Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study.

AIMS This study investigates the relationship between frequency of attendance at Narcotics Anonymous and Alcoholics Anonymous (NA/AA) meetings and substance use outcomes after residential treatment of drug dependence. It was predicted that post-treatment NA/AA attendance would be related to improved substance use outcomes. METHODS Using a longitudinal, prospective cohort design, interviews were conducted with drug-dependent clients (n = 142) at intake to residential treatment, and at 1 year, 2 years and 4-5 years follow-up. Data were collected by structured interviews. All follow-up interviews were carried out by independent professional interviewers. FINDINGS Abstinence from opiates was increased throughout the 5-year follow-up period compared to pre-treatment levels. Clients who attended NA/AA after treatment were more likely to be abstinent from opiates at follow-up. Abstinence from stimulants increased at follow-up but (except at 1-year follow-up) no additional benefit was found for NA/AA attendance. There was no overall change in alcohol abstinence after treatment but clients who attended NA/AA were more likely to be abstinent from alcohol at all follow-up points. More frequent NA/AA attenders were more likely to be abstinent from opiates and alcohol when compared both to non-attenders and to infrequent (less than weekly) attenders. CONCLUSIONS NA/AA can support and supplement residential addiction treatment as an aftercare resource. In view of the generally poor alcohol use outcomes achieved by drug-dependent patients after treatment, the improved alcohol outcomes of NA/AA attenders suggests that the effectiveness of existing treatment services may be improved by initiatives that lead to increased involvement and engagement with such groups.

[1]  G. de Leon,et al.  Psychopathology and substance abuse: what is being learned from research in therapeutic communities. , 1989, Journal of psychoactive drugs.

[2]  R. Moos,et al.  Long-term outcomes of alcohol use disorders: comparing untreated individuals with those in alcoholics anonymous and formal treatment. , 2000, Journal of studies on alcohol.

[3]  Barbara S. McCrady,et al.  Research on Alcoholics Anonymous: Opportunities and alternatives. , 1993 .

[4]  R. Gallop,et al.  The effect of 12-step self-help group attendance and participation on drug use outcomes among cocaine-dependent patients. , 2005, Drug and alcohol dependence.

[5]  J. Strang,et al.  Variation between and within Drug Treatment Modalities: Data from the National Treatment Outcome Research Study (UK) , 2000, European Addiction Research.

[6]  R. Moos,et al.  Outcome of treatment for alcohol abuse and involvement in alcoholics anonymous among previously untreated problem drinkers , 2006, The journal of mental health administration.

[7]  K. Humphreys,et al.  A comparative evaluation of substance abuse treatment: II. Linking proximal outcomes of 12-step and cognitive-behavioral treatment to substance use outcomes. , 1999, Alcoholism, clinical and experimental research.

[8]  S. Sutton,et al.  Anxiety and self-esteem as a function of abstinence time among recovering addicts attending Narcotics Anonymous. , 1994, The British journal of clinical psychology.

[9]  R. Fiorentine.  After drug treatment: are 12-step programs effective in maintaining abstinence? , 1999, The American Journal of Drug and Alcohol Abuse.

[10]  C. Franey,et al.  Drug users' spiritual beliefs, locus of control and the disease concept in relation to Narcotics Anonymous attendance and six-month outcomes. , 1995, Drug and alcohol dependence.

[11]  H. Cutter,et al.  Alcoholics Anonymous affiliation during early recovery. , 1998, Journal of substance abuse treatment.

[12]  R. Moos,et al.  Long-term influence of duration and frequency of participation in alcoholics anonymous on individuals with alcohol use disorders. , 2004, Journal of consulting and clinical psychology.

[13]  H. A. Montgomery,et al.  Does Alcoholics Anonymous involvement predict treatment outcome? , 1995, Journal of substance abuse treatment.

[14]  K. Humphreys,et al.  Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study. , 2001, Alcoholism, clinical and experimental research.

[15]  Duncan Stewart,et al.  The National Treatment Outcome Research Study in the United Kingdom: Six-month follow-up outcomes , 1997 .

