There is a long-recognized association between alcohol consumption and aggressive behavior. But does aggression and hostility continue into sobriety?
This study was designed to examine aggression in a group of socially well-adapted recovered alcoholics.
The question addressed was whether the treatment, together with long-term abstinence from alcohol, could reduce aggression and hostility in recovered alcoholics.
Sixty four male stable alcoholics with at least 3 years sobriety were compared with 69 non-alcoholics. Neither group had any other psychological problems.
Both groups were given a questionnaire on general characteristics as well as aggressive and hostility traits.
After a 3-year abstinence, men from the recovering alcoholics group displayed greater signs of hostility and covert aggression. They were different from non-alcoholics on measures for indirect aggression, irritability, negativism, suspicion, resentment, and guilt.
Research report; Ziherl S, Cebasek Travnik Z, Kores Plesnicar B, Tomori M, Zalar B. Trait aggression and hostility in recovered alcoholics. Eur Addict Res 2007; 13(2): 89-93.
The Process of Reconnecting: Recovery from the Perspective of Addicted Women
This study examined women’s experiences with addiction to drugs and/or alcohol and their process of recovery. The techniques of in-depth interviews and participant observations were employed to elicit the perspectives of the women. The study consisted of 12 participants, 6 who were currently involved in a 90-day community-based drug and alcohol treatment program and 6 who had more than five years of recovery.
Grounded theory method guided data collection and analysis. The women in this study described experiences of connectedness and disconnectedness throughout their lives, their addiction, and their recovery. The researcher constructed a substantive theory and model to explain this process of connectedness and disconnectedness.
The findings support that making connections and establishing healthy relationships play a significant role for women in achieving sobriety and maintaining recovery.
Research; The Process of Reconnecting: Recovery from the Perspective of Addicted Women. Carolynn Masters & Dorothy S. Carlson. Journal of Addictions Nursing, Volume 17, Issue 4 December 2006 , pages 205 – 210
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.
Early detection, including screening and brief interventions (for nondependent problem drinkers)
Comprehensive assessment and individualized treatment plan
Care management
Individually delivered, proven professional interventions
Contracting with patients
Social skills training
Medications
Specialized services for medical, psychiatric, employment or family problems
Continuing care
Strong bond with therapist or counselor
Longer duration (for alcohol dependent persons)
Participation in support groups
Strong patient motivation
Research Sources: McLellan, T.A. 2002; Miller,W.R. 2002; National Institute on Drug Abuse. 1999; Project MATCH Research Group. 1997.
Active participation in a support group can contribute to long-term recovery.
Project MATCH and other studies in the 1990s definitively proved that AA can be an active ingredient of treatment both during a professional intervention and afterward, depending on the patient’s type of therapy.
Patients who joined the AA fellowship or who had an AA sponsor after receiving twelve step facilitation therapy had better abstinence records than those who received an intervention but did not continue their AA participation upon completion.
Other research indicates AA participation may be less effective for patients who receive cognitive behavior therapy because the programs have different goals that may confuse patients.
What researchers still don’t understand, however, are the precise mechanisms of AA participation.
While AA affiliation is associated with self-efficacy, motivation and coping efforts, all significant predictors of good outcome following a professional intervention, some studies have shown that patients who adopt more of the fellowship’s basic tenets – such as acknowledging that alcoholism is a disease, admission of their powerlessness over alcohol and working the twelve steps of the program – relapse at the same rates as patients who adopt very few.
This suggests that the active ingredient may be less about AA per se than continuing participation in support groups that promote a lifestyle inconsistent with the problematic use of alcohol and other drugs.
The objectives of this research were to assess the prevalence of substance use among Dutch dental students and to determine their attitudes about substance use and its consequences.
METHODS: In association with a national study of drug use among US dental students, a questionnaire was translated from English into Dutch and administered to dental students at two dental schools in The Netherlands. Students received an anonymous 115-item questionnaire in the fall of 1996.
RESULTS: Alcohol was the students’ drug of choice for
lifetime (95%),
past year (94%) and
past month (88%) use.
No significant correlations were found between alcohol use and gender, schools, and years in dental education.
In the past month,
58% of students reported drinking on 5 or more days;
53% had 5 or more drinks on the same occasion,
20% had 5 or more drinks on the same occasion on 5 or more days; and
17% reported getting drunk at least monthly.
Prevalence rates for past month use of tobacco was 24% and marijuana, 4%.
Male students smoked twice as much as females, with significant differences found for all three periods of use (X2>19.00, P<0.01).
When asked whether their schools offered policies and education programs on alcohol and other drugs, 52% of students reported that these were not available.
CONCLUSIONS: Dental schools should develop effective programmes to educate students about responsible use of alcohol and other licit and illicit drugs. Schools should also inform students about their susceptibilities to substance abuse and dependency.
Community Dent Oral Epidemiol. 2001 Feb;29(1):48-54. Substance use among Dutch dental students. Plasschaert AJ, Hoogstraten J, van Emmerik BJ, Webster DB, Clayton RR.
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:
encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity);
support (regular contact, emotional support and practical support); and
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.
Twelve-step facilitation (TSF) in non-specialty settings.
Participation in the twelve-step mutual-help organization, Alcoholics Anonymous, has proven to be an effective means of helping individuals with alcohol dependence achieve lasting sobriety.
