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Dropping out of 12-Step Groups Common; Physicians Can Encourage Persistence: Presented at APA

By Paula Moyer

SAN FRANCISCO, CA -- May 22, 2003 -- When people go through substance abuse treatment, they are encouraged to participate in a 12-step group, such as Alcoholics Anonymous. However, while dropping out of 12-step groups is common and associated with relapse, physicians can anticipate barriers to persistence and intervene to encourage persistence.

"Physicians involved in substance abuse treatment should routinely expect barriers to come up and address them directly," said John F. Kelly, MD. Dr. Kelly is a research scientist at the Palo Alto Veterans Affairs Medical Center in Palo Alto, California, United States. He presented his and his colleagues' findings here May 19^th at the 156^th Annual Meeting of the American Psychiatric Association.

Typical barriers include discomfort with the spiritual direction of 12-step groups and questions that an older group member may have about comorbid psychiatric disorder and a recently treated individual's need for psychotropic medication. Physicians can help patients anticipate these issues, Dr. Kelly said. For example, they can remind patients that a belief in a deity is not a requirement for recovery from addiction, and they can help patients think through the pace at which they disclose personal details.

In this study, the investigators assessed the prevalence, predictors, and treatment-related factors affecting dropout in the first year following intensive substance use disorder treatment. Dr. Kelly and his co-investigators followed 2,778 male patients who had an average age of 43 ± 9.6 years. Among these participants, 47% were African-American and 2,518 (91%) said that they had attended 12-step self-help groups either in the 90 days prior to, or during, treatment.

When patients were followed 1 year later, 40% had discontinued 12-step participation. The most significant difference between those who persisted and those who discontinued was that people who had begun 12-step behaviors while they were in treatment were more likely to persist, Dr. Kelly said. Examples of 12-step behaviors include making a social connection to a sponsor and making amends to individuals in the patient's life who have been harmed by his or her addictive behavior.

The investigators also found that the risk of dropping out can be reduced by increased support from the staff in the treatment environment. Staff can give that support by being aware that dropping out is common and discussing openly with patients any discomfort that they may be experiencing in their 12-step groups. Additionally, staff can help patients to develop social contacts within 12-step groups and encourage them to take the actions recommended in such groups, Dr. Kelly said.


[Study title: Dropout from 12 step self help groups: prevalence, predictors, and treatment-related influences. Abstract NR6]

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