AA Utilization After Introduction in Outpatient Treatment.

Abstract; Treatment for alcohol dependence is often provided in outpatient settings, and often includes introduction to the 12-Step fellowship Alcoholics Anonymous (AA).

Relatively little is known about subsequent AA utilization.

Analyses of survey data collected from 72 clients of an outpatient treatment center introduced to AA revealed that, 6 months following intake, a large portion of the responding sample of 55 were still attending AA meetings.

Principal components analysis of self-reports of the frequencies of 12 AA-related behaviors found three dimensions of AA utilization:

• fellowship or social involvement,
• meeting attendance and participation, and
• involvement in bureaucratic functioning and meeting production.

Results suggest it is important to consider these dimensions of utilization for those wishing to understand AA involvement.

Research; Lisa Thomassen. AA Utilization After Introduction in Outpatient Treatment. Substance Use & Misuse, Volume 37, Issue 2 February 2002 , pages 239 – 253

Brief Intervention as a Bridge to AA

Brief Intervention Is Insufficient for Medical Inpatients With Unhealthy Drinking

Data show that brief intervention reduces consumption and consequences among outpatients with unhealthy, but not dependent, alcohol use. To assess whether brief interventions work among medical inpatients with unhealthy drinking,* researchers randomized 341 of such patients to a 30-minute session of motivational counseling in the hospital or to usual care.

Most subjects had alcohol dependence, were unemployed during the previous 3 months, used other drugs, and had substantial psychiatric symptoms. Almost half were hospitalized for an alcohol-related medical diagnosis.

At 3 months among subjects with alcohol dependence, similar proportions of the intervention and control groups received alcohol assistance (e.g., specialty treatment) (49% and 44%, respectively).

At 12 months among all subjects, decreases in alcohol consumption did not significantly differ between the groups (e.g., adjusted mean decreases in drinks per day, 1.5 for intervention subjects and 3.1 for usual care subjects).

Comments:

Unlike most brief intervention studies in outpatients, this study enrolled a predominantly alcohol-dependent sample with major comorbidities—a group reflective of the treatment-resistant population identified when screening occurs in inpatient settings. The study suggests that screening, assessment, and brief counseling are necessary but not sufficient to change alcohol consumption in this population. Although the findings are disappointing, this study underscores that alcoholism—like cancer, atherosclerosis and other complex diseases—will not succumb to simple solutions.

References: Saitz R, Palfai TP, Cheng DM, et al. Brief intervention for medical inpatients with unhealthy alcohol use: a randomized controlled trial. Ann Intern Med. 2007;146(3):167–176.

• Brief-TSF extends brief intervention to lifelong recovery.

What can be confidently said about AA in general and about the role of spirituality in AA in particular?

• First, there is convincing evidence that alcoholism severity predicts later AA attendance.
• Second, atheists are less likely to attend AA, relative to individuals who already hold spiritual and/or religious beliefs. However, belief in God before AA attendance does not offer any advantage in AA-related benefits, and atheists, once involved, are at no apparent disadvantage in deriving AA-related benefits.
• Third, the spiritually-based principles of AA appear to be endorsed in AA meetings regardless of the perceived social dynamics or climate of a particular meeting, eg, highly cohesive or aggressive.
• Fourth, significant increases in spiritual and religious beliefs and practices seem to occur among AA-exposed individuals.
• Fifth, in spite of much discussion to the contrary there is little evidence that spirituality directly accounts for later abstinence.

We are finding, however, that spirituality has an important indirect effect in predicting later drinking reductions. Specifically, in the past 20 years a number of effective methods have been developed to facilitate initial AA attendance. Such as Brief-TSF.

Interventions that lead to initial increases in spirituality appear to lead to sustained AA affiliation, which, in turn, produces sustained recovery over time.

Research; Tonigan JS. Spirituality and alcoholics anonymous. South Med J. 2007 Apr;100(4):437-40.

See also;

• What About This Spiritual Awakening Thing?
• 12-Step Treatment More Effective than Alternative
• Bill W.Biography
• 12 Steps and Post Traumatic Stress
• Psychology Books

If you continue to attend AA and not drop out you have nearly double chance of remaining abstinent.

Estimated Alcoholics Anonymous Membership 1991-1992

• New members during past year – 0.9 million
• On-going members – 1.5 million
• Total membership – 2.4 million

Continuation Rate in Alcoholics Anonymous

In 1991-1992 4.8 million respondents reported ever attending an Alcoholics Anonymous (AA) meeting, for reasons related to their drinking, prior to the last 12 months and 31% reported continued AA attendance during the last 12 months.

