of 12-Step is the often-controversial idea of powerlessness. There is debate about the usefulness of the concept of powerlessness, especially for women in recovery. This study used a metaphor-elicitation interviewing technique to examine the experiences of powerlessness among 13 women of varied racial, ethnic, and socioeconomic backgrounds, ages 21 to 60, who had an average of 9.5 years of recovery. Interviews were conducted during a 6-month span between 2004 and 2005 in the Washington, DC metropolitan area. Open and axial coding was used to determine emergent themes. Concepts of powerlessness were found to be process oriented and developmental. Some metaphors indicated positive emotions around powerlessness such as relief, whereas others indicated negative emotions such as fear. Implications for future research and study strengths and limitations are included.

Moos RH. Active ingredients of substance use-focused self-help groups. (review). Addiction 103(3): 387-396, 2008. (74 refs.)

Aims and methods: This paper provides an overview of some of the probable active ingredients of self-help groups in light of four related theories that identify common social processes that appear to underlie effective psychosocial treatments for and continuing remission from these disorders. Results Social control theory specifies active ingredients such as bonding, goal direction and structure; social learning theory specifies the importance of norms and role models, behavioral economics and behavioral choice theory emphasizes involvement in rewarding activities other than substance use, and stress and coping theory highlights building self-efficacy and effective coping skills. A review of existing studies suggests that the emphasis on these active ingredients probably underlies some aspects of the effectiveness of self-help groups. Conclusions: Several issues that need to be addressed to enhance understanding of the active ingredients of action of self-help groups are discussed, including consideration of indices of Alcoholics Anonymous (AA) affiliation as active ingredients, identification of personal characteristics that may moderate the influence of active ingredients on substance use outcomes, examination of whether active ingredients of self-help groups can amplify or compensate for treatment, identification of potential detrimental effects of involvement in self-help groups and focusing on the link between active ingredients of self-help groups and other aspects of the overall recovery milieu, such as the family and social networks.

Moos RH; Moos BS. Participation in treatment and Alcoholics Anonymous: A 16-year follow-up of initially untreated individuals. Journal of Clinical Psychology 62(6): 735-750, 2006. (51 refs.)

This study focused on the duration of participation in professional treatment and Alcoholics Anonymous (AA) for previously untreated individuals with alcohol use disorders. These individuals were surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later. Compared with individuals who remained untreated, individuals who obtained 27 weeks or more of treatment in the first year after seeking help had better 16-year alcohol-related outcomes. Similarly, individuals who participated in AA for 27 weeks or more had better 16-year outcomes. Subsequent AA involvement was also associated with better 16-year outcomes, but this was not true of subsequent treatment. Some of the association between treatment and long-term alcohol-related outcomes appears to be due to participation in AA.

Moos RH; Moos BS. Treated and untreated individuals with alcohol use disorders: Rates and predictors of remission and relapse. International Journal of Clinical and Health Psychology 6(3): 513-526, 2006. (35 refs.)

This observational descriptive study focused on whether individuals with alcohol use disorders who participate in professional treatment and/or Alcoholics Anonymous (AA) experience better long-term outcomes than individuals who do not obtain help. Participants were surveyed at baseline when they initiated help-seeking and 1 year, 3 years, 8 years, and 16 years later. Compared with individuals who obtained no help, individuals who participated in treatment and/or AA for 9 weeks or more in the first year after help-seeking had better 16-year outcomes. Participation in treatment and/or AA accelerated an overall pattern of change, so that individuals who obtained help improved somewhat more and more quickly than those who did not. Overall, individuals who did not obtain help were less likely to achieve remission and, even if they achieved remission, were more likely to relapse. The findings support the value of strengthening the referral process for individuals who seek help and indicate that providers should structure treatment programs to ensure continuing care and affiliation with AA.

Mueller SE; Petitjean S; Boening J; Wiesbeck GA. The impact of self-help group attendance on relapse rates after alcohol detoxification in a controlled study. Alcohol and Alcoholism 42(2): 108-112, 2007. (33 refs.)

