Arielle Cruz
Alcoholics Anonymous (AA) is a 12-step programme that helps people with alcohol addiction and recovery. The approach adopted by AA is known as the Transtheoretical Model (TTM) of change, which integrates various theories of psychotherapy. The 12-step model has been widely adopted and is considered a proven approach by the American Society of Addiction Medicine. AA meetings are free and easily accessible, making them a popular form of treatment for alcohol addiction. AA's 12-step model has also been used to form other recovery programmes for different addictions and compulsive behaviours.
| Characteristics | Values |
|---|---|
| Name of the model | Transtheoretical Model (TTM) |
| Type of model | Behavioral model |
| Stages of change | 5 |
| Stage 1 | Precontemplation |
| Stage 2 | Contemplation |
| Stage 3 | Preparation |
| Stage 4 | Action |
| Stage 5 | Maintenance |
| Effectiveness | AA/TSF is better than other well-established treatments in facilitating continuous abstinence and remission |
| AA/TSF is at least as effective as other well-established treatments in reducing drinking intensity, alcohol-related consequences, and severity of alcohol addiction | |
| AA/TSF reduces healthcare costs substantially more than other types of treatments | |
| AA's free and widespread availability makes it potentially helpful for a large number of people for extended periods | |
| AA is part of the de facto system of care for AUD in many nations | |
| AA has been found to be better than CBT and MET in terms of cost savings and continuous abstinence |
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What You'll Learn
The Transtheoretical Model (TTM)
The TTM is comprised of six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. In the precontemplation stage, individuals are not considering change, and the pros of maintaining their current behaviour outweigh the benefits of changing it. In the contemplation stage, individuals consider change but have not yet committed to it; the pros and cons of changing are about equal. During the preparation stage, individuals are preparing to change their behaviour, and the pros of changing outweigh the cons. In the action stage, individuals have recently made a change and are working to maintain it. In the maintenance stage, individuals have maintained the behaviour change for at least six months, and the pros of maintaining the change outweigh the cons, reducing the risk of relapse. Finally, in the termination stage, individuals have sustained the behaviour change.
The TTM is based on the assumption that there is a common set of change processes that can be applied across a broad range of health behaviours. It integrates principles of change from a variety of theories of intervention, including both cognitive and behavioural processes. It recognises that behavioural change is not a single step but a cyclical progression through different stages.
The TTM has been used to study and explain various behaviours, including smoking cessation, weight loss, drug addiction, and alcohol use. It has also been applied in patient education to tailor interventions based on a patient's specific stage of readiness for change. Motivational interviewing is a technique that is consistent with the TTM.
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12-Step Facilitation (TSF)
Twelve-Step Facilitation (TSF) is an evidence-based approach that has proven to increase the chances of long-term recovery from addictions and is also helpful in treating mental health disorders. The model originated from the Minnesota Model of addiction treatment, also known as the abstinence model, which was first created in a Minnesota hospital in the 1950s. The primary goal of the Minnesota Model is to engage patients with Alcoholics Anonymous (AA) and other 12-step mutual-help organizations in their community.
The Transtheoretical Model (TTM) of change is an approach to behavior change that integrates various theories of psychotherapy. TTM has been used to study and explain behaviors such as smoking cessation, weight loss, and drug addiction. It has also been applied to public health campaigns, clinical interventions, and self-help programs, including Alcoholics Anonymous. TTM consists of five stages of change: precontemplation, contemplation, preparation, action, and maintenance.
TSF interventions offer different ways to facilitate 12-step mutual-help organization participation. The approaches range from leveraging AA and other mutual-help organizations as a platform to help patients make recovery-supportive changes to their social networks (Network Support) to focusing almost entirely on AA and its core principles (Project MATCH TSF). The common thread of TSF interventions is the clinical emphasis that the patient actively participate in 12-step mutual-help organizations, like AA, to achieve and sustain long-term remission from substance use disorder.
Over the course of 4 to 12 sessions, depending on the specific type of TSF, the provider encourages and facilitates the patient’s attendance at AA meetings. TSF produces outcome benefits that are as good as or possibly better than other active treatments. It is particularly helpful in increasing rates of continuous abstinence and full sustained substance use disorder remission. While TSF has shown clear advantages in treating alcohol use disorder, evidence for its effectiveness in treating other drug use disorders is more limited.
