Recent Developments in Alcoholism: Research on Alcoholics Anonymous and Spirituality in Addiction Recovery

462 Pages·2008·3.189 MB·English

by  Thomasina Borkman (auth.), Lee Anne Kaskutas, Marc Galanter (eds.)

GALANTER
KASKUTAS
A R RECENT DEVELOPMENTS IN
E
C
L
E ALCOHOLISM
C N
T
O
D
E
H V
E
L
O
O
P
L M
I E
N
S
T
M S

I VOLUME 18
N
RESEARCH ON
ALCOHOLICS
VOLUME
ANONYMOUS AND
18
SPIRITUALITY IN
ADDICTION RECOVERY
ASAM
RSA
EDITED BY MARC GALANTER
AND LEE ANN KASKUTAS
An Official Publication of the American Society of Addiction Medicine
isbn 978-0-387-77724-5 and the Research Society on Alcoholism.
springer.com This series was founded by the National Council on Alcoholism.
RECENTDEVELOPMENTSIN
ALCOHOLISM
VOLUME18
RESEARCHONALCOHOLICS
ANONYMOUSANDSPIRITUALITY
INADDICTIONRECOVERY
RECENT
DEVELOPMENTS IN
Editedby
MARC GALANTER
NewYorkUniversitySchoolofMedicine
NewYork,NewYork
NatharKlineInstituteforPsychiatricResearch
Orangeburg,NewYork
and
LEE ANN KASKUTAS
AlcoholResearchGroup
Emeryville,California
Section Editors
LEE ANN KASKUTAS
THOMASINA BORKMAN
SARAH E. ZEMORE
J. SCOTT TONIGAN
AssistantEditor
DOLLYLAGRESSA
AnOfficialPublicationoftheAmericanSocietyofAddictionMedicine
andtheResearchSocietyonAlcoholism.
ThisserieswasfoundedbytheNationalCouncilonAlcoholism.
ALCOHOLISM
VOLUME 18
RESEARCH ON ALCOHOLICS
ANONYMOUS AND SPIRITUALITY
IN ADDICTION RECOVERY
The Twelve-Step Program Model
Spiritually Oriented Recovery
Twelve-Step Membership
Effectiveness and Outcome Research
123
MarcGalanter LeeAnnKaskutas
NewYorkUniversitySchoolofMedicine UniversityofManitoba
NewYork,NewYork Emeryville,California
NatharKlineInstitutefor
PsychiatricResearch
Orangeburg,NewYork
ISBN:978-0-387-77724-5 e-ISBN:978-0-387-77725-2
DOI:10.1007/978-0-387-77725-2
LibraryofCongressControlNumber:2008930475
(cid:2)c 2008SpringerScience+BusinessMedia,LLC
Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewrit-
tenpermissionofthepublisher(HumanaPress,999RiverviewDrive,Suite208,Totowa,NJ07512
USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis.Useinconnection
withanyformofinformationstorageandretrieval,electronicadaptation,computersoftware,orby
similarordissimilarmethodologynowknownorhereafterdevelopedisforbidden.
Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,evenif
theyarenotidentifiedassuch,isnottobetakenasanexpressionofopinionastowhetherornot
theyaresubjecttoproprietaryrights.
While the advice and information in this book are believed to be true and accurate at the date
of going to press, neither the authors nor the editors nor the publisher can accept any legal
responsibilityforanyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,
expressorimplied,withrespecttothematerialcontainedherein.
Printedonacid-freepaper
9 8 7 6 5 4 3 2 1
springer.com
ResearchSocietyonAlcoholism AmericanSocietyofAddictionMedicine
President: President:
RaymondAnton,M.D. MichaelM.Miller,M.D.,FASAM,FAPA
VicePresident: President-elect:
PeterMonti,Ph.D. LouisE.Baxter,Sr.,M.D.,FASAM
Secretary: ExecutiveVicePresident:
MaryLarimer,Ph.D. EileenMcGrath,JD
Treasurer: Secretary:
KennethLeonard,Ph.D. A.KenisonRoyIII,M.D.,FASAM,DFAPA
ImmediatePastPresident: Treasurer:
KathleenGrant,Ph.D. StuartGitlow,M.D.,M.P.H.,MBA,FAPA
PublicationsCommitteeChair: ImmediatePastPresident:
JanHoek,Ph.D. ElizabethF.Howell,M.D.,FASAM,DFAPA
Preface I
From the President of the American
Society for Addiction Medicine
RecentDevelopmentsinAlcoholismhasbeenanimportantcontributiontothelit-
eratureinAddictionMedicineforalmosttwodecades.Itisabitironicthatthis
year’santhologyaddressesnotoneoftherecent”new”thingsinrecovery,but
one of the oldest: the ability of active participation in Alcoholics Anonymous
and other related peer-assisted recovery activities to help initiate or sustain
recovery. It is not ”new” that AA, NA, Al-anon and the like are available in
communities around America and around the world or that thousands if not
millionsofpersonsinrecoveryhaveattributedtoAAamajorroleintheirrecov-
eries.Anditisnot”new”thatAAis,indeed,not”professionalhelp”andshould
neverbeconsidered”treatment”byanypatient,familymember,publicpolicy
maker, insurance company or managed care utilization reviewer.1 What is a
