Mediators of “Making Alcoholics Anonymous Easier” (MAAEZ), a group-format 12-step facilitation program

We conducted a trial (n=508) of “Making Alcoholics Anonymous Easier” (MAAEZ), a group-format 12-step facilitation program. Higher rates of past 30-day alcohol and drug abstinence at the 12-month follow-up were found among individuals treated in MAAEZ compared to usual care. The effect was especially marked in several subgroups. We studied whether the effects of MAAEZ are mediated by higher particular Alcoholics Anonymous (AA) activities in the MAAEZ group both overall and among subgroups. The pool of potential mediators consists of activities such as having a sponsor, associating with people who support sobriety, and feeling comfortable at meetings. We implemented two sets of analyses--one with lagged mediators, and the other with concurrently-measured mediators. The only variable that appeared to mediate the effects of MAAEZ in the sample overall was comfort speaking at meetings, which positively related to outcomes in both the simple concurrent model and in the multiple concurrent model. We then examined mediators for subgroups including atheists and agnostics, those with high prior AA attendance, those with high psychological severity, and those with anxiety. We found that the effect of MAAEZ after 12 months was mediated by different variables according to subgroup; these findings suggest mediated moderation, a phenomenon in which the mechanisms of action of MAAEZ on abstinence differ according to subgroups of participants. Results highlight the value of studying complicated combinations of activities as potential mediators of treatment effects, and demonstrate the importance of exploring subgroups when trying to understand treatments' mechanisms of action.