Drug-Dependent Patients Attending AA: How Do They Do?
Drug-Dependent Patients Attending AA: How Do They Do?
This study found that the rates of 12-step attendance and involvement in the sample differed somewhat depending on patients' reported primary substance at intake. In contrast to patients reporting alcohol as their primary substance, those who identified another drug as primary (i.e. either cannabis, opiates or stimulants) attended significantly more NA than AA meetings over the follow-up period. Yet, during the critical early post-treatment phase (1–3 months) primary drug patients attended AA more frequently than NA. While this presented a conceivable early mismatch between their primary substance and AA's alcohol-specific recovery emphasis, the mismatch was not associated with subsequently lower rates of 12-step attendance or involvement nor less derived recovery benefit in terms of abstinence. Since NA is generally less available, especially in smaller communities, findings offer hope for those suffering from a broad range of SUDs as well as for referring programs and clinicians, since primary drug patients may benefit just as much from attending AA if NA meetings are inaccessible in the communities in which they live.
In general, where there were differences detected in 12-step participation at baseline and over the year-long follow-up, opiate and stimulant patients tended to go to more meetings and more NA meetings, specifically, relative to alcohol and cannabis patients. The more frequent attendance in general may reflect these patients' greater addiction severity and more serious clinical profile that was observed at treatment entry. Greater addiction severity has shown to be the most robust predictor of 12-step participation (Kelly, 2003), and although not measured directly in this study, this greater degree of substance-related impairment may have resulted in greater perceived severity of the disorder which is a key mechanism of help-seeking among those with SUD (Finney and Moos, 1995). The more frequent attendance at NA among primary opiate and stimulant patients also may indicate a stronger desire to affiliate with a 12-step fellowship that contains individuals with more similar substance-specific experiences that might increase a sense of belonging and identification, and instill hope for successful recovery (Labbe et al., 2014). With regard to PDA, noteworthy too, was that the different primary substance groups, did not differ significantly. Consequently, it is plausible that aspects of the treatment and 12-step MHO participation experience may have helped partially offset a potentially worse outcome associated with a more severe clinical profile at treatment entry.
Of the 12-step meetings attended in the first 3 months post-discharge, nearly all the meetings attended by the primary alcohol patients were AA (96%). A large proportion of the meetings attended by the primary drug patients, however, were also AA (79%). We cannot determine for sure why primary drug patients attended so many AA instead of the presumably more fitting, NA meetings, but one explanation may be that it is because NA meetings were comparatively less available, as noted previously. Consequently, rather than not attend any meetings, these patients may have chosen to attend AA. This apparent mismatch, however, did not appear to lead to disillusionment as it was unrelated to subsequent 12-step participation at either the 6-month or 12-month follow-up nor was it associated with less benefit in terms of PDA at the later follow-ups relative to primary drug patients who were better matched to NA. As we have found previously with this sample, 12-step MHO participation was a strong and independent predictor of better outcomes (Kelly et al., 2013). Consequently, 12-step participation, in general, can aid youth recovery efforts and, despite less supposed similarity between primary drug patients and the explicit AA emphasis on alcohol, participation in the AA fellowship does not appear to result in less benefit nor increase the likelihood of future MHO dropout.
AA groups can vary considerably in their dynamics (Montgomery et al., 1993) and interpersonal climate (Rynes et al., 2013). Anecdotally, AA meetings can vary also in the degree to which they may embrace individuals whose primary substance and experience may be unrelated to alcohol, and some may be particularly welcoming of young members new to sobriety. It is possible that at least some primary drug patients may have selected AA groups that were more welcoming and accommodating of drug-specific differences. It is also true that, similar to the national US treatment population, patients in this sample with primary drug problems also had significant alcohol problems and the majority of patients in each primary substance group met criteria for co-occurring alcohol abuse or dependence. This was particularly true of primary stimulant patients (81%). Also, all patients were using alcohol to varying degrees prior to treatment admission (not shown). Furthermore, while from the inside of these fellowships drug specificity may seem important to group unity (Alcoholics Anonymous, 1953), from a scientific and clinical standpoint the essential features of addiction (e.g. compulsive use, craving, impaired control, continued use despite harmful consequences) are common across all psychoactive substances. Thus, conceivably, although not fitting perfectly with their primary drug preference and related addiction experience, individuals with primarily illicit drug problems would, nevertheless, share common ground with a more alcohol-specific focus given their level of alcohol involvement and prevalence of DSM-IV alcohol abuse or dependence as well as broad shared addiction phenomenology (Alcoholics Anonymous, 1953).
