12‐step programs for reducing illicit drug use

Abstract

This Campbell systematic review examines the effectiveness of 12‐step programs in reducing the use of illicit drugs. The review summarises findings from 10 studies, nine of which were conducted in the United States. The main evidence presented in this review suggests that 12‐step programs for reducing illicit drug use are neither better nor worse than other interventions. This conclusion should be read with caution given the weakness of the evidence from the studies. The power to detect a difference between the 12‐step interventions and alternative psychosocial interventions was low and the estimated effect sizes were small. Many studies failed to adjust for the fact that the intervention is administered to groups, and so may overestimate effects. Given all these shortcomings, further evidence regarding the effectiveness of this type of intervention, especially in self‐help groups, is needed. Plain language summary 12‐step programs for reducing illicit drug use are neither better nor worse than other interventionsIllicit drug abuse has serious and far‐reaching implications for the abuser, their family members, friends, and society as a whole. Preferred intervention programs are those that effectively reduce illicit drug use and its negative consequences, and are cost‐effective as well. Current evidence shows that overall, 12‐step programs are just as effective as alternative, psychosocial interventions. The costs of programs are, therefore, an important consideration. However, the strength of the studies is weak and further evidence regarding the effectiveness of 12‐step programs is needed. What did the review study?Illicit drug abuse is a globally recognised problem leading to high human, social and economic costs.The 12‐step program, modelled on the approach of Alcoholics Anonymous and adopted by Narcotics Anonymous and others, aims for complete abstinence. The 12‐step approach is used both by self‐help groups and for professional treatment called Twelve Step Facilitation (TSF).This review examines the effectiveness of 12‐step programs in reducing the use of illicit drugs. Secondary outcomes considered are on criminal behaviour, prostitution, psychiatric symptoms, social functioning, employment status, homelessness, and treatment retention. What studies are included?Included studies assess 12‐step interventions for participants with illicit drug dependence using randomized controlled trials and quasi‐experimental studies. Study populations are participants who have used one or more types of illicit drugs, regardless of gender and ethnic background.A total of 10 studies consisting of 1,071 participants are included in the final evaluation. Nine of the studies were conducted in the United States, and one in the United Kingdom. The studies compare the 12‐step program to alternative interventions. Nine studies were included in meta‐analysis. What are the main results in this review?There is no difference in the effectiveness of 12‐step interventions compared to alternative psychosocial interventions in reducing dru...

Dialectical behaviour therapy and 12‐step programmes for substance use disorder: A systematic review and meta‐analysis

“…However, the searches revealed the existence of high‐quality systematic reviews of 12‐step versus TAU (Bøg et. al., ; Ferri et al, ) and no further RCTs of this comparison. Therefore, we re‐focused the current review to compare DBT to either TAU or 12‐step programmes.…”

“…Contextual evidence from observational studies not included in this review suggested that several demonstrate that longer duration of AA attendance is associated with less drinking than shorter attendance (Grossop et al, ; Laudet et al, ; Moos & Moos ). Two uncontrolled studies (Moos & Moos, ; Timko, Moos, Finney, & Lesar, ), not included in previous systematic reviews (Bøg et al, ; Ferri et al, ; Nielsen et al, ), found an overall relationship (positive effect) between 12‐step self‐help group participation–attendance and positive drinking outcomes. Such outcomes are consistent with conclusions from previous systematic reviews of the effects of 12‐step programmes for SUD.…”

“…Our original protocol also aimed to compare 12-step programmes versus TAU, and the searches were conducted accordingly. However, the searches revealed the existence of high-quality systematic reviews of 12-step versus TAU (Bøg et. al., 2017;Ferri et al, 2006) and no further RCTs of this comparison.…”

“…Comparing DBT and TAU, we found a significant differential impact on SUD favouring DBT. DBT was superior to TAU for self-reported substance use in the short and long term (1 RCT, systematic reviews (Bøg et al, 2017;Ferri et al, 2006;Nielsen et al, 2014), found an overall relationship (positive effect) between 12-step self-help group participation-attendance and positive drinking outcomes. Such outcomes are consistent with conclusions from previous systematic reviews of the effects of 12-step programmes for SUD.…”

“…In a review of 11 randomised and quasi‐experimental studies (Q‐ES), Nielsen et al () did not report overall effect sizes, but concluded that there was some evidence of a generally positive effect of 12‐step programmes and comparison conditions in reducing drug use, with two particular studies demonstrating that 12‐step programmes are more effective than comparison (Carroll, Kathleen, Charla Nich, Ball, McCance, Frankforter & Rounsavile, ; Carroll et al, ). A recent systematic review of 12‐step programmes for illicit drug use included 10 studies, using RCT and Q‐ES, but found no significant differences between 12‐step programmes and the comparison conditions, such as treatment as usual (TAU), cognitive‐behavioural therapy (CBT), clinical management (ClM), RPT and acceptance and commitment therapy (ACT; Bøg, Filges, Brännström, Jørgensen, & Fredrikksson, ). In contrast to the results of these reviews, large observational studies have suggested beneficial effects of 12‐step programmes (Emrick, Tonigan, Montgomery, & Little, ; Tonigan, Toscova, & Miller, ).…”