Recovery benefits of the “therapeutic alliance” among 12-step mutual-help organization attendees and their sponsors

Abstract

Background The “therapeutic alliance” between clinicians and patients has been associated with treatment response and outcomes in professionally-delivered psychotherapies. Although 12-step mutual help organizations (MHOs), such as Alcoholics Anonymous, are the most commonly sought source of support for individuals with substance use disorder (SUD), little is known about whether a stronger alliance in comparable MHO relationships between 12-step sponsors and those they help (“sponsees”) confers benefits similar to those observed in professional contexts. Greater knowledge could inform clinical recommendations and enhance models that explain how individuals benefit from 12-step MHOs. Method Young adults (N = 302) enrolled in a prospective, clinical effectiveness study of residential SUD treatment were assessed at treatment entry, and 3, 6, and 12 months after discharge on whether they had a sponsor, contact with a sponsor, and degree of sponsor alliance. Hierarchical linear models (HLM) tested their effects on 12-step MHO attendance, involvement, and percent days abstinent (PDA). Results Approximately two-thirds of the sample (n = 208, 68.87%) reported having a sponsor at one or more follow-up time points. Both having sponsor contact and stronger sponsor alliance were significantly associated with greater 12-step participation and abstinence, on average, during follow-up. Interaction results revealed that more sponsor contact was associated with increasingly higher 12-step participation whereas stronger sponsor alliance was associated with increasingly greater abstinence. Conclusions Similar to the professional-clinical realm, the “therapeutic alliance” among sponsees and their sponsors predicts better substance use outcomes and may help augment explanatory models estimating effects of MHOs in SUD recovery.

Mechanisms of Behavior Change in 12-Step Approaches to Recovery in Young Adults

“…Each additional TSMHO activity during a follow-up period (1-, 3-, 6-, or 12-months post-treatment) increased the odds of abstinence in that same time period by 25% [33]. We have also found that having a sponsor and contact with one’s sponsor are associated with abstinence during the same time period [34]. One particularly novel finding in that study was that the quality of the relationship between the TSMHO participant and his/her sponsor – measured by an assessment of “sponsor alliance” adapted from a well validated measure of the professional therapeutic “working alliance” [35] – was uniquely related to abstinence.…”

“…“Sponsor alliance” was an even stronger predictor of abstinence than having sponsor contact. Given the growing body of literature on the salutary effects of having a sponsor among adults [36, 37], early data on the importance of this core TSMHO relationship among young adults [34] suggest it is similar and merits further attention.…”

“…Finally, our studies have shown that having a sponsor, contact with one’s sponsor, and having a good relationship with a sponsor (“sponsor alliance”) are related to TSMHO attendance and active involvement and better treatment outcomes [34].…”

Substance Abuse Therapeutics

“…Motivational interviewing (MI) [92] Discusses the combination of MI with cognitive behavioral technique [93] Considered the connection between therapist attitude toward MI and impact on client interpersonal functioning Drug court [94] Evaluated drug courts as a promoter of "turning points" for offenders in areas of self-esteem, relationship, educational development, employment [95] Examination of the value of compulsory treatment of addiction in Australia and the United States Alcoholics anonymous [96] Considers the value of the "therapeutic alliance" that develops in AA as a significant curative factor [97] Examines the effectiveness of AA in a research method that reduces previous method problems. Support for the effectiveness of AA is reported.…”

“Personal recovery depends on NA unity”: an exploratory study on recovery-supportive elements in Narcotics Anonymous Flanders

“…A recent Cochrane review demonstrated the efficacy of AA participation for achieving abstinence [28]. Primarily uncontrolled, longitudinal studies indicate that, for example, the presence of and support from peers and sponsors (i.e., peers who have more experience in NA than the peers they support [sponsees]) -often resulting in hope and connectednessfacilitates change [29][30][31][32][33][34]. Spirituality has been found to be a key element for tackling problems [29,34].…”