Helping other Alcoholics and Relapse

The specific mechanisms of Alcoholics Anonymous (AA) that mobilize and sustain behavior change are poorly understood.

This study examined the relationship between helping other alcoholics in AA and relapse in the year following treatment for alcohol use disorders. Data were derived from a longitudinal investigation of the efficacy of three behavioral treatments for alcohol abuse and dependence (Project MATCH). Probabilities of time to alcohol relapse were calculated using Kaplan-Meier survival estimates. Proportional hazards regressions, with control for number of AA meetings attended, were conducted to determine whether the likelihood of relapse was lower for those who were helping other alcoholics.

those who were helping other alcoholics . . . were significantly less likely to relapse in the year following treatment

Age was the only demographic characteristic that distinguished participants involved in helping other alcoholics; those who were helping other alcoholics were, on average, 3 years older than those who were not helping alcoholics and were significantly less likely to relapse in the year following treatment, independent of the number of AA meetings attended.

Thus recovering alcoholics who help other alcoholics (mutual-help) maintain long-term sobriety after formal treatment are better able to maintain their own sobriety.

The authors conclude that clinicians who treat substance abuse disorders should encourage their clients to help other recovering alcoholics to stay sober.

Research report; Pagano ME, Friend KB, Tonigan JS, and Stout RL. Helping other alcoholics in alcoholics anonymous and drinking outcomes: Findings from Project MATCH. Journal of Studies on Alcohol 65(6):766-773, November 2004.

What does the Brief-TSF model look like?

How does the Brief-TSF model work?

Defining the Brief-TSF processes

This model brings together three people to achieve sobriety in one of them. These are the;

• experiential contributor (AA Peer Sponsor) and
• professional care (Twelve Step Facilitator) to collaborate in facilitating self help recovery for the
• alcoholic (normally known as the patient or client).

Each of the three people brings to the intervention knowledge’s and functions known as ‘domains of praxes’. Within each domain are the constituents of experience, training, perceptions, goals and capabilities.

Functional Domain

The Brief Twelve Step Facilitator facilitates self-assessment by the patient, introduces them to a ‘Peer Sponsor’ and facilitates understanding of the ‘Program of Recovery’. In addition the healthcare worker assesses and addresses or refers the patient for any co-morbidities.

The Peer Sponsor shares their ‘experience, strength and hope’ with the patient, provides initial resources to attend meetings, introduces the ‘Newcomer’ to Alcoholics Anonymous members and explains the program of recovery from drinking.

The patient chooses what, when, and how they can use information, from each of the providers. This is true Self help within a paradigm of mutual help.

Additionally, the patient is supported in seeking professional treatment/therapy for other issues.

Recovery Domain

Each participant maintains their integrity and independence within their domain.

The primary goal of Brief-TSF is affiliation with Alcoholics Anonymous as described in the Stages of AA Affiliation.

Recovery includes attending AA meetings and other activities, stopping drinking, ‘working’ the program of recovery and consulting with a peer sponsor within an affiliation scheme.

The whole facilitated process producing a ‘Domain of Recovery’.

Disease Domain

Alcoholism is a primary, chronic, progressive three fold disease – mental, physical and spiritual. Alcohol dependence is fatal if not arrested by abstaining from alcohol.

Each participant has a hand in recovery

Beyond Codependency: And Getting Better All the Time

By Melody Beattie

Review By Neal J. Pollock (VA USA)

While I have not read Melody Beattie’s other works, I thought this a very valuable book in and of itself. It sheds much light on the topic and helped me to become sensitized to the obvious signs of codependency in people. By doing this, it enabled me to avoid situations where I could become codependent in a relationship.

I think that, as in the Diagnostic and Statistical Manual, there are levels of psychological situations and/or problems. Thus, there may be people inherently inclined towards codependency, but there may also be people who are thrust into it due to the demands of others. The latter may find this book incredibly helpful in avoiding such relationships and in helping their dependent person seek real help vs. codependency from another person. There are also a number of great quotes by the author in this book. A few are:

p. 70: “It’s hard to feel compassion for someone while that person is using or victimizing us.”

p. 71: “If everything looks black, we’ve probably got our eyes shut.”

p. 164: “Who we’re in a relationship with says as much about us as it does about them.” Earnie Tucker (quoted by Melody Beattie)

Codependency is not something to make light of, it’s as much (if not more) the codependent’s problem as the dependent’s. As Caroline Casey humorously noted in “Making the Gods Work for You” (Harmony Books NY 1998), on page 72:
“What do codependents see when they die? Someone else’s life flashes before their eyes.”

This is literally a life-changing book for codependents.

Reviewer: A reader

Once Melody Beattie’s Codependent No More has been “digested”, Beyond Codependency helps to move the recovering codependent past the hurt and on to the business of literally changing behaviors and making a better life. I absolutely recommend this book above any others to recovering codependents.

Mutual-aid support groups play a vital role in substance abuse treatment.

