Running head: RELAPSE PREVENTION The Role of Sponsorship in Recovery Christa Moore Arizona State University 1 RELAPSE PREVENTION 2 Abstract Background and Aims: The aim of this research was to assess whether clients receiving treatment for substance abuse in a residential treatment facility will achieve lower rates of relapse with treatment in combination with active sponsorship. Prior studies suggest sponsorship may equally be impactful as attending 12-step meetings. Design: The primary hypothesis was that active participation as defined by contact with a sponsor of an hour or more per week, as measured by the impact on affective characteristics correlated with increased levels of sobriety, when measured by the AWARE questionnaire (Advance Warning of Relapse) within 7 days of entry and prior to discharge (within 30 days). Setting: The project took place in a residential treatment facility in Phoenix, Arizona. Participants: There were 12 clients from a men’s house and 12 clients from a woman’s house, all of which were going through recovery. Intervention: The educational session explained what a sponsor is and the importance of finding one early as a key role in relapse prevention. Measurements: Pre and post-test results were compared to see if there was an impact on the predictability of relapse and sponsorship. The paired t-test was performed to compare the two means of AWARE scores. A lower score on the AWARE questionnaire indicates a person is more likely to succeed in sobriety. Findings: Based on 24 samples collected, the mean scores within the first seven days were 91.17 with a standard deviation of 18.59 and the mean score prior to discharge were 72.78 with a standard deviation (SD) of 20.02. The mean difference between the two scores was 18.39 (SD=2.84). There was a significant effect of the relapse prevention program which included sponsorship, t (22) = 4.79, p < 0.001. Conclusion: Implications for practice include increased time with sponsors to reduce rates of relapse. Future concerns include good fit matching which may reduce rates of relapse even further. RELAPSE PREVENTION 3 Keywords: Sponsor, Sponsorship. Recovery, Addiction, Residential Treatment, Relapse Background and Significance Substance abuse is derived from excessive and dysfunctional use of substances causing dangerous and maladaptive patterns leading to physiological harm and psychological impairment (Sadock, Sadock, & Ruiz, 2015). Substance abuse results in mortality, decreased quality of life, and heavy costs to society, both monetary and in terms of lost human potential. Global substance abuse estimates that 246 million people are utilizing illicit drugs, led by cannabis as the frontrunner followed by opioids, cocaine, and amphetamine type stimulants (United Nations Office on Drugs and Crime [UNODC], 2015). Approximately 12.19 million drug users inject drugs and approximately 1.65 million of them had HIV in 2013 (UNODC, 2015). In the United States in 2013, there were 24.6 million individuals who were using illicit drugs (Lipari, et. al., 2014). Gila County reports the highest rate of fatalities at 48.8 deaths per 100,000 residents (Arizona Department of Health Services [ADHS], 2015). Abstinence-contingent recovery housing such as residential treatment facilities improves abstinence following detoxification (Tuten, DeFulio, Jones, & Stitzer, 2011). Important factors in maintaining abstinence in treatment programs include finding a sponsor, meeting attendance, finding a home group, and incorporating sponsors into the client’s social networks (Zemore, Subbaraman, & Tonnigan, 2013). The sponsor is a person to whom the person in recovery can turn to for support, advice, and guidance. Sponsorship is associated significantly with abstinence from drugs and alcohol (Greenfield & Tonigan, 2013). There is an effect on sobriety when a person sustains a relationship with a sponsor earlier in recovery because it extends the time allowing for more interaction with the sponsor. According to Witbrodt, Kaskutas, Bond, & Delucchi, (2012) early sponsorship in addition to peer meeting involvement increases abstinence RELAPSE PREVENTION 4 and prevents relapse over time. Active participation and sponsorship in AA and NA is associated with positive recovery outcomes (Zemore, Subbaraman & Tonigan, 2013). Sponsor-client involvement increases the effectiveness of the program (Zemore et. al., 2013). Sponsors provide social and emotional support while maintaining a client’s accountability to remain sober. Sponsors interact as a therapeutic alliance amongst clients promoting accountability and responsibility for their actions (Kelly, Greene, Bergman, Hoeppner & Slaymaker, 2016). These mutual aid alliances are sponsors and role models mentoring like-minded persons who provide social support through recovery networks (Witbrodt et al., 2012). Stevens and Jason (2015) found that improved sponsor relationships might have a multiplicative effect upon patients recovering from substance abuse. It is imperative that the sponsor be trustworthy, empathetic, and supportive of recovery goals (Kelly et al., 2016). Stevens and Jason (2015) noted that confidentiality and availability were also critical components. Sponsors are a critical component in the recovery process and play a key role in mentoring peers while providing mutual support. A sponsor is an empathetic friend/peer that facilitates education and information expanding on AA and social networks (Stevens & Jason, 2015). They have experienced recovery and addiction, and actively communicate with the client regarding progress or feelings about recovery (Kelly, Greene, & Bergman, 2016). According to Rynes and Tonigan (2012), sustaining a sponsor early in recovery programs predicted later increases in the number of days participants abstained from alcohol. Internal evidence from the clinical site suggested that it is critical to help clients obtain a sponsor so that they can progress through recovery. Issues arising from internal evidence on sponsors include several barriers. Clients may not feel confident about getting a sponsor or asking someone to fill the role. Sponsors have employment, family, and other relationships RELAPSE PREVENTION 5 which may conflict with having enough time to be a sponsor throughout the entire day and have requirements about calling daily. Certain sponsors may have limitations in terms of who they will work with, while others have had very little sober time. Similarly, clients may not wish to be scrutinized and disconnect from the sponsor if there are too many limitations. There is limited evidence suggesting that a specific number of days leading up to the acquisition of a sponsor has a particular impact, however there is consistent evidence leading to the understanding that sponsorship plays a key role in the prevention of relapse over intervals of three months, up to a year, and for multiple years. Problem Statement Substance abuse results in decreased quality of life and other physiological harm and psychological impairments. Active participation and sponsorship in AA and NA is associated with positive recovery outcomes (Zemore, Subbaraman & Tonigan, 2013). Sponsor-client involvement increases the effectiveness of the program as a whole (Zemore et. al., 2013). Sponsors provide social and emotional support while maintaining a client’s accountability to remain sober. Internal evidence from the clinical site suggests that it is critical to help clients obtain a sponsor so that they can progress through recovery, but also shows that there are barriers to effective sponsorship which may be explored. There is a connection demonstrated throughout the literature that sponsorship has an impact on rates of recovery. The primary hypothesis is that active participation, as defined by contact with a sponsor of an hour or more per week, has an impact on the recovery process. The secondary hypothesis is that the first seven days in which one acquires a sponsor (e.g. how long they wait before they have a sponsor) has an impact on recovery and relapse. RELAPSE PREVENTION 6 Previous work in the area includes a focus on sponsorship and its effects on abstinence, versus Alcoholics Anonymous attendance (Zemore et. al. 2013; Witbrodt, et. al., 2012; Greenfield & Tonigan, 2012). Sponsorship attributes were also assessed for their impact on outcomes and sponsee perspectives (Young, 2013; Young 2012; Stevens & Jason, 2015). It can pose a problem for individuals recovering from substance abuse who do not have a sponsor because they often do not have enough support in their social and familial networks, which makes it difficult to maintain sobriety. PICOT Question (P) In a residential treatment center substance abuse patients (I) how does active sponsorship within 7 days upon admission as (C) compared to non-active sponsorship within 7 days (O) affect relapse prevention. Search Strategy An exhaustive search was performed utilizing three databases – CINAHL, PsychINFO, and PubMed. A total of 10 articles were chosen and critically examined according to the relevance and level of evidence. The combined search used key terms including active sponsorship, addiction treatment, relapse, recovery, 12 steps, and alcoholics anonymous. Studies considered for inclusion were required to address recovery from addiction. Additionally, studies were selected that addressed the role of sponsorship in recovery and prevention of relapse, characteristics of sponsors, and the role of inpatient treatment facilities on recovery. Exclusion criteria involved peer-reviewed journals written in English and published from 2012-2017. Once the initial yields were produced, the papers were examined to determine relevance to the clinical question. Only adult subjects were included. RELAPSE PREVENTION 7 PubMed (Appendix A) was searched using keywords sponsorship AND alcoholics anonymous and yielded 12 results with no limitations. When the exclusion criterion was applied to the search, 6 results were found. PubMed was searched again using keywords sponsorship AND recovery and yielded 22 results with filter. PubMed was then searched using keyword sponsorship AND recovery, AND addiction, and yielded 9 results and 4 articles