Kaskutas, Lee Ann

Subbaraman, Meenakshi S

Zemore, Sarah E

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Washington University School of MedicineDigital Commons@BeckerPosters2010: Disentangling the Genetics of Alcoholism:Understanding Pathophysiology and ImprovingTreatment2010Do particular AA activities explain the effect of a12-step facilitation program (MAAEZ) on alcoholand drug abstinence?Meenakshi S. SubbaramanUniversity of California - BerkeleyLee Ann KaskutasUniversity of California - BerkeleySarah E. ZemoreUniversity of California - BerkeleyFollow this and additional works at: http://digitalcommons.wustl.edu/guzeposter2010Part of the Medicine and Health Sciences CommonsThis Poster is brought to you for free and open access by the 2010: Disentangling the Genetics of Alcoholism: Understanding Pathophysiology andImproving Treatment at Digital Commons@Becker. It has been accepted for inclusion in Posters by an authorized administrator of DigitalCommons@Becker. For more information, please contact engeszer@wustl.edu.Recommended CitationSubbaraman, Meenakshi S.; Kaskutas, Lee Ann; and Zemore, Sarah E., "Do particular AA activities explain the effect of a 12-stepfacilitation program (MAAEZ) on alcohol and drug abstinence?" (2010). Posters. Paper 34 Samuel B. Guze Symposium onAlcoholism.http://digitalcommons.wustl.edu/guzeposter2010/34Do particular AA activities explain the effect of a 12-step facilitation program (MAAEZ) on alcohol and drug abstinence?Meenakshi S. Subbaraman, M.S., Lee Ann Kaskutas, Dr.P.H., Sarah E. Zemore, Ph.D.Alcohol Research Group, Emeryville, CA; University of California Berkeley, School of Public HealthSupported by NIAAA Grant R01 AA14688BACKGROUNDWhat is MAAEZ (Making Alcoholics Anonymous Easier)?• Manualized, group-format intervention• Designed for treatment centers• Aimed at engaging participants in 12-step fellowship• Prepares participants for 12-step cultureIs MAAEZ effective?• A recent trial showed that MAAEZ participants had increased odds of abstinence compared to the control group [OR = 1.58, p = 0.063; Kaskutas et al. (2009)]• MAAEZ also appeared especially effective for participants with high prior AA attendance, as well as those with high psychological severityDESCRIPTION of MAAEZ TRIAL PARTICIPANTS: (N=508)Sample overall:• Anyone already in treatment was eligible for the MAAEZ trial• 67% male, mean age 36, 20% African American, 52% White • 312 in MAAEZ, 196 in usual careHigh prior AA attendance (> 90 lifetime meetings):• 69% male, mean age 39, 16% African American, 66% White • 119 in MAAEZ, 84 in usual careHigh psychological severity (> median ASI psych):• 65% male, mean age 36, 20% African American, 55% White • 140 in MAAEZ, 115 in usual careMEASURES• All variables measured at baseline, 7 weeks, 6 months, and 12 months after baseline• Questions asked about social network composition, AA attitudes and involvement, psychological problems, psychological severity, and drinking and drug usePROCEDURES• Usual care compared to MAAEZ intervention in health services trial• Face to face and telephone interviews• Urinalysis performed for abstinence verificationMETHODS• Analyses were identical in the sample overall and when performed within subgroups• Because the goal of MAAEZ is to engage participants in 12-step culture, the potential pool of mediators included activities such as sponsoring, reading literature, attending meetings, doing service, comfort speaking and comfort being at meetings- Crosstabs and ANOVAs were used to empirically narrowthis pool• The Baron and Kenny (B&K) method was implemented controlling for marital status, treatment program type (long-term residential, short-term residential, outpatient), and length of stay in treatment in all models - These covariates were chosen because they related to treatment and outcome as well as several of themediators• Sobel’s test was used to verify robustness of the Baron and Kenny method findings• We also implemented a macro that allows for control of multiple continuous mediators: proportion of social network who supports sobriety, comfort being at meetings, and comfort speaking at meetingsMETHODS:SOBEL’S TESTMAAEZ conditionAbstinence, 12 monthsMediator(measured at 6 months, 12 months, or both)METHODS:THE BARON & KENNY PATHSa bc'MAAEZ conditionAbstinence, 12 monthsc2222 ** ba seasebabz+=RESULTS: Significant paths a and b, mediators measured at 6 monthsMAAEZ conditionAbstinence, 12 monthsDone serviceComfort speakingComfort @ mtgSupport for sobriety(*) (*)* * * * ** * ** *(*) * * ** (*)* p<0.05, sample overall                   (*) p<0.10, sample overall * p<0.05, high prior AA attendance   (*) p<0.10, high prior AA attendance* p<0.05, high psych severity            (*) p<0.10, high psych severityHave sponsorRESULTS: Significant paths a and b, mediators measured at 12 monthsMAAEZ conditionAbstinence, 12 monthsDone serviceComfort speakingComfort @ mtgSupport for sobriety(*) (*)(*) * * ** * ** * ** * ** * *Have sponsor* (*)(*)CONCLUSIONS AA activities, especially doing service, mediate the effects of MAAEZ in both the sample overall and within subgroups  Having support for sobriety is especially important for those with high prior AA and those with high psychological severity Neither increased meeting attendance nor composite AA activity measures appeared to mediate MAAEZ effects  Results suggest that MAAEZ works by connecting people with other AA membersRESULTS: Significant paths a and b, mediators measured at both 6 and 12 monthsMAAEZ conditionAbstinence, 12 monthsDone service6 and 12(*) * * *Have sponsor,6 and 12* * ** (*) *RESULTS: Moderated mediationMAAEZ conditionClean and sober, 12 monthsDoing service,6&12 monthsHigh psych sevMAAEZ conditionClean and sober, 12 monthsSupport for sobriety,6 monthsHigh prior AA or High Psych Sev* *** * * ** *RESULTS: Multiple mediation,mediators measured at 6 monthsMAAEZ conditionClean and sober, 12 monthsSupport for sobriety+Comfort speaking+Comfort @ mtgHigh prior AA or High Psych Sev* * * ** *RESULTS: B&K and Sobel’sMediator Overall High Prior AA High Psych Sev6 mo 12 mo 6 mo 12 mo 6 mo 12 moSponsor                                    B (S)Service          (S)       B (S) B (S) B (S)Support                                     B S          B B (S)Comf speak              B (S) BComf @ mtg             B (S) (S)Sponsor, 6&12                                       B (S)Service, 6&12            (S) B (S) B S• B = meets Baron and Kenny criteria • S = Sobel’s statistic, p<0.05• (S) =  Sobel’s statistic, p<0.1

Do particular AA activities explain the effect of a 12-step facilitation program (MAAEZ) on alcohol and drug abstinence?

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Do particular AA activities explain the effect of a 12-step facilitation program (MAAEZ) on alcohol and drug abstinence?

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