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Walsh BE, Manzler CA, Noyes ET, Schlauch RC. Examining the daily reciprocal relations between alcohol abstinence self-efficacy and drinking among non-treatment seeking individuals with alcohol use disorder (AUD). Addict Behav 2024; 156:108068. [PMID: 38772225 DOI: 10.1016/j.addbeh.2024.108068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/01/2024] [Accepted: 05/17/2024] [Indexed: 05/23/2024]
Abstract
Theoretical and empirical models of alcohol use and misuse indicate that abstinence self-efficacy (ASE) predicts improvements in treatment outcomes among individuals with alcohol use disorder (AUD). More recently, studies have begun examining daily fluctuations in ASE to better understand in-the-moment determinants of drinking behaviors. With the goal of assessing how ASE is implicated in maintenance (rather than changing) of hazardous drinking patterns, the current study examined daily reciprocal relations between ASE and drinking among individuals with AUD. Non-treatment seeking adults (n = 63) with AUD were recruited and completed daily surveys assessing ASE and drinking behaviors for 14 days. Data were analyzed using time-lagged multilevel modeling. Results indicated that both within- and between-person elevations in ASE predicted decreased likelihood of drinking, but only within-person ASE predicted fewer drinks consumed on drinking days. Previous-day drinking behavior was unrelated to next-day ASE; however, higher percentage of drinking days during the monitoring period (between-person) was associated with lower daily ASE. These results demonstrate that confidence in one's ability to abstain from drinking varies considerably across days, and that fluctuations may be implicated in daily drinking decisions. The lack of effect of previous-day drinking on ASE (combined with the significant effect of average drinking frequency) may suggest that sustained periods of reduced drinking or abstinence are necessary to impact ASE. This study points to ASE's role in the maintenance of daily drinking behavior among non-treatment-seeking individuals with AUD and reiterates the importance of self-efficacy in behavioral control and decision-making at the daily level.
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Affiliation(s)
- Brendan E Walsh
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Charles A Manzler
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Emily T Noyes
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Robert C Schlauch
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
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Bourdon JL, Fields T, Judson S, Vadhan NP, Morgenstern J. An Implementation Approach to Translating Assessment Data into Treatment for Disorders of Addiction. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241237117. [PMID: 38477304 PMCID: PMC10938602 DOI: 10.1177/00469580241237117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/18/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
Effective translation of data to inform real-time patient care is lacking in addiction inpatient settings. The current study presents the optimization of an assessment report that is used by clinicians to individualize treatment. A multi-aim, iterative approach was taken, utilizing an implementation science perspective to arrive at a final version of the assessment report. This occurred at a small inpatient addiction treatment facility. Participants were all available clinical staff (N = 7; female = 71%). A quantitative survey was used for aims 1 and 2 to, respectively, assess motives and context around the report as well as evaluate its design. Aim 3 focused on optimization via semi-structured interviews. Descriptive and modified content analyses were utilized appropriately across aims. This resulted in five versions of the assessment report being created between February 2021 and August 2022, the most recent of which was adapted into patients' electronic medical records. We discuss each version of the report in depth, including clinicians' iterative feedback and researchers' perceived barriers to this translational process. The response rate was 64.3%. The current study highlights a replicable approach for optimizing the translation of assessment data into treatment for patients with disorders of addiction as well as an assessment report that could be utilized by similar facilities with a naturally low sample size.
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Affiliation(s)
| | - Taylor Fields
- Wellbridge Addiction Treatment and Research, Calverton, NY, USA
| | - Sidney Judson
- Wellbridge Addiction Treatment and Research, Calverton, NY, USA
| | - Nehal P. Vadhan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USA
| | - Jon Morgenstern
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USA
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Balbinot P, Pellicano R, Patussi V, Caputo F, Testino G. Alcohol use disorders, self-help groups as a supplement to pharmacological and psychological therapy? A retrospective study in a population with alcohol related liver disease. Minerva Gastroenterol (Torino) 2023; 69:479-485. [PMID: 36255286 DOI: 10.23736/s2724-5985.22.03292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND According to the new criteria in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V), the prevalence of alcohol use disorders (AUDs) is 20-30% in men and 10-15% in women worldwide.2,3 The anticraving therapy/psychotherapy combination is currently used routinely in clinical practice. However, the results after one year are unsatisfactory. Meta-analytic studies found failure rates of 57 to 75%. These percentages vary in relation to the intensity and length of the treatment. In addition, the abstinence rates gradually decrease over time. In this study, the clinical outcome of alcohol related liver disease (ALD) patients who spontaneously attended self-help groups (SHGs) (club of alcoholics in treatment - multi-family community/ alcoholics anonymous) regularly versus those who did not want to start the path or did not complete it was evaluated. METHODS From January 2005 to December 2010, 1337 alcohol use disorder patients affected by compensated alcohol related liver disease, were prospectively followed and retrospectively assessed. Two hundred thirty-one patients were enrolled: 74 attended self-help groups assiduously, 27 attended sporadically and 130 refused participation in SHGs. RESULTS Constant attendance at SHGs compared to non-attendance allows for a significant increase (<0.0001) in the period of sobriety found in the median of distribution. Frequent attendance at SHGs is effectively "preventive," reducing the fraction of relapses by about 30%. The percentage of cases of cirrhosis is significantly different (P=0.0007) between those who have regularly attended SHG meetings (about 1% of patients) and those who have never attended or only occasionally (various percentages between 21 and 31% of patients); in both groups the incidence of new cases would seem to be 0.014 cases/ year. Similar difference in percentages regarding the onset of hepatocellular carcinomas (HCCs), although with a lower level of significance (P=0.017) among those who attended regularly, 4% of patients with an incidence of 0.006 cases/ year, compared to those who have never attended or only occasionally: over 14% of patients with an incidence of 0.022 cases/year. CONCLUSIONS This study suggests the importance of attending SHGs not only for the long-term achievement of alcoholic abstention, but also in positively influencing the course of alcohol-related diseases.
