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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.

Background: In the course of achieving abstinence from alcohol, longstanding members of Alcoholics Anonymous (AA) typically experience a change in their addiction-related attitudes and behaviors. These changes are reflective of physiologically grounded mechanisms which can be investigated within the disciplines of social and cognitive neuroscience., Objective: This article is designed to examine recent findings associated with these disciplines that may shed light on the mechanisms underlying this change., Method: Literature review and hypothesis development., Results: Pertinent aspects of the neural impact of drugs of abuse are summarized. After this, research regarding specific brain sites, elucidated primarily by imaging techniques, is reviewed relative to the following: Mirroring and mentalizing are described in relation to experimentally modeled studies on empathy and mutuality, which may parallel the experiences of social interaction and influence on AA members. Integration and retrieval of memories acquired in a setting like AA are described, and are related to studies on storytelling, models of self-schema development, and value formation. A model for ascription to a Higher Power is presented., Conclusion: The phenomena associated with AA reflect greater complexity than the empirical studies on which this article is based, and certainly require further elucidation. Despite this substantial limitation in currently available findings, there is heuristic value in considering the relationship between the brain-based and clinical phenomena described here., Scientific Significance: There are opportunities for the study of neuroscientific correlates of Twelve-Step-based recovery, and these can potentially enhance our understanding of related clinical phenomena., (© American Academy of Addiction Psychiatry.)

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., (Copyright © American Academy of Addiction Psychiatry.)

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.

This study was undertaken to provide an initial characterization of the current status of patients admitted to an alcoholism treatment program in Iceland. Consistent with the Minnesota Model, 12-step facilitation has been a central component of the program since its inception. Of the 94 patients assessed in this study, 67% were male and 40% had attended over 90 AA meetings prior to admission. The mean number of drinking days during the month prior to admission was 15.51 days and the mean length of hospital stay was 12.32 days. At time of hospital discharge, 39% were referred to residential treatment. Significant predictors of referral to residential treatment included having attended less than 90 AA meetings prior to admission and length of stay.

Alcoholics Anonymous (AA) is described as a spiritual fellowship by many of its members, but its spiritual orientation needs to be better understood by clinicians and researchers. Spirituality is a latent construct, one that is inferred from multiple component dimensions, such as social psychology, neurophysiology, and treatment outcome research. Mechanisms related to its role in promotion of recovery in AA are discussed from the perspective of these findings, along with related options for professionally grounded treatment, such as Twelve-Step Facilitation. This discussion illustrates the importance of further research on AA and spirituality and of employing them in the provision of psychiatric services.

Introduction: Alcoholics Anonymous is not yet fully employed by the medical community as a means to enhance patient outcome. The purpose of this study was to evaluate visitors' use of an Internet course on Alcoholics Anonymous, and to compare how various disciplines learned about, gained access to and participated in the course., Methods: Demographic information was collected from 414 visitors to the course., Results: 64% of the 414 respondents received their last educational degree within the last 10 years, and had an interest in the topic of addiction prior to their accessing the site. 294 (71%) of those who accessed the course completed it, and those who accessed it learned about it from various sources other than print advertisement in professional journals. Within the 230 physician respondents, 143 (62%) were psychiatrists, 82 (78%) of whom learned about the Internet course via professional journal., Discussion: Given the need for further training among physicians in the use of Alcoholics Anonymous, the Internet can be utilized to make information available to a large number of people. Because it allows the user to access information outside the traditional means, the barriers to its use are minimal, and it has the potential to effectively convey useful clinical information.

This is a two-phase study on attitudes of medical students toward Alcoholics Anonymous. The first phase compares views of addiction faculty to third-year medical students on the importance of spirituality in addiction treatment. We administered a questionnaire to assess attitudes toward spiritual, biological, and psychosocial approaches to addiction treatment. The faculty viewed spirituality as relatively more important in addiction treatment than did the students. The second phase was designed to assess whether medical student attitudes toward spiritually based treatments changed over the course of a psychiatry clerkship. At the beginning of the clerkship, students rated a spiritually oriented approach as important in addiction treatment as a biological approach, whereas, at the end of the clerkship, they rated the biological approach as more important. It may be important to educate medical students about the spiritual dimensions of recovery so they can integrate this into their treatment of addiction.

Rational Recovery (RR) is a new self-help movement for substance abusers, with a cognitive orientation. It has been suggested as an alternative to Alcoholics Anonymous. This study was designed to examine the nature of RR and its impact on those who join. A national sample of 433 substance-abusing people attending 63 established RR groups was evaluated, using codable self-report questionnaires completed at RR meetings. Members were mostly men with college experience who had previously attended AA. Among recruits who attended their first RR meeting in the last month, 38% were abstinent in the last month. Among members who had joined 3 or more months before, 73% were abstinent in the last month; they had attended an average of 4.1 RR meetings in that month, and carried out exercises at home based on Rational Emotive Therapy. Among those who joined 6 or more months before, 58% reported at least 6 months of abstinence. Among members with a history of heavy cocaine use, the portion reporting abstinence in the last month was not significantly different from those who had never used cocaine. The minority of members who were engaged for 3 months were still drinking, though, and did so on an average of 9.9 days in the last month. RR succeeded in engaging substance abusers and promoting abstinence among many of them while presenting a cognitive orientation that is different from the spiritual one of AA. Its utility in substance abuse treatment warrants further assessment.

The authors studied 100 impaired physicians who were successfully treated in a program that combined professionally directed psychotherapeutic treatment and peer-led self-help. An average of 33.4 months after admission they all reported being abstinent and rated Alcoholics Anonymous (AA) as more important to their recovery than professionally directed modalities. Feelings of affiliativeness to AA, which were very high, were strong predictors of the respondents' perceived support for their recovery. These feelings, and an identification with the role of care giver in addiction treatment, appeared to be central to their recovery process.

This paper describes a technology transfer initiative in which Network Therapy (NT), a substance abuse treatment that utilizes peer and family support, was disseminated to a cohort of addictions counselors located in an outpatient community-based addictions treatment center. Training methods included a didactic seminar, role-playing, use of videotaped illustrations, and clinical supervision, and are described in detail. Counselors then implemented the NT approach with a sample of cocaine-abusing patients (N = 10) who were being treated concurrently with the standard program provided by the treatment setting. NT patients were compared by chart review with a cohort of cocaine abusers who received community treatment--as-usual (TAU) (N = 20). The groups did not differ on demographic variables or the amount of TAU received at the community program. However, NT patients had significantly less positive urinalyses than TAU patients, though they were not significantly different in terms of treatment retention. Implications for technology transfer are discussed. [ABSTRACT FROM AUTHOR]