|
Article Excerpt
MOST TREATMENT PROGRAMS for substance-use problems in the United States encourage their clients to participate in Alcoholics Anonymous (AA) as a form of aftercare (Roman and Blum, 1997). This encouragement appears justified as research has shown that posttreatment participation in AA is associated with reduced drinking and fewer psychosocial problems (Emrick et al., 1993; Humphreys and Moos, 1997; Kaskutas et al., 2005; McCrady et al., 2004; Tonigan et al., 1996b). However, many persons who begin in AA do not participate at sufficient levels to benefit from the program (Fiorentine, 1999; Tonigan et al., 2003). Accordingly, there is a need to identify factors that influence AA participation. Once these factors are identified, they can be targeted to enhance an individual's readiness to participate in AA or to refer the individual to another form of aftercare.
Numerous studies have examined potential correlates of AA participation. These studies have shown that alcohol-problem severity is the most reliable predictor of this behavior (Emrick et al., 1993; Yonigan et al., 1996b). Demographic, personality, social, and cognitive variables that have been examined across several studies generally have shown nonsignificant, weak, or inconsistent associations with AA participation. However, it would be premature to draw firm conclusions from this research. The prior studies have differed substantially in their methodologies, which may have contributed to variations in findings. Further, most of the studies have not been guided by theoretical frameworks and have not examined the most logical factors (e.g., beliefs specific to AA) as potential predictors (Emrick et al., 1993). Given the widespread use and apparent effectiveness of AA, more research is needed on factors that may influence participation in it (Miller and McCrady, 1993; Moos and Moos, 2004).
Individuals can participate in AA in diverse ways, such as attending mutual-help group meetings, reading literature, and working with a sponsor. Several survey instruments have been developed to assess participation in different AA activities (e.g., Humphreys et al., 1998; Kingree, 1997; Tonigan et al., 1996a). However, uncertainty exists regarding the best way to assess AA participation. One study found that composite scores from a multi-item instrument tapping AA-related beliefs and participation in AA-related activities predicted functioning better than a single constituent item assessing frequency of participation in AA meetings (Kingree, 1997). Another study found that a single-item measure of participation in AA meetings predicted functioning as well as a multi-item instrument tapping participation in different AA activities (Kelly et al., 2002). Additional work is needed to evaluate the utility of different measures of AA participation.
The current study was designed to evaluate the predictive validity of the Survey of Readiness for Alcoholics Anonymous Participation (SYRAAP). The SYRAAP is a brief, self-administered instrument based on the health belief model (Rosenstock et al., 1988; Strecher and Rosenstock, 1997). It has three dimensions or subscales. One subscale taps perceived severity of the respondents' substance-use problems; the other two subscales tap perceived benefits and perceived barriers to participating in AA. The SYRAAP is not intended solely for persons with alcohol problems as some with other drug problems also participate heavily in AA (Crape et al., 2002; Weiss et al., 2000). The internal consistency, stability reliability, and construct validity of the SYRAAP have been established in prior research (Kingree et al., in press).
The current study expands on the prior work by examining if the responses to the SYRAAP are associated prospectively with AA participation. Given the uncertainty regarding the best way to operationalize AA participation, we examined whether the SYRAAP predicted participation in AA meetings and AA activities separately.
We hypothesized the SYRAAP would predict different forms of AA participation for at least two reasons. First, constructs based on the health belief model have been found to be related to participation in a wide array of health-related services, including treatment for alcohol and other drug problems (Bardsley and Beckman, 1988; Burton and Williamson, 1995; Ryan et al., 1995). Second, our earlier research showed that responses to the SYRAAP were related to a composite measure of prior participation in AA meetings and activities (Kingree et al., in press), and prior behavior tends to be a strong indicator of future behavior. Nonetheless, we recognized that the SYRAAP would have limited value if AA participation were predicted less strongly by it than by other relevant variables. Thus, variables measuring respondents' sociodemographic characteristics, most problematic substance, prior use of treatment and AA, mode of current treatment, psychological distress, motivation for change, alcohol-problem severity, and drug-problem severity were examined as predictors along with the SYRAAP.
Method
Sample
The sample was recruited from three treatment programs in a southeastern state. Two of the programs provided short-term (less than 7 days) detoxification treatment and one provided 6 weeks of outpatient treatment. Potential respondents were recruited in small groups during their first week of treatment. They were deemed eligible if they (1) demonstrated a 6th-grade reading level on a literacy measure (Williams et al., 1995) and (2) identified at least two persons as contacts. A 6th-grade reading level was needed for adequate comprehension of the SYRAAP items, and the contacts were to assist us in tracking the respondents for the follow-up assessments.
After screening on the eligibility criteria, the sample included 268 (85%) of the 317 individuals who initially enrolled in the study. Based on established cutpoints for the Short Michigan Alcohol Screening Test (Selzer et al., 1975) and Drug Abuse Screening Test (Skinner, 1983), 78% and 84% of the eligible respondents were classified as having clinically significant problems with alcohol...
|
