Service to Others in Sobriety (SOS)

Abstract

The Service to Others in Sobriety (SOS) scale is a brief, validated assessment tool developed to measure AA-related helping (AAH) activities among recovering alcoholics. Traditional measures of Alcoholics Anonymous (AA) participation often fail to capture the multidimensional nature of service and altruism, which are foundational components of the 12-Step philosophy. The SOS addresses this gap by providing reliable data on the intentional, voluntary acts of service and kindness that benefit others, thereby contributing to the helper’s own sustained sobriety and recovery. The scale demonstrates strong psychometric properties, including high internal consistency and test-retest reliability, establishing it as a valuable instrument for addiction research.

Keywords

Service to Others, Sobriety, Alcoholics Anonymous, AA-Related Helping (AAH), Altruism, 12-Step Programs, Addiction Recovery, Psychometric Assessment.

Authors

Maria E. Pagano, Amy R. Krentzman, Casey C. Onder, Justina L. Baryak, Jennifer L. Murphy, William H. Zywiak, Robert L. Stout

[quads id=5]

Purpose

The primary purpose of the Service to Others in Sobriety (SOS) scale is to offer a validated and reliable measure of AA-related helping behaviors. While AA participation is widely studied in addiction research, the SOS specifically isolates and quantifies the construct of service, which is considered crucial for long-term recovery and improved drinking outcomes.

This brief assessment tool distinguishes various components of service, ranging from formal roles (e.g., holding a service position) and acts of good citizenship to interpersonal actions (e.g., sponsorship, sharing experience). By providing quantitative data on the role of altruism and helping others, the SOS aids researchers and clinicians in understanding how prosocial behavior mitigates self-centeredness and contributes to positive drinking outcomes, including increased odds of abstinence.

Construct

The SOS measures the construct of Service to Others in Sobriety, which is defined as voluntary, intentional help that benefits others, with this benefit being the primary goal. This concept is deeply rooted in AA literature, which emphasizes that service and carrying the message are essential for recovery, often contrasting service with the self-centeredness identified as the core problem of the alcoholic.

The construct operationalized by the 12 items encompasses three key areas of service behaviors: acts of good citizenship within a 12-Step program (e.g., meeting setup), formal service positions (e.g., public outreach), and active AA-related helping (AAH) activities involving the transmission of personal experience, often linked to the practice of the 12th Step. The scale was developed based on AA literature, existing altruism research, and focus groups with AA members to ensure comprehensive coverage of relevant behaviors.

Validity

The convergent validity of the SOS was established by comparing the scale total score against other established measures, specifically the PSB (Prosocial Behavior) and HSNS (Help Seeking Norms Scale), using nonparametric Kruskal-Wallis chi-square tests. A strong and significant correlation was found between the SOS total score and the other-oriented empathy subscale of the PSB, with a Spearman correlation of 0.62 (p < .001). This correlation is considered a large effect size according to Cohen (1988), supporting the scale's alignment with measures of prosocial orientation.

To determine the optimal clinical cutoff score for identifying significant AA-related helping (AAH), a Receiver Operating Characteristic (ROC) curve analysis was performed. The analysis compared the SOS performance against the 2-item AAI criterion of AAH. A cutoff score of 45 or higher provided the highest average of sensitivity (SN = 0.78) and specificity (SP = 0.64). This cutoff also yielded the highest phi coefficient (phi = 0.50) and degree of concordance (k = 54), confirming the SOS’s robust utility in differentiating levels of service involvement pertinent to recovery outcomes.

Reliability

The reliability of the SOS scale was rigorously evaluated through measures of internal consistency and test–retest reliability across two administrations.

• Internal Consistency: Internal consistency was measured using Cronbach’s alpha. The overall alpha for the SOS total score was found to be 0.92, indicating excellent internal consistency. Individual item alphas ranged adequately from 0.74 to 0.77. Earlier work on the SOS items had also demonstrated adequate consistency (alpha = 0.82).
• Test–Retest Reliability: Test–retest reliability was established by correlating scores using the Spearman rank-order correlation, a nonparametric measure. The Spearman correlation for the SOS total score between the first and second administration was 0.94 (p < .001), demonstrating exceptionally high stability over time. Furthermore, comparisons for all individual SOS items showed large effect size correlations, ranging from 0.60 to 0.96.

