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Participation in alcoholics anonymous and post-treatment abstinence from alcohol and other drugs
Addictive Behaviors 36 (2011) 882–885
Contents lists available at ScienceDirect
Addictive Behaviors
Short Communication
Participation in alcoholics anonymous and post-treatment abstinence from alcohol and other drugs J.B. Kingree ⁎, Martie Thompson Department of Public Health Sciences, 517 Edwards Hall, Clemson University, Clemson, SC 29634, USA
a r t i c l e
i n f o
Keyword: Alcoholics anonymous Meeting attendance Use of a sponsor Abstinence
a b s t r a c t Background: This study examined associations between two types of AA participation (i.e., meeting attendance, having a sponsor) and two types of post-treatment abstinence (i.e., abstinence from alcohol, abstinence from drugs). Method: Respondents completed measures that assessed their demographic characteristics, the severity of their substance use, and their motivation to change when they enrolled in treatment (T1). They completed measures of AA participation at T1 and a 3 month follow-up assessment (T2), and measures of recent abstinence at T1 and a 6 month follow-up assessment (T3). Results: T2 sponsor was associated prospectively with T3 abstinence from alcohol. Conclusions: Having a sponsor served as a marker for subsequent abstinence. Future research can examine factors that may mediate or moderate the associations between having a sponsor and subsequent abstinence. © 2011 Elsevier Ltd. All rights reserved.
1. Introduction Over 2 million people aged 12 or older in the U.S. received specialty treatment for an alcohol problem in 2009 (Substance Abuse and Mental Health Services Administration, 2010). Since most treatment programs for alcohol problems in the U.S. are based on principles of Alcoholics Anonymous (AA), it can be assumed that a majority of the treatment recipients were advised to participate in AA as a form of long-term aftercare (Roman & Blum, 1997; Slaymaker & Sheehan, 2008).
1.1. Comparisons of different types of TSO participation Whereas participation in AA can occur in multiple ways, attending meetings and having a sponsor have received the most clinical emphasis and attention from researchers. At least two noteworthy studies have examined meeting attendance and having a sponsor simultaneously in relation to abstinence from alcohol at 12 months following a treatment episode. One found that both forms of AA participation were associated with abstinence among 302 respondents recruited from treatment programs in California (Witbrodt & Kaskutas, 2005). The other found that only meeting attendance was associated with abstinence among 1506 respondents from Project MATCH who were recruited from treatment programs throughout the United States (Cloud, Ziegler, & Blondell, 2004).
⁎ Corresponding author. Tel.: +1 864 656 6946; fax: +1 864 656 5502. E-mail address: [email protected] (J.B. Kingree). 0306-4603/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2011.03.011
These studies have value because they can illuminate how AA participation enhances treatment outcomes and this information can be used to guide clinical recommendations regarding optimal ways to participate. However, three aspects of the studies limit any conclusions that can be drawn from them. First, because the studies assessed meeting attendance with open-ended, continuously-coded measures and having a sponsor with forced-choice, dichotomously-coded measures, it is unclear if the findings were due to the respondents' experiences or variance in the response formats of the two measures of AA participation. Second, because the referents for the AA participation measures referred to AA exclusively in one study (Cloud et al., 2004) but to multiple 12-step groups (i.e., “AA/NA/CA;”) in the other, it is unclear if the different findings for having a sponsor that emerged between the studies were due to variations in respondent experiences or in the referents that were used to assess this form of participation. Third, because both studies assessed only concurrent associations between AA or 12-step participation and abstinence, it could not be determined if either meeting attendance or having a sponsor preceded abstinence, which is needed to infer causal effects (Kaskutas, 2009; Mausner & Kramer, 1985). 1.2. The current study The current study examined if meeting attendance and having a sponsor varied in relation to post-treatment abstinence among respondents who enrolled in a larger project that focused on predictors of AA participation (Kingree et al., 2006; Kingree, Simpson, Thompson, McCrady, & Tonigan, 2007). Abstinence was assessed separately for alcohol and other drugs because it is unclear if AA participation is more effective for the former. Three features of the study enhanced confidence
J.B. Kingree, M. Thompson / Addictive Behaviors 36 (2011) 882–885
in the findings. First, the use of dichotomous response formats for both AA participation variables ensured that any difference in findings between them was not due to a specific type of measure variance. Second, by using only AA as the referent for the meeting attendance and sponsor measures, the study produced findings that allowed for relatively clear conclusions about its putative effects. Third, the current study examined if AA participation was associated with subsequent abstinence. 2. Method 2.1. Sample The sample included 268 respondents recruited from three treatment programs in South Carolina. Respondents were asked to complete a selfadministered questionnaire within seven days of enrolling in treatment (T1) as well as in post-treatment assessments that occurred three months (T2) and six months (T3) following T1. Additional information about the sample, including recruitment procedures and eligibility requirements, has been provided elsewhere (Kingree et al., 2007, 2006).
