Posted by Larry Hoover on November 18, 2005, at 16:02:54
In reply to Re: Non-12 Step » verne, posted by AuntieMel on November 8, 2005, at 8:53:39
Sorry I missed the conversation, but it sure got me thinking. And the idea that courts order attendance has always been a sore spot for me. At meetings, I want to meet with people who want to be there, not some non-repentant drunk driver or violent person.
As to effectiveness, I went to Medline/Pubmed and asked the question. Not a lot of good statistical work from well-conducted studies. Very few head to head comparisons with e.g. Smart either. I did the 12-step thing, so I have no intimate knowledge of other programs. Any program might have been equally effective for me, because I'd had enough of addiction.
Does AA work? I read hundreds of abstracts. Followed many paths. Came up with an interesting finding. The single biggest predictor of abstinence in 12-step programs is formal participation in helping others to remain abstinent, i.e. becoming a sponsor. And it looks like AA works as well as any other treatment, if not better.
Anyway, to each his own. Smart/AA/RR/whatever you wanna choose.....you gotta wanna. That's the bottom line, in my book.
And about the powerlessness thingie. I look at it like my mind has many rooms. If I'm in the room with my addiction, I'm gonna lose. But if I move out of that room, and close the door behind me, it doesn't matter if I'm powerless or not, because the addiction is behind a closed door. Recovery for me was realizing that I didn't have to fight my addiction head to head. I could turn and walk away.
Away towards what turned out to be my spirit. But that wasn't obvious to me, at first. I had to make an act of faith. No, not of religion. Of faith. Faith is believing in something without evidence or proof. I had to trust those who where reaching out the hand of hope. I had to believe that what they were offering me was good for me. (Not god for me. My higher power was good, not god.) All the rest was coping strategies, to stay out of that room in my mind were addiction had control. I surrendered that room to it. I don't miss it.
Anyway, I did collect some abstracts along the way re:efficacy. If anybody is interested, here they are. There was a fairly weak but constant tone of criticism that AA was an American thing, and that it might reflect a bias (Christianity?) in what was written about it. The evidence is otherwise, though. I couldn't find any regional bias in outcomes. Anyway, here you go:
Aust N Z J Psychiatry. 2005 Jun;39(6):431-6.
Alcoholics Anonymous: cult or cure?Vaillant GE.
Harvard Medical School and Division of Psychiatry, Brigham and Women's Hospital, 1249 Boylston Street 3rd Floor, Boston, MA 02215, USA. gvaillant@partners.org
OBJECTIVE: To discuss the mechanism of action, the efficacy and the safety of Alcoholics Anonymous (AA) in the treatment of alcoholism. METHOD: The published works on effective treatments for alcoholism is briefly reviewed and a prospective multidisciplinary follow-up of recovery from alcoholism in two community cohorts of adolescent males followed from 1940 until the present day is reviewed. CONCLUSIONS: The suggested mechanism of action of AA is that it employs four factors widely shown to be effective in relapse prevention in addictions: external supervision, substitute dependency, new caring relationships and increased spirituality. In addition, AA serendipitously follows the principles of cognitive behaviour therapy in relapse prevention. Alcoholics Anonymous appears equal to or superior to conventional treatments for alcoholism, and the skepticism of some professionals regarding AA as a first rank treatment for alcoholism would appear to be unwarranted. Alcoholics Anonymous is probably without serious side-effects.
J Stud Alcohol. 2003 Jul;64(4):579-88.The persistent influence of social networks and alcoholics anonymous on abstinence.
Bond J, Kaskutas LA, Weisner C.
