Twelve Step Programs and Treatment Outcome, Gossom et al 2003

12-Steps Outcome

By Terence T. Gorski,
Author

The relationship between regular attendance in 12-Step Programs and improved treatment outcomes is well established. This is why 12-Step Facilitation, which is an evidenced-based practice, regular attendance at 12-Step Meetings, and systematically working the 12-steps with a sponsor has been strongly recommended to support Relapse Prevention Therapy (RPT). Secular support groups such as SMART Recovery are also available.

When addiction professionals recommend 12-Step Programs as part of an addiction recovery program it is import to be aware of the controversy and legal opinions related to the question if Alcoholics anonymous and other 12-step programs are religious in nature according to the law. This controversy is explored in an in-depth blog: Is A.A. A Religion by Terence T. Gorski.

Here is an abstract of a 2003 article reporting on a six-month followup study regarding A.A. effectiveness (Gossom et al 2003).

Gossom and his associates studied the relationship between attendance at Alcoholics Anonymous (AA) meetings prior to, during, and after inpatient treatment and treatment outcome was studied. The research sample included 150 patients in an inpatient alcohol treatment program who met ICD-10 criteria for alcohol dependence. The participants were interviewed at admission and 80% of the sample was reinterviewed 6 months following departure. The following results of the study were seen:

(1) Significant improvements in drinking behaviors, including frequency, quantity, and reported problems; in psychological problems; and in quality of life;

(2) Superior drinking outcomes for frequent AA attenders compared to non-AA attenders and infrequent attenders;

(3) Greater reductions in alcohol consumption and more abstinent days for those who attended AA on a weekly or more frequent basis after treatment;

(4) A finding that this effect was sustained after controlling for potential confounding variables; and

(5) A finding that the improvements were related only to improved drinking outcomes and that many of the sample had alcohol and psychiatric problems at follow-up. It is concluded that adequate aftercare services are often lacking and that AA is a useful aftercare resource.

Gossom, M.; Harris, J.; Best, D.; Man, L.H.; Manning, V.; Marshall, J.; Strang, J. Is attendance at Alcoholics Anonymous meetings after inpatient treatment related to improved outcomes?: A 6-month follow-up study. Alcohol and Alcoholism, 38(5):421-426, 2003. (171217)

42 Ref.

LIVE SOBER – BE RESPONSIBLE – LIVE FREE

Understanding The 12-Steps By Terence T. Gorski

GORSKI BOOKS – www.relapse.org

12 Responses to Twelve Step Programs and Treatment Outcome, Gossom et al 2003

  1. Linda R says:

    I wonder if all the AA meetings that the study participants attended were the same? Were they Big Book Study meetings where newcomers are taught the doctrines precisely as written in the Big Book? Or were they the type of AA meetings where people directly share their experience, strength and hope with each other rather than study the Big Book?

    There has been a proliferation of Back to Basics / Primary Purpose / Big Book Study Movement meetings in the last 25-30 years. This movement claims that the recovery rates are very high when people are taught the Big Book methodology precisely how it is written, and if people work the Steps precisely as written. These meetings begin with about 20 minutes of prayer and readings from the Big Book.

    Were the people in this 2003 study at those types of meetings? It seems like the outcomes of the study might be significantly impacted by the type of meetings the participants attended. If the Back to Basics / Primary Purpose / Big Book Study Movement meetings are the most effective, as is claimed by the movement, then it might be important to know what types of meetings the participants attended. To achieve the same results, one would imagine that counselors would want to know what type of meetings study participants went to, so that they can refer their clients to the type of meetings that are most effective.

    • Terry Gorski says:

      Dear Linda,

      These are excellent questions. The type of AA meetings attended were not described. They usually are not. There is the mistaken assumption that all 13-Step meetings are the same, and they are not.

      Most outcome studies are seriously flawed. For outcome research to mean anything three crucial factors must be operationally defined:

      1. Patient Type
      2. Treatment Type
      3. Outcome a Measures

      There is no agreed upon peer-reviewed standard for any of the above. So strictly speaking these are the only conclusions that can be drawn from the accumulated research on addiction Treatment:

      Assuming that we know:
      1. What types of patients are in the studies, which we don’t,
      2. what type of treatment is being used, which we don’t, (treatment is a black box of of 100 or more dynamic interactive moving parts that dynamically interact with each other. The big three categories of theses bing parts are the treatment interventions being used, the helping characteristics of the treatment providers, the setting and intensity of treatment provided.
      3. What criteria were used to measure treatment outcome, which we don’t

      Then we could say research shows that treatment, whatever that is, proves to be more effective than non-treatment, whatever that means.

      The problem is that when it comes to recovery from addiction we can’t really control what people do of don’t do in their personal recovery. Even in project match an unknown number of patients participating in the standardized CBT treatment attended some form of 12-step program. This fact is buried so deep in the discussion section that if us very difficult to find.

      For the massive increase on licensed professionals and the demand for higher credentials there is no correlation, let alone causative link, between either advanced training or licensure and improved treatment outcome.

      There is good evidence from the 1970’s, now hopelessly buried in the ore internet archives, that shows a relationship between Karkoff’s helping characteristics and patient and significant other reports on improved functioning and reduced problems.

      My gut, however, tells me that many people benefit from being exposed to treatment that matches the problems they have provided by a professional who listens to them, understands them, takes them seriously and provides them with systematic tool for learning introspection (the ability to look within self and identify and describe inner experiences), and systematic observation of external circumstances including circumstances, people and social/cultural systems.

