Project Abstract: At least 100 million adults worldwide are adversely affected by the substance addiction of a
close relative. Al-Anon Family Groups, a 12-step mutual-help program for people concerned about another’s
drinking, is widely available and effective. However, there is a critical lack of knowledge about how to facilitate
Al-Anon participation among concerned others (COs), and the extent to which Al-Anon also benefits drinkers.
This unique study will examine the effectiveness of Al-Anon Intensive Referral (AIR) with COs of
individuals in treatment for alcohol use disorders (“drinkers”). AIR’s goal is to facilitate Al-Anon participation
and positive outcomes (e.g., better quality of life, active coping) among COs. The project will also examine the
extent to which AIR is associated with treatment engagement, Alcoholics Anonymous (AA) participation, and
positive outcomes among drinkers. Although literature on alcoholism as a family disorder frequently states that
COs positively influence drinkers’ outcomes, data from methodologically strong studies are sorely lacking.
This project builds on two main lines of research by this study team: (1) implementing and showing the
effectiveness of Intensive Referral, a 12-step facilitation method, to increase AA participation and improve
outcomes among patients in treatment for substance use disorders, and their COs; and (2) a recent NIAAA
longitudinal R21 study to identify the benefits and mechanisms of Al-Anon participation to newcomers,
members, and their drinkers.
In a randomized controlled trial of AIR, this 4-year project has three Specific Aims. Aim 1: Implement
AIR at three sites (Little Rock, AR; Omaha, NE; Palo Alto, CA) to evaluate AIR’s effectiveness for COs. COs
(N=534) and their drinkers (N=534) will be assessed at baseline and 3-month, 6-month, and 1-year follow-ups.
Hypotheses are that, compared to usual care, AIR will (1A) accelerate help-seeking and increase Al-Anon
participation, and (1B) improve CO outcomes. Aim 2: Evaluate AIR’s effectiveness for drinkers. Hypotheses
are that AIR will be associated with drinkers having (2A) more treatment and AA participation, and (2B) better
drinking outcomes. We will examine Aims 1 and 2 using generalized mixed-effects regression models
(GLMM). Aim 3: Examine AIR’s mechanisms of action (mediators and moderators). In addition, we will
examine reciprocal effects of CO and drinker functioning using Structural Equation Modeling (SEM).
This project is built on the foundation that it is essential to help COs because of their own suffering. In
addition, it is essential to help COs in order to help drinkers (whose better functioning, in turn, also helps COs).
In contrast to other family-based approaches to addiction treatment, AIR is feasible to deliver in real-world
treatment programs, requiring few resources. After completing this RCT, if AIR is shown to be effective, the
next step in this research program will be to conduct an implementation study (Hybrid Type 2) to disseminate
and sustain AIR across treatment programs, thereby helping COs and drinkers.