Aims: Self-help groups such as Alcoholics Anonymous (AA) are widely recommended for aftercare of alcohol-dependent persons, even though scientific knowledge of its effectiveness is inconsistent. The aim of the present analysis was to elucidate whether persons attending AA groups regularly after detoxification have lower relapse rates within 1 year, compared to persons without self-help group attendance. Methods: Data for the present analysis were derived from the placebo-group of a multi-centre study in Germany (Wiesbeck et al., 2001). Patients were free to choose either self-help group attendance (N = 50) or no support (N = 28). Results: After 1-month of follow-up, there was a lower relapse rate in patients attending a self-help group as compared to the control group, a difference, however, that leveled off during the following months. Moreover, relapse rates did not differ significantly at any point of time between both groups. Levels of social functioning improved in both groups over 1 year. Conclusions: The present study was unable to show an advantage of self-help group attendance in reducing relapses compared to the control group.

Oakes K. Purpose in life: A mediating variable between involvement in Alcoholics Anonymous and long-term recovery. Alcoholism Treatment Quarterly 26(4): 450-463, 2008

This study proposed that the spiritual variable, purpose in life (PIL), has a significant mediating role within the empirically documented causative relationship between long-term sobriety in Alcoholics Anonymous (AA) and AA involvement. A representative sample of 78 participants, drawn from AA clubs located across the United States, was used in the study. Stepwise regression results showed PIL as a significant contributor to AA involvement, confirming the findings of previous studies. Baron and Kenny's (1986) regression analysis for mediation, however, did not support PIL as a mediator between AA involvement and long-term sobriety. It was concluded that the complexity of the AA involvement construct likely confounds the contribution of PIL to length of sobriety. Further research is needed to clarify the role of PIL in AA involvement.

Peele S; McCarley A. James Frey's one true thing. (editorial). Addiction Research & Theory 14(5): 453-460, 2006. (1 refs.)

This commentary addreses the book by James Frey, purportedly a memoir, "A Million Little Pieces" which was at central points fiction. It recounted his treatemnt for alcoholism and crack addiction at Hazelden. The author notes that while the criminal past was fabricated his attack on the 12-step treatment industry has been overlooked. (An attack which the author considers warranted.) The author considers it unfortunate that the Frey failed to chronicle the factors which were germane to his recovery.

Piderman KM; Schneekloth TD; Pankratz VS; Maloney SD; Altchuler SI. Spirituality in alcoholics during treatment. American Journal on Addictions 16(3): 232-237, 2007. (49 refs.)

The purpose of this study was to measure spiritual wellbeing (SWB), private religious practices (PRP), positive religious coping, abstinence self-efficacy (AASE), affiliation with AA (AAA), and their associations with alcoholics in treatment. Seventy-four adults in a three-week outpatient addiction treatment program were assessed at admission and discharge. Wilcoxon signed rank and t tests demonstrated significant increases in all variables. Spearman correlation coefficients detected significant associations between the spiritual variables, SWB and AASE, as well as PRP and AAA. Findings suggest that spiritual variables can change during treatment and that there may be connections between spiritual variables and variables associated with longer-term recovery.

Robinson EAR; Cranford JA; Webb JR; Brower KJ. Six-month changes in spirituality, religiousness, and heavy drinking in a treatment-seeking sample. Journal of Studies on Alcohol and Drugs 68(2): 282-290, 2007. (51 refs.)

Objective: This descriptive and exploratory study investigated change in alcoholics' spirituality and/or religiousness (S/R) from treatment entry to 6 months later and whether those changes were associated with drinking outcomes. Method: Longitudinal survey data were collected from 123 outpatients with alcohol use disorders (66% male; mean age = 39; 83% white) on 10 measures of S/R, covering behaviors, beliefs, and experiences, including the Daily Spiritual Experiences and Purpose in Life scales. Drinking behaviors were assessed with the Timeline Followback interview. Alcoholics Anonymous (AA) participation and attendance were also measured. Results: Over 6 months, there were statistically significant increases in half of the S/R measures, specifically the Daily Spiritual Experiences scale, the Purpose in Life scale, S/R practices scale, Forgiveness scale, and the Positive Religious Coping scale. There were also clinically and statistically significant decreases in alcohol use. Multiple logistic regression analyses showed that increases in Daily Spiritual Experiences and in Purpose in Life scores were associated with increased odds of no heavy drinking at 6 months, even after controlling for AA involvement and gender. Conclusions: In the first 6 months of recovery, many dimensions of S/R increased, particularly those associated with behaviors and experiences. Values, beliefs, self-assessed religiousness, perceptions of God, and the use of negative religious coping did not change. Increases in day-to-day experiences of spirituality and sense of purpose/meaning in life were associated with absence of heavy drinking at 6 months, regardless of gender and AA involvement. The results of this descriptive study support the perspective of many clinicians and recovering individuals that changes in alcoholics' S/R occur in recovery and that such changes are important to sobriety.

