Mediators Of Effectiveness In Dual-focus Self-help Groups

Abstract

Although research on the effectiveness of 12-step group participation has been increasing, there has been little examination of the processes by which such participation leads to positive outcomes. Two kinds of factors have been proposed as mediating between 12-step group affiliation and outcomes for members, common process factors that have been identified in a range of behavioral treatments and factors that are relatively unique to the 12-step model. The study tested the hypotheses that two common process factors (internal locus of control and sociability) and two unique factors (spirituality and installation of hope) mediate the effects of 12-step group affiliation on drug/alcohol abstinence and health promoting behavior. The study respondents were members of a dual focus 12-step-based fellowship, Double Trouble in Recovery (DTR), designed to address issues of both substance use and mental health. Members of 24 DTR groups in New York City were recruited and followed-up for 1 year. The degree of 12-step group affiliation during the study period was associated with more positive outcomes at follow-up. Internal locus of control and sociability mediated the effects of 12-step group affiliation on both outcomes, whereas spirituality and hope acted as mediators only for health promoting behavior. Understanding that the therapeutic factors inherent in 12-step are not mysterious, but appear to capitalize on well-documented social learning principles, may increase the acceptance of 12-step programs among addiction and mental health professionals.

Spirituality and Recovery from Familial Aspects of Alcohol and Other Drug Problems: Analysis of an Online Al-Anon Meeting

“…This results in decreased referral rates by mental health professionals of patients with addictions to these programs (Magura et al, 2003). This misunderstanding exists within a broader historical mutual suspicion between many members of Twelve Step programs and health professionals, although this divide has narrowed (BenAri, 2002).…”

Assessment of spirituality and its relevance to addiction treatment

“…Polcin and Zemore (2004) and Zemore and Kaskutas (2004) studied ambulatory patients who were predominantly drawn from AA meetings by applying a multidimensional measurement of religiousness/spirituality, and they found that those AA members who had longer periods of sobriety reported a greater level of spirituality at the time of evaluation. Magura et al (2003) reported that responses on a 12-item Spirituality Well-Being scale were not associated with increased abstinence, but were associated with health-promoting behaviors such as btaking care of yourselfQ and bgetting enough sleep.Q Some studies on ambulatory patients on recovery, however, did not show a relationship between spiritual orientation and decreased use of drugs. Christo and Franey (1995) evaluated a sample of patients attending Narcotics Anonymous in London and found, on a 6-month follow-up, no relationship between scores on a spiritual belief questionnaire and abstinence.…”

Health-Related Support and Self-help Mutual Aid Groups

“…Taking into account the relationship between DTR involvement and health maintenance behavior, internal locus of control, sociability, installation of hope, and spirituality all mediated the relationship. These findings are not surprising given that internal locus of control increases individuals' self-efficacy for recovery and sociability facilitates the formation of meaningful relationships and mutual aid in the recovery process (Magura et al, 2003).…”

“…In their investigation of the DTR groups, Magura et al (2003) found that the degree of involvement in DTR groups and their sponsoring organization (frequency of attendance, sharing at meetings, chairing meetings, speaking with other group members about issues) was significantly positively associated with drug and alcohol abstinence and associated health maintenance behaviors (medication adherence, keeping doctor's appointments, self-care). Furthermore, higher internal locus of control and degree of participant sociability mediated the relationship between DTR involvement and abstinence.…”