Substance Abuse Counseling

Journal Article Critique

Revon L. Spain

CNDV 5324 Substance Abuse Counseling

Lamar University

Alcohol is the third leading risk factor for disease and disability globally. Also, 4% of all deaths worldwide are attributable to alcohol, greater than those due to human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), violence or tuberculosis, and alcohol is the leading risk factor for death among males aged 15–59 years . In the United States, alcohol is the third leading actual cause of death, and alcohol misuse and related disorders confer an extraordinary negative social strain and economic impact approaching $200 billion annually

. In partial response, most societies provide some form of professionally delivered treatment to address these problems. However, due to the often chronic nature of alcohol use disorders (AUD) and difficulties in accessing professional services, a network of peer-led mutual-help organizations have emerged and grown providing additional support .

In 2009, approximately 2.3 million individuals with a substance use disorder attended a formal treatment program, and 5 million attended a peer-led mutual-help group for an alcohol or other drug problem . By far the largest of these groups is Alcoholics Anonymous (AA), with 1.3 million US members meeting in 57 000 groups each week . It is the most commonly sought source of help for alcohol-related problems . Given AA’s potential public health significance in reducing alcoholrelated harm, in 1990 the Institute of Medicine called for more research on AA, specifically on its mechanisms, to help elucidate how it works and for whom. A subsequent scientific monograph summarized the state of the science as well as further research opportunities . The intervening 20-year period has seen a significant increase in scientific interest and rigor focused on the study of AA. This body of work has indicated that AA confers short- and long-term therapeutic benefit on a par with professional interventions , and there are now numerous empirically supported interventions designed specifically to increase AA participation. AA has been shown also to reduce health-care costs while enhancing treatment outcomes. It is only recently, however, that research has begun to examine mechanisms through which AA confers these benefits .

Subjects were assigned randomly to one of three psychosocial interventions: cognitive–behavioral therapy (CBT), motivational enhancement therapy (MET), and 12-Step facilitation therapy (TSF) and were re-assessed at 3, 6, 9, 12 and 15 months following study intake, with follow-up rates over 90%. More details can be found elsewhere including psychometric properties of the measures . This study focused on baseline, 3-, 9- and 15-month follow-ups because only these time-points contained the variables needed for our lagged model.

Alcoholics anonymous attendance AA attendance was also assessed using the Form 90, which captured the number of AA meetings attended during the past 90 days at intake and 3, 9 and 15 months. The proportion of days attending AA was created by dividing the number of days attended by the total number of days in the period. Self-efficacy The Alcohol Abstinence Self-Efficacy Scale is a 20-item scale that assesses self-efficacy using four subscales (negative affect, social/positive, physical and other concerns, withdrawal and urges). Each item is rated on a five-point Likert scale (‘not at all confident’ to ‘extremely confident’). In this study, two subscales were included (negative affect: a = 0.88; social/positive: a = 0.82), shown to be mediators of the effect of AA attendance on alcohol outcomes.

While there are several strengths of the current study, some limitations should be noted. First, patients self select into AA and we cannot rule out ‘third’ variables that may be responsible for at least some of the observed effects. There were also limitations in the availability of certain measures at certain time-points limiting control of constructs that might have strengthened conclusions, and there were long time lags between measures. Future research should examine relationships using finer temporal resolutions. Also, mechanisms were examined concurrently and it is likely that some mechanisms may act as precursors to changes in others. Additionally, the measure of spirituality/religiosity used may not be consistent with AA’s own idea of ‘spirituality’, which may be a more subtle phenomenon captured in its later publications. Finally, only a handful of simply measured constructs were examined here as mediators and it is likely that, even among examined constructs, influential nuances across areas of the construct domain may further relate to AA and outcome.

In a 1961 letter to AA’s co-founder, Bill W., the renowned psychoanalyst, Carl Jung, described two main ways in which individuals with severe alcohol addiction might recover. One was through ‘real religious insight’; the other was through ‘the protective wall of human community’ characterized by a ‘personal and honest contact with friends’ (AA, 1963). Although AA has more earnestly expressed the former as being the principal pathway to recovery in its main texts perhaps inadvertently, stemming from its social orientation and structure, it has also tapped into the curative facets of the latter—protective and positive social influence. While other factors are certainly involved to varying degrees, this AA-facilitated combination, in particular, appears to help individuals suffering from alcohol addiction to find and sustain recovery.

Reference

Kelly JF; Hoeppner B; Stout RL; Pagano M, Addiction (Abingdon, England) [Addiction], ISSN: 1360-0443, 2012 Feb; Vol. 107 (2), pp. 289-99; Publisher: Wiley-Blackwell; PMID: 21917054, Database: MEDLINE