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

Twelve Step Facilitation Therapy facilitates patients’ active participation in the fellowship of Alcoholics Anonymous.

TSF regards such active involvement as the primary factor responsible for sustained sobriety (recovery) and therefore as the desired outcome of participation in this treatment program.

This therapy is grounded in the concept of alcoholism as a spiritual and medical disease.

TSF consists of a brief, structured, and manual-driven approach to facilitating early recovery from alcohol abuse/alcoholism and other drug abuse/addiction.

It is intended to be implemented on an individual basis in 12 to 15 sessions and is based in behavioral, spiritual, and cognitive principles that form the core of 12-step fellowships such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).

It is suitable for problem drinkers and other drug users and for those who are alcohol or other drug dependent.

• TSF is only used by specialist alcoholism therapists.
• BriefTSF is used by generalist healthcare workers.

See also;

• 12-Step Treatment More Effective than Alternative
• AA Offers Recovery Not Religion
• Brief-TSF can assist patients cease alcohol consumption.
• Subscribe to Twelve Step Facilitation by e-Mail

Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms?

Rationale  Indices of negative affect, such as depression, have been implicated in stress-induced pathways to alcohol relapse. Empirically supported continuing care resources, such as Alcoholics Anonymous (AA), emphasize reducing negative affect to reduce relapse risk, but little research has been conducted to examine putative affective mechanisms of AA’s effects.

Methods  Using lagged, controlled, hierarchical linear modelling and meditational analyses this study investigated whether AA participation mobilized changes in depression symptoms and whether such changes explained subsequent reductions in alcohol use. Alcohol-dependent adults (n = 1706), receiving treatment as part of a clinical trial, were assessed at intake, 3, 6, 9, 12 and 15 months.

Results  Findings revealed elevated levels of depression compared to the general population, which decreased during treatment and then remained stable over follow-up. Greater AA attendance was associated with better subsequent alcohol use outcomes and decreased depression. Greater depression was associated with heavier and more frequent drinking. Lagged mediation analyses revealed that the effects of AA on alcohol use was mediated partially by reductions in depression symptoms. However, this salutary effect on depression itself appeared to be explained by AA’s proximal effect on reducing concurrent drinking.

Conclusions  AA attendance was associated both concurrently and predictively with improved alcohol outcomes. Although AA attendance was associated additionally with subsequent improvements in depression, it did not predict such improvements over and above concurrent alcohol use. AA appears to lead both to improvements in alcohol use and psychological and emotional wellbeing which, in turn, may reinforce further abstinence and recovery-related change.

Research; John F. Kelly, Robert L. Stout, Molly Magill, J. Scott Tonigan & Maria E. Pagano, Addiction, Volume 105 Issue 4, Pages 626 – 636

• See also
• Disturbing Denial
• Strategies for Dealing With Denial
• Addiction & Recovery Books
• The Dual Disorders Recovery Book
• Acceptance and Surrender

Biomarkers in Alcohol Misuse: Their Role in the Prevention and Detection of Thiamine Deficiency

In Western countries alcohol misuse is the most frequent cause of thiamine (vitamin B1) deficiency (TD) and consequent neuro-impairment.

Studies have demonstrated that between 30 and 80% of alcoholics are thiamine deficient, and this puts them at risk of developing the Wernicke–Korsakoff (WK) syndrome.

The relative roles of alcohol and TD in causing brain damage remain controversial and it is important to try to determine the role played by each factor.

Animal studies support an additive effect of alcohol exposure and TD, and indicate the potential for interaction between alcohol and TD in human alcohol-related brain damage.

Early diagnosis of alcohol-related TD is therefore an important aspect of effective intervention and treatment.

Alcohol biomarkers provide a direct and indirect way of estimating the amount of alcohol being consumed, the duration of ingestion and the harmful effects that long-term alcohol use has on body functions.

Appropriate use of these markers is very helpful when considering a diagnosis of alcohol-related TD.

