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

Alcohol Research & Health, Spring, 1999 by Keith Humphreys

This hypothesis would be an excellent one for future research. Other potential research directions are presented in the following section.

DIRECTIONS FOR FUTURE RESEARCH

The studies reviewed above clearly demonstrate that TSF interventions that engage patients for a significant period (e.g., 10 to 12 sessions of outpatient care, as in Project MATCH and the couples study [McCrady et al. in press], or 21 to 28 days of 12-steporiented inpatient care, as in the VA study), can sharply increase the likelihood that patients will attend AA/NA. However, many patients in primary care and addiction treatment settings are not treated for extended periods. To make TSF interventions more useful in practice, researchers and clinicians should develop and evaluate brief TSF interventions. In one promising study, Sisson and Mallams (1981) randomly assigned alcohol outpatients to a "simple" or "enhanced" TSF intervention. In the simple condition, a therapist suggested that the patient attend AA or Al-Anon and provided a printed list of meeting times and locations. In the enhanced condition, the therapist supplemented the aforementioned intervention with an in-session telephone call to a current member of AA or Al-Anon, who talked to the patient briefly and arranged to attend a meeting with him or her. The 12-step group member contacted the patient with a reminder telephone call the night before the meeting, drove the patient to the meeting, and let the patient's therapist know on the following day whether the patient had attended. During the month following the intervention, 100 percent of patients in the enhanced TSF group attended at least one meeting (average 2.3 meetings), compared with zero-percent meeting attendance among patients in the simple TSF group. Although the study only followed patients for 1 month, the results suggest that a fairly brief intervention (i.e., the enhanced TSF intervention) can have a significant impact.

A related research priority is to evaluate whether TSF interventions can promote AA/NA affiliation in the long term to the same extent that they increase meeting attendance in the short term. The fact that patients' attendance at meetings increases significantly during and in the months following a TSF intervention does not guarantee that patients will become active affiliates of AA who continue to identify with the organization, sponsor newcomers, celebrate sober anniversaries, and read 12-step materials. To examine this important issue, researchers must extend their followups beyond the common 6- and 12-month periods and continue to examine a broad range of AA affiliation indices (i.e., indicators other than meeting attendance).

A third key priority for future research is to more fully understand the health care cost offset and cost-effectiveness of TSF interventions. One study of 227 industrial plant workers with alcohol problems (i.e., employees averaging 6 drinks per day and 20 drinking days per month) found that patients assigned directly to AA had similar work-related outcomes but more relapses than did patients assigned to inpatient treatment followed by AA. At the same time, patients initially assigned to AA had 10-percent lower alcohol-related health care costs over a 2-year period than did patients initially assigned to inpatient treatment (Walsh et al. 1991). Similarly, in a study of patients with serious alcohol problems (e.g., alcohol dependence symptoms such as shakes and hallucinations), those who sought outpatient care and those who sought AA experienced similar improvement over a 3-year period on a variety of measures. The AA-seeking group, however, had 45 percent lower (approximately $1,800 per person) alcohol-relat ed-treatment costs (e.g., costs of counseling and detoxification) over the 3-year period compared with the outpatient treatment-seeking group (Humphreys and Moos 1996). Both studies suggest that when patients with alcohol problems are connected to the AA network, they lower their reliance on professional health care. A priority for future research should be to evaluate whether this reduction in health care costs is sufficient to offset the cost of TSF interventions. Findings from that research could inform and improve health care policy. For example, if clinicians could differentiate patients who were likely to recover with a brief TSF intervention from patients who required extensive professional treatment, the treatment system could become more cost efficient without compromising patient outcomes.