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Zemore SE, Mericle AA, Martinez P, Bergman BG, Karriker-Jaffe KJ, Patterson D, Timko C. Disparities in Alcoholics Anonymous Participation from 2000 to 2020 Among U.S. Residents With an Alcohol Use Disorder in the National Alcohol Survey. J Stud Alcohol Drugs 2024; 85:32-40. [PMID: 37650830 PMCID: PMC10846609 DOI: 10.15288/jsad.23-00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE Mutual-help groups (MHGs) like Alcoholics Anonymous (AA) are effective for resolving alcohol use disorders (AUDs), but few studies have examined disparities in MHG participation, particularly recently. We used five waves of National Alcohol Survey data to investigate whether prevalence of AA attendance among those with a lifetime AUD differed by race/ethnicity, age, and sex, directly testing whether these associations varied with time. METHOD Analyses pooled weighted data from 2000 to 2020, including only participants with a lifetime AUD and identifying as non-Hispanic White, Latinx/Hispanic, or non-Hispanic Black/African American (N = 8,876). Logistic regression models examined associations between lifetime AA attendance and survey year, race/ethnicity, age, and sex; models also tested for differences in demographic effects across survey year using interaction terms. RESULTS In bivariate models, AA attendance was significantly less prevalent among participants identifying as Latinx/Hispanic (vs. White); ages 18-29 (vs. 30-64); and female (vs. male). Survey year was unrelated to AA attendance, and all interactions involving survey year were nonsignificant. In the final multivariate model (which controlled for severity and other help-seeking), disparities persisted for those identifying as Latinx/Hispanic (vs. White; adjusted odds ratio [aOR] = 0.63) and ages 18-29 (vs. 30-64; aOR = 0.35); AA attendance was also less prevalent among Black/African American (vs. White) participants (aOR = 0.59), but sex became nonsignificant. CONCLUSIONS Results replicate and extend sparse findings regarding disparities in MHG attendance and suggest a stagnation in AA's growth and reach to underserved populations. Findings highlight the need to more effectively facilitate MHG attendance (and perhaps broader social network change) among racial/ethnic minorities and emerging adults.
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Affiliation(s)
| | | | | | - Brandon G. Bergman
- Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts
| | | | | | - Christine Timko
- Stanford University, Stanford, California
- Veterans Affairs Palo Alto Health Care System, Menlo Park, California
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2
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McGeough BL, Karriker-Jaffe KJ, Zemore SE. Rates and predictors of Alcoholics Anonymous attendance across sexual orientations. J Subst Abuse Treat 2021; 129:108400. [PMID: 34080558 PMCID: PMC8380678 DOI: 10.1016/j.jsat.2021.108400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
Sexual minority (e.g., gay, lesbian, bisexual) individuals experience alcohol dependence at 2-6 times the rates of heterosexual individuals. Among the general population, Alcoholics Anonymous (AA) serves as the most common source of support for alcohol-related problems in the United States. Yet, relatively little is known about sexual minority involvement in AA, including rates and predictors of AA attendance among sexual minorities. This paper aims to: 1) Compare rates of AA attendance across sexual orientations; 2) Compare relationships between AA attendance and common predictors of AA attendance across sexual orientations. Using five waves of the National Alcohol Survey (N = 7862 respondents with at least one lifetime AUD symptom), this study found lesbian and bisexual women, but not gay and bisexual men, had greater odds of attending AA, even while controlling for lifetime AUD severity, gender, race/ethnicity, age, religiosity, and current income. Interaction models for women showed there was a stronger association between older age and AA attendance, a stronger association between greater religiosity and AA attendance, and a weaker association between lifetime AUD severity and AA attendance for sexual minority women relative to heterosexual women. This study did not find significant interactions between sexual orientation and these covariates for men. These results suggest AA may serve as a promising resource for sexual minority individuals experiencing alcohol-related problems, particularly for sexual minority women who are older, more religious, and have less severe AUD.