Research report; Rosanna Mancinelli, and Mauro Ceccanti. Biomarkers in Alcohol Misuse: Their Role in the Prevention and Detection of Thiamine Deficiency. Alcohol and Alcoholism 2009 44(2):177-182;

See also;

• 12-Step Treatment More Effective than Alternative
• AA Offers Recovery Not Religion
• AA and Treatment Work Better Together

I’ll Quit Tomorrow: A Practical Guide to Alcoholism Treatment

Bipolar Patients with Comorbid Substance Use Disorders; Diagnostic and Treatment Considerations:

Comorbidity of bipolar disorder (BD) and alcoholism and substance use disorders (SUDs) represents a serious public health problem and a major challenge to treatment systems.

Bipolar disorder is among the top causes of disabilities worldwide, and reportedly the fourth leading mental illness as a source of disease burden in established market economies. Large epidemiologic surveys in the United States have consistently confirmed a high association between bipolar disorder and SUDs. The Epidemiological Catchments Area Study reported bipolar I and bipolar II disorders as having the highest association with SUDs when compared with any other major psychiatric disorder.

The prevalence of lifetime alcohol abuse or dependence in persons with bipolar I disorder and bipolar II disorders were found to be 46%, and 39.2% respectively.

Similarly, the National Comorbidity Survey reported respondents with mania to be 8 to 9 times more likely to have an additional lifetime disorder of drug or alcohol dependence compared with the general population. The most recent and largest epidemiologic survey of more than 42,000 respondents in the United States, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), reported that mania and hypomania were associated with very high rates of SUDs. Those with mania were 6 times more likely to have alcohol dependence and 14 times more likely to have drug dependence over the past 12 months.

Research from; Psychiatric Annals, Volume 38 · Number 11, NOVEMBER 2008

 

Mutual Support: For Professionals

This article at Faces and Voices of Recovery details some of the issues in working with mutual and self-help fellowships for recovery from various substance abuse issues.

Subjects include;

A. Problems and Pitfalls in Working With Mutual Support Groups

• Taking Over the Peer Helper Role
• Over identification with Resistance
• Problems with Religion
• Gender Issues
• Discomfort in groups
• Lack of transportation and other logistical barriers
• Working at Cross Purposes With the Group

B. Indicators of Mutual Support Involvement

C. Aids to Working With Mutual Support Groups

• General
• American Self Help Clearinghouse Self help Sourcebook online
• National Mental Health Consumers’ Self Help Clearinghouse
• Chemical Dependency
• Mental Illness

D. Professional Responsibilties

E. Readings & References

Note: A PDF version of this guide for professionals is also available.

More at; Faces and Voices of Recovery

See also;

• “I’m a doctor and an addict” What happens next?
•  COUNSELOR CHARACTERISTICS

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 impact of Alcoholics Anonymous (AA) on non-professional substance abuse recovery programs and sober living houses.

In addition to being a widely used and effective approach for alcohol problems, AA has been central to the development of several types of nonprofessional recovery programs.

Known as “social model recovery,” these programs were staffed by individuals in recovery and they encouraged program participants to become involved in AA as a way to address their drinking problems. In addition, they relied on the traditions, beliefs, and recovery practices of AA as a guide for managing and operating programs (e.g., democratic group processes, shared and rotated leadership, and experiential knowledge).

This chapter reviews the philosophy, history, and recent changes in several types of these programs, along with a depiction of AA’s influence on them.

Programs examined include neighborhood recovery centers, residential social model recovery programs, and two types of sober living houses: California Sober Living Houses and Oxford Houses. Recent outcome evaluations on both types of sober living houses are presented.

Polcin DL, Borkman T. The impact of Alcoholics Anonymous (AA) on non-professional substance abuse recovery programs and sober living houses. Recent Dev Alcohol. 2008;18:91-108.

