The Twelve Promises of Alcoholics Anonymous: Psychometric Measure Validation and Mediational Testing As a 12-step Specific Mechanism of Behavior Change

Overview

Journal Drug Alcohol Depend

Publisher Elsevier

Specialty Psychiatry

Date 2013 Sep 6

PMID 24004905

Citations 6

Authors

John F Kelly

M Claire Greene

Affiliations

Soon will be listed here.

Abstract

Background: Empirical support for the recovery utility of 12-step mutual-help organizations (MHOs) has led to increased investigation of how such organizations confer benefit. The Twelve Promises of Alcoholics Anonymous (AA) feature prominently in 12-step philosophy and culture and are one of the few documented explications of the cognitive, affective, and behavioral benefits that members might accrue. This study investigated the psychometric properties of a measure of AA's Twelve Promises and examined whether it mediated the effect of 12-step participation on abstinence.

Method: Young adults (N=302, M age 20.4 [1.6], range 18-25; 27% female; 95% White) enrolled in an addiction treatment effectiveness study completed assessments at intake and 3-, 6-, and 12-months post treatment including a 26-item, Twelve Promises Scale (TPS). Factor analyses examined the TPS' psychometrics and lagged mediational analyses tested the TPS as a mechanism of behavior change.

Results: Robust principal axis factoring extraction with Varimax rotation revealed a 2-factor solution explaining 45-58% of the variance across three administrations ("Psychological Wellbeing"=26-39%; "Freedom from Craving=17-21%); internal consistency was high (alpha=.83-.93). Both factors were found to increase in relation to greater 12-step participation, but significant mediation was found only for the Freedom from Craving factor explaining 21-34% of the effect of 12-step participation in increasing abstinence.

Conclusions: The TPS shows potential as a conceptually relevant, and psychometrically sound measure and may be useful in helping elucidate the extent to which the Twelve Promises emerge as an independent benefit of 12-step participation and/or explain SUD remission and recovery.

Citing Articles

Who affiliates with SMART recovery? A comparison of individuals attending SMART recovery, alcoholics anonymous, both, or neither.

Kelly J, Levy S, Matlack M, Hoeppner B Alcohol Clin Exp Res (Hoboken). 2023; 47(10):1926-1942.

PMID: 37864536 PMC: 10605873. DOI: 10.1111/acer.15164.

Alcoholics Anonymous and other 12-step programs for alcohol use disorder.

Kelly J, Humphreys K, Ferri M Cochrane Database Syst Rev. 2020; 3:CD012880.

PMID: 32159228 PMC: 7065341. DOI: 10.1002/14651858.CD012880.pub2.

Opioid use disorder.

Strang J, Volkow N, Degenhardt L, Hickman M, Johnson K, Koob G Nat Rev Dis Primers. 2020; 6(1):3.

PMID: 31919349 DOI: 10.1038/s41572-019-0137-5.

Narrating the journey of sustained recovery from substance use disorder.

Stokes M, Schultz P, Alpaslan A Subst Abuse Treat Prev Policy. 2018; 13(1):35.

PMID: 30261888 PMC: 6161338. DOI: 10.1186/s13011-018-0167-0.

Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of mechanisms of behavior change research.

Kelly J Addiction. 2016; 112(6):929-936.

PMID: 27718303 PMC: 5385165. DOI: 10.1111/add.13590.

References

Humphreys K, Moos R . Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes. Alcohol Clin Exp Res. 2007; 31(1):64-8. DOI: 10.1111/j.1530-0277.2006.00273.x. View

Mundt M, Parthasarathy S, Chi F, Sterling S, Campbell C . 12-Step participation reduces medical use costs among adolescents with a history of alcohol and other drug treatment. Drug Alcohol Depend. 2012; 126(1-2):124-30. PMC: 3430743. DOI: 10.1016/j.drugalcdep.2012.05.002. View

Slesnick N, Tonigan J . Assessment of Alcohol and Other Drug Use by Runaway Youths: A Test-Retest Study of the Form 90. Alcohol Treat Q. 2008; 22(2):21-34. PMC: 2430749. DOI: 10.1300/J020v22n02_03. View

