Scientific evidence suggests substance-use disorder (SUD)-focused self-help group involvement is a helpful adjunct to SUD treatment, yet significant knowledge gaps remain. The principal aim of this review is to highlight areas of knowledge deficit and their implications for research and practice. To accomplish this, evidence regarding whether self-help group involvement is effective, for whom, and why, is reviewed. The appropriateness of self-help groups for certain subpopulations is considered with respect to psychiatric comorbidity, religious orientation, gender, and age. An increasingly rigorous body of evidence suggests consistent benefits of self-help group involvement. Regarding subpopulations, current evidence suggests non- or less-religious individuals benefit as much from self-help groups as more religious individuals and women become as involved and benefit as much as men. However, participation in, and effects from, traditional self-help groups for dually diagnosed patients may be moderated by type of psychiatric comorbidity. Some youth appear to benefit, but remain largely unstudied. Dropout and nonattendance rates are high, despite clinical recommendations to attend. Clinicians can significantly influence the effectiveness of self-help, but optimal methods and duration of facilitation efforts need testing. Greater understanding of the reasons why many do not attend or drop out would benefit facilitation efforts.
Aims: Many patients treated for substance use disorders (SUDs) who become involved in 12-Step self-help groups have improved treatment outcomes. However, due to high rates of psychiatric comorbidity and major depressive disorder (MDD), among SUD patients in particular, concerns have been raised over whether these benefits extend to dual diagnosis patients. This study examined the influence of comorbid MDD among patients with SUDs on 12-Step self-help group involvement and its relation to treatment outcome.
Design: A quasi-experimental, prospective, intact group design was used with assessments completed during treatment, and 1 and 2 years postdischarge.
Participants: A total of 2161 male patients recruited during in-patient SUD treatment, of whom 110 had a comorbid MDD diagnosis (SUD-MDD) and 2051 were without psychiatric comorbidity (SUD-only).
Findings: SUD-MDD patients were initially less socially involved in and derived progressively less benefit from 12-Step groups over time compared to the SUD-only group. However, substance use outcomes did not differ by diagnostic cohort. In contrast, despite using substantially more professional out-patient services, the SUD-MDD cohort continued to suffer significant levels of depression.
Conclusions: Treatment providers should allocate more resources to targeting depressive symptoms in SUD-MDD patients. Furthermore, SUD-MDD patients may not assimilate as readily into, nor benefit as much from, traditional 12-Step self-help groups such as Alcoholics Anonymous, as psychiatrically non-comorbid patients. Newer, dual-diagnosis-specific, self-help groups may be a better fit for these patients, but await further study.
Attendance at 12-step self-help groups is frequently recommended as an adjunct to professional substance use disorder (SUD) treatment, yet patient dropout from these groups is common. This study assessed the prevalence, predictors, and treatment-related factors affecting dropout in the first year following treatment for 2,778 male patients. Of these, 91% (2,518) were identified as having attended 12-step groups either in the 90 days prior to, or during, treatment. At 1-year followup 40% had dropped out. A number of baseline factors predicted dropout. Importantly, patients who initiated 12-step behaviors during treatment were less likely to drop out. Further findings suggest patients at highest risk for dropout may be at lower risk if treated in a more supportive environment. Clinicians may decrease the likelihood of dropout directly, by screening for risk factors and focusing facilitation efforts accordingly, and indirectly, by increasing the supportiveness of the treatment environment, and facilitating 12-step involvement during treatment.