Richard N. Cloud

What is alcoholics anonymous affiliation

An increasing body of research evidence supports the use of 12-step program affiliation as an effective adjunct and aftercare for formal treatment. Recently, three brief (9- or 10-item) measures of affiliation have been developed. However, the brief scales are difficult to interpret, and the question of exactly what is affiliation (or disaffiliation) remains unclear. This analysis examines the question of what is the essence of affiliation vs. disaffiliation. Data from the Project MATCH 1-year posttreatment Alcoholics Anonymous Involvement (AAI) scale (N = 1506) are used to identify the most salient items of Alcoholics Anonymous (AA) affiliation predicting 1-year posttreatment drinking outcomes. Analysis using stepwise regression suggests that a three-item solution can explain a similar amount of variance in the proportion of days abstinent in months 9 through 12 posttreatment, as does using the nine items. These three “core items predicting recovery” include AA attendance, sum of steps completed, and identifying self as an AA member. As an affiliation composite scale, these three items are easier to interpret and administer than the full AAI scale, and when combined, possess adequate reliability (α = 0.72).

Internet Screening and Interventions for Problem Drinking

Abstract The alcohol screening and brief intervention literature suggest that many individuals become concerned about their drinking, seek help and are often aided with brief and simple interventions. The Internet provides an increasingly accessible, confidential, and low cost medium to deliver these services. A pilot Web site was developed to provide anonymous, confidential and fully automated screening and brief interventions. The test consisted of the AUDIT (screening), SOCRATES (readiness for treatment measures), and demographic and alcohol history questions. During the initial 172 day trial, over 10,000 individuals visited the Web site, of these, 2,813 took the screening and limited assessment test. Results generally suggest (1) that there is a sizable population seeking help on the Internet for drinking problems; (2) that AUDIT scores are surprisingly high; and (3) that most (94%) have not been professionally diagnosed.

Motivational Interviewing to Improve Diabetes Outcomes in African Americans Adults With Diabetes

The purpose of this study was to determine the effect of a motivational interviewing intervention (MII) on regimen adherence and diabetes markers among African Americans with diabetes. Sixty-two participants were assigned to the usual care (UC; n = 36) or MII (n = 26) groups. UC participants received the usual clinic care. MII participants received a maximum of six motivational interviewing (MI) sessions over 3 months. Outcome variables were obtained at baseline and 3-month follow-up. Data were obtained using medical records, self-reports, and glucose monitor and accelerometer print-outs. MII significantly increased the odds of participants adhering to recommended physical activity level (66.7% vs. 38.8%, odds ratio = 2.92, 95% confidence interval = [1.6, 14.3], p = .018) and significantly decreased glucose levels (p = .043) and body mass index (p = .046) over time when compared with UC. Findings support using MI as an intervention for improving health outcomes and regimen adherence rates among the study population.

Adapting Motivational Interviewing Strategies to Increase Posttreatment 12-Step Meeting Attendance

Abstract Recent twelve-step (TS) program research has suggested a dose threshold consisting of minimum weekly TS meeting attendance that is necessary to derive substantial benefit. Unfortunately, other research has observed the vast majority of patients do not attend meetings or attend sporadically in the period following treatment. As another example of research advancing our understanding of recovery processes, numerous studies have refined adaptations of Motivational Interviewing (MI) into a change theory with proven practice methods. This paper reviews related literature and provides rationale for the use of a brief motivational intervention to increase TS program attendance. The paper concludes by addressing two possible problems to implementing such an intervention: (1) Resistance within the culture of the addiction counseling field and (2) a lack of objective and normative TS program feedback data. We respond to this latter gap in the literature by advancing possible specimen feedback data.

Promoting nurse interventionist fidelity to motivational interviewing in a diabetes self-care intervention.

We describe interventionist training procedures for a pilot intervention study that tested the effects of a nurse-delivered Motivational Interviewing (MI) intervention on diabetes self-care among adults diagnosed with type 2 diabetes mellitus. It reports on findings from MI fidelity assessments. Training consisted of didactic workshops plus practicum. Fidelity of MI was assessed using the MI Treatment Integrity (MITI) Scale. Fidelity assessments were conducted on 18 (25%) audiotaped MI sessions, which were randomly selected from a total of 72 sessions with 26 participants. Scores of the MITI were in the proficient and competent range. Results suggest that training strategies were sufficient to promote satisfactory interventionist fidelity to MI.

