Top Posts of 2011 #10 – How AA and NA work

photo credit: Jeff Tabaco

Here is a summary of the knowledge presented at last year’s conference on AA and NA:

  • The preponderance of evidence supports the causal pathway that AA attendance leads to abstinence (Kaskutas, Zemore).
  • 12-Step affiliation significantly enhances the odds of sustaining abstinence for multiple years among polysubstance-dependent individuals (Laudet).
  • 12-Step involvement yields benefits above and beyond meeting attendance (Kaskutas, Zemore, Laudet)—and this is especially important for women (Laudet).
  • 12-Step attendance declines over time (Laudet, Kelly). Patterns of AA and NA attendance mirror patterns of treatment attendance with multiple stop-and-start episodes (Laudet).
  • A substantial minority of recovering substance abusers in the community do not participate in 12-Step programs (Laudet).
  • For adolescents, the relationship between AA meeting attendance and percent days abstinent increase in linear and positive direction at 6 months and 12 months posttreatment (Kelly).
  • A combination of treatment and AA is most effective (Kaskutas, Zemore).
  • Among adolescents, early posttreatment attendance, even in relatively small amounts, predicts long-term helpful outcomes. Consistent attendance over time predicts favorable outcomes (Kelly).
  • Three or more AA/NA meetings per week are optimal and associated with complete abstinence. However, even one or two meetings per week are associated with sharp increases in abstinence (Kelly, White).
  • Of 1.9 million people who are addicted to drugs or alcohol, only 18% are alcohol only and only 36% are drug only (White).
  • Those who state AA is helpful have better drinking outcomes. Those who state AA is not helpful have poorer drinking outcomes (Robinson).
  • Addiction severity predicts participation in AA and NA among adults (Robinson) and adolescents (Kelly).
  • Individuals who benefit from AA identify the importance of being in a group of sober people, see AA as a source of support, benefit from others’ experiences, and search for AA meetings and members with whom they find compatibility (Robinson).

Not too shabby for an approach to problem drinking that has no evidence, huh?

RELATED POSTS: How AA and NA work, part 2

The go-to way

From an interview with the author of a book on how peer pressure has the potential to transform the world in positive ways [emphasis mine]:

Why is there so much fear around connectedness? Some of the people in that group were afraid that other people would become busybodies and that they’d almost get too close for comfort.

I think there’s still a lot of resistance to the idea of solving problems in groups. Not with the idea of addiction anymore — I think those groups [like 12-step programs] have now become the go-to way of dealing with it — but with other problems [the resistance is still there]. America is still a very individualist society compared to most other places. We’ve structured a middle class suburban life that increases that sense of alienation. Your kids don’t play in a communal park — they go to the swing set in your backyard. But I think people are realizing that it’s not healthy to live that way, that we’d be happier if we were more connected.

Interesting…particularly for an approach to drug problems that takes so much flak.

This is especially interesting in the context of social contagion of drinking and other health problems.


Harm Reduction and 12 Step Approaches Complimentary?

PeaPod has a great post on harm reduction and 12 step oriented treatment. He reviews an article that suggests that they can be complimentary.

I’m more and more convinced that this is true. However, the big question is, what values and beliefs animate the intervention?

Can the harm reduction provider embrace beliefs like:

  • for addicts, abstinence (a foundation for full recovery) is the best outcome,
  • most addicts are capable of achieving full recovery if they are given the proper treatment and support,
  • we workers can’t pick the winners and losers,
  • drug use by addicts is a bad thing (a symptom of an illness),
  • meeting people where they are at is great, but shouldn’t leave them there—it is the responsibility of all providers to look for opportunities to move the addict toward full recovery.

Can drug-free treatment providers embrace beliefs like:

  • gradual improvement is good and something to be affirmed,
  • self-determination is important,
  • choices are not a threat,
  • support of the addict should be unconditional—it should continue whether the addict is using or not,
  • dead addicts can’t recover.

Where this gets sticky is establishing priorities in the context of scarce resources.