Is level of exposure to a 12-step facilitation therapy associated with treatment outcome?

This ancillary investigation of data from National Drug Abuse Treatment Clinical Trials Network protocol CTN-0031 (“Stimulant Abuser Groups to Engage in 12-Step (STAGE-12)”), examined whether level of exposure to the STAGE-12 intervention, a 12-step facilitative therapy, is related to treatment outcome. The original study compared STAGE-12 combined with treatment-as-usual (TAU) to TAU alone. These analyses include only those randomized to STAGE-12 (n=234). Assessments occurred at baseline and 30, 60, 90, and 180 days following randomization. High-exposure patients (n=158; attended at least 2 of 3 individual and 3 of 5 group sessions), compared to those with less exposure (n=76), demonstrated: (1) higher odds of self-reported abstinence from, and lower rates of, stimulant and non-stimulant drug use; (2) lower probabilities of stimulant-positive urines; (3) more days of attending and lower odds of not attending 12-Step meetings; (4) greater likelihood of reporting no drug problems; (5) more days of duties at meetings; and (6) more types of 12-Step activities. Many of these differences declined over time, but several were still significant by the last follow-up.

Conclusions: Although outpatient substance use disorder treatment is thought to be characterized by high drop-out rates and low rates of treatment completion, exposure to STAGE-12 treatment was relatively high for this 8-session intervention embedded within intensive outpatient treatment as usual. Over two-thirds of patients met criteria for high exposure to the intervention, and there was relatively low early attrition. Those achieving high exposure to STAGE-12 demonstrated more positive outcomes, though the design of this secondary analysis cannot demonstrate a causal relationship between STAGE-12 exposure and positive outcomes. However, the current study demonstrates that it is feasible to interest people entering intensive outpatient treatment in a 12-Step oriented intervention and that individuals who agree to participate can be retained in the intervention at relatively high rates.

Related protocols: CTN-0031