Do Changes in Selfishness Explain 12-Step Benefit? A Prospective Lagged Analysis

Abstract

Objective 12-step attendance is associated with increased abstinence. A strong claim made in 12-step literature is that alcoholics are pathologically selfish and that working the 12 steps reduces this selfishness which, in turn, leads to sustained alcohol abstinence. This study tested this assumption by investigating the linkages between 12-step attendance, pathological narcissism, and drinking. Method 130 early AA affiliates with limited AA and treatment histories were recruited from treatment and community-based AA. A majority of the sample was alcohol dependent and reported illicit drug use before recruitment. Participants were interviewed at intake and at 3, 6, and 9 months. Results A majority of participants attended AA meetings throughout follow-up and such attendance predicted increased abstinence and reduced drinking intensity. 12-step affiliates were significantly higher on pathological narcissism (PN) relative to general population samples and their PN remained elevated. Contrary to predictions, PN was unrelated to 12-step meeting attendance and did not predict later abstinence or drinking intensity. Conclusion Findings did not support the hypothesis that reductions in PN explain 12-step benefit. An alternative function for the emphasis placed on pathological selfishness in 12-step programs is discussed and a recommendation is made to use unobtrusive measures of selfishness in future research.

Benefits and Costs of Alcoholic Relationships and Recovery Through Al-Anon

“…One of the paradoxes in the Twelve-Step approach is that members simultaneously learn that service to others is crucial to recovery, but that "it is a selfish program," (a popular epigram). A recent study of new AA members found the Twelve Steps are associated with recovery, but are not associated with reductions in pathological narcissism (Tonigan, Rynes, Toscova, & Hagler, 2012). A similar study of Al-Anon members might reveal whether narcissism is associated with recovery for COs and whether codependent members are susceptible to developing extreme narcissism.…”

Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of mechanisms of behavior change research

“…Also, AA participation and, specifically, increased spirituality have been shown to explain lower depression among individuals with alcohol use disorder (AUD) [37]. Conversely, methodologically rigorous studies since the initial review testing AA's other major purported AA mechanisms, such as reduced selfishness/selfcenteredness [38] and reduced anger/resentment [39], have not been supported. While studies have also shown that the benefit conferred by AA may be explained partially by reducing depressive symptoms [37,40], craving [41] and impulsivity [42], with a few exceptions [43][44][45] these studies of AAs mechanisms typically only tested models using a single mediator (e.g.…”

Active Ingredients of Treatment and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later

“…First, the AA literature emphatically states that the reduction of negative affect is instrumental for achieving abstinence (AA, 2001). Here, investigators have prospectively examined how frequency of AA meeting attendance is associated with negative affect, including reductions in depression (Kelly et al, 2010a; Wilcox et al, in press ), anger (Kelly et al, 2010b), and selfish narcissism (Tonigan et al, 2013). Findings from these studies have been relatively consistent: (1) AA members report, on average, clinically elevated levels of depression, anger, and selfish narcissism at baseline, and (2) modest changes over time, but (3) measures of negative affect have limited prognostic value in predicting subsequent alcohol use.…”