Twelve-step groups (TSGs) are a valuable recovery resource for substance-dependent individuals. However, some aspects of these fellowships are controversial and may limit clinician referrals. This study describes attitude- and knowledge-based barriers to TSG participation as seen by addiction professionals in Norway, a treatment culture in which less than 5% of programs use the 12-step philosophy, and compares the findings with those of a similar study in the United States. Data were collected in Norway in mid-2008 using a self-administered questionnaire, and the U.S. sample was obtained from historical data. The Norwegian professionals (n = 291) considered the religious aspects of TSGs a considerable obstacle to participation, whereas the U.S. providers (n = 100) did not. Treatment providers unfamiliar with the 12-step philosophy need to be better informed of TSGs' "higher power" concept to educate patients and maximize the utilization of TSGs.
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