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A pilot study: Locus of control and spiritual beliefs in alcoholics anonymous and smart recovery members

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Abstract

To investigate whether Alcoholics Anonymous' (AA's) "higher power" concept encourages externally dependent behavior, this pilot study tested whether AA and Self Management and Recovery Training (SR) members are equal on measures of external locus of control. The AA sample (N = 48) and SR sample (N = 33) were similar in age, gender, and education levels, and both required a minimum of 8 weeks group involvement. A modified spiritual beliefs questionnaire (SBQ) was first administered to each sample to compare them on spiritual beliefs, and the drinking-related locus of control scale (DRIE) was then conducted to compare each sample on locus of control. Significant differences were found between both samples on five out of seven spiritual measures, with the AA group scoring consistently higher on these factors (p < .01). In addition, the AA sample was significantly more external on the DRIE scale than the SR sample (p = .00003). These findings suggest that AA members are generally more spiritually oriented and exhibit greater external locus of control relative to SR members. Future controlled trials are necessary to confirm whether these results are caused by particular programs or primarily due to a self-selective process.

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... The earliest of these studies is a national survey of 433 RRS attendees (Galanter et al., 1993), which found that respondents were mostly college-educated males in their 40s who were seeking help for an alcohol problem. A much smaller study of SMART Recovery found a very similar member profile (67% male; M age = 46; 82% had a college or graduate degree; Li, Feifer, & Strohm, 2000). The 2010 SMART Recovery participant survey (N = 444) also found that two thirds of participants were male. ...
... There is preliminary evidence that internal locus of control is predictive of participation in SMART Recovery (Li et al., 2000). When such individuals look to their futures, they perceive addictive behavior as an issue they can manage by learning new ideas and techniques and practicing them sufficiently until the goal is accomplished. ...
... Little is known from an empirical perspective about the potential benefits of attending SMART Recovery meetings or the mechanisms through which involvement in the organization may exert its beneficial effects. Of the existing research, two cross-sectional, survey-based studies have examined characteristics of SMART Recovery members (e.g., religiosity, locus of control) relative to members of other mutual-help organizations, such as Alcoholics Anonymous (AA; Atkins & Hawdon, 2007;Li et al., 2000). One of these studies (Atkins & Hawdon) found a positive relationship between the extent of participation in mutual-help groups, including SMART Recovery, and the duration of continuous abstinence. ...
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Self-Management and Recovery Training (SMART Recovery) is an international nonprofit organization that provides free, self-empowering, science-based mutual aid groups for abstaining from any substance or activity addiction. This article summarizes the development of the organization, the current status of face-to-face and online meetings, the characteristics of participants, the nature of the SMART Recovery approach to recovery (i.e., the intersection of what is self-empowering, evidence-based, and likely to be of use in a mutual aid group facilitated by a nonprofessional volunteer), the limited evidence of effectiveness currently available, and some of the prominent questions in need of investigation about SMART Recovery.
... A few studies (Horvath & Velten, 2000;Humphreys et al., 2004) have focused on explaining the program's philosophy and providing conceptual support for the program. Li, Feifer, and Strohm (2000) highlighted philosophical differences between SMART Recovery members when compared with members of AA. Results indicated that individuals in SMART Recovery demonstrated more of an internal locus of control and less dependence on a higher power when it came to regulating drinking (or drug)-related behaviors compared with 12-step members. Hester, Lenberg, Campbell, and Delaney (2013) found that individuals who attended SMART Recovery meetings, and Overcoming Addictions (a web application based on the SMART Recovery program), demonstrated an increase in percentage of days abstinent, reduction in substance related issues, and a reduction in drinks per drinking day. ...
... Belief in a higher power was ranked as the least important recovery goal by members. This finding is congruent with prior research findings indicating far fewer SMART members identified as being spiritual compared with AA members (Li et al., 2000). The rank ordering of recovery goals is aligned with the members' response themes and quotes, which reflected a preference for cognitive approaches over spiritual ones, and a preference for the structure and format of SMART meetings. ...
Article
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Peer support groups are the most utilized form of treatment for individuals recovering from substance abuse and substance dependence. This study examined an understudied peer support program (Self-Management and Recovery Training [SMART] Recovery), which is distinct from traditional 12-step models. Although treatment planning for substance use disorders is not the primary focus of vocational rehabilitation (VR), persons with disabilities are at increased risk for these disorders. Due to the bio-psycho-social nature of substance use disorders, VR counselors must consider ethical treatment recommendations for clients who demonstrate need for supplemental treatment. This descriptive-survey study investigated two samples of member and facilitator characteristics, motivations, and recovery goals among the SMART Recovery community. Implications for VR counselors making best practice recommendations for clients with substance use disorders are discussed.
... Feasibility tended to be indexed by attendance, including the number of sessions (Hester et al., 2013), duration of involvement (Brooks & Penn, 2003/ Penn & Brooks, 2000Kelly et al., 2015;Li et al., 2000;Milin et al., 2007;O Sullivan et al., 2015) and proportion of participants accessing different types of mutual aid (Blatch et al.,2016). No studies assessed economic outcomes. ...
... Further research is needed to clarify not only whether an 'optimal' threshold of attendance exists, but to identify the factors involved in engaging participants and encouraging attendance. Interestingly, despite largely comparable addiction related outcomes, current findings suggest that the duration of attendance may be shorter for SMART Recovery relative to 12-step participants (Brooks & Penn, 2003/ Penn & Brooks, 2000Li, Feifer & Strohm, 2000;Milin, 2007). Although clearly in need of further investigation, this may be testimony to the feasibility of the SMART Recovery approach. ...
Article
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Clinical guidelines recommend Self-Management and Recovery Training (SMART Recovery) and 12-step models of mutual aid as important sources of long-term support for addiction recovery. Methodologically rigorous reviews of the efficacy and potential mechanisms of change are available for the predominant 12-step approach. A similarly rigorous exploration of SMART Recovery has yet to be undertaken. We aim to address this gap by providing a systematic overview of the evidence for SMART Recovery in adults with problematic alcohol, substance, and/or behavioral addiction, including (i) a commentary on outcomes assessed, process variables, feasibility, current understanding of mental health outcomes, and (ii) a critical evaluation of the methodology. We searched six electronic peer-reviewed and four gray literature databases for English-language SMART Recovery literature. Articles were classified, assessed against standardized criteria, and checked by an independent assessor. Twelve studies (including three evaluations of effectiveness) were identified. Alcohol-related outcomes were the primary focus. Standardized assessment of nonalcohol substance use was infrequent. Information about behavioral addiction was restricted to limited prevalence data. Functional outcomes were rarely reported. Feasibility was largely indexed by attendance. Economic analysis has not been undertaken. Little is known about the variables that may influence treatment outcome, but attendance represents a potential candidate. Assessment and reporting of mental health status was poor. Although positive effects were found, the modest sample and diversity of methods prevent us from making conclusive remarks about efficacy. Further research is needed to understand the clinical and public health utility of SMART as a viable recovery support option.
... In a pilot study exploring the locus of control (the degree to which an individual attributes their success or failures to individual behavior) at AA and SMART recovery, Li, Feifer, and Strohm (2000) found significant differences between AA (n = 48) and SMART recovery participants (n = 33). Li et al. found that AA attendees exhibited significantly greater external locus of control (p < .00003) ...
... The quantitative studies demonstrate a strong body of evidence to suggest that attendance and involvement at conveniently located AA (and possibly "non-AA") SHGs are associated with greater levels of abstinence. However, the findings should be treated with caution, as no study demonstrates a direct causal link with recovery and several studies (Curzio et al., 2012;Galanter et al., 1993;Li et al., 2000;McBride, 1991;Sheeran, 1988;Snow et al., 1994) were cross-sectional and therefore unable to detect any change over time. ...
Article
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The aim of this literature review was to scope and present evidence on self-help groups (SHGs) that aim to facilitate recovery from alcohol addiction. A three-fold search strategy was deployed. Within the 25 identified quantitative studies, three themes were identified: attendance, involvement, and location, each of which impacted on recovery. Nine qualitative studies were also identified, and five of these focused on Alcoholics Anonymous. This international review of SHGs in recovery from alcohol dependency demonstrates that they are an important and effective component of recovery. However, this review demonstrates that more research is needed into “non-AA, non-12-step”-affiliated SHGs.
... Many, including patients, think that spirituality should play a large role in cessation programs ( Arnold et al. 2002;Dermatis et al. 2004). Indeed, spirituality already permeates many established programs such as Alcoholics Anonymous (AA) (Brush and McGee 2000;Forcehimes 2004;Li, Feifer, and Strohm 2000;Moriarity 2001). Studies have suggested that religious and spiritual practices may aid recovery (Aron and Aron 1980;Avants, Warburton, and Margolin 2001;Carter 1998). ...
Article
,The study of the relationship between religion and health has grown substantially in the past decade. There is little doubt that religion plays an important role in many people’s lives and that this has an impact on their health. The question is how researchers and clinicians can best evaluate the available information and how we can improve upon the current findings. In this essay we review the cur- rent knowledge,regarding religion and health and also critically re- view issues pertaining to methodology, findings, and interpretation ofthese studies. It is important to maintain,a rigorous perspective with regard to such studies and also to recognize inherent limitations and suggest constructive ways in which to advance this field of study. In the end, such an approach can provide new information that will improve our understanding of the overall relationship between reli- gion and health. Keywords:,health; methodology; religion; spirituality. The relationship between religion and health care has cycled between co-
... CSARS Group develops community-based projects planned to confirm that the Higher Power Project research and other research results are conveyed to the occupations involved in the dealing of addiction and to people in quest of recovery. This study supported by The Higher Power Project and North Wales Recovery Community-Penrhyn House (NWRC) in partnership with local agencies and with the cooperation of Alcoholics Anonymous (Alcoholics-Anonymous, 2014), Narcotics Anonymous (Narcotics Anonymous, 2018) and SMART Recovery (Li, Feifer, & Strohm, 2000;Horvath & Velten, 2000). The projects provide a framework, support and knowledge to volunteer participants wanting to try to achieve abstinencebased recovery through 13 weekly group sessions. ...
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This paper examines the role of spirituality in a recovery context by drawing on qualitative research conducted at a residential recovery community in North Wales, United Kingdom. The study aimed to examine perceptions of spirituality among exprisoners and people identifying as in recovery from addiction. The researchers explored ideas of “spiritual coping” and “spiritual wellbeing” in terms of meaning, purpose, connectedness, forgiveness, and peace in addiction treatment programs influenced by 12-Step models, for instance, Alcoholics Anonymous (AA). Also, this paper focuses on both spiritual counseling services shaped by pre-determined meanings and values and secondly, on individuals’ perceptions about spirituality through the language of desires, needs, and expectations. The data for this research produced from five semi-structured interviews with male individuals who had recovered from their addiction and had practised some custodial life. To discover the common context of different perceptions of the language spirituality, the data was coded by the first and second loop encodings from the data analysis methods used. The central schemes that appear as “Spirituality in Experiences, Spirituality in Values, Spirituality as Meaning/Purpose of Life, Spirituality as Attachment, Spirituality as Coping Mechanism” have been evaluated within the framework of the concept of spirituality. In the conclusion of this study, it was observed that spirituality was used as a coping mechanism for buffering the sensation of hopelessness and powerlessness often experienced by people in active addiction.
... Research on the effectiveness of SMART Recovery is limited. Two cross-sectional survey studies examined characteristics of SMART Recovery members (e.g., religiosity, locus of control) relative to members of other mutual-help organizations, such as AA (Atkins & Hawdon, 2007;Li, Feifer, & Strohm, 2000). One of these studies (Atkins & Hawdon) found a significant relationship between the duration of continuous abstinence and the extent of participation in mutual-help groups, which included SMART Recovery. ...
Article
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Peer-led mutual-help organizations addressing substance use disorder (SUD) and related problems have had a long history in the United States. The modern epoch of addiction mutual help began in the postprohibition era of the 1930s with the birth of Alcoholics Anonymous (AA). Growing from 2 members to 2 million members, AA's reach and influence has drawn much public health attention as well as increasingly rigorous scientific investigation into its benefits and mechanisms. In turn, AA's growth and success have spurred the development of myriad additional mutual-help organizations. These alternatives may confer similar benefits to those found in studies of AA but have received only peripheral attention. Due to the prodigious economic, social, and medical burden attributable to substance-related problems and the diverse experiences and preferences of those attempting to recover from SUD, there is potentially immense value in societies maintaining and supporting the growth of a diverse array of mutual-help options. This article presents a concise overview of the origins, size, and state of the science on several of the largest of these alternative additional mutual-help organizations in an attempt to raise further awareness and help broaden the base of addiction mutual help.
... Given the historical S/R foundations of AA, it is perhaps not surprising that S/R variables have been shown to be associated with 12-Step attendance and involvement (Atkins & Hawdon, 2007;Kelly, Pagano, Stout, & Johnson, 2011;Kelly, Stout, Zywiak, & Schneider, 2006). Research has examined spirituality in differing mutual aid organizations and suggests AA members have more spiritual beliefs compared to members of a more secular cognitive behaviorally-oriented organization, SMART Recovery (Self-Management and Recovery Training) (Ellis & Velten, 1992;Li, Feifer, & Strohm, 2000). Atkins and Hawdon (2007) used national survey data comprising 927 MHO attendees to examine the role of religiosity and participation in MHOs on substance use outcomes. ...
Article
Alcoholics Anonymous (AA) is based on a spiritual program of action. In keeping with AA's spiritually based recovery theory, rigorous studies have revealed that spirituality may be one of the mechanisms through which AA aids recovery. A question that has lingered, however, is how exactly does an increase in spiritual beliefs and practices translate into more abstinence and remission? To help answer this question, this article reviews theory and research related to AA and spirituality as a mechanism of behavior change and offers five possible psychological pathways that may help explain how increases in spirituality may translate into enhanced abstinence and remission rates.
... The limited research to date has largely focused on comparisons between 12-step approaches and SMART Recovery. This research has included examining between group differences on specific variables such as religiosity, spiritual beliefs and locus of control (Atkins & Hawdon, 2007;Li, Feifer, & Strohm, 2000). Additionally, one study compared outcomes for people diagnosed with a co-occurring mental illness who were alternatively assigned to SMART Recovery groups or 12-step groups (Brooks & Penn, 2003). ...
Article
SMART Recovery groups are cognitive-behaviorally oriented mutual support groups for individuals with addictions•Participants attending SMART Recovery present with a complex clinical profile, including high rates of self reported co-occurring mental illness.•Participants were more likely to report the use of cognitive restructuring than behavioural activation.•Group cohesion was positively correlated with the use of both cognitive and behavioural skill utilisation by participants attending SMART Recovery
... Others posit that Supreme Beings in various religions are judgmental or punishing (Cotton, Zebracki, Rosenthal, Tsevat, & Drotar, 2006). Additionally, others will argue that overly ritualistic reliance on a Higher Power or religious-type recovery group may, itself, reflect a substitute addiction (Sussman & Black, 2008; Sussman, Reynaud, Aubin, & Leventhal, 2011; Taylor, 2002), or reduction in individual sound judgment or self-reliance (Ellis & Schoenfeld, 1990; Li, Feifer, & Strohm, 2000; Moos, 2010; Nicolaus, 2012). Some also may be uncomfortable in intensive, sometimes distressful spiritual/religious-oriented group experiences, or may feel (or be) rejected by the group for not expressing religious ideation (Galanter, 2006). ...
Article
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Spirituality has long been integrated into treatments for addiction. However, how spirituality differs from other related constructs and implications for recovery among nonspiritual persons remains a source of discussion. This article examines ways in which spirituality is delineated, identifies variables that might mediate the relations between spirituality and recovery from substance abuse disorders, describes distinctions between spiritual and nonspiritual facets of addictions treatment, and suggests means to assist in further clarification of this construct.
... Research indicates that persons affiliated with AA are more externally oriented than clients enrolled in cognitively based programs, like Rational Recovery 23 and Smart Recovery. 24 An even more important question is whether internally and externally oriented individuals experience differential outcomes when enrolled in internally and externally oriented programs. ...
