Researchers prove validated instrument to measure AA-related helping

April 8, 2010, Case Western Reserve University

Maria Pagano, PhD, assistant professor of psychiatry at Case Western Reserve University School of Medicine, has established an empirical model to quantify and gauge an alcohol addicts' level of engagement in Alcoholics Anonymous (AA)-related helping (AAH). The instrument validity study, "Running Head: Service to Others in Sobriety," is published in the spring 2010 issue of Alcoholism Treatment Quarterly.

This study is a natural extension of Dr. Pagano's 2004 study, "Helping others in Alcoholics Anonymous and drinking outcomes: Findings from Project MATCH," published in the Journal of Studies on Alcoholism (65, 766-773).The study involved 1,726 treatment-seeking alcoholics in Project MATCH. In this study, Dr. Pagano demonstrated that AAH cut the risk of relapse in half in the year following discharge.

"Service was originally conceived by AA co-founders in Ohio to represent one-third of the 12-step recovery program. Many counselors agree that service has diminished over time as an important recovery activity to involve alcoholics in as a method to stay sober," said Dr. Pagano.

With evidence of the salience of service work in sustaining sobriety, Dr. Pagano developed a method to quantify and gauge an alcoholic's participation level in AAH. In in-depth interviews with AA members with more than 20 years of sobriety, her continued research found AAH to be rated as very important during early recovery as well as in long-term recovery. As a result of the empirical work and qualitative interviews with recovering alcoholics, Dr. Pagano designed a tool that assesses AAH participation, the "Service to Others in Sobriety" (SOS) tool.

"The SOS measures the degree to which an alcoholic is giving service as a good citizen of AA, such as being the coffee maker or door greeter," said Dr. Pagano. "It also measures service activity in sharing recovery experience, strength and hope with fellow sufferers."

Both, concrete acts of service and personal sharing appear important in living sober as reported in the study.

Individuals were asked to report how often in the past month they participated in common AAH activities. The responses ranged from "rarely" to "always". SOS items were then summed to form a total score ranging from 12-60.

"Service activities measured by the SOS are free, accessible, available to all patients regardless of education, gender, or racial background, and can be encouraged right from the start," said Dr. Pagano. "The SOS tool provides a snapshot of a patient's participation in AAH, a clinical threshold associated with sustained sobriety, and concrete service activities encouraged as part of the 12-step program of recovery."

Dr. Pagano validated the SOS using a sample of 301 treatment-seeking alcoholics. Interviewed three years following treatment, alcoholics reported low AAH participation (i.e., SOS items rated "never" or "rarely") in taking calls or spending time with a sponsor (66%), guiding another through the 12-steps (59%), and holding a service position (53%). In contrast, the most common forms of AAH endorsed (i.e., SOS items rated "often" or "always") were putting away chairs after a meeting (75%), encouraging a newly sober alcoholic to go to a meeting (72%), and donating money to a 12-step organization (63%). Findings demonstrated adequate psychometric properties of the SOS, including convergent validity, internal consistent (alpha=0.92) and test-rest reliability (r=0.94).

With a recent three-year grant award from the John Templeton Foundation, Dr. Pagano is extending prior work with adults to include adolescents suffering from the disease of addiction.

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