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Randomized Controlled Trial
. 2010 Apr;105(4):626-36.
doi: 10.1111/j.1360-0443.2009.02820.x. Epub 2010 Jan 22.

Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms?

John F Kelly  1 , Robert L Stout, Molly Magill, J Scott Tonigan, Maria E Pagano
Affiliations
Randomized Controlled Trial

Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms?

John F Kelly et al. Addiction. 2010 Apr.

Abstract

Rationale: Indices of negative affect, such as depression, have been implicated in stress-induced pathways to alcohol relapse. Empirically supported continuing care resources, such as Alcoholics Anonymous (AA), emphasize reducing negative affect to reduce relapse risk, but little research has been conducted to examine putative affective mechanisms of AA's effects.

Methods: Using lagged, controlled, hierarchical linear modeling and mediational analyses this study investigated whether AA participation mobilized changes in depression symptoms and whether such changes explained subsequent reductions in alcohol use. Alcohol-dependent adults (n = 1706), receiving treatment as part of a clinical trial, were assessed at intake, 3, 6, 9, 12 and 15 months.

Results: Findings revealed elevated levels of depression compared to the general population, which decreased during treatment and then remained stable over follow-up. Greater AA attendance was associated with better subsequent alcohol use outcomes and decreased depression. Greater depression was associated with heavier and more frequent drinking. Lagged mediation analyses revealed that the effects of AA on alcohol use was mediated partially by reductions in depression symptoms. However, this salutary effect on depression itself appeared to be explained by AA's proximal effect on reducing concurrent drinking.

Conclusions: AA attendance was associated both concurrently and predictively with improved alcohol outcomes. Although AA attendance was associated additionally with subsequent improvements in depression, it did not predict such improvements over and above concurrent alcohol use. AA appears to lead both to improvements in alcohol use and psychological and emotional wellbeing which, in turn, may reinforce further abstinence and recovery-related change.

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Figures

Figure 1
Figure 1
Lagged Model Conceptualizationa a The HLM model represents averaged, lagged, effects across the two time points noted. (Conceptually, this is akin to running two separate lagged models simultaneously at the two different time points and averaging their effects). b Models were run with, and without, this variable specified in the model * Past week
Figure 2
Figure 2
Change in BDI Depression Symptoms Scores by Over Time by Gender and Study Arm
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