Article
Alcoholics Anonymous (AA) and its professional analog, the Minnesota Model, are often the only options available to persons looking for assistance in overcoming an alcohol abuse problem. Twelve reasons why alternatives to the Twelve Steps must be identified, developed, and implemented are outlined in this article. These reasons include AA's high rate of attrition; views on motivation; religious connotations; external orientation; affiliation with the disease model; emphasis on character defects, powerlessness, loss of control, abstinence, and dependence; labeling practices; and weak operationality. In short, 12-step programs may be inappropriate and ineffective for a certain portion of people who misuse alcohol. Alternatives that more closely approximate the belief systems of clients who find AA principles or practices objectionable are consequently required. Alcoholics Anonymous (AA) was conceived by two individuals within the context of their own personal struggles with alcohol. The self-help format these two individuals invented in 1935 soon catapulted into a social movement with adherents across the globe. As of January 1, 2001, there were 100,766 active chapters of AA with 2,160,013 members worldwide, with 51,735 chapters and 1,162,112 members in the United States alone. 1 While AA does not directly employ the services of mental health professionals, there are professional-led groups and programs that rely extensively on the traditions and steps of AA. The Minnesota Model is an example of a professional-run program allied with AA. 2 In the United States, if not elsewhere, AA and programs affiliated with the Minnesota Model are often the only option available to alcohol-abusing clients. The present article outlines and describes 12 reasons why alternatives to AA and the Minnesota Model must be found if we are to effectively deal with the problem of alcohol abuse in the United States and abroad.
... Individual characteristics. Based on previous reports in the literature, several characteristics appear to be associated with spirituality, including age (Koenig, 1995;Sloan, Bagiella, & Powell, 1999), race/ethnicity (Haight, 1998;Johnson et al., 2000) and treatment exposure (Li, Feifer, & Strohm, 2000). Place of residence was also examined because differences in religious expressions and commitments have been observed in rural and urban areas (Burkhardt, 1989). ...
Article
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This study examines the relationships among spirituality, religiosity, and drug use among incarcerated males. Data were collected from 661 male prison inmates from four Kentucky State Correctional facilities. Spiritual well-being was measured using a modified version of the Spiritual Well-Being Scale (SWBS), and religiosity was measured by worship attendance in the year prior to incarceration. In general, spirituality and religiosity were found to be negatively related to alcohol and drug use, and differed across several individual characteristics that were included in the analysis. Given the relationship between spiritual well-being and religiosity to individual characteristics, such as age and race reported in this study, it is suggested that individual characteristics be considered when examining spirituality and drug use patterns.
... Other research examining specific links in the causal chain suggests a complex picture. For example, AA members were found to have more spiritual beliefs and external locus of control than SMART Recovery (Ellis and Velton, 1992) members ( Li et al. 2000), but internal locus of control has been associated with long-term sobriety among AA members ( Murray et al. 2003). Long-term AA sobriety has also been related to a shift from recovery-specific, to more general community, helping, as well as endorsement of religiosity or ''theism'' ( Kaskutas et al. 2003). ...
Article
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Rigorous reviews of the science on the effectiveness of Alcoholics Anonymous (AA) indicate that AA and related 12-step treatment are at least as helpful as other intervention approaches. Exactly how AA achieves these beneficial outcomes is less well understood, yet, greater elucidation of AA's mechanisms could inform our understanding of addiction recovery and the timing and content of alcohol-related interventions. Empirical studies examining AA's mechanisms were located from searches in Pubmed, Medline, PsycINFO, Social Service Abstracts and from published reference lists. Thirteen studies completed full mediational tests. A further six were included that had completed partial tests. Mechanisms examined fell into three domains: (1) Common processes; (2) AA-specific practices; and (3) Social and spiritual processes. Results suggest AA helps individuals recover through common process mechanisms associated with enhancing self-efficacy, coping skills, and motivation, and by facilitating adaptive social network changes. Little research or support was found for AA's specific practices or spiritual mechanisms. Conclusions are limited by between-study differences in sampling, measurement, and assessment time-points, and by insufficient theoretical elaboration of recovery-related change. Similar to the common finding that theoretically-distinct professional interventions do not result in differential patient outcomes, AA's effectiveness may not be due to its specific content or process. Rather, its chief strength may lie in its ability to provide free, long-term, easy access and exposure to recovery-related common therapeutic elements, the dose of which, can be adaptively self-regulated according to perceived need.
... Spirituality was found to mediate pro-health behaviors but not substance use outcomes in this study (Magura et al., 2003). Research has examining spirituality in differing mutual aid organizations as well and suggests AA members have more spiritual beliefs compared to members of a more cognitive behaviorally-oriented organization, SMART Recovery (see Ellis and Velten, 1992;Li et al., 2000). ...
Article
Evidence indicates Alcoholics Anonymous (AA) can play a valuable role in recovery from alcohol use disorder. While AA itself purports it aids recovery through "spiritual" practices and beliefs, this claim remains contentious and has been only rarely formally investigated. Using a lagged, mediational analysis, with a large, clinical sample of adults with alcohol use disorder, this study examined the relationships among AA, spirituality/religiousness, and alcohol use, and tested whether the observed relation between AA and better alcohol outcomes can be explained by spiritual changes. Adults (N = 1,726) participating in a randomized controlled trial of psychosocial treatments for alcohol use disorder (Project MATCH) were assessed at treatment intake, and 3, 6, 9, 12, and 15 months on their AA attendance, spiritual/religious practices, and alcohol use outcomes using validated measures. General linear modeling (GLM) and controlled lagged mediational analyses were utilized to test for mediational effects. Controlling for a variety of confounding variables, attending AA was associated with increases in spiritual practices, especially for those initially low on this measure at treatment intake. Results revealed AA was also consistently associated with better subsequent alcohol outcomes, which was partially mediated by increases in spirituality. This mediational effect was demonstrated across both outpatient and aftercare samples and both alcohol outcomes (proportion of abstinent days; drinks per drinking day). Findings suggest that AA leads to better alcohol use outcomes, in part, by enhancing individuals' spiritual practices and provides support for AA's own emphasis on increasing spiritual practices to facilitate recovery from alcohol use disorder.
... In the alcohol-dependent patient who is in continuous sobriety, the internal locus of control shows a tendency to increase. 13,16 The research questions for the present study were as follows: (i) in the medical therapeutic setting, do alcohol-dependent patients with more severe alcohol dependence have a tendency towards external control on drinking-related locus of control; and (ii) do patients with severe alcohol dependence still recognize problematic drinking, feel ambivalence, and eventually take action to change. To answer these questions, this study evaluated the various degrees of alcohol dependence in response to drinking-related locus of control and readiness to change. ...
Article
The purpose of the present study was to evaluate the Drinking-Related Health Locus of Control scale (DRIE) and the three aspects of readiness to change (i.e. ambivalence, recognition, and taking action), in response to the degree of dependence. This study was carried out based on data collected from 160 male alcohol-dependent patients, and the degree of alcohol dependence was divided into three categories: light, moderate, and severe, on the basis of the total scores of the short-form Severity Degree Alcohol Dependence Data questionnaire (SADD). There were significant differences between the different degrees of dependence on drinking-related locus of control, feelings of ambivalence toward drinking, recognition of problematic drinking, and readiness to take action to change. Patients with more severe dependence usually had higher scores of drinking-related locus of control, indicating a tendency toward external locus of control, feelings of ambivalence, and recognition of their drinking problem; patients with light dependence usually had higher scores for taking action. Clinicians can strengthen readiness to change problematic drinking if the importance of degree of dependence and drinking-related locus of control are taken into consideration when devising interventions.
... Rather, as providers may explain, it reflects a power greater than oneself, such as treatment staff and/or other patients (Noordsy et al., 1996). Alternatively, patients can be referred to self-help groups with a more cognitive-behavioral focus, such as SMART Recovery (Li et al., 2000). A method for encouraging attendance and involvement among less extroverted individuals is for providers to work with 12-step group volunteers, who meet personally with patients to talk about the benefits of the 12-step program and attend meetings with them (Blondell et al., 2001; Sisson and Mallams, 1981). ...
