I Am Blessed

So what is it like a life without alcohol and drugs? Some times I take my sobriety for granted in that I forget what its like not to wake up with a hangover or what I said or did the night or day before. To have all my faculties whether I am alone or with significant others and friends gives me a silent confidence even some of our earthling friends might find themselves jealous of. 

In the beginning drinking was adventure then it became one misadventure after another as I first lost contact with what social drinking was and then later realized that I could not function without alcohol. Most of our non-alcoholic friends started to wonder where our relationships with them ended and when our love affair of alcohol began.

But those days are long since past and I don’t subscribe that if I should forget them as I do now and then that I am doomed to repeat. Life without alcohol is a way of life for me and as my health will attest there is well just no place for it in my life. 22.59 years later without a drink I may forget what my active days were like but like AA has taught me the best day drinking compares little with my worst day sober. And for that I will be eternally grateful and hopefully will remember just how blessed I am. 

Credits and A Cup of Joe

Discussion:

There are other alcohol addiction treatment programs that are as effective as A.A. This study used Certified Alcoholic Counselors (C.A.C.) practitioners and program directors to help. They passed out the survey to their patients and these directors made it clear to the individuals that it was completely voluntary. The survey consisted of 101 people in 4 different programs, and the number of participants ranged from 23-30 per program. The programs used besides A.A. were Rational Recovery, Secular Organizations for Sobriety (SOS) and Smart Recovery.  The table below illustrates that the recovery rates in the different methods available to patients is not significant enough to support the idea that one program distinguishes it as more effective than the other. The fact that Alcoholics Anonymous is the most favored program recommended by C.A.C. practitioners is not surprising because it is part of the American experience first popularized by Bill Wilson in the 1930s. It may turn out over time that some of the other protocols available today will become more popular with the passage of time. Those that claim superiority of one program over the other will have to take notice of the supporting data.  

Table 1 – Summary of patients maintaining their sobriety after one year in the program. 

 Program Number of patients

Maintaining sobriety Number of patients surveyed Percentage of patients

Maintaining sobriety

Rational Recovery 11 24 45%

Secular Organizations for Sobriety (SOS) 13 24 54%

Smart Recovery   11 23 48%

Alcoholics Anonymous (A.A.) 16 30 53%

All Programs 51 101 50%

The threats to internal validity are that people bring unique characteristics to the study such as attitude, personality, mental ability, level of maturity and ethnicity which we hope to balance out between each group studied. History may also affect the study as those with more severe drinking problems may not respond to the alternative protocols that do not adhere to a lifetime membership in abstinence programs. The fact that this psychology student obtained sobriety through the program of Alcoholics Anonymous may bias the study either negatively or positively due to conflicting attitudes toward A.A. after the fact. 

The threats to external validity could be where my study is taken as in people, places or times. People may be drinking more during the holidays such as Christmas or the 4th of July and surveys taken after the New Year may have more individuals that have decided to make resolutions to stop drinking liken to memberships in diet programs and fitness centers spiking in the month of January (Argosy University, 2010).

What my study uncovered was the fact that there was no one protocol that was better than another. What did make a difference in individuals remaining sober with greater percentages were those that surrounded themselves with friends that did not either drink or have a problem with drinking, who avoided bars and places where drinking was the primary activity and stayed away from places that were familiar to them when they did drink. The A.A. cliché of: people, places and things has more validity than might be given credit to.  It is not the method of treatment that insures continued sobriety but the environs that alcoholics find themselves in after the desire to stop drinking has been initially arrested. This will impact future studies in alcoholic addiction in that regardless of the treatment protocol, the environs that each patient surrounds themselves in out of inpatient/outpatient care will be as important if not more important than the treatment itself. The culture that patients surround themselves with, i.e., staying away from places where they previously drank, associating with others who still continue their addictive drinking habits, avoidance of placing themselves in situations that predispose them to their prior addiction habits and making healthier lifestyle choices such as diet and exercise is the key element for patients to maintain a sober life.

References

Argosy University. (2010). PSY302 XA Module 5 Retrieved December 1, 2010

Top 7 Best Alcoholics Anonymous Alternatives List. Patricelli, K., MA (2008). 

Retrieved November 9, 2010, from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=28817

12step.org. Resources and information about the 12-step program. (n.d.) Retrieved 

November 9, from http://www.12step.org/the-12-steps.html\

Miller, W.R., Meyers, R.J., & Tonigan. J.S. (1999). Engaging the Unmotivated in 

Treatment for Alcohol Problems: A Comparison of Three Strategies for Intervention Through Family Members. Journal of Consulting and Clinical Psychology, 67(5), 688-697.