883
2.3. Regression analyses Bivariate models regressed each abstinence variable separately on each of the AA participation variables and potential covariates. Multiple regression models then were conducted in two hierarchical steps. Potential covariates that were significant in the bivariate models were included in the first step, and the AA participation variables were included in the second step. 3. Results 3.1. Follow-up rates at T2 and T3 and frequency values for the study variables Among the 268 respondents at T1, 232 (87%) and 217 (81%) completed the T2 and T3 assessments, respectively. The analyses included the 205 respondents (76%) who completed each assessment. Responses to the T1 variables did not differ significantly (p b .05) between the full sample and the 205 respondents who were included in the regression analyses. Frequencies for the study variables for these 205 respondents are presented in Table 1.
2.2. Study variables Thirteen variables were examined as predictors of T3 abstinence from alcohol and T3 abstinence from drugs. Nine of the variables assessed respondent characteristics at T1 that were examined as potential covariates, and four assessed the two forms of AA participation at T1 and T2. For comparability purposes, responses to each predictor variable were dichotomized. 2.2.1. Abstinence A slightly modified version of the Drug Use Frequency Questionnaire (O'Farrell, Fals-Stewart, & Murphy, 2003) was used to assess frequency of alcohol use (one item) and multiple other drugs (eight items) at T1 and T3. Respondents who reported no use of alcohol or no use of any of the drugs over the three month period preceding the two assessments were coded as abstinent from alcohol and abstinent from drugs, respectively. 2.2.2. AA participation Separate items from the Alcoholics Anonymous Affiliation Scale (Humphreys, Kaskutas, & Weisner, 1998) assessed participation in meetings and having a sponsor at T1 and T2. Respondents who attended 12 or more meetings, or an average of one meeting per week, were coded higher than those with less attendance. 2.2.3. Potential covariates Single-item measures were used to assess gender (1 = female; 0 = male), minority race (1 = yes, 0 = no), age (1 = 35 years or older; 0 = less than 35 years), and type of treatment received (1 = detoxification; 0 = outpatient) in the index episode. Alcohol problem severity and drug problem severity were assessed with the 13-item, Short Michigan Alcoholism Screening Test (Selzer, Vinokur, & van Rooijen, 1975; range 0–13; M = 7.00; and SD = 4.25) and the 20-item, Drug Abuse Screening Test (Skinner, 1982; range = 0–20; M = 12.88; and SD= 5.79), respectively, with the total scores subsequently dichotomized (1 = high severity; 0 = low severity) based on recommended cut-points. Motivation to change (MTC) was assessed with the 32-item, University of Rhode Island Change Assessment Questionnaire (McConnaughy, Prochaska, & Velicer 1983; α = .90), which included four subscales. A single MTC score (range= .25 to 11.25; M = 8.33; SD= 1.25), was computed by subtracting the pre-contemplation subscale score from the sum of the other subscale scores. MTC scores were then collapsed into two groups [1 = high; 0 = low] based on a median split.