Article
This study examined characteristics of substance use disorder (SUD) outpatients at intake to treatment (N=345) that were associated with more 12-step group attendance and involvement, Steps worked, and acceptance of 12-step philosophy at a 6-month follow-up (N=281, 81.4%). Patient characteristics covered the domains of sociodemographics, SUD severity, personal functioning, and previous help received. Distinguishing baseline characteristics of patients who attended more 12-step group meetings during follow-up were being less-educated, more engaged in religious practices, and more extroverted and interpersonally competent, and having had more previous 12-step group exposure. These patient characteristics were generally similar to those associated with more 12-step meeting involvement and philosophy acceptance. More 12-step meeting attendance and involvement were related to abstinence at 6 months. Associations of attendance with abstinence were stronger among patients who were younger, white, less-educated, unstably employed, less religious, and less interpersonally skilled. These patients may have had fewer available social resources and so benefitted more from the fellowship and support for abstinence that 12-step group members often provide. We suggest methods by which treatment providers may encourage 12-step group affiliation among patients likely to benefit from it on substance use outcomes.
... However, the bulk of the available evidence pertains only to 12-step mutual-help participation (e.g., AA involvement; Humphreys, 2004;Kelly, 2003). Other mutual-help organizations have been in existence for decades (e.g., Rational Recovery, SMART Recovery, Secular Organization for Sobriety, Women for Sobriety, Moderation Management); yet, only a handful of descriptive, crosssectional studies have reported information on these other groups (Connors and Derman, 1996;Galanter et al., 1993;Humphreys and Klaw, 2001;Kaskutas 1996aKaskutas , 1996bLi et al., 2000). Thus, one aim of the current study is to assess and describe rates of participation in all forms of mutualhelp groups. ...
Article
Background: Addiction-focused mutual-help group participation is associated with better substance use disorder (SUD) treatment outcomes. However, little has been documented regarding which types of mutual-help organizations patients attend, what levels of participation may be beneficial, and which patients, in particular, are more or less likely to participate. Furthermore, much of the evidence supporting the use of these organizations comes from studies examining participation and outcomes concurrently, raising doubts about cause-effect connections, and little is known about influences that may moderate the degree of any general benefit. Method: Alcohol-dependent outpatients (N=227; 27% female; M age=42) enrolled in a randomized-controlled telephone case monitoring trial were assessed at treatment intake and at 1, 2, and 3 years postdischarge. Lagged-panel, hierarchical linear models tested whether mutual-help group participation in the first and second year following treatment predicted subsequent outcomes and whether these effects were moderated by gender, concurrent axis I diagnosis, religious preference, and prior mutual-help experience. Robust regression curve analysis was used to examine dose-response relationships between mutual-help and outcomes. Results: Mutual-help participation was associated with both greater abstinence and fewer drinks per drinking day and this relationship was not found to be influenced by gender, Axis I diagnosis, religious preference, or prior mutual-help participation. Mutual-help participants attended predominantly Alcoholics Anonymous and tended to be Caucasian, be more educated, have prior mutual-help experience, and have more severe alcohol involvement. Dose-response curve analyses suggested that even small amounts of participation may be helpful in increasing abstinence, whereas higher doses may be needed to reduce relapse intensity. Conclusions: Use of mutual-help groups following intensive outpatient SUD treatment appears to be beneficial for many different types of patients and even modest levels of participation may be helpful. Future emphasis should be placed on ways to engage individuals with these cost-effective resources over time and to gather and disseminate evidence regarding additional mutual-help organizations.
... 70 Another option is to refer patients to self-help groups with a more cognitive-behavioral focus, such as SMART (Self-Management and Recovery Training). 71 If patients are reluctant to join 12-step self-help groups, counselors should accept this decision and look for later opportunities to raise the topic again. 72 The findings also imply that a longer duration of treatment for alcohol use disorders is associated with better outcomes and that providers should structure treatment programs to ensure continuing care and ongoing affiliation with AA. ...
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To examine gender differences in the influence of treatment, self-help groups and life context and coping factors on remission among initially untreated individuals with alcohol use disorders. A naturalistic study in which individuals were assessed at baseline and 1, 8 and 16 years later. Participants initiated help-seeking with the alcoholism service system by contacting an information and referral service or detoxification program. A total of 461 individuals with alcohol use disorders (50% women). Participants were assessed by mail surveys and telephone interviews on participation in professional treatment and Alcoholics Anonymous (AA), alcohol-related functioning and indices of life context and coping. Compared to men, women were more likely to participate in treatment and AA, and to experience better alcohol-related and life context outcomes. In general, women and men who participated in treatment and/or AA for a longer duration were more likely to achieve remission. However, women benefited somewhat more than men from extended participation in AA. Continuing depression and reliance on avoidance coping were more closely associated with lack of remission among men than among women. Compared to men, women with alcohol use disorders were more likely to obtain help and achieve remission. Women tended to benefit more from continued participation in AA and showed greater reductions in depression and avoidance coping than men did. These findings identify specific targets for clinical interventions that appear to be especially beneficial for women and that may also enhance the likelihood of recovery among men.
... Indeed, well-known drug treatment programs tend to emphasize a stronger internal locus of control [1]. Programs with faith-based components, such as Alcoholics Anonymous (AA), have been criticized on the basis that participants are more likely to develop external loci of control as opposed to other programs focused only on recovery [14]. However, spirituality has been found to increase confidence in recovering drug users [1] and to decrease external attributions for past drug use or future relapses [15]. ...
Article
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Religious adherents from most major faith traditions struggle in balancing their individual agency with divine leadership. While this issue of individual versus divine control is complex for those in free society, it becomes even more so when applied to those in correctional and treatment settings. For those attempting to recover from drug addiction, a common conclusion is that drugs have taken control of their lives, thus it is necessary for them to reclaim control. Via a narrative analysis of semi-structured interviews with 30 former drug addicts residing in a faith-based halfway house for women, we explore how the women make sense of losing control of their lives due to their drug use, but then being taught to regain control by surrendering to a higher power. We find strong evidence of Deferring and Collaborative religious coping styles and these coping styles structure how the women discuss the future and their strategies for success.
... But many others contradicted this study and said that alcoholics are internally oriented. Strohm (2000) reported that alcoholic subjects are generally more spiritual and have greater locus of control. Locus of control orientation is an "important parameter which has effect on thought, behavior and actions" (Niazi et al., 2005). ...
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Hostility is a complex phenomenon that involves cognitive, behavioral and affective dimensions. Studies on the relationship between temperament as well as hostility and negative effects of alcohol intake found rigid alcohol patterns. Hostility is positively correlated with negative consequences of drinking. Since an external orientation seems to be connected with the induces of maladjustment, one might expect that alcoholics and heavy drinkers will be externally oriented, however many others contradicted this study and said that alcoholics are internally oriented. In our study, two groups of alcoholics and non alcoholics have been taken. The study has been conducted on males only. The age range includes subjects of 18-27 years. The fathers and sons are studied and have been further divided into four groups where either or both the fathers and sons are alcoholics. An analysis was conducted to study differences in alcoholics and non alcoholics on the variables of hostility and locus of control. Results show that the non alcoholics are high on internal locus of control and powerful others. They are also having higher mean scores on covert hostility. Alcoholics are showing high mean scores on overt hostility Further on, four groups were analyzed on the variables with the help of ANOVA by finding out the within and between group differences. Turkey's Post Hoc is applied to find where the differences lie. Main effects and interaction effects were summarized with the help of factorial design. Significant mean differences were found mostly between group I(alcoholic sons with alcoholic fathers) and group IV (non alcoholic sons having non alcoholic fathers) on the variables of overt and covert hostility, internal locus of control and powerful others.
... For example, AA offers a "fellowship" of others in recovery and a "program" for ceasing alcohol consumption, improving moral character and building a spiritual self (Humphreys, 2004). SMART too, whilst differing in its conceptualisation of alcohol dependency (Li et al., 2000), also offers a four-point programme to combat dependency (Hovarth, 2000), as well as members being expected to provide advice and support to others (Humphreys, 2004). The set up of AA and SMART recovery are also broadly similar, with both operating based on members sitting in circles and recounting "stories" (Cain, 1991;Humphreys, 2000) of their dependency and giving updates of their progress in recovery (Humphreys, 2004). ...