with exclusion criteria were selected. PsychINFO (Appendix C) was searched with keywords sponsorship AND alcoholics anonymous which yielded 41 results with the exclusion criteria and 14 without. PsychINFO (Appendix C) was searched again using keywords 12 step program AND addiction treatment which yielded 130 results with exclusion criteria. PsychINFO (Appendix C) using keyword Sponsors AND Alcoholics Anonymous yielded 13 results with exclusion criteria and 2 articles were selected. From the database CINAHL (Appendix B), using keywords sponsorship AND alcoholics anonymous, yielded 10 results without filters and 6 results with filters on. When keywords and sponsor AND recovery were used, 17 results were displayed with filters on yielding 4 articles. Evidence Synthesis Ten articles were selected for the review from randomized control trials; six articles were level II evidence using randomized control trials. Four articles were ranked level III evidence and they are cohort studies. The experiments were well-designed controlled trials. The designed experiments were performed in United States. Most of the samples consisted of white males with slight heterogeneity with minority status. (Appendix I,J). Most of the studies exhibit a large sample size with clear definition of independent and dependent variables. The most common bias demonstrated within the articles involved selection bias and recall bias. RELAPSE PREVENTION 8 The common independent variables demonstrated how often sponsors met with clients and the common dependent variable was the success rate and the completion of the program in preventing relapse. The common independent variables included experience level, spiritual beliefs, and participation rankings. The outcomes indicated that these variables increased abstinence and relapse prevention. This was supported by the statistical data of p values less than 0.001 in most cases indicating that sponsorship made an impact and demonstrated an increase in abstinence. The studies demonstrated how sponsorship influenced the common dependent variable which was client participation level in the residential and recovery treatment center. Commonalities of sponsorship demonstrated that higher levels of experience, education levels, and spiritual beliefs, resulted in a higher percentage of participation and interaction in recovery programs. All the articles reviewed were recent, ranging from 2012 to 2016. The articles pertained to positive outcomes which showed a higher percentage of clients following the recovery protocol representing the PICOT. All the articles demonstrated a relationship between sponsorship and effective treatment in AA participants and prevention of relapse (Appendix I,J). The heterogeneous variables included recovery motivation and physical consequences. Both variables contributed to abstinence and relapse prevention in recovery. There were a wide variety of measurements between the articles. Three articles utilized survey methods, while others used various clinical measuring techniques such as GAATOR, SCID, and SAI. The most popular data analysis technique was the student t-test and regression tests. Three articles performed the t-test to find the significance between sponsorship and AA participation. Two articles performed chi square tests to find the correlation between sponsorship and the number of clients completing the 12-step process (Appendix I,J). Most of the studies involved one day experimental interventions except for two of the studies. The findings from the RELAPSE PREVENTION 9 studies were consistent with each other and supported the PICOT. Many of the tests showed a significant improvement in prevention of relapse with active sponsorship in relation to AA meetings and attendance. Two of the articles discussed the importance in the number of AA meetings attended in addition to the amount of time the sponsors spent with the sponsees. Two of the articles discussed the importance of the characteristics and faithfulness of the sponsors. Overall, the studies supported the PICOT question and sustaining a sponsor within the first seven days of admission that was raised in regard to the effectiveness of sponsorship and prevention of relapse in those who have received treatment. Evidence showed significant results in the effectiveness of utilizing sponsors that help patients recovering from substance abuse in completing treatment with a higher probability in prevention of relapse. Evidence suggested that early acquisition of a sponsor had a beneficial effect and could benefit from furthering research. A practice change might result from an increased emphasis on sponsorship and finding sponsors for patients early on in recovery may become an incorporated practice. Purpose Statement The purpose of this research was to demonstrate that active sponsorship has an effect on rates of relapse. Encouraging sponsorship in residential facilities may have beneficial effects for patients’ maintenance of sobriety after discharge. Evidence Based Practice Model and Conceptual/Theoretical Model Bandura (1971) described the role of learning through modeling in the Social Learning Theory (Appendix D), also known as Cognitive Social Theory. Bandura posits that most of the behaviors that people show are learned through the influence of example (Bandura, 1971). Modeling influenced behavior that lead to self-efficacy and increased response efficacy. RELAPSE PREVENTION 10 According to Butts and Rich (2015), social learning theory suggests that learning is based on observing others and the role model was rewarded for their behavior, those who are attached to the role model, experienced vicarious reinforcement (Butts and Rich, 2015). According to Latkin and Knowlton (2015), social networks and interventions were developed to help promote social norms, which were highly effective forces demonstrated in health behavior and change. Factors at work included social rewards and factors of social identity and the practice of sponsorship in residential treatment was an intervention under the social learning theory which incorporated all categories (norms, rewards, identity). The Model for Change to Evidence-Based Practice (EBP) (Appendix D (i) was a systematic approach designed by Rosswurm and Larrabee (1999) for guiding healthcare professionals and practitioners based on research and theoretical literature. The need for a potential change in practice was assessed and inspired by the importance of sponsorship in relation to predictability of relapse while in substance abuse treatment and quality improvement of data suggesting further research was needed for a change to occur. Internal data was compared with external data and the problem was identified and addressed within the practice by an assembly of administrators and health care professionals identifying the specific issue at hand. As a result, research was incorporated into improving strategical ways to educate staff and clients into making changes within the sponsorship policy within the organization. Best evidence was synthesized from the literature and researchers address clinical feasibility of research findings (Rosswurm & Larrabee, 1999). A practice change involved the development of sequential standardized procedures designed to form the protocol. Practitioners and clinical support staff identified inter-professional outcomes and the effects of practice changes on patient outcomes. RELAPSE PREVENTION 11 Quality improvement included an evaluation plan that processes the indicators and outcomes of satisfaction and change of practice responses from the staff. Feedback from staff, coordinators, and supervisors impacted the decision to receive, reject, adapt or adopt changes. In the phase of integration and maintenance of a change in practice, recommended alterations to procedures and modifications of practices were presented to the stakeholders and staff. Project Methods This evidence-based project was approved by the IRB board affiliated with Arizona State University (ASU) (appendix H (i). Protection of human subjects and recruitment included participants who created a unique identification code for the questionnaires. To create the unique identification code, the participants were directed to pick the first letter of the city they were born in, favorite color, and favorite number. This ID linked the pre and post AWARE questionnaire scores. The graduate student kept the information confidential on a lap top with a locked password. Clinical coordinators for the residential treatment center notified all newly admitted clients an opportunity to participate in an evidenced-based project. They were educated about the definition of sponsorship and the importance of obtaining a sponsor early in treatment allowing time to answer questions during a private session held in a private office in the residential treatment center (Appendix G). The importance of active sponsorship (over one hour per week) was stressed as an important factor in reducing the predictability of relapse the clients understood that receiving treatment was not dependent on their participation in the evidence-based project. Treatment was provided to all people regardless of the evidence-based project participation, meaning their ability to receive full treatment services including sponsorship is not dependent on whether they agreed to consent and participate in the evidence-based project or not. (Appendix H). The organizational culture was positive regarding sponsorship and staff members were RELAPSE PREVENTION 12 supportive in developing a policy for implementing time spent with a sponsor with a goal of one hour or more per week and documenting hours in addition to mandated daily recovery meetings. This evidence based-project was an intervention practice outcome using a PICOT question. The quality improvement project was designed to measure the outcomes of relapse based on the status of active versus inactive sponsorship. The AWARE questionnaire scores were collected pre and post time spent with the sponsor and measured within the first 7 days of admission and near the time of discharge on week four. The demographic survey was collected at the first meeting with clients which