Recovery: With and Without Self-Help

Although self-help/mutual-help groups, like Alcoholics Anonymous, are important factors in the recovery of many chemically dependent individuals, the large dropout rates from such groups and the awareness that many who drop out do not return to dependent behavior raises interesting questions about other paths to sustained abstinence and recovery. Current emphasis on treatment outcome studies provides a means for researching factors in both those who recover with and without the assistance of self-help/mutual-help groups. The authors suggest some questions which might be investigated.

Concerns About Dose and Underutilization of Twelve-Step Programs: Models, Scales, and Theory that Inform Treatment Planning

Researchers have observed that a majority of addicted persons who are encouraged and facilitated by treatment providers to attend twelve-step (TS) programs either drop out or sporadically use twelve-step programs following treatment. This is troubling given considerable evidence of TS program benefits associated with regular weekly attendance and ubiquitous reliance by treatment professionals on these programs to provide important support services. This chapter reviews and advances theory of TS utilization and dose that is supported by prior research, multivariate models, and scales that predict risk of TS meeting underutilization. Advancing theory should organize and clarify the process of initial utilization, guide intervention development, and improve adherence of TS program referrals, all of which should lead to improved treatment planning and better outcomes. Three theories are integrated to explain processes that may influence TS program dose: the health belief model, self-determination theory (motivational theory), and a person-in-organization cultural fit theory. Four multidimensional scales developed specifically to predict participation are described. Implications for practice and future research are considered in a final discussion. Information contained in this chapter raises awareness of the need for TS-focused treatments to focus on achieving weekly attendance during and after treatment.

Development of a Brief Abstinence Self-Efficacy Measure.

This study compared the 40-item Alcohol Abstinence Self-Efficacy (AASE) scale with domains of confidence and temptation to a new 12-item version developed by the authors consisting of the same domains. There were 126 participants who completed the survey. Psychometric analysis demonstrated high reliability and validity consisting of high correlations between domains of confidence (α = .92) and temptation (α = .88) in the 40-item version of the scale compared to the briefer version. The 12-item version appears to provide a clinically reliable and valid measure of AASE domains of confidence and temptation, providing a more efficient tool for clinical practice.

Posttreatment 12-Step Program Affiliation and Dropout: Theoretical Model and Qualitative Exploration

ABSTRACT Treatment outcome research has repeatedly demonstrated that involvement in twelve-step (TS) programs (e.g., Alcoholics Anonymous or Narcotics Anonymous) following treatment is associated with improved substance use outcomes. Treatment providers widely encourage TS program attendance during treatment and for aftercare; yet, evidence suggests that minimal and sporadic attendance or complete dropout is the more common occurrence. Providers would benefit from knowledge that would contribute to a greater understanding of factors that influence posttreatment TS program affiliation or dropout to guide treatment strategies. This article reviews the literature on TS affiliation, advances theory and a model to explain affiliation, and reports findings from a qualitative research study focused on understanding what people in TS facilitative treatment report as good (the pros) and not so good (the cons) about TS program involvement. Results suggest that unresolved ambivalence as well as socio-cultural barriers to support contribute to poor TS program utilization.

Controlled Drinking as an Appropriate Treatment Goal

Abstract Treatment systems within the U.S. are almost exclusively focused on abstinence as the goal of treatment for alcohol use disorders. This article reviews literature on the natural course of recovery from alcohol disorders and examines the role of testing control over drinking in the course of successful resolution of alcohol problems. Theory, quantitative and qualitative evidence support controlled drinking trials under certain conditions as a necessary and normal stage in the natural course of recovery. Empirical evidence suggests that some who are younger; who have less severe history of alcohol use; who have never been treated or diagnosed for alcohol disorders; who possess no family history of addiction; and who believe in self-efficacy over alcohol use could benefit from a single and well conceived controlled drinking trial. This article concludes with a summary of a controlled drinking treatment protocol that can coexist in abstinence-based treatment programs.