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Purpose – An increasing literature points to the efficacy and importance of mutual aid groups for people recovering from substance dependency. However, there is a paucity of qualitative evidence into the experiences and perceptions of service users attending UK-based mutual aid groups, and the implications they could have for recovery and mental wellbeing. The paper aims to discuss this issue. Design/methodology/approach – A phenomenological approach was chosen to explore the experiences and perceptions of service users and mentors at a mutual aid group in Leeds. Semi-structured interviews were conducted with service users and mentors (ex-service users) involved with the project. Thematic analysis was used to analyse the data. Findings – This paper focuses on the influence of mutual aid attendance on mental wellbeing. It was found that attendance seemed to have positive influences on providing structure, reducing stress and boredom, “broadening the mind” and providing service users with a social network that supported their recovery and mental wellbeing. However, it was also found that for those that have little outside the project, dependency on the group could develop, resulting in negative consequences on mental wellbeing. Originality/value – This paper provides an increased understanding of why mutual attendance has influences on mental wellbeing, as well as the implications such impacts have on recovery trajectories.
... In this context, locus of control is an expectation that is generalized according to whether the rewards and punishments obtained by the individual are controlled by them or situations outside of them (Rotter, 1966). Locus of control is the effect of internal or external powers upon the achievements or failures of the individual (Mutlu et al., 2000Mutlu et al., , p. 1789 Li et al., 2000, p. 2). Locus of control is a psychological concept (CobbClark et al., 2014, p. 2). ...
Conference Paper
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The purpose of the study was stated to investigate whether self-emotion appraisal and external locus of control have effects on problem-focused coping with stress. The study was conducted in Konya, a province of Turkey among 185 healthcare employees at four hospital. In the study Wong and Law's (2002) self-emotion appraisal scale, Lewin ve Sager's (2009) problem-focused coping with stress scale and Mueller andThomas's (2000) external locus of controlscales were used. In the result of the study, self-emotion appraisal affected problem-focused coping with stress positively. External locus of control had a negative impact on problem-focused coping with stress. Self-emotion appraisal had a negative impact on external locus of control.
... Clearly, there are people in recovery who do not respond positively to being in a 12-step group program. In addition, a pilot study comparing 48 AA members to 35 SMART Recovery members found that AA members had a greater spiritual orientation and a greater external locus of control when compared to members of SMART (Feifer and Strohm, 2000). These differences in individual orientation can play important roles in whether or not individuals connect with a given recovery support group. ...
Article
Mutual-aid support groups play a vital role in substance abuse treatment in the United States. A national survey of mutual-aid support groups for addiction was conducted to identify key differences between participants in recovery groups. Survey data indicate that active involvement in support groups significantly improves one's chances of remaining clean and sober, regardless of the group in which one participates. Respondents whose individual beliefs better matched those of their primary support groups showed greater levels of group participation, resulting in better outcomes as measured by increased number of days clean and sober. Religious respondents were more likely to participate in 12-step groups and Women for Sobriety. Nonreligious respondents were significantly less likely to participate in 12-step groups. Religiosity had little impact on SMART Recovery participation but actually decreased participation in Secular Organizations for Sobriety. These results have important implications for treatment planning and matching individuals to appropriate support groups.
... Other research examining specific links in the causal chain suggests a complex picture. For example, AA members were found to have more spiritual beliefs and external locus of control than SMART Recovery (Ellis and Velton, 1992) members (Li et al. 2000), but internal locus of control has been associated with long-term sobriety among AA members (Murray et al. 2003). Long-term AA sobriety has also been related to a shift from recovery-specific, to more general community, helping, as well as endorsement of religiosity or ''theism'' . ...
... Others posit that Supreme Beings in various religions are judgmental or punishing (Cotton, Zebracki, Rosenthal, Tsevat, & Drotar, 2006). Additionally, others will argue that overly ritualistic reliance on a Higher Power or religious-type recovery group may, itself, reflect a substitute addiction (Sussman & Black, 2008;Sussman, Reynaud, Aubin, & Leventhal, 2011;Taylor, 2002), or reduction in individual sound judgment or self-reliance (Ellis & Schoenfeld, 1990;Li, Feifer, & Strohm, 2000;Moos, 2010;Nicolaus, 2012). Some also may be uncomfortable in intensive, sometimes distressful spiritual/religious-oriented group experiences, or may feel (or be) rejected by the group for not expressing religious ideation (Galanter, 2006). ...
... Some authors (Horvath & Velten, 2000;Humphreys et al., 2004) have focused on explaining the program's philosophy and providing conceptual support for the program. Li, Feifer, and Strohm (2000) highlighted philosophical differences between SMART Recovery members and members who attended AA meetings. A recent investigation using random assignment of treatment conditions (Hester, Lenberg, Campbell, & Delaney, 2013) found that individuals who attended SMART Recovery meetings and Overcoming Addictions (a web application based on the SMART Recovery program) demonstrated an increase in percentage of days abstinent, a reduction in substance-related issues, and a reduction in drinks per drinking day after 3 months compared with baseline conditions. ...
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Using the Brief Situational Confidence Questionnaire, the authors examined the refusal self-efficacy of 105 Self-Management and Recovery Training (SMART Recovery) members according to their affiliation length and meeting frequency. Results demonstrated that longer affiliation with SMART Recovery and higher meeting frequency significantly enhanced substance refusal self-efficacy.
... Many individuals are not able to overcome their biases against the spiritual aspect of 12-Step programs. In these cases, it is important to respect client's personal values and help them to find alternatives such as Self Management and Recovery Training or other support systems (Li, Feifer, & Strohm, 2000). There are also limitations for this model in terms of severity of SUD for the client. ...
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Substance use disorders (SUDs) are a major problem in the United States that have reverberating effects within families, communities, and society. Marriage and family therapists (MFTs) are uniquely positioned to be leaders in addressing SUDs through a systemic relational context. Internal Family Systems Therapy (IFS) is an evidence-based practice that has the potential to be an excellent fit for individuals, couples, and families struggling with SUDs. In addition, 12-Step facilitation provides a supportive network for individuals dealing with substance use issues. This article uses a systemic approach to integrating IFS and 12-Step facilitation for use with the emerging adult population. A case study example is provided to illustrate the integrated model.
... High religiosity was negatively correlated with ILOC. Li, Feifer, and Strohm's (2000) findings suggested that Alcoholics Anonymous members were generally more spiritually oriented and exhibited greater ELOC relative to secular alcohol rehabilitation program members, though whether this was due to program effects or to self-selection could not be discerned. Murk and Addleman (1992), examining college students on moral reasoning, LOC, and demographic variables, discovered that religiosity variables were significantly related to ILOC and ELOC scores and that Catholic students tended to score higher on ELOC than Protestant students did. ...
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The objective of this study was to test Hunter’s Durkheimian theory of atheism by examining the impact of age, race, and gender on external locus of control and, in turn, the impact of external locus of control on atheist/theist identification. I hypothesized that the lower likelihood of atheist identification among women, minorities, and the elderly would be explained by their greater external locus of control. I sent a nineteen-question online survey to various atheist, Christian, Buddhist, Hindu, and Islamic organizations and conducted univariate ANOVAs to examine relevant external locus of control differences between demographic and atheist/theist groups. I then used a path analysis to examine the model in question (N = 1,002), with the variables of age, race, gender, external locus of control, and atheist/theist identification. Nonwhites, females, and theists were found to have higher external locus of control than whites, males, and atheists. After control- ling for age, race, and gender, the latent variable of external locus of control showed a small capacity to explain variance in atheist/theist identification (R2 = 0.18). Results demonstrate partial support for Hunter’s Durkheimian theory. I discuss alternative explanations for atheist identification demographic patterns across age, race, and gender; examine shortcomings of Hunter’s theory; and recommend specific future research into locus of control and atheism/theism.
... Health insurance status, a proxy for SES, was significant when evaluating recovery status as a dichotomous variable, but not when dividing those in recovery by duration of recovery. Positive religious coping slightly decreased the risk of smoking relapse in this sample, which may be related to a spiritual external locus of control, a feature of 12-step recovery programs (Li et al., 2000). Indeed, individuals with higher religiosity are less likely to use substances (Oleckno and Blacconiere, 1991) and among those in recovery, higher levels of religiosity are associated with greater optimism, stress resiliency, and perceived support (Pardini et al., 2000), characteristics often associated with successful smoking cessation outcomes. ...