Kelly J, Stout R, Slaymaker V . Emerging adults' treatment outcomes in relation to 12-step mutual-help attendance and active involvement. Drug Alcohol Depend. 2012; 129(1-2):151-7. PMC: 3566342. DOI: 10.1016/j.drugalcdep.2012.10.005. View

Zemore S . A role for spiritual change in the benefits of 12-step involvement. Alcohol Clin Exp Res. 2007; 31(10 Suppl):76s-79s. DOI: 10.1111/j.1530-0277.2007.00499.x. View

Baron R, Kenny D . The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986; 51(6):1173-82. DOI: 10.1037//0022-3514.51.6.1173. View

Robinson E, Cranford J, Webb J, Brower K . Six-month changes in spirituality, religiousness, and heavy drinking in a treatment-seeking sample. J Stud Alcohol Drugs. 2007; 68(2):282-90. DOI: 10.15288/jsad.2007.68.282. View

Humphreys K, Moos R . Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study. Alcohol Clin Exp Res. 2001; 25(5):711-6. View

Kelly J, McCrady B . Twelve-step facilitation in non-specialty settings. Recent Dev Alcohol. 2009; 18:321-46. DOI: 10.1007/978-0-387-77725-2_18. View

10.

Hoeppner B, Kelly J, Urbanoski K, Slaymaker V . Comparative utility of a single-item versus multiple-item measure of self-efficacy in predicting relapse among young adults. J Subst Abuse Treat. 2011; 41(3):305-12. PMC: 3315352. DOI: 10.1016/j.jsat.2011.04.005. View

11.

Kelly J, Hoeppner B, Stout R, Pagano M . Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis. Addiction. 2011; 107(2):289-99. PMC: 3242865. DOI: 10.1111/j.1360-0443.2011.03593.x. View

12.

White W . Recovery: old wine, flavor of the month or new organizing paradigm?. Subst Use Misuse. 2008; 43(12-13):1987-2000. DOI: 10.1080/10826080802297518. View

13.

. Project MATCH (Matching Alcoholism Treatment to Client Heterogeneity): rationale and methods for a multisite clinical trial matching patients to alcoholism treatment. Alcohol Clin Exp Res. 1993; 17(6):1130-45. DOI: 10.1111/j.1530-0277.1993.tb05219.x. View

14.

Kelly J, Stout R, Magill M, Tonigan J, Pagano M . Spirituality in recovery: a lagged mediational analysis of alcoholics anonymous' principal theoretical mechanism of behavior change. Alcohol Clin Exp Res. 2010; 35(3):454-63. PMC: 3117904. DOI: 10.1111/j.1530-0277.2010.01362.x. View

15.

Dennis M, Scott C, Funk R, Foss M . The duration and correlates of addiction and treatment careers. J Subst Abuse Treat. 2005; 28 Suppl 1:S51-62. DOI: 10.1016/j.jsat.2004.10.013. View

16.

Krentzman A, Cranford J, Robinson E . Multiple dimensions of spirituality in recovery: a lagged mediational analysis of Alcoholics Anonymous' principal theoretical mechanism of behavior change. Subst Abus. 2013; 34(1):20-32. DOI: 10.1080/08897077.2012.691449. View

17.

Humphreys K, Mankowski E, MOOS R, Finney J . Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse?. Ann Behav Med. 2008; 21(1):54-60. DOI: 10.1007/BF02895034. View

18.

Miller W, Del Boca F . Measurement of drinking behavior using the Form 90 family of instruments. J Stud Alcohol Suppl. 1994; 12:112-8. DOI: 10.15288/jsas.1994.s12.112. View

19.

Moos R, Moos B . Long-term influence of duration and frequency of participation in alcoholics anonymous on individuals with alcohol use disorders. J Consult Clin Psychol. 2004; 72(1):81-90. DOI: 10.1037/0022-006X.72.1.81. View

20.

Kelly J, Greene M . Beyond motivation: Initial validation of the commitment to sobriety scale. J Subst Abuse Treat. 2013; 46(2):257-63. PMC: 3840075. DOI: 10.1016/j.jsat.2013.06.010. View