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Original

Attitudes and Beliefs About 12-Step Groups Among Addiction Treatment Clients and Clinicians: Toward Identifying Obstacles to Participation

, Ph.D.
Pages 2017-2047 | Published online: 16 Dec 2003
 

Abstract

Participation in 12-step groups (12SG) during and after formal treatment has been associated with positive outcome among substance users. However, the effectiveness of 12SG may be limited by high attrition rates and by low participation, areas on which there has been little research. Clinicians play an important role in fostering 12-step participation, and the insights which they develop in their practice can greatly contribute to informing the research process. Yet, little is known about clinicians’ attitudes about 12-step groups or about their experiences in referring clients. This study surveyed clients (N = 101) and clinicians (N = 102) in outpatient treatment programs to examine 12-step-related attitudes and to identify potential obstacles to participation. Data collection was conducted between 05, 2001 and 01, 2002 in New York City. Both client and clinician samples were primarily African-American and Hispanic; 32% of clients reported substance use in the previous month, with crack and marijuana cited most frequently as the primary drug problem. On average, clinicians had worked in the treatment field for 8 years. Both staff and clients viewed 12SG as a helpful recovery resource. Major obstacles to participation centered on motivation and readiness for change and on perceived need for help, rather than on aspects of the 12-step program often cited as points of resistance (e.g., religious aspect and emphasis on powerlessness). Clinicians also frequently cited convenience and scheduling issues as possible obstacles to attending 12SG. Clinical implications of these findings are discussed, including the importance of fostering motivation for change, the need to assess clients’ beliefs about and experiences with 12SG on a case-by-case basis, and to find a good fit between clients’ needs and inclinations on the one hand, and the tools and support available within 12-step groups on the other.

Resumen

La participación en grupos de 12 pasos (12SG) durante y después del tratamiento se ha asociado con el resultado positivo. Sin embargo, la eficacia de 12SG puede ser limitada por tasas altas de desgaste y participación baja; es sabido poco acerca de obstáculos a la participación en 12SG. Los clínicos juegan un papel importante a fomentar la participación en 12SG y las perspectivas que ellos desarrollan en su práctica pueden contribuir a informar el proceso de investigación. Todavía, es sabido poco acerca de actitudes de clínicos acerca de los grupos de 12 pasos o acerca de sus experiencias referendo a los clientes. Este estudio ha hablado con clientes (N = 101) y clínicos (N = 102) en programas de tratamiento para examinar sus actitudes relacionadas a los grupos de 12 pasos y para identificar obstáculos a la participación. La colección de datos se condujo entre Mayo 2001 y Enero de 2002. Los participantes eran principalmente Afro americano e Hispano; 32% de clientes habían usado drogas en el mes previo, con la “crack” y la mariguana siendo los problemas mayor. En el promedio, los clínicos habían trabajado en programas de tratamiento por 8 años. Tanto el personal como los clientes vieron 12SG como un recurso útil de recuperación. Los obstáculos mayor a la participación en 12SG centró en el motivo para el cambio y en la necesidad percibida para la ayuda, antes que en aspectos del programa de 12 pasos que se citan a menudo como puntos de la resistencia (por ejemplo, el aspecto religioso y la impotencia ante las drogas). Los clínicos también citaron a menudo asuntos práctico como obstáculos a asistir a los 12SG. Las implicaciones clínicas de estas conclusiones se discuten, inclusive la importancia de fomentar el motivo para el cambio, la necesidad para valorar las creencias y las experiencias de los clientes acerca de 12SG individualmente, y la importancia de encontrar puntos de correspondencia entre las necesidades y inclinaciones de clientes por un lado, y en los recursos disponibles dentro de los grupos de 12 pasos por otro lado.

