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. Author manuscript; available in PMC: 2023 Feb 24.
Published in final edited form as: Subst Use Misuse. 2022 Dec 6;58(1):119–128. doi: 10.1080/10826084.2022.2149245

The Involvement in Alcoholics Anonymous Scale - Short Form: Factor Structure & Validation

Christopher R Beasley a, Onawa LaBelle b, Noel Vest c,*, Bradley Olson d, Michael D Skinner a, Joseph R Ferrari e, Leonard A Jason f
PMCID: PMC9951623  NIHMSID: NIHMS1871480  PMID: 36474456

Abstract

Background:

The aim of this research was to examine the psychometrics of a short form version of the multidimensional Involvement in Alcoholics Anonymous scale (IAA-SF) by assessing the factor structure, internal consistency, and predictive validity. While there are several existing measures of involvement in Alcoholics Anonymous, many are either unidimensional or are limited in their ability to gather variation in the level of involvement in the different dimensions of 12-step programs.

Objective:

To achieve our aim, we used exploratory and principal axis factor analysis, correlation, and logistic regression with two unique and diverse samples. Longitudinal data were collected from a northern Illinois sample of 110 post-treatment adults, and cross-sectional data were from a random sample of 296 recovery home residents in the United States.

Results:

Results from the first sample suggested three exploratory factors (Principles Involvement, Social Involvement, and Spiritual Involvement) that were concordant with the proposed conceptualization and were then confirmed in the second sample. A 2nd order factor of global involvement was also found. All subscales demonstrated good to excellent internal consistency and were moderately associated with AA affiliation. Global and social involvement predicted greater odds of abstinence 2 years later, but principles and spiritual involvement did not.

Conclusion:

Overall results suggest the IAA- SF is a valid and reliable 12-item instrument for assessing involvement in the AA program, and the differential prediction suggests potential utility for a multidimensional approach to 12-step involvement.

Keywords: 12-step, Alcoholics Anonymous, psychometrics, validity, Oxford house, recovery

Introduction

The most prevalent form of support for people seeking help for alcohol or other substance use disorder is a 12-step social support program (Humphreys, 2003; Kelly et al., 2020). Although the total membership of all 12-step programs is unknown, Alcoholics Anonymous (AA) membership surveys suggest there are around 2 million AA members worldwide who attend over 115,000 AA groups (Alcoholics Anonymous World Services, 2014; Kaskutas et al., 2008). AA provides primary support for recovery, ancillary support during treatment, and continuing support following these services.

While 12-step membership is predictive of abstinence (i.e., discontinuing substance use), the depth to which one is involved appears to be more strongly related to continued abstinence and positive outcomes (DeLucia et al., 2016; LaBelle & Edelstein, 2018; Tonigan & Connors, 2015; Weiss et al., 2005). Involvement in 12-step programs includes attending meetings, working the 12 steps, seeking spiritual support from a Higher Power, social interactions, and service to both the 12-step organization as well as other members. Members of 12-step programs appear to have a greater likelihood of abstinence than nonmembers after formal treatment (Costello et al., 2019; Majer et al., 2002; Timko et al., 2006; Timko & DeBenedetti, 2007). Additionally, 12-step programs seem to be about as effective as other interventions (Kelly et al., 2020; Zemore et al., 2017).

Involvement in Alcoholics Anonymous

In AA, there are a number of factors that are considered “essential” aspects of the program and contribute to a member’s continued recovery. AA members are encouraged to engage or participate in all of them for the best possible outcome. Attendance, for example, is considered an important component of the program (Alcoholics Anonymous, 2002b); AA does not endorse a minimal frequency of attendance, but suggests regular meeting attendance, particularly early in the recovery process (Alcoholics Anonymous, 1952, 2002b). AA meeting attendance is related to increased abstinence (Timko et al., 2006; Witbrodt et al., 2012, 2014) with increased motivation for abstinence and abstinence-focused coping skills potentially serving as mediators (Kelly et al., 2000).