Rose AJ; Stein MR; Arnsten JH; Saitz R. Teaching internal medicine resident physicians about Alcoholics Anonymous: A pilot study of an educational intervention. Substance Abuse 27(3): 5-11, 2007

Greater physician confidence in treating alcoholism is associated with a higher frequency of referring alcoholic patients for treatment, but many physicians have limited experience with Alcoholics Anonymous. We implemented a brief, didactic and experiential educational intervention about AA and evaluated its effect on knowledge and attitudes, using a before-after repeated measures study design. Thirty-six first-year internal medicine resident physicians received an educational intervention, which consisted of a 45-minute lecture about AA, a visit to an AA meeting, and a 30-minute debriefing session the next day. Residents' knowledge and attitudes were assessed by a brief written anonymous survey before and after the educational intervention. Residents reported increases in self-perceived knowledge about AA and had more favorable attitudes towards AA after the intervention. Our pilot study shows that a brief, didactic and experiential course can improve physician knowledge and attitudes about AA, and holds promise for improving physician interface with this commonly used intervention.

Sachs KS. Psychotherapy and Alcoholics Anonymous: A guide for therapists. Alcoholism Treatment Quarterly 24(3): 55-69, 2006

Psychotherapy patients who attend Alcoholics Anonymous (AA) may be resistant to psychotherapeutic interventions because of the concern that their sobriety might be undermined. This article provides the psychotherapist with both a practical knowledge about AA as well as an understanding of the tools to maintain the sobriety the patient has acquired in AA. Alcoholics in therapy are viewed as having co-existing disorders of the self and therapeutic strategies are suggested which address treatment of both the disorders of the self as well as the addiction.

Sanders JM. Women and the Twelve Steps of Alcoholics Anonymous: A gendered narrative. Alcoholism Treatment Quarterly 24(3): 3-29, 2006

This paper examines how women "work" the twelve steps of Alcoholics Anonymous (AA) from a gendered perspective. Feminist critics of AA have challenged the language of AA's Twelve Steps, the spiritual nature of the steps, and the male-dominated culture of the Twelve-Step program. This paper offers insight into how women in AA approach, interpret, and utilize the Twelve Steps to recover from alcoholism. Through survey and narrative data, findings suggests that women working AA's Twelve Steps become empowered and change for the better in spite of the male-dominated culture and language of the Twelve Steps and regardless of the difficulty they may have encountered in completing these steps. In particular, the first three steps-the "surrender steps"-encourage women to let go of their alcoholic obsession and begin a spiritual path of recovery. Steps Four through Nine require women to "clean house" and get rid of old self-destructive ways so that they may develop a new and stronger sense of self. Finally, on completing Steps Ten through Twelve, women experience a spiritual awakening and then, in turn, "pass on" what they have learned from the Twelve Steps to other women in the program. Woven throughout these women's experiences is an acknowledgment of gender and the role it plays in how they work the Twelve Steps. In the end, these women express a sense of personal empowerment that is particular to a gender-specific orientation to the Twelve Steps of AA.

Sellman JD; Baker MP; Adamson SJ; Geering LG. Future of God in recovery from drug addiction. (review). Australian and New Zealand Journal of Psychiatry 41(10): 800-808, 2007. (69 refs.)

