Predictors of Adolescent A.A. Affiliation

Article excerpt

Thousands of teenagers are treated each year in in-patient or residential settings for drug and alcohol dependency. The majority of these programs use the traditional treatment model, also known as the Minnesota Model (Littrell, 1991). This model emphasizes addiction as a disease where one achieves recovery through abstinence, and that one must participate in a support group such as Alcoholics Anonymous (AA) in order to maintain this abstinence. Patients attend AA while hospitalized and are encouraged to continue their attendance upon discharge. AA itself has seen a tremendous growth in membership over the last decade. Currently there are over one million members in the United States alone (About AA, 1990) with approximately 3% of its members being under 21 years of age.

While not every adolescent who receives treatment will affiliate with AA, it is important to study the characteristics of those who do. Because referral to AA is a routine discharge plan, it may help mental health practitioners to know which of their clients may be more likely to join this self-help program. This subject is particularly pertinent because it has not been investigated with the adolescent population.

Various studies have researched A.A. affiliation with the goal of describing who joins AA in the hope that treatment providers could utilize "a more informed basis for treatment planning" (O'Leary, Calsyn, Haddock, & Freeman, 1980, p. 137). An outline of these studies can be found in Table 1.

It is virtually impossible to define the population of abstinent alcoholics, both those in AA and those not so affiliated. One of the strictest traditions of AA is that of anonymity of its members. As can be seen, the samples used in most of these studies were mainly hospitalized, adult males. Using currently hospitalized patients may pose problems because of long-term cognitive impairment (Gorski & Miller, 1982) and what Marlatt (1985) refers to as the abstinence violation effect, which is intense shame, guilt, and hopelessness that A.A. members may feel upon relapse and re-entry into treatment. This effect may bias the responses of the recently relapsed patients who are readmitted. Of all these studies, only Hurlburt, Gade and Fuqua (1983) specified race. Four of the studies used AA to recruit participants, leading to a self-selected sample. The study by Alford (1980) was a follow-up that had a somewhat better sample in that all the respondents had received the same intervention.

As a few of the researchers pointed out, it is hard to ascertain whether respondents had the characteristics studied prior to affiliation with AA or if AA caused them to develop. An example of this is Mindlin's (1964) findings of "less socially ill at ease" and "less loneliness."

At least four of the studies (Fontana, Dowds, & Bethel 1976; Greg-son & Taylor, 1977; Reilly & Sugarman, 1967; Trice, 1959) are similar in their finding that attributes could be categorized as external personality characteristics, such as use of more external sources of authority, religiosity, and formalistic thinking.

Many findings among the studies were contradictory; for example, Boscarino (1980) found less alcohol-related problems, while O'Leary et al. (1980) and Vaillant (1983) found more alcohol-related problems. Hurlburt et al. (1983) found that the AA affiliates were "less emotional" and Reilly and Sugarman (1967) found them to be more sensitive and concerned with acceptance. (See Table 1.)

This review of the literature also indicates that the area of AA affiliation has mainly been researched among adult samples. It was found that females, extroverts, and those who have suffered more alcohol-related problems are more likely to affiliate with A.A.

While A.A. affiliation has not been studied with adolescents, treatment outcome studies provide some relevant information. Hoffman [TABULAR DATA FOR TABLE 1 OMITTED] and Kaplan (1991) found in a study of treated alcoholic adolescents that those whose parents had participated in treatment were more likely to participate in a support group, and the less the teens' peers used drugs, the more likely they were to achieve abstinence. …