Impact of 12 step mutual help groups on drug use disorder patients across six clinical trials

• Published in: Drug and alcohol dependence 2020-10, Vol.215, p.108213-108213, Article 108213
• Main Authors: Humphreys, Keith, Barreto, Nicolas B., Alessi, Sheila M., Carroll, Kathleen M., Crits-Christoph, Paul, Donovan, Dennis M., Kelly, John F., Schottenfeld, Richard S., Timko, Christine, Wagner, Todd H.
• Format: Article
• Language: English
• Subjects: 12 steps; Addictions; Adult; Alcohol Drinking; Alcohol related disorders; Alcohol use; Alcoholism; Attendance; Bias; Clinical research; Clinical trials; Clinical Trials as Topic; Continuing care; Drug abuse; Drug use; Evaluation; Humans; Male; Middle Aged; Mutual help groups; Opioid addiction; Random effects; Recovery; Regression analysis; Regression models; Selection Bias; Self-help; Self-Help Groups; Substance use disorder; Substance-Related Disorders - therapy; Support groups
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2020.108213

•This is the largest, most diverse sample of drug use disorder patients employed in a study of 12 step mutual help groups•Facilitating 12 step mutual help group involvement appears more challenging in patients with drug than alcohol use disorder.•Participation in 12 step groups by drug use disorder patients is associated with lower substance use and problems over time 12 step mutual help groups are widely accessed by people with drug use disorder but infrequently subjected to rigorous evaluation. Pooling randomized trials containing a condition in which mutual help group attendance is actively facilitated presents an opportunity to assess the effectiveness of 12 step groups in large, diverse samples of drug use disorder patients. Data from six federally-funded randomized trials were pooled (n = 1730) and subjected to two-stage instrumental variables modelling, and, fixed and random effects regression models. All trials included a 12 step group facilitation condition and employed the Addiction Severity Index as a core measure. The ability of 12 step facilitation to increase mutual help group participation among drug use disorder patients was minimal, limiting ability to employ two-stage instrumental variable models that correct for selection bias. However, traditional fixed and random effect regression models found that greater 12 step mutual help group attendance by drug use disorder patients predicted reduced use of and problems with illicit drugs and also with alcohol. Facilitating significant and lasting involvement in 12 step groups may be more challenging for drug use disorder patients than for alcohol use disorder patients, which has important implications for clinical work and for effectiveness evaluations. Though selection bias could explain part of the results of traditional regression models, the finding that participation in 12 step mutual help groups predicts lower illicit drug and alcohol use and problems in a large, diverse, sample of drug use disorder patients is encouraging.