C HRONIC A LCOHOL A BUSE Group 2 Samantha Benjamin, Sara Levy, & James Zyckowski
B ACKGROUND I NFORMATION A.A was founded by Bill Wilson (Bill W.) and Dr. Bob Smith (Dr. Bob) in Akron Ohio in 1935. In 1946 “The 12 Steps” were introduced and integrated into A.A. The A.A 12 Step model is a standard protocol intervention with all drug and alcohol treatment programs. A.A principles and concepts are taught, and meetings are mandatory in most inpatient rehabilitation and prisons. Furthermore, A.A. is a major focus of outpatient treatment. A.A is the largest mutual-help group in the US with about 1.2 million members and 53,000 groups (Kelly & Yesterian, 2011).
PICO Q UESTION : Do adults suffering from chronic alcohol abuse (P) experience longer periods of sobriety (O) if they participate in alcoholics anonymous (I) as compared to those who do not (C)? Type of PICO Question: Therapy/Intervention
PICO E LEMENTS P Chronic Alcohol Abusers I Alcoholics Anonymous Non Attendance at C Alcoholics Anonymous Longer periods of O sobriety
R ESEARCH S TRATEGY Type of Search Electronic CINAHL COCHRANE Databases MEDLINE PUBMED EBSCO Alcoholics Anonymous, AA chronic alcohol abuse Keywords behavioral therapy network support longitudinal, treatment outcomes children, adolescents, & elderly Exclusions articles older than 2005 incomplete articles, i.e. abstracts and summaries
S UMMARY OF R ESEARCH S TUDIES • 1 Meta Analyses Level • 1 Cochrane Study I Level • 1 RCT II • 1 Systematic Review of Level III Correlational Studies. • 5 Longitudinal Study Level IV Level V Level VI Level VII
T ABLE OF E VIDENCE - S ARA Citation Sample Design Outcomes/Results Evidence Level QAL Kelly & Yeterian, N/A Systematic 12-step facilitation (TSF) therapy III A 2011 Review positively influences alcohol and drug-use outcomes. Moos & Moos, 461 initially Longitudinal At the end of a 16 year period, those IV B 2007 untreated clients who received treatment and/or who initiated help- participated in AA had a remission seeking. Follow up rate of 62% vs. those who did not at 1, 3, 8, and 16 participate in treatment or AA and year intervals. had a 43% remission rate. Witbrodt, 1825 health care Meta-analysis Over time, clients reporting a high I A Mertens, treatment-seeking rate of AA attendance reported the Kaskutas, Bond, clients (from two highest stable pattern of abstinence Chi, & Weisner, studies). Follow from alcohol and drugs in the past 30 2012 up at years 1, 5, 7, days while those with no AA and 9. attendance reported the lowest pattern of abstinence. Over a nine year period the AA participants had abstinence rates at 86%, 81%, 84%, and 75% at interviews at 1, 5, 7, and 9 years.
T ABLE OF E VIDENCE - J AMES Citation Sample Design Outcomes/Results Evidence Level QAL Strickler, Reif, 739 clients in an Longitudinal The data concluded that clients who IV A Horgan, & alcohol services were referred to A.A and attended Acevedo, 2012 study meetings regularly were 60% less likely to relapse and to have longer sobriety time. Ferri, Amato & 3417 total clients Cochrane An analysis of eight trials with 3417 I A Davoli, 2006 from eight Study people, the results were consistent with separate trials the outcome indicating that A.A. kept patients in treatment longer with longer sobriety rates. Gossop, Stewart Following 142 Longitudinal Clients who attended A.A were more IV B & Marsden, outpatient likely to be abstinent from alcohol for 2008 treatment longer periods of time than non- patients where participants. interviews were conducted at 1-2 and 5 year periods .
T ABLE OF E VIDENCE - S AMANTHA Citation Sample Design Outcomes/Results Evidence Level QAL Avalos & 1013 black and white Longitudinal Data found that utilization of AA was IV B Mulia, 2012 clients recruited effective in maintaining abstinence. upon entrance into Whites were found to maintain chemical abstinence via AA utilization for longer dependency periods. Religious reinforcement programs affected utilization of AA for abstinence maintenance . Kaskutas, 349 clients recruited Longitudinal Data showed that the rate of abstinence IV B Ammon, via treatment for the four AA attendance “classes” Delucchi, entrance (low, medium, high, and declined) was Room, Bond highest for those in the high AA & Weisner, attendance “class” by. At year 5 follow 2005 up, 80% abstinence reported. Litt, Kadden, 210 clients solicited RCT The data indicated that network II A Kabela- via newspaper, radio support (A.A.) is shown to be more Cormier,& and university effective in maintaining sobriety. At the Petry, 2009 medical center two year follow up patients reported programs 80% abstinence.
