Professional Interventions That Facilitate 12-Step Self-Help Group Involvement

Alcohol Research & Health, Spring, 1999 by Keith Humphreys

The study participants (2,045 men) were treated in either a 12-step-oriented or a CB inpatient program and were followed up 1 year after discharge. Thirty-six percent of the participants had either an alcohol abuse or dependence diagnosis only, 13 percent had only a drug abuse or dependence diagnosis, and 51 percent had both drug and alcohol diagnoses.

Before treatment, patients in 12-step-oriented and CB programs had similar levels of self-help group involvement. However, 1 year after treatment, the patients who had received 12-step-oriented treatment reported substantially greater involvement in AA/NA during the previous 3 months than did patients who had received CB treatment. Patients in 12-step-oriented treatment were significantly more likely than those in CB treatment to have attended 12-step meetings, to have a sponsor, to have read 12-step literature, and to have a friend who attends meetings (see figure, above), indicating that 12-step-oriented treatment programs were more effective than CB programs at increasing affiliation with 12-step self-help groups.

The results of the VA study closely parallel those of Project MATCH. In both 12-step-oriented and CB treatment, patients experienced substantial reductions in substance use, substance abuse-related problems, psychological problems, criminal behavior, and unemployment (Moos et al. 1999). The reductions were comparable across treatments, with the only notable exception again being that 12-step-oriented treatment was more effective in promoting abstinence. For example, 1 year after treatment, 45 percent of patients treated in 12-step-oriented programs reported abstinence from alcohol and other drugs during the previous 3 months, compared with 36 percent of patients treated in CB programs.

Like Project MATCH, the VA study also found some evidence suggesting that 12-step self-help group involvement after treatment may be more beneficial for patients who have received 12-step-oriented treatment, compared with patients who have received CB treatment. Among patients who received 12-step-oriented treatment, abstinence rates 1 year after treatment varied from 19 percent for patients with low involvement with self-help groups after treatment to 75 percent for patients with high involvement. Among patients who received CB treatment, abstinence rates ranged from 25 percent for patients with low involvement in self-help groups after treatment to 65 percent for patients with high involvement. This difference was statistically significant, indicating that 12-step self-help group involvement after treatment seems to benefit patients treated in 12-step-oriented programs more than it does patients treated in CB programs (Humphreys et al. 1999).

A third study comparing a TSF intervention with other treatment focused on 60 heterosexual couples in which the men were diagnosed with either alcohol abuse or dependence and their female partners were not. As part of a larger study, the couples received either outpatient, alcohol-focused, CB marital therapy only (MT-only), or the MT intervention supplemented with counseling designed to facilitate involvement in 12-step self-help groups (MT TSF) (McCrady et al. in press). The TSF intervention introduced patients to the philosophies and methods of AA and Al-Anon, [1] helped patients identify meetings at convenient locations, set goals for meeting attendance, and encouraged patients to choose a sponsor and to follow the 12 steps. The TSF therapists in this study assigned patients AA- or Al-Anon-related homework, as appropriate, and emphasized parallels between the initial CB therapy and AA techniques.