SUBSTANCE ABUSE

12-Step Program of Substance Abuse



12-Step Program of Substance Abuse

Introduction

Participation in 12-step groups such as Alcoholics Anonymous, both during and after formal treatment, is associated with better outcomes among substance users. Twelve-step groups (12SG) are a form of mutual-help or mutual aid based on the premise that individuals who share a common behavior which they identify as undesirable can collectively support each other and eliminate that behavior.One of the essential aspects of mutual-help groups, in contrast to other, more traditional forms of treatment, is the absence of professional involvement. Alcoholics Anonymous, the first and largest twelve-step organization, was started by a group of individuals dependent on alcohol at a time when little or no assistance was available to such persons. Subsequently, the organization contributed to the establishment of formal substance user treatment in the first part of the 20th century; over time, the medicalization of treatment services placed mutual-help organizations at the periphery of service delivery so that such organizations were sometimes viewed as competing with formal treatment and criticized for its lack of professionalism (Mankowski , 2006, ).

In the last two decades, 12-step organizations have become largely integrated with most formal treatment models, thus becoming somewhat homogenized and mainstreamed (see next section; for a detailed discussion of the historical relationship between mutual-help organizations and treatment services addressing substance use. While attending 12-step meetings is an important part of participating in these organizations, 12-step members are also encouraged to work the program and to embrace the 12-step ideology (Roman , 1997).

The effectiveness of 12-step groups may be somewhat limited by a high attrition rate. Moreover, a large minority of substance users never attends 12-step meetings. Little is known about reasons for dropping out or for non-attendance.

Treatment professionals can play a critical role in fostering 12-step participation among their clients, yet, we know very little about professionals' attitudes and beliefs about 12-step fellowships. Several aspects of the 12-step program have been identified as potential stumbling blocks for both clinicians and substance users. Little is known about the prevalence of these beliefs or about whether they constitute obstacles to participation. In this study, treatment professionals and clients are surveyed about their attitudes and beliefs concerning 12-step fellowships toward identifying potential obstacles to participation (Kaskutas , 2002).

According to the prevalent western view of substance use disorders, addiction is a chronic, relapse-prone disorder .

For many substance users, maintaining abstinence require ongoing support. Twelve-step groups constitute such a support: meetings are widely available and free of charge. Participation in 12SG during and after formal treatment has been associated with positive outcomes; while the majority of studies limit their investigation to substance use outcomes (4-6), the few that have assessed the influence of 12SG participation on a broader set of domains, such as psychological adjustment, have also reported positive findings.

Several researchers have noted that, as the duration and intensity of treatment services are decreasing, one of the most important tasks for clinicians is to foster stable engagement in 12SG so that clients have a ...