Changes in alcohol‐related social network composition mediate the effects of AA meeting attendance on drinking following a recovery attempt in adults with alcohol use disorder

Aims To assess whether changes in social network drinking is a mechanism of behaviour change responsible for the benefits of attending Alcoholics Anonymous (AA) during a recovery attempt. Design An observational longitudinal cohort study investigating mechanisms of behaviour change among adults with alcohol use disorder (AUD) reporting initiation of a substantial recovery attempt. Setting Boston, Massachusetts, United States, and Hamilton, Ontario, Canada. Participants From a larger observational cohort, participants were individuals who reported a substantive increase in AA attendance (increase of ≥1 + meetings/week) from baseline to 6 weeks ( n = 71) and a propensity score‐matched control group of participants who did not increase AA attendance ( n = 71). Propensity score matching used demographics and baseline drinking. Measurements Baseline assessment and a 6‐week follow‐up assessment, including outcome variables: diagnostic assessment of AUD, timeline followback interview [percent drinking days (%DD) and percent heavy drinking days (%HDD)]; and exposure variables: formal egocentric social network assessment collecting egocentric social network metrics and using up to 20 network alters. Findings Compared with the control group, participants who increased AA participation statistically significantly reduced %DD [mean (M) = 5.67% (standard error of the mean, SEM = 1.81) vs 30.91% (3.59); F = 46.22, P < 0.001] and %HDD [5.21% (1.79) vs 23.32% (3.14); F = 28.34, P < 0.001] and exhibited statistically significantly improved social network indicators including reduced network drinking frequency [1.99 (0.08) vs 2.96 (0.09); F = 42.26, P < 0.001] and severity [1.68 (0.06) vs 2.34 (0.08); F = 40.51, P < 0.001]. Changes in social network drinking statistically significantly mediated the relationship between changes in AA attendance and reductions in %DD [ b = −0.06 (0.02), P = 0.01] and %HDD [ b = −0.05 (0.02), P = 0.04] at follow‐up. Conclusions Reduced social network drinking appears to be one mechanism of behaviour change associated with the positive effects of Alcoholics Anonymous on drinking behavior during recovery.