Does active referral by a doctor or 12-Step peer improve 12-Step meeting attendance? : results from a pilot randomised control trial

Background: Active engagement in 12-Step self-help groups (SHG) is associated with improvements in substance use outcomes during and after treatment, yet levels of participation in SHG meetings in the UK remain low. Method: An RCT investigating the impact of active referral to SHG, delivered by doctors or 12-Step peers during inpatient treatment on both inpatient and post-treatment meeting attendance was conducted. 151 inpatients with alcohol, opiate, crack-cocaine or benzodiazepine dependence undergoing detoxification, received one of two active referral interventions: 12-Step peer intervention (PI), doctor intervention (DI), or no intervention (NI). 83% of the sample was followed up, 2-3 months following discharge. Results: Active referral interventions significantly increased attendance at 12-Step meetings during inpatient treatment (88% versus 73%, p<. .05). Rates of post-discharge meeting attendance were PI = 64%, DI = 48%, NI = 33%, with those in the PI group significantly (OR = 3.6; CI = 1.3, 9.8) more likely to have attended. Inpatient meeting attenders were three times as likely to have attended meetings post-discharge (59% versus 20%, p<. .01), and post-discharge meeting attenders reported significantly higher abstinence rates (60.8% versus 39.2%, p<. .05) at follow-up. However, abstinence rates did not differ significantly across intervention groups (44% [PI], 41% [DI] and 36% [NI]). Conclusion: Attendance at 12-Step SHGs is associated with greater rates of abstinence and active referral, especially by 12-Step peers, increases 12-Step SHG attendance rates. However, improved clinical outcomes among attendees might not occur until stronger recovery peer support networks are established. These results show promise for the benefit of incorporating Twelve Step Facilitation into UK treatment settings.