Professional Interventions That Facilitate 12-Step Self-Help Group Involvement
Humphreys, Keith, Alcohol Research
Facilitating patients' involvement with 12-step self-help organizations, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), is often a goal of substance abuse treatment. Twelve-step-facilitation (TSF) interventions have been found to be more effective than comparison treatments in increasing patients' 12-step group involvement and in promoting abstinence. Future TSF evaluation research should address the effectiveness of incorporating TSF interventions with cognitive-behavioral treatment methods, the relative impact of brief versus extended TSF interventions, and the cost-effectiveness and health care cost-offset of TSF interventions within managed health care systems. KEY WORDS: twelve step program; intervention; treatment outcome; cognitive therapy; behavior therapy; cost effectiveness; managed care; AODD (alcohol and other drug dependence) recovery; treatment program; evaluation; motivational interviewing; AOD (alcohol and other drug) abstinence; comparative study; literature review
Although the United States has developed an extensive array of professional alcohol treatment services over the past 30 years, the peer-led, voluntary fellowship known as Alcoholics Anonymous (AA) continues to be the most widely accessed resource for people with alcohol problems (McCrady and Miller 1993). This article discusses the rationale for interventions that facilitate alcohol-dependent patients' affiliations with AA and related mutual-help organizations (e.g., Narcotics Anonymous [NA]). The article also reviews recent research comparing those interventions with other treatment methods.
IMPORTANCE OF 12-STEP GROUP AFFILIATION IN ALCOHOL TREATMENT
The rationale for facilitating patients' involvement in 12-step self-help groups stems primarily from recent AA outcome research and from developments in the management and organization of health care in the United States. From the 1940s through the 1980s, most studies on AA did not directly evaluate AA's effectiveness. Rather, researchers examined AA's organizational structure and functioning; its history; and the ways in which AA participation changed members' values, sense of identity, and spiritual outlook (see Kurtz 1993 for a review). The few AA outcome studies that were conducted typically did not study AA members over time or include non-PA members for comparison purposes, making conclusions about AA's effectiveness tenuous. Given this limited empirical base, many clinicians and researchers doubted whether AA truly helped its members recover from alcohol dependence.
In the 1990s, the breadth and depth of AA research increased significantly, as evidenced by a National Institute on Alcohol Abuse and Alcoholism (NIAAA)-sponsored conference on PA (McCrady and Miller 1993), the International Collaborative Study of AA (Makela et al. 1996), and other projects. Recent AA outcome research, which has demonstrated the benefits of treatments intended to facilitate AA involvement, as well as of AA involvement per se, has typically employed longitudinal designs (i.e., studied AA members over time), reliable measures, comparison groups and, in some cases, random assignment to conditions. The improved methodological quality of AA research has reduced skepticism in the treatment community about AA's effectiveness and has increased clinicians' interest in facilitating connections between substance abuse treatment and 12-step self-help groups.
The other major factor that has enhanced interest in 12-step facilitation (TSF) interventions is the growth of managed health care. In both the public and private sectors, managed care has reduced the length and intensity of professional addiction treatment services (Humphreys et al. 1997) and increased the pressure for cost-effective care. Because managed care has reduced the amount of time available for practitioners to work with patients, clinicians are increasingly interested in facilitating …
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Publication information: Article title: Professional Interventions That Facilitate 12-Step Self-Help Group Involvement. Contributors: Humphreys, Keith - Author. Journal title: Alcohol Research. Volume: 23. Issue: 2 Publication date: Spring 1999. Page number: 93. © 2008 U.S. Government Printing Office. COPYRIGHT 1999 Gale Group.
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