3.2. Intercorrelations and changes among the T1 and T2 AA participation variables Meeting attendance and sponsor were associated significantly at T1 [phi (φ) = .41, p b .001] and T2 [phi (φ) = .56, p b .001] but the overlap was not so excessive to preclude examining them together in the multiple regression models (Tabachnick & Fidell 1989). Similarly, the T1 and T2 sponsor variables [phi (φ) = .14, p b .02] and the T1 and T2 meeting attendance variables [phi (φ) = .18, p b .01] were sufficiently independent to be examined together. The sample showed significant increases in meeting attendance [x2 (df = 1; n = 205) = 6.02, p b .02] and having a sponsor [x2 (df = 1; n = 205) = 5.56, p b .001) between T1 and T2. 3.3. Intercorrelations and frequencies for the abstinence variables Abstinence from alcohol and abstinence from drugs were associated significantly at T1, phi (φ) = .32, p b .001, and at T3, phi (φ) = .32, p b .001. Abstinence from alcohol [x2 (df = 1; n = 205) = 15.87, p b .001] and abstinence from drugs [x2 (df = 1; n = 205) = 6.90, p b .001) increased significantly from T1 to T3. 3.4. Analyses of the T2 and T3 abstinence variables Descriptive and inferential data from the tests of main effects on the T3 abstinence variables are presented in Table 2. The descriptive
Table 1 Frequency values for the study variables for the 205 respondents included in the regression analyses. T1
Female gender Minority race Age ≥ 35 Received detoxification High alc. problem severity High drug problem severity High motivation to change Weekly meeting attendance Have a sponsor Abstinence from alcohol Abstinence from other drugs
T2
T3
N
%
N
%
N
%
109 28 95 155 208 169 99 46 31 41 11
53 14 46 76 78 82 48 22 15 20 5
90 74 – –
44 36 – –
134 114
65 56
884
J.B. Kingree, M. Thompson / Addictive Behaviors 36 (2011) 882–885
Table 2 Descriptive and inferential values from bivariate and multivariate logistic regression analyses that examined associations of the potential covariates and AA participation variables in relation to T3 abstinence. Study variables
Gender Male Female Age ≤33 N33 Minority No Yes Detox No Yes Alc. Severity Low High Drug severity Low High MTC Low High T1 abstinence from alcohol No Yes T1 abstinence from drugs No Yes T1 meeting Low High T1 sponsor No Yes T2 meeting Low High T2 sponsor No Yes
T3 abstinence from alcohol
T3 abstinence from other drugs
Descriptive
Bivariate
Multiple
No
Yes
OR (95% CI)
AOR (95% CI)
%
%
43 28
57 72
33 39
67 61
35 36
65 64
30 36
70 64
32 36
68 64
42 35
58 65
44 50
56 50
41 10
59 90
36 9
64 91
35 33
65 67
38 19
62 81
42 25
58 75
82 44
18 56
2.03 (1.13, 3.63)
0.74 (0.42, 1.32)
0.95 (0.41, 2.18)
0.76 (0.38, 1.51)
1.09 (0.55, 2.15)
1.53 (0.73, 3.21)
1.37 (0.77, 2.44)
8.65 (2.56, 29.19)
5.65 (0.71, 45.02)
0.93 (0.52, 1.66)
2.49 (0.97, 6.38)
2.23 (1.22, 4.08)
3.62 (1.82, 7.22)
Descriptive
Bivariate
Multiple
AOR (95% CI)
AOR (95% CI)
No
Yes
%
%
55 42
45 58
47 50
53 50
48 50
52 50
44 49
56 51
44 49
56 51
42 50
58 50
49 49
51 51
51 37
49 63
50 9
50 91
48 49
52 51
52 26
48 74
52 43
48 57
53 38
47 62
1.65 (0.90, 3.02)
–
–
–
–
–
–
7.69 (2.26, 26.61)
–
1.68 (0.97, 2.93)
–
0.85 (0.49, 1.47)
–
0.90 (0.41, 2.01)
–
0.73 (0.39, 1.40)
–
0.76 (0.39, 1.47)
–
0.68 (0.33, 1.43)
–
0.91 (0.53, 1.58)
–
1.69 (0.83, 3.43)
–
10.00 (1.26, 79.63)
–
–
1.68 (0.77, 3.68)
2.69 (1.14, 6.35)
8.23 (1.02, 66.70)
0.88 (0.51, 1.54)
–
2.56 (1.12, 5.87)
2.20 (0.94, 5.16)
1.44 (0.83, 2.51)
–
1.66 (0.93, 2.97)
–
Note: OR = odds ratio; AOR = adjusted odds ratio; CI = confidence interval; MTC = motivation to change. The multiple regression models included only the predictor variables that were bivariately associated with the criterion variables. Statistically significant effects exist where CIs do not contain “1”.
