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.

PROJECT NARRATIVE For every person with an alcohol problem, at least four other people are negatively affected. Helping friends and family members of alcoholic individuals is important in its own right, and may be central to the individual’s recovery. A source of help for people concerned about another person’s drinking is Al-Anon Family Groups, a 12-step mutual-help program. This proposed study will evaluate an intervention, Al-Anon Intensive Referral, designed to facilitate Concerned Others’ participation in Al-Anon and improve their well-being and functioning. It will also examine how the intervention might help encourage the drinking individual to attend support groups, such as Alcoholics Anonymous (AA), and work toward abstinence. Results will be of interest to helpers, including treatment providers, of substance abusing individuals and their families and friends, giving them information that can be used to facilitate Al-Anon and AA utilization and improve outcomes.