Jump to content

Alcoholics Anonymous: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
m Reverted edits by 207.232.97.13 (talk) to last version by 82.35.59.169
/
Line 58: Line 58:
The study concluded that patient-treatment matching is not necessary in alcoholism treatment because the three techniques are equal in effectiveness. Although it is acknowledged that the TSF treatmeent group used in the Match study was not a true implementation of Alcoholics Anonymous some investigators believe that it represents the most rigorous investigation of this group to date.<ref>J. Scott Tonigan, Gerard J. Connors, and William R. Miller. "Participation and involvement in Alcoholics Anonymous", in Thomas Babor, Frances K. Del Boca, eds, ''Treatment Matching in Alcoholism'', Cambridge University Press: 2003, p 184.</ref>
The study concluded that patient-treatment matching is not necessary in alcoholism treatment because the three techniques are equal in effectiveness. Although it is acknowledged that the TSF treatmeent group used in the Match study was not a true implementation of Alcoholics Anonymous some investigators believe that it represents the most rigorous investigation of this group to date.<ref>J. Scott Tonigan, Gerard J. Connors, and William R. Miller. "Participation and involvement in Alcoholics Anonymous", in Thomas Babor, Frances K. Del Boca, eds, ''Treatment Matching in Alcoholism'', Cambridge University Press: 2003, p 184.</ref>


