12-Step Involvement and Treatment Outcomes Among Young Women With Substance Use Disorders

The extent to which young women with substance use disorders (SUDs) affiliate with Alcoholics Anonymous (AA) or other 12-Step groups is currently unclear. This administrative data analysis examined 12-Step involvement and its impact on outcome during the first 6 months following treatment among a sample of young adults attending 12-step–based residential treatment. Young women were just as likely as similar-aged young men to attend 12-Step meetings and engage in prescribed 12-Step practices like getting a sponsor. Frequency of meeting attendance predicted abstinence status and number of drinking days at 6 months in women, whereas 12-Step experiences (e.g., getting a sponsor, considering oneself an AA member) predicted drinking days in men. The results contribute to knowledge of SUDs and their treatment among women in their late teens and early twenties, a population that has been quite understudied in the literature.     

Changes in depression mediate the effects of AA attendance on alcohol use outcomes

Background: Depression may contribute to increased drinking in individuals with alcohol use disorder. Although Alcoholics Anonymous (AA) attendance predicts drinking reductions, there is conflicting information regarding the intermediary role played by reductions in depression. Objectives: We explored whether AA attendance reduces depressive symptoms, the degree to which improvement in depression results in reductions in drinking, and in which subgroups these effects occur. Methods: 253 early AA affiliates (63% male) were recruited and assessed at baseline 3, 6, 9, 12, 18, and 24 months. Depression was measured using the Beck Depression Inventory (BDI) and was administered at baseline 3, 6, 12, 18, and 24 months. AA attendance and alcohol use outcomes were obtained with the Form 90. Mediation analyses were performed at early (3, 6, and 9 months) and late (12, 18, and 24 months) follow-up to investigate the degree to which reductions in depression mediated the effect of AA attendance on drinking, controlling for concurrent drinking. In addition, a series of moderated mediation analyses were performed using baseline depression severity as a moderator. Results: At early follow-up, reductions in depression (6 months) mediated the effects of AA attendance (3 months) on later drinking (drinks per drinking day) (9 months) (b = ?0.02, boot CI [?0.055, ?0.0004]), controlling for drinking at 6 months. Baseline depression severity did not moderate the degree to which BDI mediated the effects of AA attendance on alcohol use (ps > .05). Conclusion: These findings provide further evidence that depression reduction is a mechanism by which AA attendance leads to reductions in alcohol use. Improving depression may help reduce alcohol use in individuals with AUD, and AA attendance may be an effective way to achieve that goal.     

The efficacy of disulfiram for the treatment of alcohol use disorder

Background: Alcohol use disorders (AUD) involving hazardous, harmful, and addictive misuse of alcohol are widespread in most parts of the world. The aim of this study was to review the effect of disulfiram in the treatment of patients with AUD. The effect of disulfiram was evaluated according to the primary outcome of an intake of alcohol below 30 and 20 g/d for men and women, respectively, as well as secondary outcomes such as days until relapse, alcohol intake, and numbers of drinking days. Methods: A systematic review of the literature was conducted using MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). Results: Eleven randomized controlled trials were included with a total of 1,527 patients. They compared disulfiram treatment with placebo, none or other abstinence‐supportive treatments. Overall, 6 studies reported of a significant better effect on abstinence for patients treated with disulfiram. Six of 9 studies measuring secondary outcomes reported that patients treated with disulfiram had significantly more days until relapse and fewer drinking days, respectively. The quality of the included studies was moderate. Heterogeneity was significant in most of the meta‐analyses, but valid results were found regarding the effect of disulfiram versus placebo over 12 months and unsupervised disulfiram versus other or no treatment. The vast majority of significant studies were of shorter duration, while only 3 studies of 12 months were significant regarding more days until relapse and/or reduction in drinking days. Conclusions: Supervised treatment with disulfiram has some effect on short‐term abstinence and days until relapse as well as number of drinking days when compared with placebo, none, or other treatments for patients with alcohol dependency or abuse. Long‐term effect on abstinence has not been evaluated yet. However, there is a need for more homogeneous and high‐quality studies in the future regarding the efficacy of disulfiram.     

