After Drug Treatment: Are 12-Step Programs Effective in Maintaining Abstinence?

Abstract

Although participation in 12-step programs is now widely utilized as a treatment aftercare resource by individuals with drug and alcohol problems, little is known about the effectiveness of such a practice. This paper identifies gaps in the existing literature and articulates methodological concerns that may compromise investigations of 12-step programs. It highlights the need for additional after-treatment studies, and it presents findings from a 24-month longitudinal after-treatment study that suggests the effectiveness of 12-step programs. Rather than a behavioral indicator of recovery motivation or a spurious relationship confounded by additional treatment, aftercare, or alumni activities that occur simultaneously with 12-step participation, the findings suggest that weekly or more frequent 12-step participation is associated with drug and alcohol abstinence. Less-than-weekly participation is not associated with favorable drug and alcohol use outcomes, and participation in 12-step programs seems to be equally useful in maintaining abstinence from both illicit drug and alcohol use. These findings point to the wisdom of a general policy that recommends weekly or more frequent participation in a 12-step program as a useful and inexpensive aftercare resource for many clients.

• Alcoholics Anonymous
• Drug treatment aftercare
• Drug treatment effectiveness
• Narcotics Anonymous
• 12-Step programs

Notes

^* It should be noted that objective tests of drug and alcohol use, such as urine analyses, are useful in detecting the use of these substances in the preceding two or so days, depending on the drug. The number of tests that need to be conducted, as well as the possibility of “carryover” of positive results from one test to the next due to frequent testing and individual differences in test responses, make objective tests less viable in the assessment of long-term abstinence.

^* Well-designed treatment motivation (TM) scales have been developed by Knight, Holcom, and Simpson [[57]] and Simpson and Chatham [[58]] and by De Leon and colleagues (Circumstances, Motivation, Readiness, and Suitability Scales [CMRS]) [[59]], [[60]]. There are three TM scales: Drug Use Problems (degree to which the user recognizes problems arising from his or her drug use), Desire for Help (not necessarily in the form of treatment), and Treatment Readiness (commitment to treatment). De Leon et al.'s CMRS scales were designed to capture four constructs: Circumstances (external conditions that influence treatment seeking), Motivation (internal desire for change), Readiness (perceived need for treatment), and Suitability (perceived match between client and treatment modality). Motivation for recovery, as conceptualized in this paper, comes closest to Motivation on the CMRS scales. The Motivation scale, however, was intended to be used prior to or during the early stages of treatment to predict retention in a therapeutic community. As such, the scale includes measures that reference treatment that may be less applicable in the assessment of posttreatment recovery motivation. Due to the multiple goals of the second follow-up that extended the length of the survey instrument, the length of the CMRS scales, and the concern about the applicability of the CMRS scales to the posttreatment period, the CMRS was not utilized in the current study.