=== George Vaillant ===
===Other studies===

In ''[[The Natural History of Alcoholism Revisited]]''<ref name="VAILLANT1995ACKNOWLEDGEMENTS">{{cite book |last = Vaillant| first = George Eman | authorlink = George Eman Vaillant | title = The Natural History of Alcoholism Revisited | publisher = Harvard University Press | edition = 2nd edition | month = May | year = 1995 | chapter = Acknowledgments | pages = vii - xi | isbn = 0674603788 | oclc = 31605790}}</ref> Harvard professor of psychiatry [[George Eman Vaillant|George E. Vaillant]], a member of the Board of Trustees of Alcoholics Anonymous World Services, described his investigations into the effectiveness of AA.<ref name="VAILLANT1995THEPROBLEM">{{cite book |last = Vaillant| first = George Eman | authorlink = George Eman Vaillant | title = The Natural History of Alcoholism Revisited | publisher = Harvard University Press | edition = 2nd edition | month = May | year = 1995 | chapter = Introduction: The Problem | pages = 1 - 11 | isbn = 0674603788 | oclc = 31605790}}</ref> In the sample of 100 severe alcoholics from his clinic, 48% of the 29 alcoholics who eventually achieved sobriety attended 300 or more AA meetings,<ref>Vaillant 1995, p 196, 257.</ref> and AA attendance was associated with good outcomes in patients who otherwise would have been predicted not to remit.<ref>Vaillant 1995, p 268.</ref> In the sample of 465 men who grew up in Boston's inner city, the more severe alcoholics attended AA, possibly because all other avenues had failed<ref>Vaillant 1996, p 262-263.</ref> Vaillant's research and literature surveys revealed growing indirect evidence that AA is an effective treatment for alcohol abuse,<ref name="VAILLANT1995CHAPTER4"/> partly because it is a cheap, community-based fellowship with easy access.<ref name="VAILLANT2005">{{cite journal | last = Vaillant | first = George E. | title = Alcoholics Anonymous: cult or cure? | journal = Australian and New Zealand Journal of Psychiatry | volume = 39 | issue = 6 | month = June | year = 2005 | pages = 431-436 | doi = 10.1111/j.1440-1614.2005.01600.x | id = PMID 15943643}}</ref> Although AA is not a magic bullet for every alcoholic, in that there were a few men who attended AA for scores of meetings without improvement, good clinical outcomes correlated with frequency of AA attendance, having a sponsor, engaging in a Twelve-Step work, and leading meetings. Vaillant concluded that AA appears equal or superior to conventional treatments for alcoholism and that skepticism of some professionals regarding AA as an effective treatment for alcoholism is unwarranted.<ref name="VAILLANT2005"/>
*1967, Ditman et Al study: a court judge randomly assigned offenders to either clinical treatment, AA treatment, or to a no treatment group {control group}, and after one year 68% in the clinic group were rearrested, 69% in the AA group were rearrested, and 56% were rearrested in the group receiving no treatment. No statistically significant differences between the three groups were discovered in [[recidivism]] rate, in number of subsequent rearrests or in time elapsed prior to rearrest.<ref>(August 1967). "A Controlled Experiment on the Use of Court Probation for Drunk Arrests". ''American Journal of Psychiatry'' 124 (2): Abstract.</ref>. + *A 1997 study assessed subjects during treatment, and at one and six-month follow-ups. Increased affiliation with AA produced better outcomes, greater motivation, and improved coping skills.<ref>J. Morgenstern et al. "Affiliation with Alcoholics Anonymous after treatment: a study of its therapeutic effects and mechanisms of action." (Department of Psychiatry, Mount Sinai School of Medicine, New York, 1997 Oct;65(5):768-7)</ref>
*1997, A study assessed subjects during treatment, and at one and six-month follow-ups. Increased affiliation with AA produced better outcomes, greater motivation, and improved coping skills.<ref>J. Morgenstern et al. "Affiliation with Alcoholics Anonymous after treatment: a study of its therapeutic effects and mechanisms of action." (Department of Psychiatry, Mount Sinai School of Medicine, New York, 1997 Oct;65(5):768-7)</ref>
*1999, Belief in the disease theory of alcoholism and high commitment to total abstinence were found to be factors correlated with increased likelihood that an alcoholic would have a full-blown relapse (substantial continued use) following an initial lapse (single use).<ref name="LARIMER1999">{{cite journal | last = Larimer | first = Mary E | coauthors = Palmer, Rebekka S; Marlatt, G. Alan | title = Relapse prevention. An overview of Marlatt's cognitive-behavioral model | year = 1999 | volume = 23 | issue = 2 | pages = 151-160 | pmid = 10890810 | journal = Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism | issn = 1535-7414 | oclc = 42453373}}</ref>
*2001 A study was undertaken to evaluate the relationship of Sponsorship and sustained abstinence in NA/AA. The 500 participants were injection drug users that came from the inner city of Baltimore , from the community at large and were independent of treatment center affilation. The study found that over the 1 year period that there was little difference in the abstitent rate for those people who had a sponsor in NA/AA and those who did not have a sponsor. The study concluded that those people who sponsored others by giving guidance and direction to other addicts had improved abstinent rates however it did little to improve the short term success rates of those being sponsored. <ref>Crape L, Latkin,Carl A , Laris Alexander and . Knowlton , Amy
- - John Hopkins University, School of Hygiene and Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
- - Received 9 August 1999; revised 1 June 2001; accepted 2 June 2001. ; Available online 5 February 2002</ref>
* 2001, In a study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at ten Department of Veteran Affairs medical centers around the United States, five of the programs were based on twelve-step principles, but run by professional therapists, and five used [[cognitive-behavioral therapy]]. Over 45% of the men in twelve-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy. Moos stated that the benefits of participation in AA may not necessarily accrue to all types of individuals and it is important to specify the characteristics of individuals who may not need to join AA in order to overcome their alcoholic-related problems. <ref name="HUMPHREYS2001">{{cite journal | last = Humphreys | first = Keith | coauthors = Moos, Rudolf | month = May | year = 2001 | title = Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study | journal = Alcoholism: Clinical and Experimental Research | volume = 25 | issue = 5 | pages = 711-716 | doi = 10.1111/j.1530-0277.2001.tb02271.x | pmid = 11371720 | issn = 1530-0277}}</ref>
*2001, The largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences. A slight positive association was also found between AA attendance and increased purpose in life – the study found that AA attendance was associated with psychosocial improvement.<ref>J. Scott Tonigan PhD. "Benefits of Alcoholics Anonymous Attendance" (University of New Mexico, 2001) pp 67 - 77</ref>
* 2004, Clients who had 27 weeks or more of treatment in the first year had better outcomes 16 years later. After the first year, continued clinical treatment had little effect on the 16-year outcomes, whereas continued involvement in AA did help. Associations between treatment and long-term alcohol-related outcomes appeared to be due to participation in AA.<ref name="MOOS2006A">{{cite journal | last = Moos | first = Rudolf H. | coauthors = Moos, Bernice S. | title = Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals | journal = Journal of Clinical Psychology | month = June | year = 2006 | pages = 735 - 750 | doi = 10.1002/jclp.20259 | id = PMID 16538654}}</ref><ref name="MOOS2006B">{{cite journal | last = Moos | first = Rudolf H. | coauthors = Moos, Bernice S. | title = Rates and predictors of relapse after natural and treated remission from alcohol use disorders | journal = Addiction | volume = 101 | issue = 2 | pages = 212 – 222 | year = 2006 | month = February | doi = 10.1111/j.1360-0443.2006.01310.x | id = PMID 16445550}}</ref><ref name="MOOS2004">{{cite journal | last = Moos | first = Rudolf H. | coauthors = Moos, Bernice S. | title = Long-Term Influence of Duration and Frequency of Participation in Alcoholics Anonymous on Individuals with Alcohol Use Disorders | journal = Journal of Consulting and Clinical Psychology | year = 2004 | month = February | volume = 72 | issue = 1 | pages = 81 - 90 | doi = 10.1037/0022-006X.72.1.81 | id = PMID 16445550}}</ref>
*2006- No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.<ref>Ferri M, Amato L, Davoli M, ''Alcoholics Anonymous and other 12-step programmes for alcohol dependence'' http://www.cochrane.org/reviews/en/ab005032.html</ref>
*2007, A national survery of mutual aid support groups for addiction was conducted to identify key differences between people participating in recovery groups. Survey data indicated that active involvement in support groups improves one's chances of remaining clean and sober, regardless of the group. Respondents whose beliefs matched that of the support group had more group involvement and more days sober. Religious respondents were more likely to participate in 12 step programs and Women for Sobriety. Non religious respondents were less likely to participate in 12-step groups. [[Religiousity]] had little impact on [[Smart Recovery]] but decreased participation in Secular Organizations for Sobriety. The results have important implications for treatment planning and matching individuals to appropriate support groups. <ref> name="ATKINS2007">Atkins, R. G. & Hawdon, J. E. Journal of Substance Abuse Treatment "Religiosity and participation in mutual-aid support groups for addiction", Vol. 33, Issue 3, Oct. 2007, pp. 321-331 available online at www.sciencedirect.com </ref>
*2007, A two year study of 556 University students. Students were assigned to one of three groups: a brief skills-training {BSTP}, alcohol-intervention program; a 12-step-influenced alcohol intervention program {TSI}; or a control group that received no intervention. The Brief skills-training program included interactive lectures and discussions and was derived from the University of Washington's Brief Alcohol Screening and Intervention for College Students program. The 12-step program provided lectures by therapists trained in the 12-step approach. All groups reduced their alcohol consumption. The Twelve step approach showed no significant difference from the No Treatment Control Group in terms of reducing consumption within the group of students that had high-risk alcohol consumption audit scores. Students with high-risk alcohol consumption scores that were assigned to the Brief Skills training showed significant differences in reduction when compared to the Control Group and had a tendency to show better results than the Twelve Step intervention. This study suggests that a BSTP is effective as an intervention in students with high-risk alcohol consumption<ref> Two-Year Outcome of Alcohol Interventions in Swedish University Halls of Residence: A Cluster Randomized Trial of a Brief Skills Training Program, Twelve-Step-Influenced Intervention, and Controls
Authors: Ståhlbrandt, Henriettæ1; Johnsson, Kent O.1; Berglund, Mats1
Source: Alcoholism Clinical and Experimental Research, Volume 31, Number 3, March 2007 , pp. 458-466(9)
Publisher: Blackwell Publishing
http://www.ingentaconnect.com/content/bsc/acer/2007/00000031/00000003/art00014