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Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, ASL3 Liguria, Genoa, Italy
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
| | | | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Translational Medicine, Center for the Study and Treatment of Alcohol-Related Diseases, University of Ferrara, Ferrara, Italy
- Department of Internal Medicine, Santissima Annunziata Hospital, University of Ferrara, Ferrara, Italy
| | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, ASL3 Liguria, Genoa, Italy
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
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Gómez Plata M, Laghi F, Zammuto M, Pastorelli C. Refusal self-efficacy and alcohol-related behaviours in community samples: a systematic review and meta-analysis. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03954-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nirmala N, Hemavathy V. Role of mindfulness meditation for enhancement of self- efficacy in alcoholism. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.22.467470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract Mindfulness meditation is an effective tool to create mental awareness and has been used in meditation practice for many decades. Mindfulness meditation is the practice that bringing clear awareness to the present not on the pastor future without evaluation. Many research studies have proved the benefits of mindfulness meditation in psychological and bodily health. Mindfulness meditation interventions is highly effective in reducing the level of anxiety, and depression, prevention of alcohol relapse, controlling of craving and enhancement of self efficacy. Mindfulness meditation technique helps to awareness of once self-efficacy. The connection between mindfulness meditation and self-efficacy helps to focus on set goals and performance. People with high self-efficacy approach obstacles in life as challenges. They set challenging goals for themselves and work hard to achieve them. People with low self- efficacy view life obstacle as life threats and instead to overcome they will focus on their own deficiencies. They rarely set goals and do not commit for that. Self-efficacy is defined as a person’s conviction in his or her ability to carry out the behaviours required to achieve certain performance goals. A self-efficacy is a reflection of once confidence in the ability to control own motivation, behaviour, and responses to the environment.. High level of self-efficacy often has high motivation. In alcoholism It refers to the strength to stop or minimize addiction and manage craving, temptation and maintain behavioural changes. These changes might be the strongest predictors of recovery from alcoholism.
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O'Sickey AJ, Hanes J, Tonigan JS. The Relationship Between Perceived Alcoholics Anonymous Social Group Dynamics and Getting an AA Sponsor. ALCOHOLISM TREATMENT QUARTERLY 2020; 38:21-31. [PMID: 32742071 DOI: 10.1080/07347324.2019.1613942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research has shown that aspects of group dynamics of AA meetings are associated with AA attendance, alcohol use, and engagement in prescribed AA behaviors. This study investigated whether perceptions of AA meeting group dynamics changed over 12-months and whether these dynamics predicted the probability that a new member would get a sponsor. Results showed that perceptions of the group dynamics of AA meetings did not change over the 12-month assessment period. Member perception of group cohesion was the only AA meeting group dynamic that predicted a new member getting a sponsor. Findings suggest that group cohesion plays an important role in AA members recovery efforts.
