CHARACTERISTICS OF ALCOHOLICS ANONYMOUS MEMBERSHIP: 1992

Comparison of Americans with alcohol use disorders who 1) never attend AA, 2) attend AA and drop out, and 3) continue to attend AA.

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1.  INTRODUCTION

In the US more people report going to an Alcoholics Anonymous (AA) meeting than reported going to any other support or therapy group for an alcohol problem. [1] Despite the importance of accurate incidence and prevalence information on AA membership the research data has been sparse.   

Data on membership in AA has been reported in the Triennial Surveys conducted by Alcoholics Anonymous World Service every three years from 1968 to 2007 . However these studies did not cover incidence and characteristics of new AA members or prevalence and characteristics of discontinued AA members. Also, the AA Triennial Surveys have other significant limitations [2] i.e., there are limitations in survey coverage, it has been estimated that about 20% of the AA groups are not registered with Intergroup Offices and therefore are not a part of the survey sample. In addition, while AA World Services in 1983 adopted a stratified sampling process, the findings of the AA surveys have never been validated in an independent representative sample of the US population.
 

This paper is a descriptive study of social, demographic, and behavioral characteristics associated with 1) never attending AA,  2) dropping out of AA, and 3) continuing membership in AA .

 

 

2.  METHODS

 

2.1  Sample

This study was based on the 1992 National Longitudinal Alcohol Epidemiologic Survey, sponsored by the National Institute on Alcohol Abuse and Alcoholism[14] data were collected via personal interviews onducted in respondents’ homes by US Bureau of the Census interviewers.  The survey sample consisted of adults 18 years or older who were selected at random from a nationally representative sample of households. .

  

2.2  Measures

 

2.2.1  Alcohol Use Disorders

Diagnoses of alcohol use disorders (AUD), as classified in the Diagnostic and Statistical  Manual of Mental Disorders, Fourth Edition (DSM-IV), were derived from the Alcohol Use Disorders and Associated Disabilities Interview Schedule, a fully structured psychiatric interview designed to be administered by trained lay interviewers[16] 

The interview schedule included an extensive list of  30 symptom items that operationalized the DSM-IV criteria for alcohol abuse and dependence.

Respondents were classified with past year dependence if they met at least 3 of the 7 DSM-IV criteria for dependence within the 1-year period preceding the interview: tolerance; withdrawal or avoidance of withdrawal; desire or attempts to cut down or stop drinking; much time spent on drinking, obtaining alcohol, or recovering from its effects; reduction/ cessation of important activities in favor of drinking; impaired control; and continue drinking despite physical or psychological problems caused or exacerbated by drinking.

Respondents were classified with past-year alcohol abuse if they met at least 1 of the 4 DSM-IV criteria for abuse in the 1-year period preceding the interview: alcohol related legal problems, continued drinking despite interpersonal problems, neglect of role responsibilities as a result of drinking, and drinking in hazardous situations.

 

2.2.2  Alcoholics Anonymous Attendance

 
Attended AA = Item 7003 and item 7015-2 or 7015-3
        Attended AA meeting during period prior-to-past year
 
Continued AA Attendance = item 7003 and item 7015-3
        Attended AA prior-to-past year and past year
 
Discontinued AA Attendance = item 7003 and item 7015-2
        Attended AA prior-to-past year and did not attend AA during past year
 
 
 

2.2.3  Socio-demographic Variables

 
Gender
1)  Male
2)  Female 
Age
1) 18-29 years
2) 30-39 years
3) 40-49 years
4) 50+ years
Race
1)  White
2)  Black
3)  American Indian/Alaskan Native
4)  Asian/Pacific Islander
Marital Status
1)  Married
2)  Cohabited
3)  Widowed
4)  Divorced
5)  Separated
6)  Never married 
Education
1) grade 7 or less
2) grade 8

3) grade 9-11
4) grade 12
5) some college
6) completed college 
Employment Status
1)  Employed
2)  Unemployed 
3   Retired
4)  In-school
5)  Full-time homemaker
6)  Other
Geographic Region
1)  North-East
2)  Mid-West
3)  South
4)  West
Urban/Rural
1)  Urban
2)  Rural
 
 
 

2.2.4  Behavioral Measures

Past-Year Drinking Behavior
 
Abstinence =  No consumption of alcoholic beverages during the past year

Low Risk Drinking=  Consumed alcohol during the past year, but did not exceed 4 drinks on any day for men and 3 drinks on any day for women

High Risk Drinking= Consumed alcohol during the past year exceeding 4 drinks on any day for men and 3 drinks on any day for women
 
 
Severity of Alcohol Problems
 
High Severity
For the purpose of this study High Severity was defined as having met 15 or more of the Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS) items used to diagnose DSM-IV Alcohol Abuse and Dependence.  
 