*2008, A study was undertaken to determine factors affecting [[adherence]] to Alcoholics Anonymous (AA) groups. It involved 300 alcoholics committed to three hospitals in Porto Alegre, Brazil. They were interviewed in their homes six months later, a questionnaire focusing on patient relationship with AA groups were used and the responses were evaluated by two independent researchers. AA adherence was below 20%. Factors that contributed for non-adherence to AA were relapse, lack of identification with the method, lack of need, and lack of credibility. The factors reported by patients as reasons for adherence were identification with the method and a way to avoid relapse. The identification of these nonadherence factors could help health professionals in referring certain alcoholic patients to therapeutic interventions other than AA.<ref>http://www.informaworld.com/smpp/content?content=10.1080/10550490701756393</ref>


===Other studies===
===Other studies===

Revision as of 00:39, 12 March 2008

AA meeting sign

Alcoholics Anonymous (AA) is an informal meeting society for recovering alcoholics whose primary purpose is to stay sober and help other alcoholics achieve sobriety.[1] AA suggests that alcoholics follow its program and abstain from alcohol in order to recover from alcoholism, and share their experience, strength, and hope with each other that they may solve their common problem.[2][3][4] AA was the first twelve-step program and has been the model for similar recovery groups like Narcotics Anonymous. Al-Anon/Alateen are programs designed to provide support for relatives and friends of alcoholics. The organization was named after its primary guidebook Alcoholics Anonymous, also known as The Big Book.

History

Main article: History of Alcoholics Anonymous

By 1934 alcoholic Bill Wilson had ruined a promising Wall Street career with his constant drunkenness. He was introduced to the idea of a spiritual cure by old drinking buddy Ebby Thacher who had become a member of a Christian movement called the Oxford Group. Wilson was treated by Dr. William Silkworth who promoted a disease concept of alcoholism. While in the hospital, Wilson underwent a spiritual experience which convinced him of the existence of a healing higher power and he was able to stop drinking. On a 1935 business trip to Akron, Ohio, Wilson felt the urge to drink again and in an effort to stay sober, he sought another alcoholic to help. Wilson was introduced to Dr. Bob Smith, and Smith also found sobriety through spiritual means.

Wilson and Smith co-founded AA with a word of mouth program to help alcoholics. By 1937 they determined that they had helped 40 alcoholics get sober, and two years later, with the first 100 members, Wilson expanded the program by writing a book entitled Alcoholics Anonymous which the organization also adopted as its name. The book, informally referred to by members as "The Big Book," described a twelve-step program involving admission of powerlessness, moral inventory, and asking for help from a higher power. In 1941 book sales and membership increased after radio interviews and favourable articles in national magazines, particularly by Jack Alexander in The Saturday Evening Post. By 1946, as membership grew, confusion and disputes within groups over practices, finances, and publicity led Wilson to write the guidelines for noncoercive group management that eventually became known as the Twelve Traditions. AA came of age at the 1955 St. Louis convention when Wilson turned over the stewardship of AA to the General Service Board.[5] In this era AA also began its international expansion, and by 2001 the number of members worldwide was estimated at two million.

Organization

See also: Twelve-step program: The Twelve Traditions

In 2006 there were a reported 1,867,212 AA members in 106,202 AA groups worldwide.[6] The Twelve Traditions informally guide how AA groups function, and the Twelve Concepts for World Service guide how AA is structured globally.[7]

A member who accepts a service position or an organizing role is a "trusted servant" with terms rotating and limited, typically lasting three months to one year and determined by group vote. Each group is a self-governing entity with AA World Services acting only in an advisory capacity. AA is served entirely by alcoholics, except for seven "nonalcoholic friends of the fellowship" out of twenty-one members of the AA Board of Trustees.[8]

AA groups are self-supporting and not charities, and they have no dues or membership fees. Groups rely on member donations, typically $1 collected per meeting in America, to pay for expenses like room rental, refreshments, and literature.[9] Visitors and new members are asked not to donate, and no one is turned away for lack of funds.[10]

AA undertakes no external restriction, screening, or vetting of its members, and the long-form version of Tradition Three states that any two or three alcoholics gathered together for sobriety may call themselves an AA group.[11]

AA receives proceeds from books and literature which constitute more than 50% of the income for the General Service Office (GSO),[12] which unlike individual groups is not self-supporting and maintains a small salaried staff. It also maintains service centers which coordinate activities like printing literature, responding to public inquiries, and organizing conferences. They are funded by local members and responsible to the AA groups they represent.

