Research on Alcoholics Anonymous and Spirituality in Addiction Recovery (eBook)

Preface I From the President of the American Society for Addiction Medicine 7
Preface II From the President of the Research Society on Alcoholism 9
Contributors 11
Contents 15
The Twelve-Step Program 26
Introduction: The Twelve-Step Program Model of AA 27
References 32
The Twelve-Step Recovery Model of AA: A Voluntary Mutual Help Association 33
1. Essentials of Self-Help/Mutual Aid 34
2. Methodologies and Frameworks of Social Science 35
3. Recovery 37
3.1. Basic Beliefs About Alcoholism 38
3.2. Becoming Abstinent 38
3.3. Identity Changes: From Drinking Nonalcoholic to Recovering Alcoholic 39
3.4. Practicing the Program 42
3.5. Long-Term Recovery 46
4. Service 47
5. Unity 49
5.1. Groups and Their Meetings 50
5.2. Fellowship 52
5.3. Principles of Organization: Traditions and Concepts 53
6. Conclusion 54
References 56
Twelve Defining Moments in the History of Alcoholics Anonymous 60
1. Introduction 60
2. Jung's Refusal 62
3. A "Hot Flash" and Failed Evangelism 64
4. Panic at the Mayflower Hotel 65
5. Professionalism: AA's First Temptation 66
6. Who Can Be an AA Member? 67
7. A RichMan'sWarning About Money 68
8. The Split from the Oxford Group 68
9. "Here Are the StepsWe Took. . .” 69
10. Growing Pains 71
11. AA and the Business of Alcoholism Treatment 71
12. The NCEA Affair 74
13. "Bill's Damned Traditions" 75
14. Alcoholics Anonymous and Alcoholism Treatment: Separate and Distinct 76
References 78
The Impact of AA on Professional Treatment 81
1. The Integration of AA into Professional Treatment 81
2. How the Twelve Steps Are Applied in Treatment 83
3. Effectiveness of Twelve-Step-Based Professional Care 85
4. AA's Role Following Treatment 88
5. Summary 89
References 90
The Impact of Alcoholics Anonymous on Other Substance Abuse- Related Twelve- Step Programs 93
1. Introduction 93
2. Twelve-Step Fellowships Focusing on Recovery from Drug Dependence 94
2.1. Narcotics Anonymous (NA) 95
2.2. Other Drug-Related Twelve-Step Recovery Fellowships 96
2.3. Twelve-Step Addiction Recovery Fellowships for Special Populations 97
3. Similarities and Differences Between AA and Drug-Recovery Fellowships 100
3.1. Meeting Format 100
3.2. Recovery Program 101
3.3. Membership and Organizational Structure 101
3.4. Characteristic of Membership in Twelve-Step Recovery Fellowships for Alcohol and Drug Dependence 102
4. Utilization of and Experiences with Drug Recovery Twelve-Step Fellowships Among Drug- Dependent Populations 104
5. Conclusions and Future Directions 107
Appendix 108
References 109
The Impact of AA on Non- Professional Substance Abuse Recovery Programs and Sober Living Houses 112
1. Introduction 113
2. Social Model Recovery 114
2.1. Paucity of Published Literature 116
3. Types of Social Model Recovery Programs 116
3.1. Neighborhood Recovery Centers 116
3.2. Residential Social Model Recovery Programs 117
4. Sober Living Houses 119
4.1. History of California Sober Living Houses 120
4.2. Contemporary California Sober Living Houses 121
4.3. Oxford Houses 123
4.4. Outcome Studies on Sober Living Houses 124
5. Conclusion 127
References 127
Spiritually Oriented Recovery 130
An Overview of Spirituality in AA ( and Recovery) 131
1. Spirituality and AA 131
2. The Chapters, in Brief 132
3. Common Themes 135
4. Applications: Cautions 138
References 142
The Concept of Spirituality in Relation to Addiction Recovery and General Psychiatry 144
1. The Concept of Spirituality 145
2. Some Physiologic Issues 146
3. Sociobiology 147
4. The Culture of Psychiatry and Psychology 148
4.1. The Placebo Response 149
4.2. Current Practice 150
5. Problems with Spirituality 151
6. Treatment Issues 152
6.1. Personal Meaning in Therapy 152
6.2. Meditation 153
7. Alcoholics Anonymous 153
7.1. AA in the Professional Context 154
References 155
Kickbacks from Helping Others: Health and Recovery 160
1. Introduction 161
2. AA's Approach to Helping 162
3. Research on Helping in the General Population 164
4. Research on Helping and Recovery 167
4.1. Helping in Group Therapy and Mutual Help Groups 167
4.2. Helping and Recovery from Substance Abuse and Dependency 170
5. Helping Can Hurt (and Other Important Cautions) 174
6. Implications 181
References 182
Issues in Measuring Spirituality and Religiousness in Alcohol Research 186
