Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis
ABSTRACT Aims Evidence indicates that Alcoholics Anonymous (AA) participation reduces relapse risk but less is known about the mechanisms through which AA confers this benefit. Initial studies indicate self‐efficacy, negative affect, adaptive social networks and spiritual practices are mediators of...
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| Veröffentlicht in: | Addiction (Abingdon, England) England), 2012-02, Vol.107 (2), p.289-299 |
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| container_title | Addiction (Abingdon, England) |
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| creator | Kelly, John F. Hoeppner, Bettina Stout, Robert L. Pagano, Maria |
| description | ABSTRACT
Aims Evidence indicates that Alcoholics Anonymous (AA) participation reduces relapse risk but less is known about the mechanisms through which AA confers this benefit. Initial studies indicate self‐efficacy, negative affect, adaptive social networks and spiritual practices are mediators of this effect, but because these have been tested in isolation, their relative importance remains elusive. This study tested multiple mediators simultaneously to help determine the most influential pathways.
Design Prospective, statistically controlled, naturalistic investigation examined the extent to which these previously identified mechanisms mediated AA attendance effects on alcohol outcomes controlling for baseline outcome values, mediators, treatment, and other confounders.
Setting Nine clinical sites within the United States.
Participants Adults (n = 1726) suffering from alcohol use disorder (AUD) initially enrolled in a randomized study with two arms: aftercare (n = 774); and out‐patient (n = 952) comparing three out‐patient treatments (Project MATCH).
Measurements AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months.
Findings Among out‐patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self‐efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self‐efficacy, AA lead to better outcomes through increasing spirituality/religiosity and by reducing negative affect. The degree to which mediators explained the relationship between AA and outcomes ranged from 43% to 67%.
Conclusion While Alcoholics Anonymous facilitates recovery by mobilizing several processes simultaneously, it is changes in social factors which appear to be of primary importance. |
| doi_str_mv | 10.1111/j.1360-0443.2011.03593.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3242865</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2562299091</sourcerecordid><originalsourceid>FETCH-LOGICAL-c6663-5d2ea9cc3a7f6e96e38fe86d32beac7a02abdd26d316103326293234d33a99473</originalsourceid><addsrcrecordid>eNqNkUuP0zAUhSMEYsrAX0AWEmKV4FecGImRSssMSCNgwUNiY7mO07g4drHTTrvll-NMS3msyMbRvd85OlcnywCCBUrf81WBCIM5pJQUGCJUQFJyUuzuZJPT4m42gZyVOUYUnmUPYlxBCKua0_vZGUYcVbCkk-zHXA869MYZtwRDp0HQVg5mq4Hp1z4M0ikNfHu76rXqpDOxj-NkoTu5NT6AcbjU4MYMnXFgapXvvDUqgqnzbt_7TXwBJOg3djBrO7o0Rg5JJ520-2jiw-xeK23Uj47vefbp8vXH2Zv8-v3V29n0OleMMZKXDdaSK0Vk1TLNmSZ1q2vWELzQUlUSYrloGpwGiCFICGaYE0xoQ4jknFbkPLs4-K43ixRCaTcEacU6mF6GvfDSiL83znRi6beCYIprViaDZ0eD4L9vdBxEb6LS1kqn05WCY0x5WWOYyCf_kCu_CeneBCFGKMQEJag-QCr4GINuT1EQFGPNYiXGNsXYphhrFrc1i12SPv7zlJPwV68JeHoEZFTStiH1aOJvrqQIV3DM8PLA3Rir9_8dQEzn8_Ev6fOD3sRB7056Gb4JVpGqFF_eXYnLVzPIvn7-ICj5CVpw1QM</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>916340231</pqid></control><display><type>article</type><title>Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Kelly, John F. ; Hoeppner, Bettina ; Stout, Robert L. ; Pagano, Maria</creator><creatorcontrib>Kelly, John F. ; Hoeppner, Bettina ; Stout, Robert L. ; Pagano, Maria</creatorcontrib><description>ABSTRACT
Aims Evidence indicates that Alcoholics Anonymous (AA) participation reduces relapse risk but less is known about the mechanisms through which AA confers this benefit. Initial studies indicate self‐efficacy, negative affect, adaptive social networks and spiritual practices are mediators of this effect, but because these have been tested in isolation, their relative importance remains elusive. This study tested multiple mediators simultaneously to help determine the most influential pathways.