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Affiliation(s)
- Briana L McGeough
- School of Social Welfare, University of Kansas, Lawrence, KS, United States of America.
| | | | - Sarah E Zemore
- Alcohol Research Group, Emeryville, CA, United States of America
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3
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Abstract
The current article provides a brief summary of biopsychosocial gender differences in alcohol use disorder (AUD), then reviews existing literature on gender differences in treatment access, retention, outcomes, and longer-term recovery. Among psychotherapies for AUD, there is support for the efficacy of providing female-specific treatment, and for female-only treatment settings but only when female-specific treatment is included. However, despite mandates from the National Institutes of Health to do so, there is little work thus far that directly compares genders on outcomes of specific psychotherapies or pharmacotherapies for AUD. Although existing research has mixed findings on sex and gender differences in overall outcomes, there are more consistent findings suggesting different mechanisms of behavior change among men and women in AUD treatment and long-term recovery. Thus, more work is needed that attends to gender and sex differences, including planning studies that are structured to examine not only gender-differentiated outcomes in treatment response, but equally important, differences in treatment access and attendance as well as differences in mechanisms of change in drinking behavior.
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Affiliation(s)
- Cathryn Glanton Holzhauer
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Research and Education, VA Central Western Massachusetts, Leeds, Massachusetts
| | - Michael Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,VA South Central Mental Illness Research, Education, and Clinical Center and Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
| | - Elizabeth E Epstein
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
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Peckham AD, Griffin ML, McHugh RK, Weiss RD. Depression history as a predictor of outcomes during buprenorphine-naloxone treatment of prescription opioid use disorder. Drug Alcohol Depend 2020; 213:108122. [PMID: 32563846 PMCID: PMC7736247 DOI: 10.1016/j.drugalcdep.2020.108122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the multi-site Prescription Opioid Addiction Treatment Study (POATS), the best predictor of successful opioid use outcome was lifetime diagnosis of major depressive disorder. The primary aim of this secondary analysis of data from POATS was to empirically assess two explanations for this counterintuitive finding. METHODS The POATS study was a national, 10-site randomized controlled trial (N = 360 enrolled in the 12-week buprenorphine-naloxone maintenance treatment phase) sponsored by the NIDA Clinical Trials Network. We evaluated how the presence of a history of depression influences opioid use outcome (negative urine drug assays). Using adjusted logistic regression models, we tested the hypotheses that 1) a reduction in depressive symptoms and 2) greater motivation and engagement in treatment account for the association between depression history and good treatment outcome. RESULTS Although depressive symptoms decreased significantly throughout treatment (p <.001), this improvement was not associated with opioid outcomes (aOR = 0.98, ns). Reporting a goal of opioid abstinence at treatment entry was also not associated with outcomes (aOR = 1.39, ns); however, mutual-help group participation was associated with good treatment outcomes (aOR = 1.67, p <.05). In each of these models, lifetime major depressive disorder remained associated with good outcomes (aORs = 1.63-1.82, ps = .01-.055). CONCLUSIONS Findings are consistent with the premise that greater engagement in treatment is associated with good opioid outcomes. Nevertheless, depression history continues to be associated with good opioid outcomes in adjusted models. More research is needed to understand how these factors could improve treatment outcomes for those with opioid use disorder.
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Affiliation(s)
- Andrew D. Peckham
- Corresponding Author: McLean Hospital/Harvard Medical School, Department of Psychiatry, 115 Mill Street, Belmont, MA, 02478, USA, Phone: 617-855-2946,
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Marlow S, Stahl D, Gilchrist G. Factors associated with women achieving and maintaining abstinence from alcohol: a rapid evidence assessment. ADVANCES IN DUAL DIAGNOSIS 2019. [DOI: 10.1108/add-12-2018-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose
The purpose of this paper is to review the literature on the factors related to women’s ability to achieve and maintain abstinence from alcohol.
Design/methodology/approach
A rapid evidence assessment was carried out in four stages: definitions and research questions were agreed, search and selection were completed, data were extracted, quality of studies was assessed, and findings were synthesised and presented.
