Alcoholics Anonymous Research Articles

Blame: A Novel

Back to table of contents Previous article Next article Book ReviewFull AccessBlame: A NovelDan Oren M.D.Dan Oren M.D.Search for more papers by this authorPublished Online:1 Dec 2010https://doi.org/10.1176/ps.2010.61.12.1271AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The book Blame is a fictional work reconstructing the life of Patsy, a professor and alcoholic, shortly before and for decades after the drunken car accident that killed a mother and child, sent her to prison, and forever altered her. For me, a psychiatrist who works daily with people who abuse or abused alcohol or are coming out of prison, this book provides useful insight into the mind of an alcoholic, illuminating detail into the rehabilitative potential of Alcoholics Anonymous (AA), and frightening detail into life in a prison setting. Huneven skillfully reconstructs American history and fads, from the AIDS outbreak in the 1980s to the popularity of organics in the 2000s. However, her text is also uneven. On the one hand she creates a host of characters who appear more as cutouts than as developed personalities; on the other she provides a quick read and entrée to the worlds that some of my patients inhabit. A dramatic late turn makes for an interesting plot, but it does not fundamentally change the ending. The paper-thin character development, however, left me struggling in trying to answer the question of why I should care enough about Patsy to follow her story to that end. Patsy begins as a heavy, careless drinker. Before and after her torturous time in prison, she repeatedly chooses life mates who do not sustain her. It is a struggle to identify what about her is appealing, with the exception of her proper atonement toward the surviving family of the dead mother and child. But in trying to resolve my own indifference to her character, I realized that perhaps Huneven has admirably succeeded in capturing one view of the alcoholic: someone whose identity is so wrapped up in booze that without it their true self is a void.The psychotherapy scenes are underwhelming. "Silver," the therapist, does a reasonable job, but even though dozens of people in Patsy's life have been named and paraded through the book, we find out only minimal details about Patsy's father and mother (who are never named). This leaves readers with the impression that we still don't really know what makes Patsy tick.Nonetheless, any mental health professional who feels that he or she knows too little about what gives AA its power or how awful jail or prison can be will find this book of value.Dr. Oren is medical director, Birmingham Group Health Services, Ansonia, Connecticut. FiguresReferencesCited byDetailsCited ByNone Volume 61Issue 12 December, 2010Pages 1271-1271PSYCHIATRIC SERVICES December 2010 Volume 61 Number 12 Metrics PDF download History Published online 1 December 2010 Published in print 1 December 2010

Alcoholism and identity: How an alternative framing of identity can facilitate Alcoholics Anonymous research

Motivational interviewing (MI), cognitive-behavioral therapy (CBT), and Alcoholics Anonymous (AA) are the most common therapeutic approaches for alcoholism recovery. Whereas the former two are clinical treatments grounded in scientific theory, AA emerged as a peer-led program grounded in an array of scientific, social, and spiritual concepts. Researchers have failed to comprehensively identify AA's therapeutic mechanisms or to definitively link them to recovery outcomes. This failure may result from the false assumption that AA frames identity in the same way evidence-based psychological treatments do. This article explores the significance of identity to recovery from alcoholism. MI presumes a personal identity and CBT presumes a social identity. Measures of personal and social attributes are appropriate to these interventions. AA, however, promotes a relational identity which cannot be fully captured using measures of individual attributes. The implications for this shortcoming are presented, along with several suggestions to enhance future research.

Personal Construct Theory and the Transformation of Identity in Alcoholics Anonymous

The dominant theoretical approach to alcoholism research presumes linear, causal relationships between individual cognitions and behavioral outcomes. This approach has largely failed to account for the recovery some alcoholics achieve in Alcoholics Anonymous (AA) because AA emphasizes the transformation of identity, framed in terms of relationships rather than cognitions and behaviors. George Kelly’s personal construct theory (PCT) provides a ready means of theorizing that transformation by explaining how AA helps alcoholics resolve four identity-relevant dialectics. The basic postulate of PCT addresses changes in stigma: normal vs. deviant identity. The construction corollary illustrates changes in perspective: subjective vs. objective view of identity. The individuality corollary informs changes in affiliation: unique vs. common identity. And the organization corollary illuminates changes in stability: fluctuating vs. permanent identity. As an alternative to causal approaches focusing on cognition and behavior, PCT should facilitate further research into alcoholism as a disorder of identity transformation.