values reflect group differences in the abstinence variables in relation to the predictor variables. As stated above, the bivariate models were used to identify the predictor variables to be included in the multiple regression models. The results of the bivariate models are not discussed here for the purpose of brevity. The results presented in Table 2 show that T1 abstinence from alcohol and T1 abstinence from drugs increased the odds that respondents would be abstinent from these substances at T3. Independent of these effects, respondents who had a sponsor at T2 were more apt than those without one at T2 to be abstinent from alcohol at T3. 4. Discussion This study examined associations between two, relatively independent forms of AA participation and abstinence. Having a sponsor, but not meeting attendance, was associated with subsequent abstinence from alcohol. Neither type of AA participation was associated prospectively with abstinence from other drugs, suggesting AA was more effective in reducing alcohol use. If replicated in future studies, the effects of having a sponsor on subsequent abstinence would have practical importance. Accordingly, knowledge of whether or not clients had a sponsor would indicate the likelihood they would be abstinent in the future. This knowledge would
allow treatment professionals to tailor specific approaches to clients who have or do not have sponsors. Future research can utilize meditational analyses to illuminate how and/or why having a sponsor promotes abstinence. Future research also can use moderation analyses to identify types of persons for whom AA is relatively more or less effective. This study was limited by its convenience sample, observational design, and self-reported data. The convenience sample does not allow for generalizing the findings to all adults who receive substance abuse treatment in the U.S. The observational design does not allow for firm conclusions regarding causal relations among the variables. The selfreported nature of the data raises the possibility that the findings were influenced by social desirability and/or other biases. Future research can evaluate the generalizability and validity of the findings by recruiting more representative samples and by adding biological measures of substance use. Although there are major obstacles to using experimental methods for studying the effects of AA directly (Kelly 2003; Kingree & Ruback 1994), there may be fewer obstacles for examining the effects of having a sponsor than for attending meetings. In summary, this study indicated that having a sponsor had stronger effects than meeting attendance on subsequent abstinence from alcohol. Future research should examine factors that may confound, mediate or moderate associations between having a sponsor, preferably
J.B. Kingree, M. Thompson / Addictive Behaviors 36 (2011) 882–885
with representative samples, biological measures of substance use, and experimental designs. Role of funding sources Funding for this study was provided by NIAAA grant R21-AA013761. NIAAA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Contributors J.B. Kingree and Martie Thompson jointly designed the study and conducted the statistical analyses. J.B. Kingree wrote the first draft of the manuscript and Dr. Thompson contributed to and approved the submitted draft. Conflict of interest The authors declare that we have no conflicts of interest in relation to the manuscript.
References Cloud, R., Ziegler, C., & Blondell, R. (2004). What is Alcoholics Anonymous affiliation? Substance Use and Misuse, 39, 1117−1136. Humphreys, K., Kaskutas, L., & Weisner, C. (1998). The Alcoholics Anonymous Affiliation Scale: Development, reliability, and norms for diverse treated and untreated populations. Alcoholism: Clinical and Experimental Research, 22, 974−978. Kaskutas, L. (2009). Alcoholics Anonymous effectiveness: Faith meets science. Journal of Addictive Disease, 28, 145−157. Kelly, J. (2003). Self-help for substance use disorders: History, effectiveness, knowledge gaps, and research opportunities. Clinical Psychology Review., 23, 639−663. Kingree, J., & Ruback, R. (1994). Understanding self-help groups. In T. Powell (Ed.), Understanding self-help groups: Frameworks and findings (pp. 272−292). Newbury Park, CA: Sage Publications.
