We evaluates the gender matching hypothesis in Project MATCH, which states that women will benefit more from Cognitive-Behavioral Coping Skills Therapy (CBT) than from Twelve Step Facilitation (TSF).

CBT was expected to address the ancillary problems (e.g., external stressors, negative mood) that are more prevalent among female alcoholics; at the same time, TSF, which would encourage women to attend Alcoholics Anonymous (AA) meetings, was expected to increase guilt and undermine self-esteem and assertion.

Tests of the matching contrasts failed to provide support for the hypothesis in either arm of the trial.

Gender did produce significant prognostic effects in analyses of the aftercare arm, with women reporting a higher proportion of abstinent days and fewer drinks per occasion than men did.

Causal chain analyses produced mixed results. Male and female clients were shown to differ in terms of their initial treatment needs, and follow-up status with respect to these needs was related to drinking outcomes.

Contrary to prediction, however, CBT sessions for women, as compared to those for men, were not appreciably more likely to teach general problem-solving or mood-management skills.

Further, women did not avoid AA meetings.

• Attendance at self-help meetings was comparable for the sexes in the outpatient arm;
• in the aftercare study, women attended significantly more meetings and reported a higher degree of AA involvement.

Gender matching hypothesis 28. Del Boca, F.K.; Mattson, M.E. Gender matching hypothesis. In R. Longabaugh and P.W. Wirtz, Eds., Project MATCH Hypotheses: Results and Causal Chain Analysis, Bethesda, MD:NIAAA, 2001. 330p. (pp. 186-203)

Alcoholics and Loss of control of drinking

Alcoholics and addicts can attest to their countless attempts to stop or cut back on their drinking or drugging. They learn but cannot really accept that they have no power over alcohol or drugs.

The following research of the 1970’s began to explore this phenomenon and in the process confirming a basic tenet of Alcoholics Anonymous.

We alcoholics are men and women who have lost the ability to control our drinking. We know that no real alcoholic ever recovers control. All of us felt at times that we were regaining control, but such intervals – usually brief – were inevitably followed by still less control, which led in time to pitiful and incomprehensible demoralization. We are convinced to a man that alcoholics of our type are in the grip of a progressive illness. Over any considerable period we get worse, never better. Alcoholics Anonymous, pp 30.

Abstract of research report; This study evaluates the ability of alcoholics to regulate their blood alcohol levels (BAL) within a designated range by relying primarily on interoceptive (internal) cues. Forty male alcoholics and 20 control subjects were exposed to an initial training session in which they received sufficient ethanol to maintain them within a designated BAL range over a 2 1/2-hour period.

They were then exposed to two experimental sessions, one providing "overfeedback" and one "underfeedback." During each session, subjects had ten drinking decisions to make with respect to regulation of their BAL.

The results indicated that alcoholics displayed greater "loss-of-control" than control subjects.

This finding supported the hypothesis that alcoholics may possess a neurophysiologic feedback dysfunction that contributes to their relative inability to regulate ethanol intake.

A. M. Ludwig, F. Bendfeldt, A. Wikler and R. B. Cain. Loss of control in alcoholics. Archives of General Psychiatry. Vol. 35 No. 3, March 1978.

Alcoholics Anonymous and Nursing; Lessons in Holism and Spiritual Care.

Alcoholic Anonymous (AA) is a worldwide, 2 million-member organization that has assisted countless alcoholics to achieve sobriety through a spiritual program of recovery from alcoholism.

Based on spiritual principles known as the “Twelve Steps” and “Twelve Traditions,” AA has provided a model for other recovery programs such as

• Narcotics Anonymous (NA),
• Gamblers Anonymous (GA), and
• Sex and Love Addicts Anonymous (SLAA).
• Al-anon
• Adult Children of Alcoholics

Recovery in AA appears to involve a process of self-transcendence.

In recent years, nursing scholars have increasingly explored the concepts of self-transcendence and spirituality as they apply to nursing theory and practice.