Current Status of Narcotics Anonymous and Alcoholics Anonymous in Greece: Factors Influencing Member Enrollment

In Greece, the self-help groups of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) have existed for more than 20 years, but both qualitative and quantitative research in this field has been limited. This is the first study to examine AA and NA groups in Greece during a 16-month period (September 2004 to January 2006) in the cities of Athens, Thessalonica, Serres, Nauplion, Herakleion, and Katerine. This research was sponsored by the program of Social and Clinical Psychology of Addictions and Psychosocial Problems at the Aristoteleion University of Thessalonica in the context of graduate work, under the supervision of interim professor of clinical psychology, Dr. Phoebos Zapheirides. The aim of this study is to comprehensively describe the current status of AA and NA groups in Greece. Our primary goal is to establish a profile of individuals who use these services in our country. This article includes our analysis of responses to 15 questions from a survey eliciting information regarding group parti...

A Look at the Evolution of the Self-Help Movement

The self-help movement clearly introduced the significance of the role of responsibility and self-actualization into the health care sector. Narcotics Anonymous and Alcoholics Anonymous are among the most influential self-help groups worldwide. However, social scientists had not recognized the importance of self-help groups for many years. Today, there are several quantitative and qualitative studies in the self-help field that can provide meaningful contributions to treatment outcomes and research directions. The purpose of this article is to review the origins and history of the self-help movement. Despite the breadth and depth of research and related findings thus far, opportunities for further investigation of certain aspects of self-help groups remain. For example, an examination of the challenges in this type of research and comparative work with respect to other treatment modalities has the potential to provide further insight into optimizing the use and expanding the applications of the self-help ...

Following Problem Drinkers Over Eleven Years: Understanding Changes in Alcohol Consumption

Much of what we know about the course of alcohol consumption in problem and dependent drinkers comes from studies of in-treatment populations. Less is known about the natural course of alcohol consumption among such drinkers in the general population and what predicts how much they drink. This study examined alcohol consumption over the course of 11 years in a randomly selected sample of 672 problem and dependent drinkers from a single, heterogeneous U.S. county. Alcohol consumption declined and leveled off over time but did not decrease to the average general U.S. population level. Several indicators of ongoing problems with drinking are associated with high levels of drinking over time: having a heavy-drinking network, receiving suggestions to do something about one's drinking, and going to treatment. Factors associated with less drinking include having contact with community agencies and going to Alcoholics Anonymous (AA). Results suggest that problem and dependent drinkers continue to drink at an elevated level over the course of years. Gatekeepers, family members, and policymakers should encourage and facilitate contact with social service agencies and with AA for problem drinkers. Suggestions from others to do something about one's drinking and seeking specialty care occur more often in those with more severe problems and do not appear to be linked to less drinking over time.

The role of Alcoholics Anonymous in mobilizing adaptive social network changes: A prospective lagged mediational analysis

Objective Many individuals entering treatment are involved in social networks and activities that heighten relapse risk. Consequently, treatment programs facilitate engagement in social recovery resources, such as Alcoholics Anonymous (AA), to provide a low risk network. While it is assumed that AA works partially through this social mechanism, research has been limited in rigor and scope. This study used lagged mediational methods to examine changes in pro-abstinent and pro-drinking network ties and activities. Method Adults ( N = 1726) participating in a randomized controlled trial of alcohol use disorder treatment were assessed at intake, and 3, 9, and 15 months. Generalized linear modeling (Generalized linear modeling) tested whether changes in pro-abstinent and pro-drinking network ties and drinking and abstinent activities helped to explain AA's effects. Results Greater AA attendance facilitated substantial decreases in pro-drinking social ties and significant, but less substantial increases in pro-abstinent ties. Also, AA attendance reduced engagement in drinking-related activities and increased engagement in abstinent activities. Lagged mediational analyses revealed that it was through reductions in pro-drinking network ties and, to a lesser degree, increases in pro-abstinent ties that AA exerted its salutary effect on abstinence, and to a lesser extent, on drinking intensity. Conclusions AA appears to facilitate recovery by mobilizing adaptive changes in the social networks of individuals exhibiting a broad range of impairment. Specifically by reducing involvement with pro-drinking ties and increasing involvement with pro-abstinent ties. These changes may aid recovery by decreasing exposure to alcohol-related cues thereby reducing craving, while simultaneously increasing rewarding social relationships.