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Behavioural change
The change model that reflects the approach adopted by Alcoholics Anonymous (AA) is known as the Transtheoretical Model (TTM). This model is an approach to behavioural change that integrates various theories of psychotherapy. It has been used to study and explain behaviours such as smoking cessation, weight loss, and drug addiction, and has been applied to public health campaigns, clinical interventions, and self-help programs, including Alcoholics Anonymous.
The Transtheoretical Model (TTM) consists of five stages of change:
- Precontemplation: The individual is not yet considering changing their behaviour.
- Contemplation: The individual considers changing their behaviour but has not yet committed to it.
- Preparation: The individual prepares to change their behaviour.
- Action: The individual actively changes their behaviour and works to maintain it.
- Maintenance: The individual works to maintain their new behaviour and prevent relapse.
The 12-Step Model of Alcoholics Anonymous is a well-known and established program that has been used to help people with alcohol and substance abuse issues for over 80 years. The 12 steps are meant to be addressed sequentially, but there is no rigid timeline, and individuals can take breaks or spend more time on certain steps as needed. The steps provide guiding principles for tackling problems related to alcoholism, drug addiction, and behavioural compulsions. They encourage the practice of honesty, humility, acceptance, courage, compassion, forgiveness, and self-discipline, which lead to positive behavioural change, emotional well-being, and spiritual growth.
Alcoholics Anonymous meetings provide a supportive network of peers where members can share their personal narratives of addiction and recovery, and help each other practice the principles of the 12-step program. The free and widespread availability of AA makes it a potentially helpful resource for many individuals struggling with alcohol use disorder (AUD).
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Spiritual growth
The AA approach to recovery is achieved through quasi-religious/spiritual means, or a "spiritual awakening". This is done through their 12-step program, which constitutes a set of guidelines necessary to maintain abstinence and achieve a fulfilling life. The program includes turning one's life and will over to a higher power, engaging in prayer and meditation, and working towards spiritual growth.
The relationship between spiritual experiences and feelings of hopelessness is indirect and is mediated by meaning in life, hope, and abstinence duration. Research has confirmed that among AA participants, spirituality is associated with reduced drinking and abstinence. The more frequent the spiritual experiences, the longer the abstinence achieved.
However, it is important to note that religious engagement is not necessary for involvement in AA. Self-help groups offer the possibility of spiritual growth without religious involvement for religious skeptics, atheists, and agnostics. AA believes that spiritual growth is essential for recovery, and this belief has been supported by research.
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Secular alternatives
The following are secular alternatives to Alcoholics Anonymous:
Secular Organizations for Sobriety (SOS)
Also known as Save Our Selves, SOS is a non-profit network of autonomous addiction recovery groups. The program emphasizes the need to prioritize sobriety and uses mutual support to help members achieve this goal. SOS provides suggested guidelines for sobriety that emphasize rational decision-making and are not religious or spiritual in nature. SOS members may also attend AA meetings, but SOS does not view spirituality or surrendering to a Higher Power as necessary for maintaining abstinence.
SMART Recovery
SMART Recovery is based on contemporary therapeutic techniques and teaches self-reliance, CBT techniques, and coping skills for dealing with cravings. Meetings are secular and can be attended in person or online, and resources like workbooks are provided.
LifeRing
LifeRing promotes a secular, self-help approach to addiction recovery, emphasizing empowerment. Participants are encouraged to develop their own personalized "sober self" identity. LifeRing incorporates peer-led support groups that focus on individual needs, without prescribed steps or higher power concepts.
Moderation Management (MM)
While controversial, MM focuses on reducing alcohol consumption rather than complete abstinence. It emphasizes moderation goals and personal responsibility and is designed for early-stage problem drinkers. MM offers a structured plan and online support groups but is likely not appropriate for people with severe addictions.
These secular alternatives to Alcoholics Anonymous provide different approaches and philosophies, allowing individuals to find a recovery path that suits their needs and beliefs.
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Frequently asked questions
The change model that reflects the approach adopted by Alcoholics Anonymous (AA) is known as the Transtheoretical Model (TTM).
The Transtheoretical Model (TTM) is an approach to behavior change that integrates various theories of psychotherapy.
The TTM consists of five stages: Precontemplation, Contemplation, Preparation, Action, and Maintenance.
The 12-Step Facilitation (TSF) approach includes extended counseling, adopting AA techniques, and encouraging meeting attendance.
AA has been found to be effective in facilitating continuous abstinence and remission, reducing drinking intensity, and improving psychological well-being. Additionally, AA is widely accessible, free of cost, and has a positive impact on public health.
