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6 - Mutual Help Approaches and Mechanisms of Change

from Part I - Micro Level

Published online by Cambridge University Press:  23 December 2021

By
J. Scott Tonigan
Edited by
Jalie A. Tucker  and
Katie Witkiewitz
Jalie A. Tucker
Affiliation:
University of Florida
Katie Witkiewitz
Affiliation:
University of New Mexico
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Summary

Mutual help programs are popular resources for persons with alcohol use disorder (AUD) and clinical referral to such programs is common. This chapter describes what is currently known about four established mutual help programs in the United States: Alcoholics Anonymous (AA), SMART Recovery, Women for Sobriety (WFS), and LifeRing. Strong correlational research indicates that AA is associated with increased abstinence and that this association arises in part because of increased social support, abstinence self-efficacy, and spiritual practices. There is little support that reductions in anger, selfishness, and depression account for AA-related benefit. Preliminary evidence indicates that persons reporting lower religiosity and higher education are more likely to affiliate with non-AA mutual help programs and that these programs may be efficacious. A series of recommendations are made to advance our knowledge of these mutual help programs, with an emphasis on the need for future investigations of SMART, WFS, and LifeRing.

Keywords

Alcoholics Anonymous (AA)LifeRingSMART RecoveryWomen for Sobriety (WFS)mutual helpself-helpmechanisms of behavior changerecovery
Type
Chapter
Information
Dynamic Pathways to Recovery from Alcohol Use Disorder
Meaning and Methods
 , pp. 95 - 113
Publisher: Cambridge University Press
Print publication year: 2022