Long-Term Care May Call For Substance Abuse Care

Long-Term Care May Call For Substance Abuse Care

A DISSENTING VIEW FROM ONE WHO HAS KNOWN BOTH NIDA AND NIAAA

A DISSENTING VIEW FROM ONE WHO HAS KNOWN BOTH NIDA AND NIAAA

A discourse about the institutional handling of the substance abuser's penchant to relapse (Relapse)

PurposeThe purpose of this paper is to present the first of two articles about substance abuse as a human disorder that defies resolution, with the primary care physician the intended audience.Design/methodology/approachThe paper is about the phenomenon of relapse as an extension of the formation of the underlying addictive‐oriented thinking. Both relapse and acceptance are about the “why” of substance abuse and not the “what.”FindingsAccording to the Substance Abuse and Mental Health Services Administration, the number of US adults who were classified as having substance dependence or abuse in 2008 based on criteria specified in the DSM‐IV was 22.2 million. Subtract on a mutually exclusive basis the 1.2 million who participate in Alcoholics Anonymous (AA) and the 1.7 million persons who are in some configuration of institutional therapy and this leaves 19.3 million persons as a potential pool of need.Research limitations/implicationsFocusing on the primary care physician is no more trivial than the two topics to be discussed.Social implicationsThe potential pool of need in the USA is much larger than the 19.3 million persons on the strength of what is implied by the to‐be‐developed views of relapse and acceptance as the “why” of substance abuse, as a subset of addictive‐oriented thinking.Originality/valueWhile the paper is in line with the World Health Organization's position that substance abuse is the most serious health problem globally, the advocated approach to the resolution of addiction is the efficiency of the relationship between the primary care physician and the patient.

David E. Schoen: The War of the Gods in Addiction: C. G. Jung, Alcoholics Anonymous, and Archetypal Evil

David E. Schoen: The War of the Gods in Addiction: C. G. Jung, Alcoholics Anonymous, and Archetypal Evil

ALCOHOLICS ANONYMOUS

Australian Occupational Therapy JournalVolume 1, Issue 6 p. 204-210 ALCOHOLICS ANONYMOUS S.J. Minogue, S.J. MinogueSearch for more papers by this author S.J. Minogue, S.J. MinogueSearch for more papers by this author First published: September‐December 1953 https://doi.org/10.1111/j.1440-1630.1953.tb00054.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume1, Issue6September‐December 1953Pages 204-210 RelatedInformation

William James’s “Sick-Minded Soul” and the AA Recovery Paradigm: Time for a Reappraisal

This article focuses on William James’s influence on Alcoholics Anonymous (AA), which arose 25 years after his death to dominate alcoholism treatment ever since as a lay organization. With its early leaders admiringly referring to James as AA’s “cofounder,” AA and the numerous 12-step programs it has spawned have generally enjoyed a favorable reputation among humanistic psychologists. However, the authors regard this reputation as reflexive and largely undeserved, rather than critically generated. For essentially AA’s originators selected and promulgated one particular paradigm in James’s multiarrayed approach to alcoholism—the “self-surrender of the sick-minded soul”—to the exclusion of all others. In this paradigm, the addicted individual descends into a state of utter despair and then experiences an epiphany leading to self-transformation. However, James never regarded this state—which Maslow later called the “nadir-experience”—as the only means to addiction recovery, but rather advocated a diversity of paths, reflecting the variability of human personality. In celebrating this centennial year James’s enduring legacy, it is time for humanistic clinicians to take the lead in moving beyond AA’s outmoded, “one-size-fits-all” approach to addiction recovery.

Poster Abstracts from the AAAP 20th Annual Meeting and Symposium

Poster Abstracts from the AAAP 20th Annual Meeting and Symposium

News and Notes

News and Notes

Negative Affect, Relapse, and Alcoholics Anonymous (AA): Does AA Work by Reducing Anger?

Anger and other indices of negative affect have been implicated in a stress-induced pathway to relapse. The Alcoholics Anonymous (AA) literature states that reduction of anger is critical to recovery, yet this proposed mechanism has rarely been investigated. Using lagged, controlled hierarchical linear modeling analyses, this study investigated whether AA attendance mobilized changes in anger and whether such changes explained AA-related benefit. Alcohol-dependent adults (N = 1,706) receiving treatment as part of a clinical trial were assessed at intake and at 3, 6, 9, 12, and 15 months. Findings revealed substantially elevated levels of anger compared with the general population (98th percentile) that decreased over 15-month follow-up but remained high (89th percentile). AA attendance was associated with better drinking outcomes, and higher levels of anger were associated with heavier drinking. However, AA attendance was unrelated to changes in anger. Although support was not found for anger as a mediator, there was strong convergence between AA's explicit emphasis on anger and the present findings: Anger appears to be a serious, enduring problem related to relapse and heavy alcohol consumption. Methodological factors may have contributed to the lack of association between AA and anger, but results suggest that AA attendance alone may be insufficient to alleviate the suffering and alcohol-related risks specifically associated with anger.