Superior Outcome of Females Over Males After Brief Treatment for the Reduction of Heavy Drinking

Problem drinkers (52 males, 38 females) recruited through advertisements were randomly assigned to one of three treatments: Guidelines: three sessions of advice using a pamphlet outlining basic steps for achieving abstinence or moderate drinking. Manual: three sessions of instruction in the use of a 'self-help’manual presenting a step-by-step approach for attaining abstinence or moderate drinking. Therapist: six or more sessions of instruction in the methods outlined in the 'self-help’manual. At 3, 6 and 12 months follow-up, no significant differences were found among the groups in reduction of heavy drinking days (i.e. days when consumption exceeded four drinks, each containing 13.6 g/ethanol). Overall, the number of heavy days were reduced from an average of 43 at intake, to 20 over the 1-year follow-up period. Females, however, had significantly greater reductions than males (75% versus 35%). Three months after treatment the rate of successful moderate drinkers was significantly higher for females than males in the Guidelines (60% versus 33%) and the Manual condition (63% versus 18%), but not in the Therapist condition (25% versus 35%). At 1-year follow-up, females were more successful than males in all conditions. Mean changes in GGT and MCV levels lended support to the change in drinking status (from heavy drinker at intake to moderate drinker at follow-up), based on clients’self-reports.     

Do Women Differ from Men on Alcoholics Anonymous Participation and Abstinence? A Multi‐Wave Analysis of Treatment Seekers

Background: Given the widespread use of Alcoholics Anonymous (AA) and other similar groups in the United States and the increasing membership of women, this study compares women with men on their meeting attendance and AA‐prescribed behaviors, factors associated with that AA participation, and tests how these relate to women’s and men’s abstinence across time. Methods: All consecutive new admissions (age ≥ 18) from county‐wide public and private treatment programs representing the larger population of treatment seekers were approached to be in the study at treatment entry. Those consenting at baseline (n = 926) were sought for follow‐up interviews 1, 3, 5, and 7 years later. Generalized linear models were used to test whether various help‐seeking factors were associated with AA participation differentially by gender and, controlling for AA and other confounders, whether women differ from men on abstinence. Results: At each follow‐up interview, women and men attended AA at similar rates and similarly practiced specific AA behaviors, and they were alike on most factors associated with AA participation and abstention across time including abstinence goal, drink volume, negative consequences, prior treatment, and encouragement to reduce drinking. Relative to men, women with higher drug severity were less likely to participate in AA. Although higher AA participation was a predictor of abstinence for both genders, men were less likely to be abstinent across time. Men were also more likely to reduce their AA participation across time. Conclusions: These findings add to an emerging literature on how women compare with men on factors related to AA participation and subsequent drinking outcomes across time. Findings have clinical implications for service providers referring clients to such groups.     

Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study

AIMS: This study investigates the relationship between frequency of attendance at Narcotics Anonymous and Alcoholics Anonymous (NA/AA) meetings and substance use outcomes after residential treatment of drug dependence. It was predicted that post-treatment NA/AA attendance would be related to improved substance use outcomes. METHODS: Using a longitudinal, prospective cohort design, interviews were conducted with drug-dependent clients (n = 142) at intake to residential treatment, and at 1 year, 2 years and 4-5 years follow-up. Data were collected by structured interviews. All follow-up interviews were carried out by independent professional interviewers. FINDINGS: Abstinence from opiates was increased throughout the 5-year follow-up period compared to pre-treatment levels. Clients who attended NA/AA after treatment were more likely to be abstinent from opiates at follow-up. Abstinence from stimulants increased at follow-up but (except at 1-year follow-up) no additional benefit was found for NA/AA attendance. There was no overall change in alcohol abstinence after treatment but clients who attended NA/AA were more likely to be abstinent from alcohol at all follow-up points. More frequent NA/AA attenders were more likely to be abstinent from opiates and alcohol when compared both to non-attenders and to infrequent (less than weekly) attenders. CONCLUSIONS: NA/AA can support and supplement residential addiction treatment as an aftercare resource. In view of the generally poor alcohol use outcomes achieved by drug-dependent patients after treatment, the improved alcohol outcomes of NA/AA attenders suggests that the effectiveness of existing treatment services may be improved by initiatives that lead to increased involvement and engagement with such groups.     

