Predictors of changes in alcohol-related self-efficacy over 16 years

Self-efficacy is a robust predictor of short- and long-term remission after alcohol treatment. This study examined the predictors of self-efficacy in the year after treatment and 15 years later.

A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years.

Predictors of self-efficacy at 1 year included

• improvement from baseline to 1 year in heavy drinking,
• alcohol-related problems,
• depression,
• impulsivity,
• avoidance coping,
• social support from friends, and
• longer duration of participation in mutual-help Alcoholics Anonymous (AA).

Female gender, more education, less change in substance use problems, and impulsivity during the first year predicted improvement in self-efficacy over 16 years.

Clinicians should focus on

• keeping patients engaged in self-help of AA,
• addressing depressive symptoms,
• improving patient’s coping, and
• enhancing social support

during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.

Research; Predictors of changes in alcohol-related self-efficacy over 16 years. John McKellar Ph.D, Mark Ilgen Ph.D., Bernice S. Moos B.A. and Rudolf Moos Ph.D. J Subst Abuse Treat. 2007 Nov 23.

See also;

• AA and Treatment Work Better Together
• Brief-TSF can assist patients cease alcohol consumption.
• AA Offers Recovery Not Religion

Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment by Marc A. Schuckit Read more about this title…

Seeking Help Could Quadruple the Likelihood of Abstinence

To quantify the effect of help seeking on recovery from alcoholism, researchers in the United States analyzed data from 4,422 adults who had participated in a nationally representative survey and developed alcohol dependence at least 1 year before their participation.

• Only 26 percent of subjects had ever sought help for their alcohol problems;
• 3 percent participated in a 12-step program only,
• 6 percent in formal treatment only, and
• 17 percent in both. 

Help seekers drank more and had higher lifetime prevalences of other drug use, mood disorders, and personality disorders than did subjects who had not sought help.

In analyses adjusted for potential confounders, help seeking significantly increased the likelihood of any recovery (odds ratio [OR] 2.4) and of abstinence (OR 4.0). Any recovery was defined as, in the past year, having no symptoms of alcohol abuse or dependence and either drinking low-risk amounts* or abstaining.

The odds of recovery were greater for those who had participated in 12-step programs with or without formal treatment than for those who had participated in formal treatment only.

Comments by Peter Friedmann, MD, MPH:

Even though they had more comorbidity and therefore were at risk for worse outcomes, seekers of formal and informal treatment had better odds of recovery from alcohol dependence. This study could not separate the motivation inherent in seeking help from the therapeutic effects of help received. However, help seeking—regardless of the patient’s level of readiness—should be encouraged. 

Research Reference: Dawson DA, Grant BF, Stinson FS, et al. Estimating the effect of help-seeking on achieving recovery from alcohol dependence. Addiction. 2006;101(6):824–834.

Brief-TSF can assist patients cease alcohol consumption.

The interplay between help seeking and alcohol related outcomes: divergent processes for professional treatment and self-help groups.

Summary:
This study examined the influence of self-selection on the duration of professional treatment and participation in Alcoholics Anonymous (AA) and the influence of social causation on alcohol-related outcomes.

A sample of alcoholics was surveyed at baseline and 1, 3, and 8 years later. Participants completed an inventory at each survey that assessed participation in treatment and AA since the last assessment and alcohol-related functioning.

There were divergent processes of self-selection and social causation with respect to the duration of participation in professional treatment and AA.

Individuals with more severe alcohol-related problems obtained longer episodes of professional treatment, but this self-selection process was much less evident for AA.

Longer participation in professional treatment in the first year predicted better alcohol-related outcomes, but the duration of subsequent treatment was not associated with better subsequent outcomes.

In contrast, longer participation in AA consistently predicted better subsequent alcohol-related outcomes.

The findings are consistent with a need-based model of professional treatment, in which more treatment is selected by and allocated to individuals with more severe problems, and an egalitarian model of self-help, in which needs play little or no role in continued participation.

Rudolf H. Moos and Bernice S. Moos. The interplay between help-seeking and alcohol-related outcomes: divergent processes for professional treatment and self-help groups. Drug and Alcohol Dependence 75(2):155-164, August 2004.

12 Step Programs Offer Broad Benefits, Study Says

A study of Alcoholics Anonymous and other 12-step oriented self-help programs finds that they can help most people recover from alcoholism, even those who are not religious or have mental-health problems.

The Pacific Institute on Research and Education (PIRE) reported that researchers tracked a group of 227 alcoholics over three years and found that those who had attended AA or other self-help programs after treatment had higher rates of abstinence, and drank less if they did relapse.

The results cut across gender and religious lines and held regardless of psychiatric history or whether the patient had previously attended AA or other similar programs.

"Here’s a widespread, chronic disorder that seems to respond well to an inexpensive resource — mutual-help groups such as AA," said study co-author Robert Stout, Ph.D., director of the Decision Sciences Institute at PIRE. "Not only do we need to get more addicts engaged in these groups, but we also need to gather evidence on this issue and make sure that the public, policy-makers and practitioners know about it."

