A randomized controlled trial of intensive referral to 12-step self-help groups: one-year outcomes

Drug Alcohol Depend. 2007 Oct 8;90(2-3):270-9. doi: 10.1016/j.drugalcdep.2007.04.007. Epub 2007 May 24.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Periodicity*
  • Referral and Consultation / statistics & numerical data*
  • Self-Help Groups / statistics & numerical data*
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / rehabilitation*
  • Surveys and Questionnaires
  • Treatment Outcome