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Kingree, J., Simpson, A., Thompson, M., McCrady, B., Tonigan, J. S., & Lautenslager, G. (2006). Development and the initial validation of the Survey of Readiness for Alcoholics Anonymous Participation. Psychology of Addictive Behaviors, 20, 453−462. Kingree, J., Simpson, A., Thompson, M., McCrady, B., & Tonigan, J. S. (2007). The predictive validity of the Survey of Readiness for Alcoholics Anonymous Participation. Journal of Studies on Alcohol and Drugs, 68, 141−148. Mausner, J., & Kramer, S. (1985). Epidemiology: An introductory text (2nd ed). Philadelphia: W. B. Saunders Company. McConnaughy, E., Prochaska, J., & Velicer, W. (1983). Stages of change in psychotherapy: Measurement and sample profiles. Psychotherapy: Theory, Research, and Practice, 20, 368−375. O'Farrell, T., Fals-Stewart, W., & Murphy, M. (2003). Concurrent validity of a brief selfreport Drug Use Frequency measure. Addictive Behaviors, 28, 327−337. Roman, P., & Blum, T. (1997). National Treatment Center Study: Summary Report. Athens, GA: University of Georgia. Selzer, M., Vinokur, A., & van Rooijen, L. (1975). A self-administered Short Michigan Alcoholism Screening Test (SMAST). Journal of Studies on Alcohol, 36, 117−126. Skinner, H. (1982). The Drug Abuse Screening Test. Addictive Behaviors, 7, 363−371. Slaymaker, V., & Sheehan, T. (2008). The impact of AA on professional treatment. In M. Galanter, & L. Kaskutas (Eds.), Recent Developments in Alcoholism (Vol. 18): Research on Alcoholics Anonymous and Spirituality in Addiction Recovery (pp. 59−67). Totowa, NJ: Springer. Substance Abuse and Mental Health Services Administration (2010). Results from the 2009 National Survey on Drug Use and Health: Volume 1. Summary of national findings (Office of Applied Studies, NSDUH Series H-38A, DHHS Publication No. SMA 08–4856) Rockville, MD. Tabachnick, B., & Fidell, L. (1989). Using multivariate statistics (2nd ed.). New York: Harper & Row. Witbrodt, J., & Kaskutas, L. (2005). Does diagnosis matter? Differential effects of 12-step participation and social networks on abstinence. American Journal of Drug and Alcohol Abuse, 31, 685−707.
Contents lists available at ScienceDirect
Addictive Behaviors
Short Communication
Participation in alcoholics anonymous and post-treatment abstinence from alcohol and other drugs J.B. Kingree ⁎, Martie Thompson Department of Public Health Sciences, 517 Edwards Hall, Clemson University, Clemson, SC 29634, USA
a r t i c l e
i n f o
Keyword: Alcoholics anonymous Meeting attendance Use of a sponsor Abstinence
a b s t r a c t Background: This study examined associations between two types of AA participation (i.e., meeting attendance, having a sponsor) and two types of post-treatment abstinence (i.e., abstinence from alcohol, abstinence from drugs). Method: Respondents completed measures that assessed their demographic characteristics, the severity of their substance use, and their motivation to change when they enrolled in treatment (T1). They completed measures of AA participation at T1 and a 3 month follow-up assessment (T2), and measures of recent abstinence at T1 and a 6 month follow-up assessment (T3). Results: T2 sponsor was associated prospectively with T3 abstinence from alcohol. Conclusions: Having a sponsor served as a marker for subsequent abstinence. Future research can examine factors that may mediate or moderate the associations between having a sponsor and subsequent abstinence. © 2011 Elsevier Ltd. All rights reserved.
1. Introduction Over 2 million people aged 12 or older in the U.S. received specialty treatment for an alcohol problem in 2009 (Substance Abuse and Mental Health Services Administration, 2010). Since most treatment programs for alcohol problems in the U.S. are based on principles of Alcoholics Anonymous (AA), it can be assumed that a majority of the treatment recipients were advised to participate in AA as a form of long-term aftercare (Roman & Blum, 1997; Slaymaker & Sheehan, 2008).
1.1. Comparisons of different types of TSO participation Whereas participation in AA can occur in multiple ways, attending meetings and having a sponsor have received the most clinical emphasis and attention from researchers. At least two noteworthy studies have examined meeting attendance and having a sponsor simultaneously in relation to abstinence from alcohol at 12 months following a treatment episode. One found that both forms of AA participation were associated with abstinence among 302 respondents recruited from treatment programs in California (Witbrodt & Kaskutas, 2005). The other found that only meeting attendance was associated with abstinence among 1506 respondents from Project MATCH who were recruited from treatment programs throughout the United States (Cloud, Ziegler, & Blondell, 2004).