Design Prospective, statistically controlled, naturalistic investigation examined the extent to which these previously identified mechanisms mediated AA attendance effects on alcohol outcomes controlling for baseline outcome values, mediators, treatment, and other confounders.
Setting Nine clinical sites within the United States.
Participants Adults (n = 1726) suffering from alcohol use disorder (AUD) initially enrolled in a randomized study with two arms: aftercare (n = 774); and out‐patient (n = 952) comparing three out‐patient treatments (Project MATCH).
Measurements AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months.
Findings Among out‐patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self‐efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self‐efficacy, AA lead to better outcomes through increasing spirituality/religiosity and by reducing negative affect. The degree to which mediators explained the relationship between AA and outcomes ranged from 43% to 67%.
Conclusion While Alcoholics Anonymous facilitates recovery by mobilizing several processes simultaneously, it is changes in social factors which appear to be of primary importance.</description><identifier>ISSN: 0965-2140</identifier><identifier>EISSN: 1360-0443</identifier><identifier>DOI: 10.1111/j.1360-0443.2011.03593.x</identifier><identifier>PMID: 21917054</identifier><identifier>CODEN: ADICE5</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Addiction ; Addictive behaviors ; Adult ; Adult and adolescent clinical studies ; Aftercare - statistics & numerical data ; Alcohol ; alcohol dependence ; Alcoholics Anonymous ; Alcoholism ; Alcoholism - rehabilitation ; Alcoholism and acute alcohol poisoning ; Ambulatory Care - statistics & numerical data ; Behavior modification ; Behavior Therapy - methods ; Behavioural psychology ; Behavioural sciences ; Biological and medical sciences ; Depression ; Depression - complications ; Female ; Humans ; Independence ; Male ; Mediation ; Medical care ; Medical sciences ; Medical treatment ; Mood disorders ; Patient Acceptance of Health Care - statistics & numerical data ; Patients ; Prospective Studies ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Religion ; Secondary Prevention ; Self Efficacy ; self-help groups ; social network ; Social networks ; Social Support ; Spirituality ; Substance abuse treatment ; Toxicology ; Treatment Outcome</subject><ispartof>Addiction (Abingdon, England), 2012-02, Vol.107 (2), p.289-299</ispartof><rights>2011 The Authors, Addiction © 2011 Society for the Study of Addiction</rights><rights>2015 INIST-CNRS</rights><rights>2011 The Authors, Addiction © 2011 Society for the Study of Addiction.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c6663-5d2ea9cc3a7f6e96e38fe86d32beac7a02abdd26d316103326293234d33a99473</citedby><cites>FETCH-LOGICAL-c6663-5d2ea9cc3a7f6e96e38fe86d32beac7a02abdd26d316103326293234d33a99473</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1360-0443.2011.03593.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1360-0443.2011.03593.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25412701$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21917054$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kelly, John F.</creatorcontrib><creatorcontrib>Hoeppner, Bettina</creatorcontrib><creatorcontrib>Stout, Robert L.</creatorcontrib><creatorcontrib>Pagano, Maria</creatorcontrib><title>Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis</title><title>Addiction (Abingdon, England)</title><addtitle>Addiction</addtitle><description>ABSTRACT
Aims Evidence indicates that Alcoholics Anonymous (AA) participation reduces relapse risk but less is known about the mechanisms through which AA confers this benefit. Initial studies indicate self‐efficacy, negative affect, adaptive social networks and spiritual practices are mediators of this effect, but because these have been tested in isolation, their relative importance remains elusive. This study tested multiple mediators simultaneously to help determine the most influential pathways.
Design Prospective, statistically controlled, naturalistic investigation examined the extent to which these previously identified mechanisms mediated AA attendance effects on alcohol outcomes controlling for baseline outcome values, mediators, treatment, and other confounders.
Setting Nine clinical sites within the United States.