Does Age Moderate the Effect of Spirituality/Religiousness in Accounting for Alcoholics Anonymous Benefit?

Gains in spiritual/religious (S/R) practices among Alcoholics Anonymous (AA) members are associated with reductions in drinking. This study had the following aims: (1) examine spirituality/religiousness as a mediator of the relationship between AA attendance and reductions in drinking behavior to replicate past research findings and to (2) examine age cohort as a moderator of the mediational analyses given that empirical evidence (e.g., generational differences in spirituality) suggests that age may influence the acquisition of gains in spirituality/religiousness during AA as well as the expression of these gains on drinking behavior. Measures were administered to 253 participants recruited from community-based AA and outpatient treatment programs at baseline, 3, 6, 9, and 12 months, and 210 (83%) participants provided complete data to test study aims. Gains in S/R practices mediated the relationship between AA attendance and increased abstinence but not drinking intensity. Simple slopes analyses indicated a positive association between AA attendance and gains in S/R practices among younger AA affiliates but not older AA affiliates in the moderated-mediational analyses. However, age was not found to moderate the global mediational effect. The results from the current study inform efforts to increase positive change in AA affiliates’ drinking behavior by highlighting specific aspects of S/R practices that should be targeted based on the age of an AA affiliate.     

Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry

BACKGROUND: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of aftercare, but we know very little about treatment seekers' patterns of AA involvement over time and how these relate to abstinence. METHOD: This paper applies latent class growth curve modeling to longitudinal data from 349 dependent drinkers recruited when they were entering treatment and were re-interviewed at one or more follow-up interviews one, three and five years later, and who reported having attended AA at least once. RESULTS: Four classes of AA "careers" of meeting attendance emerged: The low AA group mainly just attended AA during the 12 months following treatment entry. The medium and high AA groups were characterized by stable attendance at the second and third follow-ups-at about 60 meetings a year for the medium group and over 200 meetings per year for the high group, followed by slight increases for the medium group and slight decreases for the high group by year five. The declining AA group doubled its meeting attendance postbaseline, to almost 200 meetings during the year following treatment entry, but by year five they were only attending about six meetings on average. Decreases in AA meetings did not necessarily signal disengagement from AA; at the five-year follow-up, a third of the low AA group and over half of the declining AA group said they felt like a member of AA. Activities other than meeting attendance, such as having a sponsor, otherwise paralleled the meeting careers, but social networks were similar by year five. Rates of abstinence by year five (for the past 30 days) were 43% for the low AA group, 73% for the medium group, 79% for the high group and 61% for the declining group. Rates of dependence symptoms and social consequences of drinking did not differ between the groups at year five. CONCLUSIONS: The prototypical AA careers derived empirically are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable (and sometimes quite high) rates of AA attendance. However, contrary to AA lore, many who connect only for a while do well afterwards.     

Alcoholics Anonymous and hazardously drinking women returning to the community after incarceration: predictors of attendance and outcome

Background: The number of women incarcerated within the United States has risen dramatically in recent decades, and high rates of alcohol problems are evident among this population. Although little is known about the patterns of help utilization and efficacy for alcohol problems, preliminary evidence suggests that Alcoholics Anonymous (AA) is a widely available resource for this population. Methods: Data were collected as part of a study evaluating the effect of a brief intervention to reduce alcohol use among hazardously drinking (i.e., score of 8 or above on the Alcohol Use Disorders Identification Test or 4 or more drinks at a time on at least 3 days in prior 3 months) incarcerated women. The current study characterized demographic, clinical, and previous AA attendance variables associated with AA attendance in the 6 months following incarceration. Associations between frequency of AA attendance and drinking outcomes following incarceration were also evaluated. Results: Among the 224 participants who provided data about AA attendance, 54% reported some AA attendance during the follow‐up assessment period. AA attendance in the year prior to study entry (OR = 4.02; 95% CI: 3.32 to 4.71) and greater baseline consequences of alcohol use (OR = 2.09; 95% CI: 1.73 to 2.44) were associated with increased odds of higher frequency of AA attendance following incarceration. Weekly or greater AA attendance was associated with reductions in negative drinking consequences (B = ?0.45; p < 0.01) and frequency of drinking days (B = ?0.28; p < 0.01) following incarceration. Conclusions: Findings from this study suggest that AA is frequently utilized by hazardously drinking women following incarceration. Alcohol outcomes may be enhanced by AA attendance at a weekly or greater frequency is associated with better alcohol outcomes relative to lower levels of AA attendance. Evaluation of clinical guidelines for prescribing AA attendance for incarcerated women remains a task for future research.     