Findings
Medline, PsycINFO, CINAHL and ASSIA were searched for cohort studies published in English during January 2000–February 2015. Expanded search terms for Women, Alcohol and Abstinence, and Cohort were used to identify relevant studies for inclusion, resulting in 1,040 records. Of these, 32 manuscripts from 31 studies were eligible for inclusion in the review. Alcohol-related factors such as increased quantity and frequency of alcohol consumption were related to lower likelihood of achieving and maintaining abstinence; treatment factors such as type of treatment and number of treatment episodes were related to higher and lower likelihood; demographic factors such as financial problems and poor housing status were related to lower likelihood; and psychological factors such as craving, other drug use and comorbid health problems were linked to lower likelihood.
Originality/value
To the authors’ knowledge, this is the first time the factors related to the specific outcome of abstinence in women have been synthesised. Many of the factors found are also known to contribute to vulnerability for developing alcohol problems. The review revealed the paucity of studies with female only samples, or where results for women were reported separately.
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6
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Sanders J. Resistance and Fitting In: A Qualitative Analysis of Young Women in Alcoholics Anonymous. ALCOHOLISM TREATMENT QUARTERLY 2019. [DOI: 10.1080/07347324.2019.1584019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jolene Sanders
- Sociology & Social Work, Hood College, Frederick, Maryland USA
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7
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Puente LAR, Luis MAV, Castillo MMA, Heredia LPD, Bermúdez JÁ, García NAA, Vargas RAC. Stressful events, spirituality, and alcohol consumption in participants of the 12-Step AA Program. CIENCIA & SAUDE COLETIVA 2019; 24:641-648. [PMID: 30726396 DOI: 10.1590/1413-81232018242.06752017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/28/2017] [Indexed: 11/21/2022] Open
Abstract
This work sought to determine the association between stressful events, spirituality, program participation and alcohol consumption in participants of the AA 12-step program. The study used a descriptive correlation and predictive method. The population was comprised by members from AA, Mexico. A simple random sampling by clusters was performed, the sample consisted of 72 AA participants with 95% CI. The Spiritual Perspective Scale and the Social Readjustment Rating Scale were used. Stressful events are negatively and significantly related to alcohol consumption (rs = -0.316, p = 0.007), this indicates that the higher the number of stressors, the lower the number of days without alcohol consumption; participation in the program was positively and significantly related to alcohol consumption (rs = 0.776, p = 0.001), which indicates that greater years of participation means greater number of days without alcohol consumption. Spirituality showed no significant relationship (p > 0.05), there is also a significant effect of participation in the program and age on alcohol consumption (R2 = 65.2%, p = 0.001). Participation in the AA program is related to and has an effect on the number of days without alcohol consumption.
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Affiliation(s)
| | | | | | | | - Javier Álvarez Bermúdez
- Facultad de Enfermería, Universidad Autónoma de Nuevo León. San Nicolás de los Garza NL México
| | | | - Raúl Adrán Castillo Vargas
- Universidad Autónoma de Coahuila. Blvd. V. Carranza s/n, Col. República Oriente. 25280 Saltillo Coah México. México
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Karriker-Jaffe KJ, Klinger JL, Witbrodt J, Kaskutas LA. Effects of Treatment Type on Alcohol Consumption Partially Mediated by Alcoholics Anonymous Attendance. Subst Use Misuse 2018; 53:596-605. [PMID: 28910209 PMCID: PMC5820124 DOI: 10.1080/10826084.2017.1349800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND As insurance coverage, funding sources and venues for drug and alcohol treatment evolve in the United States, it is important to assess how the type of treatment received may impact long-term outcomes. The current study aims were to examine effects of treatment type on alcohol consumption in the year after treatment intake and to test mediators of effects of treatment type on later alcohol use. METHODS Longitudinal data from clients in inpatient and outpatient alcohol treatment programs in California (n = 560) were used in ordinary least squares path analysis adjusting for respondent characteristics typically associated with both treatment completion and alcohol use. The primary outcome was amount of alcohol consumed in the 12 months after treatment entry; hypothesized mediators were treatment duration and participation in Alcoholics Anonymous (AA). RESULTS Despite higher baseline problem severity and a shorter treatment duration, inpatient clients consumed less alcohol after treatment than outpatient clients (B [95% CI] = -0.95 [-1.67, -0.23]). AA involvement was a significant mediator of the relationship between treatment type and alcohol consumption, with inpatient clients being more involved in AA and also drinking less after treatment than outpatient clients; the bias-corrected bootstrap 95% confidence interval for the indirect effect (B = -0.20) was entirely below zero (-0.43 to -0.05). CONCLUSIONS Outpatient clients may benefit from customized posttreatment recommendations to identify additional resources to assist in the recovery process during the first year after treatment.