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References

Alcoholics Anonymous (1939). Alcoholics Anonymous: The story of how many thousands of men and women recovered from alcoholism. The Works Publishing Company.Google Scholar
Alcoholics Anonymous (2020). General Service Office, New York: A.A. World Services. www.aa.org/assets/en_US/smf-132_en.pdfGoogle Scholar
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596Google Scholar
Annis, H. & Graham, J. M. (1988). Situational confidence questionnaire (SCQ): User’s guide. Addiction Research Foundation.Google Scholar
Bandura, A. (1986). The explanatory and predictive scope of self-efficacy theory, Journal of Social and Clinical Psychology, 4, 359–373. https://doi.org/10.1521/jscp.1986.4.3.359Google Scholar
Beck, A. K., Forbes, E., Baker, A. L., Kelly, P. J., Peter, J., Deane, F. P., Shakeshaft, A., Hunt, D., & Kelly, J. F. (2017). Systematic review of SMART recovery: Outcomes, process variables, and implications for research, Psychology of Addictive Behaviors, 31 (1), 1–20. https://doi.org/10.1037/adb0000237Google Scholar
Brown, T. G., Seraganian, P., Tremblay, J., & Annis, H. (2002). Process and outcome changes with relapse prevention versus 12 Step aftercare programs for alcohol and other drug abusers. Addiction, 97 , 677–689. https://doi.org/10.1046/j.1360-0443.2002.00101.xGoogle Scholar
Clifford, P. R., & Longabaugh, R. (1991). Manual for the administration of the Important People and Activities Instrument. Adapted for use by Project MATCH for the National Institute on Alcohol Abuse and Alcoholism. National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism. https://pubs.niaaa.nih.gov/publications/AssessingAlcohol/InstrumentPDFs/39_IPA.pdfGoogle Scholar
Connors, G., Tonigan, J. S., & Miller, W. R. (1996). Measure of religious background and behavior for use in behavior change research. Psychology of Addictive Behaviors, 10(2), 90–96. https://doi.org/10.1037/0893-164X.10.2.90CrossRefGoogle Scholar
DiClemente, C. C., Carbonari, J. P., Montgomery, R. P., & Hughes, S. O. (1994). The alcohol abstinence self-efficacy scale. Journal of Studies on Alcohol, 55(2), 141–148. https://doi.org/10.15288/jsa.1994.55.141CrossRefGoogle ScholarPubMed
Emrick, C. D., Tonigan, J. S., Montgomery, H., & Little, L. (1993). Alcoholics Anonymous: What is currently known? In McCrady, B. S. & Miller, W. R. (Eds.), Research on Alcoholics Anonymous: Opportunities and alternatives (pp. 41–76). Rutgers Center of Alcohol Studies.Google Scholar
Galanter, M., Josipovic, Z., Dermatis, H., Weber, J., & Millard, M. A., (2017). An initial fMRI study on neural correlates of prayer in members of Alcoholics Anonymous. The American Journal of Drug and Alcohol Abuse, 43(1), 44–54. https://doi.org/10.3109/00952990.2016.1141912CrossRefGoogle Scholar
Greenfield, B. L., & Tonigan, J. S. (2013). The general Alcoholics Anonymous tools of recovery: The adoption of 12 Step practices and beliefs. Psychology of Addictive Behaviors, 27(3), 553–561. https://doi.org/10.1037/a0029268Google Scholar
Groh, D. R., Jason, L. A., & Keys, C. B. (2008). Social network variables in alcoholics anonymous: A literature review. Clinical Psychology Review, 28 (3), 430–450. https://doi.org/10.1016/j.cpr.2007.07.014CrossRefGoogle ScholarPubMed
Hardin, R. (2013). SMART Recovery handbook (3rd ed.). Alcohol & Drug Abuse Self-Help Network, Inc. dba SMART Recovery.Google Scholar
Harris, J., Best, D., Gossop, M., Marshall, J., Man, L. O., Manning, V., & Strang, J. (2003). Prior Alcoholics Anonymous (AA) affiliation and the acceptability of the 12 Steps to patients entering UK statutory addiction treatment. Journal of Studies on Alcohol and Drugs, 64(2), 257–261. https://doi.org/10.15288/jsa.2003.64.257Google Scholar
Humphreys, K., Blodgett, J. C., & Wagner, T. H. (2014). Estimating the efficacy of Alcoholics Anonymous without self‐selection bias: An instrumental variables re‐analysis of randomized clinical trials. Alcoholism: Clinical and Experimental Research, 38(11), 2688–2699. https://doi.org/10.1111/acer.12557Google Scholar
Humphreys, K. & Moos, R. H. (1996). Reduced substance-abuse-related health care costs among voluntary participants in Alcoholics Anonymous. Psychiatric Services, 47 (7), 709–713. https://doi.org/10.1176/ps.47.7.709Google ScholarPubMed
Humphreys, K., Phibbs, C. S., & Moos, R. H. (1996). Addressing self-selection effects in evaluations of mutual help groups and professional mental health services: An introduction to two-stage sample selection models. Evaluation and Program Planning, 19(4), 301–308. https://doi.org/10.1016/S0149-7189(96)00028-6CrossRefGoogle Scholar
Kaskutas, L. A., (1994). What do women get out of self-help? Their reasons for attending Women for Sobriety and Alcoholics Anonymous. Journal of Substance Abuse Treatment, 11 (3) 185–195. https://doi.org/10.1016/0740-5472(94)90075-2Google Scholar