This article explores the roots and spiritual dimensions of 12-step recovery programs. It further explores the ways in which theoretical and clinical knowledge about the delivery of spiritual care interventions may be gained from an understanding of AA’s spiritual approach to recovery.

Alcoholics Anonymous and Nursing; Lessons in Holism and Spiritual Care. Eileen M. McGee, J Holist Nurs 2000; 18; 11.

Brief-TSF can assist patients cease alcohol consumption.

A closer look at the role of a spiritual approach in addictions treatment.

Twelve Step Programs such as AA play a major role in addictions treatment, and their members are increasingly accepting of psychotherapy and medication.

However, many clinicians question the role of an approach defined by these Programs as spiritual.

This paper explores the nature, indications, and limitations of a spiritual approach to addiction and the implications for collaboration with mental health professionals.

It suggests that Twelve Step Programs not only provide accessible group support and a clear ideology regarding addiction but address individuals’ needs for identity, integrity, an inner life and interdependence within a larger social and moral, or spiritual context.

It examines the ways in which the religious connotations of the Program remain an obstacle for many patients and clinicians.

Clarification of the different needs met by modalities such as AA can improve the specificity and the comprehensiveness of treatment for patients with substance use disorders.

Peteet JR. A closer look at the role of a spiritual approach in addictions treatment. J Subst Abuse Treat. 1993 May-Jun;10(3):263-7.

The Measure of a Man: A Spiritual Autobiography (Oprah’s Book Club) by Sidney Poitier Read more about this title…

Dr Harry M. Tiebout

One of the first psychiatrists to describe alcoholism as a disease rather than a moral failing or criminal activity.

Harry M. Tiebout was also one of the first to wholeheartedly endorse Alcoholics Anonymous as an effective force in the struggle against compulsive drinking.

This volume brings together, for the first time, some of Tiebout’s most influential writings. Many of these pieces–from explorations of the therapeutic approach to alcoholism to instructive discussions of the act of surrender so crucial to recovery–are seminal documents in the history, treatment, and understanding of alcoholism.

Together, they represent the significant contribution of one man to the countless lives shaken by alcoholism and steadied with the help of Alcoholics Anonymous, psychiatric intervention, and the foresight and commitment of doctors like Harry Tiebout.

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Harry Tiebout Buy Now!

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The 1956 General Service Conference of A.A. adopted unanimously the following statement of “A.A.’s Public Information

Policy”: In all public relationships, A.A.’s sole objective is to help the still suffering alcoholic. Always mindful of the importance of personal anonymity, we believe this can be done by making known to him, and to those who may be interested in his problem, our own experience as individuals and as a fellowship in learning to live without alcohol. We believe that our experience should be made available freely to all who express sincere interest.

We believe further that all our efforts in this field should always reflect our gratitude for the gift of sobriety and our awareness that many outside A.A. are equally concerned with the serious problem of alcoholism.

This statement reflects a longstanding A.A. tradition of not seeking publicity for promotional purposes, but of always being willing to cooperate with representatives of all media who seek information about the recovery program or about the structure of the Fellowship. Thousands of inquiries of this type are handled each year at the General Service Office (475 Riverside Drive, New York, NY 10115; mail address: Box 459, Grand Central Station, New York, NY 10163; telephone: 2128703400; www.aa.org). Many countries have local website’s that can be accessed from this main site.

Information and public relations matters affecting the Fellowship of A.A. as a whole are the concern of the Public Information Committee and the Committee on Cooperation with the Professional Community/Treatment Facilities of the General Service Board of Alcoholics Anonymous.

Reporters are welcome at A.A. open meetings, dinners, regional gettogethers, or similar gatherings of recovered alcoholics.

The only restriction is a request not to disclose the name of any A.A. member. (For obvious reasons, photographs cannot be taken at A.A. meetings.)

Note: In many areas, A.A. members have established committees on public information and cooperation with the professional community, to assist local media in obtaining accurate information about the Fellowship. Background material on A.A. may also be obtained upon request from these groups.