⁎ Corresponding author. Tel.: +1 864 656 6946; fax: +1 864 656 5502. E-mail address: [email protected] (J.B. Kingree). 0306-4603/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2011.03.011
These studies have value because they can illuminate how AA participation enhances treatment outcomes and this information can be used to guide clinical recommendations regarding optimal ways to participate. However, three aspects of the studies limit any conclusions that can be drawn from them. First, because the studies assessed meeting attendance with open-ended, continuously-coded measures and having a sponsor with forced-choice, dichotomously-coded measures, it is unclear if the findings were due to the respondents' experiences or variance in the response formats of the two measures of AA participation. Second, because the referents for the AA participation measures referred to AA exclusively in one study (Cloud et al., 2004) but to multiple 12-step groups (i.e., “AA/NA/CA;”) in the other, it is unclear if the different findings for having a sponsor that emerged between the studies were due to variations in respondent experiences or in the referents that were used to assess this form of participation. Third, because both studies assessed only concurrent associations between AA or 12-step participation and abstinence, it could not be determined if either meeting attendance or having a sponsor preceded abstinence, which is needed to infer causal effects (Kaskutas, 2009; Mausner & Kramer, 1985). 1.2. The current study The current study examined if meeting attendance and having a sponsor varied in relation to post-treatment abstinence among respondents who enrolled in a larger project that focused on predictors of AA participation (Kingree et al., 2006; Kingree, Simpson, Thompson, McCrady, & Tonigan, 2007). Abstinence was assessed separately for alcohol and other drugs because it is unclear if AA participation is more effective for the former. Three features of the study enhanced confidence
J.B. Kingree, M. Thompson / Addictive Behaviors 36 (2011) 882–885
in the findings. First, the use of dichotomous response formats for both AA participation variables ensured that any difference in findings between them was not due to a specific type of measure variance. Second, by using only AA as the referent for the meeting attendance and sponsor measures, the study produced findings that allowed for relatively clear conclusions about its putative effects. Third, the current study examined if AA participation was associated with subsequent abstinence. 2. Method 2.1. Sample The sample included 268 respondents recruited from three treatment programs in South Carolina. Respondents were asked to complete a selfadministered questionnaire within seven days of enrolling in treatment (T1) as well as in post-treatment assessments that occurred three months (T2) and six months (T3) following T1. Additional information about the sample, including recruitment procedures and eligibility requirements, has been provided elsewhere (Kingree et al., 2007, 2006).
883
2.3. Regression analyses Bivariate models regressed each abstinence variable separately on each of the AA participation variables and potential covariates. Multiple regression models then were conducted in two hierarchical steps. Potential covariates that were significant in the bivariate models were included in the first step, and the AA participation variables were included in the second step. 3. Results 3.1. Follow-up rates at T2 and T3 and frequency values for the study variables Among the 268 respondents at T1, 232 (87%) and 217 (81%) completed the T2 and T3 assessments, respectively. The analyses included the 205 respondents (76%) who completed each assessment. Responses to the T1 variables did not differ significantly (p b .05) between the full sample and the 205 respondents who were included in the regression analyses. Frequencies for the study variables for these 205 respondents are presented in Table 1.
2.2. Study variables Thirteen variables were examined as predictors of T3 abstinence from alcohol and T3 abstinence from drugs. Nine of the variables assessed respondent characteristics at T1 that were examined as potential covariates, and four assessed the two forms of AA participation at T1 and T2. For comparability purposes, responses to each predictor variable were dichotomized. 2.2.1. Abstinence A slightly modified version of the Drug Use Frequency Questionnaire (O'Farrell, Fals-Stewart, & Murphy, 2003) was used to assess frequency of alcohol use (one item) and multiple other drugs (eight items) at T1 and T3. Respondents who reported no use of alcohol or no use of any of the drugs over the three month period preceding the two assessments were coded as abstinent from alcohol and abstinent from drugs, respectively. 2.2.2. AA participation Separate items from the Alcoholics Anonymous Affiliation Scale (Humphreys, Kaskutas, & Weisner, 1998) assessed participation in meetings and having a sponsor at T1 and T2. Respondents who attended 12 or more meetings, or an average of one meeting per week, were coded higher than those with less attendance. 2.2.3. Potential covariates Single-item measures were used to assess gender (1 = female; 0 = male), minority race (1 = yes, 0 = no), age (1 = 35 years or older; 0 = less than 35 years), and type of treatment received (1 = detoxification; 0 = outpatient) in the index episode. Alcohol problem severity and drug problem severity were assessed with the 13-item, Short Michigan Alcoholism Screening Test (Selzer, Vinokur, & van Rooijen, 1975; range 0–13; M = 7.00; and SD = 4.25) and the 20-item, Drug Abuse Screening Test (Skinner, 1982; range = 0–20; M = 12.88; and SD= 5.79), respectively, with the total scores subsequently dichotomized (1 = high severity; 0 = low severity) based on recommended cut-points. Motivation to change (MTC) was assessed with the 32-item, University of Rhode Island Change Assessment Questionnaire (McConnaughy, Prochaska, & Velicer 1983; α = .90), which included four subscales. A single MTC score (range= .25 to 11.25; M = 8.33; SD= 1.25), was computed by subtracting the pre-contemplation subscale score from the sum of the other subscale scores. MTC scores were then collapsed into two groups [1 = high; 0 = low] based on a median split.