AA literature also suggests the 12 steps are the core of the program and members are strongly encouraged to “work the steps” (Alcoholics Anonymous, 1952). Prior research has shown that continued abstinence (i.e. sobriety) is related to the number of steps an AA member has worked (Timko et al., 2006), and that more involvement in the 12 steps is related to better outcomes among AA members, including more post-traumatic growth, social support, and gratitude, as well as less stress and physical health symptoms (LaBelle & Edelstein, 2018).

Furthermore, AA literature emphasizes the pursuit of support from a Higher Power (Alcoholics Anonymous, 2002a) and suggests that the AA program itself is based on spiritual values (Alcoholics Anonymous, 1952). Spirituality may indirectly increase abstinence by increasing 12-step involvement, degree of affiliation, and engagement in various 12-step practices (Tonigan, 2007; Tonigan et al., 2013), and may also partially explain the relationship between involvement and abstinence (Kelly, 2017; Kelly et al., 2012; Zemore, 2007).

AA literature also promotes social activity during and between meetings (Alcoholics Anonymous, 1952). For example, food and drink are often served at meetings, and members form clubs, gather for dinners, arrange parties, and meet up for lunch or coffee. AA suggests social interaction with sober peers will lead to friendships that take the place of former substance using acquaintances (Alcoholics Anonymous, 1952). Peer support from other people in recovery is linked to abstinence (Bassuk et al., 2016; Best et al., 2021; Bond et al., 2003; Groh et al., 2007), and the adoption of pro-recovery social networks may explain the effect of AA (Kelly et al., 2012).

Lastly, AA members are strongly encouraged to be of service to other members and the organization as a means of staying sober and for passing on the support they received from others (Alcoholics Anonymous, 1972). One aspect of service, sponsoring others, is related to better abstinence rates (Crape et al., 2002; Pagano et al., 2004; Tonigan & Rice, 2010; Witbrodt et al., 2012). Additionally, for AA-based interventions, sponsoring others may be an important mediator of the interventions’ effects (Subbaraman et al., 2011). Similarly, other forms of helping others have been shown to be related to abstinence (Magura et al., 2003; Zemore et al., 2004) and positive outcomes (LaBelle, 2020). Taken together, these findings suggest that specific components (i.e., principle, spiritual, social) of AA may be vital to successful recovery from alcohol use disorder.

12-step Involvement Measures

While there is no shortage of measures designed to capture general involvement in AA, there is a noted absence of multidimensional measures that could help identify limited engagement in a specific area and thus highlight gaps in a recovery program that need to be filled in order to maintain sobriety and improve well-being. Existing 12-step measurement instruments examine expectations (Kahler et al., 2006), attitudes and beliefs (Gilbert, 1991), embracement of the 12-step model (Humphreys et al., 1998; Kingree, 1997; Klein et al., 2011), adherence to the steps (Carroll, 1993), step work (Greenfield & Tonigan, 2013) and program involvement (Majer et al., 2010; Tonigan et al., 1996). Kingree’s (1997) 12-step affiliation instrument, the Alcoholics Anonymous Affiliation Scale (Humphreys et al., 1998) and the Twelve-Step Affiliation and Practices Scale (Klein et al., 2011) ask behavioral questions related to involvement; however, these questions indicate association with 12-step programs rather an involvement construct. Twelve-step affiliation has been previously defined as a combined measurement of AA attendance, sum of steps completed, and identifying one’s self as an AA member (Cloud et al., 2004), which may be similar but distinctly different from a more encompassing construct of AA involvement.

Three measures specifically designed to examine involvement are the Step Questionnaire (Carroll, 1993), Alcoholics Anonymous Involvement (AAI) scale (Tonigan et al., 1996) and Majer et al. (2010) categorical involvement instrument. The Step Questionnaire (Carroll, 1993) mostly focuses on spiritual behaviors and beliefs but also includes items related to attendance, sponsorship, and service to others. After entering recovery, spirituality is often developed over time; a measure that is primarily focused on spirituality is not likely to capture AA involvement among newer members. Further, the instrument’s unidimensional construction does not allow for assessment of specific facets of involvement. Similarly, while the AAI (Tonigan et al., 1996) includes items related to various facets of 12-step involvement, much of its focus is on attendance, and for this reason it is also unidimensional. Given that many people attend AA meetings after experiencing consequences related to drinking but are not necessarily otherwise “involved” in the AA program, measuring involvement with meeting attendance does not provide accurate information about the dimensions of AA that are important for continued sobriety. Lastly, while the 4-item categorical instrument (Majer et al., 2010) measures involvement in AA activities (i.e., “I have a sponsor who knows something about the 12 steps”, “I utilize a network of AA/NA members outside of meetings”, “I am involved with service” and “I have a home group that I attend regularly”), the measure is limited by the low total number of items and the dichotomous responses format, which does not allow for an assessment of variability in AA involvement.

