Faculty Bibliography

BACKGROUND: Many individuals with alcohol-use disorders who had experienced alcohol craving before joining Alcoholics Anonymous (AA) report little or no craving after becoming long-term members. Their use of AA prayers may contribute to this. Neural mechanisms underlying this process have not been delineated. OBJECTIVE: To define experiential and neural correlates of diminished alcohol craving following AA prayers among members with long-term abstinence. METHODS: Twenty AA members with long-term abstinence participated. Self-report measures and functional magnetic resonance imaging of differential neural response to alcohol-craving-inducing images were obtained in three conditions: after reading of AA prayers, after reading irrelevant news, and with passive viewing. Random-effects robust regressions were computed for the main effect (prayer > passive + news) and for estimating the correlations between the main effect and the self-report measures. RESULTS: Compared to the other two conditions, the prayer condition was characterized by: less self-reported craving; increased activation in left-anterior middle frontal gyrus, left superior parietal lobule, bilateral precuneus, and bilateral posterior middle temporal gyrus. Craving following prayer was inversely correlated with activation in brain areas associated with self-referential processing and the default mode network, and with characteristics reflecting AA program involvement. CONCLUSION: AA members' prayer was associated with a relative reduction in self-reported craving and with concomitant engagement of neural mechanisms that reflect control of attention and emotion. These findings suggest neural processes underlying the apparent effectiveness of AA prayer.

This paper reviews empirical studies conducted on the role of spirituality and religiosity (S/R) characteristics in 12-step recovery among program members followed up after substance abuse treatment and those assessed independent of formal treatment. Aspects of spiritual functioning that change in relation to program participation and those S/R characteristics that were found to mediate the association between program involvement and drinking-related outcomes are discussed. In addition, a review is provided of 12-step program studies investigating S/R-related predictors of clinical outcomes relevant to risk of relapse among members in long-term recovery. To further examine the role of S/R characteristics in recovery, a study was conducted on long-term AA members to assess the relationship of S/R characteristics and AA program involvement to craving for alcohol and emotional distress after controlling for relevant demographic variables. Feeling God's presence daily, believing in a higher power as a universal spirit, and serving as an AA sponsor were all predictive of positive outcomes.

Abstract Substance use disorder, often comorbid with post-traumatic stress disorder, is a problem confronted by many veterans. In order to determine the potential utility of Narcotics Anonymous for veterans, 508 NA attendees were studied. Veterans (N = 172) were more likely to have been referred by a professional than were non-veterans (77% vs. 27%); 70% had been hospitalized for alcohol or drug problems, and 51% had been treated for non-substance psychological problems. The 70% of veterans who responded at least one of 3 service-related stressful experiences were more likely to report PTSD-related symptoms. NA apparently can serve as a recovery resource for certain veterans with SUD, with or without PTSD.

Spiritual awakening, a key aspect of 12-Step recovery, is designated in the 12th Step of Alcoholics Anonymous (AA). The authors applied a psychiatric survey instrument to 161 long-term AA members who reported having had such an awakening. Sixty-seven percent of respondents reported no craving for alcohol or drugs at the time of this survey. Their awakening had most often taken place gradually (60%), while they were working the Steps (52%), and right after bottoming out (57%). Their responses reflected a major experiential transformation, including highly significant changes: decreases in craving and depression and increases in service to other AA members. A factor analysis of descriptors of the awakening revealed the following six dimensions of the experience, with variability across respondents: positive mood, abstinence, interpersonally related, a sensory experience, God-related, and related to personal meaning. Findings showed that it is feasible to characterize commonalities in the nature of a spiritual awakening as a major transformative event across many long-term AA members, though the specific character of the experience differs across individuals.

This article explores the convergence of the Alcoholics Anonymous (AA) model for addictions with recent advances in empirically supported cognitive-behavioral therapy (CBT) for addictions. This convergence stems from CBT entering its "third wave," which incorporates techniques associated with mindfulness, meditation, and Buddhist philosophy and practice. Research findings associated with various third-wave CBT treatment programs on substance abuse outcome will be reviewed. Implications for research on 12-Step interventions based on areas of convergence of these psychotherapeutic approaches are also discussed.