included gender, age and race, last time of substance use, and preferred substance use. The intervention measured self-reported time spent with a sponsor as active (over one hour) versus inactive (less than one hour) per week in correlation with AWARE scores. The AWARE questionnaire was designed to evaluate the predictability of relapse and utilized a twenty-eight-item scale that measured warning signs of relapse according to Miller and Harris (2000) (Attachment F). Components of the AWARE tool were indicators of the potential for maintaining sobriety and were broken into three categories, from which research questions arise. They include, physical symptoms of depression, anxiety, and recurrent thoughts of substance use. Reponses were given on a Likert scale integrating a 7-point system ranging from “always” to “never.” The AWARE questionnaire survey was collected after the clients filled out every question and measured within the first 7 days of admission and at the time of discharge at 28-30 days. The educational session was completed at the first meeting. This included an introductory meeting which explained the definition of what a sponsor is and the importance of finding one RELAPSE PREVENTION 13 early in recovery and the idea that it can play a key role in relapse prevention. An overview of the AWARE questionnaire and its significance in the predictability of relapse was discussed. Outcome Measures Instruments/Validity/Reliability The Advance Warning of Relapse (AWARE) questionnaire was used as a tool in directly measuring relapse rates while assessing the predictability of relapse upon admission in comparison to discharge on week four of treatment. According to Kelly, Hoeppner, Urbanoski, & Slaymaker (2011), strategic approaches have prompted more efficient designs to evaluate psychometric properties by measuring the risks and predictability of relapse when examining the warning signs in the Advance Warning of Relapse scale (AWARE) questionnaire tool. The outcomes measured pre and post results of the AWARE questionnaire upon entering the residential facility within seven days and prior to discharge. This questionnaire was designed to evaluate the predictability of relapse in a twenty-eight item scale that measures advance warning signs of relapse according to Miller and Harris (2000). Reponses were given on a Likert scale integrating a 7 point system ranging from “always” to “never.” Patients self -reported their feelings, thoughts and experiences, which showed warning signs and predicting factors impacting relapse. Components of the AWARE tool were indicators of the potential for maintaining sobriety and were broken into three categories, from which research questions arise. They included, negative self-perceptions, physical symptoms of depression, anxiety, somatization, and recurrent thoughts of drinking or substance use. According to Kelly et al. (2011), AWARE scores predicted relapse at the one month and six-month assessments and neared statistically significant predictability at three months. The use of other factors can help to make the tool more effective in its predictive validity, though RELAPSE PREVENTION 14 demographic factors and others are not being studied here. Kelly addressed biases with regards to retention, including demographic factors. Covariates also included education, drug of choice, and percent of days abstinent, prior substance abuse related hospitalization. All these covariates were factors that could have affected the data in this project in addition to the small sample size. To address internal reliability, the authors calculated the ordinal version of the coefficient alpha and addressed the convergent validity the authors calculated bivariate correlations between AWARE and the Brief Symptom Inventory-18 tools. The BSI-18 is a similar tool in that is looks at depression, anxiety, and somatization symptoms (Kelly et al., 2011). The AWARE tool was applied to the project by using a paired t-test to compare between groups of people who have used a sponsor actively versus those who have not. AWARE scores were measured pre- and post-treatment (between the first seven days of admission and prior to discharge). The AWARE tool is an evidence-based strategy for measuring rates of relapse by proxy. While it predictive validity may not be perfect, in combination with other indicators it was very effective. Furthermore, it is imperative for researchers to find scales such as AWARE to ensure the ethical nature of measuring results related to relapse, which cannot in this study be measured directly. Data Collection and Analysis Data regarding time spent with sponsors, demographics, and AWARE scores were stored indefinitely and managed and updated with clinical staff. The data was collected from participants and stored in an Excel/SPSS file on a laptop with a security password. The information and data collected was destroyed if the client decided to withdraw and all data was excluded from any analysis. Every member of the research team received CITI training and RELAPSE PREVENTION 15 possesses a current certification with CITI training approved by ASU faculty. Data was shared with stakeholders, clinical support, administration, and specified team members with CITI training authorized for this project. Paired t-tests were used to analyze and compare pre and post AWARE scores, differences between groups with active vs. inactive sponsors, and differences between genders. The proposed budget was $0 as the clinical coordinators, staff, and interprofessional team members developed a team plan with clinical support members and volunteers to recruit the clients randomly upon admission on a volunteer basis and assist by locating clients and providing privacy in an office to complete the educational portion of the intervention in addition to filling out the surveys. Privacy was allowed and time for questions was respected throughout the evidence-based project. Participants included twelve male and twelve female residents in substance abuse treatment over the age of 18 years old. Outcomes/Results The demographics showed the average age of the participants were 35 years old. 50% of the participants were single, 25% were married and 25% were divorced. Clients were voluntary admission and agreed to participate in the evidence-based project during their stay at Crossroads. Pregnant women, involuntary admission, undocumented individuals, pretrial adults, and/or Native American, and special populations were included in the study sample; however, these special populations were not the target of the study. Exclusion criteria involved minors who were under the age of 18, adults who were unable to consent and clients who did not speak English. RELAPSE PREVENTION 16 Paired Samples t-test Paired Differences Mean t Std. Std. Error 95% Confidence Deviation Mean Interval of the df Sig. (2tailed) Difference yes no Pair TotalScorePre - 1 TotalScorePost Pair TotalScorePre - 1 TotalScorePost Lower Upper 34.40000 18.86908 4.21925 25.56900 43.23100 8.153 19 .000 28.50000 4.43471 2.21736 21.44338 35.55662 12.853 3 .001 Table 1. Results of paired t-test of pre- and post -AWARE scores Pre AWARE Scores Vs Post AWARE Scores Mean AWARE Scores 100 80 60 40 20 0 Mean-Score-Pre Mean-Score-Post Status of Treatment Figure 1. Pre-AWARE mean scores versus Post-AWARE mean scores Based on the 24 samples collected, the mean pre-score during the first week of treatment was 91.17 with standard deviation of 18.59 and the mean post-score during week 4 was 72.78 with standard deviation of 20.02 (Table 1 & Figure 1). The mean difference between the two scores was 18.39 (SD=2.84). There was a significant effect on relapse prevention and active sponsorship, t (22) = 4.79, p < 0.001. The results indicated that there was a statistically significant difference between the two scores, indicating improvement in relapse prevention. RELAPSE PREVENTION AWARE scores 62 17 AWARE Scores for active sponsorship versus non-active sponsorship 61 60 59 58 57 Sponsorship Sponsorship Status Non Sponsorship Figure 2. Average AWARE scores for Active sponsorship vs. Non-active sponsorship. When comparing the AWARE scores for participants who had sponsors at the end of week 4 to those who did not, the scores for the participants with sponsors were slightly less (M = 58.85, S.D = 19.37) than those who did not have sponsors (M = 61, S.D = 12.19) (Figure 2.) Difference in AWARE Scores Difference in AWARE Score Gender Comparison 40 30 20 10 0 Female Male Gender Figure 3. The obtained average AWARE scores for Male vs. Female. The effects of sponsorship in substance abuse treatment included comparing of genders by performing paired t-tests in males and females (Figure 3). The results demonstrated that the mean differences between AWARE scores for the participants during week 1 and week 4 were larger for males (M = 36.67, S.D. = 21.15) when compared to females (M=30.17, S.D. = 12.66). This had a p-value < 0.001. Results showed that the sponsorship program positively influenced relapse prevention by decreasing the predictability of relapse upon discharge. RELAPSE PREVENTION 18 The benefits demonstrate that there is a lower predictability of relapse in clients receiving treatment for substance abuse in combination with the assistance of an active sponsor. Early sponsorship and prevention of relapse is strongly correlated with higher rates of abstinence and remission of substance abuse. Discussion The impact of the project is reduced rates of relapse for the patient, in which social networks evolve with peer engagement and expertise. For the service provider, increased success rates with sponsors decreased the predictability of relapse. This project has a high level of sustainability because it requires very little fiscal input. In settings where sponsors are common it would be simple to encourage more interaction with them. In terms of policy, education and training in residential treatment centers should be encouraged. It would lower systematic monetary costs of addiction. Strengths of the project demonstrate strong leadership and team collaboration with an interprofessional team, clinical supervisors, volunteers, clinical staff members, and