A.A. FACT FILE; PREPARED BY GENERAL SERVICE OFFICE OF ALCOHOLICS ANONYMOUS

Patterns of AA involvement five years after treatment entry

BACKGROUND: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of aftercare, but we know very little about treatment seekers’ patterns of AA involvement over time and how these relate to abstinence.

METHOD: This paper applies latent class growth curve modeling to longitudinal data from 349 dependent drinkers recruited when they were entering treatment and were re-interviewed at one or more follow-up interviews one, three and five years later, and who reported having attended AA at least once.

RESULTS: Four classes of AA "careers" of meeting attendance emerged:

• The low AA group mainly just attended AA during the 12 months following treatment entry.
• The medium and high AA groups were characterized by stable attendance at the second and third follow-ups-at about 60 meetings a year for the medium group and over 200 meetings per year for the high group, followed by slight increases for the medium group and slight decreases for the high group by year five.
• The declining AA group doubled its meeting attendance post-baseline, to almost 200 meetings during the year following treatment entry, but by year five they were only attending about six meetings on average.

Decreases in AA meetings did not necessarily signal disengagement from AA; at the five-year follow-up, a third of the low AA group and over half of the declining AA group said they felt like a member of AA.

Activities other than meeting attendance, such as having a sponsor, otherwise paralleled the meeting careers, but social networks were similar by year five.

Rates of abstinence by year five (for the past 30 days) were

• 43% for the low AA group,
• 73% for the medium group,
• 79% for the high group and
• 61% for the declining group.

Rates of dependence symptoms and social consequences of drinking did not differ between the groups at year five.

CONCLUSIONS: The prototypical AA careers derived empirically are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable (and sometimes quite high) rates of AA attendance. However, contrary to AA lore, many who connect only for a while do well afterwards.

Kaskutas LA, Ammon L, Delucchi K, Room R, Bond J, Weisner C. Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry. Alcohol Clin Exp Res. 2005 Nov;29(11):1983-90.

Spirituality in alcoholics during treatment

The purpose of this study was to measure

• spiritual well-being (SWB),
• private religious practices (PRP),
• positive religious coping,
• abstinence self-efficacy (AASE),
• affiliation with Alcoholics Anonymous (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.

Piderman KM, Schneekloth TD, Pankratz VS, Maloney SD, Altchuler SI. Spirituality in alcoholics during treatment. Am J Addict. 2007 May-Jun;16(3):232-7

Brief-TSF does not address spirituality. It leaves that to the AA Fellowship.

Spirituality/religiosity promotes acceptance-based responding and 12-step involvement.

BACKGROUND: Previous investigations have observed that spirituality/religiosity (S/R) is associated with enhanced 12-step involvement.

However, relatively few studies have attempted to examine the mechanisms for this effect.

For the present investigation, we examined whether acceptance-based responding (ABR) – awareness or acknowledgement of internal experiences that allows one to consider and perform potentially adaptive responses – accounted for the effect of S/R on 12-step self-help group involvement 2 years after a treatment episode.

METHODS: Data were collected as part of a multi-site treatment outcome study with 3698 substance-dependent male veterans recruited at baseline.

Assessments were conducted at baseline, discharge, 1-year follow-up, and 2-year follow-up. We utilized structural equation modeling to examine the relationships among latent variables of S/R, ABR, and 12-step involvement over time.

RESULTS:

• In the final model, S/R was not directly related to 12-step involvement at 2-year follow-up.
• However, S/R predicted enhanced ABR at 1-year follow-up after accounting for discharge levels of ABR.
• In turn, ABR at 1-year follow-up predicted increased 12-step involvement at 2-year follow-up after accounting for discharge levels of 12-step involvement.

CONCLUSIONS: S/R promotes the use of post-treatment self-regulation skills that, in turn, directly contribute to ongoing 12-step self-help group involvement.