Program

See also: Twelve-step program: The Twelve Steps

The suggested AA recovery program for alcoholics includes not drinking alcohol one day at a time, following Twelve Steps,[13] helping with duties and service work in AA,[14] and regular AA meeting attendance[15] or contact with AA members.[13] Members are encouraged to ask their group for help in finding an experienced fellow alcoholic called a sponsor to help them follow the AA program, ideally one that has enjoyed sobriety for at least a year and is of the same sex as the sponsee, and who does not impose personal views on sponsees but only teaches the suggested AA program.[16]

Anyone is allowed to attend "open" AA meetings while "closed" meetings are for alcoholics, or those who feel they might be alcoholics, only.[17] There are groups for men only, groups for women only, groups angled at gay people, and groups for speakers of minority languages. Meeting formats vary between groups, for example a beginner meeting might include a talk by a long-time sober member about his or her drinking, how he or she came to AA and what was learned, then a group discussion on topics related to alcoholism and the AA program.[18]

AA Demographics

AA's 2004 survey of over 7500 members in Canada and the United States concluded that AA is composed of 89.1% white, 65% male, and 35% female members. Average member sobriety is eight years with 36% sober more than ten years, 14% sober from five to ten years, 24% sober from one to five years, and 26% sober less than one year. Before coming to AA, 64% of members received some type of treatment or counselling, such as medical, psychological, or spiritual. After coming to AA, 65% received outside treatment or counselling, and 84% of those members said that that outside help played an important part in their recovery.[19]

Influences on US Treatment Industry

Since 1949 when Hazelden treatment center was founded by members of alcoholics anonymous, some alcoholic rehabilitation clinics have frequently incorporated precepts of the AA program into their own treatment programs.[20] A reverse influence has also occurred with AA receiving 31% of its membership from treatment center referrals.[21]

Court Rulings

In the United States of America, Courts have ruled since 1996 that inmates, parolees, and probationers cannot be ordered to attend a religious based program such as AA or other recovery programs that have substantial religious components since such coercion is in violation of the Establishment Clause of the First Amendment of the Constitution.[22][23] AA receives 11% of its membership from court ordered attendance.[24]

The courts have found that communication between AA members is not covered under client patient or clergy privilege. AA members can be called upon to testify against other AA members in a court of law. Even though two people may promise not to disclose a shared confidence, the courts are not bound to honor that promise.[25][26]

Effectiveness

The issue of AA effectiveness is controversial. Although AA is not for everyone and attrition rates tend to be high,[27] there is evidence supporting the effectiveness of AA as a treatment for alcoholism.[28]

Limitations on research

The study of AA, like politics, tends to polarize observers into believers and non-believers,[29] and discussion of AA often creates argument rather than objective reflection.[30] Many researchers take a skeptical view of AA because some of AA's methods are spiritual, not scientific.[31] Membership is voluntary and determined by the individual, not by the group, with no requirements, dues or fees, or membership lists.[32] A randomized trial of AA is very difficult because members are self-selected, not randomly selected.[33] Two opposing types of self-selection bias are that drinkers may be motivated to stop drinking before they attend AA, and AA may attract the more severe and difficult cases.[34] Control groups with AA versus non-AA subjects are also difficult because AA is so easily accessible.[34] AA can work, but how well and for whom has not yet been adequately researched.[35]

Attrition

In a 1989 internal AA report based on an average of five surveys, it was estimated that of those who attended AA for the first time, 19% remained in AA after one month and 5% remained after twelve months. After the first year the rate of attrition continues at a slower rate. 40% of the Members sober for less than a year will remain another year and 90 % of members sober for five years will remain another year however, this does not predict the number that will remain sober, also those that remain sober but do not remain in the fellowship cannot be determined. There is no accurate way to determine why people leave, but the high attrition rate was significant in revealing that more needed to be done to help newcomers remain in AA.[27]

Project MATCH

Project MATCH began in 1989 and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The project was an 8-year, multi site, $27-million investigation that studied which types of alcoholics respond best to which forms of treatment. MATCH studied whether treatment should be uniform or assigned to patients based on specific needs and characteristics. The programs were administered by psychotherapists and, although twelve-step methods were incorporated into the therapy, actual AA meetings were not included.[36][37] Three types of treatment were investigated:

  • Cognitive Behavioral Coping Skills Therapy, focusing on correcting poor self-esteem and distorted, negative, and self-defeating thinking.[38][39]
  • Motivational Enhancement Therapy, which helps clients to become aware of and build on personal strengths that can help improve readiness to quit.[40]
  • Twelve-Step Facilitation Therapy administered as an independent treatment designed to familiarize patients with the AA philosophy and to encourage participation.[36]

The study concluded that patient-treatment matching is not necessary in alcoholism treatment because the three techniques are equal in effectiveness. Although it is acknowledged that the TSF treatmeent group used in the Match study was not a true implementation of Alcoholics Anonymous some investigators believe that it represents the most rigorous investigation of this group to date.[41]

Other studies

  • 1967, Ditman et Al study: a court judge randomly assigned offenders to either clinical treatment, AA treatment, or to a no treatment group {control group}, and after one year 68% in the clinic group were rearrested, 69% in the AA group were rearrested, and 56% were rearrested in the group receiving no treatment. No statistically significant differences between the three groups were discovered in recidivism rate, in number of subsequent rearrests or in time elapsed prior to rearrest.[42]. + *A 1997 study assessed subjects during treatment, and at one and six-month follow-ups. Increased affiliation with AA produced better outcomes, greater motivation, and improved coping skills.[43]


  • 1997, A study assessed subjects during treatment, and at one and six-month follow-ups. Increased affiliation with AA produced better outcomes, greater motivation, and improved coping skills.[44]


  • 1999, Belief in the disease theory of alcoholism and high commitment to total abstinence were found to be factors correlated with increased likelihood that an alcoholic would have a full-blown relapse (substantial continued use) following an initial lapse (single use).[45]


  • 2001 A study was undertaken to evaluate the relationship of Sponsorship and sustained abstinence in NA/AA. The 500 participants were injection drug users that came from the inner city of Baltimore , from the community at large and were independent of treatment center affilation. The study found that over the 1 year period that there was little difference in the abstitent rate for those people who had a sponsor in NA/AA and those who did not have a sponsor. The study concluded that those people who sponsored others by giving guidance and direction to other addicts had improved abstinent rates however it did little to improve the short term success rates of those being sponsored. [46]


