The relative contributions of medication adherence and AA meeting attendance to abstinent outcome for chronic alcoholics.

Pisani, Vincent D.; Fawcett, Jan; Clark, David; McGuire, Marcella

doi:10.15288/jsa.1993.54.115

Cited by 29 publications

(12 citation statements)

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“…Determining whether this association truly reflected AA’s effectiveness or was merely an artifact of the most motivated, less troubled or most socially stable alcohol dependent individuals attending the organization has been a goal of researchers for decades. Using multiple regression techniques (Morgenstern et al, 1997), structural equation models (McKellar et al, 2003; Pisani et al, 1993), quasi-experiments (Humphreys and Moos, 2001; 2007), and propensity scoring methods (e.g., Magura et al, 2013; Ye and Kaskutas, 2009) evaluators mounted progressively more sophisticated efforts to separate self-selection bias from outcome estimates and thereby obtain an accurate estimate of AA’s effectiveness (or lack thereof). We believe the present study is a qualitative step forward in this direction that became possible only recently in light of developments in statistics (Nobel Prize Winner James Heckman’s work on instrumental variables) and alcohol research (the emergence of randomized clinical trials of AA facilitation interventions).…”

Section: Discussionmentioning

confidence: 99%

Estimating the Efficacy of Alcoholics Anonymous without Self‐Selection Bias: An Instrumental Variables Re‐Analysis of Randomized Clinical Trials

Humphreys

Blodgett

Wagner

2014

Alcoholism Clin & Exp Res

106

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Background Observational studies of Alcoholics Anonymous’ (AA) effectiveness are vulnerable to self-selection bias because individuals choose whether or not to attend AA. The present study therefore employed an innovative statistical technique to derive a selection bias-free estimate of AA’s impact. Methods Six datasets from 5 National Institutes of Health-funded randomized trials (one with two independent parallel arms) of AA facilitation interventions were analyzed using instrumental variables models. Alcohol dependent individuals in one of the datasets (n = 774) were analyzed separately from the rest of sample (n = 1582 individuals pooled from 5 datasets) because of heterogeneity in sample parameters. Randomization itself was used as the instrumental variable. Results Randomization was a good instrument in both samples, effectively predicting increased AA attendance that could not be attributed to self-selection. In five of the six data sets, which were pooled for analysis, increased AA attendance that was attributable to randomization (i.e., free of self-selection bias) was effective at increasing days of abstinence at 3-month (B = .38, p = .001) and 15-month (B = 0.42, p = .04) follow-up. However, in the remaining dataset, in which pre-existing AA attendance was much higher, further increases in AA involvement caused by the randomly assigned facilitation intervention did not affect drinking outcome. Conclusions For most individuals seeking help for alcohol problems, increasing AA attendance leads to short and long term decreases in alcohol consumption that cannot be attributed to self-selection. However, for populations with high pre-existing AA involvement, further increases in AA attendance may have little impact.

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Section: Discussionmentioning

confidence: 99%

Estimating the Efficacy of Alcoholics Anonymous without Self‐Selection Bias: An Instrumental Variables Re‐Analysis of Randomized Clinical Trials

Humphreys

Blodgett

Wagner

2014

Alcoholism Clin & Exp Res

106

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“…Originating in 1933 in Akron, Ohio, AA has grown to become the largest and most popular mutual-help program in the U.S. for individuals with alcohol problems (Emrick, 1999). The frequency at which AA meetings occur on any given day in the majority of American cities and the absence of membership fees contribute to the popularity of this community-based resource.The limited but advancing empirical literature examining the impact of AA, most commonly measured as frequency counts of AA meeting attendance, has generally concluded that participation in AA may be modestly associated with improved psychosocial functioning and drinking outcomes, possibly in a dose-response relationship Cross et al, 1990;Emrick, 1999;Humphreys et al, 1996;Montgomery et al, 1995;Pisani et al, 1993;Tonigan, 1995;Tonigan et al, 1996a;Zywiak et al, 1999). Notable biases exist, however, including study methodological quality and sample selection (Kownacki and Shadish, 1999).…”

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confidence: 99%

Helping other alcoholics in alcoholics anonymous and drinking outcomes: findings from project MATCH.