The Involvement in Alcoholics Anonymous (IAA) scale (Kairouz, 1998; Kairouz & Fortin, 2013) is a 23-item multidimensional assessment of the degree to which one is involved in various aspects of Alcoholics Anonymous. Participants respond to items on a 9-point Likert-type scale (0 = don’t agree at all to 8 = agree completely) across 5 dimensions of involvement in AA. These five dimensions included psychological engagement in the movement, socialization with other members, belief in a higher power, application of the maintenance steps, and involvement in meetings. Kairouz and Fortin (2013) found that a principal component analysis for this instrument supported the intended five factor structure and that each factor had acceptable internal consistency, with the overall measure having excellent internal consistency. They further found that involvement in social and step work aspects of AA were related to life satisfaction, social involvement was related to positive affect, and step work was related to meaning in life. As with the aforementioned instruments, this scale appears to assess multiple constructs. Some items appear to evaluate affiliation, some affective experiences with AA, some beliefs, and some AA involvement self-efficacy. Additionally, some question response options are frequencies of behaviors rather than parallel Likert-type questions, and the author has offered no clear justification or calculation for an index score.

Prior to the publication of this 23-item 5-factor measure, Kairouz (2000) presented a 13-item version of the AAI with three subscales, each representing a fundamental aspect of Alcoholics Anonymous: (1) following the steps, (2) social interactions, and (3) seeking spiritual support. This short form of the 23-item measure shared 10 items with the long form. The shared items were “I continued to take personal inventory,” “I admit when I am wrong,” “I try to practice AA principles in all my affairs,” “During coffee breaks, I talk with other members of the group,” “I stay after the meetings to talk with members of the group,” “I see some members outside of meetings,” “I invest myself completely with AA members,” “I turn my life to God,” “It is with faith that I can be sober,” and “I sought through meditation to improve my contact with God.” The three additional items were, ““I made a list of all people I had harmed,” “I admitted to God, myself, and others the exact nature of my wrongs,” and “I sought through prayer to improve my contact with God.” Although, to date, neither the construct validity nor factor structure validity for the short form of this measure have been established, this short form has excellent face validity. The three factors appear to assess a single construct of AA involvement, they are conceptually consistent with AA practices, phrasing of questions and response options are consistent across the three factors, and the instrument provides a concise assessment of these AA involvement.

The current study examined psychometric properties of the short form version of the IAA. An exploratory analysis first examined the instrument’s structure. We hypothesized that an additional confirmatory factor analysis would validate this exploratory structure. Because these factors are all underlying facets of 12-step involvement, we also hypothesized the subscales would be indicators of a global factor of involvement. Given that affiliation and involvement appear to be related but distinct constructs, we further hypothesized the IAA-Short Form would be moderately related to greater 12-step affiliation. We also hypothesized that more global involvement, social support, and involvement in the principles of 12-step groups would predict greater likelihood of future abstinence.

Methods

Samples

Sample 1

Sample 1 was derived from a prior clinical trial of the Oxford House system of mutual-help addiction recovery housing (see Jason et al., 2006), in which participants were recruited from inpatient treatment centers in northern Illinois and were randomly assigned to live in an Oxford House or receive usual care with no research intervention. The sample included 110 adult participants who completed the 12-step involvement measure assessed in this secondary data analysis. The sample was composed mainly of women (75%), African-American (81%; 10% European-American, 7% Latino/a, and 2% another race or ethnicity), and never married (65%; 17% divorced, 13% married, and 6% separated) participants. On average, participants were 36.90 (SD = 7.94) years of age and had completed 11.96 years (SD = 2.23) of education.