The purpose of the present paper was to explore the concept and experience of God in relation to recovery from drug addiction from a scientific perspective. Examination of a diverse literature was undertaken, including five key threads: the universality of the experience of God; the induction of spiritual experiences of God through hallucinogenic drugs; the nature of drug addiction from an evolutionary neurobiological perspective; the 12 Step movement as the prototype for the place of God in recovery from drug addiction; and identified ingredients for successful recovery from addiction. The diverse threads of literature examined can be integrated around the concept of higher power as an important factor in recovery from drug addiction. Higher power can be manifested in individuals in diverse ways: religious, ethnic, spiritual including the use of entheogens, as well as cognitive behavioural development, but a common final pathway for all is the strengthening of executive functions (the brain's 'higher power'). Practical implications for assisting people with drug addiction to achieve recovery through their own experience of God /development of higher power are outlined.

Sias SM; Goodwin LR Jr. Students' reactions to attending 12-step meetings: Implications for counselor education. Journal of Addictions & Offender Counseling 27(2): 113-126, 2007. (24 refs.)

This content analysis of reflective papers examined undergraduate and graduate students' reactions to attending a 12-step meeting. Qualitative analysis of student comments suggested that meeting attendance had a personal impact and increased understanding of the purpose of 12-step programs. Implications for counselor educators are discussed.

Slaski S; Zylicz PO. The effect of psychotherapy on self-awareness in incarcerated and nonincarcerated alcoholics: A pilot study. International Journal of Offender Therapy and Comparative Criminology 50(5): 559-569, 2006. (30 refs.)

Changes in self-awareness in incarcerated and nonincarcerated male alcoholics are measured before and after disaccustoming therapy based on Alcoholics Anonymous principles. The four-mode conception of self-awareness of Zaborowski is employed. The results show significant and expected changes in incarcerated participants (in defensive, individual, and reflective modes of self-awareness) and almost no changes in nonincarcerated individuals. An effect of motivation on therapy is also identified. Incarceration appears to be more conducive to recovery than to conditions outside the prison.

Streifel C; Servanty-Seib H. Alcoholics Anonymous: Novel applications of two theories. Alcoholism Treatment Quarterly 24(3): 71-91, 2006

The present paper offers two theories that help to explain why the 12-step program of Alcoholics Anonymous (AA) is such an effective intervention for recovering alcoholics, and provides directions for future research on AA. It is argued that Schlossberg's (1984) transition theory and Rando's (1995) theory of grief and mourning are applicable to the AA program because, as will be discussed, the concepts in each theory run parallel to the concepts and steps of the AA program. Specifically, we propose: (1) participation in AA helps individuals cope with the difficult transition from active alcoholism to recovery and (2) participation in AA facilitates individual's working through the loss and grief issues associated with recovery from alcoholism. Implications for clinical work with alcoholics as well as directions for future research on AA are provided.

Suire JG; Bothwell RK. The psychosocial benefits of Alcoholics Anonymous. American Journal on Addictions 15(3): 252-255, 2006. (15 refs.)

A quasi-experimental design was implemented to evaluate the attitudes of alcoholics toward themselves and others after they had worked all twelve steps of an AA program compared to those who had not yet completed all twelve steps. One hundred individuals who were attending AA meetings were selected so that one half had completed all of the steps and the other half had not. Participants were tested in individual sessions during which they completed a series of questionnaires. Measures were taken of global self-esteem, social self-esteem, social confidence, network trust, fear of negative evaluation, need for approval, preoccupation with relationships, discomfort with closeness, relationships as secondary, and optimism. A principal components analysis of participants' responses to these measures revealed that the factors being assessed could be divided into one regarding interpersonal insecurity and another regarding social potency. The data showed that alcoholics who had been able to stay in the program and work through all twelve steps had lower levels of interpersonal insecurity than those who were just beginning to work the steps. No significant differences were found in social potency between those who had completed the steps and those who had not completed the steps. Further research is needed to clarify the specific nature of changes that occur in personality as alcoholics work through the twelve steps within community-based AA programs.

Sykes T. What did I do last night?. Emmaus PA: Rodale, 2006. (0 refs.)

