title: Alcoholics Anonymous attendance, decreases in impulsivity and drinking and psychosocial outcomes over 16 years: moderated-mediation from a developmental perspective.
abstract: OBJECTIVE
  To examine whether decreases in impulsivity account for links between Alcoholics Anonymous (AA) attendance and better drinking and psychosocial outcomes, and whether these mediational 'effects' are conditional on age.
  
  
  METHODS
  A naturalistic study in which individuals were assessed at baseline, and 1, 8 and 16 years later.
  
  
  METHODS
  Participants initiated help-seeking through the alcohol intervention system (detoxification programs, information and referral centers).
  
  
  METHODS
  Individuals with alcohol use disorders and no prior history of substance abuse treatment at baseline [n=628; 47% women; mean age=34.7 years (standard deviation=9.4)].
  
  
  METHODS
  Self-reports of impulsivity and drinking pattern at baseline and year 1, duration of AA (number of weeks) in year 1 and drinking (alcohol use problems, self-efficacy to resist drinking) and psychosocial outcomes (emotional discharge coping, social support) at baseline and follow-ups.
  
  
  RESULTS
  Controlling for changes in drinking pattern, decreases in impulsivity were associated with fewer alcohol use problems, better coping and greater social support and self-efficacy at year 1, and better coping and greater social support at year 8. Decreases in impulsivity statistically mediated associations between longer AA duration and improvements on all year 1 outcomes and indirect effects were moderated by participant age (significant only for individuals 25 years of age or younger).
  
  
  CONCLUSIONS
  Decreased impulsivity appears to mediate reductions in alcohol-related problems over 8 years in people attending Alcoholics Anonymous.
authors.affiliation: Center for Health Care Evaluation, Department of Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road, Menlo Park, CA 94025, USA. bloni001@stanford.edu
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Blonigen
authors.forename: Christine
authors.initials: C
authors.lastname: Timko
authors.forename: John W
authors.initials: JW
authors.lastname: Finney
authors.forename: Bernice S
authors.initials: BS
authors.lastname: Moos
authors.forename: Rudolf H
authors.initials: RH
authors.lastname: Moos
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000517:prevention & control* / Q000523:psychology; D019973:Alcohol-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D000436:Alcoholics Anonymous; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007175:Impulsive Behavior / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D010342:Patient Acceptance of Health Care; D010553:Personality Development; D020377:Self Efficacy; D012944:Social Support; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult