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Issues in the Implementation of a Randomized Clinical Trial That Includes Alcoholics Anonymous: Studying AA-Related Behaviors during Treatment
Barbara S. McCrady, Elizabeth E. Epstein, Linda S. Hirsch
Objective: The purpose of this study is to examine implementation of a randomized clinical trial and within treatment behavior when AA is included as an element of treatment. Special attention is given to the measurement of compliance, use of treatment skills, and the nature and extent of involvement with AA during the active phase of treatment. Method: Subjects, 90 male alcoholics and their female partners seeking conjoint, outpatient behavioral alcoholism treatment, were randomly assigned to one of three treatments: alcohol-focused behavioral marital therapy (ABMT), ABMT plus AA/Alanon (AA/ABMT), or ABMT plus relapse prevention (RP/ABMT). Within treatment data are reported for the 68 couples who completed at least five treatment sessions. Measures included: treatment attrition, number of treatment sessions, attendance at AA and Alanon, use of AA and Alanon skills, compliance with homework assignments and drinking during treatment. Results: Several aspects of within treatment behavior were examined: (1) Attrition: There was no differential attrition across treatment conditions, with 24.4% of couples discontinuing treatment prior to the fifth session. (2) AA and Alanon attendance: Subjects in the AA/ABMT treatment were more likely to attend AA (91.7% attended at least one AA meeting; 58.3% attended at least one Alanon meeting) than were subjects in the other treatment conditions (18% attended at least one AA meeting and 14% at least one Alanon meeting). Subjects in the AA/ABMT condition attended significantly more AA and Alanon meetings than did subjects in the other treatment conditions. (3) Homework compliance: Subjects generally showed no differences in compliance with homework assignments, but spouses in the AA/ABMT condition completed less condition-specific homework (37.2%, versus 67.8% for the RP/ABMT spouses) because of low utilization of Alanon. (4) Use of AA-related skills: Subjects reported using AA-related skills more frequently in the AA/ABMT condition than in the other treatment conditions. (5) Patterns of attendance: Analyses of AA attendance during treatment revealed three patterns: positive attendance, characterized by regular AA attendance or increasing use of AA across treatment; negative attendance, characterized by decreased AA attendance over time; and nonattendance, characterized by none or infrequent and erratic attendance. Conclusions: Randomized clinical trials can be used to study AA. Use of multiple measures of treatment compliance and examination of patterns of AA utilization use over time provide more complex views of the patterns of involvement with AA than do simple descriptive reports of attendance. (J. Stud. Alcohol 57: 604-612, 1996)