In 2005, a national survey of participants in mutual-aid support groups for addiction was conducted to identify key differences between participants in various recovery groups. Extensive data was collected from survey respondents on many aspects of recovery.

In their recently published article, researchers focus on the impact of survey respondents’ level of spirituality on their recovery and their participation in mutual-aid support groups.

Key findings include:

• Active involvement in groups significantly improves the chances of remaining clean and sober, regardless of the group (Save Our Souls, SMART, Women For Sobriety, and 12-step such as Alcoholics Anonymous) 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.
• Spiritual respondents were more likely to actively participate in 12-Step groups and WFS, both of which have spiritual components in their programs.
• Non-religious respondents were significantly less likely to participate in 12-Step groups.
• Respondents with low levels of spirituality were more likely to actively participate in groups with secular programs, such as SOS and SMART Recovery.

This study provides more evidence that in recovery “one size does not fit all.” These results have important implications for treatment planning and implementation, indicating that matching clients to appropriate support groups according to their individual beliefs can have a positive impact on their program involvement and, ultimately, on their treatment outcomes.

When participants in recovery groups feel more comfortable with the philosophies of the groups they attend, they are more likely to become actively involved in these groups, which often results in longer periods of remaining abstinent from the use of alcohol and other drugs.

This research was funded by a grant from the National Institute on Drug Abuse. The survey was conducted with the assistance of The Center for Survey Research at the University of Virginia, Secular Organizations for Sobriety (SOS), SMART Recovery, and Women for Sobriety (WFS).

Reference: Atkins, R.G., Hawdon, J.E. (2007) Religiosity and participation in mutual-aid support groups for addiction. Journal of Substance Abuse Treatment, 33(3): 321-331.

The Spirituality of Imperfection: Storytelling and the Search for Meaning by Ernest Kurtz, Katherine Ketcham Read more about this title…

This study analyzed the Alcoholics Anonymous (AA) participation of 55 patients during the 3 months after their discharge from structured treatment, when dropout is high.

Three levels of meeting attendance were discerned:

• low,
• mid-level, and
• “90 meetings in 90 days.”

Of greatest interest, the mid-level group showed mixed interest in AA practices despite substantial meeting attendance, that is,

• they admitted powerlessness over alcohol, but had less enthusiasm for the higher power concept, and relapsed significantly;
• they were likely to have a sponsor, but were less involved with other AA members; and
• they reported working the 12 Steps, but were less interested in the AA literature.

Findings suggest that individuals who are attending AA but having difficulty embracing key aspects of the program need professional assistance that focuses more on AA practices and tenets and meeting attendance.

Barriers to affiliation can also serve as opportunities for furthering both counselling goals and affiliation.

Research; Paul Elliott Caldwell and Henry S.G. Cutter. Journal of Substance Abuse Treatment. Volume 15, Issue 3, May-June 1998, Pages 221-228

• See also:
• Twelve Step Facilitation
• Brief-TSF Description
• AA and Treatment Work Better Together
• Alcohol Related Brain Injury
• THE TWELVE REWARDS OF RECOVERY

Religiosity and participation in mutual-aid support groups for addiction

Mutual-aid support groups, such as the 12-Step fellowship Alcoholics Anonymous play a vital role in substance abuse treatment in the United States.  In 2005, The Walsh Group conducted a national survey of participants in mutual-aid support groups for addiction to identify key differences between participants in various recovery groups.  The survey was conducted with the assistance of The Center for Survey Research at the University of Virginia, Secular Organizations for Sobriety (SOS), SMART Recovery, and Women for Sobriety (WFS).  Extensive data was collected from survey respondents on many aspects of recovery.  This paper focuses on the impact of survey respondents’ level of religiosity on their recovery and their participation in mutual-aid support groups.

Key findings from the survey on mutual-aid support groups discussed in this paper include:

• Active involvement in groups significantly improves the chances of remaining clean and sober, regardless of the group (SOS, SMART, WFS, 12-step) 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 actively participate in 12-Step groups and WFS, both of which have spiritual components in their programs.
• Non-religious respondents were significantly less likely to participate in 12-Step groups. 
• Respondents with low levels of religiosity were more likely to actively participate in groups with secular programs, such as SOS and SMART Recovery.  

These results have important implications for treatment planning and implementation, indicating that matching clients to appropriate support groups according to their individual beliefs can have a positive impact on their program involvement and, ultimately, on their treatment outcomes.  When participants in recovery groups feel more comfortable with the philosophies of the groups they attend, they are more likely to become actively involved in these groups, which often results in longer periods of remaining abstinent from the use of alcohol and other drugs.

Research; Randolph G. Atkins, Jr, and James E. Hawdon. Religiosity and participation in mutual-aid support groups for addiction. Journal of Substance Abuse Treatment, Volume 33, Issue 3, October 2007, Pages 321-331

Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism by AA Services Read more about this title…

Review of the book ’Alcoholics Anonymous’

From; The NEW ENGLAND JOURNAL OF MEDICINE, Vol. 221(15), October 12, 1939

ALCOHOLICS ANONYMOUS: The story of how more than one hundred men have recovered from alcoholism. 400 pp. New York Works Publishing Co., 1939, $3.50.