[16]  K. Humphreys,et al.  Alcoholics anonymous involvement and positive alcohol-related outcomes: cause, consequence, or just a correlate? A prospective 2-year study of 2,319 alcohol-dependent men. , 2003, Journal of consulting and clinical psychology.

[17]  K. Humphreys,et al.  Reduced substance-abuse-related health care costs among voluntary participants in Alcoholics Anonymous. , 1996, Psychiatric services.

[18]  M. Gossop,et al.  Lapse, Relapse and Survival among Opiate Addicts after Treatment , 1989, British Journal of Psychiatry.

[19]  M. Hillhouse,et al.  Exploring the Additive Effects of Drug Misuse Treatment and Twelve-Step Involvement: Does Twelve-Step Ideology Matter? , 2000, Substance use & misuse.

[20]  K. Humphreys,et al.  Self-help group participation among substance use disorder patients with posttraumatic stress disorder. , 2001, Journal of Substance Abuse Treatment.

[21]  S. B. Sells,et al.  Effectiveness of treatment for drug abuse: An overview of the DARP research program. , 1982 .

[22]  R. Moos,et al.  Twelve-step and cognitive--behavioral treatment for substance abuse: a comparison of treatment effectiveness. , 1997, Journal of consulting and clinical psychology.

[23]  C. Emrick,et al.  Alcoholics Anonymous: affiliation processes and effectiveness as treatment. , 1987, Alcoholism, clinical and experimental research.

[24]  K. Humphreys.  Alcoholics Anonymous and 12-step alcoholism treatment programs. , 2003, Recent developments in alcoholism : an official publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism.

[25]  L. Herringer,et al.  A note on the utilization of common support activities and relapse following substance abuse treatment. , 1993, The Journal of psychology.

[26]  Keith Humphreys,et al.  CIRCLES OF RECOVERY Self-Help Organizations for Addictions , 2003 .

[27]  J. Strang,et al.  Is attendance at Alcoholics Anonymous meetings after inpatient treatment related to improved outcomes? A 6-month follow-up study. , 2003, Alcohol and alcoholism.

[28]  J. Marsden,et al.  Alcohol use outcomes and heavy drinking at 4-5 years among a treatment sample of drug misusers. , 2003, Journal of substance abuse treatment.

[29]  J W Finney,et al.  Influence of outpatient treatment and 12-step group involvement on one-year substance abuse treatment outcomes. , 1998, Journal of studies on alcohol.

[30]  C. Diclemente,et al.  Matching alcoholism treatments to client heterogeneity , 1998 .

[31]  C. Emrick.  Alcoholics Anonymous and Other 12-Step Groups , 1999 .

[32]  G. Leon.  The Therapeutic Community , 2000 .

[33]  R. Hubbard,et al.  Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). , 1997 .

[34]  J. Marsden,et al.  Treatment retention and 1 year outcomes for residential programmes in England. , 1999, Drug and alcohol dependence.

[35]  K. Humphreys,et al.  The Influence of Posttreatment Mutual Help Group Participation on the Friendship Networks of Substance Abuse Patients , 1997, American journal of community psychology.

[36]  J. Marsden,et al.  Substance use, health and social problems of service users at 54 drug treatment agencies , 1998, British Journal of Psychiatry.

[37]  K. Humphreys,et al.  The relationship of pre-treatment Alcoholics Anonymous affiliation with problem severity, social resources and treatment history. , 1998, Drug and alcohol dependence.

[38]  K. Humphreys,et al.  Social and community resources and long-term recovery from treated and untreated alcoholism. , 1997, Journal of studies on alcohol.

[39]  J. Marsden,et al.  National Treatment Outcome Research Study (NTORS) After five years.Changes in substance use, health and criminal behaviour during the five years after intake. , 2002 .

[40]  J. Strang,et al.  Are the Twelve Steps More Acceptable to Drug Users than to Drinkers? , 2001, European Addiction Research.

[41]  C. Timko,et al.  Intensive referral to 12-Step self-help groups and 6-month substance use disorder outcomes. , 2006, Addiction.

[42]  C. Leukefeld,et al.  Relapse and Recovery in Addictions , 2001, BMJ : British Medical Journal.