3.2. Intercorrelations and changes among the T1 and T2 AA participation variables Meeting attendance and sponsor were associated significantly at T1 [phi (φ) = .41, p b .001] and T2 [phi (φ) = .56, p b .001] but the overlap was not so excessive to preclude examining them together in the multiple regression models (Tabachnick & Fidell 1989). Similarly, the T1 and T2 sponsor variables [phi (φ) = .14, p b .02] and the T1 and T2 meeting attendance variables [phi (φ) = .18, p b .01] were sufficiently independent to be examined together. The sample showed significant increases in meeting attendance [x2 (df = 1; n = 205) = 6.02, p b .02] and having a sponsor [x2 (df = 1; n = 205) = 5.56, p b .001) between T1 and T2. 3.3. Intercorrelations and frequencies for the abstinence variables Abstinence from alcohol and abstinence from drugs were associated significantly at T1, phi (φ) = .32, p b .001, and at T3, phi (φ) = .32, p b .001. Abstinence from alcohol [x2 (df = 1; n = 205) = 15.87, p b .001] and abstinence from drugs [x2 (df = 1; n = 205) = 6.90, p b .001) increased significantly from T1 to T3. 3.4. Analyses of the T2 and T3 abstinence variables Descriptive and inferential data from the tests of main effects on the T3 abstinence variables are presented in Table 2. The descriptive
Table 1 Frequency values for the study variables for the 205 respondents included in the regression analyses. T1
Female gender Minority race Age ≥ 35 Received detoxification High alc. problem severity High drug problem severity High motivation to change Weekly meeting attendance Have a sponsor Abstinence from alcohol Abstinence from other drugs
T2
T3
N
%
N
%
N
%
109 28 95 155 208 169 99 46 31 41 11
53 14 46 76 78 82 48 22 15 20 5
90 74 – –
44 36 – –
134 114
65 56
884
J.B. Kingree, M. Thompson / Addictive Behaviors 36 (2011) 882–885
Table 2 Descriptive and inferential values from bivariate and multivariate logistic regression analyses that examined associations of the potential covariates and AA participation variables in relation to T3 abstinence. Study variables
Gender Male Female Age ≤33 N33 Minority No Yes Detox No Yes Alc. Severity Low High Drug severity Low High MTC Low High T1 abstinence from alcohol No Yes T1 abstinence from drugs No Yes T1 meeting Low High T1 sponsor No Yes T2 meeting Low High T2 sponsor No Yes
T3 abstinence from alcohol
T3 abstinence from other drugs
Descriptive
Bivariate
Multiple
No
Yes
OR (95% CI)
AOR (95% CI)
%
%
43 28
57 72
33 39
67 61
35 36
65 64
30 36
70 64
32 36
68 64
42 35
58 65
44 50
56 50
41 10
59 90
36 9
64 91
35 33
65 67
38 19
62 81
42 25
58 75
82 44
18 56
2.03 (1.13, 3.63)
0.74 (0.42, 1.32)
0.95 (0.41, 2.18)
0.76 (0.38, 1.51)
1.09 (0.55, 2.15)
1.53 (0.73, 3.21)
1.37 (0.77, 2.44)
8.65 (2.56, 29.19)
5.65 (0.71, 45.02)
0.93 (0.52, 1.66)
2.49 (0.97, 6.38)
2.23 (1.22, 4.08)
3.62 (1.82, 7.22)
Descriptive
Bivariate
Multiple
AOR (95% CI)
AOR (95% CI)
No
Yes
%
%
55 42
45 58
47 50
53 50
48 50
52 50
44 49
56 51
44 49
56 51
42 50
58 50
49 49
51 51
51 37
49 63
50 9
50 91
48 49
52 51
52 26
48 74
52 43
48 57
53 38
47 62
1.65 (0.90, 3.02)
–
–
–
–
–
–
7.69 (2.26, 26.61)
–
1.68 (0.97, 2.93)
–
0.85 (0.49, 1.47)
–
0.90 (0.41, 2.01)
–
0.73 (0.39, 1.40)
–
0.76 (0.39, 1.47)
–
0.68 (0.33, 1.43)
–
0.91 (0.53, 1.58)
–
1.69 (0.83, 3.43)
–
10.00 (1.26, 79.63)
–
–
1.68 (0.77, 3.68)
2.69 (1.14, 6.35)
8.23 (1.02, 66.70)
0.88 (0.51, 1.54)
–
2.56 (1.12, 5.87)
2.20 (0.94, 5.16)
1.44 (0.83, 2.51)
–
1.66 (0.93, 2.97)
–
Note: OR = odds ratio; AOR = adjusted odds ratio; CI = confidence interval; MTC = motivation to change. The multiple regression models included only the predictor variables that were bivariately associated with the criterion variables. Statistically significant effects exist where CIs do not contain “1”.