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Affiliation(s)
- A J O'Sickey
- Center on Alcoholism, Substance Abuse, & Addictions, 2650 Yale Blvd SE, Albuquerque, NM 87106, USA.,University of New Mexico, Logan Hall MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Jacob Hanes
- University of New Mexico, Logan Hall MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - J Scott Tonigan
- Center on Alcoholism, Substance Abuse, & Addictions, 2650 Yale Blvd SE, Albuquerque, NM 87106, USA.,University of New Mexico, Logan Hall MSC03-2220, 1 University of New Mexico, Albuquerque, NM 87131, USA
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Liu Y, Kornfield R, Shaw BR, Shah DV, McTavish F, Gustafson DH. Giving and receiving social support in online substance use disorder forums: How self-efficacy moderates effects on relapse. PATIENT EDUCATION AND COUNSELING 2020; 103:1125-1133. [PMID: 31901364 PMCID: PMC7253337 DOI: 10.1016/j.pec.2019.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Individuals in recovery for substance use disorders (SUDs) increasingly use online social support forums, necessitating research on how communicating through these forums can affect recovery. This study examines how giving and receiving support within an SUDs recovery forum predict substance use, and considers whether effects vary according to participants' self-efficacy. METHODS We applied content analysis to 3440 messages that were posted by 231 participants in an online SUDs forum. Surveys assessed social support reception and substance use at three timepoints. We assessed relationships between giving and receiving support and substance use (risky drinking days, illicit drug use days), and the interactions between self-efficacy and social support in predicting substance use outcomes. RESULTS Receiving more emotional support was associated with reduced illicit drug use at 6 and 12 months. For those with low self-efficacy, giving more emotional support predicted less risky drinking at month 12, whereas giving more informational support predicted more risky drinking at month 12. CONCLUSION These results suggest conditional benefits of exchanging support in an online SUDs forum, depending upon type of support (informational versus emotional), the participants' role (giver or receiver), and their self-efficacy. PRACTICE IMPLICATIONS We discuss implications for designing and using peer-to-peer support platforms.
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Affiliation(s)
- Yan Liu
- School of Journalism & Communication, Shanghai University, Shanghai, 200072, China.
| | - Rachel Kornfield
- Department of Communication Studies, Northwestern University, Evanston, IL, 60208, USA
| | - Bret R Shaw
- Department of Life Sciences Communication, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Dhavan V Shah
- School of Journalism & Mass Communication, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Fiona McTavish
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - David H Gustafson
- Center for Health Enhancement System Studies, University of Wisconsin-Madison, Madison, WI, 53706, USA
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Hovhannisyan K, Günther M, Raffing R, Wikström M, Adami J, Tønnesen H. Compliance with the Very Integrated Program (VIP) for Smoking Cessation, Nutrition, Physical Activity and Comorbidity Education Among Patients in Treatment for Alcohol and Drug Addiction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2285. [PMID: 31261620 PMCID: PMC6650928 DOI: 10.3390/ijerph16132285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 12/20/2022]
Abstract
Meeting adherence is an important element of compliance in treatment programmes. It is influenced by several factors one being self-efficacy. We aimed to investigate the association between self-efficacy and meeting adherence and other factors of importance for adherence among patients with alcohol and drug addiction who were undergoing an intensive lifestyle intervention. The intervention consisted of a 6-week Very Integrated Programme. High meeting adherence was defined as >75% participation. The association between self-efficacy and meeting adherence were analysed. The qualitative analyses identified themes important for the patients and were performed as text condensation. High self-efficacy was associated with high meeting adherence (ρ = 0.24, p = 0.03). In the multivariate analyses two variables were significant: avoid complications (OR: 0.51, 95% CI: 0.29-0.90) and self-efficacy (OR: 1.28, 95% CI: 1.00-1.63). Reflections on lifestyle change resulted in the themes of Health and Wellbeing, Personal Economy, Acceptance of Change, and Emotions Related to Lifestyle Change. A higher level of self-efficacy was positively associated with meeting adherence. Patients score high on avoiding complications but then adherence to the intervention drops. There was no difference in the reflections on lifestyle change between the group with high adherence and the group with low adherence.
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Affiliation(s)
- Karen Hovhannisyan
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden.
| | - Michelle Günther
- Skånevård Kryh, Medicon Village, Region Skåne, 223 81 Lund, Sweden
| | - Rie Raffing
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden.
- Clinical Health Promotion Centre, WHO Collaborating Centre for Evidence-based Health promotion in Hospitals and Health Services, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57-59, Entr. 5, 2000 Frederiksberg, Denmark.
