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Article Excerpt
TWELVE-STEP MUTUAL-HELP GROUPS, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), are attractive as adjuncts or alternatives to addictions treatment, because they can be attended free of charge, are easily accessible, and are widely available in most communities. Increasing evidence regarding the utility of AA-NA (e.g., Emrick et al., 1993; Kelly, 2003; Timko et al., 2000; Tonigan et al., 2003) has led to widespread referrals to such groups (Humphreys, 1997). However, many patients do not attend at all, and others discontinue attendance after some initial exposure (Kelly and Moos, 2003; Tonigan et al., 2003). Greater understanding regarding which patients participate in AA-NA, and why, would inform and help target efforts to facilitate 12-step involvement. Decision-making theory suggests that individuals engage in a conscious appraisal of the benefits and drawbacks associated with a given course of behavior before engaging in behavior change (Janis and Mann, 1977). Assessment of beliefs about potential positive and negative outcomes of AA-NA participation may enhance predictive precision regarding who participates in these fellowships and could provide valuable clinical information by identifying specific barriers to participation. However, we are aware of no validated measures that assess beliefs or attitudes regarding 12-step participation.
AA and NA offer a number of potential benefits that may influence decisions to participate. For example, these programs may offer abstinence-specific social support and may act to maintain motivation for recovery through the sharing of personal testimony (e.g., Kelly et al., 2000). Stories of recovery may be uplifting and inspiring for attendees, and participation in 12-step programs may enhance sober living skills and confidence in staying sober (e.g., Morgenstern et al., 1997). AA-NA also may provide a way of structuring sober time, especially during high-risk periods such as evenings and weekends. Assessing the degree to which individual patients perceive these potential benefits of 12-step participation as being likely to occur for themselves may be of predictive value and clinically may provide a means of highlighting and reinforcing the benefits of increased mutual-help involvement.
Patients also may perceive 12-step programs in negative ways. For example, some may dislike the group format of AA-NA meetings or may perceive meetings as aversive, causing boredom, embarrassment, or hopelessness. For others, barriers may be more logistical such as difficulty obtaining transportation. Finally, the explicit spiritual emphasis of AA-NA may be a concern for some. Assessing these potential barriers to participation may help clinicians better understand and manage resistance to engaging in 12-step mutual-help groups.
Study aims
The purpose of the present study was to develop a measure of attitudes pertaining to 12-step participation, to conduct preliminary analyses on its psychometric properties, and to examine its concurrent and predictive validity.
Method
Participants
Participants were 37 men and 11 women recruited from a private, nonprofit, inpatient detoxification program to participate in a randomized clinical trial comparing brief advice to attend AA-NA with a motivational enhancement intervention that focused on increasing involvement in 12-step mutual-help groups (ME-12; Kahler et al., 2004). Alcohol-dependent patients ages 18-65 were included. Exclusion criteria were current suicidal or homicidal intent, organic impairment, psychotic symptoms or history of psychotic disorder, or use of methadone maintenance. Drug dependence was diagnosed in 22.9% of participants. The participants mean (SD) age was 43 (7.4) years, and 50% had some schooling beyond high school. The sample was 81.2% white, 8.3% black, 6.3% Hispanic/Latino, and 4.2% of other backgrounds. Participants drank on 65.2% (31.3%) of days in the 3 months prior to treatment, an average of 23.5 (17.4) drinks per...
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