      There is evidence that systematically self-monitoring of any specific problem behavior results in positive self-reports of change that are maintained as long as the systematic self monitoring is continued and made habitual.

      The human condition is a difficult thing for people to agree upon. Healthy skepticism and personal arrogance seem to frequently get in the way. We also need it consider financial rewards linked to certain points if view.

      Life. What a difficult thing for people to agree about.

      • Linda R says:

        I agree with much of your comments, in particular your comment:

        “My gut, however, tells me that many people benefit from being exposed to treatment that matches the problems they have provided by a professional who listens to them, understands them, takes them seriously and provides them with systematic tool for learning introspection (the ability to look within self and identify and describe inner experiences), and systematic observation of external circumstances including circumstances, people and social/cultural systems.”

        When you use the word “treatment” it seems like you are referring to TSF programs that are professionally facilitated and paid for by the client and/or health insurance. It seems like these studies are trying to measure the effectiveness of these “treatments.” But perhaps not.

        Perhaps instead they are trying to measure the effectiveness and benefit that is derived by the patients / clients from interacting with non-professionals in the community who have recovered from alcohol or drug addiction? These social networks (or fellowships) are populated by people who teach others from two textbooks – the Big Book and 12 & 12. They have no other training and do not use other tools / texts.

        It seems like there is a mixing of apples and oranges in these studies. They seem to be declaring BOTH the professional services provide by the health care industry and the non-professional services of Big Book teachers (AA members) to be “treatment.” Are they equally effective? Why would anyone who reads a magazine about 12 Step treatment bother to go to a professional when they can go to a local AA meeting and get the same 12 Step “treatment.”

      • Terry Gorski says:

        I don’t know of any psychological or psychotherapy research that will stand up to hard scrutiny. There are more therapists with more different credentials and higher levels of education than ever before. Yet the rate of addiction, mental illness, and societal problems keeps going up. How do you make sense out of that?

  2. Guy Lamunyon says:

    I assume similar outcomes from SMART RECOVERY, SOS, WFS and similar sobriety support groups.

    • Terry Gorski says:

      All psychological research is just a guess. Way too many variables involved in defining patient type, treatment type, and outcome. SMART RECOVERY and Women For Sobriety (WFS) have my respect. SOS, in my opinion, represents lunatic fringe who have had a bad 12-Step experience. It is primarily and organization fro A.A. bashers. Your battle cry should be remember Jack Trippey and Rational Recovery. That story needs to be told. You should tell it. Remember the words of George Santayana: “Those who cannot learn from history are doomed to repeat it.”

      • Linda R says:

        I tend to agree with your comments about SOS meetings – my impression is that they are filled with people who spend a lot of time bashing AA/NA meetings. However, I still try to inform people about all options and choices for finding a face to face sobriety meeting in their local community. One issue I’ve noticed in recent newspaper and magazine articles is the tendency to give the impression that only AA is based on supporting and encouraging abstinence.

        I think one of the most pervasive and damaging myth about recovery alternatives is that only AA is abstinent, and that all the alternatives promote moderation or controlled drinking. This misconception needs to absolutely be swept aside.

        I have started to add comments to online sites of newspapers and magazines where they publish articles on addiction and seem to confuse abstinence and moderation organizations. My reader comment is usually something like this:

        -Alcoholics Anonymous (AA) is based on “the desire to stop drinking.” Abstinence

        -Narcotics Anonymous (NA) is based on “the desire to stop using.” Abstinence

        -LifeRing Secular Recovery (LSR) is based on “the desire to stop drinking / using.” Abstinence

        -Smart Recovery is based on “the desire to stop drinking / using.” Abstinence

        -Secular Organizations for Sobriety (SOS) is based on “the desire to stop drinking / using.” Abstinence

        -Women for Sobriety (WFS) is based on “the desire to stop drinking.” Abstinence

        All of these meetings/groups/networks/organizations are based on supporting and encouraging ABSTINENCE from substances such as alcohol and other non-prescribed drugs (opiates, stimulants, marijuana, etc.)

        For those who are trying to learn to moderate their drinking / using there are meeting/groups/networks/organizations that support and encourage MODERATION. These are:

        -Moderation Management (MM)
        -Harm Reduction, Abstinence and Moderation Support (HAMS)

        Posting comments on these online magazine and newspaper sites is a way to raise visibility about all the options and choices. I don’t just promote one option or choice. I try to show the range of options and choices by listing all of the meetings/groups/networks/organizations. My choice is ABSTINENCE.

      • Terry Gorski says:

        Thank you. This is excellent information.

      • Harm reduction and moderation can be pathways to abstinence. In my work in psychiatric home health (10 years) I found harm reduction works better than abstinence for the seriously mentally ill (schizophrenia, bipolar and major depression). Don’t knock it if you haven’t tried it ! ! ! !

      • Terry Gorski says:

        In my mmd harm reduction methods and moderation approaches are valid parts of a continuum of care. In my mind the important thing is finding an approach that patients are motivated to use and then work with them to modify or enhance or change the recovery recommendations based upon experience.

        THERE IS NO WRONG DOOR INTO RECOVERY. THERE ARE MANY PATHS TO THE TOP OF THE MOUNTAIN.

  3. Linda R says:

    FYI – There will be a joint NCADD and ONDCP event hosted at the White House on Sept 17. They are looking for input and questions for their panelists on recovery to discuss. Choice in recovery seems like it should be something both the NCADD and ONDCP should be discussing. Here’s a link to the write up on the event, with a place to provide comments and input to the panelists:

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