Participants Adults (n = 1726) suffering from alcohol use disorder (AUD) initially enrolled in a randomized study with two arms: aftercare (n = 774); and out‐patient (n = 952) comparing three out‐patient treatments (Project MATCH).
Measurements AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months.
Findings Among out‐patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self‐efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self‐efficacy, AA lead to better outcomes through increasing spirituality/religiosity and by reducing negative affect. The degree to which mediators explained the relationship between AA and outcomes ranged from 43% to 67%.
Conclusion While Alcoholics Anonymous facilitates recovery by mobilizing several processes simultaneously, it is changes in social factors which appear to be of primary importance.</description><subject>Addiction</subject><subject>Addictive behaviors</subject><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Aftercare - statistics & numerical data</subject><subject>Alcohol</subject><subject>alcohol dependence</subject><subject>Alcoholics Anonymous</subject><subject>Alcoholism</subject><subject>Alcoholism - rehabilitation</subject><subject>Alcoholism and acute alcohol poisoning</subject><subject>Ambulatory Care - statistics & numerical data</subject><subject>Behavior modification</subject><subject>Behavior Therapy - methods</subject><subject>Behavioural psychology</subject><subject>Behavioural sciences</subject><subject>Biological and medical sciences</subject><subject>Depression</subject><subject>Depression - complications</subject><subject>Female</subject><subject>Humans</subject><subject>Independence</subject><subject>Male</subject><subject>Mediation</subject><subject>Medical care</subject><subject>Medical sciences</subject><subject>Medical treatment</subject><subject>Mood disorders</subject><subject>Patient Acceptance of Health Care - statistics & numerical data</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Religion</subject><subject>Secondary Prevention</subject><subject>Self Efficacy</subject><subject>self-help groups</subject><subject>social network</subject><subject>Social networks</subject><subject>Social Support</subject><subject>Spirituality</subject><subject>Substance abuse treatment</subject><subject>Toxicology</subject><subject>Treatment Outcome</subject><issn>0965-2140</issn><issn>1360-0443</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUuP0zAUhSMEYsrAX0AWEmKV4FecGImRSssMSCNgwUNiY7mO07g4drHTTrvll-NMS3msyMbRvd85OlcnywCCBUrf81WBCIM5pJQUGCJUQFJyUuzuZJPT4m42gZyVOUYUnmUPYlxBCKua0_vZGUYcVbCkk-zHXA869MYZtwRDp0HQVg5mq4Hp1z4M0ikNfHu76rXqpDOxj-NkoTu5NT6AcbjU4MYMnXFgapXvvDUqgqnzbt_7TXwBJOg3djBrO7o0Rg5JJ520-2jiw-xeK23Uj47vefbp8vXH2Zv8-v3V29n0OleMMZKXDdaSK0Vk1TLNmSZ1q2vWELzQUlUSYrloGpwGiCFICGaYE0xoQ4jknFbkPLs4-K43ixRCaTcEacU6mF6GvfDSiL83znRi6beCYIprViaDZ0eD4L9vdBxEb6LS1kqn05WCY0x5WWOYyCf_kCu_CeneBCFGKMQEJag-QCr4GINuT1EQFGPNYiXGNsXYphhrFrc1i12SPv7zlJPwV68JeHoEZFTStiH1aOJvrqQIV3DM8PLA3Rir9_8dQEzn8_Ev6fOD3sRB7056Gb4JVpGqFF_eXYnLVzPIvn7-ICj5CVpw1QM</recordid><startdate>201202</startdate><enddate>201202</enddate><creator>Kelly, John F.</creator><creator>Hoeppner, Bettina</creator><creator>Stout, Robert L.</creator><creator>Pagano, Maria</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QG</scope><scope>7TK</scope><scope>8BJ</scope><scope>FQK</scope><scope>JBE</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>5PM</scope></search><sort><creationdate>201202</creationdate><title>Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis</title><author>Kelly, John F. ; Hoeppner, Bettina ; Stout, Robert L. ; Pagano, Maria</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c6663-5d2ea9cc3a7f6e96e38fe86d32beac7a02abdd26d316103326293234d33a99473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Addiction</topic><topic>Addictive behaviors</topic><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>Aftercare - statistics & numerical data</topic><topic>Alcohol</topic><topic>alcohol dependence</topic><topic>Alcoholics Anonymous</topic><topic>Alcoholism</topic><topic>Alcoholism - rehabilitation</topic><topic>Alcoholism and acute alcohol poisoning</topic><topic>Ambulatory Care - statistics & numerical data</topic><topic>Behavior modification</topic><topic>Behavior Therapy - methods</topic><topic>Behavioural psychology</topic><topic>Behavioural sciences</topic><topic>Biological