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Thursday, January 28, 2010
One of many reasons that attendance at Alcoholics Anonymous (AA) meetings helps people with alcohol use disorders stay sober appears to be alleviation of depression. A team of researchers has found that study participants who attended AA meetings more frequently had fewer symptoms of depression - along with less drinking - than did those with less AA participation. The report will appear in the journal Addiction and has been released online.
"Our study is one of the first to examine the mechanisms underlying behavioral change with AA and to find that AA attendance alleviates depression symptoms," says study leader John F. Kelly, PhD, associate director of the Massachusetts General Hospital (MGH) Center for Addiction Medicine. "Perhaps the social aspects of AA helps people feel better psychologically and emotionally as well as stop drinking."
The authors note that problems with mood regulation such as depression are common among people with alcohol problems - both preceding and being exacerbated by alcohol use. Although AA does not explicitly address depression, the program's 12 steps and social fellowship are designed to support participants' sense of well being. While mood problems often improve after several weeks of abstinence, that process may happen more quickly in AA participants. The current study was designed to investigate whether decreasing depression and enhancing psychological well-being help explain AA's positive effects.
The researchers analyzed data from Project MATCH, a federally funded trial comparing three treatment approaches for alcohol use disorder in more than 1,700 participants. While participants in that study were randomly assigned to a specific treatment plan, all were able to attend AA meetings as well. Among the data gathered at several points during Project MATCH’s 15-month study period were participants' alcohol consumption, the number of AA meetings attended, and recent symptoms of depression.
At the beginning of the study period, participants reported greater symptoms of depression than would be seen in the general public, which is typical among alcohol-dependent individuals. As the study proceeded, those participants who attended more AA meetings had significantly greater reductions in their depression symptoms, along with less frequent and less intensive drinking.
"Some critics of AA have claimed that the organization's emphasis on 'powerlessness' against alcohol use and the need to work on 'character defects' cultivates a pessimistic world view, but this suggests the opposite is true," Kelly says. "AA is a complex social organization with many mechanisms of action that probably differ for different people and change over time. Most treatment programs refer patients to AA or similar 12-step groups, and now clinicians can tell patients that, along with supporting abstinence, attending meetings can help improve their mood. Who wouldn't want that?"
Kelly is an associate professor in the Harvard Medical School Department of Psychiatry. Co-authors of the study - which was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism - are Robert Stout, PhD, Decision Sciences Institute/PIRE, Providence, R.I.; Molly Magill, PhD, Brown University, Providence; Scott Tonigan, PhD, Center of Alcoholism, Substance Abuse and Addiction, Albuquerque, N.M.; and Maria Pagano, PhD, Case Western Reserve University School of Medicine, Cleveland.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $600 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, systems biology, transplantation biology and photomedicine.
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