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Affiliation(s)
| | - Jamie L Klinger
- a Alcohol Research Group , Public Health Institute , Emeryville , California , USA
| | - Jane Witbrodt
- a Alcohol Research Group , Public Health Institute , Emeryville , California , USA
| | - Lee Ann Kaskutas
- a Alcohol Research Group , Public Health Institute , Emeryville , California , USA
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Klinger JL, Karriker-Jaffe KJ, Witbrodt J, Kaskutas LA. Effects of Distance to Treatment on Subsequent Alcohol Consumption. DRUGS (ABINGDON, ENGLAND) 2016; 25:173-180. [PMID: 29551857 PMCID: PMC5849272 DOI: 10.1080/09687637.2016.1189875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Distance and travel time are barriers to attending and completing drug and alcohol treatment. Few studies have examined proximity to treatment in relation to long-term outcomes. OBJECTIVES Aims were to examine effects of distance to treatment on alcohol consumption in the year after treatment intake; assess moderation of distance effects by treatment type; and test mediators of effects of distance to treatment on later alcohol use. METHODS Data from clients in inpatient and outpatient alcohol treatment programs in California (n=560) were used in linear regression models. RESULTS There was a significant interaction between treatment type and distance on later drinking, with a significant positive association of distance to treatment with alcohol use after treatment for inpatient clients only. Among inpatient clients, none of the mediators significantly explained the relationship between a longer distance to treatment and greater subsequent alcohol use. CONCLUSION Inpatient clients may benefit from customized post-treatment recommendations to identify recovery resources near home.
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Affiliation(s)
- Jamie L. Klinger
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | | | - Jane Witbrodt
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Lee Ann Kaskutas
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
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10
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Parkman TJ, Lloyd C, Splisbury K. Self-Help Groups for Alcohol Dependency: A Scoping Review. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/1556035x.2015.1034824] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lozano-Verduzco I, Marín-Navarrete R, Romero-Mendoza M, Tena-Suck A. Experiences of Power and Violence in Mexican Men Attending Mutual-Aid Residential Centers for Addiction Treatment. Am J Mens Health 2015; 10:237-49. [PMID: 25585860 DOI: 10.1177/1557988314565812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fundamental elements of hegemonic masculinity such as power and violence are analyzed through characteristics of 12-step programs and philosophy immersed in Mutual-Aid Residential Centers for Addiction Treatment (CRAMAAs). CRAMAAs are a culturally specific form of substance abuse treatment in Mexico that are characterized by control and violence. Fifteen interviews were carried out with men of varied sociodemographic characteristics, and who resided in at least two of these centers. Results identify that power is expressed through drug abuse and leads them to subsequent biopsychosocial degradation. Residency in CRAMAAs is motivated by women, but men do not seek the residency and are usually admitted unwillingly. Power through violence is carried out inside CRAMAAs where men are victims of abuse. From a 12-step philosophy, this violence is believed to lead them to a path of recovery but instead produces feelings of anger and frustration. The implications of these centers on Mexican public health are discussed.
