title: Negative affect, relapse, and Alcoholics Anonymous (AA): does AA work by reducing anger?
abstract: OBJECTIVE
  Anger and other indices of negative affect have been implicated in a stress-induced pathway to relapse. The Alcoholics Anonymous (AA) literature states that reduction of anger is critical to recovery, yet this proposed mechanism has rarely been investigated. Using lagged, controlled hierarchical linear modeling analyses, this study investigated whether AA attendance mobilized changes in anger and whether such changes explained AA-related benefit.
  
  
  METHODS
  Alcohol-dependent adults (N = 1,706) receiving treatment as part of a clinical trial were assessed at intake and at 3, 6, 9, 12, and 15 months.
  
  
  RESULTS
  Findings revealed substantially elevated levels of anger compared with the general population (98th percentile) that decreased over 15-month follow-up but remained high (89th percentile). AA attendance was associated with better drinking outcomes, and higher levels of anger were associated with heavier drinking. However, AA attendance was unrelated to changes in anger.
  
  
  CONCLUSIONS
  Although support was not found for anger as a mediator, there was strong convergence between AA's explicit emphasis on anger and the present findings: Anger appears to be a serious, enduring problem related to relapse and heavy alcohol consumption. Methodological factors may have contributed to the lack of association between AA and anger, but results suggest that AA attendance alone may be insufficient to alleviate the suffering and alcohol-related risks specifically associated with anger.
authors.affiliation: Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Suite 120, Boston, Massachusetts 02114, USA. jkelly11@partners.org
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stout
authors.forename: J Scott
authors.initials: JS
authors.lastname: Tonigan
authors.forename: Molly
authors.initials: M
authors.lastname: Magill
authors.forename: Maria E
authors.initials: ME
authors.lastname: Pagano
mesh_terms: D000328:Adult; D000339:Affect; D000436:Alcoholics Anonymous; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation*; D000786:Anger; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome
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