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Research Summary

Intensive Referral to 12-Step Groups Improves Outcomes

Some patients with substance dependence who are referred to self-help groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), choose not to participate. In this study, researchers examined whether intensive referral is more effective than standard referral at increasing self-help involvement and subsequently improving substance use outcomes.

Researchers randomized 345 veterans entering outpatient substance abuse treatment to either standard referral, including a schedule of and encouragement to attend local 12-step meetings, or intensive referral, including additional information and clinician support (e.g., linkage to AA/NA volunteers, follow-up on meeting attendance, encouragement to obtain a sponsor). Almost all subjects had attended 12-step meetings previously, and 46% preferred alcohol to other substances.

  • At 6 months, attendance at 12-step meetings did not significantly differ among the groups. But, of subjects with less exposure to 12-step groups at study entry, those assigned to intensive referral had better attendance.
  • The intensive referral group had significantly greater 12-step involvement (e.g., obtained a sponsor) and improvement in substance use problems than did the standard referral group.
  • The intensive referral group was also more likely to be abstinent from drugs (78% versus 70%, P<0.05) and alcohol (76% versus 70%, P<0.12).
  • Involvement in 12-step groups partially mediated improvements in alcohol outcomes.


Because 12-step groups do not sponsor research, rigorous trials of their effectiveness are difficult to perform. Nevertheless, this study provides strong evidence that clinicians should support patients’ active participation in AA/NA. Linking patients with AA/NA volunteers, following up on attendance, and encouraging sponsorship are essential to successful 12-step facilitation.

Peter D. Friedmann, MD, MPH


Timko C, DeBenedetti A, Billow R. Intensive referral to 12-Step self-help groups and 6-month substance use disorder outcomes. Addiction. 2006;101(5):678–688.