How do people recover from alcohol dependence? A systematic review of the research on mechanisms of behavior change in Alcoholics Anonymous

Abstract

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 recoveryrelated 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 selfregulated according to perceived need.

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

“…Such studies that have performed appropriate mediational tests (see MacKinnon, 2008) have found that measures of coping, motivation, self-efficacy, social network changes, and spirituality appear to be some of the mechanisms through which AA transmits its beneficial effects (Forceheimes and Tonigan, 2008;Kelly et al, 2009). However, to our knowledge, important affectrelated mechanisms that AA itself specifies as critical to recovery have not been formally tested.…”

Asmenų, priklausomų nuo alkoholio, psichoemocinė sveikata

“…G. E. Vaillant [8] pažymi, jog anoniminiai alkoholikai atranda džiaugsmą padėdami kitiems, o dalyvavimas 12 žingsnių programoje prisideda prie ilgalaikio depresijos mažinimo. J. F. Kelly et al [9] nurodo, kad daž-nesnis anoniminių alkoholikų grupių lankymas susijęs su geresnėmis alkoholio vartojimo pasekmėmis ir depresijos mažėjimu. A. Kolbergytė ir V. Indrašienė [10] nurodo, kad žmonių dalyvavimas savitarpio pagalbos grupėse gerina jų emocinę būseną, jie išmoksta "gyventi su savo problema".…”

Estilos de afrontamiento a la “obsesión mental por beber” (craving) en bebedores en proceso de recuperación

“…Se acepta con bastante frecuencia que afrontar con éxi-to situaciones de alto riesgo de recaída es sustancial para el proceso de cambio en las adicciones, 1 además de ser uno de los mecanismos que se facilitan con la asistencia a los grupos de AA. [15][16][17] Un elemento central en AA es el reforzamiento de la abstinencia, mediante el "ayudar a otros a recuperarse del alcoholismo". 18 Los testimonios en las reuniones y el apadrinamiento son los mecanismos clave de tal ayuda y por medio de los cuales se aprenden y modelan las conductas de recuperación.…”