  • 2001, In a study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at ten Department of Veteran Affairs medical centers around the United States, five of the programs were based on twelve-step principles, but run by professional therapists, and five used cognitive-behavioral therapy. Over 45% of the men in twelve-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy. Moos stated that the benefits of participation in AA may not necessarily accrue to all types of individuals and it is important to specify the characteristics of individuals who may not need to join AA in order to overcome their alcoholic-related problems. [47]
  • 2001, The largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences. A slight positive association was also found between AA attendance and increased purpose in life – the study found that AA attendance was associated with psychosocial improvement.[48]


  • 2004, Clients who had 27 weeks or more of treatment in the first year had better outcomes 16 years later. After the first year, continued clinical treatment had little effect on the 16-year outcomes, whereas continued involvement in AA did help. Associations between treatment and long-term alcohol-related outcomes appeared to be due to participation in AA.[49][50][51]


  • 2006- No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed.[52]


  • 2007, A national survery of mutual aid support groups for addiction was conducted to identify key differences between people participating in recovery groups. Survey data indicated that active involvement in support groups improves one's chances of remaining clean and sober, regardless of the group. Respondents whose beliefs matched that of the support group had more group involvement and more days sober. Religious respondents were more likely to participate in 12 step programs and Women for Sobriety. Non religious respondents were less likely to participate in 12-step groups. Religiousity had little impact on Smart Recovery but decreased participation in Secular Organizations for Sobriety. The results have important implications for treatment planning and matching individuals to appropriate support groups. [53]


  • 2007, A two year study of 556 University students. Students were assigned to one of three groups: a brief skills-training {BSTP}, alcohol-intervention program; a 12-step-influenced alcohol intervention program {TSI}; or a control group that received no intervention. The Brief skills-training program included interactive lectures and discussions and was derived from the University of Washington's Brief Alcohol Screening and Intervention for College Students program. The 12-step program provided lectures by therapists trained in the 12-step approach. All groups reduced their alcohol consumption. The Twelve step approach showed no significant difference from the No Treatment Control Group in terms of reducing consumption within the group of students that had high-risk alcohol consumption audit scores. Students with high-risk alcohol consumption scores that were assigned to the Brief Skills training showed significant differences in reduction when compared to the Control Group and had a tendency to show better results than the Twelve Step intervention. This study suggests that a BSTP is effective as an intervention in students with high-risk alcohol consumptionCite error: A <ref> tag is missing the closing </ref> (see the help page).

Other studies

  • Clients who had 27 weeks or more of treatment in the first year had better outcomes 16 years later. After the first year, continued clinical treatment had little effect on the 16-year outcomes, whereas continued involvement in AA did help. Associations between treatment and long-term alcohol-related outcomes appeared to be due to participation in AA.[49][50][51]
  • In a study of 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at ten Department of Veteran Affairs medical centers around the United States, five of the programs were twelve-step based and five used cognitive-behavioral therapy. Over 45% of the men in twelve-step programs were abstinent one year after discharge, compared to 36% of those treated by cognitive-behavioral therapy.[54]
  • A 1997 study assessed subjects during treatment, and at one and six-month follow-ups. Increased affiliation with AA produced better outcomes, greater motivation, and improved coping skills.[55]
  • The largest benefit associated with AA attendance was increased abstinence, followed by reductions in alcohol-related consequences. A slight positive association was also found between AA attendance and increased purpose in life – the study found that AA attendance was associated with psychosocial improvement.[56]
  • For a 1967 study a court judge randomly assigned offenders to either clinical treatment, AA treatment, or no treatment, and after one year 68% in the clinic group were rearrested, 69% in the AA group were rearrested, and 56% were rearrested in the group receiving no treatment. No statistically significant differences between the three groups were discovered in recidivism rate, in number of subsequent rearrests or in time elapsed prior to rearrest.[57]
  • Belief in the disease theory of alcoholism and high commitment to total abstinence were found to be factors correlated with increased likelihood that an alcoholic would have a full-blown relapse (substantial continued use) following an initial lapse (single use).[45]

Criticism and controversy

See also: Twelve-step program: Criticism

Moderation vs. abstinence

The debate about moderation versus total abstinence is one of the most hotly contested issues in alcohol treatment.[58] AA acknowledges that not all drinkers are alcoholics, but advocates total abstinence for those who are.[59] Critics believe more options should be available to problem drinkers who can manage their drinking with the right treatment.[58]

A 2002 U.S. study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. However, this group showed fewer initial symptoms of dependency.[60] A follow-up study, using the same NESARC subjects that were judged to be in remission in 2001-2002, examined the rates of return to problem drinking in 2004-2005. The major conclusion made by the authors of this NIAAA study was "Abstinence represents the most stable form of remission for most recovering alcoholics". [61]

Disease of alcoholism

Main article: Disease theory of alcoholism

The concept of alcoholism and addiction as a disease is controversial.[62] Dr. William Silkworth introduced to Wilson and AA the idea that alcoholism is a disease consisting of an obsession to drink alcohol, and an allergy, which was the compulsion to continue drinking once the first drink had been taken.[63] Alcoholics, he argued, can never safely use alcohol in any form at all, since once forming the habit, they cannot break it.[64]

AA regards alcoholism as a disease[65][66] (though Bill Wilson once stated that it was not and more comparable to an illness or malady)[67] and uses the concept to challenge the belief of chronic, compulsive drinkers that they can stay sober by willpower alone.[68] AA has been criticized by opponents of the disease model, especially those who argue that AA groups apply the disease model to all problem drinkers, whether or not they are full-blown alcoholics.[69]

