For whom does Alcoholics Anonymous work?

Narcotics Anonymous attendees' perceptions and experiences of substitute behaviors in the Western Cape, South Africa

BACKGROUND

Much remains unknown about the dynamics of substitute behaviors during addiction recovery among persons attending recovery support groups. Insight into the nature, motives for, and course of substitute behaviors could help to shape recovery support and harm reduction services.

METHODS

Twenty-three semi-structured in-depth interviews (n = 14 males and n = 9 females) were conducted with a convenience sample of Narcotics Anonymous attendees from a number of groups in the Western Cape, South Africa. Participants ranged in age from 22-55 years (M = 39.3, SD = 9.35).

RESULTS

Thematic analysis yielded four themes: (i) substance-to-substance substitution; (ii) substance-to-behavior substitution; (iii) substitute behaviors and harm (reduction) and (iv) support needs to manage and resolve substitute behaviors. According to the study, participants' substitute behaviors developed across recovery stages; were temporary or long-term replacements for substance use disorders and were engaged for distraction, isolation from others, calming, assuaging boredom, keeping occupied, filling a perceived experiential void, modifying mood and to self-medicate. While substitutes were utilized for harm reduction or relapse prevention, the potential for ostensibly healthy behaviors to threaten recovery and lead to relapse was also recognized.

CONCLUSIONS

Self-monitoring, ongoing vigilance, and awareness of when substitutes become genuine addictions are critical for timely, suitable interventions.

An Apologetic Interpretation of Alcoholics Anonymous (AA): Timeless Wisdom, Outdated Language

BACKGROUND

The Twelve Steps of Alcoholics Anonymous (AA) has proven to be an effective aid in recovery for many people with alcohol use disorder. While constructive criticisms of AA can be beneficial to the organization, other criticisms have merely served as rhetorical devices intent on discrediting the 12-step approach.

OBJECTIVES

This paper examines six prominent critiques of AA, paying special attention to the premises, tone, and factual basis of the statements. Interpretations grounded in AA literature are offered to address claims or critiques around prominent themes, which are organized into two main classes: purported causes of alcoholism and factors maintaining alcoholism.

RESULTS

Findings reveal tenuous statements in the AA literature that appear contradictory and thereby invite a misreading. These statements, some of which misrepresent the tenets of AA and its founders, underscore certain vocal criticisms that are not entirely unfounded. While many pages of the AA literature are imbued with timeless wisdom, even the most apologetic interpretations-distilled into benefit-of-the-doubt renderings-largely falter in defending the nature of the language that originated in the early 1900s at odds with 21st century understandings of alcohol use disorder. Conclusions/Importance: The AA literature essentially presents a valid target for critics, fueling resistance to this free community-based resource that may prevent people who could benefit from AA from seeking the help of the 12-steps.

Opioid use and misuse: health impact, prevalence, correlates and interventions

Objective: To provide a broad overview of the state of drug misuse research, particularly focusing on opioid drug use in the U.S.A. Design: An overview of published reviews of the literature. Results: Prescription opioid use has increased globally from 2008 to 2013, while use of opiates such as heroin and opium have remained stable in many countries, although, decreases have been observed in parts of Europe. Opioid misuse is highest in the United States; approximately 11.8 million Americans misused opioids in 2016. Demographic, genetic, psychosocial and structural/environmental factors all play a role in determining who will become an opioid misuser. Strategies such as increased prescribing of non-opioid derived pain relievers, expansion of medication treatment, distribution of naloxone for overdose reversal and supervised consumption sites are some of the solutions posed to reduce the spread and consequences of opioid misuse. Conclusion: Research focused on understanding of opioid neurobiology, as well as empirically based, effective alternatives to pain management and implementation studies on combined prevention and treatment approaches are needed. It will take the combined effort of community members, healthcare professionals, policymakers and researchers in order to prevent and treat opioid misuse.

Gender Aspects of Affiliation with Alcoholics Anonymous after Treatment

Studies incorporating gender aspects of post-treatment affiliation with Alcoholics Anonymous (AA) have often focused on meeting attendance, disregarding behavioral indicators of affiliation. This article describes meeting attendance and affiliative behaviors in a Swedish treatment sample of 112 men and 40 women, and also identifies predictors of high affiliation. While no gender differences were found for meeting attendance, more women than men reported that they had called an AA member for help, had experienced a spiritual awakening, and read AA literature after treatment. Bivariate analyses identified a treatment goal of abstinence as predictive of high affiliation for both sexes, and in a multivariate context, female gender, a treatment goal of abstinence and pre-treatment AA exposure increased the likelihood of high affiliation (R2 = .31). Findings suggest that the affiliation process differs by gender, but reflect study methodology and Swedish AA culture, so that these issues need further exploration.