values reflect group differences in the abstinence variables in relation to the predictor variables. As stated above, the bivariate models were used to identify the predictor variables to be included in the multiple regression models. The results of the bivariate models are not discussed here for the purpose of brevity. The results presented in Table 2 show that T1 abstinence from alcohol and T1 abstinence from drugs increased the odds that respondents would be abstinent from these substances at T3. Independent of these effects, respondents who had a sponsor at T2 were more apt than those without one at T2 to be abstinent from alcohol at T3. 4. Discussion This study examined associations between two, relatively independent forms of AA participation and abstinence. Having a sponsor, but not meeting attendance, was associated with subsequent abstinence from alcohol. Neither type of AA participation was associated prospectively with abstinence from other drugs, suggesting AA was more effective in reducing alcohol use. If replicated in future studies, the effects of having a sponsor on subsequent abstinence would have practical importance. Accordingly, knowledge of whether or not clients had a sponsor would indicate the likelihood they would be abstinent in the future. This knowledge would
allow treatment professionals to tailor specific approaches to clients who have or do not have sponsors. Future research can utilize meditational analyses to illuminate how and/or why having a sponsor promotes abstinence. Future research also can use moderation analyses to identify types of persons for whom AA is relatively more or less effective. This study was limited by its convenience sample, observational design, and self-reported data. The convenience sample does not allow for generalizing the findings to all adults who receive substance abuse treatment in the U.S. The observational design does not allow for firm conclusions regarding causal relations among the variables. The selfreported nature of the data raises the possibility that the findings were influenced by social desirability and/or other biases. Future research can evaluate the generalizability and validity of the findings by recruiting more representative samples and by adding biological measures of substance use. Although there are major obstacles to using experimental methods for studying the effects of AA directly (Kelly 2003; Kingree & Ruback 1994), there may be fewer obstacles for examining the effects of having a sponsor than for attending meetings. In summary, this study indicated that having a sponsor had stronger effects than meeting attendance on subsequent abstinence from alcohol. Future research should examine factors that may confound, mediate or moderate associations between having a sponsor, preferably
J.B. Kingree, M. Thompson / Addictive Behaviors 36 (2011) 882–885
with representative samples, biological measures of substance use, and experimental designs. Role of funding sources Funding for this study was provided by NIAAA grant R21-AA013761. NIAAA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Contributors J.B. Kingree and Martie Thompson jointly designed the study and conducted the statistical analyses. J.B. Kingree wrote the first draft of the manuscript and Dr. Thompson contributed to and approved the submitted draft. Conflict of interest The authors declare that we have no conflicts of interest in relation to the manuscript.
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