... CSARS Group develops community-based projects planned to confirm that the Higher Power Project research and other research results are conveyed to the occupations involved in the dealing of addiction and to people in quest of recovery. This study supported by The Higher Power Project and North Wales Recovery Community-Penrhyn House (NWRC) in partnership with local agencies and with the cooperation of Alcoholics Anonymous (Alcoholics-Anonymous, 2014), Narcotics Anonymous (Narcotics Anonymous, 2018) and SMART Recovery (Li, Feifer, & Strohm, 2000;Horvath & Velten, 2000). The projects provide a framework, support and knowledge to volunteer participants wanting to try to achieve abstinencebased recovery through 13 weekly group sessions. ...
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This paper examines the role of spirituality in a recovery context by drawing on qualitative research conducted at a residential recovery community in North Wales, United Kingdom. The study aimed to examine perceptions of spirituality among ex-prisoners and people identifying as in recovery from addiction. The researchers explored ideas of "spiritual coping" and "spiritual wellbeing" in terms of meaning, purpose, connectedness, forgiveness, and peace in addiction treatment programs influenced by 12-Step models, for instance, Alcoholics Anonymous (AA). Also, this paper focuses on both spiritual counselling services shaped by predetermined meanings and values and secondly, on individuals' perceptions about spirituality through the language of desires, needs, and expectations. The data for this research produced from five semi-structured interviews with male individuals who had recovered from their addiction and had practised some custodial life. To discover the common context of different perceptions of the language spirituality, the data was coded by the first and second loop encodings from the data analysis methods used. The central schemes that appear as "Spirituality in Experiences, Spirituality in Values, Spirituality as Meaning/Purpose of Life, Spirituality as Attachment, Spirituality as Coping Mechanism" have been evaluated within the framework of the concept of spirituality. In the conclusion of this study, it was observed that spirituality was used as a coping mechanism for buffering the sensation of hopelessness and powerlessness often experienced by people in active addiction.
... One study has compared SMART Recovery with an online, abstinence orientated adaption of the SMART program (14). Other research has largely compared SMART Recovery and 12-step approaches (8,15,16). Only one study has examined the therapeutic aspects of SMART Recovery groups. ...
Article
Introduction and aims: The Self-Management and Recovery Training (SMART Recovery) program provides facilitated mutual aid for people with addictions. To date, little research has examined SMART Recovery. This paper examined participant and facilitator perceptions of the helpfulness of cognitive behaviour therapy tools in SMART Recovery groups. SMART Recovery's strengths and areas for improvement were also explored, as well as overall participant satisfaction with SMART Recovery. Design and methods: This exploratory study was conducted as part of the first national survey of SMART Recovery in Australia. Paper surveys were posted to all registered SMART Recovery groups for participants. SMART Recovery facilitators were emailed a link to an online survey. Results: Overall, satisfaction with SMART Recovery was moderate to strong. Participants and facilitators perceived the cognitive behaviour therapy tools incorporated within SMART Recovery to be helpful. Participants and facilitators nominated the group experience and the SMART Recovery tools and strategies as helpful aspects of SMART Recovery. Participants and facilitators were concerned with improving public knowledge about SMART Recovery groups, updating the structure and content of SMART Recovery groups, and increasing training for facilitators. Discussion and conclusions: SMART Recovery displays strengths as communicated by those who utilise its services. However, there are opportunities to continue to improve SMART Recovery. Updating the training for facilitators and increasing communication between SMART Recovery Australia's head office and its facilitators may serve to improve service delivery. Future research should focus on examining the efficacy of SMART Recovery groups on participant outcomes.[Kelly PJ, Raftery D, Deane FP, Baker AL, Hunt D, Shakeshaft A. From both sides: Participant and facilitator perceptions of SMART Recovery groups. Drug Alcohol Rev 2016;00:000-000].
Conference Paper
The purpose of the study was stated to investigate whether self-emotion appraisal and external locus of control have effects on problem-focused coping with stress. The study was conducted in Konya, a province of Turkey among 185 healthcare employees at four hospital. In the study Wong and Law's (2002) self-emotion appraisal scale, Lewin ve Sager's (2009) problem-focused coping with stress scale and Mueller and Thomas's (2000) external locus of controlscales were used. In the result of the study, self-emotion appraisal affected problem-focused coping with stress positively. External locus of control had a negative impact on problem-focused coping with stress. Self-emotion appraisal had a negative impact on external locus of control.
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Alcoholics Anonymous, with its steady but nonspecific promotion of belief in a higher power and its emphasis on the group process, long held a near-monopoly in the outpatient alcohol recovery field, but its hegemony has now been challenged by two very different perspectives. The first is a nonspiritual approach that emphasizes the individual's capability to find a personal pathway to sobriety, exemplified by Rational Recovery. The second is a faith-based method, built on a religious understanding of alcoholism, of which Celebrate Recovery is a prominent example, based upon Christianity. Most communities offer a variety of approaches, so clinicians who are aware of these differences are in a good position to help patients make intelligent choices among the competing recovery philosophies.
Article
The primary aim of this prospective study was to examine the role of several aspects of spirituality in maintaining abstinence from alcohol for one year in persons treated for alcohol dependence. The roles of alcohol abstinence self-efficacy and Alcoholics Anonymous affiliation were also examined. Seventy-four adults with alcohol dependence who had completed a three-week outpatient addiction program participated in this study. Instruments used included the Spiritual Well-Being Scale, Duke Religion Index, Brief Religious Coping Scale, Alcohol Abstinence Self-Efficacy Scale, and Alcoholics Anonymous Affiliation Scale. Abstinence data was collected from participants and collaterals three, six, and twelve months after treatment discharge. Demographics, discharge measures, and the change in scores from admission to discharge were compared between those with and without 12-month alcohol abstinence using logistic regression or Fisher's exact tests. Twenty-eight participants were categorized as continuously abstinent for one year. The strongest associations between 12 month abstinence and the variables of interest were discharge scores of abstinence self-efficacy and existential well-being, and increases during treatment in scores of private spiritual practices. Increased age demonstrated a significant association with positive outcome. The associations of private spiritual practices, existential well-being, and abstinence self-efficacy with one year of continuous abstinence following treatment discharge suggest the importance of addressing issues related to these variables during alcoholism treatment. More research is needed to understand the role of these variables in promoting and maintaining abstinence and to determine whether or not a related intervention would improve abstinence rates.
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Background: Many studies suggest that participation in 12-step groups contributes to better recovery outcomes, but people often object to such groups and most do not sustain regular involvement. Yet, research on alternatives to 12-step groups is very sparse. The present study aimed to extend the knowledge base on mutual help group alternatives for those with an alcohol use disorder (AUD), sampling from large, active, abstinence-focused groups including Women for Sobriety (WFS), LifeRing, and SMART Recovery (SMART). This paper presents a cross-sectional analysis of this longitudinal study, using baseline data to describe the profile and participation characteristics of attendees of these groups in comparison to 12-step members. Methods: Data from participants 18 and over with a lifetime AUD (N=651) were collected using Web-based surveys. Members of alternative 12-step groups were recruited in collaboration with group directors, who helped publicize the study by emailing meeting conveners and attendees and posting announcements on social media. A comparison group of current (past-30-day) 12-step attendees was recruited from an online meeting hub for recovering persons. Interested parties were directed to a Webpage where they were screened, and eligible participants completed an online survey assessing demographic and clinical variables; in-person and online mutual help involvement; and group satisfaction and cohesion. Analyses involved comparing those identifying WFS, SMART, and LifeRing as their primary group to 12-step members on the above characteristics. Results: Compared to 12-step members, members of the mutual help alternatives were less religious and generally higher on education and income. WFS and LifeRing members were also older, more likely to be married, and lower on lifetime drug and psychiatric severity; meanwhile, LifeRing and SMART members were less likely to endorse the most stringent abstinence goal. Finally, despite lower levels of in-person meeting attendance, members of all the 12-step alternatives showed equivalent activity involvement and higher levels of satisfaction and cohesion, compared to 12-step members. Conclusions: Results suggest differences across 12-step groups and their alternatives that may be relevant when advising clients on a choice of mutual help group. Meanwhile, findings for high levels of participation, satisfaction, and cohesion among members of the mutual help alternatives suggest promise for these groups in addressing addiction problems.