This is a well-written memoir of the author's emerging alcohol problem, the events that led him to recognize the need to cease drinking, and what he did to accomplish this, and his experience of this. The book covers a 15 year period. The chapters are titled in a count-down fashion, i.e the number of days prior to or after the day on which he had his last drink, Day 0. It begins on "-5214 days", when as a student at Eton in England he was allowed to drink at the the College's school bar, the Tap, which circumvented licensing laws by presenting itself as a private social club. It proceeds through a number of landmark occasions, if unrecognized at the time, such as on "-350 Days" finding the perfect job. In New York as a journalist, he became the bar columnist for the New York Post. It concludes on "+396 Days", when, still living in New York, he is headed to the airport to journey to Ireland where he and his wife will await the birth of their first son.

Terra MB; Barros HMT; Stein AT; Figueira I; Palermo LH; Athayde LD et al. Do Alcoholics Anonymous groups really work? Factors of adherence in a Brazilian sample of hospitalized alcohol dependents. American Journal on Addictions 17(1): 48-53, 2008. (31 refs.)

This study was designed to determine factors affecting adherence to Alcoholics Anonymous (AA) groups. This cohort involved 300 alcoholics committed to three hospitals in Porto Alegre, Brazil. They were interviewed again in their homes after six months. The SCID-I and a questionnaire focusing on patient relationship with AA groups were used. The responses obtained through the questionnaire were independently evaluated by two researchers. AA adherence was below 20%. The main factors reported by patients as reasons for non-adherence to AA were relapse, lack of identification with the method, lack of need, and lack of credibility. The factors reported by patients as reasons for adherence were identification with the method and a way to avoid relapse. Although AA is considered an effective intervention for alcoholism, its adherence rate was excessively low. The identification of these nonadherence factors could help health professionals in referring certain alcoholic patients to therapeutic interventions other than AA.

Terra MB; Barros MHT; Stein AT; Figueira I; Athayde LD; Spanemberg L et al. Does co-occurring social phobia interfere with alcoholism treatment adherence and relapse? Journal of Substance Abuse Treatment 31(4): 403-409, 2006. (21 refs.)

This study investigates the impact of social phobia on adherence to and outcomes 6 months following standard alcohol treatment and Alcoholics Anonymous (AA) group meetings among alcohol-dependent patients with and without social phobia.In a cohort study, 300 detoxified alcohol-dependent individuals in Porto Alegre, Brazil, were interviewed during, as well as 3 and 6 months after hospital detoxification. At both follow-up points, treatment adherence was low and relapse rates were high among patients with and without social phobia, and no significant differences were seen between the two groups of patients in relapse, adherence to AA, or adherence to psychotherapy. Findings from this sample suggest that although alcohol-dependent patients with social phobia showed a tendency for less adherence at AA and felt less integrated with their AA group, social phobia comorbidity was not a significant risk factor for alcohol use relapse or for nonadherence to AA or psychotherapy.

Terra MB; Barros HMT; Stein AT; Athayde IFLD; Palermo LH; Tergolina LP. Predictors of engagement in the Alcoholics Anonymous group or to psychotherapy among Brazilian alcoholics - A six-month follow-up study. European Archives of Psychiatry and Clinical Neuroscience 257(4): 237-244, 2007. (41 refs.)

Objective To ascertain factors associated with engagement of patients with alcohol dependence in Alcoholics Anonymous (AA) groups and psychotherapy. Methods About 300 hospitalized alcoholics were interviewed at hospitalization and again 3 and 6 months thereafter. Assessment included the administration of standardized instruments. Determinants of engagement in both interventions were assessed through logistic regression analysis. Results Higher educational level was predictive of engagement in AA after 6 months (OR = 2.19; CI 1.08-4.41). Engagement in psychotherapy after 6 months was related to having a university degree (OR = 3.60; CI 1.6-7.9), to a comorbid depressive disorder (OR = 3.47; CI 1.8-6.5), to the use of other drugs together with alcohol (OR = 3.08; CI 1.5-6.19), to previous treatment (OR = 2.87; CI 1.29-6.40), and to having a high school degree (OR = 2.44; Cl 1.24-4.80). The presence of substance-induced anxiety disorder was associated with non-engagement in psychotherapy (OR = 0.27; CI 0.63-0.003). Conclusion The identification of predictors of engagement is important to guide clinicians in the choice of the treatment strategies that are more likely to be successful.

