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Randomized Controlled Trial
. 2009 Mar;104(3):391-401.
doi: 10.1111/j.1360-0443.2008.02467.x.

Facilitating involvement in Alcoholics Anonymous during out-patient treatment: a randomized clinical trial

Kimberly S Walitzer  1 , Kurt H Dermen, Christopher Barrick
Affiliations
Randomized Controlled Trial

Facilitating involvement in Alcoholics Anonymous during out-patient treatment: a randomized clinical trial

Kimberly S Walitzer et al. Addiction. 2009 Mar.

Abstract

Aim: This study evaluated two strategies to facilitate involvement in Alcoholics Anonymous (AA)--a 12-Step-based directive approach and a motivational enhancement approach--during skills-focused individual treatment.

Design: Randomized controlled trial with assessments at baseline, end of treatment and 3, 6, 9 and 12 months after treatment. PARTICIPANTS, SETTING AND INTERVENTION: A total of 169 alcoholic out-patients (57 women) assigned randomly to one of three conditions: a directive approach to facilitating AA, a motivational enhancement approach to facilitating AA or treatment as usual, with no special emphasis on AA.

Measurements: Self-report of AA meeting attendance and involvement, alcohol consumption (percentage of days abstinent, percentage of days heavy drinking) and negative alcohol consequences.

Findings: Participants exposed to the 12-Step directive condition for facilitating AA involvement reported more AA meeting attendance, more evidence of active involvement in AA and a higher percentage of days abstinent relative to participants in the treatment-as-usual comparison group. Evidence also suggested that the effect of the directive strategy on abstinent days was mediated partially through AA involvement. The motivational enhancement approach to facilitating AA had no effect on outcome measures.

Conclusions: These results suggest that treatment providers can use a 12-Step-based directive approach to effectively facilitate involvement in AA and thereby improve client outcome.

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Figures

Figure 1
Figure 1
Participant flow through the study.
Figure 2
Figure 2
Raw means for baseline (AA Meetings) or lifetime scores (AA Behaviors, AA Steps) and follow-up assessments for Alcoholics Anonymous variables as a function of treatment condition.
Figure 3
Figure 3
Raw means for baseline and follow-up assessments for drinking outcomes as a function of treatment condition.
Figure 4
Figure 4
Mediation analysis examining the indirect effect of Alcoholics Anonymous involvement in the relationship between the directive facilitation strategy and percent days abstinent. Standardized regression weights are presented. +p < .06, ++p < .10, *p < .05, **p < .01. Paths that are drawn but have no coefficients were included in the model, but not significant. The AA Meetings variable underwent an inverse transformation, thus reversing the direction of the variable. TAU + MOT versus DIR = the combined treatment as usual and motivational enhancement approach conditions versus the directive strategy condition; PDA = percent days abstinent (arc sine transformed); AA = Alcoholics Anonymous; AAI = Alcoholics Anonymous involvement; 4-6 Month = behavior occurring between four and six months after treatment end; 10-12 Month = behavior occurring between 10 and 12 months after treatment end.
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