The psychological aspect of alcoholism taxes the entire skill and intuition of the therapist, and the authors of this book claim that in the long run the ex-alcoholic patient who is properly trained in psychological method is an extremely effective person to bring about the cure of the neurotic alcoholic individual.

The first part of the book discusses methods, with particular stress on twelve steps in the recovery program. This program includes the general principles of psychotherapy found in such books as those by Durfee and Peabody. There is, however, an essentially new note, namely, that the alcoholic individual should be helped to admit to God, to himself and to another human being (preferably an ex-alcoholic patient) the exact nature of his personality deficit Some will perhaps shy from the emphasis on God and religion until it is realized that the alcoholic patient is asked in this relation to believe sincerely in a power greater than himself. He then sees that his life is really unmanageable without this power.

The second part contains the stories of twenty-nine individuals who were cured by the method of working out their character problems in relation to God, themselves and another human being. All these individuals were "convinced by an ex-alcoholic therapist" Those who at some time must deal with the problem of alcoholism are urged to read this stimulating account

The authors have presented their case well, in fact, in such good style that it may be of considerable influence when read by alcoholic patients.

Bloggers note; Its now sold over 25 million copies and has helped over 100 million people recover from alcoholism and about 500 other maladies – not just alcoholism.

Combined Alcoholics Anonymous and professional care for addicted physicians

We surveyed 100 impaired physicians who were successfully treated in a substance abuse program that combined professionally directed treatment and peer-led self-help.

An average of 33.4 months after admission, subjects reported being abstinent and rated Alcoholics Anonymous (AA) as more important to their recovery than professionally directed modalities.

Feelings of affiliativeness to AA, which were very high, were strong predictors of subjects perceived support for their recovery.

Three psychological variables were seen as influential to this process:

• shared belief,
• group cohesiveness, and
• mutual identification.

Feelings of affiliativeness and an identification with the role of care giver in addiction treatment appeared to be central to subjects recovery process.

Research report; Galanter, Marc; Talbott, Douglas; Gallegos, Karl; Rubenstone, Elizabeth. Combined Alcoholics Anonymous and professional care for addicted physicians. American Journal of Psychiatry. Vol 147(1), Jan 1990, 64-68.

ACOA Mutual help groups, perceived status benefits, and well-being: A test with adult children of alcoholics with personal substance abuse problems.

A field experiment was conducted to examine the potential effects of mutual help group participation on perceived status benefits, depression, and substance use among 82 adult children of alcoholics (ACOA’s; aged 22-60 yrs) with personal substance abuse problems.

Participants were randomly assigned to attend either ACOA-specific mutual help group meetings or substance abuse education classes during the initial month that they were enrolled in a residential treatment program for low-income substance abusers.

Analyses were based on assessments made at baseline, a 1-month posttest, and a 6-month follow-up.

Results indicate that participation in the mutual help group promoted perceived status benefits, which in turn led to reductions in depression and substance use.

These findings have clear implications for consumers of ACOA groups and can inform research on the social psychological underpinnings of different types of mutual help groups.

Kingree, J. B; Thompson, Martie. Mutual help groups, perceived status benefits, and well-being: A test with adult children of alcoholics with personal substance abuse problems. American Journal of Community Psychology. Vol 28(3), Jun 2000, 325-342.

The Complete ACOA Sourcebook: Adult Children of Alcoholics at Home, at Work and in Love by Janet Woititz Read more about this title…

Alcoholics Anonymous Treatment

Of all the treatments for alcohol misuse, Alcoholics Anonymous (AA) is probably the most well known.

In AA, a form of "self-help" treatment, participants take part in a series of mental, written and verbal activities that can lead to recovery and abstinence.

In one study, alcoholic patients who received inpatient and outpatient psychotherapy, as well as AA, had better outcomes than those patients who attended only one kind of treatment.

It is thought that AA helps people because it provides a new social network that replaces the alcohol abuser’s usual group of friends who drink with him or her, and provides a fellowship that inspires motivation and lends support toward the goal of reaching and maintaining abstinence.

AA also teaches a set of coping skills so that, when stressed, the alcohol abuser has more constructive ways of coping, and does not need to turn to alcohol to escape his or her problems.

Another study, conducted at a Department of Veteran Affairs hospital, indicated that those alcoholic patients who underwent either cognitive-behavioral therapy (CBT) or a 12-step program in combination with CBT did better, over the long run, than those who participated in the 12-step program alone. (CBT entails learning coping skills, new ways of interpreting and reacting to stressful situations, and changing one’s destructive or maladaptive behavior patterns.) The patients who received the combination treatment stayed sober longer and were able to hold down a job for longer periods than those patients who received only CBT.

Both of these studies seem to show that a combination of some kind of psychotherapy and a 12-step program such as AA produces the most beneficial results for patients who use alcohol in excess.