CHRONIC ALCOHOL ABUSE Group 2

Samantha Benjamin, Sara Levy, & James Zyckowski

BACKGROUND INFORMATION

A.A was founded by Bill Wilson (Bill W.) and Dr. Bob Smith (Dr.

Bob) in Akron Ohio in 1935.

In 1946 “The 12 Steps” were introduced and integrated into

A.A.

The A.A 12 Step model is a standard protocol intervention with

all drug and alcohol treatment programs.

A.A principles and concepts are taught, and meetings are

mandatory in most inpatient rehabilitation and prisons.

Furthermore, A.A. is a major focus of outpatient treatment.

A.A is the largest mutual-help group in the US with about 1.2

million members and 53,000 groups (Kelly & Yesterian, 2011).

PICO QUESTION:

Do adults suffering from chronic alcohol abuse (P)

experience longer periods of sobriety (O) if they

participate in alcoholics anonymous (I) as

compared to those who do not (C)?

Type of PICO Question: Therapy/Intervention

PICO ELEMENTS

Chronic Alcohol Abusers

Alcoholics Anonymous

Non Attendance at Alcoholics Anonymous

Longer periods of sobriety

P

I

C

O

RESEARCH STRATEGY

Type of Search Electronic

Databases

CINAHL

COCHRANE

MEDLINE

PUBMED

EBSCO

Keywords

Alcoholics Anonymous, AA

chronic alcohol abuse

behavioral therapy

network support

longitudinal, treatment outcomes

Exclusions

children, adolescents, & elderly

articles older than 2005

incomplete articles, i.e. abstracts and summaries

SUMMARY OF RESEARCH STUDIES

• 1 Meta Analyses

• 1 Cochrane Study Level

I

• 1 RCT Level

II

• 1 Systematic Review of Correlational Studies. Level III

• 5 Longitudinal Study Level IV

Level V

Level VI

Level VII

TABLE OF EVIDENCE - SARA

Citation Sample Design Outcomes/Results Evidence

Level QAL

Kelly & Yeterian,

2011

N/A Systematic

Review

12-step facilitation (TSF) therapy

positively influences alcohol and

drug-use outcomes.

III A

Moos & Moos,

2007

461 initially

untreated clients

who initiated help-

seeking. Follow up

at 1, 3, 8, and 16

year intervals.

Longitudinal At the end of a 16 year period, those

who received treatment and/or

participated in AA had a remission

rate of 62% vs. those who did not

participate in treatment or AA and

had a 43% remission rate.

IV B

Witbrodt,

Mertens,

Kaskutas, Bond,

Chi, & Weisner,

2012

1825 health care

treatment-seeking

clients (from two

studies). Follow

up at years 1, 5, 7,

and 9.

Meta-analysis Over time, clients reporting a high

rate of AA attendance reported the

highest stable pattern of abstinence

from alcohol and drugs in the past 30

days while those with no AA

attendance reported the lowest

pattern of abstinence. Over a nine

year period the AA participants had

abstinence rates at 86%, 81%, 84%,

and 75% at interviews at 1, 5, 7, and 9

years.

I A

TABLE OF EVIDENCE - JAMES Citation Sample Design Outcomes/Results Evidence

Level QAL

Strickler, Reif,

Horgan, &

Acevedo, 2012

739 clients in an

alcohol services

study

Longitudinal The data concluded that clients who

were referred to A.A and attended

meetings regularly were 60% less likely

to relapse and to have longer sobriety

time.

IV A

Ferri, Amato &

Davoli, 2006

3417 total clients

from eight

separate trials

Cochrane

Study

An analysis of eight trials with 3417

people, the results were consistent with

the outcome indicating that A.A. kept

patients in treatment longer with longer

sobriety rates.

I A

Gossop, Stewart

& Marsden,

2008

Following 142

outpatient

treatment

patients where

interviews were

conducted at 1-2

and 5 year

periods .

Longitudinal Clients who attended A.A were more

likely to be abstinent from alcohol for

longer periods of time than non-

participants.

IV B

TABLE OF EVIDENCE - SAMANTHA Citation Sample Design Outcomes/Results Evidence

Level QAL

Avalos & Mulia, 2012

1013 black and white clients recruited upon entrance into chemical dependency programs

Longitudinal Data found that utilization of AA was effective in maintaining abstinence. Whites were found to maintain abstinence via AA utilization for longer periods. Religious reinforcement affected utilization of AA for abstinence maintenance .

IV B

Kaskutas, Ammon, Delucchi, Room, Bond & Weisner, 2005

349 clients recruited via treatment entrance

Longitudinal Data showed that the rate of abstinence for the four AA attendance “classes” (low, medium, high, and declined) was highest for those in the high AA attendance “class” by. At year 5 follow up, 80% abstinence reported.