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Affiliation(s)
- Ignacio Lozano-Verduzco
- Universidad Pedagógica Nacional, Carretera al Ajusco No. 24, Col. Héroes de Padierna Del., Tlalpan, Mexico D.F., Mexico
| | - Rodrigo Marín-Navarrete
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Calz. México-Xochimilco, San Lorenzo Huipulco, Tlalpan, Mexico D.F., Mexico Universidad Iberoamericana Ciudad de México, Prolongación Paseo de la Reforma, Lomas de Santa Fe, Mexico D.F., Mexico
| | - Martha Romero-Mendoza
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Calz. México-Xochimilco, San Lorenzo Huipulco, Tlalpan, Mexico D.F., Mexico
| | - Antonio Tena-Suck
- Universidad Iberoamericana Ciudad de México, Prolongación Paseo de la Reforma, Lomas de Santa Fe, Mexico D.F., Mexico
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12
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Short NA, Cronkite R, Moos R, Timko C. Men and women who attend Al-Anon: gender differences in reasons for attendance, health status and personal functioning, and drinker characteristics. Subst Use Misuse 2015; 50:53-61. [PMID: 25245105 DOI: 10.3109/10826084.2014.957772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although Al-Anon Family Groups (Al-Anon) is the most common source of help for people concerned about someone else's drinking, only 16% of members are men. To identify gender differences, we compared demographics, reasons for attendance, health status, and personal functioning, and drinker characteristics of 174 men and women attending Al-Anon. Men and women were similar in most areas; however, some key differences emerged. Men reported better overall mental health than women, and described some differing concerns and drinker characteristics. With this information, healthcare providers may facilitate men's participation in Al-Anon by addressing their unique concerns and possible barriers to attendance.
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Affiliation(s)
- Nicole A Short
- 1Department of Psychology, Florida State University , Tallahassee, Florida , USA
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13
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Bergman BG, Greene MC, Hoeppner BB, Slaymaker V, Kelly JF. Psychiatric comorbidity and 12-step participation: a longitudinal investigation of treated young adults. Alcohol Clin Exp Res 2014; 38:501-10. [PMID: 24033550 PMCID: PMC3946781 DOI: 10.1111/acer.12249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 05/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence indicates that 12-step mutual-help organizations (MHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), can play an important role in extending and potentiating the recovery benefits of professionally delivered addiction treatment among young adults with substance use disorders (SUD). However, concerns have lingered regarding the suitability of 12-step organizations for certain clinical subgroups, such as those with dual diagnosis (DD). This study examined the influence of diagnostic status (DD vs. SUD-only) on both attendance and active involvement (e.g., having a sponsor, verbal participation during meetings) in, and derived benefits from, 12-step MHOs following residential treatment. METHODS Young adults (N = 296; 18 to 24 years old; 26% female; 95% Caucasian; 47% DD [based on structured diagnostic interview]), enrolled in a prospective naturalistic study of SUD treatment effectiveness, were assessed at intake and 3, 6, and 12 months posttreatment on 12-step attendance/active involvement and percent days abstinent (PDA). t-Tests and lagged, hierarchical linear models (HLM) examined the extent to which diagnostic status influenced 12-step participation and any derived benefits, respectively. RESULTS For DD and SUD-only patients, posttreatment attendance and active involvement in 12-step organizations were similarly high. Overall, DD patients had significantly lower PDA relative to SUD-only patients. All patients appeared to benefit significantly from attendance and active involvement on a combined 8-item index. Regarding the primary effects of interest, significant differences did not emerge in derived benefit between DD and SUD-only patients for either attendance (p = 0.436) or active involvement (p = 0.062). Subsidiary analyses showed, however, that DD patients experienced significantly greater abstinence-related benefit from having a 12-step sponsor. CONCLUSIONS Despite concerns regarding the clinical utility of 12-step MHOs for DD patients, findings indicate that DD young adults participate and benefit as much as SUD-only patients, and may benefit more from high levels of active involvement, particularly having a 12-step sponsor. Future work is needed to clarify how active 12-step involvement might offset the additional recovery burden of a comorbid mental illness on substance use outcomes.
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Affiliation(s)
- Brandon G Bergman
- Center for Addiction Medicine , Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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14
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Wall R, Sondhi A, Day E. What influences referral to 12-step mutual self-help groups by treatment professionals? Eur Addict Res 2014; 20:241-7. [PMID: 24853315 DOI: 10.1159/000357940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 12/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Twelve-step mutual self-help groups provide cost-effective support for recovery from substance misuse problems. Evidence suggests they are successful as an adjunct to formal treatment and that referral from clinicians is important in fostering engagement. METHODS This study surveyed substance misuse treatment professionals employed within two agencies in Birmingham (UK). RESULTS A total of 92 clinicians (79.3%) eligible to participate completed a questionnaire that explored their attitudes, knowledge and referral practices with regard to 12-step groups (TSGs). Most (74%) had a positive attitude, and almost 80% referred at least some of their clients to TSGs. However, 30% had not referred any clients in the past month, and multivariate analysis showed that referral was associated with greater objective knowledge about TSGs when other factors were controlled for. CONCLUSIONS These results have implications for linking professional treatment to mutual self-help groups, and potential strategies to increase referral are discussed.