BACKGROUND: There is little empirical literature on the experience in sobriety of long-term, committed members of Alcoholics Anonymous (AA). OBJECTIVE: Studies on the experience of long-term members, however, can yield a better understanding of the role of spirituality in AA membership, and how the program helps stabilize abstinence. METHODS: We studied 144 physicians at a conference of doctors in AA. RESULTS: Respondents had a mean period of sobriety of 140 months. Compared to normative populations, they scored higher on scales for depression and anxiety, and were more adherent to the spiritual character of AA, rather than a formally religious orientation. Those who reported "having a spiritual awakening" were more likely to "experience God's presence" on most days (81% vs. 19%) and were less likely to report craving for alcohol (21% vs. 41%) than those who did not. Respondents who had a history of being enrolled in State Physicians' Health Programs did not differ significantly on any of the aforesaid subjective variables from those who were not enrolled. CONCLUSION: The experience of long-term AA members can be characterized in terms of abstinence, spirituality, and alcohol craving. SCIENTIFIC SIGNIFICANCE: The study of long-term AA members can shed light on mechanisms of achieving abstinence in this fellowship. (Am J Addict 2013;22:323-328).

BACKGROUND: : Narcotics Anonymous is a worldwide fellowship that employs the Twelve-Step model for members dependent on drugs of abuse. The spiritual orientation of its program of abstinence has not been subjected to empirical study. METHODS: : Responses of 527 American Narcotics Anonymous meeting attendees to a structured questionnaire were evaluated for the roles of cognitive and psychosocial aspects of spirituality in their recovery. RESULTS: : Respondents had last used drugs or alcohol on average 6.1 years previously. They were found to be more oriented toward a spiritual than a formally religious orientation than probability samples of the general population. Aspects of membership such as affiliation toward other members and the experience of spiritual awakening were associated with lower rates of drug or alcohol craving, whereas scores on depression were associated with higher craving scores. CONCLUSIONS: : Spiritual renewal combined with an abstinence-oriented regimen in Narcotics Anonymous social context can play a role in long-term recovery from drug addiction.

ABSTRACT. Objective: Narcotics Anonymous (NA) is an abstinence-based fellowship with more than 58,000 groups worldwide. There has, however, been little research reported on its members. This study was designed to clarify the nature of the participants in NA who are primarily abstinent, long-term members. Method: A protocol was implemented to survey members at 10 NA group meetings in three different states, through the cooperation of the NA World Service Office. A 51-item self-administered questionnaire, addressing key aspects of substance use and recovery, was anonymously completed by 396 respondents. Results: Respondents were 71.5% male; the mean age was 38.1 years; 68.2% were White; and the principal drug problems comprised cocaine (28.5%), heroin (27.5%), other opiates (13.4%), methamphetamine (12.9%), alcohol (8.6%), marijuana (6.6%), and other stimulants (2.5%). Eighty-seven percent had prior treatment for a substance use disorder. On average respondents had first encountered NA at age 26.9, they had been abstinent an average of 5.7 years at the time they filled out the questionnaire, and 47.5% had served as sponsors. Ninety-four percent designated themselves as spiritual, and only 29.6% designated themselves as religious. Conclusions: NA offers support for long-term abstinence from diverse misuse of drugs among users of different backgrounds. (J. Stud. Alcohol Drugs, 74, 349-352, 2013).

Empirical findings characterizing long-term, committed Alcoholics Anonymous (AA) members are limited, particularly among younger members. The authors studied a sample of 266 highly committed attendees (mean age, 27 years) at an annual conference of Young People in Alcoholics Anonymous (YPAA), whose first encounter with AA was 6 years previously. Most (72%) had abused drugs and alcohol, and 36% had never received substance abuse treatment. They now reported a mean duration of abstinence of 44 months and had attended an average of 233 AA meetings in the previous year; 66% had served as AA sponsors, and 92% reported experiencing an AA "spiritual awakening," itself associated with a decreased likelihood of alcohol craving. Scores on AA beliefs, affiliation to other members, and the experience of spiritual awakening were associated with lower depression scores. These findings are discussed to clarify the nature of long-term AA membership.