Sample 2

A second sample was derived from a national cross-sectional survey of Oxford House residents. We mailed surveys to 641 residents of 96 houses and received 306 surveys from 83 houses. Therefore, the house and individual survey response rates were 86% and 48% respectively. After exclusion of unusable data, 296 participants from 83 houses remained in the study. The sample was primarily men (59%), European-American (75%; 17% African American, 4% Hispanic, 2% Native-American, 1% Asian-American, and 1% Pacific Islander), single/never married (54%; 28% divorced, 9% separated, 4% married, 3% widowed, and 2% in lifelong committed relationships). Additionally, 9% identified as LGBTQ and 39% had been to prison. Furthermore, 50% had at least some college education, 6% had completed trade school, 33% had completed high school or received a GED, and 12% had less than a high school education. On average, participants had actively used substances for 17.83 years (SD = 10.58), had been sober for 17.39 months (SD = 19.34), and lived in their current Oxford House for 10.51 months (SD = 16.67). Participants from both samples were treated according to APA recommendations for responsible conduct of research (American Psychological Association, 2017).

Measures

Involvement in Alcoholics Anonymous Scale - Short Form

(IAA-SF; Kairouz, 2000). The IAA- SF is a 13-item measure that assesses facets of AA involvement. Participants respond to items on a 9-point Likert-type scale (0 = don’t agree at all to 8 = agree completely). The IAA- SF subscales examine involvement in the program’s principles (Principles Involvement), social interactions (Social Involvement), and involvement in spiritual aspects of the program (Spiritual Involvement). Prior research has shown global IAA- SF scores to be reliable (α = 0.82) as well as its three subscales, Principles Involvement (α = .73), Social Involvement (α = .74), and Spiritual Involvement (α =.73) (Kairouz, 2000).

Alcoholics Anonymous Affiliation Scale

(AAAS; Humphreys et al., 1998). The AAAS (Humphreys et al., 1998) is a 9-item instrument assessing affiliation and involvement with Alcoholics Anonymous. Respondents respond to questions about whether they have beliefs, behaviors, and experiences that demonstrate affiliation in a dichotomous format (0 = no, 1 = yes) For example, “Have you ever considered yourself a member of AA?”, “Have you ever called an AA member for help?”, and “Have you had a spiritual awakening or conversion experience through your involvement in AA?” These items have noted similarities to items in the IAA, but importantly, do not offer separate factors. The measure also gathers information about meeting attendance over the past year and across one’s lifetime; both items are coded as 0 for no meetings, 0.25 for 1 to 30 meetings, 0.5 for 30 to 90 meetings, 0.75 for 90 to 500 meetings, and 1 for >500 meetings). All items are summed to create an overall AA involvement score ranging from 0 (no affiliation) to 9 (highest affiliation). The AAAS has good internal consistency (α = 0.85) and has been previously validated (Humphreys et al., 1998)

Substance use

The Form 90 Timeline Followback (Miller & Del Boca, 1994) was administered to Sample 1 at baseline and all subsequent follow-ups at 6, 12, 18, and 24 months. The instrument assesses healthcare utilization and residential history, as well as any alcohol or other substance use in the past 90 days. The TLFB has demonstrated good-to-excellent internal consistency, test-retest and cross site reliability, and temporal stability (Tonigan et al., 1997). The instrument has also been shown to be valid across multiple contexts (Brown et al., 1998; Carey, 1997; Hjorthøj et al., 2012, Pedersen et al., 2012). Given the abstinence-based goals of AA, we assessed whether participants were abstinent at the final wave of the study (i.e., at 24 months post-baseline) and created a dichotomous score of 0 (no alcohol or other drug use in the past 90 days) and 1 (any use).

Analyses

Exploratory factor structure

Prior to assessing the factor structure of the IAA-SF, individual items were examined. Item #5 (corresponding to AA step 5—I admitted to God, myself, and others the exact nature of my wrongs) was triple-barreled and potentially related to spirituality, principles, and social interactions, and was eliminated before analysis. All other items were retained. Using data from Sample 1, we determined the number of factors to keep using the parallel analysis. We then conducted a principle axis factor analysis (PAF) with direct oblimin rotation to allow correlation between factors.