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15
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Kelly JF, Hoeppner BB. Does Alcoholics Anonymous work differently for men and women? A moderated multiple-mediation analysis in a large clinical sample. Drug Alcohol Depend 2013; 130:186-93. [PMID: 23206376 PMCID: PMC3596430 DOI: 10.1016/j.drugalcdep.2012.11.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/23/2012] [Accepted: 11/04/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alcoholics Anonymous (AA) began as a male organization, but about one third is now female. Studies have found that women participate at least as much as men and benefit equally from AA, but it is unclear whether women benefit from AA in the same or different ways as men. This study tested whether gender moderated the mechanisms through which AA aids recovery. METHODS A cohort study of alcohol dependent adults (N=1726; 24% female; Project MATCH) was assessed on AA attendance during treatment; with mediators at 9 months; outcomes (Percent Days Abstinent [PDA] and Drinks per Drinking Day [DDD]) at 15 months. Multiple mediator models tested whether purported mechanisms (i.e., self-efficacy, depression, social networks, spirituality/religiosity) explained AA's effects differently for men and women controlling for baseline values, mediators, treatment, and other confounders. RESULTS For PDA, the proportion of AA's effect accounted for by the mediators was similar for men (53%) and women (49%). Both men and women were found to benefit from changes in social factors but these mechanisms were more important among men. For DDD, the mediators accounted for 70% of the effect of AA for men and 41% for women. Again, men benefitted mostly from social changes. Independent of AA's effects, negative affect self-efficacy was shown to have a strong relationship to outcome for women but not men. CONCLUSIONS The recovery benefits derived from AA differ in nature and magnitude between men and women and may reflect differing needs based on recovery challenges related to gender-based social roles and drinking contexts.
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Affiliation(s)
- John F Kelly
- Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States.
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Donovan DM, Ingalsbe MH, Benbow J, Daley DC. 12-step interventions and mutual support programs for substance use disorders: an overview. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:313-32. [PMID: 23731422 PMCID: PMC3753023 DOI: 10.1080/19371918.2013.774663] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Social workers and other behavioral health professionals are likely to encounter individuals with substance use disorders in a variety of practice settings outside of specialty treatment. 12-Step mutual support programs represent readily available, no cost community-based resources for such individuals; however, practitioners are often unfamiliar with such programs. The present article provides a brief overview of 12-Step programs, the positive substance use and psychosocial outcomes associated with active 12-Step involvement, and approaches ranging from ones that can be utilized by social workers in any practice setting to those developed for specialty treatment programs to facilitate engagement in 12-Step meetings and recovery activities. The goal is to familiarize social workers with 12-Step approaches so that they are better able to make informed referrals that match clients to mutual support groups that best meet the individual's needs and maximize the likelihood of engagement and positive outcomes.
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Affiliation(s)
- Dennis M Donovan
- Alcohol and Drug Abuse Institute, University of Washington and Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98105, USA.
