Does active referral by a doctor or 12-Step peer improve 12-Step meeting attendance? Results from a pilot randomised control trial.
BACKGROUND
Active engagement in 12-Step self-help groups (SHG) is associated with improvements in substance use outcomes during and after treatment, yet levels of participation in SHG meetings in the U.K. remain low.


METHODS
An RCT investigating the impact of active referral to SHG, delivered by doctors or 12-Step peers during inpatient treatment on both inpatient and post-treatment meeting attendance was conducted. 151 inpatients with alcohol, opiate, crack-cocaine or benzodiazepine dependence undergoing detoxification, received one of two active referral interventions: 12-Step peer intervention (PI), doctor intervention (DI), or no intervention (NI). 83% of the sample was followed up, 2-3 months following discharge.


RESULTS
Active referral interventions significantly increased attendance at 12-Step meetings during inpatient treatment (88% versus 73%, p<.05). Rates of post-discharge meeting attendance were PI=64%, DI=48%, NI=33%, with those in the PI group significantly (OR=3.6; CI=1.3, 9.8) more likely to have attended. Inpatient meeting attenders were three times as likely to have attended meetings post-discharge (59% versus 20%, p<.01), and post-discharge meeting attenders reported significantly higher abstinence rates (60.8% versus 39.2%, p<.05) at follow-up. However, abstinence rates did not differ significantly across intervention groups (44% [PI], 41% [DI] and 36% [NI]).


CONCLUSIONS
Attendance at 12-Step SHGs is associated with greater rates of abstinence and active referral, especially by 12-Step peers, increases 12-Step SHG attendance rates. However, improved clinical outcomes among attendees might not occur until stronger recovery peer support networks are established. These results show promise for the benefit of incorporating Twelve Step Facilitation into U.K. treatment settings.
Kings College London, National Addiction Centre, Maudsley Hospital/Institute of Psychiatry, 4 Windsor Walk, London SE5 8BB, UK. victoria.2.manning@kcl.ac.uk
Victoria
V
Manning
David
D
Best
Nathan
N
Faulkner
Emily
E
Titherington
Alun
A
Morinan
Francis
F
Keaney
Michael
M
Gossop
John
J
Strang
D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation; D001569:Benzodiazepines; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000534:rehabilitation; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000523:psychology / Q000534:rehabilitation; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D010820:Physicians; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D012657:Self-Help Groups; D019966:Substance-Related Disorders / Q000534:rehabilitation*
D001569:Benzodiazepines