A Rasch model analysis[3]  of the alcohol abuse and dependence items in the the AUDADIS demonstrated the unidemensional nature of the AUDADIS items and supports the creation of an additive index of items as a measure of severity.
 
Low Severity
Having met 14 or less of the AUDADIS criteria items.
 

 

Age First Drinking
1)  15 Years or older
2)  14 years or young 

Mental Health Problems
Item 6168 “Have you ever had a mental or emotional problem”,  
item 7170  “Have you ever seen anyone for a mental or emotional problem – a doctor, counselor, or any othe health professional?”.
 
Item 7171  “Have you ever been a patient in any type of hospital or clinic overnight because of  mental or emotional problems?”
Health Problems
Item 2244 “Did you ever have any health problem as a result of your drinking – like stomach or liver disease, memory problems, or pancreatits?”
 
Item 2142 “Continue to drink even though you knew it was causing you a health problem or making a health problem worse?”
 
Item 2217 ” Continue to drink even though you had a sertious health problem that might be made worse by drinking?”
 School/job problems
Item 2224  Have job or school trouble because of your drinking – like missing too much work, not doing your work well, being demoted at work, or dropping out of school?” 
Family problems
Item 2225  “Drift apart from a spouse, boyfriend/girlfriend, relative, or friend you cared about because of your drinking?” 
Personal Accidents
Item 2243 ” Accidentally injure yourself while under the influence of alcohol, for example , have a bad fall or cut yourself badly, get hurt in a traffic accident, or anything else.” 
Vehicle Acidents
Item 2226  “Have a car, notorcycle, truck, boat, or other accident becuse of your drinking?” 
Arrests
Item 2227  “Get arrested or held at a police station because of your drinking?”
Fights
Fights
Item 2228   “Get into a physical fight while drinking or right after drinking?” 
Driving problems
Item 2111  “Drive a car, motorcycle, truck, boat, or other vehicle after having too much to drink?”
 
Drug Use
Sedatives
Item 5104  Did you ever use sedatives, for example sleeping pills, barbituates, Seconal, Quaaludes, or Chloral Hydrate at least 12 times, on your own, before past year
Tranquilizers
Item 5123  Did you ever use tranquilizers or ant-anxiety drugs, for example Valium, Librium, muscle relaxants,or Xanax at least 12 times, on your own, before past year
 
Painkillers
Item  5142   Did you ever use painkillers, for example Codine, Darvon, Percodan, Dilaudid, or Demerol at least 12 times, on your own, before past year 
Stimulants
Item 5161  Did you ever use stimulants, for example Preludin, benzadrine, methedrine, uppers, or speed at least 12 times, on your own, before past year
 
Marijuana

Item 5180   Did you ever use marijuana, hash, THC, or grass at least 12 times, on your own, before past year

Cocaine
Item 5199   Did you ever use cocaine or crack at least 12 times, on your own, before past year
Heroin
Item 5219   Did you ever use heroin at least 12 times, on your own, before past year
Methadone
Item 5234   Did you ever use methadone at least 12 times, on your own, before past year
Any Other Drug
Item 5251 or item 5268    Did you ever use other medicines, drugs or substances, for example, amyl nitrate, nitrous oxide, elavil, thorazine, or hallucinogens, such as LSD, mescaline, psilocybin, PCP, angel dust or peyote least 12 times, on your own, before past year
 

2.3  ANALYSIS

 

The descriptive statististics in this study are categorical data therefore the chi-square test is used to determine whether there is association between the categorical variables and attendance in AA.   

For the purposes of this study the acceptance of the null hypothesis that there is no association is a P-value greater than 0.05.

 

3.  Results

 

3.1   AA Attendance

 
 
 
Of the individuals who met the criteria for DM-IV alcohol abuse/dependence during the period prior-to-the past year, 85% never attended an AA meeting,  10% attended AA but dropped out, and 5% continued to attend AA during the past year.  (Table 1.)
 
 
 ALCOHOLICS  ANONYMOUS  ATTENDANCE       %
 Never Attended AA      85%
 Dropped Out of AA      10%
 Continued in AA        5%
   
 No. of Cases     5,728    
Table 1.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period prior-to-past year by attendance in Alcoholics Anonymous:  NLAES 1992

 
 

 3.2  Gender

 
 

 
As shown in Table  2, women, with alcohol use disorders, where less likely to attend AA, but when they did attend they were more likely to continue ( X2  =  4.4278, df = 1, p = <.05).
 