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Witbrodt J, Romelsjö A. Treatment seeking and subsequent 1-year drinking outcomes among treatment clients in Sweden and the U.S.A.: a cross-cultural comparison. Addict Behav 2012; 37:1122-31. [PMID: 22673154 PMCID: PMC3395428 DOI: 10.1016/j.addbeh.2012.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 05/15/2012] [Accepted: 05/16/2012] [Indexed: 10/28/2022]
Abstract
Cross-cultural comparisons provide a method for distinguishing unique aspects as well as shared aspects of different cultures. Theoretically framed by a health-services conceptual model, we examine the extent that culture-specific versus common characteristics are associated with treatment seeking and drinking outcome. Swedish (n=997) and U.S. (n=501) alcohol-dependent individuals were interviewed at baseline and 1-year (n=635 and n=384 respectively). Both studies gathered comparable background, help-seeking, and drinking data. Regression models tested predictors of 1-year follow-up drinking defined as abstinence or moderate drinking versus heavy drinking. Swedish individuals were older and had social networks comprised mostly of substance abusers compared to U.S. individuals who reported higher problem severity and greater drug involvement. Whereas U.S. individuals reported greater prior mutual-help attendance, Swedish individuals reported greater prior treatment involvement. Better 1-year drinking outcomes were reported by women, younger age groups and those with an abstinence goal in both samples. Cultural and institutional differences were apparent. For example, with Swedish individuals having a mostly non-using network predicted better outcomes, whereas lower problem severity was a predictor for U.S. individuals.
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Affiliation(s)
- Jane Witbrodt
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA.
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Witbrodt J, Mertens J, Kaskutas LA, Bond J, Chi F, Weisner C. Do 12-step meeting attendance trajectories over 9 years predict abstinence? J Subst Abuse Treat 2012; 43:30-43. [PMID: 22206631 PMCID: PMC3320672 DOI: 10.1016/j.jsat.2011.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 09/30/2011] [Accepted: 10/05/2011] [Indexed: 10/14/2022]
Abstract
This study grouped treatment-seeking individuals (n = 1825) by common patterns of 12-step attendance using 5 waves of data (75% interviewed Year 9) to isolate unique characteristics and use-related outcomes distinguishing each class profile. The "high" class reported the highest attendance and abstention. The "descending" class reported high baseline alcohol severity, long treatment episodes, and high initial attendance and abstinence, but by Year 5, their attendance and abstinence dropped. The "early-drop" class, which started with high attendance and abstinence but with low problem severity, reported no attendance after Year 1. The "rising" class, with fairly high alcohol and psychiatric severity throughout, reported initially low attendance, followed by increasing attendance paralleling their abstention. Last, the "low" and "no" classes, which reported low problem severity and very low/no attendance, had the lowest abstention. Female gender and high alcohol severity predicted attendance all years. Consistent with a sustained benefit for 12-step exposure, abstinence patterns aligned much like attendance profiles.
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Affiliation(s)
- Jane Witbrodt
- Alcohol Research Group, Emeryville, CA 94608-1010, USA.
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Witbrodt J, Kaskutas L, Bond J, Delucchi K. Does sponsorship improve outcomes above Alcoholics Anonymous attendance? A latent class growth curve analysis. Addiction 2012; 107:301-11. [PMID: 21752145 PMCID: PMC3260344 DOI: 10.1111/j.1360-0443.2011.03570.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To construct Alcoholics Anonymous (AA) attendance, sponsorship and abstinence latent class trajectories to test the added benefit of having a sponsor above the benefits of attendance in predicting abstinence over time. DESIGN Prospective with 1-, 3-, 5- and 7-year follow-ups. SETTING AND PARTICIPANTS Alcoholic-dependent individuals from two probability samples, one from representative public and private treatment programs and another from the general population (n = 495). FINDINGS Individuals in the low attendance class (four classes identified) were less likely than those in the high, descending and medium attendance classes to be in high (versus low) abstinence class (three classes identified). No differences were found between the other attendance classes as related to abstinence class membership. Overall, being in the high sponsor class (three classes identified) predicted better abstinence outcomes than being in either of two other classes (descending and low), independent of attendance class effects. Although declining sponsor involvement was associated with greater likelihood of high abstinence than low sponsor involvement, being in the descending sponsor class also increased the odds of being in the descending abstinence class. CONCLUSIONS Any pattern of Alcoholics Anonymous attendance, even if it declines or is never high for a particular 12-month period, is better than little or no attendance in terms of abstinence. Greater initial attendance carries added value. There is a benefit for maintaining a sponsor over time above that found for attendance.
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Affiliation(s)
- Jane Witbrodt
- Alcohol Research Group, Emeryville, CA 94608-1010, USA.
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