| | - Maria Wikström
- Student Health, Malmö University, Neptuniplan 7, 21118 Malmö, Sweden
| | - Johanna Adami
- President Office, Sophiahemmet University, Box 5605, 114 86 Stockholm, Sweden
| | - Hanne Tønnesen
- Clinical Health Promotion Centre, WHO Collaborating Centre for Implementation of Evidence-based Clinical Health Promotion, Faculty of Medicine, Lund University and Addiction Centre Malmö, Region Skåne, Södra Förstadsgatan 35, 4th floor, SE 205 02 Malmö, Sweden
- Clinical Health Promotion Centre, WHO Collaborating Centre for Evidence-based Health promotion in Hospitals and Health Services, The Parker Institute, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57-59, Entr. 5, 2000 Frederiksberg, Denmark
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Tonigan JS, Pearson MR, Magill M, Hagler KJ. AA attendance and abstinence for dually diagnosed patients: a meta-analytic review. Addiction 2018; 113:1970-1981. [PMID: 29845709 DOI: 10.1111/add.14268] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/14/2017] [Accepted: 05/10/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS There is consensus that best clinical practice for dual diagnosis (DD) is integrated mental health and substance use treatment augmented with Alcoholics Anonymous (AA) attendance. This is the first quantitative review of the direction and magnitude of the association between AA attendance and alcohol abstinence for DD patients. METHOD A systematic literature search (1993-2017) identified 22 studies yielding 24 effect sizes that met our inclusion criteria (8075 patients). Inverse-variance weighting of correlation coefficients (r) was used to aggregate sample-level findings and study aims were addressed using random- and mixed-effect models. Sensitivity and publication bias analyses were conducted to assess the likelihood of bias in the overall estimate of AA-related benefit. RESULTS AA exposure and abstinence for DD patients were associated significantly and positively [rw = 0.249; 95% confidence interval (CI) = 0.203-0.293; tau = 0.097). There was also significant heterogeneity in the distribution of effect sizes and high between-sample variance (I2 = 74.6, P < 0.001). Subgroup analyses indicated that the magnitude of AA-related benefit did not differ between 6- (k = 7) and 12- (k = 12) month follow-up (Q = 0.068, P = 0.794), type of treatment received (in-patient k = 9; intensive out-patient, out-patient, community k = 15; Q = 2.057, P = 0.152), and whether a majority of patients in a sample had (k = 11) or did not have (k = 13) major depression (Q = 0.563, P = 0.453). Sensitivity analyses indicated that the overall meta-analytical estimate of AA benefit was not impacted adversely or substantively by pooling randomized controlled trial (RCT) and observational samples (Q = 0.763, P = 0.382), pooling count, binary and ordinal-based AA (Q = 0.023, P = 0.879) and outcome data (Q = 1.906, P = 0.167) and reversing direction of correlations extracted from studies (Q = 0.006, P = 0.937). No support was found for publication bias. CONCLUSIONS Clinical referral of dual diagnosis patients to Alcoholics Anonymous is common and, in many cases, dual diagnosis patients who attend Alcoholics Anonymous will report higher rates of alcohol abstinence relative to dual diagnosis patients who do not attend Alcoholics Anonymous.
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Affiliation(s)
- J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Matthew R Pearson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Kylee J Hagler
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
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McMullan A, Kelly-Campbell RJ, Wise K. Improving Hearing Aid Self-Efficacy and Utility Through Revising a Hearing Aid User Guide: A Pilot Study. Am J Audiol 2018; 27:45-56. [PMID: 29222574 DOI: 10.1044/2017_aja-17-0035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/26/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associated with improved hearing aid self-efficacy and utility performance. METHOD In Part 1, an HAUG was evaluated using the Suitability Assessment of Material (SAM) and readability formulas (Flesch Reading Ease [Flesch, 1943], Flesch-Kincaid Readability Formula [Kincaid, Fishburne, Rogers, & Chissom, 1957], and Simple Measure of Gobbledygook [McLaughlin, 1969]). The HAUG was revised using results from the SAM and best practice guidelines. The revision included generating a video. In Part 2, 30 adults with hearing impairment were randomly assigned to use either the original guide (N = 15) or the revised guide and video (N = 15) to perform a utility task. Participants' self-efficacy was measured using the Basic and Advanced Handling subscales of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids questionnaire. SAM and readability were compared between the original and revised guides (Doak, Doak, & Root, 1996). RESULTS SAM and readability were improved following the revision. Participants in the revised guide group performed significantly better on the utility task and on the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids subscales than participants in the original guide group. CONCLUSIONS These results are encouraging as they indicate that there is scope to influence self-efficacy and utility performance through the use of appropriate HAUGs.
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Affiliation(s)
- Alexandra McMullan
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
| | | | - Kim Wise
- Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
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Johnson BR, Pagano ME, Lee MT, Post SG. Alone on the Inside: The Impact of Social Isolation and Helping Others on AOD Use and Criminal Activity. YOUTH & SOCIETY 2018; 50:529-550. [PMID: 29628533 PMCID: PMC5889144 DOI: 10.1177/0044118x15617400] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Because addiction is a socially isolating disease, social support for recovery is an important element of treatment planning. This study examines the relationship between social isolation, giving and receiving social support in Alcoholics Anonymous during treatment, and post-treatment outcomes among juvenile offenders court-referred to addiction treatment. Adolescents (N = 195) aged 14 to 18 years were prospectively assessed at treatment admission, treatment discharge, 6 months, and 12 months after treatment discharge. The influence of social isolation variables on relapse and severe criminal activity in the 12-months post-treatment was examined using negative binomial logistic regressions and event history methods. Juveniles entering treatment with social estrangement were significantly more likely to relapse, be incarcerated, and commit a violent crime in the 12-months post-treatment. Giving help to others in Alcoholics Anonymous during treatment significantly reduced the risk of relapse, incarceration, and violent crime in the 12-months post-treatment whereas receiving help did not.