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Self Management And Recovery Training (SMART), a free self-help discussion group that is largely a cognitive-behavioral extrapolation of research findings on treatment of addictive disorders, is described. Information regarding its organization and operation is provided, and predictions are made about its future development. Self Management And Recovery Training (SMART), a free self-help discussion group that is largely a cognitive-behavioral extrapolation of research findings on treatment of addictive disorders, is described. Information regarding its organization and operation is provided, and predictions are made about its future development.
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There has been a growing interest in the substance abuse treatment field in bringing together the treatment and research communities. While dialogues about logistical and philosophical issues are important, the development of shared core concepts could potentially be quite helpful in facilitating communication and creating common treatment and research goals. It is the contention of this paper that all psychosocial and, potentially, pharmacological treatments ideally address, in part or in full, three aspects of the self--the capacity to regulate emotional and behavioral expression, the ability to engage in future-oriented, goal-directed behavior, and the development of nonaddict and/or recovery-oriented identities. Examples from the research and treatment literature are provided.
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Cognitive symptoms, considered in conjunction both with their regional brain and biomarkers as well as affective, attributional and neurode-velopmental components, demonstate ever-increasing complexity to facilitate conceptualization yet, unavoidably, bedevil diagnosis in neuropsychiatry even before considerations of the enigmatic processes in memory, such as executive function and working memory, are drawn into the myriads of equations that await remedial interpretations. Prefrontal and limbic regions of the brain are involved in a diversity of expressions of cognition, normal or dysfunctional, at synaptic, intracellular and molecular levels that mobilize a concatenation of signaling entities. Serotoninergic neurotransission at prefrontal regions directs cogntive-affective entities that mediate decision-making and goal-directed behaviour. Clinical, non-clinical and basic studies challenge attempts to consolidate the multitude of evidence in order to obtain therapeutic notions to alleviate the disordered status of the diagnosed and yet-to-be diagnosed individuals. Locus of control, a concept of some utility in health-seeking procedures, is examined in three self-report studies from the perspective of a cognitive-emotional situation through observations of ordinary, ‘healthy’ young and middle-aged individuals, to assess the predictors of internal and external locus of control. A notion based on high level executive functioning in the dorsolateral prefrontal cortex (DLPFC) in individuals characterised by internal locus of control is contrasted with a hypofunctional executive DLPFC, characterising individuals that express an external locus of control, is discussed.
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Although recovery has gained considerable momentum in recent years, pathways into recovery programs are less understood. “You do the MAFS” is a 6-session, peer-led group that educates service users about abstinence-based recovery and provides a gateway into mutual aid. Through a mixed methodological approach, this study found that attendance at “You do the MAFS” improved participant health and social functioning, increased mutual aid attendance and reduced substance use. An intervention such as this would be a useful addition to the substance misuse treatment sector as provision to make links to and increase support for those in recovery.
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The apparent success of Alcoholics Anonymous and its spiritually based program of recovery in 1935 led early researchers to explore how AA worked and ultimately led to more formalized research on alcoholism and spirituality in the latter part of the 20th century. Using Miller's suggested research framework, a review of empirical research was conducted on four roles of spiritual variables in alcohol abuse and recovery. Tentative conclusions about the relationship between alcoholism and spirituality are provided. Limitations of studies are examined and implications for social work research are discussed.
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Both academic and popular literature report that employees wish for soul-enriching fulfillment at work, and that employers have at least recognized, and in some cases embraced, this wish. The increasing incidence of spirituality and religion at work (SRW), however, creates an interesting balance for organizational administrators to strike: how should SRW needs be accommodated when crafting policy, given the legal reality of Title VII and the tradition of American workplace secularism? We discuss this tension and suggest that relying on legal compliance or historical organizational secularism is insufficient. Recent evidence offers insight into a “non-interventionist” approach that may assist policy makers in going forward with SRW opportunities.
Research on Alcoholics Anonymous and other self-help programs has shown mixed results regarding lifetime participation at the individual level. No one has systematically studied whether lifetime membership contributes to the success of the program as a whole. This project analyzes the relationship of lifetime membership and program growth using a series of agent-based models. Results demonstrate that programs encouraging lifetime attendance produce more groups and recruit more members than programs encouraging graduation. Rapid graduation disrupts the availability of senior members to help newcomers, limiting program growth. Self-help programs may improve program effectiveness by encouraging long-term attendance.
Conference Paper
In this study, the effect of cynicism, organizational cynicism on alienation was investigated. In the study, Organizational Cynicism scale (Brandes, 1997); Cynicism scale (Wrightsman, 1992) and Alienation scale (Banai and Weisberg'in, 2003) were used. Our surveys were carried out with 210 health care employees in the health sector providing services at three hospitals in the province of Konya, Turkey. In the result of the study, it was determined that cynicism and the organizational cynicism has affected on alienation positively. In addition, the organizational cynicism has impacted on cynicism positively.
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Issues of psychological control feature prominently in the area of alcohol dependence (AD) and its treatment, yet the reliance on 'locus of control' (LOG) as the most common depiction of control in such research is problematic. Using a multidimensional measure to overcome such problems, this study investigates the relationship between sense of control and clinical features of AD in 50 people presenting for treatment. Severity of dependence was associated with a reduced overall sense of control. Measures of day-to-day drinking problems were significantly associated with an adverse control profile consisting of a reduced sense of control in both general and specific domains, along with reliance on negative means of gaining control. Multidimensional control inventories enable a more sophisticated functional analysis of the relationship between psychological control and features of AD, and this holds greater promise for understanding and specifying the mechanisms of action in treatments such as cognitive-behavioural therapy which explicitly employ control constructs.
Research
This is the final version of our working theoretical paper. Addiction and recovery science is sorely lacking a comprehensive and inclusive social theory which is broad enough to encompass the entirety of addiction and recovery processes, from genetics, to neuroscience, and classic addiction theories. CETAR presents a complete and mechanistic theory which covers the breadth of addiction: From possible etiologies, through social and physical decline trajectories, and the mechanisms which spark and sustain recovery. CETAR was designed to create new directions and testable hypotheses in addiction and recovery science. CETAR functions primarily on Terror Management Theory and other established theories. Additionally, CETAR is the first theory that seeks to encompass, rather than exclude various theories involving addiction that had previously been thought to be in in conflict.
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Résumé L’objectif de la présente étude est de vérifier l’existence d’un lien entre le locus de contrôle (LOC) et l’impulsivité parmi une population de patients présentant une dépendance à l’alcool. L’impulsivité étant un marqueur de faibles résultats pour les traitements de dépendance aux substances (Moeller et al., 2001 ; Patkar et al., 2004), il serait cliniquement plus abordable de travailler sur les croyances qui constituent le LOC du sujet afin de réguler indirectement ses comportements impulsifs, favorisant de fait le traitement des maladies addictives. Les 20 participants (14 hommes et 6 femmes) présentent une dépendance à l’alcool et ont complété un questionnaire composé notamment de l’échelle d’impulsivité UPPS-P version courte (Billieux et al., 2012) et de l’échelle IPC de Levenson (1974). D’après les résultats, il existe une relation négative entre la facette d’impulsivité « manque de persévérance » et le LOC interne, ainsi que des relations positives entre le LOC Chance et les facettes respectives « urgence » et « urgence positive ».
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Purpose – The purpose of this paper is to explore the theme of dependence on mutual aid identified in a previous paper. It is a theme which to date, has had very little empirical attention, especially in a UK context. Design/methodology/approach – A phenomenological approach was adopted. Interviews with service users, mentors and professional staff involved with the Learning to Live Again project were undertaken over a ten-month period of data collection. Thematic analysis was used to analyse the data. Findings – It was found that service users with very little access to recovery capital or social support are at risk of developing a dependency on mutual aid. Dependence seemed to manifest itself in two different forms – those that over engaged with the project and those that under engaged with the project. Consequently, there were a cohort of service users identified that seemed to strike a balance with the project and their life outside the project that was “just right”. They were referred to as the “Goldilocks group”. Originality/value – This paper explored a theme which has had very little attention paid to it. The theme of dependence on mutual aid will raise the awareness of such a threat, thus helping to identify those in treatment most at risk of developing dependency on mutual aid, thus detrimentally impacting on mental wellbeing.
