Alcoholics Anonymous (AA) is the most popular approach in the United States for dealing with alcohol-related problems, and for many persons AA participation in associated with drinking reductions and improved psychosocial functioning. Both manual guided and less controlled studies examining 12-step therapy indicate that it is equally effective as cognitive behavioral therapy, and may actually be superior when total abstinence is the treatment goal. While progress has been made in identifying both the characteristics of individuals most likely to affiliate with AA and the magnitude and kind of benefits that AA may offer, we still know very little about the relationships between prescribed AA-related practices and outcome. According to AA doctrine, central to AA-related change mechanisms is the spiritual development of AA members, of which we know even less. In response to the NIAAA and Fetzer Institute RFA on """"""""Studying Spirituality and Alcohol"""""""" (AA-00-002), the purpose of this study is to conduct a 10-year follow-up of clients recruited in Project MATCH at the Albuquerque clinical research unit (N-224). In addition to extending knowledge of the relative outcome of clients assigned to three psychosocial therapies beyond three-years, this study will address the long-term development of spiritual beliefs and practices of AA exposed individuals. Longitudinal study of AA exposed individuals suggests that reductions in AA meeting attendance can be accompanied with increased practice of AA-related behaviors, a riddle not explained by AA doctrine or research assumptions about AA disaffiliation. A major aim of this study is to examine what role, if any, spiritual development plays in the process of internalizing AA-related behaviors. Spiritual development itself can be viewed as a dependent measure, a process measure, and as a predictor of outcome in regards to AA affiliation. This study will examine each of these three perspectives of spiritual development, and in so doing will offer a radically new definition of AA disaffiliation, one based upon the cessation of AA-related practices and beliefs rather than upon AA meeting attendance. Maturation is an important consideration when evaluating changes in spirituality because of the tendency for aging individuals to increasingly embrace religious and spiritual beliefs and practices. This is an especially salient concern in a 10-year follow-up study, and the proposed study offers several strategies to partial out the unique aspects of spirituality as it is practiced in AA.
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