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Montes KS, Tonigan JS. Does Age Moderate the Effect of Spirituality/Religiousness in Accounting for Alcoholics Anonymous Benefit? ALCOHOLISM TREATMENT QUARTERLY 2017; 35:96-112. [PMID: 28824222 DOI: 10.1080/07347324.2017.1288487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Gains in spiritual/religious (S/R) practices among Alcoholics Anonymous (AA) members are associated with reductions in drinking. This study had the following aims: (a) examine spirituality/religiousness as a mediator of the relationship between AA attendance and reductions in drinking behavior to replicate past research findings and to (b) examine age-cohort as a moderator of the mediational analyses given that empirical evidence (e.g., generational differences in spirituality) suggests that age may influence the acquisition of gains in spirituality/religiousness during AA as well as the expression of these gains on drinking behavior. METHOD Measures were administered to 253 participants recruited from community-based AA and outpatient treatment programs at baseline, 3, 6, 9, and 12-months, and 210 (83%) participants provided complete data to test study aims. RESULTS Gains in S/R practices mediated the relationship between AA attendance and increased abstinence, but not drinking intensity. Simple slopes analyses indicated a positive association between AA attendance and gains in S/R practices among younger AA affiliates but not older AA affiliates in the moderated-mediational analyses. However, age was not found to moderate the global mediational effect. CONCLUSIONS The results from the current study inform efforts to increase positive change in AA affiliates' drinking behavior by highlighting specific aspects of S/R practices that should be targeted based on the age of an AA affiliate.
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Affiliation(s)
- K S Montes
- Center on Alcoholism, Substance Abuse, & Addictions, University of New Mexico
| | - J S Tonigan
- Center on Alcoholism, Substance Abuse, & Addictions, University of New Mexico
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Sherman BJ, Baker NL, McRae-Clark AL. Gender differences in cannabis use disorder treatment: Change readiness and taking steps predict worse cannabis outcomes for women. Addict Behav 2016; 60:197-202. [PMID: 27156221 PMCID: PMC4884498 DOI: 10.1016/j.addbeh.2016.04.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 04/05/2016] [Accepted: 04/20/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Gender differences in cannabis use and cannabis use disorder have been established. Regarding treatment, some evidence suggests that women are less responsive, though the mechanisms are not well understood. Motivation to change and self-efficacy are associated with better outcomes overall, and may help explain gender differences in cannabis use outcomes. METHODS A secondary data analysis of a double-blind placebo controlled trial of buspirone treatment for cannabis dependence (N=175) was conducted. Self-report assessments of motivation to change, self-efficacy, and other clinical correlates were completed at baseline, and cannabis use was measured throughout the study. RESULTS There was a significant interaction between gender and taking steps on abstinence. Counter to hypothesis, higher taking steps reduced likelihood of achieving abstinence among women; there was no association among men. Subsequently, taking steps was associated with self-efficacy and quantity of use among men, and cannabis related problems among women. There was a significant interaction between gender and readiness to change on creatinine adjusted cannabinoid levels. Change readiness was positively associated with cannabinoid levels among women, but not men. CONCLUSIONS Motivation to change and initiation of change behavior predict worse cannabis outcomes in women. Men and women differ in what motivates change behavior. Social desirability, neurobiology, and treatment type may impact these effects. Gender differences in cannabis use and treatment responsiveness must be considered in future studies.
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Affiliation(s)
- Brian J Sherman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States.
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Aimee L McRae-Clark
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States
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Magill M, Apodaca TR, Walthers J, Gaume J, Durst A, Longabaugh R, Stout RL, Carroll KM. The Alcohol Intervention Mechanisms Scale (AIMS): Preliminary Reliability and Validity of a Common Factor Observational Rating Measure. J Subst Abuse Treat 2016; 70:28-34. [PMID: 27692185 DOI: 10.1016/j.jsat.2016.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 06/27/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022]
Abstract
The present work provides an overview, and pilot reliability and validity for the Alcohol Intervention Mechanisms Scale (AIMS). The AIMS measures therapist interventions that occur broadly across modalities of behavioral treatment for alcohol use disorder. It was developed based on identified commonalities in the function rather than content of therapist interventions in observed therapy sessions, as well as from existing observer rating systems. In the AIMS, the primary function areas are: explore (four behavior count codes), teach (five behavior count codes), and connect (three behavior count codes). Therapist behavior counts provide a frequency rating of occurrence (i.e., adherence). The three functions (explore, teach, connect) are then rated on global skillfulness, which provides a quality valence (i.e., competence) to the entire session. In the present study, three independent raters received roughly 30 hours of training on the use of the AIMS by the first author. Data were a sample of therapy session audio files from a Project MATCH clinical research site. Reliability results showed generally good performance for the measure. Specifically, 2-way mixed intraclass coefficients were 'excellent', ranging from .94 to .99 for function summary scores, while prevalence-adjusted, bias-adjusted kappa for global skillfulness measures were in the 'fair' to 'moderate' range (k=.36 to.40). Internal consistency reliability was acceptable, as were preliminary factor models by behavioral treatment function (i.e., explore, teach, connect). However, confirmatory fit for the subsequent three factor model was poor. In concurrent validity analyses, AIMS summary and skillfulness scores showed associations with relevant Project MATCH criterion measures (i.e., MATCH Tape Rating Scale) that were consistent with expectations. The AIMS is a promising and reliable observational measure of three proposed common functions of behavioral alcohol treatment.