 
 GENDER  Never Attended AA     Dropped Out of AA      Continued in AA       Total
 Male            60%          73%          66%      62%
 Female            40%          27%          34%       38%
     Total              100%        100%         100%      100%
 No. of Cases          4,961          568          299      5,728    
Table  2.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period prior-to-past year by attenance in Alcoholics Anonymous by gender:  NLAES 1992
 
 

 3.3  Age

 
 
As shown in Table 3,  the younger age group, 18-29 years, is significantly less likely to attend AA   (X2 = 32.4039, df = 1, p = <0.001).
 
__

 AGE   Never Attended AA      Dropped Out of AA       Continued in AA          Total    
 18 to 29 years              32%              23%              21%       31%
 30 to  39 years              31%              31%              32%        31%
 40 to 49 years              19%              21%              24%        19%
 50+  years              18%              25%              23%        19%
     Total            100%            100%            100%      100%
No. of cases              4,861              568              299      5,728

 Table  3.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period prior-to-past year by attendance in Alcoholics Anonymous by age:  NLAES 1992

                                          

 

 

3.4  Race

 
A significatly higher proportion, 9%, of Americans who dropped out of AA where Black, while only 5% of individuals continuing in AA where Black.  (Table  4).
(X2 = 4.1483,  df = 1,  p = <.05)
 

 

 RACE   Never Attended AA      Dropped Out of AA       Continued in AA       Total
 White              89%              88%              92%        89%
 Black                8%                9%                 5%          8%
 Amer Indian  Alaska Native                1%                2%                 2%          1%
 Asian  Pacific Islander                1%                0%                 0%          1%
 Other                1%                1%                 1%          1%
     Total            100%            100%              100%      100%
 No. of cases          4,861              568                 299       5,684    

Table  4.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period prior-to-past year by attendance in Alcoholics Anonymous by race:  NLAES 1992 

 

 3.5  Marital Status

 
 
AA attendance is associated with marital status (Table  5).   The proportion of divorced individuals who continued to attend AA, 26%, is significantly larger than the proportion of divorced individuals who never attended AA, 13%   (X2 = 70.9722,  df  1,  p = < 0.001.

                         

 MARITAL STATUS   Never Attended AA      Dropped Out of AA       Continued in AA      Total 
 Married              51%              43%              37%      49%
 Cohabited                4%                4%                 6%          4%
 Widowed                3%                3%                 4%           3%
 Divorced              13%               22%               26%         13%
 Separated                4%                5%                 6%          4%
 Never  Married              26%              23%               21%        25%
     Total            100%            100%              100%      100%
 No. of cases              4,824              565                 298       5,687    

Table  5.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period prior-to-past year by attendance in Alcoholics Anonymous by marital status:  NLAES 1992 

 
 

3.6  EDUCATION 

 
 
Continuation in AA is associated with education level (Table  6).  Individuals who completed college were less likely to drop out of AA   (X2 =  11.9529 , df = 1,  p =  <0.001)
 

__

 EDUCATION   Never Attended AA      Dropped Out of AA       Continued in AA         Total
 Grade 7 or less                2%                    3%                1%          2%
 Grade 8                2%                    2%                3%          2%
 Grade 9 to 11              10%                  15%              12%        10%
 Grade 12              28%                  36%              29%        29%
 Some college              31%                  29%              30%        31%
 Completed  college              27%                  15%              25%        26%
     Total          100%                100%            100%      100%
 No. of cases              4,821                  560              297      5,678    

Table  6.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period prior-to-past year by attendance in Alcoholics Anonymous by education:  NLAES 1992 

 

 
3.7  EMPLOYMENT
 

AA attendance is associated with employment status.  Individuals who were unemployed were significantly more likely to continue to attend AA  (Table 7)  (X2 = 59.7, df=1, p = ,0.001).

 
 EMPLOYMENT   Never Attended AA     Dropped Out of AA       Continued in AA     Total    
 Employed               72%             68%          67%      72%
 Unemployed                6%             12%           10%         7%
 Retired                7%               9%            7%        7%
 In school                6%               4%             5%        6%
 Homemaker                6%               6%                 7%         6%
 Other                2%               2%            3%        2%
     Total                100%              100%          100%      100%
 No .of cases              4,789                  551              294      5,634
Table  7.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period prior-to-past year by attendance in Alcoholics Anonymous by employment:  NLAES 1992 

 

 

3.5  REGION

 

 

