This study has some limitations, which should be considered. The sample was mostly male and Caucasian and participants were recruited to participate in a rigorous controlled trial. Thus, it is unknown to what extent these findings extend to other groups, particularly non-treatment-seeking populations. Although we found that the measures of our hypothesized social mechanisms were sensitive to change and were successful mediators of AA attendance, social influence is clearly a highly complex and multidimensional construct (Valente, 2010). Furthermore, the four social processes were examined simultaneously in relation to drinking outcomes. Although the inter-correlations among these variables were generally low, this analysis yielded potentially more conservative estimates than might have been obtained had each mediator's effect on drinking been obtained separately. In addition, although we employed a lagged design, our findings relate specifically to the influence of AA attendance during outpatient-delivered treatment on subsequent social network/activity changes and subsequent alcohol use. Inferences to the influence of AA on social processes later in recovery should not be made without further longitudinal investigation. Additional research is needed to determine how optimally to measure and model these complex phenomena and to determine how they may shape human behavior over time (Valente, 2010).