Spirituality in addictions treatment: wisdom to know…what it is

Spirituality has long been integrated into treatments for addiction. However, how spirituality differs from other related constructs and implications for recovery among nonspiritual persons remains a source of discussion. This article examines ways in which spirituality is delineated, identifies variables that might mediate the relations between spirituality and recovery from substance abuse disorders, describes distinctions between spiritual and nonspiritual facets of addictions treatment, and suggests means to assist in further clarification of this construct.

A review of Alcoholics Anonymous/ Narcotics Anonymous programs for teens

The investigation of the applicability of Alcoholics Anonymous/Narcotics Anonymous (AA/NA) for teens has only been a subject of empirical research investigation since the early 1990s. In the present review, the author describes teen involvement in AA/NA programming, provides an exhaustive review of the outcomes of 19 studies that used an AA/NA model as part of their formal teen substance abuse treatment programs, and provides data on the effects of AA/NA attendance on abstinence at follow-up, on which youth tend to become involved in AA/NA, and on mediation of the benefits of AA/NA participation. In addition, the author suggests the reasons for somewhat limited participation by teens in more informal, community-based 12-step meetings, and makes suggestions for maximizing participation at meetings in the community. The author concludes that AA/ NA participation is a valuable modality of substance abuse treatment for teens and that much can be done to increase teen participation, though more research is needed.

Predictors of initial AA-related helping: findings from project MATCH

OBJECTIVE

The purpose of this article is to identify the factors that predict initial Alcoholics Anonymous (AA)-related helping following treatment admission.

METHOD

Data were derived from Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a longitudinal investigation of the efficacy of three behavioral treatments for alcohol abuse and dependence. Cox proportional hazard regressions were performed to determine the extent to which demographic, clinical, belief, and AA factors predicted initial AA-related helping.

RESULTS

Demographic characteristics, drinking severity, antisocial personality, and purpose in life were not associated with initial AA-related helping. Increased self-efficacy, faith-based practices, meeting attendance, number of steps worked, having a sponsor, and length of sobriety predicted initial AA-related helping. Alcoholics reported elevated depressive symptoms before initial AA-related helping, lowered depressive symptoms at the start of AA-related helping, and similarly lowered depressive symptoms in the interval following initial AA-related helping.

CONCLUSIONS

The profile of prospective helpers in AA is not limited to alcoholics from certain backgrounds or higher functioning in terms of drinking or clinical severity. To increase participation in AA-related helping, and hence outcomes, results suggest strengthening self-efficacy and progress in other AA programmatic components.

Active ingredients of substance use-focused self-help groups

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.

Solution-focused group therapy for level 1 substance abusers

The present study compared solution-focused group therapy (SFGT) with a traditional problem-focused treatment for level 1 substance abusers. Outcome research on the effectiveness of solution-focused group therapy is minimal, especially in treating substance abusers. In the present study, clients were measured before and after treatment to determine therapeutic effectiveness. Clients in the solution-focused group significantly improved on both the Beck Depression Inventory and the Outcome Questionnaire. The clients in the comparison group did not improve significantly on either measure. Therapist skill level and adherence to theoretical models were measured in each group to reduce confounding variables.

Substitute addiction: a concern for researchers and practitioners

An understanding of the role of substitute addictions remains unclear. This article examines the range and possible reward functions of substitute addictions. We suggest that prevention education and treatment need to take into account substitute addictions as an influential aspect ofrecovery. Research is needed to better understand the prevalence and functions of, and solutions to substitute addictions.

Sixteen-year changes and stable remission among treated and untreated individuals with alcohol use disorders

AIMS

This study examined changes over a 16-year interval and predictors of stable remission among previously untreated individuals with alcohol-use disorders who did not obtain help or who entered either alcoholics anonymous (AA) or professional treatment in the first year after initially seeking help.

DESIGN AND MEASURES

A sample of individuals (N = 461) who initiated help-seeking was surveyed at baseline and 1, 3, 8, and 16 years later. In addition to providing information on life history of drinking at each contact point, participants described their current alcohol-related and psychosocial functioning and life context, and coping responses.