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Affiliation(s)
- M Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
| | - Timothy R Apodaca
- Children's Mercy Kansas City, USA; University of Missouri-Kansas City School of Medicine, USA
| | - Justin Walthers
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Jacques Gaume
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA; Lausanne University Hospital, Lausanne, Switzerland
| | - Ayla Durst
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Richard Longabaugh
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Robert L Stout
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA; Pacific Institute for Research and Evaluation, Providence, RI, USA
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Pagano ME, Wang AR, Rowles BM, Lee MT, Johnson BR. Social anxiety and peer helping in adolescent addiction treatment. Alcohol Clin Exp Res 2016; 39:887-95. [PMID: 25872598 DOI: 10.1111/acer.12691] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/26/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The developmental need to fit in may lead to higher alcohol and other drug use among socially anxious youths which exacerbates the drink/trouble cycle. In treatment, youths with social anxiety disorder (SAD) may avoid participating in therapeutic activities with risk of negative peer appraisal. Peer-helping is a low-intensity, social activity in the 12-step program associated with greater abstinence among treatment-seeking adults. This study examined the influence of SAD on clinical severity at intake, peer-helping during treatment, and outcomes in a large sample of adolescents court-referred to residential treatment. METHODS Adolescents (N = 195; 52% female, 30% Black) aged 14 to 18 were prospectively assessed at treatment admission, treatment discharge, and 6 months after treatment discharge. Data were collected using rater-administered assessments, youth reports, clinician reports, medical charts, and electronic court records. The influence of SAD on peer-helping and outcomes was examined using hierarchical linear regression and event history methods. RESULTS Forty-two percent of youths reported a persistent fear of being humiliated or scrutinized in social situations, and 15% met current diagnostic criteria for SAD. SAD onset preceded initial use for two-thirds of youths with SAD and substance dependency. SAD youths presented for treatment with greater clinical severity in terms of earlier age of first use (p < 0.01), greater lifetime use of heroin and polysubstance use (p < 0.05), incarceration history (p < 0.01), and lifetime trauma (p < 0.001). Twelve-step participation patterns during treatment did not differ between youths with and without SAD except for peer-helping, which was associated with reduced risk of relapse (p < 0.01) and incarceration (p < 0.05) in the 6 months posttreatment. CONCLUSIONS This study found evidence of an association between SAD and earlier age of first use, greater lifetime use of heroin, incarceration history, and lifetime trauma. SAD was associated with higher service participation during treatment, which was associated with reduced risk of relapse and incarceration in the 6 months posttreatment. Findings indicate the benefits of service participation for juveniles with SAD which provides a nonjudgmental, task-focused venue for developing sober networks in the transition back into the community.
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Affiliation(s)
- Maria E Pagano
- Department of Psychiatry, Division of Child Psychiatry, Case Western Reserve University, Cleveland, Ohio
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16
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Pagano ME, White WL, Kelly JF, Stout RL, Tonigan JS. The 10-year course of Alcoholics Anonymous participation and long-term outcomes: a follow-up study of outpatient subjects in Project MATCH. Subst Abus 2014; 34:51-9. [PMID: 23327504 DOI: 10.1080/08897077.2012.691450] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study investigates the 10-year course and impact of Alcoholics Anonymous (AA)-related helping (AAH), step-work, and meeting attendance on long-term outcomes. Data were derived from 226 treatment-seeking alcoholics recruited from an outpatient site in Project MATCH and followed for 10 years post treatment. Alcohol consumption, AA participation, and other-oriented behavior were assessed at baseline, end of the 3-month treatment period, and 1, 3, and 10 years post treatment. Controlling for explanatory baseline and time-varying variables, results showed significant direct effects of AAH and meeting attendance on reduced alcohol outcomes and a direct effect of AAH on improved other-oriented interest.
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Affiliation(s)
- Maria E Pagano
- Division of Child Psychiatry, Department of Psychiatry, Case Western Reserve UniversitySchool of Medicine, 10524 Euclid Avenue, Cleveland, OH 44106, USA.
