2009, Number 5
Alcohólicos Anónimos (AA): aspectos relacionados con la adherencia (afiliación) y diferencias entre recaídos y no recaídos
Gutiérrez RR, Andrade PP, Jiménez TA, Saldívar HG, Juárez GF
Full text
Language: Spanish
References: 25
Page: 427-433
PDF size: 119.51 Kb.
ABSTRACT
The work of Alcoholics Anonymous (AA) in fighting against alcohol abuse and alcoholism has placed it as an institution of great importance in Mexico and around the world. Although its labor has been subject for controversy, there is a lot of evidence that frequent attendance and affiliation to the groups and sessions can be very helpful for many individuals.Research has been dedicated to the identification of the elements contributing to affiliation, such as involvement, commitment, and participation, or the level of adherence to the program’s beliefs and activities. Some studies have used the time of membership and the frequency of attendance to AA as indicators of affiliation, but there are some authors who think that it is difficult to explore it using only these variables. Other authors have mentioned that alcoholics can go to AA for many reasons, but that mere attendance is not enough for reaching or maintaining abstinence. It has been established that when the impact of AA is measured only by the time of membership or the frequency of attendance, it is not possible to comprehend the essence of the subjective and behavioral characteristics involved in the process. Thus, it is important to differentiate between these and the true affiliation.
There are only a few researches about the elements forming the affiliation to AA, and the ones available do not bring light over the process of its beginning. Some authors say that it is something more than the time or the frequency of attendance to meetings, and that is possible that it is a complex and heterogeneous phenomenon formed by several behaviors and beliefs about the 12 steps.
Some studies have pointed out the interaction of different factors to achieve affiliation, but they have also remarked the need for including more variables in measuring it. One conclusion is that affiliation is a whole dimension that encompasses attendance and the level of participation in the activities.
There are different questionnaires to measure the affiliation process, but most of them are difficult to interpret, and little is known about their fitting to AA members’ perspective of things. Research in Mexico is complicated because of a lack of instruments developed from the local situation and experience.
There are data that about 14 000 alcoholics enter AA every year. Relapse is high during the first three months (near 50%), but almost half of the persons that stay show adherence to the program, and eventually reach abstinence. Yet, the topic of the specific elements of affiliation, as well as their influence to maintain abstinence, has not received enough attention. The objectives of this study were: 1. to analyze the elements that constitute an affiliation profile, 2. to know if such elements are different or if they are part of a single construct, and 3. to find out if the amount of affiliation (the way an alcoholic involves him/herself in the activities of the group) can distinguish between those who have relapsed and those who have not.
Method: The sample was non-probabilistic; it included 192 AA members (87% men and 13% women). Average age was 42 years old. Two groups were formed: relapsed and non-relapsed (143 who did not consume any amount of alcohol since they entered AA or 10 years or more ago, and 49 who consumed any amount of alcohol within the four years prior to the interview). The questionnaire included scales to measure the service, the practice of the 12 steps, the spiritual awakening, sponsoring, time spent in AA, frequency of attendance, and reading of the materials. The questionnaire was specifically designed for measuring affiliation.
Results: There were significative differences in the mean participation time (it was higher in the non-relapsed subjects: t=-3.225, df=181, p‹.00), in the activities related to «service» (they were more frequent and more extended in time in the non-relapsed subjects: χ2 = 7.76, p‹ .01; t =-2.258, df= 145, p‹ .02), in «being a sponsor» (most of the nonrelapsed subjects are one: χ2 = 15.06, p‹ .000), in the practice of the steps 3-12 (non-relapsed AA practiced them more: χ2 = 5.16, p‹.02), and in having the spiritual awakening experience (more frequent in the non-relapsed subjects: χ2 = 4.282, p‹. 05).
Internal consistency tests were executed, as well as a factor analysis to explore if the items that differentiated between the groups could form a single dimension. The first analysis resulted in a satisfactory internal consistency (α=.67). The items were grouped in a unique dimension with an explained variance of 43.6%. An indicator for affiliation was developed through the sum of the scores from variables grouped in the factor analysis. A comparison using this indicator showed significant differences in the degree of involvement in AA (Z=-3.367, p‹.001). Non-relapsed subjects had an affiliation ranging from high to very high.
Discussion: Results suggest that affiliation is an event formed by several elements that, either separated or combined, can behave significantly different between relapsed and non-relapsed AA members. This could mean that such variables are adherence or affiliation indicators.
These elements are not exclusive or unrelated entities, but they constitute a measure of affiliation to AA. Its structure leads to consider them as part of the same phenomenon which could help to determine more precisely the degree of affiliation; the categorization made evident that there is an important association with abstinence. Thus, affiliation scores varied importantly between groups; the highest ones were on those who have maintained abstinence.
It is possible to deduct that alcoholic subjects who participate more actively and during more time in AA get more positive results. These results concur with others in the sense that reaching long periods of abstinence in AA is related to a greater involvement in the activities of the groups.
Likewise, the frequency of attendance to the meetings did not differentiate between relapsed and non-relapsed; this could suggest that just being there is not enough to obtain a satisfactory result. AA literature points out to the fact that attendance is a necessary condition for recovering, but its benefits reduce considerably without a genuine desire of involvement.
The performance of the affiliation indicators identified in this study suggests the possibility of considering them as a dimension that explain the amount in which it exists in AA members. The fact that such dimension emerged from the experience of members from national groups represents an opportunity to use it as a valid scale in broader researches with bigger samples, and a chance to find out in a more reliable way the real role of AA in the recovery process.
Since AA represents one of the most popular choices for the treatment of alcoholism in Mexico, research should continue for broadening the knowledge that health professionals, researchers, and everyone involved in prevention have about this organization. As shown by the results of this study, a better understanding of the benefits produced by the active participation in AA could help to motivate not only attendance to the meetings, but a full involvement in the activities suggested by the groups. The final effects may result in a reduction of the health costs generated by alcoholism and related problems attention.
REFERENCES