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Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis

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Kelly, John F., Hoeppner, Bettina, Stout, Robert L., Pagano, Maria·2012·Addiction
DOI 10.1111/j.1360-0443.2011.03593.xPMC PMC3242865
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Abstract

Aims Evidence indicates that Alcoholics Anonymous (AA) participation reduces relapse risk but less is known about the mechanisms through which AA confers this benefit. Initial studies indicate self‐efficacy, negative affect, adaptive social networks and spiritual practices are mediators of this effect, but because these have been tested in isolation, their relative importance remains elusive. This study tested multiple mediators simultaneously to help determine the most influential pathways. Design Prospective, statistically controlled, naturalistic investigation examined the extent to which these previously identified mechanisms mediated AA attendance effects on alcohol outcomes controlling for baseline outcome values, mediators, treatment, and other confounders. Setting Nine clinical sites within the United States. Participants Adults ( n = 1726) suffering from alcohol use disorder (AUD) initially enrolled in a randomized study with two arms: aftercare ( n = 774); and out‐patient ( n = 952) comparing three out‐patient treatments (Project MATCH). Measurements AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months. Findings Among out‐patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self‐efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self‐efficacy, AA lead to better outcomes through increasing spirituality/religiosity and by reducing negative affect. The degree to which mediators explained the relationship between AA and outcomes ranged from 43% to 67%. Conclusion While Alcoholics Anonymous facilitates recovery by mobilizing several processes simultaneously, it is changes in social factors which appear to be of primary importance.

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  • TSF programs encourage participation in self- and mutual-help organizations, which aim to reduce alcohol use via changes in the composition of one's social network, increases in abstinence self-efficacy and spirituality, and reductions in negative affect.

    “TSF programs encourage participation in self‐ and mutual‐help organizations (e.g. Alcoholics Anonymous), which aim to reduce alcohol use via changes in the composition of one's social network, increases in abstinence self‐efficacy and spirituality, and reductions in negative affect (National Institute on Drug Abuse 2000; Kelly 2012; Humphreys 2014).”

    From Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries (2023) · cites this paper as Kelly 2012

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  1. [62]The Bill W. -Carl Jung Letters Alcoholics Anonymous Grapevine January 1963

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Authors
Kelly, J. F., Hoeppner, B., Stout, R. L., & Pagano, M.
Affiliations
  • Harvard University (US)
  • Case Western Reserve University (US)
Corresponding author
Kelly, John F.
ORCID
Venue
Addiction
Publisher
Wiley
Published
2011-09-19
Volume
107
Issue
2
Pages
289-299
ISSN
  • 0965-2140 (ISSN-L)
  • 1360-0443
DOI
10.1111/j.1360-0443.2011.03593.x
PMC
PMC3242865
OpenAlex
W2154896792
Semantic Scholar
ad96714175f332b4030c5634e0111c8da5685ea8
Cited by
303
References
60
Citations by year
2026: 10 · 2025: 9 · 2024: 13 · 2023: 53 · 2022: 11 · 2021: 19 · 2020: 64 · 2019: 12 · 2018: 9 · 2017: 17 · 2016: 14 · 2015: 22 · 2014: 17 · 2013: 19 · 2012: 14
FWCI
12.00
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Addiction (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Alcohol Abuse and Alcoholism (R21AA016762)
  • National Institute on Drug Abuse (K01DA027097, L30 DA025511)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
Keywords
Alcoholics Anonymous, alcoholism, relapse prevention, social networks, self-efficacy, spirituality, religiosity, negative affect, abstinence, follow-up care, Project MATCH, peer support groups, behavior change mechanisms
MeSH terms
Adult, Aftercare, Alcoholics Anonymous, Alcoholism, Ambulatory Care, Behavior Therapy, Depression, Female, Humans, Male, Patient Acceptance of Health Care, Prospective Studies, Religion, Social Support, Treatment Outcome, Self Efficacy, Spirituality, Secondary Prevention

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