Thatcher, MS. Bakhtin applied: Employing dialogism to analyze the interplay of the ideologies of individualism and community within the discourse of Alcoholics Anonymous. Journal of Applied Communication Research 34(4): 349-367, 2006. (63 refs.)

An ongoing debate regarding the nature of therapeutic communities concerns the extent to which these communities reinforce the ideologies of individualism and community. This article engages this discussion through a process of social text analysis informed by the dialogism theory of Russian philosopher and literary scholar Mikhail Bakhtin. Dialogism seeks to understand the multiple voices interpenetrating particular utterances, revealing an emergent social construction of meaning. Applying this approach to examples of discourse from a prominent therapeutic community, Alcoholics Anonymous, illustrates how meaning in the discourse of this movement can be understood to emerge among the interplay between the ideologies of individualism and community as expressed within the movement's narrative practice.

Timko C; Billow R; DeBenedetti A. Determinants of 12-step group affiliation and moderators of the affiliation-abstinence relationship. Drug and Alcohol Dependence 83(2): 111-121, 2006. (80 refs.)

This study examined characteristics of substance use disorder (SUD) outpatients at intake to treatment (N=345) that were associated with more 12-step group attendance and involvement, Steps worked, and acceptance of 12-step philosophy at a 6-month follow-up (N=281, 81.4%). Patient characteristics covered the domains of sociodemographics, SUD severity, personal functioning, and previous help received. Distinguishing baseline characteristics of patients who attended more 12-step group meetings during follow-up were being less-educated, more engaged in religious practices, and more extroverted and interpersonally competent, and having had more previous 12-step group exposure. These patient characteristics were generally similar to those associated with more 12-step meeting involvement and philosophy acceptance. More 12-step meeting attendance and involvement were related to abstinence at 6 months. Associations of attendance with abstinence were stronger among patients who were younger, white, less-educated, unstably employed, less religious, and less interpersonally skilled. These patients may have had fewer available social resources and so benefitted more from the fellowship and support for abstinence that 12-step group members often provide. We suggest methods by which treatment providers may encourage 12-step group affiliation among patients likely to benefit from it on substance use outcomes.

Timko C; DeBenedetti A; Moos BS; Moos RH. Predictors of 16-year mortality among individuals initiating help-seeking for an alcoholic use disorder. Alcoholism: Clinical and Experimental Research 30(10): 1711-1720, 2006. (86 refs.)

Background and Methods: We examined rates and predictors of mortality in individuals (47% women) who had just initiated help-seeking for their alcohol use disorders (AUDs) at the start of the study (n=628) and were followed for 16 years. Results: For both women and men, the observed-to-expected mortality ratio (1.4) was lower than rates found in samples of treated individuals with AUDs, suggesting that those initiating help-seeking careers have better chances of long-term survival. Of the individuals for whom cause of death was known, 68% died of alcohol-related causes. Men were more likely to die than were women. When gender was controlled, individuals who were older and unmarried and had more alcohol dependence symptoms at baseline were more likely to die over the 16-year period. When these baseline characteristics were controlled, better drinking outcomes at 1 year were associated with a lower likelihood of subsequent death. The combination of a shorter duration of inpatient/residential care and better drinking outcomes at 1 year was related to a lower probability of death, as was the combination of a longer duration of outpatient care or Alcoholics Anonymous attendance and better drinking outcomes at 1 year. Conclusions: Efforts should be made to help providers identify individuals who are not responding positively to inpatient or residential treatment and intervene to motivate participation in continuing outpatient care and community 12-step self-help groups to reduce the likelihood of a chronic and fatal AUD course.

Tonigan JS. Spirituality and Alcoholics Anonymous. Southern Medical Journal 100(4): 437-440, 2007. (22 refs.)

