12-Step Involvement and Peer Helping in Day Hospital and Residential Programs

Abstract

This study compares peer helping and 12-step involvement among participants receiving chemical dependency treatment at day hospital (N = 503) and residential (N = 230) programs, and examines relationships between both variables and outcomes. Findings show that residential (vs. day hospital) participants reported significantly more peer helping and 12-step involvement during treatment, and marginally more 12-step involvement at 6 months. Both peer helping and 12-step involvement predicted higher odds of sobriety across follow-ups; helping showed an indirect effect on sobriety via 12-step involvement. Results contribute to the 12-step facilitation literature; confirm prior results regarding benefits of mutual aid; and highlight methodological issues in helping research. The study's limitations are noted.

Keywords:

• helping
• mutual help
• Alcoholics Anonymous (AA)
• 12-step groups
• social model
• peer helping

Acknowledgments

This study was funded by a grant from the National Institute on Drug Abuse (R01 DA12297). The authors extend their thanks to David Pating for his comments on the manuscript.

Notes

¹ The reader is reminded that the term treatment continues to be an empowered and mystified container concept, which is rarely defined albeit its being understood both by care-givers who represent 4 basic treatment models (tradition-based, professional-based, mutual-help-based, and self-help based, or “natural recovery”) and the care recipients A simple definition of treatment would be a planned, goal directed process of intervention-change. From this perspective each of the treatment models includes the relevant person(s), posited etiologies, diagnostic-screening processes and tools, goal selection, techniques, sites, change agents, policies, criteria for success and failure, etc. In any given culture, time, and place there are no unique “treatments” for substance users—of whatever types—which are not also used with and for nonsubstance users although issues such as treatment availability, accessibility, parity, and opportunity for use may, and all-too-often do, differ. Editor's note.

² The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

³ This approach, characterized by a deemphasis on staff-driven treatment planning in favor of client-driven recovery planning, is discussed in some detail by Borkman (1998).

⁴ In studies on 12-step involvement, involvement has been operationalized in a variety of ways. Investigators typically measure the number of meetings attended and may also ask about other relevant experiences and activities, such as doing service work and reading the literature; several items are often analyzed as a composite.

⁵ The reader is referred to Hills's criteria for causation which were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes, or merely associated (Hill, 1965). The environment and disease: associations or causation? Proceedings of the Royal Society of Medicine, 58, 295–300.). Editor's note.

⁶ The study reported here is not affiliated with the SMART Recovery™ program (SMART Recovery, 2006).

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⁷ At intake, the randomized sample was significantly higher than the nonrandomized sample on five of seven problem domains of the Addiction Severity Index (ASI; McLellan, 1980, including drug use severity (p < 0.05), psychiatric severity (p < 0.05), family severity (p < 0.001), legal severity (p < 0.001), and employment severity (p < 0.05). The randomized sample was also (at intake) relatively less likely to be diagnosed with drug dependence (p < 0.05), younger (p < 0.001), lower on income (p < 0.001), and less likely to be employed (p < 0.01).

⁸ Readers might refer to (Hill, 1965) for a more extended discussion around establishing causality in science.