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17
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Bergman BG, Greene MC, Slaymaker V, Hoeppner BB, Kelly JF. Young adults with co-occurring disorders: substance use disorder treatment response and outcomes. J Subst Abuse Treat 2013; 46:420-8. [PMID: 24484710 DOI: 10.1016/j.jsat.2013.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/14/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
Compared to other life stages, young adulthood (ages 18-24) is characterized by qualitative differences including the highest rates of co-occurring substance use and psychiatric disorders (COD). Little is known, however, regarding young adults' response to substance use disorder (SUD) treatment, especially those with COD. Greater knowledge in this area could inform and enhance the effectiveness and efficiency of SUD care for this patient population. The current study investigated differences between 141 COD and 159 SUD-only young adults attending psychiatrically-integrated residential SUD treatment on intake characteristics, during-treatment changes on clinical targets (e.g., coping skills; abstinence self-efficacy), and outcomes during the year post-discharge. Contrary to expectations, despite more severe clinical profiles at intake, COD patients showed similar during-treatment improvements on clinical target variables, and comparable post-treatment abstinence rates and psychiatric symptoms. Clinicians referring young adults with COD to specialized care may wish to consider residential SUD treatment programs that integrate evidence-based psychiatric services.
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Affiliation(s)
- Brandon G Bergman
- Center for Addiction Medicine, Massachusetts General Hospital, Boston MA; Center for Addiction Medicine, Harvard Medical School, Boston MA.
| | - M Claire Greene
- Center for Addiction Medicine, Massachusetts General Hospital, Boston MA
| | | | - Bettina B Hoeppner
- Center for Addiction Medicine, Massachusetts General Hospital, Boston MA; Center for Addiction Medicine, Harvard Medical School, Boston MA
| | - John F Kelly
- Center for Addiction Medicine, Massachusetts General Hospital, Boston MA; Center for Addiction Medicine, Harvard Medical School, Boston MA
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18
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Lai MHC, Wu AMS, Tong KK. Validation of the Gambling Refusal Self-Efficacy Questionnaire for Chinese Undergraduate Students. J Gambl Stud 2013; 31:243-256. [PMID: 24078304 DOI: 10.1007/s10899-013-9412-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although research on self-efficacy in the gambling literature took place more than 25 years ago, only in the recent decade did researchers attempt to develop valid and reliable measures of gambling-related self-efficacy. Recently Casey et al. (J Gambl Stud 24:229-246, 2008) developed the Gambling Refusal Self-Efficacy Questionnaire (GRSEQ) in an Australian sample, which is a valuable tool for gambling research. The first objective of this study is to validate the measure in a new sample. Given that previous research on Chinese's gamblers' self-efficacy is lacking, and that related research often used ad-hoc measures of the construct, a second objective of this study is to evaluate whether the GRSEQ is suitable for Chinese people. A sample of 427 university students (56.4 % females, 50.7 % gamblers) answered a questionnaire with measures including the GRSEQ, subjective norms, intentions toward gambling, general self-efficacy, impulsiveness, and pathological gambling symptoms. Evidence was found for the four-factor structure, internal consistency, criterion-related validity, and discriminant validity of the Chinese version of the GRSEQ among this young Chinese group.
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Brown AE, Tonigan JS, Pavlik VN, Kosten TR, Volk RJ. Spirituality and confidence to resist substance use among celebrate recovery participants. JOURNAL OF RELIGION AND HEALTH 2013; 52:107-113. [PMID: 21246280 DOI: 10.1007/s10943-011-9456-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Since self-efficacy is a positive predictor of substance use treatment outcome, we investigated whether it is associated with spirituality within a religious 12-step program. This was a cross-sectional survey (N = 91) of 10 different Celebrate Recovery sites held at community churches. The mean spirituality score for those with high confidence was significantly greater than those with low confidence. Spirituality associated with greater confidence to resist substance use (OR = 1.09, 95% CI 1.02-1.17, P < 0.05). So every unit increase of measured spirituality increased the odds of being above the median in self-efficacy by 9%. We conclude that spirituality may be an important explanatory variable in outcomes of a faith-based 12-step recovery program.
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Affiliation(s)
- Anthony E Brown
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA.
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Carter RR, Johnson SM, Exline JJ, Post SG, Pagano ME. Addiction and "Generation Me:" Narcissistic and Prosocial Behaviors of Adolescents with Substance Dependency Disorder in Comparison to Normative Adolescents. ALCOHOLISM TREATMENT QUARTERLY 2012; 30:163-178. [PMID: 22544995 DOI: 10.1080/07347324.2012.663286] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The purpose of this study is to explore narcissistic and prosocial behaviors as reported by adolescents with and without substance dependency disorder (SDD). This study employs a quasi-experimental design using SDD adolescents compared with two normative samples of adolescents. In comparison to normative adolescents, adolescents with SDD were strongly distinguished by overt narcissistic behaviors and less monetary giving. Levels of narcissistic and prosocial behaviors among adolescents with SDD suggest a connection between self-centeredness and addiction. Results also suggest volunteerism as a potential option to counter narcissism in substance dependent adolescents.