Alcoholics Anonymous, despite its formal efforts to eschew public controversy, has at times been a lightening rod for varied opinion. In a review of the vast body of AA research, severe drinking is positively associated with AA attendance and continued AA attendance is associated with abstinence and improved social functioning. Also, over time, among members the spiritual beliefs and practices increase over time. This article reviews what is currently known about AA-related spirituality and how changes in spirituality may account for improved functioning among AA members. Of note is that regardless of spiritual orientation, individuals derive equal benefit with AA affiliation. Whatever the dynamics or "climate" of a particular meeting, spiritually-based principles are endorsed equally. There is little evidence at this point that spirituality directly accounts for later abstinence, but it may facilitate initial attendance which can lead to sustained recovery over time.

Tonigan JS; Bogenschutz MP; Miller WR. Is alcoholism typology a predictor of both Alcoholics Anonymous affiliation and disaffillation after treatment? Journal of Substance Abuse Treatment 30(4): 323-330, 2006. (32 refs.)

Twelve Steps (TS) has demonstrated effectiveness; induction into Alcoholics Anonymous (AA) is a primary objective of TS and is a pivotal mechanism explaining its effectiveness. However, evidence suggests that, after treatment, dropout from AA is high. This study investigated whether alcohol problem severity predicted both AA affiliation and disaffiliation among clients receiving TS. This study of a Project MATCH sample included 453 alcohol-dependent clients randomly assigned to TS who reported AA attendance during treatment. Greater alcohol problem severity predicted AA attendance; opposite to prediction, less alcohol-impaired clients were more than twice as likely to discontinue AA attendance after treatment. When sustained AA attendance is desired, the evaluation of client pretreatment alcohol involvement may be useful for identifying potential AA dropout after TS treatment. Findings also indicate that, among treatment-seeking problem drinkers, AA dropout and disaffiliation are distinct, albeit correlated, constructs that require future investigation.

Yeh MY; Che HL; Lee LW; Horng FF. An empowerment process: successful recovery from alcohol dependence. Journal of Clinical Nursing 17(7): 921-929, 2008. (20 refs.)

Aims. The purpose of this study was to explore the concepts and processes for successful abstinence from alcohol for Taiwanese Alcoholics Anonymous members. Background. Attempting to identify the psychological and social influences upon alcohol consumption remission outside of alcoholism treatment could help professionals to engage in a broad array of community interventions in an informed fashion. Methods. Grounded theory method was utilized in this study. The study chose nine participants who had succeeded in abstinence, using theoretical sampling and conducted in-depth interviews by an open-ended questionnaire. Results. The results of this study indicated that the core of the process during which alcoholic individuals succeeded in abstaining from further alcohol consumption was an empowerment process for the involved individual. Alcoholics felt that their family, interpersonal relationships, jobs and personal finances all had been at 'rock-bottom' level following a long period of alcohol dependence. This feeling caused the individual to experience an emotion of a loss of control and provoked the arousal of an alcoholic's inner consciousness levels, this then resulting in the generation of a driving force for abstinence from alcohol for these individuals. Conclusions. The expansion of an individual's internal awakening power helps the individual to obtain assistance and to resist the temptation of further alcohol consumption. Therefore, the power derived by individuals from the stages of repositioning, releasing, active sharing, resistance and assistance are the maintenance factors for an individual's empowerment process that help maintain the successful recovery from alcohol for the involved individual. Relevance to clinical practice. A good comprehension of the recovery processes for alcoholics, we believe, will trigger clinical professionals to pay appropriate attention to the specific problems and needs of alcoholic individuals, to build an effective resource network for treatment and to help solve alcoholics' physical and psychosocial problems.

Zemore SE. Helping as healing among recovering alcoholics. Southern Medical Journal 100(4): 447-450, 2007. (43 refs.)

This is one of several articles in a special section "Spirituality/Medicine Interface Project." This paper focuses on the role of peer helping in relation to mutual help group involvement among alcohol-dependent populations. In brief it has been suggested that helping helps the helper, and this is most common when both the helper and person being helped share a common problem. The hypothesis is that in the process of persuading and encouraging others, that people also persuade themselves. The results of several quantitative studies are considered. In general, the results suggest that those engaged in helping others in fact have higher rates of abstinence at follow-up, although, the research design allows for potential confounding factors. Also summarized is a longitudinal study of members of "Double Trouble in Recovery" -- a mutual aid group for those with substance abuse and a co-occurring psychiatric problem.