Moos, R.H., (2003). Addictive Disorders in Context: Principles and Puzzles of Effective 

Treatment and Recovery. Psychology of Addictive Behaviors, 17(1), 3-12.

Petty, N.M., Martin, B., Cooney, J.L., & Kranzler, H.R. (2000). Give Them Prizes, and 

They Will Come: Contingency Management for Treatment of Alcohol Dependence. Journal of Consulting and Clinical Psychology, 68(2), 250-257.

Rychtarik, R.G., Connors, G.J., Whitney, R.B., McGillicuddy, N.B., Fitterling, J.M. & 

Wirtz, P.W. (2000). Treatment Settings for Persons With Alcoholism: Evidence for Matching Clients to Inpatient Versus Outpatient Care. Journal of Consulting and Clinical Psychology, 68(2), 277-289.

Sobell, M.B., & Sobell, L.C. (2000). Stepped Care as a Heuristic Approach to the 

Treatment of Alcohol Problems. Journal of Consulting and Clinical Psychology, 68(4), 573-579.

Jacobsen, N.S. & Christensen, A. (1996).  Studying the Effectiveness of Psychotherapy:

How well can clinical trials do the job? American Psychologist, 51(10), 1031-1039.

Brown, R.A., Evans, D.M., Miller, I.W., Burgess, E.S., & Mueller, T.I. (1997). 

Cognitive–behavioral treatment for depression in alcoholism. Journal of Consulting and Clinical Psychology, 65(5), 715-726.

Rotunda, R.J., O'Farrell, T.J. (1997). Marital and family therapy of alcohol use disorders: 

Bridging the gap between research and practice. Professional Psychology: Research and Practice, 28(3), 246-252.

Smith, Jane Ellen, Meyers, Robert J., Delaney, Harold D. (1998). The Community

Reinforcement Approach with Homeless Alcohol-Dependant Individuals. Journal of Consulting and Clinical Psychology, 66(3), 541-548.

Read, J.P., Kahler, C.W. & Stevenson, J.F. (2001). Bridging the gap between alcoholism 

treatment research and practice: Identifying what works and why. Professional Psychology: Research and Practice, 32(3), 227-238.

Results

Results
       The intended research study determined whether or not a significant difference exists in the success rate between Alcoholics Anonymous (A.A.) and several other alcohol addiction treatment programs. The study specifically looked at the success rate of the program based on whether or not the participants had or had not maintained their sobriety for one year upon their entering their respective program.  If the resulting percentage of patients maintaining their sobriety was consistent in all four programs, then the study would deem that all of the programs were equally successful. Although the programs outside of A.A. do not have equal notoriety that A.A. does, the question of whether they are just as effective or possibly more effective is what this study attempted to show. The most recognized alternatives to A.A. were selected and the study utilized convenient sampling which is not generalizable to the whole universe. A random sample was not possible due to geographical limitations.
The sample size of 101 was chosen and by the resulting success rates, the study bears out that the sample size was adequate.  The number of study participants ranged from a low of 23 in Smart Recovery, to 24 in both Rational Recovery and Secular Organizations for Sobriety (SOS) and a high of 30 participants from A.A.   The data was analyzed from a purely quantitative standpoint.   The key question asked of participants was “After one year in the program, did you maintain your sobriety?” The percentage of participants maintaining their sobriety ranged from a low of 45% for those in Rational Recovery to a high of 54% for participants in Secular Organizations for Sobriety (SOS).  The average rate of those maintaining their sobriety was 50%.

Instruments

Instruments

The instrument I would use is surveys that have simple to understand 

questions. It would be a purely quantitative study with only closed ended questions.  The key question was whether or not the individual had maintained their sobriety after one year in their respective program. The survey also contained demographic questions, including gender, age, and race.  Other questions included the length of time they had been heavy drinkers, which program they were enrolled in and when they had joined the program.  I also asked if their counselors were helpful assisting them with an ongoing treatment protocol for maintaining their life sober.  

TheLab

Setting

The setting carried out for practicality reasons would be the location where each of these programs originates. 

Participants

The sample participants would be purely voluntary in an attempt to 

obtain a random sample.  The participants would be individuals who 

that are attending A.A. meetings and those that are attending alternative alcohol treatment programs selected.  The sample would be diverse in terms of age, sex and income level.  Additionally sobriety would not be required, but a minimum of one year in the program would be the requirement.

