Few studies have examined the effectiveness of 12-step peer recovery support programs with drug use disorders, especially stimulant use, and it is difficult to know how outcomes related to 12-step attendance and participation generalize to individuals with non-alcohol substance use disorders (SUDs).
The NIDA Clinical Trials Network study, STAGE-12, was a clinical trial of 12-step facilitation lead by the Pacific Northwest Node (N=471) focusing on individuals with cocaine or methamphetamine use disorders. It allowed for examination of four questions:
- To what extent do treatment-seeking stimulant users use 12-step programs and which ones?
- Do factors previously found to predict 12-step participation among those with alcohol use disorders also predict participation among stimulant users?
- What specific baseline “12-step readiness” factors predict subsequent 12-step participation and attendance?
- Does stimulant drug of choice differentially predict 12-step participation and attendance?
The four outcome variables, attendance, speaking, duties and 12-step meetings, and other peer recovery support activities, were not related to baseline demographic or substance problem history or severity.
Drug of choice was associated with differential days of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) attendance among those who reported attending, and cocaine users reported more days of attending AA or NA at 1-, 3-, and 6-month follow-ups than did methamphetamine users.
Pre-randomization measures of perceived benefit of 12-step groups predicted 12-step attendance at 3- and 6-month follow-ups. Pre-randomization 12-step attendance significantly predicted number of other self-help activities at end-of-treatment, 3- and 6-month follow-ups. Pre-randomization perceived benefit and problem severity both predicted number of self-help activities at end-of-treatment self-help activities at end-of-treatment and 3-month follow-up. Pre-randomization perceived barriers to 12-step groups were negatively associated with self-help activities at end-of-treatment and 3-month follow-up. Whether or not one participated in any duties was predicted at all times points by pre-randomization in self-help actitivies.
Conclusions: The primary finding of this study is one of continuity: both readiness to engage in 12-step content and specific prior attendance and active participation (defined as speaking, having duties at, or engaging in related activities) with 12-step programs were the main signs pointing to future involvement in these same areas. Based on these findings, there may be little value in continuing to explore demographic characteristics as predictors of 12-step involvement, and instead future research should focus on measures of perceptions and behaviors that are 12-step specific.
Citation: Hatch-Maillette MA, et al. Predictors of 12-Step Attendance and Participation for Individuals with Stimulant Use Disorders. Journal of Substance Abuse Treatment 2016;68:74-82.