and medical sciences</topic><topic>Depression</topic><topic>Depression - complications</topic><topic>Female</topic><topic>Humans</topic><topic>Independence</topic><topic>Male</topic><topic>Mediation</topic><topic>Medical care</topic><topic>Medical sciences</topic><topic>Medical treatment</topic><topic>Mood disorders</topic><topic>Patient Acceptance of Health Care - statistics & numerical data</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Religion</topic><topic>Secondary Prevention</topic><topic>Self Efficacy</topic><topic>self-help groups</topic><topic>social network</topic><topic>Social networks</topic><topic>Social Support</topic><topic>Spirituality</topic><topic>Substance abuse treatment</topic><topic>Toxicology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kelly, John F.</creatorcontrib><creatorcontrib>Hoeppner, Bettina</creatorcontrib><creatorcontrib>Stout, Robert L.</creatorcontrib><creatorcontrib>Pagano, Maria</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Animal Behavior Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Addiction (Abingdon, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kelly, John F.</au><au>Hoeppner, Bettina</au><au>Stout, Robert L.</au><au>Pagano, Maria</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis</atitle><jtitle>Addiction (Abingdon, England)</jtitle><addtitle>Addiction</addtitle><date>2012-02</date><risdate>2012</risdate><volume>107</volume><issue>2</issue><spage>289</spage><epage>299</epage><pages>289-299</pages><issn>0965-2140</issn><eissn>1360-0443</eissn><coden>ADICE5</coden><abstract>ABSTRACT
Aims Evidence indicates that Alcoholics Anonymous (AA) participation reduces relapse risk but less is known about the mechanisms through which AA confers this benefit. Initial studies indicate self‐efficacy, negative affect, adaptive social networks and spiritual practices are mediators of this effect, but because these have been tested in isolation, their relative importance remains elusive. This study tested multiple mediators simultaneously to help determine the most influential pathways.
Design Prospective, statistically controlled, naturalistic investigation examined the extent to which these previously identified mechanisms mediated AA attendance effects on alcohol outcomes controlling for baseline outcome values, mediators, treatment, and other confounders.
Setting Nine clinical sites within the United States.
Participants Adults (n = 1726) suffering from alcohol use disorder (AUD) initially enrolled in a randomized study with two arms: aftercare (n = 774); and out‐patient (n = 952) comparing three out‐patient treatments (Project MATCH).
Measurements AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months.
Findings Among out‐patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self‐efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self‐efficacy, AA lead to better outcomes through increasing spirituality/religiosity and by reducing negative affect. The degree to which mediators explained the relationship between AA and outcomes ranged from 43% to 67%.
Conclusion While Alcoholics Anonymous facilitates recovery by mobilizing several processes simultaneously, it is changes in social factors which appear to be of primary importance.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>21917054</pmid><doi>10.1111/j.1360-0443.2011.03593.x</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Addiction Addictive behaviors Adult Adult and adolescent clinical studies Aftercare - statistics & numerical data Alcohol alcohol dependence Alcoholics Anonymous Alcoholism Alcoholism - rehabilitation Alcoholism and acute alcohol poisoning Ambulatory Care - statistics & numerical data Behavior modification Behavior Therapy - methods Behavioural psychology Behavioural sciences Biological and medical sciences Depression Depression - complications Female Humans Independence Male Mediation Medical care Medical sciences Medical treatment Mood disorders Patient Acceptance of Health Care - statistics & numerical data Patients Prospective Studies Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Religion Secondary Prevention Self Efficacy self-help groups social network Social networks Social Support Spirituality Substance abuse treatment Toxicology Treatment Outcome |
| title | Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis |
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