Facilitating patients' involvement with 12-step self-help organizations.

Facilitating patients' involvement with 12-step self-help organizations, as it was as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), is frequently a goal of substance abuse treatment. Twelve-step-facilitation (TSF) interventions have been raise to be more effective than comparison treatments in increasing patients' 12-step cluster involvement and in promoting abstinence. coming time TSF evaluation research should address the effectiveness of incorporating TSF interventions with cognitive-behavioral treatment orderly dispositions the relative impact of brief versus fill outed TSF interventions, and the cost-effectiveness and health care cost-offset of TSF interventions within managed health care combination of parts to form a wholes KEY WORDS: twelve step program; intervention; treatment outcome; cognitive therapy; behavior therapy; price effectiveness; managed care; AODD (alcohol and other physic dependence) recovery; treatment program; evaluation; motivational interviewing; AOD (alcohol and other drug) abstinence; comparative study; literature review

Although the United States has unraveled an extensive array of professional alcohol treatment services athwart the past 30 years, the peer-l voluntary fellowship known as Alcoholics Anonymous (AA) continues to be the greatest in quantity widely accessed resource for clan with alcohol problems (McCrady and Miller 1993) This article discusses the rationale for interventions that facilitate alcohol-dependent patients' affiliations with AA and related mutual-help organizations (eg Narcotics Anonymous [NA]). The article also reviews newly come research comparing those interventions with other treatment methods

IMPORTANCE OF 12-STEP cluster AFFILIATION IN ALCOHOL TREATMENT

The rationale for facilitating patients' involvement in 12-step self-help clusters stems primarily from recent AA issue research and from developments in the management and organization of health care in the United States. From the 1940 by means of the 1980s, most studies upon AA did not directly evaluate AA's effectiveness. Rather, researchers examined AA's organizational composition and functioning; its history; and the ways in which AA participation changed members' values, intellect of identity, and spiritual sight (see Kurtz 1993 for a review). The not many AA outcome studies that were guidanceed typically did not study AA members athwart time or include non-PA members for comparison intents making conclusions about AA's effectiveness tenuous. Given this limited empirical base, many clinicians and researchers doubted whether AA verily helped its members recover from alcohol dependence

In the 1990 the breadth and stillest part of AA research increased significantly, as evidenced by way of a National Institute on Alcohol Abuse and Alcoholism (NIAAA)-sponsored colloquy on PA (McCrady and Miller 1993) the International Collaborative thought of AA (Makela et al. 1996) and other concocts Recent AA outcome research, which has demonstrated the benefits of treatments intended to facilitate AA involvement, as well as of AA involvement through se, has typically employed longitudinal designs (i.e., studied AA members from one side of to the other time), reliable measures, comparison clusters and, in some cases, random assignment to conditions. The improved methodological quality of AA research has reduc skepticism in the treatment community about AA's effectiveness and has increased clinicians' interest in facilitating connections between substance abuse treatment and 12-step self-help groups

The other major factor that has enhanced interest in 12-step facilitation (TSF) interventions is the expansion of managed health care. In the pair the public and private sectors, managed care has reduc the extent and intensity of professional addiction treatment services (Humphrey et al. 1997) and increased the influence for cost-effective care. Because managed care has reduc the amount of time available for practitioners to work with patients, clinicians are increasingly interested in facilitating patient involvement in self-help assign places tos as an inexpensive way to achieve and maintain treatment gains. Three late studies (Tonigan et al. in press; Humphrey et al. 1999; McCrady et al. in press) have evaluated the effectiveness of like efforts.

RECENT EVALUATIONS OF TSF INTERVENTIONS

united large study, known as plot MATCH, compared a TSF intervention with cognitive-behavioral (CB) therapy and motivational enhancement therapy (MET) among 1726 patients (76 percent male) diagnosed with either alcohol abuse or stay including 774 inpatients who were beginning outpatient aftercare and 952 patients receiving outpatient care as their primary treatment (Project MATCH Research assign places to 1997, 1998). GB therapy focuses onward teaching coping skills to bring to alcohol use (i.e., patients who use alcohol to cope with stres learn and practice alternative coping methods) In contrast, MET occupys motivational strategies to mobilize patients' internal resources for change.

The TSF intervention in the plan MATCH study was a form of one-on-one professional counseling explicitly designed to work synergistically with AA and other 12-step clusters (Nowinski et al. 1992). Consistent with AA's philosophy, TSF therapists readyed alcohol dependence as a disease with spiritual, emotional, and physical constitutings and emphasized that the disease could be arrested if it be not that not cured through permanent abstinence from alcohol. Also consistent with AA's approach, patients were powerfully urged, but neither ordered nor forced, to attend AA meetings and to maintain a journal describing their reactions to the meetings. The textbox above lists the major goals of the 12-session TSF intervention applyed in Project MATCH.