1. Definitions of Spirituality and Religiousness 186
1.1. Some Definitions of Spirituality and Religion/Religiousness 187
1.2. Distinguishing Between Spirituality and Religiousness 188
1.3. Dimensions of Spirituality and Religiousness 189
2. Other Measurement Issues 190
2.1. Measuring Single vs. Multiple Dimensions 190
2.2. Reliance on Self-Report 191
2.3. Potential Confounding with Third Variables 192
2.4. Cultural Issues 192
3. Measures of Spirituality and Religiousness 192
3.1. Resources 192
3.2. Measures of Religiousness 193
3.3. Measures of Spiritual and Religious Experience 195
3.4. Measures of Spiritual and Religious Struggles 197
3.5. Measures of Meaning 198
4. Conclusions 200
References 201
Spirituality and Health: Empirically Based Reflections on Recovery 206
1. Introduction 207
2. Empirical Review of Spirituality andMental Health Literature 209
2.1. Depression 209
2.2. Anxiety 210
2.3. Suicide 211
2.4. Guilt 211
2.5. Positive Emotions 212
2.6. Religious Coping 213
2.7. Summary of Empirical Research 214
3. ExplanatoryMechanisms: Spirituality, Health, and Recovery in AA 214
3.1. Social Support 214
3.2. Community in Alcoholics Anonymous 215
3.3. Framework for Meaning-Making and Purpose 217
3.4. Narrative Framework for Meaning-Making in AA 218
3.5. Psychological Coping Resource and Active Surrender 219
3.6. Control and Surrender in AA 220
3.7. Prescribed Lifestyle Behaviors: Altruism and Forgiveness 221
3.8. Prescribed Altruistic Behavior in AA 222
4. Summary and Conclusions 223
References 224
Spiritual Change in Recovery 228
1. Introduction 228
2. Defining Spirituality 229
3. Alcoholism as a Spiritual Disease 230
4. Spirituality and AA 230
4.1. Distinguishing the Program and the Fellowship 230
4.2. Spiritual Beliefs in AA 231
4.3. The Practice of Spirituality in AA 234
4.4. Subjective Experiences of Spirituality in AA 236
4.5. Spiritual Awakening 238
5. Changes in Spirituality over the Course of Recovery 239
5.1. AA Activities in Relation to Spirituality and Outcome 240
5.2. Changes in Spirituality in Recovery 241
6. Conclusions 243
References 244
Mindfulness and Addiction 247
1. Introduction 247
2. Mindfulness and Addiction: History and Definitions 248
2.1. Definitions of Mindfulness 248
2.2. Mindfulness and Addiction 248
3. Mechanisms of Action 249
3.1. Examining Mindfulness Utilizing Three Different Models 249
3.2. From a Neurological Perspective 250
3.3. Active Ingredients in Mindfulness Meditation 251
4. Clinical Applications 253
4.1. Applications in Three Different Settings 253
4.2. Applications in Addiction Research 253
5. Mindfulness Meditation and Substance Use in an Incarcerated Population 254
6. Mindfulness-Based Relapse Prevention Study 254
7. Mindfulness Meditation and Twelve Steps 256
7.1. "Pure" Buddhist Meditation and Twelve Steps 256
7.2. Secular Mindfulness and Alcoholics Anonymous 258
8. Future Direction 262
9. A Case Study 263
References 265
Twelve-Step Membership 269
Introduction 270
References 275
Epidemiology of Alcoholics Anonymous Participation 277
1. Introduction 277
2. Methods 280
2.1. AA Membership Surveys 280
2.2. National Alcohol Surveys (NAS) 280
2.3. NIAAA's National Epidemiological Survey on Alcoholism and Related Conditions ( NESARC) 282
2.4. Epidemiological Laboratory (EpiLab) Longitudinal Treatment Surveys 283
3. Results 284
3.1. Trends in AA Membership Based on the AA Membership Surveys (Table 1) 284
3.2. Trends in AA Membership Based on National Alcohol Surveys ( Table 2) 285
3.3. AA Engagement and Disengagement Profiles Based on NESARC ( Table 3) 286
3.4. Patterns of AA Exposure over Time Based on the EpiLab Longitudinal Treatment Surveys 287
4. Discussion 290
4.1. Demographics of AA Exposure 291
4.2. Specialty Treatment and AA 292
4.3. Abstinence and AA 294
5. Summary 296
References 297
Concerns About Dose and Underutilization of Twelve-Step Programs: Models, Scales, and Theory that Inform Treatment Planning 299
1. Introduction 300
2. Literature Review 301
3. Scales Predicting TS Program Underutilization 304
3.1. Survey of Readiness for AA Participation (SYRAAP) 305
3.2. TS Ambivalence Scale (TSAS) 305
3.3. The TS Participation Expectancies Questionnaire (TSPEQ) 306
3.4. Negative Aspects of TS Group Scale (NATSGS) 307
3.5. Content Analysis of Subscale Domains 308
4. Theories Used to Explain Dose 308
