Twelve-Step-Based Programs Effective for Substance Use Problems
Spiritual or religious based programs, such as those based on the principles of Alcoholics Anonymous, are effective for treating people with substance use disorders, according to the first systematic review of such programs.
In the U.S., more than 20 million people 12 years and older (about 7.4%) have a substance use disorder and among 18-to-25-year-olds, 15% have a substance use disorder, according to the 2018 National Survey on Drug Use and Health. Substance use disorders are a significant contributor to disability and premature death and take a tremendous toll on individuals, families and society.
A new meta-analysis examines 20 randomized controlled studies of spiritual or religious based programs for substance use problems. Previous research has identified spirituality and religiosity as having important roles as a protective factor against substance use and in recovery from substance use disorders. Spiritual/religious based interventions, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), are commonly part of treatment for substance use problems. This study is the first systematic review and meta-analysis looking at the efficacy of spiritual/religious based interventions for substance use problems.
The study included both interventions based on AA and similar 12-step programs and other non-AA spiritual or religious based interventions. It did not include mindfulness-based programs. The comparison treatments in the studies reviewed included active controls (such as cognitive-behavioral therapy, methadone maintenance, motivations enhancement therapy and acceptance and commitment therapy) and inactive controls (no treatment).
The researchers looked at two types of outcomes – substance use reduction/abstinence and improvements in psycho-social-spiritual outcomes (such as spiritual coping, depression, anxiety, employment, relationships).
Most of the studies in the meta-analysis involved Twelve Step Facilitation programs. These programs involve a series of counseling sessions with a professional counselor based on principles of 12-step fellowships such as AA and NA. The programs used individual counseling, group counseling or a combination of both. Other programs provided counseling and encourage/required attendance at AA or NA meetings. One program used a three-part approach: group counseling, mandatory AA/NA meetings, and social/recreational activities with family/friends and program staff. Among the non-12-step based programs included in the research were one based on Islamic teachings and one based on a spirituality program not tied to a religion.
Based on their analysis of these programs, the research authors conclude that spiritual and religious based interventions are more efficacious than comparison interventions for people with substance use problems. The spiritual/religious based programs were more effective at reducing or eliminating substance use and equally as effective as other programs on broader measure of wellness and function.
Commenting on the study in NEJM Journal Watch, Clair Wilcox, M.D., notes that these results may influence program design and suggests that “practitioners should become more familiar with the Twelve Step Facilitation and other 12-step-oriented therapies.”
- Hang HA, et al. The efficacy of spiritual/religious interventions for substance use problems: A systematic review and meta-Analysis of randomized controlled trails. Drug and Alcohol Dependence. 2019, 202(1):134-148.
- Wilcox, C. Twelve-Step-Based Interventions are at Least as Good as Other treatments. JAMA Psychiatry. July 29, 2019. (Reviewing Hai AH et al. Drug Alcohol Depend 2019, Sep 1.)
- Substance Abuse and Mental Health Services Administration. 2018 National Survey on Drug Use and Health (Results Presentation). 2019.