Posttreatment 12-Step Program Affiliation and Dropout: Theoretical Model and Qualitative Exploration

ABSTRACT

Treatment outcome research has repeatedly demonstrated that involvement in twelve-step (TS) programs (e.g., Alcoholics Anonymous or Narcotics Anonymous) following treatment is associated with improved substance use outcomes. Treatment providers widely encourage TS program attendance during treatment and for aftercare; yet, evidence suggests that minimal and sporadic attendance or complete dropout is the more common occurrence. Providers would benefit from knowledge that would contribute to a greater understanding of factors that influence posttreatment TS program affiliation or dropout to guide treatment strategies. This article reviews the literature on TS affiliation, advances theory and a model to explain affiliation, and reports findings from a qualitative research study focused on understanding what people in TS facilitative treatment report as good (the pros) and not so good (the cons) about TS program involvement. Results suggest that unresolved ambivalence as well as socio-cultural barriers to support contribute to poor TS program utilization.

KEYWORDS:

• Addiction recovery
• 12-step groups
• group affiliation