Alcoholics Anonymous: Affiliation Processes and Effectiveness as Treatment

Recent findings from the empirical literature on Alcoholics Anonymous (AA) suggest that no clear exclusionary criteria for this organization exist, except that alcohol-dependent individuals who become nonproblem drinkers appear to be less likely to affiliate with or maintain involvement in AA. Of those alcoholics who become long term, active AA members, about 40 to 50% enjoy several years of total abstinence, with about 60 to 68% improving to some extent, drinking less or not at all during their participation. Those who combine AA with other forms of treatment seem to do as well as or better than those who go to AA alone. More active AA participants do as well as or better than those who participate less actively. Compared to professionally treated alcoholics, AA members seem to achieve abstinence at a higher rate. Consideration is given to the apparent unsuitability of AA for problem drinkers who choose the goal of nonproblem drinking.     

Time to alcohol dependence after abstinence and first drink

The first relapse into alcohol dependence after abstinence is characterized by sudden immoderate drinking. The time after abstinence to re-establishing dependence has never been compared to the time taken to establish dependence initially. Thirty one subjects who had been dependent on alcohol, had subsequently been abstinent for at least 2 months, and had had a relapse into dependence were interviewed. The median time to first dependence on alcohol was 13 years (Mean (SD) 14.7 (8) years); median time to dependence when relapsing was 7 days, a 700-fold acceleration (p < 0.00003). Only three subjects drank for more than 30 days (range 90-1825 days) before re-establishing dependence; the average was 82 (330) days overall and 9.3 (8.0) days if these subjects were excluded. Times to initial and subsequent dependence were not correlated nor related to the duration of abstinence (median 9, mean 16.9 (22) months). While abstinent the subjects had felt as if they were healed. It should be emphasized to abstinent patients that alcohol dependence has a latent sequel: they are at risk of accelerated dependence after recurrent drinking, which should be regarded as an emergency.     

Validity of Self-Report in Alcoholism Research: Results of a Veterans Administration Cooperative Study

The validity of self-report in alcoholism treatment research is controversial. Our recently completed Veterans Administration Cooperative Study evaluating the efficacy of disulfiram treatment for alcoholism provided an opportunity to assess the validity of self-report. To assess treatment response, patients and household contacts were interviewed at seven scheduled points during the 1 year of follow-up. Blood specimens also were obtained from the patients at these times and were analyzed for ethanol. Eighty-eight percent of the patient and/or collateral interviews were obtained at 6 months and 90% at 1 year. The mean number of blood and urine specimens collected per patient was 4.3 and 14.4, respectively. Outcome criteria included continuous abstinence during the year and total number of drinking days. Continuous abstinence: If we had had only the patients' self reports, we would have significantly underestimated the percentage of men who drank. By self-report 58.7% (355/605) relapsed whereas the combination of self report, collaterals' reports, and laboratory tests indicated that 72.4% (438/605) drank (p less than 0.001). Using Bayes' theorem, the conditional probability that a patient is continuously abstinent for 1 year when he so claims is 65%. Total drinking days: Of the 213 patient-collateral pairs each of whom provided all seven scheduled interviews, 46.9% (100/213) agreed on the total number of drinking days during the year.(ABSTRACT TRUNCATED AT 250 WORDS)     

Spirituality,Religious Problem-Solving,and Sobriety in Alcoholics Anonymous

Abstract

This study focused on the problem-solving or coping aspect of religiousness as well as spiritual support, spiritual openness, and religious faith practice as the key predictors of long-term sobriety in Alcoholics Anonymous (AA). Purpose in life and AA involvement were also included as important indicators for sustained abstinence from drinking. The 78 participants were members of AA clubs located in Maryland, New York, Kansas, Missouri, South Carolina, and California. Results confirmed the findings of previous studies that indicated AA involvement to be the single most, important predictor of abstinence and sobriety in AA.     

