Intensive referral to 12-Step self-help groups and 6-month substance use disorder outcomes

Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University Medical Center, Palo Alto, CA 94025, USA.
Addiction (Impact Factor: 4.74). 06/2006; 101(5):678-88. DOI: 10.1111/j.1360-0443.2006.01391.x
Source: PubMed


This study implemented and evaluated procedures to help clinicians make effective referrals to 12-Step self-help groups.
Randomized controlled trial. Setting Out-patient substance use disorder treatment. Participants Individuals with substance use disorders (SUDs) entering a new treatment episode (n = 345) who were assigned randomly to a standard referral- or an intensive referral-to-self-help condition.
Self-reports of 12-Step group attendance and involvement and substance use at baseline and a 6-month follow-up.
The intensive referral intervention focused on encouraging patients to attend 12-Step meetings by connecting them to 12-Step volunteers.
Among patients with relatively less previous 12-Step meeting attendance, intensive referral was associated with more meeting attendance during follow-up than was standard referral. Among all patients, compared with those who received standard referral, those who received intensive referral were more likely to be involved with 12-Step groups during the 6-month follow-up (i.e. had provided service, had a spiritual awakening and currently had a sponsor). Intensive referral patients also had better alcohol and drug use outcomes at 6 months. Twelve-Step involvement mediated part of the association between referral condition and alcohol outcomes.
The brief intensive referral intervention was associated with improved 12-Step group involvement and substance use outcomes even among patients with considerable previous 12-Step group exposure and formal treatment. Future 12-Step intensive referral procedures should focus on encouraging 12-Step group involvement in addition to attendance to benefit patients most effectively.

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Available from: Anna DeBenedetti Rubinsky
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    • "The three individual sessions included adaptations of the introductory and termination sessions from the TSF manual and incorporated an intensive referral procedure (Timko et al., 2006). A major portion of the first individual session was devoted to the intensive referral process, which emphasized active participation in 12-step activities as a primary means to recovery and focused primarily on facilitating participants' attendance at 12-step groups. "
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    ABSTRACT: AIMS: The study evaluated the effectiveness of an 8-week combined group plus individual 12-step facilitative intervention on stimulant drug use and 12-step meeting attendance and service. DESIGN: Multisite randomized controlled trial, with assessments at baseline, mid-treatment, end of treatment, and 3- and 6-month post-randomization follow-ups (FUs). SETTING: Intensive outpatient substance treatment programs. PARTICIPANTS: Individuals with stimulant use disorders (n=471) randomly assigned to treatment as usual (TAU) or TAU into which the Stimulant Abuser Groups to Engage in 12-Step (STAGE-12) intervention was integrated. MEASUREMENTS: Urinalysis and self-reports of substance use and 12-step attendance and activities. INTERVENTION: Group sessions focused on increasing acceptance of 12-step principles; individual sessions incorporated an intensive referral procedure connecting participants to 12-step volunteers. FINDINGS: Compared with TAU, STAGE-12 participants had significantly greater odds of self-reported stimulant abstinence during the active 8-week treatment phase; however, among those who had not achieved abstinence during this period, STAGE-12 participants had more days of use. STAGE-12 participants had lower Addiction Severity Index Drug Composite scores at and a significant reduction from baseline to the 3-month FU, attended 12-step meetings on a greater number of days during the early phase of active treatment, engaged in more other types of 12-step activities throughout the active treatment phase and the entire FU period, and had more days of self-reported service at meetings from mid-treatment through the 6-month FU. CONCLUSIONS: The present findings are mixed with respect to the impact of integrating the STAGE-12 intervention into intensive outpatient drug treatment compared with TAU on stimulant drug use. However, the results more clearly indicate that individuals in STAGE-12 had higher rates of 12-step meeting attendance and were engaged in more related activities throughout both the active treatment phase and the entire 6-month FU period than did those in TAU.
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    • "These groups respectively represent a large proportion of treatment populations (Humphreys et al., 1998b; Regier et al., 1990) and are especially difficult to treat successfully (Rounsaville et al., 1987; Weisner et al., 2000). In contrast to MAAEZ, Project MATCH TSF carried an advantage at 1-year only among those with low psychiatric severity (Project MATCH Research Group, 1997), and Timko's " Intensive Referral " TSF was superior at 6 months among those with low levels of prior 12-step group meeting exposure (Timko et al., 2006). "
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    • "TSF is a professionally delivered intervention that is designed to educate patients about, and promote active engagement in, AA. For example, clinicians using TSF might help connect patients with current MHG members (Sisson and Mallams 1981; Timko et al. 2006) or help them prepare to attend an MHG meeting by dispelling myths and providing information about what to expect (Kaskutas et al. 2009; Walitzer et al. 2009). Clinicians also may monitor and discuss patients’ reactions to meetings and explore potential barriers to attendance (Donovan et al. 2003; Kelly and McCrady 2008). "
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