Distinct factor structure

To assess the similarity between the IAA-SF and a previously established measure of AA affiliation, we examined the correlation of the AAAS to global involvement and individual subscales using summary scores. Given that affiliation and involvement are related but distinct constructs, we set a moderate correlation as the lower threshold >.40 and a strong correlation as the upper threshold <.85 for demonstrating distinct factor structure. Longitudinal data from Sample 1 was used for these analyses.

Predictive validity

To assess how well the IAA-SF predicted abstinence, we conducted a multiple logistic regression in which global involvement was used to predict the likelihood of substance use two years after the IAA Short Form was administered. Again, we used longitudinal data from Sample 1 for these analyses. Variables that may have had an influence on the outcome were also included in each model as controls, including experimental condition (living in an Oxford House or not), gender, race and ethnicity, and whether participants were living in a controlled setting (residential treatment, recovery residence, or incarceration) when substance use was assessed. Similarly, we conducted a second multiple logistic regression to predict abstinence from the factor subscales. All the subscales were entered into the model simultaneously. In both logistic regression models the control variables were entered into block 1 and predictors were entered into block 2.

Cross-validating factor structure

To cross-validate the factors, we examined how well the structure obtained for Sample 1 fit data from a separate sample (Sample 2) using confirmatory factor analysis in Mplus version 7.11 with a maximum likelihood, robust estimation. Given that Sample 2 had a complex nested structure of residents nested within houses, we first tested the degree of dependence in the data by assessing the intraclass correlation (ICC). Any variable with an ICC under 0.10 was treated as a single level. The model specified items 1-4 loading onto one factor, items 6-9 loading on second, and items 10-13 loading on a third. We specified these subscales as indicators of a global factor. Fit was assessed using the Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR), with acceptable fit cutoffs of CFI ≥ .94, RMSEA ≤ .08, and SRMR ≤ .08 (Hu & Bentler, 1999).

Results

Exploratory Factor Analysis: Sample 1

The Kaiser-Meyer-Olkin (KMO = 0.90) demonstrated the Sample 1 size of 110 was superb for the exploratory factor analysis, and all KMO values for individual items were above 0.82, which is substantially higher than the acceptable limit of 0.50 (Kaiser, 1974). This sample size adequacy is further supported by MacCallum et al. (2001), finding that sample sizes as low as 100 can produce stable solutions when three to four items have strong loadings (.70 or greater). Table 1 indicates the inter-item correlations for the measure. Barlett’s test of sphericity [χ2(66) = 1018.51, p < 0.001] indicated these correlations were appropriate for use in principal axis factor analysis (PAF), and the determinant of < 0.001 suggested multicollinearity was not likely. The parallel analysis indicated three factors (see Figure 1).

Table 1.

Inter-item correlations.

# 1 2 3 4 6 7 8 9 10 11 12 13
1 1.00
2 0.53 1.00
3 0.68 0.53 1.00
4 0.48 0.46 0.45 1.00
6 0.63 0.41 0.59 0.40 1.00
7 0.59 0.30 0.64 0.34 0.81 1.00
8 0.55 0.33 0.63 0.31 0.63 0.70 1.00
9 0.52 0.37 0.69 0.23 0.67 0.68 0.64 1.00
10 0.57 0.37 0.64 0.25 0.48 0.52 0.45 0.49 1.00
11 0.63 0.46 0.62 0.32 0.50 0.46 0.44 0.51 0.64 1.00
12 0.68 0.39 0.63 0.33 0.57 0.58 0.50 0.59 0.77 0.78 1.00
13 0.65 0.43 0.61 0.33 0.62 0.63 0.50 0.60 0.67 0.69 0.90 1.00
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Note: All inter-item correlations significant at p < 0.001.

Figure 1.

Figure 1.

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Parallel analysis plot of Eigen values.