Factor Analysis

Psychometric analyses included detailed item analysis to ensure that all 12 items contribute meaningfully to the overall score. While the study confirmed the strong internal consistency of the SOS total score (alpha = 0.92), specific details regarding a formal factor structure (e.g., identified factors or component loadings) were not explicitly provided in the source content. The scale is conceptually designed to measure a unified, multidimensional construct encompassing various aspects of service, including formal program roles, good citizenship, and direct interpersonal helping (sponsorship and sharing).

Instrument

Test Type: Self-report psychological assessment tool

Format: 12 core items rated on a 5-point Likert-type scale, plus one overall question regarding perceived benefit of helping others.

Language Available: English (Original)

Population Group: Individuals engaged in recovery from Alcohol Use Disorder (AUD), particularly those participating in 12-Step programs.

Age Group: Adults

Population Details: The scale is specifically validated for use among recovering alcoholics and addicts who are actively involved in 12-Step fellowships, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).

Test Methodology: The SOS is a brief, self-administered questionnaire. Items are scored on a 5-point scale ranging from 1 (rarely) to 5 (always), referencing behavior performed in the prior month. The instrument is highly feasible, requiring fewer than 10 minutes to complete. The original PDF can be downloaded here: SOS Instrument.

Keywords

Sponsorship, Abstinence, Prosocial Behavior, Cronbach’s Alpha, Test-Retest Reliability, ROC Curve, 12th Step, Recovery Outcomes, Likert Scale.

[quads id=5]

Authors

Author ORCID Identifier: [Information not provided in source]

Affiliation Email addresses: [Information not provided in source]

Correspondence Address: [Information not provided in source]

Permissions & Fee and Test Year

The Service to Others in Sobriety (SOS) scale was developed by Maria E. Pagano and colleagues, with initial psychometric findings published in 2009 (Pagano, Zeltner, et al.) and further validation studies documented in subsequent publications (Pagano, Krentzman, et al., in press). Researchers or clinicians intending to use the scale must seek official permissions and information regarding any associated fees directly from the corresponding author, Maria E. Pagano, or the publisher of the journal Alcoholism Treatment Quarterly.

Reference’s

• Pagano, M.E., Krentzman, A.R., Onder, C.C., Baryak, J.L., Murphy, J.L., Zywiak, W.H., & Stout, R.L. (in press). Assessment of service to others in sobriety (SOS). Alcoholism Treatment Quarterly.
• Pagano, M. E., Zeltner, B., Post, S., Jaber, J., Zywiak, W. H., & Stout, R. L. (2009). Who should I help to stay sober?: Helping behaviors among alcoholics who maintain long-term sobriety. Alcohol Treatment Quarterly, 27(1), 38-50.
• Tonigan, J. S., Connors, G. J., Miller, W.R. (2003). Participation and involvement in Alcoholics Anonymous. In T. F. Babor & F. K. Del Boca (Eds.), Treatment Matching in Alcoholism (pp. 184-204). Cambridge, United Kingdom: Cambridge University Press.

[quads id=5]

Items of the Service to Others in Sobriety (SOS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Please rate the following items on a scale from 1 to 5: 1 = never, 2 = rarely, 3 = sometimes, 4 = often, and 5 = always

If the item does not apply to you, please give a response of 1 (never) to the question.

How often in the past month…

1. Took calls or spent time with a sponsee?__________
2. Guided an alcoholic/addict through the 12-Steps? __________
3. Held a service position in a 12-Step program? __________
4. Say something positive to an alcoholic/addict? __________
5. Listened to an alcoholic/addict? __________
6. Say hello to a newcomer? __________
7. Reached out to an alcoholic/addict having a hard time? __________
8. Shared personal story with an alcoholic/addict? __________
9. Read program literature to an alcoholic/addict? __________
10. Encourage an alcoholic/addict to go to a meeting? __________
11. Donated money to AA/NA? __________
12. Put away chairs after a meeting? __________

Overall in the past month, how much did helping other alcoholics help you to not drink or use drugs?

__________not at all __________a little __________some __________a lot