Thirteenth-stepping

"Thirteenth-stepping" is a euphemistic term describing the practice of targeting new and vulnerable AA members for dates or sex. Fifty-five female AA members, selected through convenience and snowball sampling, were surveyed on the thirteenth-stepping behavior they witnessed or experienced in AA, such as: feeling seduced, or feeling intimidated and uncomfortable with sexual comments; receiving unwanted hugs and flirting; observing men flirting with, pressuring, and seducing of other women; and observing men who seemed more interested in sex than in recovery. At least 50% of the survey participants experienced seven or more of these behaviors; two volunteered that they had been raped by men they met in AA. Chemical dependency treatment providers should be aware of this trend, and vulnerable women like those with histories of sexual abuse should be referred to female-only groups or be trained to avoid sexual exploitation in coed meetings.[70]

A leaked internal AA memorandum stated that the UK AA service board was considering how to deal with a small minority of members being investigated by police for taking advantage of vulnerable new AA members.[71] Former members of a Washington DC Midtown AA group alleged that females were manipulated into sexual relationships with older male group members, older male sponsors were assigned to young women, members were told to cut off ties with family and friends, and others told to stop taking their medications. Several churches banned the group from meeting in their facilities, and members complaining to AA General Service Office in New York found that AA has no firm hierarchy and exercises no oversight of individual groups.[72][73][74]

Cult-like behavior

The rhetoric and emotional language of AA lead Arthur H. Cain to fear AA is a religion or cult: he said in 1963, that the term "sobriety" has taken on a religious flavor and AA members over-rely on dogmatic slogans and are slaves to the group.[75] Alexander and Rollins measured AA against criteria developed by Robert Jay Lifton, in his work on Thought Reform and concluded “AA uses all the methods of brain washing, which are also the methods employed by cults,” “It is our contention that AA is a cult.”[76][77]

Helpful aspects of AA include tolerance, a non-threatening personal style, and acceptance of self and others. Vaillant states that AA's encouragement of dependence is healthy in the way that dependence on exercise is healthy, and that the rigidity of AA is like the discipline of post-coronary exercise programs. AA is unlike cults in that its program is based on suggestion only, religious conviction does not prevent AA membership and minority opinions are respected, it has no prescribed concept of "higher power" or charismatic leaders, and it operates on the principle of leadership rotation.[78][79]

Confidentiality

Twelve-step program members are not legally bound to keep confidentiality agreements like therapists or clergy.[80]

See also: Alcoholics Anonymous program: Court Rulings

Literature

  • Alcoholics Anonymous (1976-06-01). Alcoholics Anonymous. Alcoholics Anonymous World Services. ISBN 0916856593. OCLC 32014950.
  • Alcoholics Anonymous (2002-02-10). Twelve Steps and Twelve Traditions. Alcoholics Anonymous World Services. ISBN 0916856011. OCLC 13572433.
  • Alcoholics Anonymous (1984). Pass It On. Alcoholics Anonymous World Services. ISBN 0916856011.