administration. The men’s treatment facility is currently documenting weekly time spent with a sponsor and noting it as active or inactive with the intention to intervene and ensure the client’s needs are being met in terms of sponsorship and the compatibility of a mentor. Limitations impacting the project are a result of a small sample size in addition to interrupting clients during residential treatment for 30 – 60 minutes during right track classes and group meetings throughout their first thirty days of rehabilitation. More research is needed to evaluate the outcomes of early sponsorship in residential treatment and the impact on the predictability of relapse and active versus inactive sponsorship. Barriers are related to unknown length of stay upon admission secondary to insurance purposes or criminal justice penalties related to pretrial RELAPSE PREVENTION 19 clients and the potential for sentencing during treatment services and lack of time in developing a larger sample size. The study successfully demonstrated the effectiveness of sponsorship in helping patients recovering from substance abuse and preventing relapse in residential treatment. Studies showed various ways to improve the relationship between sponsors and sponsees to provide a better chance for the patient to complete the program. Evidence was consistent with current literature which demonstrated strong support when securing a sponsor makes a difference on increasing abstinence in recovery and preventing relapse. Consistent meetings between sponsors and sponsees exhibit dramatic improvement in participation of the program. The female participants were limited in their access to sponsors during the first week of treatment, therefore five residents were paired up with one sponsor at times who attended weekly AA meetings. This allowed them more time to search for a compatible sponsor. Due to this limitation the women often appeased clinicians by verbalizing interest in searching for a new sponsor to appear more compliant with their role in treatment. Education was reinforced to ensure an assertive method was applied to securing a sponsor since self-esteem and insecurities were key factors inhibiting their ability to approach one during meetings. Clients verbalized feelings of anxiety when attempting to introduce themselves, and did not feel confident in asking a particular sponsor of interest due to fear of rejection. This evidence-based project was beneficial in helping clients assess for intended sponsor characteristics. Staff-members were open to collaborating with clients about compatibility traits that would promote a more successful relationship with a sponsor. Conclusion RELAPSE PREVENTION 20 Active sponsorship was encouraged for recently sober individuals resulting in fewer relapses and higher rates of abstinence in patients recovering from substance abuse, as measured by the AWARE tool. The project demonstrated a significant correlation between interaction with a sponsor and decreased predictability of relapse. More efficient correspondence and matching of sponsors will improve with monitoring patient feedback ensuring a more effective recovery rate overall in preventing relapse. This practice may help reduce mortality and morbidity and increase overall quality of life. RELAPSE PREVENTION 21 References Arizona Department of Health Services. (2015). Poisonings among Arizona Residents 2014. Retrieved from http://www.azdhs.gov/documents/prevention/womens-childrens-health/reports-factsheets/injury-prevention/poisonings-among-arizona-residents-report-2014.pdf Bandura, A. (1971). Social Learning Theory. New York City, NY: General Learning Corporation. Bergman, B. G., Hoeppner, B. B., Nelson, L. M., Slaymaker, V., & Kelly, J. F. (2015, May 14). The effects of continuing care on emerging adult outcomes following residential addiction treatment. Drug and Alcohol Dependence, 153, 207-214. http://dx.doi.org/10.1016/j.drugalcdep.2015.05.017 Butts, J. B., & Rich, K. L. (2015). Philosophies and Theories for advanced Nursing Practice (2nd ed.). Sudbury, MA: Jones & Bartlett. Davis, J. P., Dumas, T. M., Wagner, E. F., & Merrin, G. J. (2016, August 08). Social ecological determinants of substance use treatment entry among serious juvenile offenders from adolescence through emerging adulthood. Journal of Substance Abuse Treatment, 71, 8-15. http://dx.doi.org/10.1016/j.jsat2016.08.004 Decker, K. P., Peglow, S. L., Samples, C. R., & Cunningham, T. D. (2017). Long-term outcomes after residential substance use treatment: Relapse, morbidity, and mortality. MILITARY MEDICINE, 182, 1589-1595. Donovan, D. M., Ingalsbe, M. H., Benbow, J., & Daley, D. C. (2013). 12-Step interventions and mutual support programs for substance use disorders: an overview. Social Work in Public Health, 28, 313332. http://dx.doi.org/10.1080/19371918.2013.774663 Greenfield, B. L., & Tonnigan, J. S. (2012, August 06). The general alcoholics anonymous tools of recovery: The adoption of 12-step practices and beliefs. Psychology of Addictive Behaviors, 27:3, 553-561. http://dx.doi.org/10.1037/a0029268 Kelly, J. F., Greene, C. M., & Bergman, B. G. (2016). Recovery benefits of the “therapeutic alliance” among 12-step mutual-help organizations attendees and their sponsors. Drug and alcohol dependence, 162, 64-71. http://dx.doi.org/10.1016/j.drugalcdep.2016.02.028 RELAPSE PREVENTION 22 Kelly, J. F., Greene, C. M., Bergman, B., Hoeppner, B. B., & Slaymaker, V. (2016). The sponsor alliance inventory: Assessing the therapeutic bond between 12-Step attendees and their sponsors. Alcohol and Alcoholism, 5 (1), 32-39. http://dx.doi.org/10.1093/alcal/agv071 Kelly, J. F., Greene, M. C., & Bergman, B. G. (2016, February 15). Recovery benefits of the “therapeutic alliance” among 12-step mutual-help organization attendees and their sponsors. Drug and Alcohol Dependence, 162, 64-71. http://dx.doi.org/10.1016/j,drugalcdep.2016.02.028 Kelly, J. F., Hoeppner, B., Urbanoski, K. A., & Slaymaker, V. (2011). Predicting relapse among young adults: Psychometric validation of the advanced warning of relapse (AWARE) scale. Addictive Behaviors, 36(10), 987-993. http://dx.doi.org/10.1016/l.addbeh.2011.05.013 Kelly, J. F., Stout, R. L., & Slaymaker, V. (2013, October 08). Emerging adults’ treatment outcomes in relation to 12-step mutual-help attendance and active involvement. Drug and Alcohol Dependence , 129, 151-157. http://dx.doi.org/10.1016/.j.drugalcdep.2012.10.005 Kidorf, M., Latkin, C., & Brooner, R. (2016, August 07). Presence of drug-free family and friends in the personal social networks of people receiving treatment. Journal of Substance Abuse Treatment, 70, 87-92. http://dx.doi.org/10.1016/j.jsat2016.013 Latkin, C. A., & Knowlton, A. R. (2015). Social network assessments and interventions for health beahvior change: A critical review. Behavioral Medicine, 41, 90-97. http://dx.doi.org/10.1080/08964289.2015.1034645 Lipari, R. N., Hedden, S. L., & Hughes, A. (2014, September 04). Substance use and mental health estimates from the 2013 national survey on drug use and health: Overview of findings. Samhsa: The cbhsq report , , 1-10. National Institute on Drug Abuse. (2017). Trends & Statistics. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics Rosswurm, M., & Larrabee, J. H. (1999). A model for change to evidence-based practice. Journal of Nursing Scholarship, 31 (4), 317-322. RELAPSE PREVENTION 23 Rynes, K. N., & Tonigan, S. J. (2012, November 03). Do social networks explain 12-step sponsorship effects?: A prospective lagged mediation analysis. Psychology of Addictive Behaviors, 26 (3), 432439. http://dx.doi.org/10.1037/a0025377 Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer. Stahler, G. J., Mennis, J., & DuCette, J. P. (2016). Residential and outpatient treatment completion for substance use disorder in the U.S.: Moderation analysis by demographics and drug of choice. Addictive Behaviors, 58, 129-135. Stevens, E. B., & Jason, L. A. (2015, ). Evaluating alcoholics anonymous sponsor attributes using conjoing analysis. Addictive Behavior, 51, 12-17. http://dx.doi.org/10.1016/j.addbeh.2015.06.043 Stevens, E. B., & Jason, L. A. (2015). An exploratory investigation of important qualities and characteristics of alcoholics anonymous sponsors. Alcoholism Treatment Quarterly, 33 (4), 367384. http://dx.doi.org/10.1080/07347324.2015.1077632 Tuten, M., DeFulio, A., Jones, H. E., & Stitzer, M. (2011, November 28). Abstinence-contingent recovery housing and reinforcement-based recovery housing and reinforcement-based treatment following opioid detoxification. Addiction: Research Report, 107, 973-982. http://dx.doi.org/10.1111/j1.3600443.2011.03750.x United Nations Office on Drugs and Crime. (2015). World drug report 2015. Retrieved from https://www.unodc.org/documents/wdr2015/World_Drug_Report_2015.pdf Witbrodt, J., Kaskutas, K., Bond, J., & Delucchl, K. (in press). Does sponsorship improve outcomes above alcoholics anonymous attentdance? A latent class growth curve analysis. National Institutes of Health. Retrieved from 10.111/j.1360-0443.2011.03570.x. RELAPSE PREVENTION 24 Witbrodt, J., Kaskutas, L., Bond, J., & Delucchi, K. (2012). Does sponsorship improve outcomes above alcoholics anonymous attendance? A latent class growth curve analysis. NIH Public Access: Author Manuscript, 107 (2), 301-311. http://dx.doi.org/10.1111/j.1360-0443.2011.03570.x. Young, L. B. (2012). Alcoholics anonymous sponsorship: Characteristics of sponsored and sponsoring members. Alcoholism Treatment Quarterly, 30:1, 52-66. http://dx.doi.org/10.1080/07347324.2012.635553 Young, L. B. (2013). Characteristics and practices of sponsored members of alcoholics anonymous. Journal of Groups in Addiction and Recovery, 8, 149-164. http://dx.doi.org/10.1080/1556035X2013.764203 Zemore, S. E., Subbaraman, M., & Tonnigan, J. S. (2013). Involvement in 12-step activities and treatment outcomes. Substance Abuse, 34, 60-69. http://dx.doi.org/10.1080/08897077.2012.691452 Appendix A PubMed search result RELAPSE PREVENTION 25 Appendix B CINAHL search results RELAPSE PREVENTION 26 Appendix C PsychINFO search results RELAPSE PREVENTION 27 Appendix D Social Learning Theory RELAPSE PREVENTION 28 Appendix D (i) Rosswurm and Larabee