recent development is that it is no longer appropriate to say ”there is no
evidence about what AA is or how helpful it may be” or that ”evidence-
basedmedicineincludespharmacotherapiesandspecificprofessionalcounsel-
inginterventionsasreportedthroughrandomizedclinicaltrials,butitexcludes
peer-assisted recovery activities.” The R. Brinkley Smithers Distinguished Sci-
entistAwardgrantedattheASAMMedicalScientificConferencein2007hon-
ored the work of one of the co-editors of this volume, Lee Ann Kaskutas,
Dr.P.H.,oftheSchoolofPublicHealthoftheUniversityofCalifornia-Berkeley,
examiningeffectivenessliteratureonAAandtheroleofspiritualityinaddiction
andrecovery.
Much of health care is showing increasing interest in not only the
bio-psycho-social aspects of many health conditions, but the role of spiritu-
ality in recovery from illness. The addiction field can lead the way for the
rest of medicine in uncovering insights about this essential aspect of human
1 Relationship Between Treatment and Self Help: A Joint Statement of the American Society of
Addiction Medicine, the American Academy of Addiction Psychiatry and the American
PsychiatricAssociation.Adopted1997.
vii
viii Preface
experience.ThisvolumeincludesimportantarticlesbyDr.Kaskutasandmany
otheracademicianstoexpandourknowledgebaseandtoserveasanimportant
compilationofcontemporarythoughtanddata.Relatedtopics,suchastherole
of mindfulness meditation in recovery, are also addressed. As scientists such
as Richard Davidson, Ph.D. of the University of Wisconsin HealthEmotions
ResearchInstitute,learnmoreabouttheneurobiologyofemotionandtheneu-
rophysiologicchangesthatoccurwithmeditation,wegetclosertounderstand-
ingtheneurobiologyofrecoveryitself,whichwilllikelybeshownthroughneu-
roimagingstudiestobeaffectedbypeer-assistedactivitiesandother”self-help”
activitiessuchasparticipationin12-stepgroups.
MichaelM.Miller,M.D.,FASAM,FAPA
Preface II
From the President of the Research
Society on Alcoholism
ThisvolumeoftheRecentDevelopmentsinAlcoholismseries“ResearchonAlco-
holics Anonymous and Spirituality in Recovery” is an important and unique
contribution to our scientific understanding of recovery from alcoholism. In
essence, the body of work contained here frames an overall question of how
thetwelve-stepprocessestablishedbyAlcoholicsAnonymous(AA)intersects
withspiritualbeliefstoestablishabstinenceandguiderecoverywithlittlepro-
fessional input. The scientific debate over AA and twelve-step programs has
evolvedfromwhethertheyareeffectiveforindividualsthatutilizethemtowhy
they are effective and how to improve participation. This includes a detailed
look at special populations and the self-selection bias reflected in a voluntary
organization.ThefirstfourchaptersaddresswhoparticipatesinAAandhow
tomakeimprovementsintheparticipationoftwelve-stepprograms.Forindi-
vidualsthat“work”twelve-stepprograms,thereappearstobeincreasesinthe
spiritualgrowthandimprovementsinpsychosocialfunctioning.Severalchap-
ters, beginning with Chapter 5, define spiritual experiences and the impact of
spiritualityonrecoveryandrehabilitationfrommanypsychiatricdisorders,in-
cludingalcoholism.Anexpandeddefinitionofspiritualityincludesmeditative
practicesandthislendsitselftoexperimentaldesignsthataddresseffectiveness.
The“corespiritualbeliefs”ofAAandtheexplicitstepsinenhancingspirituality
are defined and examined. Chapters are devoted to understanding the role of
spiritualgrowththroughbuildingacommunitybyhelpingotheralcoholicsand
participatinginself-government.SeveralauthorsmakethedistinctionthatAA
is more than a twelve-step approach to attaining sobriety. Nevertheless, it is
alsoclearthatthetwelve-stepprogramofAAsetsaprototype“roadtorecov-
ery” for many other addictions. Also included is how the research questions
that address the effectiveness of AA and the role of spirituality are framed by
historical perspectives, a lesson for how this volume will be received decades
fromnow.
ix
x Preface
Thescopeanddepthofthisvolumewillundoubtedlymakeitanimpor-
tantreferenceforthepracticingphysicianandscientistsinterestedinimproving
recoveryfromalcoholismorotheraddictions.
KathleenGrant,Ph.D.