title: Longitudinal study of urban American Indian 12-step attendance, attrition, and outcome.
abstract: OBJECTIVE
  Strong opinions have been voiced about the "fit" between 12-step treatment, community-based 12-step practices, and American Indian beliefs and values. Little is known, however, about the relative benefit of 12-step programs for urban American Indians, although they are the most widely accessed type of treatment by American Indians. This study investigated rates of 12-step attendance, attrition, and substance use outcomes for American Indians for 9 months relative to non-Hispanic White participants.
  
  
  METHODS
  This study compared urban American Indian (n = 63) and non-Hispanic White (n = 133) 12-step attendance, attrition, and substance use over 9 months. The sample was formed by merging data from two prospective single-group longitudinal studies investigating behavior change in community-based 12-step programs. Participants were interviewed at baseline and at 3-, 6-, and 9-month follow-ups. No intervention was provided. Participants were recruited from Alcoholics Anonymous meetings in the community and as they presented for outpatient substance use disorder treatment. Substance use and patterns of 12-step attendance were measured using the Form 90 calendar-based interview, and the General Alcoholics Anonymous Tools of Recovery was administered to assess the adoption of prescribed 12-step practices and beliefs.
  
  
  RESULTS
  Trajectories in 12-step meeting attendance over 9 months did not differ between American Indian and non-Hispanic White participants. However, American Indian participants discontinued 12-step attendance significantly less often than non-Hispanic White participants. Higher rates of 12-step attendance predicted increased alcohol abstinence and decreased drinking intensity for both American Indian and non-Hispanic White participants. Twelve-step attendance was unrelated to later illicit drug use for both American Indian and non-Hispanic White participants.
  
  
  CONCLUSIONS
  Community-based 12-step program attendance is associated with drinking reductions among urban American Indians.
authors.affiliation: Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, New Mexico 87106, USA. jtonigan@unm.edu
authors.forename: J Scott
authors.initials: JS
authors.lastname: Tonigan
authors.forename: Brenda
authors.initials: B
authors.lastname: Martinez-Papponi
authors.forename: Kylee J
authors.initials: KJ
authors.lastname: Hagler
authors.forename: Brenna L
authors.initials: BL
authors.lastname: Greenfield
authors.forename: Kamilla L
authors.initials: KL
authors.lastname: Venner
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control; D000436:Alcoholics Anonymous / Q000458:organization & administration; D000437:Alcoholism / Q000208:ethnology / Q000534:rehabilitation*; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012657:Self-Help Groups / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000208:ethnology / Q000534:rehabilitation*; D013997:Time Factors; D016896:Treatment Outcome; D014505:Urban Population; D044465:White People / Q000706:statistics & numerical data