See also

References

  1. ^ "What is AA? Defining "Alcoholics Anonymous"". The General Service Board of Alcoholics Anonymous (Great Britain). Retrieved 2006-11-27.
  2. ^ AA Preamble
  3. ^ AA Fact File, 'The Recovery Program'
  4. ^ Alcoholics Anonymous : the story of how many thousands of men and women have recovered from alcoholism. 4th ed. New York : Alcoholics Anonymous World Services, 2001. ISBN 1893007162. Available online at www.AA.org
  5. ^ Pass It On p 359
  6. ^ AA Fact File
  7. ^ The AA Service Manual/Twelve Concepts for World Service (BM-31).
  8. ^ The AA Fact File, 'The Structure of AA'
  9. ^ Once Upon A Time... Mitchel K. 04/08/98
  10. ^ [1]AA Fact File p 17
  11. ^ The A.A. Tradition
  12. ^ GSO 2005 Operating Results, 'Gross Profit from Literature ~$6.7M (55%), Contributions ~$5.4M (45%)'
  13. ^ a b http://www.alcoholics-anonymous.org/en_pdfs/p-1_thisisAA.pdf This is AA pamphlet
  14. ^ http://www.alcoholics-anonymous.org/en_services_for_members.cfm?PageID=98&SubPage=119 Sponsorship-A Vital Stepping Stone to Service & Sobriety
  15. ^ http://www.alcoholics-anonymous.org/en_is_aa_for_you.cfm?PageID=14 A Newcomer Asks pamphlet
  16. ^ http://www.alcoholics-anonymous.org/en_pdfs/p-15_Q&AonSpon.pdf Questions and Answers on Sponsorship pamphlet
  17. ^ http://www.alcoholics-anonymous.org/en_information_aa.cfm?PageID=10 AA at a Glance pamphlet
  18. ^ [2] Suggestions for Leading Beginners Meetings pamphlet
  19. ^ http://www.alcoholics-anonymous.org/en_pdfs/p-48_04survey.pdf AA 2004 Membership Survey
  20. ^ N. Roberson, Getting Better:Inside Alcoholics Anonymous (London: Macmillan, 1988), p 220
  21. ^ http://www.alcoholics-anonymous.org/en_pdfs/p-48_04survey.pdf AA 2004 Membership Survey
  22. ^ name="EGELKO2007">Egelko, Bob (2007-09-08). "Appeals court says requirement to attend AA unconstitutional". San Francisco Chronicle. Retrieved 2007-10-08.
  23. ^ Inouye vs. Kemna page 11889
  24. ^ http://www.alcoholics-anonymous.org/en_pdfs/p-48_04survey.pdf AA 2004 Membership Survey
  25. ^ New York Times, Jan Hoffman June 15, 1994 ["Faith in Confidentiality of Therapy Is Shaken" http://query.nytimes.com/gst/fullpage.html?res=9F0CE4D81F3AF936A25755C0A962958260&sec=&spon=&pagewanted=all]
  26. ^ Associated Press ["Federal Appals Court backs Use of AA confessions to convict man" http://www.freedomforum.org/templates/document.asp?documentID=16575&printerfriendly=1]
  27. ^ a b "Comments On A.A. Triennial Surveys" (PDF, 2 MB), Dec. 1990, Alcoholics Anonymous World Services.
  28. ^ Practice Guideline for the Treatment of Patients With Substance Use Disorders, 2nd ed. American Psychiatric Association, August 2006, p 98. [3]
  29. ^ Vaillant, 1995, p 255.
  30. ^ Vaillant, 1995, p 265.
  31. ^ Vaillant, George Eman (1995). "Chapter 4: Paths into Abstinence". The Natural History of Alcoholism Revisited (2nd edition ed.). Harvard University Press. pp. 231–277. ISBN 0674603788. OCLC 31605790. {{cite book}}: |edition= has extra text (help); Unknown parameter |month= ignored (help)
  32. ^ Maria Gabrielle Swora. "The rhetoric of transformation in the healing of alcoholism: The twelve steps of alcoholics anonymous." Mental Health, Religion & Culture, Sep2004, Vol. 7 Issue 3, p187-209.
  33. ^ Edwards, Griffith (2002). "Chapter 8: Alcoholics Anonymous". Alcohol: The World's Favorite Drug (1st edition ed.). Thomas Dunne Books. pp. 103–117. ISBN 0312283873. OCLC 48176740. {{cite book}}: |edition= has extra text (help); Unknown parameter |month= ignored (help)
  34. ^ a b Humphreys, Keith (2002). "Alcoholics Anonymous and 12-Step Alcoholism Treatment Programs". Recent Developments in Alcoholism. Vol. 16. Springer US. pp. 149–164. doi:10.1007/b100495. ISBN 978-0-306-47258-9. PMID 12638636.
  35. ^ Nace, Edgar P. "Alcoholics Anonymous" in Substance abuse: a comprehensive textbook. Ed. Joyce H. Lowinson et al. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2005, p 597 & 598.
  36. ^ a b NIAAA Reports Project MATCH Main Findings, Press release from National Institute on Alcohol Abuse and Alcoholism, Dec 1996. Retrieved 2007-05-25.
  37. ^ Project Match Research Group. (1997). "Matching alcoholism treatments to client heterogeneity: Project MATCH Posttreatment drinking outcomes." Journal of Studies on Alcohol, 58(1), 7-29.
  38. ^ Treatment of alcoholism: New results. Harvard Mental Health Letter, Aug2006, Vol. 23 Issue 2, p6-7, 2p
  39. ^ Adler, Jerry; Underwood, Anne; Kelley, Raina; Springen, Karen; Breslau, Karen. "Rehab Reality Check" Newsweek, 2/19/2007, Vol. 149 Issue 8, p44-46, 3p, 4c
  40. ^ Bruce Bower. Alcoholics synonymous: heavy drinkers of all stripes may get comparable help from a variety of therapies. Science News v151.n4 (Jan 25, 1997): pp62(2).
  41. ^ J. Scott Tonigan, Gerard J. Connors, and William R. Miller. "Participation and involvement in Alcoholics Anonymous", in Thomas Babor, Frances K. Del Boca, eds, Treatment Matching in Alcoholism, Cambridge University Press: 2003, p 184.
  42. ^ (August 1967). "A Controlled Experiment on the Use of Court Probation for Drunk Arrests". American Journal of Psychiatry 124 (2): Abstract.
  43. ^ J. Morgenstern et al. "Affiliation with Alcoholics Anonymous after treatment: a study of its therapeutic effects and mechanisms of action." (Department of Psychiatry, Mount Sinai School of Medicine, New York, 1997 Oct;65(5):768-7)
  44. ^ J. Morgenstern et al. "Affiliation with Alcoholics Anonymous after treatment: a study of its therapeutic effects and mechanisms of action." (Department of Psychiatry, Mount Sinai School of Medicine, New York, 1997 Oct;65(5):768-7)
  45. ^ a b Larimer, Mary E (1999). "Relapse prevention. An overview of Marlatt's cognitive-behavioral model". Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism. 23 (2): 151–160. ISSN 1535-7414. OCLC 42453373. PMID 10890810. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  46. ^ Crape L, Latkin,Carl A , Laris Alexander and . Knowlton , Amy - - John Hopkins University, School of Hygiene and Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA - - Received 9 August 1999; revised 1 June 2001; accepted 2 June 2001. ; Available online 5 February 2002