A Model for Change to Evidence – Based Practice RELAPSE PREVENTION 29 Appendix E Demographic Questionnaire Please fill in the blanks or place an X or check mark next to the word or phrase that best matches your response. Date: RELAPSE PREVENTION 30 Date of Admission: Male ______ Female ______ Other __________ Date of last drug/alcohol use: Are you 18 years of age Yes ___ No _____ What is your age? _____ Do you have a sponsor: Yes ____ No ______ What is your marital status? Single Married Divorced Prefer not to say How would you describe your race or ethnicity Substance Use: Check all that apply Native American Alcohol Asian Marijuana African American / Black Heroin Caucasian / White Cocaine Hispanic / Latino Methamphetamines Pacific Islander Other Bi/Multiracial Appendix F The AWARE Questionnaire (Revised Form) The AWARE Questionnaire (Advance WArning of RElapse) was designed as a measure of the warning signs of relapse, as described by Gorski (Gorski & Miller, 1982). In a prospective study of relapse following outpatient treatment for alcohol abuse or dependence (Miller et al., 1996) we found the AWARE score to be a good predictor of the occurrence of relapse (r = .42, p < .001). With subsequent analyses, we refined the scale from its 37-item original version to the current 28-item scale (version 3.0) (Miller & Harris, 2000). RELAPSE PREVENTION 31 The items are arranged in the order of occurrence of warning signs, as hypothesized by Gorski. In our prospective study, however, we found no evidence that the warning signs actually occur in this order in real time (Miller & Harris, 2000). Rather, the total score was the best predictor of impending relapse. ADMINISTRATION: This is a self-report questionnaire that can be filled out by the client. Be sure that the client understands the 1-7 rating scale. When the client has finished, make sure that all items have been answered and none omitted. SCORING: Total the numbers circled for all items, but reverse the scoring for the following five items: 8, 14, 20, 24, 26. For these five items only: If the client circles this number: Add this number to the total score: 1 7 2 6 3 5 4 4 5 3 6 2 7 1 INTERPRETATION: The higher the score, the more warning signs of relapse are being reported by the client. The range of scores is from 28 (lowest possible score) to 196 (highest possible score). The following table shows the probability of heavy drinking/drug use (not just a slip) during the next two months, based on our prospective study of relapse in the first year after treatment (Miller & Harris, 2000). Probability of Heavy Drinking/Drug Use During the Next Two Months AWARE Score If already drinking/drug If abstinent during the use in prior 2 months prior 2 months 28-55 37% 11% 56-69 62% 21% 70-83 72% 24% 84-97 82% 25% 98-111 86% 28% 112-125 77% 37% 126-168 90% 43% 169-196 >95% 53% RELAPSE PREVENTION 32 This instrument was developed through research funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA, contract ADM 281-91-0006). It is in the public domain, and may be used without specific permission provided that proper acknowledgment is given to its source. The appropriate citation is Miller & Harris (2000). References Gorski, T. F., & Miller, M. (1982). Counseling for relapse prevention. Independence, MO: Herald House - Independence Press. Miller, W. R., & Harris, R. J. (2000). A simple scale of Gorski’s warning signs for relapse. Journal of Studies on Alcohol, 61, 759-765. Miller, W. R., Westerberg, V. S., Harris, R. J., & Tonigan, J. S. (1996). What predicts relapse? Prospective testing of antecedent models. Addiction, 91 (Supplement), S155-S171. RELAPSE PREVENTION 33 AWARE Questionnaire 3.0 Please read the following statements and for each one circle a number, from 1 to 7, to indicate how much this has been true for you recently. Please circle one and only one number for every statement. Date of last alcoholic drink/drug use:_______ Never Rarely Sometimes Fairly often Often Almost always Always 1. I feel nervous or unsure of my ability to stay sober. 1 2 3 4 5 6 7 2. I have many problems in my life. 1 2 3 4 5 6 7 3. I tend to overreact or act impulsively. 1 2 3 4 5 6 7 4. I keep to myself and feel lonely. 1 2 3 4 5 6 7 5. I get too focused on one area of my life. 1 2 3 4 5 6 7 6. I feel blue, down, listless, or depressed. 1 2 3 4 5 6 7 7. I engage in wishful thinking. 1 2 3 4 5 6 7 8. The plans that I make succeed. 1 2 3 4 5 6 7 9. I have trouble concentrating and prefer to dream about how things could be. 1 2 3 4 5 6 7 10. Things don’t work out well for me. 1 2 3 4 5 6 7 11. I feel confused. 1 2 3 4 5 6 7 12. I get irritated or annoyed with my friends. 1 2 3 4 5 6 7 13. I feel angry or frustrated. 1 2 3 4 5 6 7 14. I have good eating habits. 1 2 3 4 5 6 7 Never Rarely Sometimes Fairly often Often Almost always Always RELAPSE PREVENTION 34 Never Rarely Sometimes Fairly often Often Almost always Always 15. I feel trapped and stuck, like there is no way out. 1 2 3 4 5 6 7 16. I have trouble sleeping. 1 2 3 4 5 6 7 17. I have long periods of serious depression. 1 2 3 4 5 6 7 18. I don’t really care what happens. 1 2 3 4 5 6 7 19. I feel like things are so bad that I might as well drink/use drugs. 1 2 3 4 5 6 7 20. I am able to think clearly. 1 2 3 4 5 6 7 21. I feel sorry for myself. 1 2 3 4 5 6 7 22. I think about drinking/drug use. 1 2 3 4 5 6 7 23. I lie to other people. 1 2 3 4 5 6 7 24. I feel hopeful and confident. 1 2 3 4 5 6 7 25. I feel angry at the world in general. 1 2 3 4 5 6 7 26. I am doing things to stay sober. 1 2 3 4 5 6 7 27. I am afraid that I am losing my mind. 1 2 3 4 5 6 7 28. I am drinking/use drugs out of control. 1 2 3 4 5 6 7 Did you spend more than one hour per week Week 1 with your sponsor? Yes (Y) or No (N) Y N Week 4 Y N RELAPSE PREVENTION 35 Scoring sheet for AWARE Questionnaire 3.0 For these items, record the number circled 1. 2. 3. 4. 5. 6. For these 5 items, reverse the scale (* see below) *For reverse-scaled items: 1 = 7 2=6 3=5 4=4 7. 5=3 9. 10. 11. 12. 6=2 7=1 8. 13. 15. 16. 17. 18. 14. 19. 21. 22. 23. 25. 20. 27. 28. 24. Total: Subtotal+Subtotal = AWARE Score 26. RELAPSE PREVENTION 36 Appendix G Educational Session Introduction: • Introductory period and explanation about my role as a Psychiatric Mental Health Nurse Practitioner (PMHNP) student. A brief definition of what a sponsor is and their role in alcohol and drug addiction while in residential treatment and recovery. Orientation: • Explain the importance of finding a sponsor within the first seven days • Educate about the findings from research and the impact of sponsorship and sobriety in prevention of relapse • Educate about the importance of obtaining early sponsorship and being matched up with a compatible sponsor. • Discuss the importance of spending a minimum of one hour per week with a sponsor in person, with access to texting, emails, and phone calls. • Brief overview of the Advance Warning of relapse (AWARE) questionnaire tool with a description of scoring results, including the times it will be administered within the first seven days of admission and prior to discharge. • Review how early sponsorship with increased time spent with a sponsor has been known to prevent relapse and sustain sobriety. Conclusion • Brief overview of discussion • Questions and Answers RELAPSE PREVENTION 37 Appendix H Consent/Recruitment Form Sponsorship and Prevention of Relapse April 01, 2018 Dear Participant, I am a graduate student under the direction of Dr. Ann Guthery PhD, RN, PMHNP-BC Clincial Assistant Professor and Specialty Coordinator for Graduate Psychiatric Program Education in the College of Nursing and Health Innovation at Arizona State University. I am inviting you to participate in an evidence-based education and intervention program to see if sponsorship has an effect on the relapse outcomes of people in recovery from drug and alcohol addiction who are receiving treatment in a residential treatment facility. In order for the intervention to be effective, I will ensure that every client has access to a sponsor and educate about the benefits of obtaining a sponsor and its effect on preventing relapse. Staff will be informed about the goal to increase use of sponsors and assist in collecting the time spent with the sponsor. I will administer the pre and post measurement Advanced Warning Signs of Relapse (AWARE) questionnaire which is designed to measure the warning signs of relapse during the first 7 days of admission and before discharge within 30 days. Prior to discharge there is a self-report question at the bottom of the AWARE questionnaire asking you to answer if you spent more than one hour or less than one hour per week with a sponsor while in treatment. The total time required to complete the questionnaire will be approximately 15 minutes and the education time will be 15 minutes. Your participation in the evidenced-based education and intervention program is voluntary and you are encouraged to ask questions at any time. Please complete questions in the survey and if you choose not to participate or to withdraw from the program, there will be no penalty. The information and data collected will be destroyed if you decide to withdraw and all data will be excluded from any analysis. It will not affect the care you receive prior to, during, or after your participation in the program. You must be 18 years of age or older to participate in this program. Responses to the questionnaires and time spent with sponsors will be used to assess the effectiveness of the patient and organizational support in addition to the education you receive. The results of this evidenced based project may be used in reports, presentations, or publications, but your name will not be known or used. There is no known risk greater than those that are associated with everyday types of activity. Your responses on the questionnaires will be confidential and will be identified by a unique identification code that will not be connected to your name or other personal identifying information. The unique identification code will be composed of the first letter of the city you are were born in, favorite color, and favorite number. RELAPSE PREVENTION 38 Your attendance at the session