Instruments

The instrument I would use is surveys that have simple to understand 

questions. It would be a purely quantitative study with only closed ended questions.  The key question was whether or not the individual had maintained their sobriety after one year in their respective program. The survey also contained demographic questions, including gender, age, and race.  Other questions included the length of time they had been heavy drinkers, which program they were enrolled in and when they had joined the program.  I also asked if their counselors were helpful assisting them with an ongoing treatment protocol for maintaining their life sober.  

Procedures

I engaged Certified Alcoholic Counselors (C.A.C.) and the directors who run each of the treatment programs.  I asked both the CAC’s and Program Directors to pass out my surveys within each of their programs.  The surveys continued to be passed out long enough to get a sample size needed to be representative. My goal was to have 100 participants in my sample, consisting of 23 to 30 in each program.  

Ethical Considerations

The informed consent was clearly stated on the surveys that all data collected would never include an individuals name and that every answer would be completely confidential. Because A.A. is an anonymous program, patients felt comfortable with that explanation. 

Methodology

Methodology

This study examined if there other alcohol addiction treatment programs that are as effective as Alcoholics Anonymous is in helping alcoholics to stop their addictive drinking?  Since 93% of the rehabilitation programs in the United States are geared toward having an A.A. component attached to it whether it be an inpatient or outpatient component of therapy, it could easily become a daunting task to answer the question posed. In this study a random sampling was used to evaluate A.A. and three other nationally recognized alcohol addiction treatment programs.  The other programs that were studied are absent in the spirituality/religiosity components that A.A. is known to contain.  Additionally other programs do not necessarily demand that membership be maintained for life as A.A. espouses. Some even have the belief system that if the problem is not severe that individuals can actually return to moderate drinking.  

CRAFT

Community reinforcement and family training or CRAFT was shown to be a stronger counseling approach over Al-Anon and the Johnson Institute intervention.  The empowerment of CRAFT more than doubled the rate of treatment engagement by concerned significant others or CSOs.  CRAFT is more flexible than family confrontation that problem drinkers or alcoholics might find unacceptable as in the Johnson Model of Intervention suggests.  Al-Anon is more of a coping strategy for those family members who live with an active alcoholic rather than being an intervention strategy.  In fact the rates for engagement were 13% for Al-Anon, 30% for the more aggressive Johnson model and a significant higher success ratio of 64% with the less confrontational CRAFT (Miller, W.R., Meyers, R.J. & Tonigan, J.S., 1999).

In summation, to the question of whether A.A. is more effective than other protocols the problem of answering this question becomes significantly more complex than originally contemplated. It would seem after reading the five peer reviewed articles that it is not so much as whether or not A.A. is better or not (because no one program showed more efficacy) it is the support networks that surround 12-step programs that enhance the chance of longer sobriety. The network of concerned significant others or CSOs are not a program in itself but provide significant impetus for engaging family members into treatment as well.  

Cognitive Based Programs

Cognitive based programs have not shown better outcomes after 1 year as for patients in 12-step programs according to a study by Finney, Moos, & Humphreys in 1999.  The project MATCH was shown that these behavioral treatments did not enhance social skills any better than 12-step programs either. However as I will later show it would seem that it is not so much the protocol as it is the social environment and culture 12-step programs create outside the meeting rooms. It was also found that these cognitive-behavioral treatments enhance patients coping skills as cited by Morgenstern & Longabaugh in 2000.  These 12-step programs create congruent settings outside the meeting rooms, which seem to enhance their impact.  These programs provide mechanisms for motivation to avoid drinking because of friendship networks and their assistance in coping strategies. The question becomes whether or not these benefits begin to wane when treatment ends

or individuals stop going to meetings. A.A. does not teach coping skills directly as direct treatment does but does the influence of 12-step taper off more quickly than the influence of treatment (Moos, R.H., 2003).  It would seem to this student that the phrase: people, places and things has greater relevance in relapse than the type of intervention that is used. It seems reasonable that when a person changes the environs of where and when they socialize that once included drinking that the absence of these friends, places and situations the impetus of drinking is lessened. Something akin to a couple that tries to stop smoking and both cease as opposed to one continuing to smoke while the other tries to quit.  

More on the Effectiveness of AA

A Study of Alcoholics Anonymous and its Effectiveness as Compared to Other Alcohol Addiction Treatment Programs

Introduction

The question of whether or not Alcoholics Anonymous is more effective  

than alternative strategies are the question I pose. What follows is a much different study than originally anticipated. 

