Christine Timko1, Anna DeBenedetti. 1. Center for Health Care Evaluation, VA HSR&D Center of Excellence, Department of Veterans Affairs Health Care System, and Stanford University Medical Center, 3801 Miranda Avenue, Palo Alto, CA 94304, United States. ctimko@stanford.edu
Abstract
OBJECTIVE: This study implemented and evaluated procedures to help clinicians make effective referrals to 12-step self-help groups (SHGs). METHODS: In this randomized controlled trial, individuals with substance use disorders (SUDs) entering a new outpatient treatment episode (N=345; 96% had previous SUD treatment) were randomly assigned to a standard referral or an intensive referral-to-self-help condition and provided self-reports of 12-step group attendance and involvement and substance use at baseline and at six-month and one-year follow-ups (93%). In standard referral, patients received a schedule for local 12-step SHG meetings and were encouraged to attend. Intensive referral had the key elements of counselors linking patients to 12-step volunteers and using 12-step journals to check on meeting attendance. RESULTS: 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% versus 61%, p=.049) and had higher SHG involvement (mean=4.9 versus 3.7, p=.021) and abstinence rates (51% versus 41%, p=.048). Twelve-step involvement mediated the association between referral condition and alcohol and drug outcomes, and was associated with better outcomes above and beyond group attendance. CONCLUSIONS: The intensive referral intervention was associated with improved 12-step group attendance and involvement and substance use outcomes. To most benefit patients, SUD treatment providers should focus 12-step referral procedures on encouraging broad 12-step group involvement, such as reading 12-step literature, doing service at meetings, and gaining self-identity as a SHG member.
RCT Entities:
OBJECTIVE: This study implemented and evaluated procedures to help clinicians make effective referrals to 12-step self-help groups (SHGs). METHODS: In this randomized controlled trial, individuals with substance use disorders (SUDs) entering a new outpatient treatment episode (N=345; 96% had previous SUD treatment) were randomly assigned to a standard referral or an intensive referral-to-self-help condition and provided self-reports of 12-step group attendance and involvement and substance use at baseline and at six-month and one-year follow-ups (93%). In standard referral, patients received a schedule for local 12-step SHG meetings and were encouraged to attend. Intensive referral had the key elements of counselors linking patients to 12-step volunteers and using 12-step journals to check on meeting attendance. RESULTS: 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% versus 61%, p=.049) and had higher SHG involvement (mean=4.9 versus 3.7, p=.021) and abstinence rates (51% versus 41%, p=.048). Twelve-step involvement mediated the association between referral condition and alcohol and drug outcomes, and was associated with better outcomes above and beyond group attendance. CONCLUSIONS: The intensive referral intervention was associated with improved 12-step group attendance and involvement and substance use outcomes. To most benefit patients, SUD treatment providers should focus 12-step referral procedures on encouraging broad 12-step group involvement, such as reading 12-step literature, doing service at meetings, and gaining self-identity as a SHG member.
Authors: Mary Hatch-Maillette; Elizabeth A Wells; Suzanne R Doyle; Gregory S Brigham; Dennis Daley; Jessica DiCenzo; Dennis Donovan; Sharon Garrett; Viviana E Horigian; Lindsay Jenkins; Therese Killeen; Mandy Owens; Harold I Perl Journal: J Subst Abuse Treat Date: 2016-06-16
Authors: Adam J Gordon; David A Fiellin; Peter D Friedmann; Marc N Gourevitch; Kevin L Kraemer; Julia H Arnsten; Richard Saitz Journal: J Gen Intern Med Date: 2008-10-02 Impact factor: 5.128