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Affiliation(s)
- Rebecca R Carter
- Case Western Reserve University, Department of Psychiatry, Division of Child Psychiatry, Cleveland, OH
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21
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Scherer M, Worthington EL, Hook JN, Campana KL. Forgiveness and the bottle: promoting self-forgiveness in individuals who abuse alcohol. J Addict Dis 2012; 30:382-95. [PMID: 22026530 DOI: 10.1080/10550887.2011.609804] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In the current article, the authors explore the efficacy of a 4-hour self-forgiveness intervention. Participants (n = 79) undergoing a routine alcohol treatment protocol were randomly assigned to an intervention or treatment as usual condition. Those in the intervention condition completed the self-forgiveness intervention. All participants completed measures of self-forgiveness, drinking refusal self-efficacy, and guilt and shame over an alcohol-related transgression. Participants in the intervention condition reported more positive gains on measures of self-forgiveness and drinking refusal efficacy, as well as guilt and shame over alcohol-related offenses. Implications of the self-forgiveness intervention for individuals who misuse alcohol are discussed.
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22
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Rice SL, Tonigan JS. Impressions of Alcoholics Anonymous (AA) Group Cohesion: A Case for a Nonspecific Factor Predicting Later AA Attendance. ALCOHOLISM TREATMENT QUARTERLY 2012; 30:40-51. [PMID: 25089071 DOI: 10.1080/07347324.2012.635550] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Social support for abstinence in Alcoholics Anonymous (AA) has been reported to be a consistent factor accounting for AA benefit. However, the nonspecific or unintended effects of such support remain poorly understood and rarely investigated. This prospective study investigated how one nonspecific factor-perceived AA group cohesiveness-predicted increased practice of AA-related behaviors. Findings indicated that impressions of AA group cohesion predicted increased AA attendance, the practice of prescribed AA activities, and self-reported AA usefulness. It appears that a sense of belongingness predicts subsequent engagement in the AA social network that, in turn, is predictive of increased abstinence.
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Affiliation(s)
- Samara Lloyd Rice
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico USA
| | - J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico USA
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Blonigen DM, Timko C, Finney JW, Moos BS, Moos RH. Alcoholics Anonymous attendance, decreases in impulsivity and drinking and psychosocial outcomes over 16 years: moderated-mediation from a developmental perspective. Addiction 2011; 106:2167-77. [PMID: 21631626 PMCID: PMC3208772 DOI: 10.1111/j.1360-0443.2011.03522.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS To examine whether decreases in impulsivity account for links between Alcoholics Anonymous (AA) attendance and better drinking and psychosocial outcomes, and whether these mediational 'effects' are conditional on age. DESIGN A naturalistic study in which individuals were assessed at baseline, and 1, 8 and 16 years later. SETTING Participants initiated help-seeking through the alcohol intervention system (detoxification programs, information and referral centers). PARTICIPANTS Individuals with alcohol use disorders and no prior history of substance abuse treatment at baseline [n=628; 47% women; mean age=34.7 years (standard deviation=9.4)]. MEASUREMENTS Self-reports of impulsivity and drinking pattern at baseline and year 1, duration of AA (number of weeks) in year 1 and drinking (alcohol use problems, self-efficacy to resist drinking) and psychosocial outcomes (emotional discharge coping, social support) at baseline and follow-ups. FINDINGS Controlling for changes in drinking pattern, decreases in impulsivity were associated with fewer alcohol use problems, better coping and greater social support and self-efficacy at year 1, and better coping and greater social support at year 8. Decreases in impulsivity statistically mediated associations between longer AA duration and improvements on all year 1 outcomes and indirect effects were moderated by participant age (significant only for individuals 25 years of age or younger). CONCLUSIONS Decreased impulsivity appears to mediate reductions in alcohol-related problems over 8 years in people attending Alcoholics Anonymous.
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Affiliation(s)
- Daniel M. Blonigen
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University School of Medicine
| | - Christine Timko
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University School of Medicine
| | - John W. Finney
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University School of Medicine
| | - Bernice S. Moos
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University School of Medicine
| | - Rudolf H. Moos
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University School of Medicine
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Tonigan JS, Book SW, Pagano ME, Randall PK, Smith JP, Randall CL. 12-Step Therapy and Women with and without Social Phobia: A Study of the Effectiveness of 12-Step Therapy to Facilitate AA Engagement. ALCOHOLISM TREATMENT QUARTERLY 2010; 28:151-162. [PMID: 21423569 DOI: 10.1080/07347321003648596] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Alcoholism treatment often encourages involvement in Alcoholics Anonymous (AA). Little provision is made for women with social phobia (SP), who have been reported to have worse outcomes in twelve-step-facilitation (TSF) relative to cognitive behavioral therapy. This study examined whether SP moderated the effects of gender for these women in TSF. 133 SP alcoholics assigned to TSF (35 females and 98 males) in Project MATCH were compared to a non-SP control group. SP women drank earlier and more intensely than non-SP women and all males, had equivalent AA attendance and completion of Step 5, and were less likely to acquire a sponsor during TSF.
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Affiliation(s)
- J Scott Tonigan
- Department of Psychology, University of New Mexico, Albuquerque
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