FINDINGS

Irrespective of whether or not individuals obtained help, their alcohol-related functioning, life context, and coping improved. However, individuals who obtained help (AA or treatment) in the first year improved more and were more likely to achieve stable remission than those who did not. Nevertheless, the factors associated with stable remission were comparable for individuals who did and those who did not obtain timely help.

CONCLUSIONS

Compared with individuals who do not obtain timely help, those who enter either AA or treatment relatively soon after initiating help-seeking improve more quickly and achieve higher long-term remission rates.

Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program

AIMS

This study compared 5-year treatment outcomes of older adults to those of middle-aged and younger adults in a large managed care chemical dependency program. We examined age group differences in individual, treatment and extra-treatment factors, which may influence long-term outcome.

DESIGN

Seventy-seven per cent of original study participants completed a telephone interview 5 years after out-patient chemical dependency treatment at Kaiser Permanente. This sample (N = 925) included 65 patients aged 55-77, 296 patients aged 40-54 and 564 patients aged 18-39 (age at baseline).

MEASUREMENTS

Measures at follow-up included alcohol and drug use, Addiction Severity Index (ASI), Alcoholics Anonymous Affiliation Scale, social resource and self-reported health questions. Mortality data were obtained from contact with family members of patients as well as automated health plan records.

FINDINGS

Older adults were less likely to be drug-dependent at baseline than younger and middle-aged adults, and had longer retention in treatment than younger adults. At 5 years, older adults were less likely than younger adults to have close family or friends who encouraged alcohol or drug use. Fifty-two per cent of older adults reported total abstinence from alcohol and drugs in the previous 30 days versus 40% of younger adults. Older women had higher 30-day abstinence than older men or younger women. Among participants dependent only on alcohol, there were no significant age differences in 30-day abstinence. In logistic regression analysis, age group was not significant. Variables associated with greater age that independently predicted 30-day abstinence in the logistic regression model included longer retention in treatment and having no close family or friends who encouraged alcohol or drug use at 5 years; female gender was also significant.

CONCLUSIONS

Results indicate that older adults have favorable long-term outcome following treatment relative to younger adults, but these differences may be accounted for by variables associated with age such as type of substance dependence, treatment retention, social networks and gender. Age differences in these characteristics inform intervention strategies to support long-term recovery of older adults and provide direction for investigation of how age affects outcome.

Matching substance abuse aftercare treatments to client characteristics

This study investigated matching client attributes to different aftercare treatments. A naturalistic sample of adults entering substance abuse treatment was randomized into either Structured Relapse Prevention (RP, n=61) or a 12-Step Facilitation (TSF, n=72) aftercare program. Four patient attributes were matched to treatment: age, gender, substance abuse profile, and psychological status. Substance use outcomes were assessed 3 and 6 months posttreatment. At 6 months, four significant matches were uncovered. Females and individuals with a multiple substance abuse profile reported better alcohol outcomes with TSF aftercare than their cohorts exposed to RP aftercare. Individuals with high psychological distress at treatment entry were able to maintain longer periods of posttreatment abstinence with TSF aftercare compared to their cohorts exposed to RP. Inversely, RP was found to maintain abstinence significantly longer for individuals reporting low distress compared to those with high distress. Finally, better outcomes were achieved when random assignment to aftercare was consistent with participant preference. Overall, an Alcoholics Anonymous approach to aftercare appears to provide the most favorable substance use outcomes for most groups of substance abusers. RP may be most suitable for clients whose psychological distress is low, especially where maintenance of abstinence is targeted. Where choice in aftercare program is possible, matching client preference with type of aftercare program can improve outcome.

Em busca de uma nova identidade: o grupo de alcoólicos anônimos

Este artigo descreve uma investigação com membros de Alcoólicos Anônimos, conduzida com o objetivo de verificar transformações em seu cotidiano e em suas concepções sobre temas relacionados ao alcoolismo. Foram entrevistados 19 homens, utilizando-se um roteiro de questões que solicitava de diversas formas que comparassem sua condição anterior de alcoolista na ativa com sua condição atual de abstinente. Foi utilizado, também, um instrumento adaptado da técnica do diferencial semântico. Os resultados revelaram extensas alterações -tanto nas concepções sobre alcoolismo e temas relacionados, como nas ações pessoais dos membros de AA - em várias esferas de suas vidas (família, grupo de amigos, trabalho, vizinhança). Tais resultados indicam a construção de uma nova identidade social revestida de caráter positivo. Fica evidente também a grande aceitação, pelos sujeitos, dos princípios de AA e adesão às propostas do grupo na condução de suas vidas. Adicionalmente, os resultados permitiram discutir alguns mecanismos de influência dos grupos de AA.

