Public Release: 

Adopting 12-step philosophy may enhance outcomes of counseling for cocaine addiction

NIH/National Institute on Drug Abuse

Study results suggest that encouraging patients to adopt the "12-step" philosophy and its associated behaviors may be responsible in part for the therapeutic success of combined individual and group counseling for cocaine addiction. The researchers who conducted these studies also found that counseling may affect a drug abuser's beliefs about drug abuse.

The 12-step philosophy includes believing in a "higher power" to help someone remain drug-free, and believing that recovery from addiction is a life-long process. Other recommended behaviors include attending meetings, obtaining a sponsor, and staying away from the people, places, and things that trigger substance abuse.

The study, conducted by Dr. Paul Crits-Christoph, of the University of Pennsylvania, and his colleagues, focused on 487 patients who were randomly assigned to receive 6 months of group drug counseling, either alone or in combination with individual drug counseling (IDC), supportive-expressive psychotherapy (SEP), or cognitive psychotherapy (CT). The researchers then analyzed outcomes using the Addiction Recovery Scale to assess the effectiveness of the 12-step program among people receiving group and individual drug counseling. They also used other scales to examine how IDC, SEP, and CT achieved their effects.

The researchers found a statistical correlation between the adoption of the 12-step philosophy and behaviors and drug counseling outcomes.

In what was an unexpected finding, the scientists also found that the combination of individual and group drug counseling may have influenced patients' beliefs about substance abuse. Negative beliefs about substance abuse (e.g., "Life without using drugs is boring," or "I don't deserve to recover from drug abuse") may help maintain usage. When patients' beliefs became less negative, there were more reductions in drug use. In fact, changing beliefs about addiction was more highly correlated with reduced drug use than was adopting the 12-step philosophy. A possible explanation, the scientists suggest, is that beliefs about substance abuse change in response to changes in drug use.

WHAT IT MEANS: Although the 12-step philosophy and associated behaviors are linked with the positive effects seen with group and individual counseling for cocaine addiction, the inability to show a sequential process--first adopting the 12-step philosophy and then undergoing counseling--means the mechanism that drives these affirming results remains unknown. The authors also say that changing beliefs about addiction may play an important part in successful treatment.

The NIDA-funded study was published in the October 2003 issue of the Journal of Consulting and Clinical Psychology.


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