  47. ^ Humphreys, Keith (2001). "Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study". Alcoholism: Clinical and Experimental Research. 25 (5): 711–716. doi:10.1111/j.1530-0277.2001.tb02271.x. ISSN 1530-0277. PMID 11371720. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  48. ^ J. Scott Tonigan PhD. "Benefits of Alcoholics Anonymous Attendance" (University of New Mexico, 2001) pp 67 - 77
  49. ^ a b Moos, Rudolf H. (2006). "Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of Initially Untreated Individuals". Journal of Clinical Psychology: 735–750. doi:10.1002/jclp.20259. PMID 16538654. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help) Cite error: The named reference "MOOS2006A" was defined multiple times with different content (see the help page).
  50. ^ a b Moos, Rudolf H. (2006). "Rates and predictors of relapse after natural and treated remission from alcohol use disorders". Addiction. 101 (2): 212–222. doi:10.1111/j.1360-0443.2006.01310.x. PMID 16445550. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  51. ^ a b Moos, Rudolf H. (2004). "Long-Term Influence of Duration and Frequency of Participation in Alcoholics Anonymous on Individuals with Alcohol Use Disorders". Journal of Consulting and Clinical Psychology. 72 (1): 81–90. doi:10.1037/0022-006X.72.1.81. PMID 16445550. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  52. ^ Ferri M, Amato L, Davoli M, Alcoholics Anonymous and other 12-step programmes for alcohol dependence http://www.cochrane.org/reviews/en/ab005032.html
  53. ^ name="ATKINS2007">Atkins, R. G. & Hawdon, J. E. Journal of Substance Abuse Treatment "Religiosity and participation in mutual-aid support groups for addiction", Vol. 33, Issue 3, Oct. 2007, pp. 321-331 available online at www.sciencedirect.com
  54. ^ Krista Conger. "Study points out value of 12-step groups in treating substance abuse." Stanford Report, May 23, 2001. Retrieved 2007-05-05.
  55. ^ J. Morgenstern et al. "Affiliation with Alcoholics Anonymous after treatment: a study of its therapeutic effects and mechanisms of action." (Department of Psychiatry, Mount Sinai School of Medicine, New York, 1997 Oct;65(5):768-7)
  56. ^ J. Scott Tonigan PhD. "Benefits of Alcoholics Anonymous Attendance" (University of New Mexico, 2001) pp 67 - 77
  57. ^ (August 1967). "A Controlled Experiment on the Use of Court Probation for Drunk Arrests". American Journal of Psychiatry 124 (2): Abstract.
  58. ^ a b Shute, Nancy (1997). "The drinking dilemma: by calling abstinence the only cure, we ensure that the nation's $100 billion alcohol problem won't be solved". U.S. News & World Report. 123 (9): 54–64. {{cite journal}}: Unknown parameter |month= ignored (help)[4]
  59. ^ Alcoholics Anonymous (2001). Alcoholics Anonymous (PDF) (4th edition ed.). New York, New York: Alcoholics Anonymous World Services. ISBN 1893007162. OCLC 32014950. {{cite book}}: |edition= has extra text (help); Unknown parameter |month= ignored (help)
  60. ^ Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ. 2005. Recovery from DSM-IV alcohol dependence: United States, 2001-2002.  : Addiction. Mar;100(3):281-92
  61. ^ Dawson DA, Goldstein RB, Grant BF. 2007. Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up. Alcohol Clin Exp Res. 2007 Dec;31(12):2036-45.
  62. ^ Alan I. Leshner. "What does it mean that addiction is a brain disease?" Monitor on Psychology (American Psychological Association) Volume 32, No. 5 June 2001.
  63. ^ Dale Mitchel, Silkworth: The Little Doctor Who Loved Drunks. Hazelden, 2002.
  64. ^ Alcoholics Anonymous The Doctor's Opinion page xxviii.
  65. ^ A Newcomer Asks (AA pamphlet)
  66. ^ The Alcoholic Can Recover (AA pamphlet)
  67. ^ "A Conversation with Bill W." 2003. Retrieved 2006-10-20. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)
  68. ^ Alcoholics Anonymous (2001). "Chapter 3: More About Alcoholism". Alcoholics Anonymous (PDF) (4th edition ed.). New York, New York: Alcoholics Anonymous World Services. pp. 30–43. ISBN 1893007162. OCLC 32014950. {{cite book}}: |edition= has extra text (help); Unknown parameter |month= ignored (help)
  69. ^ Stanton Peele. The Diseasing of America. Lexington, MA: Lexington Books, 1989, http://www.peele.net/lib/diseasing.html
  70. ^ Bogart, Cathy J. (2003). "'13th-Stepping:' Why Alcoholics Anonymous Is Not Always a Safe Place for Women". Journal of Addictions Nursing: A Journal for the Prevention and Management of Addictions. 14 (1): 43–47. doi:10.1080/10884600305373. ISSN 1548-7148. OCLC 34618968. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  71. ^ Gerard Seenan. "Drink advice service confronts sex abuse." The Guardian, July 5, 2000.
  72. ^ Fisher, Marc. "Seeking Recovery, Finding Confusion." Washington Post. Sunday, July 22, 2007, p A01.
  73. ^ Summers, Nick. "" A Struggle Inside AA." Newsweek May 7, 2007.
  74. ^ Midtown AA Accused Of Sexual Exploitation - News Story - WRC | Washington
  75. ^ Arthur H. Cain, "Alcoholics Anonymous: Cult or Cure?." Harper's Magazine, February 1963
  76. ^ Alexander, F. (1985). "Alcoholics Anonymous: the unseen cult". California Sociologist. 17 (1). Los Angeles: California State University: 33–48. ISSN 0162-8712. OCLC 4025459. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  77. ^ Alexander and Rollins Alcoholics Anonymous the Unseen cult pdf file http://ww.silkworth.net/sociology/Soc63OCR.pdf
  78. ^ Cite error: The named reference VAILLANT2005 was invoked but never defined (see the help page).
  79. ^ Vaillant 1995, p 266. Summarizing Nace, E.P. 1992. "Alcoholics Anonymous" in J.H.Lowinson, P.Ruiz, and R.B.Millman, eds. Substance Abuse: A Comprehensive Text Book. Baltimore: Williams and Wilkins. Pp 486-495.
  80. ^ name="COLEMAN2005">Coleman, Phyllis (2005). "Privilege and Confidentiality in 12-Step Self-Help Programs: Believing The Promises Could Be Hazardous to an Addict's Freedom". The Journal of Legal Medicine. 26 (4): 435–474. doi:10.1080/01947640500364713. ISSN 0194-7648. OCLC 4997813. {{cite journal}}: Unknown parameter |month= ignored (help)
Retrieved from "https://en.wikipedia.org/w/index.php?title=Alcoholics_Anonymous&oldid=197609903"