Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

516 V. TREATMENTS FOR ADDICTIONSSelf-Help and Treatment OutcomeAlcoholics AnonymousAA has received more attention from investigators studying outcome variablesthan other 12-step programs. Consequently, most of our knowledge about theimpact of 12-step programs on the lives of addicts is limited to the effects of AAon some samples of alcoholics. The structure of 12-step organizations and theiremphasis on anonymity make scientific research on these groups a very difficulttask (Glaser & Osborne, 1982). Investigators have studied outcome variablesrelated to participation in AA, such as severity of drinking, personality traits,attendance at meetings, total abstinence versus controlled drinking as a therapeuticgoal, and concomitance of AA attendance with professional care (Elal-Lawrence, Slade, & Dewey, 1987; Seixas, Washburn, & Eisen, 1988; Thurstin,Alfano, & Nerviano, 1987; Thurstin, Alfano, & Sherer, 1986).The first variable to deserve attention is that those alcoholics who joinAA are not representative of the total population of alcoholics receiving treatment(Emrick, 1987). AA members tend to be, as common sense would indicate,more sociable and affiliative. Studies also suggest that AA members havemore severe problems resulting from their drinking and experience more guiltregarding their behavior. Attendance at meetings has been associated in somestudies (Emrick, 1987) with better outcome, although the nature of this associationremains unclear. Thurstin and colleagues (1986) found no clear personalitytraits that might seem to be associated with AA membership, but theyreported that success among members appears to be related to less depression,less anxiety, and better sociability. AA seems not to benefit those who canbecome nonproblem users, and it may actually be detrimental to patients whocan learn to control their drinking (Emrick, 1987). AA members who receiveother forms of treatment concomitantly with their participation in AA meetingsprobably do better.As noted earlier, several problems make it difficult to study outcome factorsrelated to participation in 12-step programs. One is the changing compositionof AA membership: more women, younger people, and multiply addictedalcoholics that have been joining the organization. The heterogeneity of addictivedisorders, the anonymity of membership, the impossibility of experimentationwith components of the programs, the self-selection factor in affiliation,and the lack of appropriate group controls all impose serious methodologicaldifficulties in evaluating outcome variables. For clinical purposes, the benefit ofmembership in self-help groups has to be empirically evaluated for each individualpatient.12-Step FacilitationTSF is a manualized individual counseling method developed for use in ProjectMATCH (Anonymous, 1997), a large multicenter study of the effect of cus-