This aim was largely exploratory in nature but was included to provide a unique longitudinal perspective on step-work. And, fourth, we investigated whether self-reported step-work practices and beliefs prospectively predicted substance use outcomes, with substance use defined as drinks per drinking day, percentage of alcohol abstinent days, percentage of illicit drug use days, and a categorical measure of alcohol abstinence.
Aside from assessing the underlying structure of the GAATOR items Aim 2 , to our knowledge the study aims had not been addressed in prior research. This single-group naturalistic study investigated early affiliation with step programs with special attention directed to the mechanisms accounting for step related benefit R21AA, Tonigan. Determined prior to consent by a research assistant, study eligibility criteria included 1 current DSM-IV alcohol abuse or dependence, 2 alcohol use in the past three months, and 3 attending at least one AA meeting in the past three months.
Individuals were not eligible if they reported more than 16 weeks of lifetime AA meeting exposure or one year or more of abstinence from alcohol post-alcohol use disorder onset. Presence of a drug use disorder was not an exclusion criterion. Participants were recruited in a large Southwestern city. The University of New Mexico Institutional Review Board approved the study , and all participants provided written informed consent.
No intervention was provided in this assessment-only study. However, participants were given referrals to treatment programs if interested or if study staff deemed it to be appropriate.
Participants were given a Breathalyzer test to verify that their BAC was. Participants with a BAC above. To support study retention, participants provided contact information for one locator at intake whom research staff could contact in the event that participants could not be contacted to schedule a follow-up interview. This information was updated at each follow-up interview, as needed. Participants were also given cab or bus fare to travel home. Following the initial baseline assessment, follow-up assessments occurred at 3, 6, and 9 months.
Four response choices indicate the occurrence of each item in the past 90 days definitely false, false, true, and definitely true. For each item, GAATOR responses of definitely false and false were recoded as 0, and responses of true and definitely true were recoded as 1.
All items included in a step had to be endorsed as true or definitely true i. For all other analyses, a continuous measure of completed step-work was used. Item responses were recoded as 0 definitely false or false , 1 true , or 2 definitely true. Two items on the AAI specifically ask about the completion of steps in step programs, the difference being that one item asks about the completion of specific steps only within the context of formal treatment and the second item inquires about completion of specific steps regardless of whether it was encouraged in formal treatment or within the context of attending community-based step programs.
We used the latter measure of steps completed as the direct measure of step work, and it was completed at each assessment point. In a previous study the test-retest correlation for the summed number of steps completed using this question was.
The Form 90 Miller, is an interviewer-administered questionnaire that includes information on substance use, help seeking, and health care utilization in the previous 90 days.
In a multi-site test-retest exercise, for example, intra-class correlation coefficients for proportion abstinent days, drinks per drinking day, and total alcohol consumption in standard drinks were.
Four measures of substance use were calculated using the Form 1 Percent days abstinent PDA was defined as the number of days alcohol was not used in a period divided by the total number of days in that assessment period, 2 Alcohol abstinence was defined as complete abstinence from alcohol consumption during a period, 3 Drinks per drinking day was defined as the total number of standard drinks consumed in a period divided by the number of days on which alcohol was consumed abstinent days excluded from the denominator , and 4 Proportion days illicit drug use was defined as the number of days an illicit drug was reported to have been used divided by the total number of days in an assessment period.
Proportion of days step programs were attended was deduced from the Form 90 by dividing the reported number of days step meetings had been attended by the total number of days in an assessment period. Participants At study intake, 57 were single Half had a H. Diploma or GED At baseline participants consumed alcohol an average of Compared to baseline, participants reported 9. Abstinence rates from both alcohol and illicit drugs since the previous interview were respectively The mean proportion of days of Step meetings attended in the day period before recruitment was.
This figure was. At intake, At the three-month follow-up, the percentage of participants reporting step-work on the AAI ranged from a high of More participants tended to endorse working the earlier versus later steps, consistent with their limited exposure to step programs.
Correspondence between these two measures of step-work was for the most part poor. Varimax rotation with alpha extraction yielded two interpretable factors with eigenvalues greater than 1. The first factor included Steps 4, 5, 8, 9, 10, 11 and 12, steps that comprise concrete behavioral activities, such as taking inventory and making amends.
Unlike the three-month factor structure, at nine months step 12 only loaded significantly on the Behavioral Step-Work factor. Similar to three months, step 11 loaded significantly on both factors, but slightly more on the Spiritual Step-Work factor. Across assessment points, alpha coefficients ranged from. Analyses were conducted using HLM 6. Time was centered at intake, and the four assessment points in the study were coded as 0, 3, 6, and 9 to provide information about net changes in step-work per month.
At intake, participants had scores for Behavioral Step-Work and participants had scores for Spiritual Step-Work. At 6 and 9 months, participants had scores for Behavioral and Spiritual Step-Work. At baseline, the mean Behavioral Step-Work score was 6. Adding this set of predictors to the model did not alter the non-significant effect of linear time on Behavioral Step-Work. Using the same two-step process, changes in Spiritual Step-Work over time were examined.