In the United States AA attendance varies significantly by geographic region. 
The majority, 57%, of individuals with AUD live in the Mid-West/South regions
of the United States, but only 48% of individuals in the Mid-West/South regions
 continued to attend AA (Table 8).  (X2 = 6.4718, df -=1, p =<.05)
 
 REGION   Never Attended AA      Dropped Out of AA       Continued in AA      Total 
 NorthEast &  West              43%              43%              52%       43%    
 MidWest & South              57%              57%              48%        57%
     Total            100%            100%            100%      100%
No. of cases          4,861             568              299     5,728
Table  8.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period prior-to-past year by attendance in Alcoholics Anonymous by geographic region:  NLAES 1992

 

 3.  URBAN/RURAL

The majority, 76%, of Americans with AUD live in the urban areas of the United States. 
A significantly higher proportion, 81%, of the urban residents continued to attend AA 
 (Table  9) (X2 = 4.0964, df = 1, p = < .05). 

 

 URBAN/RURAL   Never Attended AA      Dropped Out of AA       Continued in AA       Total
 Urban              76%              75%             81%        76%    
 Rural              24%              25%             19%        24%
     Total            100%            100%            100%      100%
No. of cases              4,758              552              292      5,602
Table  9.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period prior-to-past year by attendance in Alcoholics Anonymous by urban/rural:  NLAES 1992 
 
 

4.  BEHAVIORAL MEASURES

 

4.1  PAST YEAR DRINKING BEHAVIOR

 
 
Drinking behavior during the past year is associated with AA attendance.  Only
21% of the total Americans with AUD reported abstinence during the past year,
but 64% of those who continued to attend AA were abstinent  during the past
 year  (Table 10).   High risk drinking during the past year is associated with
never attending AA, 57%, vs contined attendance in AA (28%)

 

 Past Year Drinking
 Never Attended AA     Dropped Out of AA   Continued in AA    Total
 Abstinent            16%            37%               64%        21%
 Low Risk            27%            11%              8%        24%
 High Risk            57%            52%                                    28%          55%
     Total          100%          100%          100%      100%
 No. of cases          4,861              569              290      5,728    
Table 10.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period
 prior-to-past year by attendance in Alcoholics Anonymous by past year drinking behavior :  NLAES
1992 
 
 

4.2  SEVERITY OF ALCOHOL PROBLEMS

 
 

AA attendance is associated with the level of severity of alcohol problems.   A higher 

proportion, 68%, of individuals continuing to attend AA report high severity of alcohol
problems as compared to only 13% of those who never attended AA  (Table  11) .

 

 

 SEVERITY
  Never Attended AA   
 Dropped Out of AA
  Continued in AA  
 Total
 Low Severity
             87%
            53% 
             32%
       80%    
 High Severity
             13%        
            47% 
             68%    
       20%
     Total
         100%
         100%
           100%
     100%
 No. of cases
         4,861
             568
             299
     5,728

Table  11.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period
 prior-to-past year by attendance in Alcoholics Anonymous by severity of alcohol problems:  NLAES
1992 
 
 

              

                 

             

 4.3    AGE OF FIRST DRINK   

 

             

               

          

 AGE FIRST DRINK  Never Attended AA  Dropped Out of AA  Continued in AA  Total
 15 years or older              87%              76%          66%      85%
 14 years or younger              13%              24%          34%      15%
     Total            100%            100%        100%    100%
 No. of cases          4,819             567               297      5,683    
                                         
 Table  12.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period
prior-to-past year by attendance in Alcoholics Anonymous by age of first drink:  NLAES 1992 

 

 

     

 4.4   NEGATIVE LIFE EVENTS

 
 NEGATIVE LIFE PROBLEMS
 Never Attended AA  Dropped Out of AA  Continued in AA  Total
 Mental  Health                9%              39%          56%      15%    
 Health                5%              23%                      37%      10%
 School/Job                9%              33%          50%      14%
 Family              34%              47%          71%      20%
 Personal  Accidents              20%              42%           60%      25%
 Vehicle  Acfidents              14%              37%          52%      18%
 Arrersts              19%              56%          58%      25%
 Fights              29%              54%          55%      33%
 Driving              77%              83%          90%      78%
         
 No. of cases             4,861               561          299      5,691
Table  13.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period
prior-to-past year by attendance in Alcoholics Anonymous by negative life problems:  NLAES 1992 
 
 
     