Methadone Withdrawal Regime for Heroin Misusers: short-term outcome and effect of parental involvement

Fifty young outpatient attenders at a regional drug dependence service were traced between 6 and 12 months after entering treatment. All had been physically dependent on heroin and received outpatient detoxification by a 14-day methadone withdrawal regime. The initial 25 patients were offered individual counselling and the remainder were counselled together with their parents. Forty-three subjects were interviewed (23 without and 20 with parental involvement in therapy). Abstinence was confirmed by urine testing on nine patients interviewed outside prison. Parental involvement made no difference to outcome in respect of abstinence and other changes in heroin usage, or to criminal activity. Heroin smokers were no more likely than injectors to abstain or decrease heroin use. It is likely that abstinence and decreased heroin consumption were spontaneous changes unrelated to therapeutic intervention.     

Remission of Late-Life Drinking Problems: A 4- Year Follow-up

This 4-year follow-up study compared stably remitted late-life problem drinkers to nonremitted problem drinkers and nonproblem drinkers. At time 1, to-be-remitted drinkers reported less alcohol consumption and fewer drinking problems, more depression and less self-confidence, less spousal support and approval of drinking from friends, and more help-seeking than did to-be-nonremitted drinkers. Remitted drinkers showed improvement in functioning and life context at the 4-year follow-up, but compared with nonproblem drinkers some deficits persisted. Stable remission and abstinence among late-onset drinkers were closely tied to receiving less spousal support and approval from friends for drinking at time 1, whereas helpseeking was a strong predictor of stable remission and abstinence among early-onset problem drinkers. For both late- and early-onset drinkers, abstinence was predicted by initially having more drinking problems, depression, and health stressors.     

Relapse by Alcohol Abusers

During the first year after treatment, 44% of a sample of alcohol abusers reported relapse to alcohol use. Relapse rate increased to a peak at 6 months after treatment and then declined. Depressed or anxious mood was the reason most frequently given (31%) for relapse. Of subjects who relapsed, almost half (42%) reported a subsequent return to abstinence which was then maintained for the remainder of the followup period. Of these subjects, half (51%) reported the duration of the drinking period to be less than 2 weeks. Of subjects showing a daily drinking pattern prior to treatment, 20% showed a daily drinking pattern after relapse, 46% showed bouts of drinking and abstinence, and 33% showed abstinence with no further drinking. Of subjects showing bouts of drinking prior to treatment, none showed a daily drinking pattern after relapse, 44% showed bouts of drinking and abstinence, and 56% showed abstinence with no further drinking. There was no significant effect of sex or age on relapse rate, time to relapse, or reasons for relapse.     

Physical Health and Drinking Among Medical Inpatients With Unhealthy Alcohol Use: A Prospective Study1