Mean Spiritual Step-Work score at intake was Within the context of other step related influences, then, Spiritual Step-Work was observed to decrease over time. Independent of time, therefore, higher rates of step attendance and formal treatment were associated with more Spiritual Step-Work. Four lagged HLM analyses were conducted to assess the extent, if any, that proportion days step attendance, endorsement of Behavioral and Spiritual Step-Work collected at months 0, 3, and 6 and time linear uniquely predicted four measures of substance use collected at months 3, 6, and 9.
Results of these four conservative tests of the importance of step-work in predicting later substance use reductions can be seen in Table 5. First, substance use reductions were made between baseline and the 3-month interview, and these reductions were sustained but did not continue to improve throughout the remaining six months of the study non-significant time effect.
Second, proportion days step attendance was a significant predictor of later abstinence regardless of whether abstinence was defined as a categorical or continuous outcome measure. And, fourth, Behavioral Step-Work failed to predict later reductions in any of the four measures of substance use. The prescribed beliefs and practices of AA are most succinctly stated in the 12 steps, and working the steps is widely endorsed and considered by many to be the underlying reason accounting for AA-related benefit Booth, Our findings indicate that directly asking early step affiliates about the steps they have completed is a poor indicator of their endorsement and practice of the beliefs and practices embedded in the steps.
In this regard, efforts to understand the adoption of prescribed beliefs and practices of early AA affiliates on the basis of reported completion of steps is likely to systematically produce false negatives. At the same time, indirect measures such as the GAATOR may overestimate step-work completion to some degree by casting a wider net that includes general beliefs and practices that can occur both within AA and through other outlets e.
Exploratory factor analysis in this study indicated an alternative conceptualization of the 12 steps as practiced and endorsed by early AA affiliates; namely, behaviorally-oriented and spiritually-focused steps. Common to the behaviorally-oriented steps steps 4, 5, 8, 9, 10, and 12 were prescriptions that called for overt behavior. Such behaviors included preparing a written self-inventory step 4 , sharing of an inventory with another step 5 , making a list of harmed persons step 8 , making amends to harmed persons step 9 , taking a daily inventory and promptly acknowledging wrong doing step 10 , and working with other alcoholics step The findings of our factor analysis are not qualitatively different than those reported by Tonigan et al.
The nine items within the Higher Power component identified by Tonigan et al. The key difference in findings resides in the manner in which prescribed behavioral practices in the steps were classified: Tonigan et al. We suspect that this nuance is explained by sample differences in the extent that participants attended and were engaged in AA.
Well documented, for example, AA prescribed behaviors and beliefs are positively correlated during early AA affiliation, especially so when members are actively engaged in AA e. Higher rates of AA engagement would logically result in more uniform rates of endorsement of both self and other behavioral practices whereas lower rates of AA engagement may result in differential endorsement of self-other prescribed behaviors.
Described earlier, the conditions in which Tonigan et al. This study offered a rare view of how the endorsement and practice of the 12 steps changed over a 9-month period among early AA affiliates. Aggregating endorsement of step prescribed beliefs and practices into the behavioral and spiritually-based categories, for example, we found that the extent of endorsement of these categories did not change over time among participants if we ignored factors outside of the individual e.
In contrast, having a step sponsor was associated with increased endorsement of the behaviorally-anchored practices and beliefs but not spiritually-focused steps. This is probably the case because of steps 4 and 5. We suspect that the difference in findings may be the result of their combining spiritual and behavioral steps into a single scale as opposed to our distinguishing these types of steps. First, frequency of step attendance was positively associated with increased endorsement of spiritually focused beliefs.
Second, many participants reported concurrent formal treatment during study participation and such experiences also predicted increases in spiritually directed practices that are prescribed in the 12 steps. Make Coffee Clean up after a meeting Date: Mar 26, Date: Mar 28, I think we have tools in AA, don't we??? Quick Reply. Remember Me. Board Refresh. Search Search Advanced Search. List of AA Tools. Please add tools to the list.
The tools are in no particular order of usage or importance. Prayer partner AA Pamphlets Phone Numbers Grapevine Principles before Personalities Daily Reflections Count my Blessings Listening Chips Awareness Acceptance Home Group Staying in the Moment Serenity Prayer Willingness ORG Doctors Working with Others Honesty Authentic Big Book AA Girlfriend for women only Meetings God Religion Sponsor Open-mindness Journeling Surrender Highlighting and notes in Big Book Giving a ride to a meeting Fellowship Sponsoring On my knees Prayer Service We have found the Serenity Prayer to be very helpful:.
Make your recovery your number one priority. All your hopes and plans, even your very survival, depend on a drug-free you. Staying away from cocaine and all other mind-altering substances may be the greatest challenge you will ever face. We hope that by using these tools you will find the same joy and freedom we have found.
Just remember to be patient and keep coming back. We have found the Serenity Prayer to be very helpful: God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Close Privacy Overview This website uses cookies to improve your experience while you navigate through the website.
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