In a study by Sobel and Sobel in 2000 it was cited that Project MATCH  (Matching Alcoholism Treatment to Client Heterogeneity) compared the effectiveness of three different outpatient treatments: 12 step program or Alcoholics Anonymous, motivational enhancement and cognitive-behavioral.  A.A. is a clinically common but has little evaluation, whereas the latter two have seen development largely on the basis of research.  This study found that neither of the three differed in their effectiveness. Although the motivational enhancement method required 1/3 the amount of sessions than the other two did. The three approaches did not differ either when the level of severity was considered as well (Sobel, M.B., & Sobel, L.C., 2000).

The level of intensity of alcohol dependence has to be considered when using inpatient or outpatient treatment.  For individuals with more severe alcohol problems and cognitive dysfunction an inpatient program might be the more preferred setting. However, those more suited to inpatient are not assigned to outpatient aftercare.  It would seem that the level of care has to be matched to the individual (Rychtarik, R.G., et. al., 2000).

The program of Alcoholics Anonymous uses a token reinforcement ritual as a way for members to show to themselves and others in the group that they have abstained from using alcohol. Coins for 90 day, and annual abstinence are awarded at ceremonies usually held each month at the members home group or meeting where they attend regularly.  These coins mark sobriety every year and in these monthly celebrations although they are awarded to individuals the message is more for the newcomer that sobriety is possible. The affect of these tokens may not be relevant to success ratios but in a study by Petry and Martin, et. al. done in 2000 showed that contingency management was more effective than standard treatment or behavioral counseling.  When vouchers were added to the behavioral therapy 55% of a cocaine dependent group stayed clean in a 24-week trial as opposed to 15% of those assigned to behavioral therapy only.  This study demonstrated that a reinforcement system of vouchers was efficacious in keeping alcohol dependent people from relapsing back into alcohol abuse (Petry, N.M., Martin, M., 2000).  The study showed that when prizes were added to alcohol treatment individuals abstain longer than if these incentives is left out.  A.A. has had this tradition and I will attempt to show how this token economy shares in the efficaciousness of the 12-step program. It may be that alternatives to A.A. might also consider using these trinkets as a way of reinforcing abstinences as well.  

As I dig deeper into the different protocols of A.A. and alternative programs to the most recognized, I have discovered that the severity of problematic drinking has a great deal to do with the type of treatment that is most effective. For those individuals with less severe problematic drinking they respond better to shorter interventions than those with more severe drinking problems who do better when these interventions are longer.  

Indifference

Maybe some of you AA’ers can identify with this shall we state of mind rather than emotion. It could be said that indifference is lack of emotion but more likely it is a cover for envy and fear.  I always thought that indifference was a defense mechanism and a way for me to detach. However there are ways to emotionally detach with love. Indifference is not about love it is self-preservation, egotism, self-pride and quite simply a strategy to help us cope with life’s situations. On the surface this may seem to be true but indifference is for this alcoholic  like deadening a nerve. And I spent plenty of time doing just that when I imbibed my former good friend alcohol. 

As I think about it rather than indifference I think that detachment with love might suit me just a bit better. In this way I can get in touch with the emotion and then send it on it’s way with a prayer instead of rolling my eyes back in disdain or worse yet dismissing the experience as not worth my time.  Detachment with love has a great side benefit and that is that it will enhance those emotions that   empower me. Things like friendship, belonging, and healthy self-preservation, love and of course our number one, Sobriety.  

I can send indifference on its way and install detachment with love in its place instead

A.A. In the 21st Century

Alcoholics Anonymous (A.A.) started in 1935 by Bill Wilson and Dr. Bob was the second instance in American history where the seeds of a program were developed to help other alcoholics stop their addictive drinking. In view of the fact that this program continues to be the most widely utilized inpatient and outpatient alcohol addiction treatment program in the United States virtually without question and examination of just how effective it is should be of major concern due to the fact that problems and concerns with the rudimentary cornerstones of A.A. prevent some individuals from having other choices to seek treatment from. Religion, spirituality and lifetime commitment to one program may not apply to every individual with an alcohol addiction.  These elements must be considered if A.A. is truly worthy of being the Gold Standard for alcohol addiction treatment in the U.S.  This study examined the effectiveness of A.A. measured against the other protocols available to patients in the 21st century.  When compared to Alcoholics Anonymous, it was found that there is no significant statistical difference in the effectiveness of A.A. and three nationally recognized alternative treatment programs. Further, the study found that the environs and personal associations that alcoholics maintain during and after active treatment carry a major significance equal to or greater than the treatment itself.