Alcoholics Anonymous attendance, decreases in impulsivity and drinking and psychosocial outcomes over 16 years: moderated-mediation from a developmental perspective

Aims 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. Design A naturalistic study in which individuals were assessed at baseline, and 1, 8 and 16 years later. Setting Participants initiated help-seeking through the alcohol intervention system (detoxification programs, information and referral centers). Participants 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)]. Measurements 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. Findings 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.