et al. 2004

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Section: Research On 12-step Participationmentioning

confidence: 99%

“…In several studies, 12-step meeting attendance was the best single predictor of positive outcome following treatment for substance use disorders (Morgensten et al, 2003), a factor that rises in tandem with addiction severity (Tonigan et al, 1995). Further, the probability of stable remission increases with the number of meetings attended early on (Hoffmann, Harrison, Belille, 1983;Pisani, Fawcett, Clark, and McGuire, 1993;Humphreys, Moos, and Cohen, 1997).Studies on 12-step participation traditionally were limited to relatively short-term follow-up periods that are inadequate to study remission from chronic disorders (typically under two years); several recent reports have extended the timeframe significantly including a 16-year follow-up study of initially untreated alcohol-dependent persons showing that 12-step participation in the first year of the study predicted better substance use outcomes at 16 years ; also see Kaskutas, Ammon, Delucchi, Room, Bond, and Weisner, 2005;Kelly, Stout, Zywiak, and Schneider, 2006). As with formal treatment, longer duration and higher level of 12-step meeting attendance are associated with better outcomes (e.g., Fiorentine, 1999;Moos, Schaefer and Moos et al, 2001;.…”

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confidence: 99%

An Exploration of the Effect of On-Site 12-Step Meetings on Post-Treatment Outcomes among Polysubstance-Dependent Outpatient Clients

Laudet

Stanick²,

Sands

2007

Eval Rev

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Rates of return to active substance use after addiction treatment tend to be high; participation in 12-step fellowships (e.g., Alcoholics Anonymous) reduces relapse rates but many clients do not attend or attend for a short period only. This quasi-experimental study uses repeated measurement to explore the role of presence/absence of onsite 12-step meetings during treatment on post-treatment outcomes. Polysubstance-dependent clients (N = 219) recruited at a program with and one without 12-step onsite, were followed for one year post-treatment. Onsite 12-step enhanced 12-step attendance, especially during treatment, and predicted continuous abstinence for the post treatment year. Holding 12-step meetings onsite is a low-cost strategy that programs should consider to foster post-treatment remission maintenance. Keywords 12-step; treatment; recovery; self-helpSubstance use disorders (SUD) are conceptualized as chronic (e.g., McLellan, Lewis, O'Brien, C., and Kleber, 2000); the chronicity of SUD is empirically supported by findings on addiction and treatment 'career' indicating that most SUD-affected individuals, especially those with severe dependence, make multiple attempts at remission often involving several treatment episodes prior to resolving their alcohol or drug dependence (e.g., Dennis, Scott, Funk, and Foss, 2005;Hser, Anglin, Grella, Longshore and Prendergast, 1997; Laudet, Stanick, Carway, and Sands, 2004). Because of the multiple costs of long chronic addiction 'careers' that include the acquisition/transmission of infectious diseases (e.g., HIV, HepC), deterioration in mental and physical health and other functioning impairments (e.g., Smith and Larson, 2003), it is critical to identify strategies that contribute to sustaining remission, thus shortening addition careers and resulting nefarious effects to the individual and to society. A number of therapeutic modalities have proven effective at addressing drug and alcohol dependence and improving related functioning but treatment gains are often short lived (Hser, Grella, Hsieh and Anglin, 1999). Participation in post-treatment 'stepped down' continuing (or after) care is associated with sustained treatment gains (McKay, Alterman, Cacciola, Rutherford and O'Brien, 1997;Mckay 2001). In the currently austere fiscal context of health services provision, few drug and alcohol treatment programs offer continuing care, NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript especially following outpatient treatment, the most prevalent treatment modality in the US. Twelve-step fellowships such as Alcoholics and Narcotics Anonymous are the most frequently used form of aftercare in the United States (Tonigan, Toscova, and Miller, 1996). Twelve-step fellowships are particularly well-suited to provide ongoing recovery support from chronic substance abuse and dependence because, unlike formal services that are limited in time, these groups are widely and consistently available throughout the US and free of charge. As with treatment, 12-st...

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The relative contributions of medication adherence and AA meeting attendance to abstinent outcome for chronic alcoholics.

Cited by 29 publications

References 10 publications

Estimating the Efficacy of Alcoholics Anonymous without Self‐Selection Bias: An Instrumental Variables Re‐Analysis of Randomized Clinical Trials

Estimating the Efficacy of Alcoholics Anonymous without Self‐Selection Bias: An Instrumental Variables Re‐Analysis of Randomized Clinical Trials

Helping other alcoholics in alcoholics anonymous and drinking outcomes: findings from project MATCH.

An Exploration of the Effect of On-Site 12-Step Meetings on Post-Treatment Outcomes among Polysubstance-Dependent Outpatient Clients

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