Although many patients choose to attend AA of their own accord, clinicians’ facilitation of AA involvement ("Twelve-Step Facilitation" [TSF]) has shown to substantially increase the likelihood that patients will become engaged with these freely available resources.
Importantly, many individuals with alcohol dependence never seek help from addiction specialists, yet often encounter other health professionals due to alcohol-related physical or psychological problems providing an opportunity for intervention.
However, for clinicians who do not specialize in addiction treatment, knowledge about what AA actually is and does is often lacking, and confidence in implementing TSF strategies is low.
This chapter provides essential information for clinicians working in non-specialty settings who have little knowledge of, or experience with, AA or TSF, but who may wish to utilize proven strategies to augment existing interventions by helping educate, link, and engage patients with AA.
Detailed information on the origins and specific elements of AA is provided along with recommended TSF approaches and strategies to aid the non-specialist in building effective interventions for patients with alcohol dependence.
Kelly JF, McCrady BS. Twelve-step facilitation in non-specialty settings. Recent Dev Alcohol. 2008;18:321-46.
Is Attendance At Alcoholics Anonymous Meetings After Inpatient Treatment Related To Improved Outcomes? A 6-Month Follow-Up Study
Abstract – Aims: This study investigates the relationship between attendance at Alcoholics Anonymous (AA) meetings prior to, during, and after leaving treatment, and changes in clinical outcome following inpatient alcohol treatment.
Methods: A longitudinal design was used in which participants were interviewed at admission (within 5 days of entry), and 6 months following departure. The sample comprised 150 patients in an inpatient alcohol treatment programme who met ICD-10 criteria for alcohol dependence. The full sample was interviewed at admission to treatment. Six months after departure from treatment, 120 (80%) were re-interviewed.
Results: Significant improvements in drinking behaviours (frequency, quantity and reported problems), psychological problems and quality of life were reported. Frequent AA attenders had superior drinking outcomes to non-AA attenders and infrequent attenders. Those who attended AA on a weekly or more frequent basis after treatment reported greater reductions in alcohol consumption and more abstinent days. This relationship was sustained after controlling for potential confounding variables. Frequent AA attendance related only to improved drinking outcomes.
Conclusions: The importance of aftercare has long been acknowledged. Despite this, adequate aftercare services are often lacking. The findings support the role of Alcoholics Anonymous as a useful aftercare resource.
Research; Michael Gossop, Jennifer Harris, David Best, Lan-Ho Man, Victoria Manning, Jane Marshall And John Strang, Is Attendance At Alcoholics Anonymous Meetings After Inpatient Treatment Related To Improved Outcomes? A 6-Month Follow-Up Study Alcohol & Alcoholism Vol. 38, No. 5, pp. 421-426, 2003
Predictors of 2-Year Drinking Outcomes in a Swedish Treatment Sample.
Background: Few studies have investigated predictors of short- and longer-term outcomes in relatively well functioning treatment samples.
Methods: Multivariate logistic regression analyses were used to identify predictors of continuous abstinence in 188 individuals during their 2nd year after private 12-step treatment in Sweden, and findings are related to a previous report on 1-year outcomes.
Results: Individual baseline characteristics were not directly related to 2nd year outcomes, while a higher 1st-year drinking severity decreased the likelihood of 2nd-year abstinence.
affiliation with Alcoholics Anonymous increased the likelihood of 2nd year abstinence
Satisfaction with treatment and affiliation with the 12 Step group Alcoholics Anonymous, but not program aftercare during the 1st year increased the likelihood of 2nd-year abstinence.
Conclusion: Results are consistent with previous studies showing that shorter-term outcomes are likely to be maintained, and that baseline characteristics and treatment factors account less for outcomes over longer terms.
Research; Maria C. Bodin & Anders Romelsjö. Predictors of 2-Year Drinking Outcomes in a Swedish Treatment Sample. European Addiction Research 2007;13:136-143
Prevalence of alcohol and drug use in a highly educated workforce.
This study examined alcohol and licit and illicit drug use in a highly educated medical related workforce.
A comprehensive health survey of a 10% random sample of a workforce (n = 8,567) yielded a 60% response rate (n = 504) after accounting for 15 undeliverable surveys.
Many respondents reported past-year use of alcohol (87%).
Thirteen percent of respondents consumed three or more drinks daily; 15% were binge drinkers.
Twelve percent of the workforce was assessed as having a high likelihood of lifetime alcohol dependence;
5% of respondents met criteria for current problem drinking.
Overall, 42% reported using mood-altering prescription drugs (analgesics, antidepressants, sedatives, or tranquilizers).
Eleven percent reported using illicit drugs (cocaine, hallucinogens, heroin, or marijuana) in the past year.
Significant relationships were found between gender, age, ethnicity, and occupation with some measures of alcohol consumption and use of mood-altering drugs.
These results indicate prevention and early intervention programs need to address use of mood-altering substances (including alcohol) in highly educated workforces.
Research; J Behav Health Serv Res. ;29(1):30-44. Prevalence of alcohol and drug use in a highly educated workforce. Matano RA, Wanat SF, Westrup D, Koopman C, Whitsell SD.
Group Treatment for Substance Abuse: A Stages-of-Change Therapy Manual
Twelve-step facilitation (TSF) in non-specialty settings. 
Introduction To Alcoholism Counseling: A Bio-Psycho-Social Approach
