12-step self-help groups improve abstinence rates
Twelve-step self-help groups have been shown to be effective resources, helping many people who misuse substances to address their problem successfully. Referral of suitable patients by clinicians, however, is associated with high non-attendance and drop-out rates.
A study has now reported that an intensive referral process is associated with improved attendance and involvement with a 12-step group, and with better alcohol and drug outcomes, compared with standard referral.
The study included 345 new patients in a substance treatment programme in the US. Participants were randomised to ‘standard' or ‘intensive' referral pathways. Standard referral reflected current practice in the programme and included encouragement to attend a 12-step group, together with a schedule of local meetings. Intensive referral involved in-depth discussion of 12-step philosophy and practice, see table 1,attached, provision of information leaflets, setting of practical goals for attendance and the support of an existing Alcoholics Anonymous or Narcotics Anonymous member in attending the first meeting.
Telephone follow-up was undertaken at six months and one year. It included measures of attendance and involvement with a 12-step group and current substance use.
Patients in both referral cohorts who showed good involvement with a 12-step group improved more in alcohol and drug use scores than patients who were less involved. Patients who were more involved were more likely to be abstinent from problem substances at both six months and one year.
Compared with patients who received standard referral, patients who received intensive referral were more likely to attend and be involved with 12-step groups during both the first and second six-month follow-up periods, and improved more on alcohol and drug use outcomes over the year. Specifically, during both follow-up periods, patients in intensive referral were more likely to attend at least one meeting per week (70% vs 61%, P=0.049) and had higher 12-step self-help group involvement (mean = 4.9 vs 3.7, P=0.021) and abstinence rates (51% versus 41%, P=0.048).
The study confirms the usefulness of 12-step self-help groups in helping some patients to address substance misuse and GPs may want to refer patients to local groups.
Attending a first meeting and engaging with a group must be a daunting process and many patients referred will fail to go. As GPs we should remember this. Referral associated with the provision of good information, leaflets and support is more likely to result in successful engagement and in better alcohol and drug outcomes than simple advice to attend.
Timko C, DeBenedetti A. A randomized controlled trial of intensive referral to 12-step self-help groups: One-year outcomes. Drug Alcohol Depend 2007;90:270-9Table 1: The Twelve Steps Reviewer
Dr Jez Thompson
Former GP, Clinical Director, Leeds Community Drug Services