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Internal control beliefs appear to be important factors in recovery from alcoholism. However, no instrument for assessing drinking-related locus of control has been developed in Taiwan. After translating the drinking-related locus-of-control scale (DRIE) into Chinese, we examined the psychometric properties of the Chinese version of the DRIE in alcohol-dependent patients. A total sample of 161 alcohol-dependent patients received treatment for alcoholism in psychiatric hospital outpatient and inpatient units. Confirmatory factor analyses were conducted on three-factor, two-factor, and one-factor measurement models of the DRIE based on prior studies. The results indicated that the one-factor model of the DRIE provided goodness of fit to the data in this study. The Chinese version of the DRIE has been demonstrated to be a reliable and valid tool for the assessment of locus-of-control beliefs in alcohol-dependent patients.
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The percentages of items of the Personal Philosophy Inventories that reflect either traditional religious or exotic (alien intelligence, reincarnation) beliefs were compared for 504 female and 343 male university students as a function of church attendance; the data were collected over a 10-yr. period. A statistically significant interaction between the two clusters of beliefs and church attendance suggested that exotic beliefs may substitute for religious beliefs. Years of university experience did not reduce the incidence of either type of belief while preteenage religious experiences enhanced endorsement of both religious and exotic beliefs.
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50 alcoholics were administered the I-E scale and a specially constructed scale to determine the perceived locus of control for their drinking behavior. It was hypothesized and found that alcoholics perceive themselves in control of their behavior in general and of their drinking behavior in particular. Theoretical implications of these findings were discussed.
Article
The self-perceived locus of control of three groups of alcoholics who had had varying amounts of exposure to treatment was measured on the Internal-External (I-E) scale. Alcoholics who had had more treatment perceived themselves in greater control of their behavior in general and of their drinking in particualar than those who had had less treatment.
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Research literature dealing with the relationships of locus of control to alcoholism and the treatment of alcoholism is reviewed. The review includes a discussion of some of the scales used in this research, the relative locus of control of alcoholics compared with controls, the change in locus of control during treatment of alcoholics, and the relationship of locus of control to treatment success. Much of the research is inconclusive. Research on the control orientation of alcoholics compared to controls has had equivocal results, but the better designed studies tend to find no difference or externality in alcoholics. Most studies find that alcoholics become more internal over treatment, but the relationship of locus of control to treatment success is unclear. Methodological difficulties have included problems with sampling, selecting appropriate controls, assuming homogeneity of alcoholics as a group, and assuming linearity and unidimensionality of the scales. A number of needed studies which would clarify some of the questions are suggested.
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Locus of control is viewed as a measure of the degree of responsibility an individual perceives himself to have over meaningful life events. The drinking-related Internal-External locus of control scale represents the translation of generalized expectancies for locus of control into a measure of specific expectancies dealing with a variety of drinking behaviors. The present study examined scores on the drinking scale cross-sectionally for a specific alcoholic patient population. The results suggest that over-all scores shifted from externality toward internality over the duration of treatment for alcoholism. Examination of factor scores, however, showed a shift toward externality over time on the interpersonal control factor alone. Specific mechanisms of these attitudinal shifts as they relate to the treatment process are discussed.
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Fifty alcoholics successfully completing a 2-month rehabilitation program were administered the I-E Scale and a drinking locus of control scale during their first week in treatment and again the week prior to discharge from treatment. A test--retest non-alcoholic control group was administered the I-E Scale at a 7-week interval. Alcoholics were significantly more internal with regard to their behavior in general and their drinking behavior in particular at the close of treatment than at the onset. The control group evidenced no change. It was suggested that the alcoholics perceived internality was a function of exposure to treatment rather than a predisposing personality dimension.
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Studied the relationship between internal-external control and drinking behavior in 517 men in basic training whose drinking behavior ranged from abstinence to problem drinking. Results show a clear pattern of increased externality with increased drinking.
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Alcoholics Anonymous and related 12-step programs are the predominant influence on chemical dependency treatment programs in the United States today. 12-step programs have a strong religious orientation, despite rationalizations that Higher Power need not mean the traditional definition of God. The teaching of religious beliefs is not a proper function of therapists treating addictions in a general population. Moreover, teaching patients they can only recover through the intervention of a Higher Power locks them into a pattern of dependence on something outside themselves in order to function. 12-step programs have helped millions of people. Even more could be helped were they to eliminate the concept of needing a Higher Power.
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An alcoholic's relapse to drinking is thought to be related to various interpersonal and intrapersonal factors. Drinking-Related Locus of Control (DRIE) scores among alcoholics, recovering alcoholics, and non-alcoholics were compared in this investigation. Each group consisted of 22 males similar in age and other socioeconomic factors. Results indicated significant differences among the three groups. The non-alcoholic group scored more internally than the alcoholic or recovering alcoholic groups; the recovering alcoholic group scored more internally than the alcoholic group. The findings suggest that assessment of the alcoholic's DRIE scores may be useful in planning and monitoring the treatment of this disease.
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Hypothesized that there would be a negative correlation between the Edward's Social Desirability Scale and Rotter's Internal-External Control Scale. 102 army mental health clinic outpatients, 218 army stockade prisoners, 99 alcoholic inpatients, and 48 new careers participants were administered both tests. All correlations were negative, ranging from -.7 to -.29, and were significant at the .025 level or greater. It is suggested that since internalizers feel that they have some control over reinforcements, they may try to influence the dispensers of these reinforcers by behaving in socially acceptable ways, while externalizers, who feel they have no control over reinforcements, may not be so motivated.
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Attempted to ascertain the relationship between field dependency, as measured by the Rod and Frame Test (RFT), and arousal level in alcoholic and nonalcoholic Ss. Ss were tested serially with RFT and a number of electrophysiological measures and objective tests. It was found that level of field dependency decreased in the alcoholics but not in the nonalcoholics. The decreased field dependency was not associated with increased arousal, as was hypothesized, except in 1 aspect. It was associated with an increasing number of responses on the Rotter Internal-External Locus of Control Scale indicating internal locus of control. (15 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Alcoholism is no longer regarded as a unitary disorder, but conventional measures of cognition and personality have yet to be shown capable of consistently predicting clinical outcomes. The present study evaluated the ability of two measures of locus of control--a generalized measure (IE) and a drinking-related one (DRIE)--to predict therapy involvement during, and treatment outcome following, an abstinence-oriented inpatient program for alcoholics. Both measures were administered to 106 patients (32 women) once near the beginning and once near the end of treatment. A range of other sociodemographic and psychological data was also recorded. Significant and independent shifts in the internal direction were found on both measures from the first to second testing. Relationship between locus of control and treatment participation was weak. DRIE fared better than IE in predicting treatment outcome. Ability to predict outcome was enhanced when interactions between locus of control and cognitive dysfunction were considered and when analyses included nonlinear relationships between these measures and treatment outcome.
Article
This study evaluated the predictive utility of the drinking-related control orientation for successful treatment outcome among Finnish inpatient alcoholics (N = 106, 16% women). Using the Drinking-Related Locus of Control (DRIE) scale by Keyson and Janda (unpublished; see Lettieri, Nelson, & Sayers, 1985), it aimed to discover to what extent the DRIE scores measured at the end of treatment predict (a) the timing and severity of the first drinking occasion after treatment, and (b) the 6 and 12 months' total treatment outcome of the sample. The DRIE scores correlated with the time to the first drinking occasion (r = -.27, p < .02). Internal subjects started to drink later (p < .004), drank less on the first occasion (p < .001), and continued for fewer days (p < .005) than external subjects. Moreover, internal orientation was more common among abstinent and external orientation among unimproved subjects during the first 6 (p < .02) and 12 months (p < .05) after treatment. The results thus support the beneficial role of internal control attributions.