3
10 or more meetings in the previous 6
months. Analyses revealed that attend-
ing at least 10 meetings in the previous
6 months at 1 year was associated with
higher alcohol but not drug absti-
nence at 3 years (51% vs. 35% and 62%
vs. 56%, respectively).
At 3 years, findings showed that 68
adolescents (19%) had attended at least
one 12-Step meeting in the previous 6
months, with 42 adolescents attending 10
or more meetings. Forty-nine adolescents
(14%) reported involvement in at least
one of the seven activities. Five activi-
ties considering themselves a member,
having called a member for help, having a
sponsor, reading literature, or performing
service activities were associated with
alcohol and drug abstinence.
Additional analyses examining alcohol
and drug abstinence by various group-
ings of attendance and activity involve-
ment found that adolescents involved in
three or more activities had significantly
higher abstinence rates from alcohol and
drugs than adolescents reporting fewer
activities. Findings further indicated
that adolescents involved in one to two
activities had abstinence rates that were
no different from those with none. Like-
wise, adolescents who attended 10 or
more meetings had alcohol and drug
abstinence rates significantly higher than
those reporting fewer meetings. Those
attending one to nine meetings had alco-
hol abstinence rates that were lower than
nonattendants and drug abstinence rates
that were not significantly different from
nonattendants.
Findings also suggested possible
mediating effects of social support and
religious service attendance on post-
treatment 12-Step affiliation and 3-year
outcomes.
Treatment Outcomes
Client motivation and functioning related to engagement in drug treatment
Client scores on treatment participa-
tion and counseling rapport in England
were directly related to higher level of
motivation and psychosocial function-
ing, as well as to staff ratings of pro-
fessional attributes and program atmo-
sphere, concludes research published
recently in the Journal of Substance
Abuse Treatment.
The Brown University Digest of Addiction Theory and Application August 2009
Study limits
Methodological limitations of this
study include the lack of proper tempo-
rality among posttreatment 12-Step affil-
iation at 3 years, the dependent variables
(30-day alcohol and drug abstinence),
and the potential mediators (social sup-
port and religious service attendance).
The time frame for both measures of
post-treatment 12-Step affiliation, and
for frequency of religious attendance
was 6 months prior to the 3-year inter-
view and was open-ended for the mea-
sure of social support. In addition, this
study was conducted in a private, man-
aged care health plan; results may not
be generalizable to other health plans
or public populations. The findings of
this observational study cannot be inter-
preted as causal.
Only a small proportion of partici-
pants attended 12-Step meetings and
were involved in 12-Step activities so it
is possible that some, but not all, ado-
lescents may benefit from 12-Step affili-
ation. Measures of 12-Step affiliation
referred to any type of 12-Step meetings
and did not distinguish among them.
Detailed information was not available
on discharge type and reasons for CD
treatment that may have been related to
12-Step attendance.
Another limitation is that the social
support measure generated an absolute
total number rather than a proportion of
the social support for the respondents
effort to reduce substance use. The use
of a single-item measure as a proxy for
religiosity may have limitations.
Authors conclusions
These findings have important impli-
cations for clinical approaches in that
Researcher Dwayne Simpson and col-
leagues reached this conclusion after
examining patient- and program-level
functioning assessments of addiction
services and their patients sampled from
diverse treatment settings in England.
The researchers sought to determine
if patient motivation and psychosocial
functioning as well as organizational
chemical dependency programs have
the option of facilitating 12-Step atten-
dance. Findings also suggest that early
12-Step attendance might help sustain
better long-term alcohol abstinence for
adolescents. Additionally, these findings
suggest that minimum threshold levels
of 12-Step affiliation were associated
with improved outcomes among these
adolescents. Adolescents attending 10
or more meetings were twice, and those
involved in three or more 12-Step activi-
ties were more than five times as likely
to be abstinent from alcohol and drugs
as their peers.
Future directions for research include
examining more extensively whether a
minimum threshold or frequency and
intensity is associated with the benefits
of 12-Step affiliation, whether affilia-
tion levels increase as adolescents move
into adulthood, how the relationship
between 12-Step affiliation and out-
comes changes over time and whether
the relationship varies for alcohol ver-
sus drugs.