Added co-author John F. Kelly: "There is a clear dose-response relationship: If you don’t go to any meetings, you have the worst outcomes. If you go to a few, you have a little bit better outcome, and if you go to a lot, you have an even better outcome." Kelly is the associate director of the Massachusetts General Hospital/Harvard Addiction Research Program.

The study was published in the August 2006 issue of Alcoholism: Clinical and Experimental Research.

Brief-TSF intervention training; how best to get alcoholics to AA.

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.

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.

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.

Cirrhosis, Drinking and AA participation.

The authors tested the hypotheses that cirrhosis mortality rates are positively associated with per capita alcohol consumption and negatively associated with the 12-Step fellowship Alcoholics Anonymous (AA) membership rates, using data from the province of Ontario, Canada, for 1968 to 1989. Time-series analyses with auto-regressive integrated moving average (ARIMA) modeling were applied to male and female cirrhosis mortality rates in three age groups: 15-44, 45-64 and e65 years. Missing AA membership data were interpolated using two methods: linear splines and cubic splines.

In general, cirrhosis mortality rates were positively associated with alcohol consumption and negatively associated with AA membership. These effects were not statistically significant for some age and gender combinations. Limitations of this study include restrictions in the length of series available and in the ability to infer causality. Nevertheless, the findings are consistent with previous research demonstrating that per capita consumption is a strong determinant of cirrhosis mortality and that higher levels of AA membership can reduce cirrhosis mortality.

Research report; Robert E. Mann, Reginald G. Smart, Brian R. Rush, Rosely Flam Zalcman, and Helen Suurvali. Cirrhosis mortality in Ontario: Effects of alcohol consumption and Alcoholics Anonymous participation. Addiction 100(11):1669-1679, November 2005.

A study of Alcoholics Anonymous and other 12-step oriented self-help programs finds that they can help most people recover from alcoholism, even those who are not religious or have mental-health problems.

The Pacific Institute on Research and Education (PIRE) reported that researchers tracked a group of 227 alcoholics over three years and found that those who had attended AA or other self-help programs after treatment had higher rates of abstinence, and drank less if they did relapse. The results cut across gender and religious lines and held regardless of psychiatric history or whether the patient had previously attended AA or other similar programs.

“Here’s a widespread, chronic disorder that seems to respond well to an inexpensive resource — mutual-help groups such as AA,” said study co-author Robert Stout, Ph.D., director of the Decision Sciences Institute at PIRE. “Not only do we need to get more addicts engaged in these groups, but we also need to gather evidence on this issue and make sure that the public, policy-makers and practitioners know about it.”

Added co-author John F. Kelly: “There is a clear dose-response relationship: If you don’t go to any meetings, you have the worst outcomes. If you go to a few, you have a little bit better outcome, and if you go to a lot, you have an even better outcome.” Kelly is the associate director of the Massachusetts General Hospital/Harvard Addiction Research Program.

The study was published in the August 2006 issue of Alcoholism: Clinical and Experimental Research.

Lack of Humility as a Barrier in Surrendering to the Spiritual Aspect of Alcoholics Anonymous

Kenneth E. Hart and Cherry Huggett

Aims. We tested the hypothesis that recovering alcoholic outpatients who lack humility will be particularly reluctant to accept the first three “surrender” steps of Alcoholics Anonymous: (1) surrendering to powerlessness over alcohol; (2) surrendering to the existence and availability of a “Higher Power” which can help; (3) surrendering control to this “Higher Power”.

Participants & Measurement. Twenty-nine newly recovering alcoholic outpatients drawn from a Minnesota-Model type treatment program in the United Kingdom completed the NPI narcissism scale and the ‘Steps Questionnaire’, which yielded scores assessing the degree of surrender to each of AA’s first three steps.

Findings.

• Unexpectedly, results showed that none of the narcissism subscales were related to acceptance of Step 1.
• However, the narcissistic “authority” subscale showed a very strong inverse relationship to level of surrender to Step 2 (r = -.74, p < .001), and step 3 (r = -.60, < .001).
• Also, the narcissistic “superiority” subscale showed a significant inverse association with acceptance of step 3 (r = -.40, p < .05).

Conclusions. The present results suggest that, relative to their more humble counterparts, recovering alcoholics who lack humility (ie., high narcissists) do not have more difficulty surrendering to the idea they are powerless over their drinking problem.

However, recovering alcoholics who lack authority-related humility do show a marked lack of faith in the proposition that “God” offers a viable solution to their alcohol problem.

Consequently, they are quite reluctant to surrender their willfulness, and thereby accept help from a Higher Power.

Given that faith in the existence, availability or efficacy of a Higher Power is difficult for this subsample of individuals, it seems likely that - in the context of 12-step recovery - deficits in humility may serve to increase a client’s vulnerability to treatment dropout, disaffiliation with AA and relapse. Implications for pastoral counseling are discussed.

Drugs: Education, Policy and Prevention, 2001, 8, 233-242.