A randomized controlled trial of intensive referral to 12-step self-help groups: one-year outcomes.

Timko C, DeBenedetti A. A randomized controlled trial of intensive referral to 12-step self-help groups: one-year outcomes. Drug and Alcohol Dependence. 2007 Oct 8; 90(2-3):270-9.

Related HSR&D Project(s)

• IIR 20-067 – Substance Abuse Self-Help Group Referral: Outcome and Services Use
• RCS 00-001 – Quality and Care of Substance Abuse and Psychiatric Treatment

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Abstract:

OBJECTIVE: This study implemented and evaluated procedures to help clinicians make effective referrals to 12-step self-help groups (SHGs). METHODS: In this randomized controlled trial, individuals with substance use disorders (SUDs) entering a new outpatient treatment episode (N = 345; 96% had previous SUD treatment) were randomly assigned to a standard referral or an intensive referral-to-self-help condition and provided self-reports of 12-step group attendance and involvement and substance use at baseline and at six-month and one-year follow-ups (93%). In standard referral, patients received a schedule for local 12-step SHG meetings and were encouraged to attend. Intensive referral had the key elements of counselors linking patients to 12-step volunteers and using 12-step journals to check on meeting attendance. RESULTS: Compared with patients who received standard referral, patients who received intensive referral were more likely to attend and be involved with 12-step groups during both the first and second six-month follow-up periods, and improved more on alcohol and drug use outcomes over the year. Specifically, during both follow-up periods, patients in intensive referral were more likely to attend at least one meeting per week (70% versus 61%, p = .049) and had higher SHG involvement (mean = 4.9 versus 3.7, p = .021) and abstinence rates (51% versus 41%, p = .048). Twelve-step involvement mediated the association between referral condition and alcohol and drug outcomes, and was associated with better outcomes above and beyond group attendance. CONCLUSIONS: The intensive referral intervention was associated with improved 12-step group attendance and involvement and substance use outcomes. To most benefit patients, SUD treatment providers should focus 12-step referral procedures on encouraging broad 12-step group involvement, such as reading 12-step literature, doing service at meetings, and gaining self-identity as a SHG member.