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Several studies have investigated "AA-specific" cognitive psychological mechanisms in 12-step therapy, arguably replicating the mechanisms of change in community-based AA. Morgenstern et al. (2002), for example, investigated how effectively 12-step therapy promoted desired changes in 12-step cognitions by patients (N = 370) and, in turn, how these shifts in attitudes and beliefs predicted drinking at discharge and at 6- and 12-month follow-up. Somewhat unexpectedly, at intake patient endorsement of 12-step cognitions such as commitment to AA and abstinence, disease attribution, and a belief in powerlessness over alcohol (e.g., loss of control) was already high, with most patients already "in agreement" with these prescriptions. Nevertheless, significant gains in these beliefs and attitudes were achieved during treatment, although, in general, these gains faded during the follow-up phase of the study. Several 12-step cognitions at treatment discharge did not predict 12-month abstinence, including powerlessness over alcohol, belief in a higher power, and disease attribution. Commitment to AA and to abstinence, however, significantly predicted increased abstinence at both 6- and 12-month follow-up. As noted by Morgenstern et al. (2002), commitment to abstinence is not unique to 12-step therapy, and AA referral across different kinds of therapy is common (Humphreys and Noke 1997). In this light, it is unclear whether 12-step specific cognitions (or more general and shared psychological mechanisms) accounted for later abstinence.

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FIGURE 34–2. Comparison of three Alcoholics Anonymous (AA)–exposed groups of treatment-seeking individuals on religious practices and God consciousness over a 10-year period.Source. From Connors et al. 1996.
Table Reference Number
TABLE 34–1. Summary of self-efficacy and Alcoholics Anonymous (AA) meta-analysis

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