IV B

Litt, Kadden, Kabela-Cormier,& Petry, 2009

210 clients solicited via newspaper, radio and university medical center programs

RCT The data indicated that network support (A.A.) is shown to be more effective in maintaining sobriety. At the two year follow up patients reported 80% abstinence.

II A

STRENGTHS & WEAKNESSES OF THE STUDIES

• Longitudinal studies

• Large sample sizes

• Preponderance of data

• Diversity of research models

• Current research: ≥2005

Strengths

• Self-reporting of subjective data

• Infrequent data collection

• Short sobriety timeframe

• Culture and religion not considered

• Attrition

Weaknesses

BARRIERS AND FACILITATORS TO

IMPLEMENTATION

Facilitators

• No cost

• 24/7 availability of support through

meetings and mentors

• Referral programs in community and

healthcare facilities

• Healthcare worker intervention

• Run by A.A. members

Barriers • Dual diagnoses

• Clients on psychotropic drugs

• Low social functioning

MAJOR FINDINGS AND SUMMARY

Our findings indicate that A.A. can be correlated to maintaining sobriety for longer periods of time.

A.A as a self-help therapy has shown over time its success with the personal and psychosocial rehabilitation of chronic alcohol abusers.

A.A provides a safe community as well as education and support for those struggling with addiction. The group therapy model provides interaction with other abusers as well as self reflection on one’s journey towards recovery.

From meta-analyses, to RCTs, to Longitudinal studies, the rates of remission and sobriety related to A.A. as an intervention are all similar indicating a preponderance of evidence.

RECOMMENDATION

As student and registered nurses we should

strongly recommend Alcoholics Anonymous or 12-

step programs to clients, particularly if they are

seeking help.

Remember! The recommendation of 12-step programs

from a nurse makes it more likely the patient will attend.

Furthermore, the earlier the patient starts participating

the better their prognosis for a positive outcome!

REFERENCES

Avalos, L. A., & Mulia, N. (2012). Formal and informal substance use treatment utilization

and alcohol abstinence over seven years: Is the relationship different for blacks and

whites? Drug & Alcohol Dependence, 121(1-2), 73-80. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2011431168&site=eh

ost-live

Ferri, M., Amato, L., Davoli. (2006). Alcoholics Anonymous and other 12- step programmes

for alcohol dependence. Cochrane Database of Systematic Reviews 2006, Issue 3. Art.

No: CD005032. DOI: 10.1002/14651858.CD005032.pub2

Gossop, M., Stewart, D., & Marsden, J. (2008). Attendance at narcotics anonymous and

alcoholics anonymous meetings, frequency of attendance and substance use outcomes

after residential treatment for drug dependence: A 5-year follow-up study. Addiction,

103(1), 119-125. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009769859&site=ehos

t-live

REFERENCES CON’T

Kaskutas, L. A., Ammon, L., Delucchi, K., Room, R., Bond, J., & Weisner, C. (2005).

Alcoholics anonymous careers: Patterns of AA involvement five years after treatment

entry. Alcoholism: Clinical & Experimental Research, 29(11), 1983-1990. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2009580223&site=eh

ost-live

Kelly, J.F., & Yeterian, J.D. (2011). The role of mutual-help groups in extending the

framework of treatment. Alcohol Research & Health, 33(4), 350-355. Retrieved

fromhttp://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011032306&site=

ehost-live

Litt, M. D., Kadden, R. M., Kabela-Cormier, E., & Petry, N. M. (2009). Changing network

support for drinking: Network support project 2-year follow-up. Journal of Consulting and

Clinical Psychology, 77(2), 229-242. doi: 10.1037/a0015252

REFERENCES CON’T

Moos, R. H., & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated

remission from alcohol use disorders. Addiction, 101(2), 212-222. Retrieved

fromhttp://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009119607&site=

ehost-live

Strickler, G.K., Reif, S., Horgan, C.M. & Acevedo, A. (2012): The Relationship Between

Substance Abuse Performance Measures and Mutual-Help Group Participation after

Treatment. Alcoholism Treatment Quarterly, 30:2, 190-210.

http://dx.doi.org/10.1080/07347324.2012.663305

Witbrodt, J., Mertens, J., Kaskutas, L. A., Bond, J., Chi, F., & Weisner, C. (2012). Do 12-step

meeting attendance trajectories over 9 years predict abstinence? Journal of Substance

Abuse Treatment,43(1), 30-43. doi: 10.1016/j.jsat.2011.10.004