There are a variety of treatment programs designed to lead alcoholics into recovery and alcohol abstinence. However, the most important part of any program or treatment plan is the success rate. If it is not successful, then alcoholics will not experience continued abstinence from alcohol. Research shows that the most effective plan is one that includes a treatment program followed by participation in Alcoholics Anonymous (AA), a 12-step program.
Alcoholism is a chronic, progressive disease. It is characterized by a loss of control over drinking to the point that it interferes with one or more vital area of life such as personal relationships, job or health. Alcoholism is a treatable disease.
Treatment programs dealing with substance abuse include inpatient and outpatient programs. The methodology varies greatly as well as their success rates in recovery.
Recovery is the absence of alcohol and the return to a healthy mental and/ or physical state.
A twelve step program is designed to assist in the recovery from addiction or compulsive behavior, especially a spiritually-oriented program based on the principles of acknowledging one’s personal insufficiency and accepting help from a higher power.
Lê, Ingvarson, and Page (1995) discuss the debate about the 12-step program of AA being in conflict with counseling theories. First, Lê et al. (1995) makes the point that the research on the AA program does in fact show that those who attend meetings are more likely to abstain from alcohol. However, AA members who do attend meetings do so by choice. Lê et al. (1995) argues that those participants may have a higher degree of self-motivation, resulting in continued alcohol abstinence. It is not AA attendance leading to the continued recovery. Second, counselors often refer clients to AA even though main components of the 12-steps are out of line with counseling theories. Moreover, counselors need to change the relationship they have with AA and use a proposed 12-step program that is based on counseling theories, not AA philosophies.
Research of this topic will be pursued by using scientific journals that contain articles about alcoholism and reliable university research studies.
The main branches of science that will be used are psychology and psychiatry with a focus on addiction studies.
A wide range of options are available for the treatment of alcohol abuse or alcoholism. Included in treatment options are in-patient and out-patient plans, 12- step programs, and individual therapy. These options may be used individually or in combination with one another. In terms of continued sobriety, there is scientific evidence that concludes the combining alcohol abuse treatment with participation in Alcoholics Anonymous has the best outcome. Specifically, in-patient or out-patient treatment for alcoholism along with Alcoholics Anonymous attendance is the most successful plan for continued abstinence from alcohol. Research studies that focus on this issue specifically or as a component of a study strongly support this stance.
The study conducted by Campbell, Davis, Lieber and Tax (2002) examines the success of standard treatment for alcohol abuse, group and individual therapy with an emphasis on AA, compared to a minimal treatment approach consisting of alcohol education movies and the ensuing affects of abstinence from alcohol over a six-month period. At intake both screener and patient remained blind to the study until eligibility was determined. Once eligibility was established the study became open. Eligibility requirements consisted of patients who had alcohol dependence or abuse that had consumed alcohol recently. Patients in both treatment groups totaled 105 men ages 29-65 with comparable socio-economic backgrounds. A main conclusion of the study found that those in standard treatment attending AA had higher alcohol abstinence rates then those in minimal treatment.
Similarly, this study also showed evidence that AA involvement has a positive affect on continued sobriety. An open twenty-four month longitudinal study discusses the positive influence of 12-step programs, primarily AA, on sobriety. In this study a total of 262 sample patients completed three interviews after attending treatment for alcoholism. The demographics were comprised of 42% African-American, 29% Latino, 29% European American, with the rest consisting of Asian or Native Americans. Approximate ages of the participants were from 18 to 54 years with majority under age 35. Nearly half the population was compromised of women. Fiorentine (1999) found that attending one AA meeting or more weekly suggests a greater rate of abstinence than those who attend meetings less than once a week.
Bond, Kaskutas, and Weiner (2003) also argue the affect of AA involvement related to alcohol abstinence proceeding in-patient treatment. The open study occurs at different treatment center locations throughout California that include a total of 10 public and private rehabilitation centers. A demographical cross section of patients was used. The baseline sample of 367 men and 288 women accepting treatment were interviewed at intake, 1 and 3 years later to collect data about consumption, dependence symptoms, social support and AA participation. Bond et al. (2003) assert that AA attendance between the 12 -36 month time period bettered the odds of abstinence upwards of 35% above those at 12 months. Moreover, involvement in AA after a treatment episode demonstrates the significant importance of membership. AA membership is key to the alcoholic for ongoing abstinence post-treatment.
Another study on alcohol addiction, treatment, and AA involvement focuses on 337 male clients who participated in outpatient treatment and aftercare. The ethnicity of the men consisted primarily of White, Hispanic and Black. Project match consisted of two parallel multi-site independent matching studies. The first study focuses on male clients recruited from outpatient settings, while the parallel study focuses on male patients receiving aftercare treatment following in-patient care. There was random assignment to three types of therapies that included; twelve-step facilitation, cognitive-behavioral coping skills, and motivational enhancement therapy.
Patients were followed for one year reporting abstinence at 3-month intervals following the 12-week treatment period. Connors, Tonigan, and Miller (2001) measured three constructs: intake symptomaology, AA participation, and outcome. Self-reporting was used to assess abstinence and, as a result, careful attention was given to reliability, evaluation and validity. Self-reports were correlated with gamma glutamyl transpeptidase levels in the blood. High levels of this liver enzyme can be indicative of heavy alcohol consumption.
In addition, the Alcoholics Anonymous Inventory (AAI) was administered in the beginning of treatment and again at 6 and 12 months post-treatment. The AAI has strong reliability and test re-test correlations. Connors et al. (2001) could determine from the test whether the client considered himself a member of AA, had gone to meetings, celebrated a monthly or one year sobriety date, had an AA sponsor or had been an AA sponsor. The conclusion shows that regardless of in-patient or out-patient treatment, AA participation was positively and significantly related to higher percentage rates of abstinence compared to those men who did not use AA as an ongoing treatment tool.