S TRENGTHS & W EAKNESSES OF THE S TUDIES • Longitudinal studies • Large sample sizes Strengths • Preponderance of data • Diversity of research models • Current research: ≥ 2005 • Self-reporting of subjective data • Infrequent data collection Weaknesses • Short sobriety timeframe • Culture and religion not considered • Attrition
B ARRIERS AND F ACILITATORS TO I MPLEMENTATION • Dual diagnoses • Barriers Clients on psychotropic drugs • Low social functioning • No cost • 24/7 availability of support through meetings and mentors • Facilitators Referral programs in community and healthcare facilities • Healthcare worker intervention • Run by A.A. members
M AJOR F INDINGS AND S UMMARY Our findings indicate that A.A. can be correlated to maintaining sobriety for longer periods of time. A.A as a self-help therapy has shown over time its success with the personal and psychosocial rehabilitation of chronic alcohol abusers. A.A provides a safe community as well as education and support for those struggling with addiction. The group therapy model provides interaction with other abusers as well as self reflection on one’s journey towards recovery. From meta-analyses, to RCTs, to Longitudinal studies, the rates of remission and sobriety related to A.A. as an intervention are all similar indicating a preponderance of evidence.
R ECOMMENDATION As student and registered nurses we should strongly recommend Alcoholics Anonymous or 12- step programs to clients, particularly if they are seeking help. Remember! The recommendation of 12-step programs from a nurse makes it more likely the patient will attend. Furthermore, the earlier the patient starts participating the better their prognosis for a positive outcome!
R EFERENCES Avalos, L. A., & Mulia, N. (2012). Formal and informal substance use treatment utilization and alcohol abstinence over seven years: Is the relationship different for blacks and whites? Drug & Alcohol Dependence, 121 (1-2), 73-80. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2011431168&site=eh ost-live Ferri, M., Amato, L., Davoli. (2006). Alcoholics Anonymous and other 12- step programmes for alcohol dependence. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No: CD005032. DOI: 10.1002/14651858.CD005032.pub2 Gossop, M., Stewart, D., & Marsden, J. (2008). Attendance at narcotics anonymous and alcoholics anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: A 5-year follow-up study. Addiction, 103 (1), 119-125. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009769859&site=ehos t-live
R EFERENCES CON ’ T Kaskutas, L. A., Ammon, L., Delucchi, K., Room, R., Bond, J., & Weisner, C. (2005). Alcoholics anonymous careers: Patterns of AA involvement five years after treatment entry. Alcoholism: Clinical & Experimental Research, 29 (11), 1983-1990. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2009580223&site=eh ost-live Kelly, J.F., & Yeterian, J.D. (2011). The role of mutual-help groups in extending the framework of treatment. Alcohol Research & Health, 33 (4), 350-355. Retrieved fromhttp://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011032306&site= ehost-live Litt, M. D., Kadden, R. M., Kabela-Cormier, E., & Petry, N. M. (2009). Changing network support for drinking: Network support project 2-year follow-up. Journal of Consulting and Clinical Psychology, 77 (2), 229-242. doi: 10.1037/a0015252
R EFERENCES CON ’ T Moos, R. H., & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 101 (2), 212-222. Retrieved fromhttp://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009119607&site= ehost-live Strickler, G.K., Reif, S., Horgan, C.M. & Acevedo, A. (2012): The Relationship Between Substance Abuse Performance Measures and Mutual-Help Group Participation after Treatment. Alcoholism Treatment Quarterly , 30:2, 190-210. http://dx.doi.org/10.1080/07347324.2012.663305 Witbrodt, J., Mertens, J., Kaskutas, L. A., Bond, J., Chi, F., & Weisner, C. (2012). Do 12-step meeting attendance trajectories over 9 years predict abstinence? Journal of Substance Abuse Treatment,43 (1), 30-43. doi: 10.1016/j.jsat.2011.10.004
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