Résumé

La participation dans les groupes de 12 étapes (12SG) pendant et après le traitement a été associée avec des résultats positifs. Cependant, l’efficacité des groupes peut être limitée par de hauts taux d’attrition et par la non-participation; On sait très peu sur les obstacles à la participation dans 12SG. Les praticiens jouent un rôle important pour encourager la participation dans les groupes de 12 étapes et la perspective qu'ils développent dans leur pratique peut contribuer à informer le procédé de recherche. Pourtant, on sait peu des opinions des praticiens vis a vis des groupes de 12 étapes ou de leurs expériences a suggérer que les clients participent à ces groupes. Cette étude a collectionné des données parmi un échantillon de clients (N = 101) et de praticiens (N = 102) dans des programmes de traitement de drogues pour examiner leurs attitudes vis a vis des groups de 12-etapes et pour identifier les obstacles a la participation. La collection des données a été effectuée entre mai 2001 et janvier 2002. Les deux échantillons étaient principalement Africain Américains et Hispaniques; 32% des clients avait utilise de la drogue le mois précédant, le crack et la marijuana étant cités le plus fréquemment comme substance problématique. En moyenne, les praticiens avaient travaillé en programme de traitement depuis 8 ans. Le personnel et les clients regardent les 12SG comme une ressource de rétablissement utile. Les obstacles majeurs a la participation se centraient sur la motivation pour le changement et sur la perception du besoin d'aide, plutôt que sur les aspects du programme de 12 étapes souvent cités comme les points de résistance (par ex., l’aspect religieux et l’impuissance devant les drogues). Les praticiens ont aussi fréquemment cité des questions pratiques comme obstacles possibles à assister aux 12SG (par ex., emploi du temps et accès). Les implications cliniques de ces résultats sont discutées, y compris l’importance d’encourager la motivation pour le changement, le besoin d’évaluer des croyances des clients ainsi que leurs expériences avec 12SG individuellement, et de trouver des points de correspondance entre les besoins et les inclinations des clients d'une part, et les ressources disponibles dans groupes de 12 étapes d‘autre part.

Notes

aTwelve-step groups such as AA, NA, and GA, OA are traditionally categorized as “self-help” groups, which is misleading. A useful, and more accurate treatment paradigm taxonomy, in a field deluged with many stereotypes and myths is: professional-based treatment; mutual-help/aid and self-help or “natural recovery.”

bThe author recognizes that terms such as “addiction,” “treatment,” and “recovery” can be viewed in other cultures and from other perspectives on substance use as labels that may carry stigmatizing connotations. Such terms are used here because they are widely accepted as convention and understood in the field, particularly in the United States and where the English language is used in scientific literature—and should not be interpreted as an endorsement of the negative labels they sometimes convey

cThe two other areas of conflict cited in the study were (a) Feeling out of place among AA members because one's drinking problem that was less severe, and (b) being unable to relate to unemployed, homeless or otherwise “down and out” members. The authors note that Moderation Management members surveyed were predominantly an “elite” of highly educated, employed, Caucasian persons

dAnalyses conducted to detect any differences in the variables under study between data collected before and after Sept. 11, 2001, yielded no significant findings

eThe term “recovery” as used most often in the literature, generally refers broadly to positive outcome among substance users but is rarely defined. While a detailed discussion of the concept of recovery is beyond the scope of this study, we note that recovery is not a finite event but rather, a process that often begins with multiple attempts to change and may ultimately include total abstinence from substance use. More importantly, recovery entails a lifelong complex, dynamic, and multidimensional effort toward self-change. Further, the term is also bound in western culture and especially, in the ideology of 12-step programs, as members typically identify as being “in recovery” whereas persons who resolved substance use-related problems through other means such as unassisted (natural) resolution may not readily identify with that term

Additional information

Notes on contributors

Alexandre B. Laudet

Alexandre B. Laudet, Ph.D., is an NIH-funded Principal Investigator at the National Development and Research Institutes, Inc. (NDRI) in New York City. Her research focuses on elucidating processes of addiction and recovery over time, in particular, on psychosocial factors that promote the maintenance of lifelong recovery, such as social support and affiliation with 12-step groups. She is also interested in cross-cultural perspectives on addiction and recovery.

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