Research suggests that AA involvement may lead to improved alcohol outcomes and psychosocial adjustment. Alcoholism clients who participate in both formal treatment (e.g., outpatient treatment) and AA have improved drinking outcomes relative to those who participate in treatment only. However, despite AA's apparent popularity, many problem drinkers do not avail themselves of AA's resources or quickly cease attendance after only brief exposure. With this evidence in mind, the proposed project will assess the effectiveness of two strategies designed to facilitate involvement in AA in the context of a 12-session outpatient alcoholism treatment program. Clients will be assigned to one of three treatment conditions: minimal encouragement of AA, a directive-confrontive approach, and a motivational approach. All clients, regardless of condition, will be instructed by their therapist to attend AA meetings. The control condition will consist of a standard structured outpatient alcoholism therapy package with a minimal emphasis on AA. The directive- confrontive approach will include confrontation and interpretation of resistance towards AA as """"""""denial,"""""""" and directives for AA-related discussions and readings, and maintaining an AA journal. The motivational approach will attempt to reduce ambivalence toward AA and enhance clients' levels of intrinsic motivation for participation in AA. These facilitation strategies are designed to be easily portable to other treatment protocols. In terms of between-group differences, we hypothesize that the AA facilitation strategies will lead to greater AA involvement relative to the control condition. Further, in terms of the Elaboration Likelihood Model of persuasion, the motivational approach encourages greater cognitive elaboration and is expected to lead to more AA involvement than the directive-confrontive approach. Analyses will focus on the relative effects of the AA-facilitating interventions on AA involvement and treatment outcome, the prediction of AA participation, and the role of mediating variables in AA involvement. The proposal contains a priori and post hoc hypotheses and analyses to study the simple and complex relations among substance involvement and AA involvement, pragmatism, spirituality, meaning seeking, disease model beliefs, psychiatric symptomatology, personality measures, stages of change, and social support.
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