Spirituality in Recovery: A Lagged Mediational Analysis of Alcoholics Anonymous’ Principal Theoretical Mechanism of Behavior Change

Authors

  • John F. Kelly,

    1. From the Center for Addiction Medicine (JFK), Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Decision Sciences Institute/PIRE (RLS), Providence, Rhode Island; Center for Alcohol and Addiction Studies (MM), Brown University, Providence, Rhode Island; Center on Alcoholism, Substance Abuse and Addiction (JST), Albuquerque, New Mexico; and Division of Child Psychiatry (MEP), Department of Psychiatry, Case Western Reserve University School of Medicine, W.O. Walker Center, Cleveland, Ohio.
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  • Robert L. Stout,

    1. From the Center for Addiction Medicine (JFK), Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Decision Sciences Institute/PIRE (RLS), Providence, Rhode Island; Center for Alcohol and Addiction Studies (MM), Brown University, Providence, Rhode Island; Center on Alcoholism, Substance Abuse and Addiction (JST), Albuquerque, New Mexico; and Division of Child Psychiatry (MEP), Department of Psychiatry, Case Western Reserve University School of Medicine, W.O. Walker Center, Cleveland, Ohio.
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  • Molly Magill,

    1. From the Center for Addiction Medicine (JFK), Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Decision Sciences Institute/PIRE (RLS), Providence, Rhode Island; Center for Alcohol and Addiction Studies (MM), Brown University, Providence, Rhode Island; Center on Alcoholism, Substance Abuse and Addiction (JST), Albuquerque, New Mexico; and Division of Child Psychiatry (MEP), Department of Psychiatry, Case Western Reserve University School of Medicine, W.O. Walker Center, Cleveland, Ohio.
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  • J. Scott Tonigan,

    1. From the Center for Addiction Medicine (JFK), Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Decision Sciences Institute/PIRE (RLS), Providence, Rhode Island; Center for Alcohol and Addiction Studies (MM), Brown University, Providence, Rhode Island; Center on Alcoholism, Substance Abuse and Addiction (JST), Albuquerque, New Mexico; and Division of Child Psychiatry (MEP), Department of Psychiatry, Case Western Reserve University School of Medicine, W.O. Walker Center, Cleveland, Ohio.
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  • Maria E. Pagano

    1. From the Center for Addiction Medicine (JFK), Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Decision Sciences Institute/PIRE (RLS), Providence, Rhode Island; Center for Alcohol and Addiction Studies (MM), Brown University, Providence, Rhode Island; Center on Alcoholism, Substance Abuse and Addiction (JST), Albuquerque, New Mexico; and Division of Child Psychiatry (MEP), Department of Psychiatry, Case Western Reserve University School of Medicine, W.O. Walker Center, Cleveland, Ohio.
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Reprint requests: John F. Kelly, PhD, Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, 60 Staniford St., Suite 120, Boston, MA 02114; Tel: 617-643-1980; Fax: 617-643-1998; E-mails: jkelly11@partners.org, kellyjohn@verizon.net

Abstract

Background:  Evidence indicates Alcoholics Anonymous (AA) can play a valuable role in recovery from alcohol use disorder. While AA itself purports it aids recovery through “spiritual” practices and beliefs, this claim remains contentious and has been only rarely formally investigated. Using a lagged, mediational analysis, with a large, clinical sample of adults with alcohol use disorder, this study examined the relationships among AA, spirituality/religiousness, and alcohol use, and tested whether the observed relation between AA and better alcohol outcomes can be explained by spiritual changes.

Method:  Adults (= 1,726) participating in a randomized controlled trial of psychosocial treatments for alcohol use disorder (Project MATCH) were assessed at treatment intake, and 3, 6, 9, 12, and 15 months on their AA attendance, spiritual/religious practices, and alcohol use outcomes using validated measures. General linear modeling (GLM) and controlled lagged mediational analyses were utilized to test for mediational effects.

Results:  Controlling for a variety of confounding variables, attending AA was associated with increases in spiritual practices, especially for those initially low on this measure at treatment intake. Results revealed AA was also consistently associated with better subsequent alcohol outcomes, which was partially mediated by increases in spirituality. This mediational effect was demonstrated across both outpatient and aftercare samples and both alcohol outcomes (proportion of abstinent days; drinks per drinking day).

Conclusions:  Findings suggest that AA leads to better alcohol use outcomes, in part, by enhancing individuals’ spiritual practices and provides support for AA’s own emphasis on increasing spiritual practices to facilitate recovery from alcohol use disorder.

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