Is alcoholism typology a predictor of both Alcoholics Anonymous affiliation and disaffiliation after treatment?

Department of Psychology, University of New Mexico, Albuquerque, New Mexico, United States
Journal of Substance Abuse Treatment (Impact Factor: 3.14). 07/2006; 30(4):323-30. DOI: 10.1016/j.jsat.2006.02.008
Source: PubMed


Twelve Steps (TS) has demonstrated effectiveness; induction into Alcoholics Anonymous (AA) is a primary objective of TS and is a pivotal mechanism explaining its effectiveness. However, evidence suggests that, after treatment, dropout from AA is high. This study investigated whether alcohol problem severity predicted both AA affiliation and disaffiliation among clients receiving TS. This study of a Project MATCH sample included 453 alcohol-dependent clients randomly assigned to TS who reported AA attendance during treatment. Greater alcohol problem severity predicted AA attendance; opposite to prediction, less alcohol-impaired clients were more than twice as likely to discontinue AA attendance after treatment. When sustained AA attendance is desired, the evaluation of client pretreatment alcohol involvement may be useful for identifying potential AA dropout after TS treatment. Findings also indicate that, among treatment-seeking problem drinkers, AA dropout and disaffiliation are distinct, albeit correlated, constructs that require future investigation.

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    • "Few consistent predictors of affi liation with 12-step organizations have been identifi ed. The most robust fi nding has been the positive association between alcohol problem severity and group engagement: greater alcohol problem severity predicted both initiation of group affi liation (Emrick et al., 1993; Tonigan et al., 2006) and lower rates of dropout (Tonigan et al., 2006). Demographic characteristics, on the other hand, consistently proved to be poor predictors of attendance: similar rates of affi liation and attendance were found between treatment-seeking adults and adolescents referred to 12-step groups (Kelly et al., 2010a), between men and women (Hillhouse and Fiorentine, 2001; Witbrodt and Romelsjö, 2010), and among ethnic and economic groups (Hillhouse and Fiorentine, 2001; Tonigan et al., 1998). "
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    ABSTRACT: Researchers have observed that a majority of addicted persons who are encouraged and facilitated by treatment providers to attend twelve-step (TS) programs either drop out or sporadically use twelve-step programs following treatment. This is troubling given considerable evidence of TS program benefits associated with regular weekly attendance and ubiquitous reliance by treatment professionals on these programs to provide important support services. This chapter reviews and advances theory of TS utilization and dose that is supported by prior research, multivariate models, and scales that predict risk of TS meeting underutilization. Advancing theory should organize and clarify the process of initial utilization, guide intervention development, and improve adherence of TS program referrals, all of which should lead to improved treatment planning and better outcomes. Three theories are integrated to explain processes that may influence TS program dose: the health belief model, self-determination theory (motivational theory), and a person-in-organization cultural fit theory. Four multidimensional scales developed specifically to predict participation are described. Implications for practice and future research are considered in a final discussion. Information contained in this chapter raises awareness of the need for TS-focused treatments to focus on achieving weekly attendance during and after treatment.
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