The PAF found all 3 factors had eigenvalues above Kaiser’s criterion of 1 and explained a total of 68.42% of the variance, with each factor explaining at least 5% of the total variance. Table 2 indicates the factor loadings before and after rotation. The first factor (Spiritual Involvement) included behaviors suggestive of being spiritually involved. The second factor (Social Involvement) included behaviors suggestive of being socially involved. The third factor (Principles Involvement) included behaviors suggestive of being involved in the foundational principles of 12-step groups. Items for Spiritual Involvement and Social Involvement were uniquely associated with their respective factors. Although one item for Principles Involvement (practicing AA principles in all of one’s affairs) loaded slightly higher on Social Involvement, this item is conceptually associated more with involvement in program principles. In accordance with Sellbom and Tellegen (2019) recommendations for theoretically informed factor analysis, we maintained this item as an indicator of program principles involvement. Therefore, the aforementioned three-factor solution was retained for this exploratory analysis.

Table 2.

Factor matrix loadings.

Factor
1 2 3
12. I sought through prayer to improve my contact with God.  .99  .65  .49
13. I sought through medication to improve my contact with God.  .88  .69  .51
11. It is with faith that I can stay sober.  .81  .56  .57
10. I turn my life to God.  .78  .58  .46
7. I stay after the meetings to talk with members of the group.  .61  .92  .45
6. During coffee breaks, I talk with other members of the group.  .60  .84  .55
9. I invest myself completely with AA members.  .62  .79  .45
8. I see some members outside the meetings.  .53  .78  .47
3. I try to practice AA principles in all my affairs.  .70  .75  .70
1. I continued to take personal inventory.  .71  .68  .73
2. I admit when I am wrong.  .46  .41  .72
4. I made a list of all people I had harmed.  .34  .38  .64
Pattern Matrix
12. I sought through prayer to improve my contact with God.   1.07 −0.03 −0.09
13. I sought through medication to improve my contact with God.   0.77   0.16 −0.01
11. It is with faith that I can stay sober.   0.74 −0.05   0.18
10. I turn my life to God.   0.73   0.07   0.01
7. I stay after the meetings to talk with members of the group. −0.02   0.98 −0.09
6. During coffee breaks, I talk with other members of the group.   0.00   0.78   0.12
8. I see some members outside the meetings. −0.03   0.77   0.06
9. I invest myself completely with AA members.   0.15   0.71 −0.03
2. I admit when I am wrong.   0.11 −0.05   0.69
4. I made a list of all people I had harmed. −0.07   0.07   0.65
1. I continued to take personal inventory.   0.33   0.21   0.43
3. I try to practice AA principles in all my affairs.   0.23   0.39   0.35
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Notes: Principal axis factor analysis with direct oblimin rotation and Kaiser normalization.

The global instrument demonstrated excellent internal consistency (α = 0.93, Ω = 0.94). The Principles Involvement (α = 0.80, Ω = 0.80), Social Involvement (α = 0.90, Ω = 0.90) and Spiritual Involvement (α = 0.92, Ω = 0.93) subscales similarly demonstrated good to excellent internal consistency.

Confirmatory Factor Analysis: Sample

Confirming model fit

The ICC for the global score and subscale scores ranged from 0.01 to 0.04, so all variables were treated as solely individual-level constructs for the CFA. The three-factor structure with a 2nd-order global factor model adequately fit the data (χ2(51) = 109.21, p < 0.001; CFI = 0.94; RMSEA = 0.06, 95% CIs [0.05, 0.08]; SRMR = 0.05), thus confirming the proposed conceptualization and results of the exploratory analysis and a higher-order factor structure from Sample 1 (see Figure 2 for factor loadings).

Figure 2.

Figure 2.

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Confirmatory factor analysis higher-order model with standardized (STDYX) loadings. All loadings significant at p < 0.05.

The global IAA Cronbach’s alpha for Sample 2 was lower (α = 0.87, Ω = 0.86) than that for the exploratory factor analysis (Sample 1) but remained good. Similarly, the internal consistency of the Principles Involvement (α = 0.71, Ω = 0.72), Social Involvement (α = 0.86, Ω = 0.86), and Spiritual Involvement (α = 0.83, Ω = 0.83) subscales in Sample 2 was lower but remained good.

Validity

Distinct factor structure

The AAAS was moderately and positively correlated with the global IAA- SF (r = 0.61, p < 0.01), Principles Involvement (r = 0.44, p < 0.01, 95% CI [0.25, 0.61]), Social Involvement (r = 0.61, p < 0.01, 95% CI [0.44, 0.76]), and Spiritual Involvement (r = 0.56, p < 0.01, 95% CI [0.41, 0.71]). Additionally, neither the global or factor correlations with the AAAS affiliation scale were above .85, indicating that the scales were not measuring the same construct. This suggests a related but distinct factor structure for the IAA-SF global measure and subscales.

