Stanford Report Online

Stanford Report, May 23, 2001

Study points out value of 12-step groups in treating substance abuse


Inpatient substance abuse treatment programs emphasizing the spiritually oriented "12-step" approach to addiction save money and promote abstinence more effectively than treatment programs that emphasize practical coping skills, say medical school researchers. Graduates from the 12-step-oriented programs slice their long-term health care costs by more than half by turning to community-based self-help groups rather than to professional mental health services for support in the year after discharge, say the researchers. They are also significantly more likely to remain abstinent in the year following their treatment.

"Groups like Alcoholics Anonymous and Narcotics Anonymous are taking a huge burden off of the health care system," said Keith Humphreys, PhD. "We found that addiction treatment programs are more effective and less expensive when they link patients to spiritually based self-help groups."

Humphreys, assistant professor of psychiatry and behavioral sciences, is the lead author of the study published in the May issue of Alcoholism: Clinical and Experimental Research. Humphreys is also the associate director of the Program Evaluation and Resource Center at the Veterans Affairs Palo Alto Health Care System in Menlo Park, Calif.

Although one-quarter of all deaths in this country are caused by alcohol, tobacco or illegal drugs, funding for substance abuse treatment programs nationwide has decreased dramatically in recent years, Humphreys said. "Most mental health treatment professionals are being asked to do more and more with less and less," he said. He and co-author Rudolf Moos, PhD, investigated whether free, community-based support groups could stand in for professional mental health treatment, reducing health care costs without compromising patient outcome.

Humphreys studied 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at 10 Department of Veteran Affairs medical centers around the country. Five of the programs strongly emphasized the 12-step approach to addiction ­ a spiritually oriented philosophy that urges individuals to take responsibility for their actions and ask for help from God in conquering their dependency. These programs frequently hold Alcoholics Anonymous or Narcotics Anonymous meetings on-site, and refer to the "Big Book" ­ an inspirational text that complements the 12 steps.

The remaining five programs used an approach called cognitive-behavioral therapy that concentrates on teaching individuals coping skills to avoid relapse. These programs, which emphasized a medical and scientific approach to addiction treatment, spent only about 7 percent of treatment time discussing the 12-step approach. The men in the study were evenly divided between the two types of programs.

Humphreys paired up men from the two programs whose mental health care costs in the year preceding treatment were similar. He then compared the mental health care costs between the men in the year following discharge. He found that the total mental health care costs for men enrolled in cognitive-behavioral programs were about $4,700 higher than those for men enrolled in 12-step-oriented programs, even though their starting values were similar.

The cost difference was attributed to the increased likelihood of men enrolled in the 12-step-oriented approach to attend meetings of community- based self-help groups after discharge while also being less likely to seek help from traditional medical professionals to avoid relapsing.

The 12-step-oriented programs were not only cost-efficient, they were also effective -- nearly 46 percent of the men in these programs were abstinent one year after discharge, compared to 36 percent of those treated in cognitive-behavioral programs. This may be due in part to strong endorsements from staff members at the 12-step-oriented programs who are more likely to be recovering addicts.

"They tend to be people who really believe in the approach they're teaching," said Humphreys. "They are more likely to say, 'I can help you overcome your cocaine addiction, because I overcame one.'" Once the patients of these programs are discharged, they can call on self-help group members and sponsors they met during their treatment, creating a mutual support network that can in some ways mirror the support provided by professional counselors.

The study suggests that it may be beneficial for treatment programs around the United States to incorporate more of the 12-step philosophy into their substance abuse therapies, and to increase their efforts to link patients with community-based self-help groups after discharge.

"In the current health care climate, a clinical strategy that reduces the ongoing health care costs of substance abuse patients by 64 percent while also promoting good outcome deserves serious attention," Humphreys and Moos concluded in the paper.

The study was funded by the Department of Veterans Affairs Mental Health Strategic Health Group, the Health Services Research and Development Service, and a VA Young Investigator Award for Humphreys.

Moos is a professor of psychiatry and behavioral health sciences at Stanford University Medical Center and the director of the VA Center for Health Care Evaluation.