Discussion
This study found that the rates of 12-step attendance and involvement in the sample differed somewhat depending on patients' reported primary substance at intake. In contrast to patients reporting alcohol as their primary substance, those who identified another drug as primary (i.e. either cannabis, opiates or stimulants) attended significantly more NA than AA meetings over the follow-up period. Yet, during the critical early post-treatment phase (1–3 months) primary drug patients attended AA more frequently than NA. While this presented a conceivable early mismatch between their primary substance and AA's alcohol-specific recovery emphasis, the mismatch was not associated with subsequently lower rates of 12-step attendance or involvement nor less derived recovery benefit in terms of abstinence. Since NA is generally less available, especially in smaller communities, findings offer hope for those suffering from a broad range of SUDs as well as for referring programs and clinicians, since primary drug patients may benefit just as much from attending AA if NA meetings are inaccessible in the communities in which they live.
Differences in 12-step Participation Over the Study Period
In general, where there were differences detected in 12-step participation at baseline and over the year-long follow-up, opiate and stimulant patients tended to go to more meetings and more NA meetings, specifically, relative to alcohol and cannabis patients. The more frequent attendance in general may reflect these patients' greater addiction severity and more serious clinical profile that was observed at treatment entry. Greater addiction severity has shown to be the most robust predictor of 12-step participation (Kelly, 2003), and although not measured directly in this study, this greater degree of substance-related impairment may have resulted in greater perceived severity of the disorder which is a key mechanism of help-seeking among those with SUD (Finney and Moos, 1995). The more frequent attendance at NA among primary opiate and stimulant patients also may indicate a stronger desire to affiliate with a 12-step fellowship that contains individuals with more similar substance-specific experiences that might increase a sense of belonging and identification, and instill hope for successful recovery (Labbe et al., 2014). With regard to PDA, noteworthy too, was that the different primary substance groups, did not differ significantly. Consequently, it is plausible that aspects of the treatment and 12-step MHO participation experience may have helped partially offset a potentially worse outcome associated with a more severe clinical profile at treatment entry.
The Influence of an Early Post-treatment Mismatch Between Primary Drug Patients and AA vs. NA on Subsequent 12-step Participation and Abstinence
Of the 12-step meetings attended in the first 3 months post-discharge, nearly all the meetings attended by the primary alcohol patients were AA (96%). A large proportion of the meetings attended by the primary drug patients, however, were also AA (79%). We cannot determine for sure why primary drug patients attended so many AA instead of the presumably more fitting, NA meetings, but one explanation may be that it is because NA meetings were comparatively less available, as noted previously. Consequently, rather than not attend any meetings, these patients may have chosen to attend AA. This apparent mismatch, however, did not appear to lead to disillusionment as it was unrelated to subsequent 12-step participation at either the 6-month or 12-month follow-up nor was it associated with less benefit in terms of PDA at the later follow-ups relative to primary drug patients who were better matched to NA. As we have found previously with this sample, 12-step MHO participation was a strong and independent predictor of better outcomes (Kelly et al., 2013). Consequently, 12-step participation, in general, can aid youth recovery efforts and, despite less supposed similarity between primary drug patients and the explicit AA emphasis on alcohol, participation in the AA fellowship does not appear to result in less benefit nor increase the likelihood of future MHO dropout.
AA groups can vary considerably in their dynamics (Montgomery et al., 1993) and interpersonal climate (Rynes et al., 2013). Anecdotally, AA meetings can vary also in the degree to which they may embrace individuals whose primary substance and experience may be unrelated to alcohol, and some may be particularly welcoming of young members new to sobriety. It is possible that at least some primary drug patients may have selected AA groups that were more welcoming and accommodating of drug-specific differences. It is also true that, similar to the national US treatment population, patients in this sample with primary drug problems also had significant alcohol problems and the majority of patients in each primary substance group met criteria for co-occurring alcohol abuse or dependence. This was particularly true of primary stimulant patients (81%). Also, all patients were using alcohol to varying degrees prior to treatment admission (not shown). Furthermore, while from the inside of these fellowships drug specificity may seem important to group unity (Alcoholics Anonymous, 1953), from a scientific and clinical standpoint the essential features of addiction (e.g. compulsive use, craving, impaired control, continued use despite harmful consequences) are common across all psychoactive substances. Thus, conceivably, although not fitting perfectly with their primary drug preference and related addiction experience, individuals with primarily illicit drug problems would, nevertheless, share common ground with a more alcohol-specific focus given their level of alcohol involvement and prevalence of DSM-IV alcohol abuse or dependence as well as broad shared addiction phenomenology (Alcoholics Anonymous, 1953).
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