Predictive validity: Sample 1

The first logistic regression (see Step 1 in Table 3) assessing global involvement’s predictive validity indicated the set of predictors reliably distinguished those who were abstinent at the final assessment from those who were not. The Wald criterion demonstrated only treatment condition and 12-step involvement made significant contributions to the prediction of abstinence. Those in the Oxford House condition (versus usual care) were 5.51 times more likely to be abstinent while accounting for other variables in the model. The model further showed participants were 1.42 times more likely to maintain abstinence for each unit increase in 12-step involvement while accounting for other variables in the model.

Table 3.

Predictive validity IAA- SF global and subscale factors.

95% C.I.
Predictor β SE β Wald’s χ2 df p O.R. Lower Upper
Global Predictive Validity a
Constant −3.16 1.43   4.91 1 .03 0.04 --- ---
Oxford House 1.71 0.49 12.20 1 < .001 5.51 2.12 14.36
Controlled Setting −0.56 0.80   0.49 1 .49 0.57 0.12 2.74
Male −0.16 0.58   0.08 1 .78 0.85 0.27 2.68
White 1.99 1.12   3.14 1 .08 7.32 0.81 66.19
Age 0.01 0.03   0.05 1 .82 1.01 0.95 1.07
12-Step Involvement 0.35 0.17   4.23 1 .04 1.42 1.02 1.98
Subscales Predictive Validity b
Constant −2.03 1.59   1.62 1 .20 0.13 --- ---
Oxford House 1.47 0.51   8.51 1   .004 4.36 1.62 11.74
Controlled Setting −0.59 0.85   0.49 1 .49 0.55 0.11 2.91
Male −0.08 0.60   0.02 1 .90 0.93 0.28 3.01
White 1.68 1.09   2.35 1 .13 5.34 0.63 45.50
Age 0.02 0.03   0.32 1 .57 1.02 0.95 1.09
Principles Involvement 0.08 0.23   0.12 1 .74 1.08 0.69 1.70
Social Involvement 0.46 0.20   5.03 1 .03 1.58 1.06 2.37
Spiritual Involvement −0.35 0.27   1.67 1 .20 0.70 0.41 1.20
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Notes:

a

Homer-Lemeshow Test χ2(8) = 8.59, p = .38; Nagelkerke R2 = .28; Cox & Snell R2 = .21.

b

Homer-Lemeshow Test χ2(8) = 6.87, p = .55; Nagelkerke R2 = .33; Cox & Snell R2 = .25.

The second logistic regression (see Step 2 in Table 3) assessed subscale predictive validity. Only treatment condition and social involvement made significant contributions to the prediction of abstinence. Those in the Oxford House condition were 4.36 times more likely to be abstinent while accounting for other variables in the model. The model further showed participants were 1.58 times more likely to have maintained abstinence for each unit increase in social involvement.

Discussion

The current study examined psychometrics for a short-form version of the Involvement in Alcoholics Anonymous Scale (IAA-SF; see Appendix), which assesses involvement in 12-step program principles as well as engagement in the social and spiritual aspects of the program. Although 12-step programs are the most common support system for people in addiction recovery, and involvement appears to be important, existing measures of this construct seem limited in their ability to fully capture aspects of such involvement.

As expected, exploratory factor analysis indicated a structure concordant with Kairouz’s (2000) conceptualization of the instrument. This analysis suggested three factors, (1) Principles Involvement, (2) Social Involvement, and (3) Spiritual Involvement. This structure was also validated with a confirmatory factor analysis, and the three subscales loaded onto a global factor of 12-step involvement. Internal consistency for both the global measure and subscales ranged from good to excellent. Results further indicated the IAA-SF and its subscales were moderately related to greater AA affiliation. This suggests that involvement and affiliation may be related yet distinct constructs. This was expected given the AAAS’s greater emphasis on attendance and inclusion of items related to group identification and program experiences. Although global and social involvement predicted abstinence two years after treatment as expected, involvement in the principles of the program and spiritual involvement did not predict abstinence. Overall, these findings suggest a valid global and factor structure for the IAA-SF, but that the principle and spiritual subscales may not be predictive of abstinence at 2 years post-treatment. Future research will be needed to establish the importance of these factors among other recovery related outcomes.