Kaskutas, L. A., Bond, J., & Humphreys, K. (2002). Social networks as mediators of the effect of Alcoholics Anonymous. Addiction, 97(7), 891–900. https://doi.org/10.1046/j.1360-0443.2002.00118.xGoogle Scholar
Kaskutas, L. A., Borkman, T. J., Laudet, A., Ritter, L. A., Witbrodt, J., Subbaraman, M. S., Stunz, A., & Bond, J. (2014). Elements that define recovery: The experiential perspective. Journal of Studies on Alcohol and Drugs, 75 (6), 999–1010. https://doi.org/10.15288/jsad.2014.75.999CrossRefGoogle ScholarPubMed
Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27. https://doi.org/10.1146/annurev.clinpsy.3.022806.091432Google Scholar
Kelly, J. F., Abry, A., Ferri, M., & Humphreys, K. (2020). Alcoholics Anonymous and 12 Step facilitation treatments for alcohol use disorder: A distillation of a 2020 Cochrane Review for clinicians and policy makers. Alcohol and Alcoholism, 55 (6), 641–651. https://doi.org/10.1093/alcalc/agaa050CrossRefGoogle ScholarPubMed
Kelly, J. F. & Greene, M. C. (2013). The twelve promises of Alcoholics Anonymous: Psychometric measure validation and mediational testing as a 12 Step specific mechanism of behavior change. Drug and Alcohol Dependence, 133(2), 633–640. https://doi.org/10.1016/j.drugalcdep.2013.08.006Google Scholar
Kelly, J. F., Greene, M. C., & Bergman, B. G. (2016). Recovery benefits of the “therapeutic alliance” among 12 Step mutual help organization attendees and their sponsors. Drug and Alcohol Dependence, 162, 64–71. https://dx.doi.org/10.1016%2Fj.drugalcdep.2016.02.028Google Scholar
Kelly, J. F., Stout, R. L., Magill, M., & Tonigan, J. S. (2011). The role of Alcoholics Anonymous in mobilizing adaptive social network changes: A prospective lagged mediational analysis. Drug and Alcohol Dependence, 114 , 119–126. https://doi.org/10.1016/j.drugalcdep.2010.09.009Google Scholar
Kelly, J. F., Stout, R. L., Magill, M., Tonigan, J. S., & Pagano, M. E. (2011). Spirituality in recovery: A lagged meditational analysis of Alcoholics Anonymous’ principal theoretical mechanism of behavior change. Alcoholism: Clinical and Experimental Research, 35(3), 454–463. https://doi.org/10.1111/j.1530-0277.2010.01362.xGoogle Scholar
Kelly, J. F., Stout, R. L., Tonigan, J. S., Magill, M., & Pagano, M. E. (2010). Negative affect, relapse, and Alcoholics Anonymous (AA): Does AA work by reducing anger? Journal of Studies on Alcohol and Drugs, 71(3), 434–444. https://doi.org/10.15288/jsad.2010.71.434Google Scholar
Kelly, J. F., Stout, R. L., Magill, M., Tonigan, J. S., & Pagano, M. E. (2010). Mechanisms of behavior change in Alcoholics Anonymous: Does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms? Addiction, 105(4), 626–636. https://doi.org/10.1111/j.1360-0443.2009.02820.xGoogle Scholar
Kirkpatrick, J., (1977). Turnabout: New help for the woman alcoholic. Women for Sobriety, Inc.Google Scholar
Kurtz, E. (1979). Not God: A history of Alcoholics Anonymous. Hazelden Publishing.Google Scholar
Kuerbis, A., & Tonigan, J. S. (2018). More than taking a chair: The perceived group social dynamics of Alcoholics Anonymous related to changes in spiritual practices. Alcoholism Treatment Quarterly, 36(3), 314–329. https://doi.org/10.1080/07347324.2017.1420437Google Scholar
Magill, M., Kiluk, B. D. McCrady, B. S., Tonigan, J. S., & Longabaugh, R. (2015). Active ingredients of treatment and client mechanisms of change in behavioral treatments for alcohol use disorders: Progress 10 years later. Alcoholism: Clinical and Experimental Research, 39 (10), 1852–1862. https://doi.org/10.1111/acer.12848Google Scholar
Magura, S., McKean, J., Kosten, S., & Tonigan, J. S. (2012). A novel application of propensity score matching to estimate Alcoholics Anonymous’ effect on drinking outcomes. Drug and Alcohol Dependence, 129 (1-2), 54–59. https://doi.org/10.1016/j.drugalcdep.2012.09.011Google Scholar
Marlatt, G. A., & Donovan, D. M. (Eds.) (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press.Google Scholar
Montgomery, H. A., Miller, W. R., & Tonigan, J. S. (1995). Does Alcoholics Anonymous involvement predict treatment outcome? Journal of Substance Abuse Treatment, 12(4), 241–246. https://doi.org/10.1016/0740-5472(95)00018-zCrossRefGoogle ScholarPubMed
Moos, R. H. (1986). Group Environment Scale manual. Consulting Psychologists Press.Google Scholar
Moos, R. H., Fenn, C. B., & Billings, A. G. (1988). Life stressors and social resources: An integrated assessment approach. Social Science & Medicine, 27 (9), 999–1002. https://doi.org/10.1016/0277-9536(88)90291-2Google Scholar
Moos, R. H., & Moos, B. S. (2004). Long-term influence of duration and frequency of participation in Alcoholics Anonymous on individuals with alcohol use disorders. Journal of Consulting and Clinical Psychology 72(1), 81–90. https://doi.org/10.1037/0022-006x.72.1.81CrossRefGoogle ScholarPubMed