Objective: Unhealthy alcohol use is common in medical inpatients, and hospitalization has been hypothesized to serve as a “teachable moment” that could motivate patients to decrease drinking, but studies of hospital‐based brief interventions have often not found decreases. Evaluating associations between physical health and subsequent drinking among medical inpatients with unhealthy alcohol use could inform refinement of hospital‐based brief interventions by identifying an important foundation on which to build them. We tested associations between poor physical health and drinking after hospitalization and whether associations varied by alcohol dependence status and readiness to change. Methods: Participants were medical inpatients who screened positive for unhealthy alcohol use and consented to participate in a randomized trial of brief intervention (n = 341). Five measures of physical health were independent variables. Outcomes were abstinence and the number of heavy drinking days (HDDs) reported in the 30 days prior to interviews 3 months after hospitalization. Separate regression models were fit to evaluate each independent variable controlling for age, gender, randomization group, and baseline alcohol use. Interactions between each independent variable and alcohol dependence and readiness to change were tested. Stratified models were fit when significant interactions were identified. Results: Among all participants, measures of physical health were not significantly associated with either abstinence or number of HDDs at 3 months. Having an alcohol‐attributable principal admitting diagnosis was significantly associated with fewer HDDs in patients who were nondependent [adjusted incidence rate ratio (aIRR) 0.10, 95% CI 0.03–0.32] or who had low alcohol problem perception (aIRR 0.36, 95% CI 0.13–0.99) at hospital admission. No significant association between alcohol‐attributable principal admitting diagnosis and number of HDDs was identified for participants with alcohol dependence or high problem perception. Conclusions: Among medical inpatients with nondependent unhealthy alcohol use and those who do not view their drinking as problematic, alcohol‐attributable illness may catalyze decreased drinking. Brief interventions that highlight alcohol‐related illness might be more successful.     

Alcoholism, Alcoholics Anonymous attendance, and outcome in a prison system

The purpose of this study was to assess the relationship between attendance at meetings of Alcoholics Anonymous (AA) and follow-up status in a sample of prison inmates. Subjects (N = 102) were administered three self-report measures of alcoholism: the MAST, CAGE, and Rosett Quantity-Frequency tests. AA attendance during incarceration was recorded. One-year follow-up status, ranging from transfer to a more secure facility to discharge from the prison system, was used as an outcome indicator. ResuLts revealed that 56% of the subjects met the criteria for alcoholism on at least one measure, and that scores on the alcoholism measures were significantly correlated with AA attendance. Thus, the most severe alcoholics were the best AA attenders. The hypothesis that greater AA attendance would predict follow-up outcome was not confirmed. However, the extent of drinking reported prior to admission (average alcohol quantity per week) was related to security status at 1-year follow-up. The greater the drinking quantity, the more likely the inmate was to be in a more secure facility. Possible explanations for the findings and the need for a longer follow-up period are discussed.     

Efficacy of extended-release naltrexone in patients with relatively higher severity of alcohol dependence

Background: Because some literature reviews have suggested that naltrexone’s benefit may be limited to less‐severe alcohol dependence, and exclusively to reduction in heavy drinking rather than abstinence, we examined the efficacy of once per month, injectable extended‐release naltrexone (XR‐NTX 380 mg) in patients with relatively higher severity alcohol dependence. Methods: Post hoc analyses examined data from a multicenter, placebo‐controlled, 24‐week randomized trial of XR‐NTX for alcohol dependence (N = 624). We analyzed treatment effects in alcohol‐dependent patients who had higher baseline severity, as measured by: (i) the Alcohol Dependence Scale (ADS) or (ii) having been medically detoxified in the week before randomization. Efficacy was also examined via the relationship between pretreatment severity indices and reporting at least 4 days of lead‐in abstinence prior to treatment—a major predictor of good outcome in the original study. Results: Higher severity alcohol‐dependent patients, defined by the ADS, when receiving XR‐NTX 380 mg (n = 50) compared with placebo (n = 47), had significantly fewer heavy‐drinking days in‐trial (hazard ratio=0.583; p = 0.0049) and showed an average reduction of 37.3% in heavy‐drinking days compared with 27.4% for placebo‐treated patients (p = 0.039). Among those who had a detoxification just prior to randomization, these reductions were 48.9% (XR‐NTX 380 mg; n = 11) and 30.9% (placebo; n = 15) (p = 0.004). Subjects with at least 4 days of pretreatment abstinence (n = 82) versus those without (n = 542) had significantly higher pretreatment ADS scores (p = 0.002) and were more likely to require detoxification prior to randomization (p < 0.001). Patients with lead‐in abstinence experienced significantly better maintenance of initial and 6‐month abstinence. Conclusions: These secondary analyses support the efficacy of XR‐NTX 380 mg in relatively higher severity alcohol dependence for both reduction in heavy drinking and maintenance of abstinence, with implications for the role of adherence pharmacotherapy.