and completion of the AWARE questionnaire is an agreement for consent to participate in the project. If you have any questions concerning this program, please contact the following team member. Dr Ann Guthery, Ann.Guthery@asu.edu (602) 496-0794 The Office of Research Integrity and Assurance: research.integrity@asu.edu (1877-786-3385) Sincerely, Christa Moore, RN ASU PMHNP student (HRP-503A) cmmoor13@asu.edu (602)-299-2650 RELAPSE PREVENTION 39 Appendix H (i) SPONSORSHIP AND RECOVERY 40 Appendix I Synthesis Table Author Greenfield (2013) N=129 Participants Characteristics (F= 46.5 %) Kelly (2016) N=302 Kelly (2015) N=302 N=157 Kelly (2013) N=607 EA (M=73 %) FAS (M=73.9%) Stevens (2015) N=245 n=117F n=128 M SUDR Stevens (2015) N=215 Witbrodt (2012) N=1598 n=926 Young (2012) N=254 F=109 M=116 AFA=41 N=672 n=117 SP n=146 NSP Ages: (19-64 yo) Ages: (18-24 yo) Ages: (18-24 yo) MA =38.6 MA=20.4 MA=20.5 MA=20.4 MA=40.9 SD=1.6 SD=1.56 SD=1.6 SD=10.7 C=95 % C=96.8% (20-64 yo) MA=38.76 S=100% General population of ADP in AA ADP public/priva te treatment programs Young (2013) N=264 Zemore (2013) N=508 n=196 No MAAEZP n=312 MAAEZP US=95.1% NE=22.3% SE=18.9% MW=19.3 % W=34.5% SD=11.5 MA=47.3 MR=32.7 % ADP- Alcohol dependent participant, AFA- African American, C -Caucasian, CS -Convenience Sample, CP- Community programs, EDU= education, EA – Emerging adults, EL-Experience level, F-Female, FAS -Final analytical sample, GAATOR -General alcoholics anonymous tools of recovery, LOE- Level of Evidence, LOMA -Level meeting attendance, M – male, MA – mean age, MAAEZP– Making Alcoholics Anonymous Easier Program, MR- married, MW Midwest, N-number participants, n- subset participants, NE -Northeast, NSP- Not sponsoring, PC- Physical Consequence, PR- Participation Ranking, R-Race, RTC-Residential treatment center, RM -Recovery motivation, S- Single. SD- Standard deviation, SE- Southeast, SP- Sponsoring SUDR - Substance use disorder recovery, US -United States, W-West, yo-years old, ↑- increased; ↓- decreased, > = greater than; ++ high quality; --poor quality, X – Yes, − No SPONSORSHIP AND RECOVERY Interventions or Review criteria Generalizability Validity/ Reliability 41 Sponsor AA Attendance Encouragement Treatment Attendance Behavioral Step Work Spiritual Step Work Sponsor Contact with Sponsor Degree of Sponsor Alliance Sponsor 12Step Attendance Sponsor 12Step Attendance "Active Involvement " in AA Engaging with other 12-step members outside of meetings Experience Knowledge Availability Confidentia lity GoalSetting Involvement in 12-Step Respects confidentiality Trustworthy Honest Feedback Integrity Availability Age Sex Race Way of Being Introduced to AA Age First Attended Never Relapsed in AA Age Sex Race Married Belong to a Home Group Have a Sponsor Ways of Being Introduced to AA Length of Sobriety Sponsorship Meeting Attendance Use of a Sponsor 30-day Meeting Attendance Social Interaction with Members CP RTC CP RTC CP RTC CP RTC CP RTC CP RTC CP RTC CP RTC CP RTC CP RTC X Indirect measures of GAATOR may overestimate step-work completion impact X ++ Nonrandom samples, 95% C X -- response rate X ++ response rate X X CS X Internet Survey Descriptive Only X Internet Survey Descriptive Only X X CS ++ Longitudinal design, Response Rate ++ Response Rate ADP- Alcohol dependent participant, AFA- African American, C -Caucasian, CP- Community programs CS -Convenience Sample, , EDU= education, EA – Emerging adults, EL-Experience level, F-Female, FAS -Final analytical sample, GAATOR -General alcoholics anonymous tools of recovery, LOE- Level of Evidence, LOMA -Level meeting attendance, M – male, MA – mean age, MAAEZP– Making Alcoholics Anonymous Easier Program, MR- married, MW Midwest, N-number participants, n- subset participants, NE -Northeast, NSP- Not sponsoring, PC- Physical Consequence, PR- Participation Ranking, R-Race, RTC-Residential treatment center, RM -Recovery motivation, S- Single. SD- Standard deviation, SE- Southeast, SP- Sponsoring SUDR - Substance use disorder recovery, US -United States, W-West, yo-years old, ↑- increased; ↓- decreased, > = greater than; ++ high quality; --poor quality, X – Yes, − No SPONSORSHIP AND RECOVERY 42 II II III II III II II III III III Independent Variables (homogenous) PR EL EDU LOMA SP X X ─ ─ X X ─ ─ ─ ─ ─ ─ ─ ─ ─ X ─ ─ ─ ─ ─ ─ X ─ ─ X ─ ─ ─ ─ ─ X ─ X ─ ─ ─ X X X X X ─ ─ X ─ X X ─ ─ Independent Variables (heterogenous) RM PC ─ ─ X ─ ─ ─ ─ ─ ─ ─ ─ ─ ─ ─ ─ X ─ ─ ─ ─ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ <0.001 <0.01 <0.001 <0.05 Level of Evidence Dependent Variable Abstinence Relapse Prevention Outcome P-Value Analysis T-test Chi Square Regression Factor Mann-Whitney <0.001 <0.001 >0.05 0.01 X X <0.001 <0.001 X X X X X X X X ADP- Alcohol dependent participant, AFA- African American, C -Caucasian, CP- Community programs CS -Convenience Sample, , EDU= education, EA – Emerging adults, EL-Experience level, F-Female, FAS -Final analytical sample, GAATOR -General alcoholics anonymous tools of recovery, LOE- Level of Evidence, LOMA -Level meeting attendance, M – male, MA – mean age, MAAEZP– Making Alcoholics Anonymous Easier Program, MR- married, MW Midwest, N-number participants, n- subset participants, NE -Northeast, NSP- Not sponsoring, PC- Physical Consequence, PR- Participation Ranking, R-Race, RTC-Residential treatment center, RM -Recovery motivation, S- Single. SD- Standard deviation, SE- Southeast, SP- Sponsoring SUDR - Substance use disorder recovery, US -United States, W-West, yo-years old, ↑- increased; ↓- decreased, > = greater than; ++ high quality; --poor quality, X – Yes, − No X SPONSORSHIP AND RECOVERY 43 Conjoint ADP- Alcohol dependent participant, AFA- African American, C -Caucasian, CP- Community programs CS -Convenience Sample, , EDU= education, EA – Emerging adults, EL-Experience level, F-Female, FAS -Final analytical sample, GAATOR -General alcoholics anonymous tools of recovery, LOE- Level of Evidence, LOMA -Level meeting attendance, M – male, MA – mean age, MAAEZP– Making Alcoholics Anonymous Easier Program, MR- married, MW Midwest, N-number participants, n- subset participants, NE -Northeast, NSP- Not sponsoring, PC- Physical Consequence, PR- Participation Ranking, R-Race, RTC-Residential treatment center, RM -Recovery motivation, S- Single. SD- Standard deviation, SE- Southeast, SP- Sponsoring SUDR - Substance use disorder recovery, US -United States, W-West, yo-years old, ↑- increased; ↓- decreased, > = greater than; ++ high quality; --poor quality, X – Yes, − No SPONSORSHIP AND RECOVERY 44 Appendix F Citation Conceptual Framework Design/ Method Sample/ Setting Major Measurement/ Data Analysis Findings/ Decision for Variables & Results practice Definitions Greenfield & Cognitive Social Design: N=129 (46.5% F) IV1: INT GAATOR Factor Analysis DV1: Level II Tonigan (2013). Learning LLA, SG, 19 to 64 years, IV2: T AAI Mean = 6.67 Strength: The general Theory, Naturalistic with a (M) age of IV3: AAA SE = 0.43 fairly large Alcoholics Sociobiology 38.76 IV4: SP P<0.001 sample size N. Anonymous non-Hispanic W (n IV5: ENC DV2: Weakness: Purpose: Indirect tools of To illustrate = 47) IV6: TRA Mean = how the measures of recovery: The New IV7: PDSA 12.23 endorsement GAATOR may adoption of 12Mexican/Spanish IV8: BS SE = 0.45 and practice of American (n = 43) IV9: SSW overestimate step practices P<0.001 American the 12 steps step-work and beliefs. DV1: BE Indian/Alaska changed over competing DV2: SE a 9-month Native (n = 20) DV3: ALA process to certain A – age, AA – Alcoholics Anonymous, AAA –Attendance, AAI – Alcoholics Anonymous Inventory, AB- abstinence ALA – Alcohol abstinence, AS – Addiction severity, ADP – Alcohol dependent people, AI – American Indian, ARG – Alcohol Research Group, AS – addiction severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - availability level, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – Baseline severity, BA – Biological assay, BVR: Bivariate Regression BAS: Baseline alcohol severity, BHG – belongs to a home group, BS – Behavioral step work, CF – Correctional Facility, CO – Court order, COM – comorbidities, COS: Completion of steps, COSM- Considering oneself a member, CS – Cohort Study, DI – diagnoses, DA – Days absent, DDD – Drinks per day, DOC – Drug of choice, DV-dependent variable, EA – Emerging adult, EL – experience level, ENC – encouragement, F – female, FQSU - Frequency and quantity of substance use, GAATOR – General Alcoholics Anonymous Tools of recovery, G - Gender, GP – General population, HCP – Healthcare provider, UHG –Home group, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug,, IMN – Incorporation of members in network, INT – Intercept, IAAAAM – Introduced to AA via AA member, IAASM –self-motivation, IAATF – Introduced to AA via TF, IV- independent variable, KL – knowledge level, LA – Lagged Analysis, LHLM – Lagged hierarchical linear model, LC - Latent class, LOS – Level of sponsorship, LOMA –Meeting attendance, LHLM - Lagged hierarchical linear model, LLA - Longitudinal lagged analysis, LOS – Length of sobriety, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MC – Mental Consequences, MHP – Mutual help participation, MOOM- Meeting with others outside meetings, MSOM- Meeting with a sponsor outside meetings, MVR:- Multivariate regressions, N-number of participants, n- subset of participants, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- non recovering alcoholics, NS – Not sponsoring, OS - Obtaining a sponsor, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern of use, PA– Psychoanalytic Theory, PD – Psychological Diagnosis, PDA – Percent days absent, PDAA– percent days abstinent from alcohol PDATSM – percent of days attending a 12-step meeting, PDSA - Proportion days 12-step attended, PR – participants ranking, PS - Psychiatric symptoms, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading the literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, , RTSL – Read 12-step literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Sponsor contact, SD – Standard deviation, SE – Spiritual estimate, SM – motivation, SG – Single group, , SIM – Interaction, SLT - Social Learning Theory, SOC – Social Consequences, SP – sponsor, SRC – Substance related consequences, SSW – Spiritual step work, SCID - Structured Clinical Interview-TR, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – 30 day abstinence, TDMA - 30 day attendance,, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA – Treatment attendance, US – Use of a sponsor, UHG – Use of a home group, VPM – Verbal Participation during meetings, W – White, WE – weekend, WTTS – Working 12 steps, SPONSORSHIP AND RECOVERY Funded by NIAAA Bias: Selection bias, Recall bias period among early AA affiliates 45 Mexican American (n = 14) Inclusion Criteria: New AA affiliates USA Exclusion Criteria: Non-AA affiliates, not new affiliates DV4: ID DV5: PDAA DV6: DDD extent due to wider arrangement including general beliefs and practices. Conclusion: Behavioral step work and spiritual step work influence the patients independently to predict the substance use. As a result, two distinct tools of A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY 46 recovery have unique impacts on outcomes. A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Citation Kelly et al., (2016). Recovery benefits of the “therapeutic alliance” among 12-step mutualhelp organization attendees and their sponsors. Theory/ Conceptual Framework Therapeutic Alliance; Psychoanalytic theory Design/ Method 47 Sample/ Setting Major Variables & Definitions IV1: DI IV2: PS IV3: RM IV4: AS IV5: FQSU IV6: SRC IV7: MHP IV8: S IV9: SC IV10: SA IV11: BA. DV1: TSP DV2: AB. Measurement/ Data Analysis Findings/ Results Decision for practice N=302 (age 18Psychiatric sample t-tests 3months: Level II 24) symptoms and chi-squared r=0.28 Strength: Mean age = 20.4 index of analyses. P<0.001 large sample size hierarchical years old severity. 6months The results Purpose: To Commitment multivariate SD = 1.6 r=0.27 clearly showing assess the to Sobriety linear models Caucasian = 95% p<0.05 the relationship strength of the Male = 73% 12months between the Leeds impact of Single = 100% r=0.39 sponsorship and Dependence varying HS diploma = p<0.01 abstinence. Questionnaire strengths of 83% Weakness: The Form-90 Non random sponsor Inclusion samples mainly Criteria: Young alliance with Funded by U.S. consisting of adults in persons in National recovery. residential males. Also the A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps Design: Longitudinal LA, CS SPONSORSHIP AND RECOVERY Institute of Alcohol Abuse and Alcoholism Bias: Selection bias, Recall bias USA 48 treatment Exclusion Criteria: Adults, not in residential treatment. sponsor alliance inventory was adapted close to the existing measure which intended to find the relationship between the sponsor and the patients. Conclusion: 12-step sponsor are found to be helping the young adults recovering from the substance A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY 49 abuse. A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Citation Theory/ Conceptual Framework Design/ Method 50 Sample/ Setting Major Variables & Definitions Measurement/ Instrumentati on Data Analysis (stats used) Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Kelly et al., Cognitive Social Design: N=302 IV1: DOC SCID, FormNon-parametric DV1: Level III (2015). Learning N=157 IV2:G 90,SAI Mann-Whitney, Mean = Strength: The Sponsor The Spearman Theory (SCID) Final analytical DV1:SAI Kruskal Wallis, 56.10 Alliance . rank order Form-90 sample DV2:PDATSM Spearman Rank SD=57.14 Inventory: correlations (SAI), Mean age = 20.5 DV3:INV order P>0.05 Assessing the show that SAI Twelve-Step years old DV4:PDA correlations DV2: Therapeutic scores were Affiliation SD = 1.56 Mean = Bond Between significantly Saliva tests Caucasian = 61.91 12-Step correlated with 96.8% SD=13.84 Attendees and each other across M= 70.7% P>0.05 Purpose: Their Sponsors. To determine AL = 31.0% DV3: time. The result A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Funded by MGH Psychiatry, Center for Addiction Medicine, Recovery Research Institute NIAAA and by an anonymous donation to the Hazelden Betty Ford Foundation in Minnesota, the role of sponsorship in the road to recovery from substance abuse 51 MA = 23.2% OO=21.3 ST = 19.4% OD=5.2% Inclusion Criteria: Young adults who reported having a 12-step sponsor and are in residential treatment Exclusion Criteria: Adults, people who do not Mean = 6.94 SD=1.27 P>0.05 DV4: Mean = 96.78 SD=11.49 P>0.023 showed 10-item measure with internal consistency coefficients above 0.95. Weakness: Bias due to attrition and SIA non-completion Conclusion: Important part of 12-step MHOs is the sponsorship. There is an association between the A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Bias: Selection bias 52 have a 12-step sponsor sponsorship and the recovery outcomes. USA A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Citation Theory/ Conceptual Framework Design/ Method 53 Sample/ Setting Major Variables & Definitions Measurement/ Instrumentati on Data Analysis (stats used) Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Kelly et al., Cognitive Social Design: N= 607 emerging IV-1: R Multidimensio Multivariate DV : Level II (2013). Learning LHLM, CS adults (18-24 IV-2: COM nal Mutualregression Strength: PDA= Emerging Theory years) enrolled at IV-3: TSA help Meeting Good control and −2.26; adults’ intake in RTC, IV4: ATSI Activity Scale, baseline to show Purpose: PDHD = To illustrate n=303 completed treatment IV4: COSM Global the effect of the 4.89 the e effects of the survey outcomes in IV5:VPM Severity Index, sponsors on the PDHD vs. 12 step 12-step (M) age = 20.4 relation to 12IV6: MOOM Stages of attendance and years step mutualIV7: WTTS Change and treatment. 12-step active 12-step SD = 1.6 help attendance IV8: OS Readiness and attendance Weakness: The noninvolvement Male = 73.9% and active IV9: MSOM Treatment (p = .06) involvement. on substance Caucasian = IV10: ATS Eagerness experimental A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Funded by NIAAA Bias: Selection bias, Recall bias USA use outcomes following RT among EA’s 54 94.7% 1.7% identified as AI, 1.3% identified as African American, and 1.0% as Asian Inclusion Criteria: Adults in residential treatment Exclusion Criteria: Not adult, not in residential treatment IV11: RTSL IV12:HSM DV-1 PDA DV-2 PDHD Scale, InDUC2R, Alcohol/Drug Self-Efficacy Scale Main effect vs. 12-step attendance (p=0.09) DV1: (F = 9.17, p = .002 DV2: (F = 6.58, p = .01) manipulation of the independent variable could result in various factors other than 12-step participation to be responsible for outcome variability. Conclusion: The emerging adults who were aided by the sponsors increased their levels of 12-step A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY 55 completion and active involvement in the following year treatment. Citation Theory/ Design/ Sample/ Setting Major Measurement/ Data Analysis Findings/ Level/Quality of Conceptual Method Variables & Instrumentati (stats used) Results Evidence; Framework Definitions on Decision for practice/ application to practice Stevens & Conjoint Additive N=245 AAM IV1: KL Survey Chi square test Chi square = Level III Jason. (2015) measurement conjoint n=117 F IV2: EL 20.493, df = Strength: An exploratory theory model, cohort n=128 male. IV3: AL 19. P= 0.365 The sponsorship Chi square = sections in this investigation of study IV4: CL 22.929 important study has never Inclusion criteria: IV5: GSL qualities and Purpose: To Males and females IV6: SEX Df = 19 been researched A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY characteristics of Alcoholics Anonymous sponsors.. Funded by National Institute on Drug Abuse Bias: Selection bias USA determine the qualities of character that make an effective AA sponsor. 56 in substance abuse recovery Exclusion criteria: Not adults and never had a sponsor IV7: S/SP DVPWU P=0.240 in the past. The survey successfully demonstrated the important quality of being a good sponsor. Weakness: The convenience sample was used with a cross – sectional, selfreport design. The sample is associated with AA as well as communal OH. A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY 57 There were no tested theories regarding the sponsorship mechanisms. Conclusion: A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Citation Theory/ Conceptual Framework Design/ Method 58 Sample/ Setting Major Variables & Definitions Measurement/ Instrumentati on Data Analysis (stats used) Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Stevens & Cognitive Social Design:: N=215 IV1: PR Conjoint Level II τ = 0.410 conjoint 2 Jason (2015) Learning Conjoint Female = 109 DV1: KL method, Strength: r = .36 analysis Evaluating Theory method Male = 116 DV:-EL Use of conjoint pwu = 0.698 methods as alcoholics involving W = 163 DV3:AL method enables p<0.001 implemented anonymous participants African American the separation by SYSTAT, sponsor ranking = 41 between the attributes using hypothetical Mean age = 40.9 effective and Kendall’s tau conjoint sponsors SD = 10.7 ineffective analysis. College = 35.1% sponsorship. Purpose: To HS = 94.3% Weakness: Funded by evaluate the This research has Inclusion A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY DePaul University Bias: Selection bias USA attributes of AA sponsors, and ascertain how these characteristics affect the sponsorship relationship. 