Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3002 — Veteran Substance Use Disorder Patients with Fewer Resources Benefit More from 12-Step Groups

Author List:
DeBenedetti AF (Northwest HSR&D Center of Excellence)
Timko C (Center for Health Care Evaluation)

Objectives:
Objectives of this study were to (1) examine characteristics of substance use disorder (SUD) outpatients at intake to VA treatment that were associated with more 12-step self-help group (SHG) attendance and involvement at a 6-month follow-up; and (2) examine sociodemographic and personal resources that moderated associations between 12-step affiliation and substance use outcomes.

Methods:
Of 345 outpatients enrolled, 281 (81.4%) were followed at 6 months. Intake data covered the domains of sociodemograhics, SUD severity, personal functioning, and previous help received. Follow-up data covered 12-step SHG attendance (number of meetings attended during the past 6 months) and involvement (sum of “yes” responses to items assessing engagement in 12-step practices, e.g., being sponsored) and abstinence (no use of alcohol or drugs during the past 30 days).

Results:
Distinguishing baseline characteristics of patients who, during follow-up, attended more 12-step meetings and were more involved in 12-step groups were being younger, less educated, less stably housed, more engaged in religious practices, more extroverted and interpersonally competent, and having more previous 12-step exposure. More 12-step meeting attendance and involvement were related to abstinence at 6 months. Associations of attendance and involvement with abstinence were stronger among patients who were white (white patients were the minority in the study’s region), younger, less educated, unstably employed, less religious, and less interpersonally skilled.

Implications:
Those patients who benefitted most from 12-step SHG attendance and involvement had fewer socioeconomic and personal resources, and took greater advantage of the fellowship and support for abstinence that 12-step members often provide. Patients with fewer social resources and skills may need 12-step membership more to stay clean and sober than do those with ongoing social resources and interpersonal successes.

Impacts:
Treatment providers should encourage 12-step affiliation among patients most likely to benefit from it on substance use outcomes. Specifically, providers should screen for patient characteristics marking fewer social resources and skills and focus 12-step facilitation efforts accordingly. Providers should provide education about SHGs in order to dispel myths, remove barriers, and prepare patients about what to realistically expect, and work with 12-step volunteers to help patients attend and become involved in meetings.