Further evidence of the increased abstinence success rate of treatment and AA are detailed in a clinical alcohol study. The study follows 466 problem drinkers, 51% who are male with comparable baseline socio-demographic characteristics, for 8 years after initial contact with a treatment center. Finney, Lesar, Moos and Timko (2000) examine the way in which type and timing of treatment over a period of 8 years correlates with abstinence. Participants in the study were self-selected into four groups: no treatment, AA only, formal treatment, and formal treatment including AA. Participants completed questionnaires at the studies inception followed by continued inventory throughout.
Finney et al. (2000) reported that inventory results indicate participants who attended AA only, but had no alcohol abuse treatment were more likely to be abstinent at the 1, 3 and 8 year time frames. Also, those individuals that had formal treatment plus AA compared to those that had no treatment were also more likely to be abstinent at the given time frames. Furthermore, participants who had formal treatment followed by AA involvement showed higher abstinent rates through 1-3 years then those just attending treatment. The conclusion, in regards to abstinence rates, once again shows that participants who attended some form of treatment and AA meetings fared much better then those who had no treatment or treatment without AA involvement.
Similar conclusions were drawn from an investigative 6-month longitudinal research study that focuses on the connection between attending AA meetings, before, during and after inpatient treatment and continued abstinence. One hundred-fifty cross demographical subjects were interviewed at intake and 120 of the subjects were interviewed again 6 months after the completion of treatment. Best et al., (2003) finds that attending AA once weekly or more correlates with better abstinent outcomes compared to those patients who attend minimally or not at all. These findings maintain the role of AA as a beneficial resource for abstinence following a treatment episode. In addition, this study contributes more evidence to the stance that higher abstinence rates occur with a combination of treatment and AA.
In conclusion, the studies collectively provide evidence that initial treatment for alcoholism along with involvement in AA has a higher abstinent rate than other options. The research clearly shows that when AA is coupled with an inpatient or outpatient treatment plan, it proves to be beneficial in maintaining sobriety for a greater length of time than those who do not attend AA meetings at least once weekly. In regard to maintained abstinence from alcohol, treatment programs without AA attendance or AA attendance without treatment are shown not to be as effective as the combination of both.
While these studies showed a positive correlation between treatment and AA, the question is why? The treatment detailed in the studies took place at different facilities, likely with varying treatment philosophies with some being inpatient programs and others being outpatient. So the treatment differed, but the constant was AA. Therefore, more studies need to be conducted to determine what factors of AA or aspects of the program may have made the difference.
Future research should focus on the program itself with respect to members who have received treatment. What is it about AA attendance that made a difference? Studies should be conducted to research if those remaining abstinent from alcohol participate in 12-step work, service work and/or sponsorship. Are those that sponsor other AA members more likely to stay abstinent themselves? The key is to find out if those who remain abstinent are participating in specific actions within the group or if it is just simply the support of the group.
Additionally, it seems that more specific studies need to be conducted as well. The majority of the studies showing the positive link between AA and treatment included men and women, more than one racial group and covered a wide age range. The results at the end were given as a whole and not detailed according to group make-up. It would be beneficial in the future to have similar studies focus on gender, race, or a combination of these. This would allow for a more precise measurement on who was benefiting and remaining abstinent, instead of a percentage rate based on a diverse group.
Best, D., Gossop, M., Harris, J., Mann, L.H., Manning, V., Marshall, J., Strang, J. (2003). Is attendance at alcoholics anonymous meetings after inpatient treatment related to improved outcomes? A 6-month follow-up study. Journal of Alcohol and Alcoholism, 38, 421-426. Retrieved February 15, 2006, from the Medline Database.
Bond, J., Kaskutas, L.A., & Weisner, C., (2003). The persistent influence of social networks and alcoholics anonymous on abstinence. Journal of Studies on Alcohol, 64, 579-589. Retrieved February 9, 2006, from Academic Premier Database.
Campbell, L., M.S., Davis, W.T., Ph.D., Lieber, C.S., M.A.C.P., & Tax, J., C.S.W. (2002). A trial of standard treatment vs. a minimal treatment control, Journal of Substance Abuse Treatment, 23, 9-19. Retrieved February 9, 2006, from Academic Premier Database.
Connors, G.J., Tonigan, J.S., & Miller, W.R., (2001). A longitudinal model of intake symptomatology, a.a. participation and outcome: Retrospective study of the project match outpatient and aftercare samples, Journal of Studies on Alcohol, 62, 817-826. Retrieved February 19, 2006, from Academic Premier Database.
Finney, J.W., Lesar M.D., Moos, R.H., & Timko, C. (2000). Long-term outcomes of alcohol use disorders: Comparing untreated individuals with those in alcoholics anonymous and formal treatment. Journal of Studies on Alcohol, 61, 529-548. Retrieved February 20, 2006, from Academic Premier database.
Fiorentine, R.F., Ph.D., (1999). After drug treatment: Are 12-step programs effective in maintaining abstinence? American Journal of Drug and Alcohol Abuse, 25, 93-116. Retrieved January 26, 2006 from Academic Premier Database.
Lê, C., Ingvarson, E.P., Page, R. (1195). Alcoholics anonymous and the counseling profession: philosophies in conflict, Journal of Counseling & Development, 73, 603-609. Retrieved February 9, 2006, from Academic Premier database.