Evaluating Impulsivity as a Mechanism of Behaviour Change for 12-step Engagement during Alcohol Use Disorder Recovery

Objective Participation in 12-step groups (TS), such as Alcoholics Anonymous, confers benefits among individuals with alcohol use disorder (AUD), and one candidate mechanism underlying these effects is reductions in impulsivity. Using a multidimensional assessment of impulsivity, the current study examined impulsive personality and action in a longitudinal cohort of adults with AUD initiating a significant recovery attempt. Methods A prospective matched-sample cohort study design compared participants who reported a clinically meaningful increase in TS attendance (i.e., increase of ≥ 1 meetings/week; n  = 74) from enrollment to 6 weeks to a matched control group who did not increase attendance ( n  = 74). Drinking was assessed using the Timeline Followback (% drinking days [%DD], % heavy drinking days [%HDD]); impulsivity was assessed using delay discounting (DD) and five UPPS-P subscales. Mediation models evaluated whether impulsivity explained the relationship between increased TS attendance and alcohol outcomes. Results Compared to matched controls, participants who increased TS significantly differentially reduced %DD, %HDD ( p  < 0.001), as well as Negative Urgency (i.e., acting out due to negative emotions) and Lack of Perseverance (i.e., failure to persist in tasks; ps  = 0.03) after their recovery attempt. Reductions in impulsivity, however, did not mediate the association between increased TS attendance and drinking. Conclusions Increased TS attendance was associated with significant reductions in drinking and certain impulsivity traits. However, while the changes were contemporaneous, impulsivity did not explain the benefits of TS effects in early AUD recovery process. Future research should evaluate this hypothesis in larger samples and over longer follow-up periods. Public Health Significance Statement: While 12-step group participation is well-established as beneficial for reducing alcohol use, the specific mechanisms that explain its benefits remain unclear. Impulsivity is one candidate that has received relatively little attention. These findings reveal that certain aspects of impulsivity contemporaneously change with increased 12-step participation, but did not find evidence the impulsivity changes are causally responsible for 12-step benefits. Although further investigation is warranted, these findings do not suggest the benefits of 12-step are partially attributable to reductions in impulsivity.