A strength of this study is the diversity of the samples, particularly Sample 1. Traditionally, Alcoholics Anonymous has a high proportion of European (White/Caucasian) members (89%; Alcoholics Anonymous World Services, 2014), whereas Sample 1 was comprised of a 90% minority sample (African American, Latino/a, and “other”) and Sample 2 was 25% minority (African American, Hispanic, Native American, Asian, Pacific Islander). Further, 9% of Sample 2 reported their sexual orientation or identity as LGBTQ, indicating diversity with regard to sexual identity as well as race and ethnicity.

This study contains limitations and areas of future exploration. First, the study was limited to secondary data analysis and the two samples differed in terms of type of treatment and recovery trajectories. Ideally, data would have been available to establish convergent construct validity through the IAA-SF’s relationship to other involvement measures. Additionally, although global and social involvement were related to 2-year abstinence, the study did not manipulate involvement, so we cannot conclude this is a causal relationship. Second, the Oxford house sample only included 48% of potential participants, limiting the representation of this population. Third, we were only able to predict a single measure of abstinence, but because successful long-term recovery often includes a comprehensive set of outcomes, future research will need to examine additional outcomes such as decreases in symptom severity, reductions in alcohol intake, and improved quality of life. Fourth, it will be necessary for a more robust study in the future to determine the discriminant validity of the IAA-SF. Lastly, generalizability is limited by the first sample’s inclusion of only post-treatment participants from northern Illinois, and the second sample’s inclusion of only recovery home residents.

Even with these limitations in mind, this study has implications for 12-step involvement measurement. Results suggest multiple facets of involvement can be measured. Additionally, differential relationships of subscales to abstinence suggest it may be important to consider and assess multidimensional AA involvement. Furthermore, other research suggests involvement in program principles may be related to meaning in life, whereas social and spiritual involvement do not demonstrate the same relationship (Kairouz, 1998; Kairouz & Fortin, 2013). Similarly, happiness appears to be uniquely related to social involvement while life satisfaction may be related to both social and spiritual involvement (Kairouz, 1998; Kairouz & Fortin, 2013). It is plausible all factors of involvement have positive but different outcomes. It is also possible that factors may have negative implications for some outcomes but positive implications for others.

Future studies are needed to address limitations and further develop the IAA-SF. Inquiry could further support the IAA- SF’s validity by examining its relationship to other involvement measures and additional validation of the subscales. To improve the development and predictive ability of the IAA- SF, future studies predicting measures that constitute progress in recovery (i.e., reductions in use, improved quality of life) and other recovery related outcomes (i.e., depression, pain, sleep) will be needed.

Conclusions

In conclusion, these results offer evidence suggesting that the IAA- SF is a valid and reliable instrument for assessing 12-step program involvement. The IAA- SF assesses facets of involvement that include adherence to program principles, social interactions, and spirituality. This multidimensional assessment may be important for examining differential relationships with recovery-related outcomes. Given the importance of each dimension of the AA program for continued abstinence, the IAA- SF can be used to identify the areas in which individual AA members are strong, and the areas in which they are putting forth less effort. The dimensional approach offered by this short-form measure is a valuable tool that may be used by clinicians to assist people in recovery.

Funding

Research in this publication was supported by the National Institutes of Drug Abuse and National Institute on Alcohol and Alcoholism of the National Institutes of Health under award numbers DA032195, DA019935, and AA012218. Award # AA012218 provided support for Sample 1 data collection. Award #DA032195 provided support for Sample 2 data collection. Both awards #DA032195 and #DA019935 provided support for analysis and manuscript preparation. Dr. Vest was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number T32DA035165. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funders had no role in the study design, data collection, analysis, interpretation, manuscript preparation, or decision to submit for publication.

Footnotes

Declaration of interest

The authors report no conflicts of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and its later amendments. Informed consent was obtained from all participants included in the study.

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