59 Criteria: adults who have acted as a sponsor, sponsee, or both Exclusion Criteria: Not adults, never had a sponsor. cross-sectional, self-report resign with a convenience sample. The samples are involved with Oxford Houses which are communal. Conclusion: The availability of the sponsorship has close ties with effective sponsorship. In A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY 60 addition, the effective sponsors provide structures for the patients to progress in recovery. A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Citation Theory/ Conceptual Framework Design/ Method 61 Sample/ Setting Major Variables & Definitions Measurement/ Instrumentati on Data Analysis (stats used) Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Witbrodt et al., Cognitive Social Design: N=1598 IV-1: LOMA Diagnostic DV: Level II latent class 2 (2012). Learning Theory TA, CS n=926 ADP in IV-2: LOS Interview Strength: Χ =35.8, growth Does IV-3: A The hypothesis public and private Schedule p<.001 analyses, sponsorship IV-4: REL was tested and treatment Purpose: High Block-entry (2 To construct improve IV-5: BS confirmed that programs blocks) attendan being in a high AAA, outcomes above IV-6: G n= 672 GP of multinomial ce sponsorship, alcoholics DV-1: TDA sponsor class ADP in AA regression OR = 3.9, and abstinence anonymous resulted in better Medium LC trajectories Inclusion attendance? A abstinence Attendanc to test the latent class compared to the Criteria: growth curve added benefit ADP from public e low sponsor. A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY analysis Funded by NIAAA Bias: Selection bias, Recall bias USA of having a sponsor 62 and private TPS Exclusion Criteria: Nonalcohol-dependent individuals who are not in public or private treatment programs. OR = 2.3 Low Attendanc e OR = 2.0 Weakness: The follow-ups occurred at 1,3,5,7 years the data was missing for the years 2,4,and 6. There is a possibility of deviation if all the data was collected. Conclusion: AA attendance and sponsorship have a close relationship. The sponsors should A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY 63 be involved in long term treatment goals for AA patients. A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Citation Theory/ Conceptual Framework Design/ Method 64 Sample/ Setting Major Variables & Definitions Measurement/ Instrumentati on Data Analysis (stats used) Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Young (2012). Cognitive Social Design: N=254 IV1: A Survey method Statitical DV: Level III Alcoholics Learning Theory Logit model, n= 117 Sponsoring IV3: R Analysis Power = Strength: Cohens d Large sample Anonymous Crossectional n=146 Not IV4: MAR 0.98 Two tailed tsponsorship: data, sponsoring IV5: BHG Two-tailed size was test conducted with characteristics CS IV6: S t- test of sponsored IV7: IAAAAM Inclusion (Cohen’s random and sponsoring Criteria: Older IV8: IAATF Purpose: d D=0.5, sampling. Also To investigate than age 18 and the multiple members. IV9: IAASM p<0.05) associations categories were self-identified as a IV10: IAAF Funded by between tested on sponsor member of AA. IV11: IAACO Age: Department of background IV12: IAACA characters. Exclusion A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, and the VA Midwest Rural Health Resource Center. Bias: Selection variables and sponsorship roles 65 Criteria: Younger than age 18 and not self-identified as a member of AA. IV13: IAAHCP IV14: IAAE/FW IV15: IAANAFN IV16: IAAAAM IV17: IAACF IV18: LOS IV19: PST IV20: SP IV21: EMP IV22: EDU IV23: ADS IV24: NDY IV25: DOC-A IV26: OTR IV27: AD IV28: AW T =0.43 p<0.001 Sex: Χ2=35.8 p<0.01 Race: Χ2=12.0 9 p<0.01 Married: T = 0.61 NS Have a sponsor: Χ2=4.2 p<0.05 Weakness: Sampling bias resulting in generalizability of the finding, The analytic methods precluded longitudinal analysis. Many ttests results in increase in Type I Error Conclusion: The sponsors were significantly A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY bias USA 66 IV29: SPR IV30: SC IV31:: PC IV32: MC IV33: PD IV34: HB IV35: MB IV36: LB DV1: UNS DV2: SPO DV3: MB DV4: NS DV5: SPON Length of sobriety: Χ2=84.7 3 older, married, and to be parents while being spiritually strong. p<0.01 A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Citation Theory/ Conceptual Framework Design/ Method 67 Sample/ Setting Major Variables & Definitions Measurement/ Instrumentati on Data Analysis (stats used) Findings/ Results Level/Quality of Evidence; Decision for practice/ application to practice Young, L. B. Cognitive Social 40 survey N=264 IV1 KL Survey Pearson’s chiLevel III (2013). Learning Theory questions US = 95.1% IV2: EL questions square test, Sobriety Strength: Characteristics NE=22.3% IV3: AL Two tailed Average = Large amount of and Practices of Purpose: To sample was SE=18.9% IV4 : CL student’s t-tests 10.76 Sponsored compare the obtained. In MW=19.3% IV5 GSL years Members of difference addition, the W=34.5% IV6 SEX P<0.05) Alcoholics between short term and Mean Age = 47.3 IV7 S/SPDVSurrender Anonymous. sponsored and years long term PWU Scale = Funding: Center unsponsored sponsorship data SD = 11.5 21.96 for members of was obtained and MR=32.7% (p<0.001) Comprehensive AA. analyzed. Inclusion A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System Bias: Selection bias 68 Criteria: Unsponsored and sponsored AA members Exclusion Criteria: Non-AA members Weakness: Biased sample selection which could have influenced in sample not being the representative of the populations. Unsponsored group is likely heterogeneous. USA Conclusion: Sponsorship is a vital part of the AA patients. The A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY 69 Citation Conceptual Framework Design/ Method Sample/ Setting Major Variables & Definitions Measurement Data Analysis Findings Zemore et al., (2013) Cognitive Social Learning Theory Design: LLA N=508 n=196, no IV-1:TD MA IV-2: US; SW Survey assessing Bivariate and multivariate DV-1: [OR] = article shows that the sponsorship does not depend on when they were introduced, but the frequent engagement, and high degree of spirituality. Decision for practice Level of Evidence: II A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY Involvement in 12-step activities and treatment outcomes Funded by NIAAA Bias: Selection bias, Recall bias USA CS Purpose: To address the relative importance of specific 12step activities to recovery, and how treatment affects participation in those activities. 70 MAAEZ P n=312, MAAEZP. Inclusion Criteria: RA entering and emerging from a TF Exclusion Criteria: NRA who are not emerging from a TF. IV-3: RL IV-4: SIM IV-5: UHG IV-6: IMN IV-7: COS IV-8: BAS IV-9: TLOS. DV-1: TDA participation in 12-step activities at time intervals; BrownPeterson Recovery Progress Inventory. regression. 1.22, P < .05 SI; OR = 2.07, P = .09 12-step members; OR = 2.41, P = .13 longer treatment duration Strengths: Medium N. Multiple measurement points after baseline. Weaknesses: Unclear as to how results generalize across programs. Conclusions: Sponsorship and consistent meeting attendance is significant. Step A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY 71 trended toward associati on with increased use of a home group (OR = 1.32, P = .12) completion may not be significant. Harm: None Feasibility: High A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps SPONSORSHIP AND RECOVERY 72 A – age, AA – Alcoholics Anonymous, AAA – AA Attendance AB- Abstinence AD – Always drinking, ADS – Age started, ALA – Alcohol abstinence, AS – Addiction severity, ADP – Recovering alcoholics, AI – American Indian, ARG – Alcohol Research Group, AS –Severity, Attended any 12-step meetings, ATSI – Active 12 step, AL - Available, AW – After work, BA – Biological Assay, BAS – Baseline alcohol severity, BE - Behavioral Estimate, BS – steps, CF – Correctional Facility, CL – Confidentiality level , CO – Court order, COM – comorbidities, COS: Completion steps, COSM- Considering self member, , CS – Cohort Study, DI – Diagnoses, DA – Days absent, DDD – Drinks per drinking day, DOC – Drug of choice, DOC-A – Drug of choice, alcohol, DV-dependent variable, EA – Emerging adult, EDU – Education, EL – Experience level, EMP - Employment, ENC – Encouraget, F – female, FQSU - Frequency and quantity of use, G – Gender, GAATOR – General Alcoholics Anonymous Tools of Recovery, G - Gender, GP – General population, GSL – Goal setting, HB High bottom, HCP – Healthcare provider, HS – High school, HSM – Helped setup meetings, ID – Illicit d rug, IMN – Incorporation of members in network, INT – Intercept, INV - Involvement IAAAAM – Intro to AA via AA, IAACA – Intro to AA via counseling agency, IAACO – Intro to AA via CO, IAAE/FW – Intro to AA via employer, IAAF – Intro to AA via family, IAAHCP – Intro to AA via HCP, IAACF – Intro to AA via CF, IAANAFN – Intro to AA non-AA friend, IAASM – Intro to AA self-motivation, IAATF – Intro to AA via TF, IV- independent variable, KL – knowledge, LA – Lagged analysis, LB – Low bottom, LC - Latent class, LHLM – Lagged hierarchical model, LOS – Level sponsorship, LOMA – Level meeting attendance, LLA - Longitudinal lagged analysis, LOS – Length sober, M – mean , MA – Meeting Attendance, MAAEZP– Making Alcoholics Anonymous Easier Program, MAR – Married, MB – Middle bottom, MB – Member, MC – Mental Consequences, MM – Members, MHP – Mutual help, MOOM- Meet others outside meet, MSOM- Meet sponsor outside meet, MVR:- Multivariate regressions, N-number participants, n- subset participants, NDY – Number drinking years, NIAAA – National Institute on Alcohol Abuse and Alcoholism, NRA- Not recovering alcoholics, NS – Not sponsor, OS - Obtaining sponsor, OTR – Other, PC – Physical consequences, PDHD – Percent days heavy drinking, POU – Pattern use, PA– Psychoanalytic Theory, PWU – Part-worth utility, PD – Psych diagnosis, PDA – Percent days abstinent, PDAA Percent days abstinent PDATSM – percent days attending meeting, PDSA - Proportion days attended, PR – participants ranking, PS - Psychiatric symptoms, PST – Parental status, R – Race, RA – Recovering alcoholics, REL – Religiosity, RL – Reading literature RM – Recovery motivation, RT - Residential Treatment, RTC – Residential treatment facility, RTSL – Read literature, S – sponsor, SA – Sponsor Alliance, SAI – Sponsor alliance inventory, SC - Contact, SCID – Structured Clinical Interview for DSM –IV, SD – Standard deviation, SE – Spiritual estimate, SEX - Sex, SM – Self motivation, SG – Single group, SIM – Social interaction, SLT - Social Learning Theory, SOC DSM-IV-TR test, SP - Spirituality, SPO – Sponsored, SPR – Spree, SPON- Sponsoring, SU – Substance Use, SW - Service Work, T – Time, TA – Trajectories analysis, TDA – Thirty day abstinence, TDMA - Thirty day meeting attendance, TF – Treatment Facility, THA - Therapeutic Alliance, TLOS – Treatment length of stay, TSP – 12-step participation, TO - Treatment outcomes, TSA– 12 step attendance, TPS – treatment programs, TRA –Attendance, UHG –Home group, UNS – Unsponsored, US – Use sponsor, UHG – home group, VPM – Verbal Participate, W – White, WE – weekend, WTTS – Working steps