Twelve-Step Program Attendance and Polysubstance Use: Interplay of Alcohol and Illicit Drug Use

Abstract

ABSTRACT. Objective:The primary aim of this study was to advance understanding of the effi cacy of 12-step programs by determining the temporal relationships between alcohol and illicit drug use among 12-step program affi liates. Method: A total of 253 early 12-step affi liates without extensive histories of Alcoholics Anonymous (AA) attendance were recruited from substance use treatment and community-based AA. A majority of the sample met criteria for a diagnosis of alcohol dependence, reported lifetime use of illicit drugs, and reported illicit drug use in the 90-day period before recruitment. After informed consent, participants were interviewed at intake and in 3-month increments for 1 year. Results: Preliminary analyses indicated that 12-step attendance was predictive of reductions in substance use and that such reductions were not moderated by illicit substance use disorder diagnosis or alcohol problem severity. Lagged hierarchical linear models indicated that illicit drug use was a robust predictor of later use of alcohol, although the frequency and intensity of drinking were contingent on whether participants sustained 12-step program affi liation. Alcohol use did not predict later illicit drug use among participants who sustained 12-step program participation. Conclusions: Findings suggest that 12-step participation may serve as a protective factor after substance use occurs. Although our results suggest that the initiation of illicit drug use may undermine efforts to achieve and sustain abstinence from alcohol, our fi ndings do not suggest that alcohol use necessarily mobilizes relapse across different substances among 12-step program affi liates. (J. Stud. Alcohol Drugs, 72, 864-871, 2011)

Men and Women Who Attend Al-Anon: Gender Differences in Reasons for Attendance, Health Status and Personal Functioning, and Drinker Characteristics

“…Over a third had "some" or "a lot" of concern about their drinker's prescription or non-prescription drug use. This is consistent with recent rates of substance use disorder comorbidity from the Al-Anon membership survey, and research regarding the increasing prevalence of comorbid alcohol and drug addictions in 12-step groups (Al-Anon, 2012; Tonigan & Beatty, 2011). Both men and women reported that their drinkers had problems in many domains, particularly in their relationships with the CO, the drinker's alcohol use, and the drinker's overall quality of life, again highlighting the escalating problems that often lead to Al-Anon attendance (Cutter & Cutter, 1987).…”

Spirituality as a Change Mechanism in 12-Step Programs: A Replication, Extension, and Refinement

“…Thus, if from baseline to 3 months, a participant used cocaine more than any other illicit drug, cocaine use days were divided by the number of days in the measurement period to attain a measure of IDD for that participant (cf. Tonigan & Beatty, 2011). Measuring IDD in this way provides a conservative estimate of drug use days when a participant uses multiple drugs within one assessment period.…”

“…It is important to note that long-term investigations into the benefits of 12-step programs are relatively rare, and a majority of studies are limited to 12-month follow-up. Recent work also suggests that sustained 12-step attendance may even serve to off-set relapse to illicit drug use once alcohol use has occurred (Tonigan & Beatty, 2011). Understandably, then, many studies have sought to identify the prescribed 12-step behaviors and practices that predict increased abstinence (e.g., Kelly & Moos, 2003; Pagano, Friend, Tonigan, & Stout, 2004; Tonigan & Rice, 2010), with equal attention directed to understanding why these 12-step practices predict improved functioning.…”

Longitudinal Trajectories of Readiness to Change: Alcohol Use and Help-Seeking Behavior

“…To control for prior learning effects when investigating change processes, the parent study excluded adults who had prior success at achieving abstinence (Tonigan and Beatty, 2011;Tonigan and Rice, 2010). Thus, participants were excluded from the study if they had already achieved alcohol abstinence for 12 months or longer or had attended AA for more than 4 months.…”

“…Sample characteristics are reported in Table 1. Additional information regarding this sample has been published elsewhere (Jenkins and Tonigan, 2010;Tonigan and Beatty, 2011;Tonigan and Rice, 2010).…”