Alcohol Research Group, 2000 Hearst Avenue, Suite 300, Berkeley, California 94709, USA. jbond@arg.org
OBJECTIVE: The role of changes in Alcoholics Anonymous (AA) involvement and social networks in relation to abstinence following substance abuse treatment is studied. Specifically, the role of AA and network support for abstinence are examined in relation to their effect on changes in abstinence states between follow-ups. METHOD: Study sites were 10 representative public and private alcohol treatment programs in a northern California county. A recruitment of 367 men and 288 women seeking treatment were interviewed at intake and re-interviewed 1 and 3 years later to collect information about alcohol consumption, dependence symptoms, social support for reducing drinking, number of heavy drinkers in the social network and AA involvement. RESULTS: Significant predictors of 90-day abstinence at both the 1- and 3-year follow-up interviews included AA involvement in the last year, percentage of heavy or problem drinkers in the social network, percentage encouraging alcohol reduction and AA-based support for reducing drinking. Panel models estimated an increase in AA participation between 12 and 36 months posttreatment increased the odds of abstinence at 3 years by 35% above those at 12 months. The only significant mediator of AA's effect on abstinence was the number of AA-based contacts supporting reduced drinking, which reduced the magnitude of the relationship by 16%. CONCLUSIONS: AA involvement and the type of support received from AA members were consistent contributors to abstinence 3 years following a treatment episode. The enduring effects observed from supportive networks demonstrate the importance of ongoing mechanisms of action that contribute to an abstinent lifestyle.
Alcohol Alcohol. 2003 Sep-Oct;38(5):421-6.
Is attendance at Alcoholics Anonymous meetings after inpatient treatment related to improved outcomes? A 6-month follow-up study.Gossop M, Harris J, Best D, Man LH, Manning V, Marshall J, Strang J.
National Addiction Centre, Maudsley Hospital/Institute of Psychiatry, 4 Windsor Walk, London SE5 8RF, UK. m.gossop@iop.kcl.ac.uk
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. Despite the improved outcomes, many of the sample had alcohol and psychiatric problems at follow-up. 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.
Addiction. 1998 Sep;93(9):1313-33.
Network support for drinking, Alcoholics Anonymous and long-term matching effects.Longabaugh R, Wirtz PW, Zweben A, Stout RL.
Brown University, Center for Alcohol & Addiction Studies, Providence, RI 02912, USA.
AIMS: (1) To examine the matching hypothesis that Twelve Step Facilitation Therapy (TSF) is more effective than Motivational Enhancement Therapy (MET) for alcohol-dependent clients with networks highly supportive of drinking 3 years following treatment; (2) to test a causal chain providing the rationale for this effect. DESIGN: Outpatients were re-interviewed 3 years following treatment. ANCOVAs tested the matching hypothesis. SETTING: Outpatients from five clinical research units distributed across the United States. Participants: Eight hundred and six alcohol-dependent clients. INTERVENTION: Clients were randomly assigned to one of three 12-week, manually-guided, individual treatments: TSF, MET or Cognitive Behavioral Coping Skills Therapy (CBT). MEASUREMENTS: Network support for drinking prior to treatment, Alcoholics Anonymous (AA) involvement during and following treatment, percentage of days abstinent and drinks per drinking day during months 37-39. FINDINGS: (1) The a priori matching hypothesis that TSF is more effective than MET for clients with networks supportive of drinking was supported at the 3 year follow-up; (2) AA involvement was a partial mediator of this effect; clients with networks supportive of drinking assigned to TSF were more likely to be involved in AA; AA involvement was associated with better 3-year drinking outcomes for such clients. CONCLUSIONS: (1) In the long-term TSF may be the treatment of choice for alcohol-dependent clients with networks supportive of drinking; (2) involvement in AA should be given special consideration for clients with networks supportive of drinking, irrespective of the therapy they will receive.
J Consult Clin Psychol. 2003 Apr;71(2):302-8.
Alcoholics anonymous involvement and positive alcohol-related outcomes: cause, consequence, or just a correlate? A prospective 2-year study of 2,319 alcohol-dependent men.McKellar J, Stewart E, Humphreys K.
Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California 94025, USA. mckellarjd@yahoo.com
A positive corelation between Alcoholics Anonymous (AA) involvement and better alcohol-related outcomes has been identified in research studies, but whether this correlation reflects a causal relationship remains a subject of meaningful debate. The present study evaluated the question of whether AA affiliation appears causally related to positive alcohol-related outcomes in a sample of 2,319 male alcohol-dependent patients. An initial structural equation model indicated that 1-year posttreatment levels of AA affiliation predicted lower alcohol-related problems at 2-year follow-up, whereas level of alcohol-related problems at 1-year did not predict AA affiliation at 2-year follow-up. Additional models found that these effects were not attributable to motivation or psychopathology. The findings are consistent with the hypothesis that AA participation has a positive effect on alcohol-related outcomes.
Tidsskr Nor Laegeforen. 2005 Oct 20;125(20):2798-801.[Self-help programs in drug addiction therapy]
[Article in Norwegian]
Kristensen O, Vederhus JK.
Avdeling for rus- og avhengighetsbehandling, Sorlandet Sykehus HF, Serviceboks 416, 4604 Kristiansand. oistein.kristensen@sshf.no
BACKGROUND: Treatment of drug addiction is complex; hence there is a debate in the field of what is the best approach. An honest desire to stop using drugs is the entry ticket into the self-help programmes Alcoholics Anonymous (AA) and Narcotics Anonymous (NA); these groups are a possible supplement to ordinary treatment. They employ the twelve-step programme and are found in most large cities in Norway and around the world. The usefulness of these groups has been disputed, and few Norwegian treatment facilities have developed a systematic cooperation with them. The purpose of this study was to examine whether the use of self-help groups is associated with higher rates of abstinence two years after participants started attending groups. MATERIALS AND METHODS: 114 patients, 59 with alcohol addiction and 55 with drug addiction, who started in self-help groups after a drug treatment, were approached two years later with a questionnaire. The response rate was 66%; 6 (5%) patients were dead. RESULTS:Intention to treat analysis showed that 38% participated in self-help programmes two years after treatment. Of regular participants, 81% had been abstinent over the previous 6 months, compared with only 26% among non-participants. Logistic regression analysis showed odds ratio = 12.6, 95% CI (4.1-38.3), p < 0.001, for participation and abstinence. CONCLUSION: The study has several methodological problems; particularly that correlation does not necessarily indicate causality. These problems are discussed here; the conclusion is that the probability of a positive effect is strong enough to recommend participation in self-help groups as a supplement to drug addiction treatment.
Fortschr Neurol Psychiatr. 2005 Mar;73(3):150-5.
[Catamnestic study on the efficacy of an intensive outpatient treatment programme for alcohol-dependent patients: impact of participation in AA on the abstinence rates][Article in German]
Bottlender M, Soyka M.
Psychiatrische Klinik und Poliklinik, Ludwig-Maximilians-Universitat Munchen, Deutschland. bottlend@psy.med.uni-muenchen.de
This study analyzed the Alcoholics Anonymous participation and the impact on the abstinence rate of 103 alcohol dependent patients (ICD-10) during the 24 months after their discharge from high-structured out-patient treatment. The treatment retention amounted to n = 74 (72 %), 18 of the 25 dropouts took place because of alcohol relapse. At 6-, 12- and 24-months-follow-up 87 - 95 % of the patients were successfully located and re-interviewed. Analyses revealed that 64 % of the patients were abstinent at the 6-months-follow-up evaluation, 56 % at the total 12-months-follow-up evaluation. 49 % of the patients remained abstinent until the 24-months-follow-up evaluation, 14 % were improved and 37 % relapsed. 56 patients (55 %) participated in selfhelp-groups the first six months following treatment, two years later 45 patients (44 %) still attended a group. 53 - 56 % participated on a weekly basis. Patients who participated regularly on a weekly basis in self-help-groups fared the best on 2-year outcome. Patients who infrequently at all participated or not had the poorest outcome (relapse). After controlling for confounding variables (sex, treatment drop-out, relapse during treatment) these results were still statistical significant. Results indicate the predictive value of AA attendance for relapse prevention after controlling for confounding variables. The value of self-help-groups in the network of alcoholism treatment is discussed.
poster:Larry Hoover
thread:573995
URL: http://www.dr-bob.org/babble/subs/20051106/msgs/580127.html