4.1. Health Seeking Explained Using the Health Belief Model 308
4.2. Motivation and Self-Determination Theory 309
4.3. Person-in-Organizational Culture Fit Theory 310
4.4. An Integrated Theory of Attendance 311
5. Discussion 312
References 313
Facilitating Involvement in Twelve- Step Programs 318
1. Role of Twelve-Step Self-Help Groups in Substance Abuse Treatment and Recovery 319
2. Effectiveness/Efficacy of Twelve-Step Self-Help Groups 319
3. Twelve-Step Meeting Attendance vs. Engagement in Twelve- Step Activities 320
4. Low Rates of Twelve-Step Attendance and Involvement Following Treatment as Usual 321
5. Methods of Facilitating Twelve-Step Involvement 322
5.1. General Facilitation Through Program Orientation 322
5.2. Specific Facilitation Through Targeted Interventions 323
6. Summary and Conclusions 330
References 331
Twelve-Step Facilitation in Non- specialty Settings 336
1. Introduction 337
2. Alcoholics Anonymous 339
2.1. Brief AA History and Origins 339
2.2. How Are Patients Likely to Benefit from AA Participation? 341
2.3. The Twelve Steps 342
2.4. The Twelve Traditions 346
2.5. AA Meetings 347
2.6. Sponsorship and Fellowship 349
2.7. Concept of Higher Power 350
2.8. Slogans 351
2.9. Service 352
2.10. Literature 352
3. Twelve-Step Facilitation (TSF) 353
3.1. TSF Clinical Strategies 354
3.2. Possible Patient and Clinician Barriers to TSF 356
4. Summary and Conclusions 357
References 358
Effectiveness and Outcome Research 362
Introduction 363
1. AA Outcomes Overview 363
References 367
Alcoholics Anonymous Outcomes and Benefits 370
1. Introduction 370
2. Three Eras of AA-Related Outcome Studies 372
3. Empirical-Based Review of AA Effectiveness 374
3.1. Early AA Studies 374
3.2. Maturing AA Studies 1989-2001 376
3.3. Secondary Measures of AA Outcome 379
4. Conclusions 382
References 383
Outcomes of AA for Special Populations 386
1. What Are Special Populations? 386
2. Why Should We Study AA Outcomes in Special Populations? 387
3. Outcomes of AA forWomen 388
4. Outcomes of AA for Youth 389
5. Outcomes of AA for Older People 391
6. AA Outcomes for Racial and Ethnic Groups 392
6.1. African-Americans 392
6.2. American Indians 393
6.3. Hispanics 394
7. AA Outcomes for Disabled Groups 395
7.1. Cognitive Impairment 395
8. AA Outcomes for Individuals with Dual Substance Use and Psychiatric Disorders 396
9. Summary and Directions for Future Research 400
References 402
How and Why Twelve-Step Self-Help Groups Are Effective 406
1. Participation in Self-Help Groups and Substance Use Outcomes 407
1.1. Attendance and Substance Use Outcomes 407
1.2. Involvement and Substance Use Outcomes 408
2. Theory-Based Explanations of Self-Help Group Outcomes 409
2.1. Social Control Theory 409
2.2. Social Learning Theory 410
2.3. Behavioral Economics or Behavioral Choice Theory 410
2.4. Stress and Coping Theory 410
3. Probable Active Ingredients of Self-Help Groups 411
3.1. Support, Goal Direction, and Structure 412
3.2. Abstinence-Oriented Norms and Role Models 413
3.3. Engagement in Rewarding Activities 414
3.4. Building Self-Efficacy and Coping Skills 415
4. Probable Active Ingredients of Effective Psychosocial Treatments 416
4.1. Support, Goal Direction, and Structure 417
4.2. Abstinence-Oriented Norms and Role Models 418
4.3. Engagement in Rewarding Activities 418
4.4. Building Self-Efficacy and Coping Skills 418
5. Conclusions and Future Directions 419
5.1. Personal Factors that Moderate Active Ingredients 419
5.2. Active Ingredients of SHGs and Treatment 420
5.3. Potential Detrimental Effects of Active Ingredients 420
5.4. Active Ingredients and Other Aspects of the Recovery Milieu 421
References 422
Individual and Contextual Factors That Influence AA Affiliation and Outcomes 426
1. Introduction 426
1.1. Scope of the Chapter 426
1.2. Methodological Issues 426
2. Factors Affecting AA Affiliation and Outcomes Related to AA Affiliation 428
2.1. Religiosity and Spirituality 428
2.2. Age 429
2.3. Gender 430
2.4. Sexual Orientation 430
2.5. History, Type, and Setting of Treatment 431
2.6. Legal Status 432
2.7. Ethnicity 432
2.8. Severity 434
2.9. Cognitive Impairment 435
2.10. Comorbidity (Psychiatric and Substance Use) 435
2.11. Personality 437
2.12. Social Support 438
2.13. Socioeconomic Status 438
2.14. Motivation 439
2.15. Pattern of Affiliation 439
3. Unanswered Questions 440
References 441
Index 447