An Exploration of the Effect of On-Site 12-Step Meetings on Post-Treatment Outcomes among Polysubstance-Dependent Outpatient Clients

Abstract

Rates of return to active substance use after addiction treatment tend to be high; participation in 12-step fellowships (e.g., Alcoholics Anonymous) reduces relapse rates but many clients do not attend or attend for a short period only. This quasi-experimental study uses repeated measurement to explore the role of presence/absence of onsite 12-step meetings during treatment on post-treatment outcomes. Polysubstance-dependent clients (N = 219) recruited at a program with and one without 12-step onsite, were followed for one year post-treatment. Onsite 12-step enhanced 12-step attendance, especially during treatment, and predicted continuous abstinence for the post treatment year. Holding 12-step meetings onsite is a low-cost strategy that programs should consider to foster post-treatment remission maintenance. Keywords 12-step; treatment; recovery; self-helpSubstance use disorders (SUD) are conceptualized as chronic (e.g., McLellan, Lewis, O'Brien, C., and Kleber, 2000); the chronicity of SUD is empirically supported by findings on addiction and treatment 'career' indicating that most SUD-affected individuals, especially those with severe dependence, make multiple attempts at remission often involving several treatment episodes prior to resolving their alcohol or drug dependence (e.g., Dennis, Scott, Funk, and Foss, 2005;Hser, Anglin, Grella, Longshore and Prendergast, 1997; Laudet, Stanick, Carway, and Sands, 2004). Because of the multiple costs of long chronic addiction 'careers' that include the acquisition/transmission of infectious diseases (e.g., HIV, HepC), deterioration in mental and physical health and other functioning impairments (e.g., Smith and Larson, 2003), it is critical to identify strategies that contribute to sustaining remission, thus shortening addition careers and resulting nefarious effects to the individual and to society. A number of therapeutic modalities have proven effective at addressing drug and alcohol dependence and improving related functioning but treatment gains are often short lived (Hser, Grella, Hsieh and Anglin, 1999). Participation in post-treatment 'stepped down' continuing (or after) care is associated with sustained treatment gains (McKay, Alterman, Cacciola, Rutherford and O'Brien, 1997;Mckay 2001). In the currently austere fiscal context of health services provision, few drug and alcohol treatment programs offer continuing care, NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript especially following outpatient treatment, the most prevalent treatment modality in the US. Twelve-step fellowships such as Alcoholics and Narcotics Anonymous are the most frequently used form of aftercare in the United States (Tonigan, Toscova, and Miller, 1996). Twelve-step fellowships are particularly well-suited to provide ongoing recovery support from chronic substance abuse and dependence because, unlike formal services that are limited in time, these groups are widely and consistently available throughout the US and free of charge. As with treatment, 12-st...

Characteristics of Students Participating in Collegiate Recovery Programs: A National Survey

“…The instrument consisted of measures and inventories summarized below, all of which we have used in previous federally funded studies of persons in SUD remission (Kaskutas et al, 2014; A. Laudet, 2007; A. Laudet, Stanick, & Sands, 2007; A.…”

The Road to Recovery: Where Are We Going and How Do We Get There? Empirically Driven Conclusions and Future Directions for Service Development and Research

“…Professional substance user treatment is effective at promoting reductions in substance use and improvements in related functioning (Magura, Laudet, Kang, & Whitney, 1999;Mojtabai & Graff Zivin, 2003;Simpson, Joe, & Broome, 2002;Teesson et al, 2006); however, treatment lasts a relatively short period of time, even when clients complete the planned duration of services. Treatment gains tend to be shortlived and post-treatment rates of return to substance use are high, often occurring within a short time after services end (Gossop, Stewart, Browne, & Marsden, 2002;Laudet, Stanick, & Sands, 2007). It is therefore important to identify non-treatment factors that promote the maintenance of treatment gains into the post-treatment period; these factors may also be useful to persons who wish to stop using drugs and/or alcohol without seeking professional help -'selfchangers' (Toneatto, Sobell, Sobell, & Rubel, 1999;Sobell et al, 2001).…”

The Impact of Alcoholics Anonymous on Other Substance Abuse-Related Twelve-Step Programs

“…In spite of these high rates of 12-step participation, we have documented high rates of attrition from both AA and NA among drug-dependent samples (Laudet, Stanick, & Sands, 2007). For example, in the outpatient sample, among clients who had attended 12-step at intake, 85% reported having attended NA and dropped out for a month or longer, and 91% reported a similar patterns for AA; mean number of interrupted attendance for a month or longer since attendance began was 6 (6.1 in NA, 5.4 in AA) (Laudet et al, 2004).…”

“…Information is needed on the differential effectiveness of AA and NA among drug dependent persons to inform clinicians' referral and service delivery. We have shown that the mere presence of a 12-sep group onsite in outpatient treatment, a cost-free strategy easily implemented through AA or NA's H&I for any treatment program that requests it, enhances nearly three-fold the likelihood of 12-step engagement during treatment as well as nearly six times the likelihood of continuous abstinence from drug one year after treatment ends (Laudet et al, 2007). In our remitted sample of polysubstance users, continuous 12-step attendance over the three year study duration was associated with odds two to five times greater of sustaining continuous drug abstinence over three years, compared to less than continuous participation (Laudet & White, 2007).…”