N. Peter Johnson

Using AA and other 12-step programs more effectively

EVEN THE BEST intentioned health professionals may refer people with alcohol and other drug abuse problems to Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) groups without providing them a minimal understanding or preparation. This article describes some characteristics of the groups to which persons are referred and some ways to enhance the positive outcomes of referrals to these groups. We do not use the term self-help, because it is not an accurate description of AA or other 1Zstep programs. Keep in mind that some alcoholics do not require formal health care; they may approach 12-step groups directly and initiate their recovery in that fashion. Knowledge and understanding of the 12-step groups in your locale may facilitate the entry and recovery of your clients/patients. These programs are a resource that helps health professionals deal with the estimated 15% to 20% of clients/patients in an office practice and 30% of general hospital clients/patients who meet criteria of addiction to alcohol and/or other drugs (Johnson, Phelps, & McCuen, 1990). It is especially important to understand the characteristics of 12-step programs because the prospective study by Vaillant (1983) attributed 7% of the variance of good clinical outcome to “stable adjustment, married, employed, never detoxified” but 28% of the variance to attendance at AA meetings (over 300 meetings). AA is more important over the long term than professional treatment. Most well-educated professionals know the general clinical characteristics of alcoholism, but fewer know

Emotional disturbance and substance abuse in youth placed in residential group homes

Residential group homes are increasingly important components of the system of mental health care for children and adolescents. However, they often do not have sufficient resources to provide active therapeutic programs as a result of their usual missions in serving abandoned or runaway youth. The authors studied 299 youth, ages 12 to 17 years, in five large residential group home programs in South Carolina. The instruments administered were (1) the Center for Epidemiological Survey—Depression Scale (CES-D), (2) a brief substance abuse questionnaire, and (3) questions about socioeconomic status, previous placements, and family relationship variables. A significant percentage scored above conservative clinical cut-off scores for the CES-D (51.7% scored 16 or above and 33.6% scored 23 or above). The youth also had significant levels of substance abuse problems. However, these variables were not predictive of previous multiple out-of-home placements (runaway behavior was predictive). These findings support the importance of addressing the clinical needs of youth in these programs.

Coping strategies of alcoholic women.

Recent efforts have increased research on alcoholic women. Few studies have examined the coping mechanisms characteristic of alcoholic women relative to their nonalcoholic controls. Conforming to DSM-IV criteria for alcohol dependence, 159 alcoholic women stratified by race (black and white) and age (20–29, 30–39, and 40–49 years) were compared to 150 nonalcoholic women from a variety of public and private inpatient and outpatient treatment facilities regarding the types of coping strategies used. Alcoholic women were significantly more likely to favor maladaptive styles of coping, while nonalcoholic women employed significantly more problem-solving and emotion-based coping strategies. Neither race nor age differences significantly influenced the types of coping utilized by these women. The profile of coping strategies utilized by the alcoholic group is consistent with a poor quality of life and compounding of problems.

Childhood Experiences of Alcoholic African-American and Caucasian Women

Abstract Three hundred nine African-American and Caucasian alcoholic and nonalcoholic females ranging in age from 20 to 49 years old were individually administered a 77-page questionnaire. Results of a series of multivariate odds-ratio analyses based on self-report from memories of childhood indicate that alcoholic women reported significantly more nightmares, bedwetting, temper tantrums, phobias, bruxism, and nervous problems than nonalcoholic women. They reported significantly more school-related problems including expulsion/suspension, skipping school, trouble with school authorities, and dropping out of high school compared to nonalcoholic women. Feelings of nervousness, loneliness, and embarrassment around peers were reported significantly more often by alcoholic women. The prediction of alcoholism by childhood behavioral dysfunction differed as a function of race or age on only 4 of the 20 variables examined.

Substance Abuse in Freshmen Medical Students Over Time

Abstract This study assessed the extent of alcohol use among six classes of freshman medical students over an 8-year period to provide actuarial feedback about drinking patterns to these students. A total of 278 freshman medical students was anonymously surveyed in class using the Michigan Alcoholism Screening Test (MAST). Students were given subsequent group feedback about these data with ample time for discussion. Signs of clinical detection and community resources were highlighted. Of all students 11.7% were nondrinkers, 51% were nonproblematic drinkers, 7% were borderline, 23% were 80% likely to be alcoholic, and 7% were 100% likely to be alcoholic based on the MAST score. No time trends were evident in substance use patterns. The 13-item Short MAST (SMAST) compared to the MAST had a sensitivity of 52% and a specificity of 98%. The need for better education, detection, and intervention regarding alcohol abuse among medical students was evident. Fortunately, no time trends are evident in this schools ...

Childhood problems of alcoholic women.

Abstract A sample of three hundred and nine alcoholic and nonalcoholic women in South Carolina were asked three family-of-origin questions that were thought to relate to the development of alcoholism. Specifically the women were asked: “While you were growing up did anyone in your family: (1) drink a lot? (2) use drugs? or (3) serve a jail sentence?” Results of multivariate odds ratio analyses indicate that alcoholic women were 7.31 times more likely to indicate a family member who drank a lot, 3.57 times more likely to report a family member who used drugs, and 5.6 times more likely to report a family member who served a jail sentence in their families of origin. The prediction of alcoholism by any of these family of origin variables did not differ as a function of age or race. These data suggest that policy makers may contribute to improved outcome measures by providing attention to children passing through these difficulties.

Recent Major Life Stressors Among White and Black Alcoholic Women

Abstract Three-hundred nine alcoholic and nonalcoholic women were matched as a function of age (20-29 vs. 30-39 vs. 40-49) and race (black vs. white) and compared regarding the occurrence of a number of recent (within the last 2 years) major life stressors, which included assessment of relationship, residential and job/school changes, legal difficulties, and changes in leisure activities. Results of odds-ratio analyses indicated that alcoholic women reported significantly more recent life stress on 11 of the 19 variables sampled. Vie race and age of the respondent did not significantly alter the relationship of alcoholism to recent life stress.

A commentary on the 12-step program

PROFESSOR KBANTZLAN HAS numerous articles on this subject that I frequently use for medical student and resident education, especially his published beliefs that abstinence must be attempted and attained before psychotherapy can be effective. In fact, much faculty discussion has evolved over the past 8 years at my university about this subject. I excerpted several of his prior articles in defense of my belief that abstinence is the first and most basic tenet for establishment of recovery and caused a great discussion among some colleagues. However, the present article is a statement of author opinions rather than research. My colleague and friend, John Chappel, long ago reminded me that Alcoholics Anonymous (AA) is not a “self-help” group. If it were the individual (self) who was doing the helping, there would be no need for a group. Rather, a more appropriate phrasing might be “group-help” (my term, not John’s) because recovery seems to hinge on attendance of meetings and the reinforcement received from others for following the proscribed processes. For those groups that follow the precepts of AA, a far more acceptable term might be “12-step.” However, for the non-1Zstep groups, I suggest use of the term, “group-help.” Most recovering individuals in my acquaintance have done so using the precepts of AA. I frequently hear of therapies that are successful, but I never seem to meet any of the recovering individuals from those therapies. The recovering men and women I have met came predominantly through 12-step programs, occasionally through other spiritual groups such as church (maybe 5%?), and even more rarely through “spontaneous remission” (maybe 1%) although all of my patients have tried this method). My pragmatic approach is that because 12-step pro-