Research report; Carrico AW, Gifford EV, Moos RH. Spirituality/religiosity promotes acceptance-based responding and 12-step involvement. Drug Alcohol Depend. 2007 Jun 15;89(1):66-73. Epub 2007 Jan 16.

Blue Like Jazz: Nonreligious Thoughts on Christian Spirituality by Donald Miller Read more about this title…

A researcher studying the influence of spirituality on sobriety encourages recovering alcoholics to nourish their spiritual needs through praying, taking a course in meditation, or simply walking in the woods.

“While people’s actual beliefs don’t seem to change during recovery, the extent [to which] they have spiritual experiences and are open to spirituality in their lives does change,” said Elizabeth Robinson, Ph.D., a research assistant professor at the Addiction Research Center at the University of Michigan’s Department of Psychiatry.

While anecdotal evidence indicates that spirituality plays a role in alcohol recovery, until recently there were few hard data to prove if and how it impacts sobriety.

Now a team of researchers at the University of Michigan Addiction Research Center (UMARC) headed by Robinson have found that many measures of spirituality increase during alcohol recovery. And increases in day-to-day spiritual experiences and sense of purpose in life were associated with fewer episodes of heavy drinking six months later, independent of involvement in Alcoholics Anonymous (AA).

Their report appears in the March Journal of Studies on Alcohol and Drugs.

“I was surprised that there was a relationship between spirituality and a change in drinking independent of AA involvement, because AA involvement certainly impacts spirituality,” Robinson told Psychiatric News.

The researchers assessed the changes in spirituality and religiosity (S/R) of 123 adults (66 percent men; mean age 39; 83 percent white) with alcohol use disorders at entry into treatment and six months later. They also investigated whether those changes were associated with drinking outcome. The 10 S/R measures of the participants’ spirituality and religiousness, measured with standard research questionnaires, included their views of God, religious practices such as prayer or church attendance, forgiveness, spiritual experiences, using religion or spirituality to cope, and existential meaning. Drinking behaviors were assessed with the Time-line Followback interview. AA participation and attendance were also measured.

In all, the study showed that during the six-month period there were statistically significant changes in half of the measures of spirituality, including daily spiritual experiences, use of religious practices, forgiveness, positive use of religion for coping, and feelings of purpose in life.

But the measures that assessed individuals’ core beliefs and values about God or religion didn’t change. At the same time there was a statistically significant decrease in alcohol use, and 72 percent of participants did not relapse to heavy drinking. Heavy drinking was defined as five or more drinks a day for men and four or more drinks a day for women. Increases in Daily Spiritual Experiences and Purpose in Life scores were associated with increased odds of no heavy drinking at six months, even after controlling for AA involvement and gender. Changes in the other measures of spirituality were not statistically associated with likelihood of sobriety.

Robinson and her colleagues said that because spiritual practices and experiences increased significantly over time while spiritual and religious beliefs did not, the results suggest that proactive and experiential dimensions of spirituality, rather than cognitive dimensions of spirituality, were contributing to recovery and less drinking during the first six months.

They noted that this pattern of differential changes in S/R experiences and behavior rather than beliefs is consistent with two AA slogans: “Bring your body, your mind will follow,” and “Fake it ’til you make it.” In other words, changes in core beliefs and values don’t have to occur for someone to be more open to spiritual experiences or to take part in more spiritual activities.

Robinson said that including spirituality of all kinds into recovery programs for alcoholism may indeed provide benefit. Many individual faiths or religious institutions offer recovery services, and some advocates have suggested that faith-based recovery is effective for most people. But Robinson noted that the spirituality seen in the study was not necessarily a matter of believing in one interpretation of God, religions, or even belief in a God of any kind.

Each individual’s spirituality the ability to experience growth in that spirituality appear to be paramount, the authors suggested. Thus, each individual alcoholic might do best by searching for a recovery program that best matches his or her belief system.

By David Milne at Psychiatric News. From research; Psychiatr News May 4, 2007, Volume 42, Number 9, page 19.