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Epidemiology of Alcohol Problems
Component 5: Health Services Core Abstract:Alcoholics Anonymous is the most widely sought source of help for alcohol problems in the U.S., with the majority of treatment programs recommending AA attendance during, and following, treatment. However, we know very little about treatment clients’ long-term use of AA, or the predictors of AA involvement over time among untreated dependent and problem drinkers. The relationship between AA involvement and abstinence also is a topic of large debate, despite an evolving body of literature suggesting that AA meeting attendance can be associated with abstinence both short- and long-term. This secondary analysis component proposes to address these understudied questions, using existing longitudinal data from a probability sample of dependent and problem drinkers recruited when they sought treatment (n=926) and a parallel probability sample of 672 untreated dependent and problem drinkers from the general population, re-interviewed 1, 3, 5 and 7 years later (75% response rate at year 7). Our conceptual framework is drawn from Aday’s model of health services utilization that has been modified by work in alcohol and drug research, which includes predisposing characteristics, enabling influences and need factors. The analytic approach applies a class of modeling individual developmental change known as latent class growth curve modeling to the problem of uncovering and summarizing the long-term course of AA utilization and alcohol abstinence. Our hypotheses about AA’s impact on drinking are derived from an evolving literature that encourages researchers to focus not only on AA meetings but also on other key prescribed AA-related activities, most importantly having an AA sponsor or guide. We thus propose to model two sets of AA trajectories across time, one based on meeting attendance alone and the other based both on meeting attendance and sponsor status. We hypothesize that both sets of trajectories will be influenced by specific predisposing characteristics (female gender, religious or spiritual self-designation, and having a smaller number of heavy drinkers and drug users in the social network), enabling influences (receipt of substance abuse treatment, receiving an ultimatum from the workplace or criminal justice system, interventions from the family, and having less encouragement to drink), and need factors (alcohol and drug problem severity). We then aim to study how well these trajectories predict alcohol abstinence at 1, 3, 5 and 7 years, hypothesizing that AA trajectories based on meetings and sponsor status will be better predictors of abstinence than trajectories based on meetings alone. Results will have implications for 12-step-oriented treatment programs, by providing them with guidance on the patterns of AA meeting attendance and having a sponsor that are most important for abstinence over time.
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Last updating of page: August 15, 2006 |
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