 4.5  PRIOR-TO-PAST YEAR DRUG USE
 
 DRUG USE
 Never Attended AA
 Dropped Out of AA
 Continued in AA
 Total
 Sedatives
               7%
             20%
             23%
       9%
 Tranquilizers                7%              21%              26%      10%
 Painkillers
               7%
             19%
             22%
       9%
 Stimulants
             14%
             28%
             36%
     17%
 Marijuana
             39%
             52%
             56%    
     41%
 Cocaine
             12%       
             28%
             34%
     15%
 Heroin
               1%
               5%
               8%
       2%
 Methadone
               1 %
               2%
               5%
       1%
 Other
               8%
             19%
             25%
     10%
 
 
 
 
 
 No.of cases
         4,861
             568
             299
     5,728

 

Table  14.   Americans who met the criteria for DSM-IV alcohol abuse/dependence during the period prior-to-past year by attendance in Alcoholics Anonymous by prior-to-past yeasr drug use:  NLAES 1992 

 
 
4.  CONCLUSIONS
 
In this study, a wide array of socio-economic and behavioral variables demonstrate the heterogenity of the DSM-IV alcohol abuse/dependence diagnostic catergory.   This heterogeniety has been modeled by Markon and Krueger [6] as an externalizing disorders spectrum.
 
Only 15% of Americans with DSM-IV alcohol abuse/dependence ever attended AA meetingsThe socio-economic and behavioral characteristics of the 15% who ever attend AA meetings form a cluster which represent a high severity dimension of the externalizing disorder spectrum continuum.
 
The 85% of Americans with DSM-IV alcohol abuse/dependence who never attend AA meetings form a cluster which represents the low severity dimension of the externalizing disorders spectrum continuum. 
 
This study’s findings concerning gender, age and occupations of ,individuals continuing to attend AA replicate and validate the findings in the Alcoholics Anonymous 1992 Membership Survey [4]  This is the first study validating the AA surveys in an independant representative sample of the US population.
 
In addition to validating the AA membership surveys this study provides information on additional socio-demographic and behavioral variables associated with AA membership including AA drop outs and individuals with alcohol use disorders who never attend AA.
 
This study’s findings support Battaglini et al’s [5]  behavioral economic model of Alcoholics Anonymous as a self-control commitment device used by respondents, with high perceived severity of alcohol-related problems, to achieve and supporting abstinence.
 
Only 15% of Americans with alcohol use disorders ever attended AA meetings.  This low level of AA meeting attendance is associated with the low level, 20%,  of perceived severity of alcohol-related problems in the alcohol use disorders group.
 
As characterized by the socio-demographic and behavioral variables in this study the categories “never attended AA” and “ever attended AA” represent statisticaly discrete dimensions in the externalizing disorders spectrum as modeled by Markon and Krueger [6].
 
 
Low Severity Externalizing                High Severity Externalizing     
        Disorder                                                    Disorder
       [Never Attended AA ]                     [Ever Attended AA]
 
 
    Younger age, 18-29 years                Older age, 30 years and over
 
    Some college or higher                    High schol graduate or less
 
    Non-Divorced                                   Divorced
 
    Employed                                          Unemployed
 
    Low alcohol severity                         High alcohol severity
 
    Late age first drink, 15 years            Early age first drink, 14 years
     or older                                                or younger
 
    Low number of negative life            High number of negative life           
     events                                                 events

    Low prior year drug usage              High prior year drug usage              
 
 
In 1992 Americans with alcohol use disorders who continued to attend AA were more likely achieve abstinence (64%) than those who attended AA and dropped out (37%) or those who never attended AA (16%).
 

Low risk drinking as a recovery outcome was highest in those who never attended AA (27%), and lowest in those who dropped out of AA (11%) and in those who continued to attend AA (8%).

High risk drinking relapse was highest in those who never attended AA (57%) and in those who dropped out of AA (52%).  Those continuing to attend AA had a significantly lower proportion that relapsed and returned to high risk drinking (28%)

Drinking behavior outcomes during the past year were significantly associated with the level of severity.  Abstinence was associated with high severity 41% vs low severity 16% .  Low risk drinking was associated with low severity 26s% vs high severity  16%.  High risk drinking was associated with low severity 58% vs high severity 43%.

 
AA attendance was associated with level of severity. Never attending AA was associated with low severity 87% vs high severity 13%.  Respondents reporting low level of severity showed a higher proportion dropping out of AA  53% vs high severity 47%.  Continuation in AA was associated with high severity 68% vs 32% low severity.
 
AA attendance was associated with age.  As age increased the proportion of Americans with alcohol use disorders who never attended AA decreased, 18-29 years 32%, 30-39 years 31%, 40-49 years 19%, 50 years and older 18%.  The  proportion who attended AA and dropped out and the proportion who continued to attend AA both increased with increased age.
 
Drinking behavior outcomes were significantly associated with age .