12-Step Program Participation and Effectiveness: Do Gender and Ethnic Differences Exist?

Although 12-Step is increasingly utilized as a recovery resource and is viewed by many addiction specialists as an integral component of treatment and long-term recovery, questions regarding participation and effectiveness of 12-Step programs for women and ethnic minorities have been raised. Utilizing data from the Los Angeles Target Cites Evaluation Project (n = 356), participants in adult outpatient alcohol and drug treatment were followed for 24 months and rates of 12-Step participation and effectiveness were assessed for all gender and ethnic groups. Contrary to reports that 12-Step is more appropriate for European-American males, statistical analyses reveals that women and ethnic minorities are equally likely to attend 12-Step programs, and to recover In conjunction with such participation as European-American males. Although 12-Step may not appeal to all seeking to cease alcohol and drug use, the clinical implications for treatment providers and other addiction specialists points to the benefits of Integrating 12-Step components into traditional treatment programs and recommending 12-Step participation for clients of all gender and ethnic groups.

Drug treatment and 12-step program participation: the additive effects of integrated recovery activities

The dramatic rise in the number of 12-step programs and participants raises questions concerning client participation in drug treatment and 12-step programs, and their separate and combined effects on recovery. The results of a treatment outcomes study indicate that rather than recovery alternatives, drug treatment and 12-step programs are utilized by the client as integrated recovery activities. Treatment participants with pretreatment 12-step involvement stayed in treatment longer, and were more likely to complete the 24-week program. Both pretreatment 12-step involvement and duration of participation in drug treatment are associated with subsequent 12-step involvement. Most importantly, there is an additive effect of these recovery activities in that those who participated concurrently in both drug treatment and 12-step programs had higher rates of abstinence than those who participated only in treatment or in 12-step programs.

Does Alcoholics Anonymous work? The results from a meta-analysis of controlled experiments

This article reviews the outcome (usually abstinence at 12 months) of 21 controlled studies of AA, with emphasis on methodological quality. Severe selection biases compromised all quasi-experiments. Randomized studies yielded worse results for AA than nonrandomized studies, but were biased by selection of coerced subjects. Attending conventional AA meetings was worse than no treatment or alternative treatment; residential AA-modeled treatments performed no better or worse than alternatives; and several components of AA seemed supported (recovering alcoholics as therapists, peer-led self-help therapy groups, teaching the Twelve-Step process, and doing an honest inventory).

After drug treatment: are 12-step programs effective in maintaining abstinence?

Although participation in 12-step programs is now widely utilized as a treatment aftercare resource by individuals with drug and alcohol problems, little is known about the effectiveness of such a practice. This paper identifies gaps in the existing literature and articulates methodological concerns that may compromise investigations of 12-step programs. It highlights the need for additional after-treatment studies, and it presents findings from a 24-month longitudinal after-treatment study that suggests the effectiveness of 12-step programs. Rather than a behavioral indicator of recovery motivation or a spurious relationship confounded by additional treatment, aftercare, or alumni activities that occur simultaneously with 12-step participation, the findings suggest that weekly or more frequent 12-step participation is associated with drug and alcohol abstinence. Less-than-weekly participation is not associated with favorable drug and alcohol use outcomes, and participation in 12-step programs seems to be equally useful in maintaining abstinence from both illicit drug and alcohol use. These findings point to the wisdom of a general policy that recommends weekly or more frequent participation in a 12-step program as a useful and inexpensive aftercare resource for many clients.

Retention in an aftercare program for recovering women

Examining the correlates of aftercare participation is critical to program development and successful relapse prevention. This study assesses retention in an aftercare program of case management and peer support for formerly homeless recovering mothers. Length of residential drug treatment, length of sobriety, strong support networks, and concerns about housing and parenting predicted completion of the case management component. Emotional instability and the severity of problems were found to be correlated with participation in the peer support group. Sociodemographic characteristics were not related to program retention. The findings illustrate the need to tailor aftercare services to the level of clients' recovery and the need for female-only aftercare groups where women can safely discuss physical and sexual abuse issues related to their misuse of drugs.