Rate of continued AA attendance was associated with years since first AA meeting

• 1-4 years since first AA meeting – 36% remained
• 5-9 years since first AA meeting – 30% remained
• 10-19 years since first AA meeting – 29% remained
• 20 years or more since first AA meeting – 32% remained

Comparison of Past Year Drinking Status – Dropouts and Continuing AA Members

Dropouts:

• Abstinent 33%
• Low risk drinking 14%
• High risk drinking 53%

Continued AA attendance:

• Abstinent 62%
• Low risk drinking 9%
• High risk drinking 29%

1. low risk drinking = never exceed 4 drinks per day(male) or 3 drinks per day (female)
2. high risk drinking = exceeds 4 drinks per day (male) or 3 drinks per day (female)

Research Source: NIAAA 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). Data Brief – National Longitudinal Alcohol Epidemiologic Survey (NLAES) Findings on Alcoholics Anonymous Membership by Loran Archer.

Thus, 36% remain attending A.A. at the end of one year and 32% are still attending at the end of 20 years.

Teaching internal medicine resident physicians about alcoholics anonymous: a pilot study of an educational intervention.

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.

Rose AJ, Stein MR, Arnsten JH, Saitz R. Teaching internal medicine resident physicians about alcoholics anonymous: a pilot study of an educational intervention. Subst Abus. 2006 Sep;27(3):5-11.

Brief-TSF follows a similar education model.

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

Relatively little is known about how substance abuse treatment facilitates positive outcomes.

This study examined the therapeutic effects and mechanisms of action of affiliation with Alcoholics Anonymous (AA) after treatment. Patients (N = 100) in intensive 12-step substance abuse treatment were assessed during treatment and at 1- and 6-month follow-ups.

Results indicated that increased affiliation with AA predicted better outcomes.

The effects of AA affiliation were mediated by a set of common change factors.

Affiliation with AA after treatment was related to maintenance of self-efficacy and motivation, as well as to increased active coping efforts.

These processes, in turn, were significant predictors of outcome. Findings help to illustrate the value of embedding a test of explanatory models in an evaluation study.

Research; Morgenstern, Jon; Labouvie, Erich; McCrady, Barbara S; Kahler, Christopher W; Frey, Ronni M. Affiliation with Alcoholics Anonymous after treatment: A study of its therapeutic effects and mechanisms of action. Journal of Consulting & Clinical Psychology. Vol 65(5), Oct 1997, 768-777.

A new report shows that people in recovery can help hospitalized alcoholics by encouraging them to quit drinking and enter counseling, Reuters reported June 11.

“A recovering alcoholic can help alcoholics who are still suffering from the disease, because the patients relate to them,” said Dr. Richard D. Blondell, an addiction-medicine specialist at the University of Louisville School of Medicine in Kentucky. “The patients credit the visitor as the main thing that motivated them.”

The study included 140 patients who were hospitalized for alcohol-related incidents. One group received standard medical care, a second group received medical care plus a 15-minute intervention by a trained addiction specialist, and the third group received medical care, intervention, and an in-depth talk with a recovering alcoholic.

Researchers found that 59 percent of those who met with recovering alcoholics abstained from drinking for six months after the incident, compared to 44 percent of those who received addiction counseling alone, and one-third of those who only received medical care.

In addition, half the patients who met with recovering alcoholics had entered some form of treatment, compared with only 15 percent of those who received medical treatment and counseling by an addiction specialist.

The study is published in the May issue of the Journal of Family Practice.

From; Jointogether

Brief-TSF is based on these principles.

Risk factors for non-remission among initially untreated individuals with alcohol use disorders

This study identified risk factors for 1-year and 8-year non-remission among initially untreated individuals with alcohol use disorders and examined whether a longer duration of professional treatment or Alcoholics Anonymous (AA) increased the likelihood of remission, moderated the influence of risk factors on remission status and reduced modifiable risk factors.

A sample of individuals with alcohol use disorders (N=473) was recruited at alcoholism information and referral centers and detoxification units and was surveyed at baseline and 1 year, 3 years and 8 years later. At each contact, participants completed an inventory that assessed their alcohol-related problems and personal characteristics and their participation in treatment and AA since the last assessment. An 11-item baseline risk index was associated with 1-year non-remission.

Longer duration of treatment and AA in the first year predicted remission and a decline in modifiable risk factors.

In addition, longer duration of AA increased the likelihood of remission more among high-risk than among low-risk individuals.

The risk factors at 1 year were associated with 8-year non-remission; longer duration of additional treatment or AA was associated with a higher likelihood of 8-year remission and further reductions in modifiable risk factors.

Referral counselors and treatment providers can identify high-risk individuals early in their help-seeking career and intervene to reduce the likelihood of a chronic course of their alcohol use disorder.

Research report; Moos, R.H.; Moos, B.S. Risk factors for non-remission among initially untreated individuals with alcohol use disorders. Journal of Studies on Alcohol, 64(4):555-563, 2003.

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.

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.

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.

• 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 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.

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. 2007 Nov 20.

Brief-TSF can assist patients cease alcohol consumption.

How do alcoholics get to AA?¹

AA has grown to over 100,000 groups world wide with more than two million members simply on word-of-mouth recommendation. Often the recommendation has come from friends, family, employers, healthcare workers or law courts.

People progress through stages of affiliation with others and with Alcoholics Anonymous in pursuit of solutions to their problems. Two paths are identified; Direct Affiliation and Facilitated Affiliation².

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