Nicolaus, M. (2009). Empowering your sober self (2nd ed.). LifeRing Bookstore.Google Scholar
Raskin, R., & Terry, H. (1988). A principal-components analysis of the Narcissistic personality inventory and further evidence of its construct validity. Journal of Personality and Social Psychology, 54 (5), 890–902. https://doi.org/10.1037//0022-3514.54.5.890Google Scholar
Rynes, K. N., Tonigan, J. S., & Rice, S. (2013). Interpersonal climate of 12 Step groups predicts reductions in alcohol use. Alcohol Treatment Quarterly, 31 (2), 167–185. https://doi.org/10.1080/07347324.2013.771983Google Scholar
Stevens, E. B., & Jason, L. A. (2015). Evaluating Alcoholics Anonymous sponsor attributes using conjoint analysis. Addictive Behaviors, 51 , 12–17. https://doi.org/10.1016/j.addbeh.2015.06.043Google Scholar
Tonigan, J. S. (2001). Benefits of Alcoholics Anonymous attendance: Replication of findings between clinical research sites in Project MATCH. Alcoholism Treatment Quarterly, 19(1), 67–77. https://doi.org/10.1300/J020v19n01_05CrossRefGoogle Scholar
Tonigan, J. S., Ashcroft, F., & Miller, W. R. (1995). AA group dynamics and 12 Step activity. Journal of Studies on Alcohol, 54 , 616–621. https://doi.org/10.15288/jsa.1995.56.616Google Scholar
Tonigan, J. S., Miller, W. R., & Schermer, C. (2002). Atheist, agnostics, and Alcoholics Anonymous. Journal of Studies on Alcohol and Drugs, 63(5), 534–541. https://doi.org/10.15288/jsa.2002.63.534Google Scholar
Tonigan, J. S., Pearson, M. R., Magill, M., & Hagler, K. J. (2018). AA attendance and abstinence for dually diagnosed patients: A meta‐analytic review. Addiction, 113(11), 1970–1981. https://doi.org/10.1111/add.14268Google Scholar
Tonigan, J. S., & Rice, S. L. (2010). Is it beneficial to have an Alcoholics Anonymous sponsor? Psychology of Addictive Behaviors, 24(3), 397–403. https://doi.org/10.1037/a0019013Google Scholar
Tonigan, J. S., Rynes, K., & McCrady, B. S. (2013) Spirituality as a change mechanism in 12 Step programs: A replication, refinement and extension. Substance Use and Misuse, 48 (12) 1161–1173. https://doi.org/10.3109/10826084.2013.808540Google Scholar
Tonigan, J. S., Rynes, K., Toscova, R., & Hagler, K. (2013). Do changes in selfishness explain 12 Step benefit? A prospective lagged analysis. Substance Abuse, 34(1), 13–19. https://doi.org/10.1080/08897077.2012.691453Google Scholar
Tonigan, J. S., Toscova, R., & Miller, W. R. (1996). Meta-analysis of the literature on Alcoholics Anonymous: Sample and study characteristics moderate findings. Journal of Studies on Alcohol, 57(1), 65–72. https://doi.org/10.15288/jsa.1996.57.65Google Scholar
Whelan, P. J. P., Marshall, E. J., Ball, D. M., & Humphreys, K. (2009). The role of AA sponsors: A pilot study. Alcohol and Alcoholism, 44(4) 416–422. https://doi.org/10.1093/alcalc/agp014Google Scholar
White, W., & Kurtz, E. (2008). Twelve defining moments in the history of Alcoholics Anonymous. In M. Galanter, & L. A. Kaskutas, (Eds.) Recent developments in alcoholism (pp. 37–57). Plenum Publishing Corporation.CrossRefGoogle Scholar
Wilcox, C., & Tonigan, J. S. (2018). Changes in depression mediate the effects of AA attendance on alcohol use outcomes. The American Journal of Drug and Alcohol Abuse, 44(1), 103–112. https://doi.org/10.1080/00952990.2016.1249283Google Scholar
Witbrodt, J., Kaskutas, L., Bond, J., & Delucchi, K. (2012). Does sponsorship improve outcomes above Alcoholics Anonymous attendance? A latent class growth curve analysis. Addiction, 107(2), 301–311. https://doi.org/10.1111/j.1360-0443.2011.03570.xGoogle Scholar
Worley, M. J., Tate, S. R., & Brown, S. A. (2012). Mediational relations between 12 Step attendance, depression, and substance use in patients with comorbid substance dependence and major depression. Addiction, 107(11), 1974–1983. https://doi.org/10.1111/j.1360-0443.2012.03943.xGoogle Scholar
Zemore, S. E., Kaskutas, L. A., Mericle, A., & Hemberg, J. (2017). Comparison of 12 Step groups to mutual help alternatives for AUD in a large, national study: Differences in membership characteristics and group participation, cohesion, and satisfaction. Journal Substance Abuse Treatment, 73 , 16–26. https://doi.org/10.1016/j.jsat.2016.10.004CrossRefGoogle Scholar
Zemore, S. E., Lui, C., Mericle, A., Hemberg, J., & Kaskutas, L. A. (2018). A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12 Step groups for those with AUD. Journal of Substance Abuse Treatment, 88, 18–26. https://doi.org/10.1016/j.jsat.2018.02.004Google Scholar
Zemore, S. E., Subbaraman, M., & Tonigan, J. S., (2013). Involvement in 12 Step activities and treatment outcomes. Substance Abuse, 34(1), 60–69. https://doi.org/10.1080/08897077.2012.691452Google Scholar

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