See also;

• Brief-TSF ASSESSMENT
• AA and Treatment Work Better Together
• If you have healthcare training this manual may help.
• The Most Effective Form of Harm Reduction

Group Treatment for Substance Abuse: A Stages-of-Change Therapy Manual

Abstinence Resolves Most Brain Cognitive Problems Caused by Drinking

A study of alcoholics who have abstained from drinking for between six months and 13 years concludes that sobriety can counteract most of the brain and thinking damage caused by heavy drinking, News Today reported Aug. 29.

Researchers looked at a wide range of problem areas for alcoholics, including abstraction/cognitive flexibility, attention, auditory working memory, immediate memory, delayed memory, psychomotor function, reaction time, spatial processing, and verbal skills.

They found that all but spatial processing recovered with sustained sobriety, noting that even alcoholics in long-term recovery may have lingering problems with tasks like map-reading or assembling things.

“Alcoholics may have periods of abstinence, during which time they give their nervous system time for repair,” according to researcher Edith Sullivan of the Stanford University School of Medicine. “Thus, longitudinal studies of alcoholics are critical for identifying functional areas that are targeted by alcoholism, those that are relatively spared, and those that can recover with sobriety.”

The research was published in the September 2006 issue of Alcoholism: Clinical & Experimental Research.  

Reference: Fein, G. et al. (September 2006). Cognitive Performance in Long-Term Abstinent Alcoholic Individuals. Alcoholism: Clinical & Experimental Research, 30,: 1538. 

From; Join Together Online

Alcoholics Anonymous has the most consistent and well known global recovery record.

A pilot study of the role of AA sponsors

An AA sponsor is a close 1-on-1 collaboration between an older sober member and a relative newcomer to sobriety. Its a two way helping relationship – the sponsor affirms their own sobriety and the sponsee gains new insights.

AIMS: The aim of this study was to explore the roles of Alcoholics Anonymous (AA) sponsors and to describe the characteristics of a sample of sponsors.

METHODS: Twenty-eight AA sponsors, recruited using a purposive sampling method, were administered an unstructured qualitative interview and standardized questionnaires. The measurements included: a content analysis of sponsors’ responses; Severity of Alcohol Dependence Questionnaire-Community version (SADQ-C) and Alcoholics Anonymous Affiliation Scale (AAAS).

RESULTS: Sample characteristics were as follows:

• the median length of AA attendance was 9.5 years (range 5-28);
• the median length of sobriety was 11 years (range 4.5-28);
• the median number of sponsees per sponsor was 1 but there was a wide range (0-17, interquartile range 3.75); and
• the sponsors were highly affiliated to AA (median AAAS score 8.75, range 5.5-8.75, maximum possible score 9).

Past alcohol dependence scores were surprisingly low:

• 5 (18%) sponsors had mild,
• 14 (50%) moderate and
• 9 (32%) severe dependence according to the SADQ-C (median 26.5, range 11-56).

Sponsorship roles were as follows: 16 roles were identified through the initial content analysis. These were distilled into three super-ordinate roles through a thematic analysis:

1. encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity);
2. support (regular contact, emotional support and practical support); and
3. carrying the message of AA (sharing sponsor’s personal experience of recovery with sponsees).

CONCLUSIONS: The roles identified broadly corresponded with the AA literature delineating the duties of a sponsor. This non-random sample of sponsors was highly engaged in AA activity but only had a past history of moderate alcohol dependence.

Research; The role of AA sponsors: a pilot study. Whelan PJ, Marshall EJ, Ball DM, Humphreys K. Alcohol Alcohol. 2009 Jul-Aug;44(4):416-22. Epub 2009 Mar 18.

• See also;
• 12 Step Sponsor

The Twelve-Step Facilitation Handbook: A Systematic Approach to Early Recovery from Alcoholism and Addiction by Joseph Nowinski

The Twelve Steps Of Alcoholics Anonymous: Interpreted By The Hazelden Foundation by Hazelden Foundation