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Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms?

  1. John F. Kelly1,*,
  2. Robert L. Stout2,
  3. Molly Magill3,
  4. J. Scott Tonigan4,
  5. Maria E. Pagano5

Article first published online: 22 JAN 2010

DOI: 10.1111/j.1360-0443.2009.02820.x

Issue

Addiction

Addiction

Volume 105, Issue 4, pages 626–636, April 2010

Additional Information

How to Cite

Kelly, J. F., Stout, R. L., Magill, M., Tonigan, J. S. and Pagano, M. E. (2010), Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms?. Addiction, 105: 626–636. doi: 10.1111/j.1360-0443.2009.02820.x

Author Information

  1. 1

    Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA,

  2. 2

    Decision Sciences Institute/PIRE, Pawtucket, RI, USA,

  3. 3

    Brown University, Center for Alcohol and Addiction Studies, Providence, RI, USA,

  4. 4

    Center on Alcoholism, Substance Abuse and Addiction (CASAA), Albuquerque, NM, USA and

  5. 5

    Case Western Reserve University School of Medicine, Department of Psychiatry, Division of Child Psychiatry, W.O. Walker Center, Cleveland, OH, USA

*John F. Kelly, Massachusetts General Hospital, Department of Psychiatry, Center for Addiction Medicine, 60 Staniford Street, Suite 120, Boston, MA 02114, USA. E-mail: jkelly11@partners.org.

Publication History

  1. Issue published online: 10 MAR 2010
  2. Article first published online: 22 JAN 2010
  3. Submitted 5 August 2009; initial review completed 31 August 2009; final version accepted 29 September 2009

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Keywords:

  • Alcohol dependence;
  • Alcoholics Anonymous;
  • depression;
  • mechanisms;
  • mutual-help groups;
  • self-help groups

ABSTRACT

Rationale  Indices of negative affect, such as depression, have been implicated in stress-induced pathways to alcohol relapse. Empirically supported continuing care resources, such as Alcoholics Anonymous (AA), emphasize reducing negative affect to reduce relapse risk, but little research has been conducted to examine putative affective mechanisms of AA's effects.

Methods  Using lagged, controlled, hierarchical linear modeling and mediational analyses this study investigated whether AA participation mobilized changes in depression symptoms and whether such changes explained subsequent reductions in alcohol use. Alcohol-dependent adults (n = 1706), receiving treatment as part of a clinical trial, were assessed at intake, 3, 6, 9, 12 and 15 months.

Results  Findings revealed elevated levels of depression compared to the general population, which decreased during treatment and then remained stable over follow-up. Greater AA attendance was associated with better subsequent alcohol use outcomes and decreased depression. Greater depression was associated with heavier and more frequent drinking. Lagged mediation analyses revealed that the effects of AA on alcohol use was mediated partially by reductions in depression symptoms. However, this salutary effect on depression itself appeared to be explained by AA's proximal effect on reducing concurrent drinking.

Conclusions  AA attendance was associated both concurrently and predictively with improved alcohol outcomes. Although AA attendance was associated additionally with subsequent improvements in depression, it did not predict such improvements over and above concurrent alcohol use. AA appears to lead both to improvements in alcohol use and psychological and emotional wellbeing which, in turn, may reinforce further abstinence and recovery-related change.

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