12-Step Therapy and Women with and without Social Phobia: A Study of the Effectiveness of 12-Step Therapy to Facilitate Alcoholics Anonymous Engagement

Alcoholism treatment often encourages involvement in Alcoholics Anonymous (AA). Little provision is made for women with social phobia (SP), who have been reported to have worse outcomes in 12-step facilitation (TSF) relative to cognitive behavioral therapy. This study examined whether SP moderated the effects of gender for these women in TSF. One hundred thirty-three SP alcoholics assigned to TSF (35 females and 98 males) in Project MATCH were compared to a no-SP control group. SP women drank earlier and more intensely than no-SP women and all males, had equivalent completion of Step 5, and were less likely to acquire a sponsor during TSF.

Can 12-step group participation strengthen and extend the benefits of adolescent addiction treatment? A prospective analysis

Background Despite advances in the development of treatments for adolescents with substance use disorders (SUD), relapse remains common following an index treatment episode. Community continuing care resources, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), have been shown to be helpful and cost-effective recovery resources among adults. However, little is known about the clinical utility and effectiveness of AA/NA for adolescents, despite widespread treatment referrals. Method Adolescents ( N = 127; 24% female, 87% White, M age = 16.7 years) enrolled in a naturalistic, prospective study of community outpatient treatment were assessed at intake, and 3 and 6 months later using a battery of standardized and validated measures. Results Just over one-quarter of youth attended AA/NA meetings during the first 3 months, which was predicted by a goal of abstinence, prior AA/NA attendance, and prior SUD treatment experiences. Controlled multiple regression analyses revealed an independent effect of AA/NA on abstinence, in both contemporaneous and lagged models, which persisted over and above the effects of pre-treatment AA/NA attendance, prior treatment, self-efficacy, abstinence goal, and concomitant outpatient treatment. Conclusions Results suggest that, similar to findings comparing adult outpatients to inpatients, AA/NA participation is less common among less severe adolescent outpatients. Nonetheless, attendance appears to strengthen and extend the benefits of typical community outpatient treatment. Given the dramatic increase in rates of substance use among same-aged peers in the population at this life-stage, and the relative dearth of abstainers and recovery-specific supports, these resources may provide a concentrated cost-effective social recovery resource for young people.

Does the severity of the neurobehavioral effects of traumatic brain injury affect caregiver perceptions of discrimination?

Several pilot studies have provided evidence supporting the potential of classic psychedelics like psilocybin in the treatment of substance use disorders (SUDs). If larger trials confirm efficacy, classic psychedelic-assisted psychotherapy may eventually be integrated into existing addiction treatments such as cognitive behavioral therapy, contingency management, and medication-assisted therapies. Many individuals seeking treatment for SUDs also join twelve-step facilitation (TSF) programs like Alcoholics Anonymous (AA), which are among the most widely available and accessed treatments for alcohol use disorder worldwide. For such individuals, engaging in classic psychedelic-assisted psychotherapy could be seen as controversial, as members of AA/TSF programs have historically rejected medication-assisted treatments in favor of a pharmacotherapy-free approach. We argue that classic psychedelics and the subjective experiences they elicit may represent a special, more compatible case than conventional medications. In support of this claim, we describe Bill Wilson's (the founder of AA) little known experiences with psychedelics and on this basis, we argue that aspects of classic psychedelic treatments could complement AA/TSF programs. We provide a review of clinical trials evaluating psychedelics in the context of SUDs and discuss their potential large-scale impact should they be ultimately integrated into AA/TSF.

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

ABSTRACTRationale Indices of negative affect, such as depression, have been implicated in stress‐induced pathways to alcohol relapse. Empirically supported continuing care resources, such as Alcoholics Anonymous (AA), emphasize reducing negative affect to reduce relapse risk, but little research has been conducted to examine putative affective mechanisms of AA's effects.Methods Using lagged, controlled, hierarchical linear modeling and mediational analyses this study investigated whether AA participation mobilized changes in depression symptoms and whether such changes explained subsequent reductions in alcohol use. Alcohol‐dependent adults (n = 1706), receiving treatment as part of a clinical trial, were assessed at intake, 3, 6, 9, 12 and 15 months.Results Findings revealed elevated levels of depression compared to the general population, which decreased during treatment and then remained stable over follow‐up. Greater AA attendance was associated with better subsequent alcohol use outcomes and decreased depression. Greater depression was associated with heavier and more frequent drinking. Lagged mediation analyses revealed that the effects of AA on alcohol use was mediated partially by reductions in depression symptoms. However, this salutary effect on depression itself appeared to be explained by AA's proximal effect on reducing concurrent drinking.Conclusions AA attendance was associated both concurrently and predictively with improved alcohol outcomes. Although AA attendance was associated additionally with subsequent improvements in depression, it did not predict such improvements over and above concurrent alcohol use. AA appears to lead both to improvements in alcohol use and psychological and emotional wellbeing which, in turn, may reinforce further abstinence and recovery‐related change.