Funded by the Robert Wood Johnson Foundation
(RWJF), the Center for Substance Abuse Treat-
ment (CSAT), the National Institute on Drug Abuse
(NIDA), and the National Institute on Alcohol
Abuse and Alcoholism (NIAAA).
Chi FW, Kaskutas LA, Sterling S, et al.: Twelve-
Step affiliation and 3-year substance use
outcomes among adolescents: Social support
and religious service attendance as potential
mediators. Addiction 2009; 104: 927939. E-mail:
Felicia.w.chi@kp.org.
Suggested readings:
Kelly JF, Myers MG: Adolescents participation
in Alcoholics Anonymous and Narcotics Anony-
mous: Review, implications and future directions.
J Psychoact Drugs 2007; 39:259269.
functional domains were related to treat-
ment engagement indicators in a man-
ner similar to those found for patients in
the United States.
Data for the study were obtained in
collaboration with treatment agencies
located in England and coordinated
through the National Treatment Agency
Continued on next page

Continued from page 3
Table 1. Sample characteristics
of patients and staff members
Patients Staff
N 1,539 439
Male
Caucasian
68%
78%
27%
82%
Mean age (y) 35 38
(NTA) over a two-year period. Participants
consisted of clinical staff and patients at
44 drug services. (See Table 1.) Some of
these agencies included multiple treat-
ment units; that is, different program
sites under the oversight of the same par-
ent umbrella. A large sample of treatment
programs in the U.S. were used for mak-
ing general comparative interpretations
of the U.K. findings.
Measures
Client engagement in treatment (sat-
isfaction, participation, and counseling
rapport) was measured via the Client
Evaluation of Self and Treatment (CEST)
assessment, administered at each par-
ticipating treatment unit. Services com-
prised both voluntary (private) and statu-
tory (NHS) agencies and offered both
alcohol and drug treatment. The agencies
represented a broad spectrum of com-
munity services, ranging from day care
and outreach programs to community
drug teams and drug intervention pro-
gram teams. Organizational structure,
climate, and staff attributes of treatment
organizations were assessed by using the
Organizational Readiness for Change
(ORC) questionnaire.
Results
Self-report data showed that 13% of
patients were in treatment for under a
month, 18% were in treatment for 1 to
3 months, 27% for more than 3 months
Treatment Approach
Treatment to improve social network can aid drinking outcomes
A manualized treatment focused
specifically on changing the social envi-
ronment can lead to lasting adaptive
changes in the social network of alcohol-
dependent patients, and these changes
are predictive of lasting improvement in
The Brown University Digest of Addiction Theory and Application August 2009
4
(but less than 1 year), and 42% had been
in treatment for at least 1 year. Among
staff members, data indicated that about
a third (35%) had at least 5 years of expe-
rience in drug treatment services; most
(74%) had been on their present job for 3
years or less.
Study findings showed that almost all
patient motivational and psychosocial
functioning scales were significantly and
consistently correlated with treatment
engagement (CEST). Results were similar
to those found in U.S. samples. Regres-
sion analyses showed that for treatment
participation predictors in the U.K. sam-
ple included desire for help, treatment
readiness, treatment needs, self-esteem,
anxiety, decision-making, self-efficacy,
and social consciousness, and accounted
for one half of the variance in the patient
engagement measures.
Similar results were observed for cli-
ent report of counselor rapport: desire for
help, treatment readiness, self-esteem,
depression, anxiety, decision-making,
and social consciousness accounted for
33% of its variance. Similar results were
found for treatment participation and
counselor rapport in the U.S. sample.
Additional analyses revealed that, for
the U.K. sample, treatment participation
scores were significantly correlated with
training resources, staff attributes scales
(growth, efficacy, adaptability), and two
climate scales (i.e., positively related to
mission and negatively related to stress).
Counselor rapport was found to be
related only to one staff attribute scale
(growth) and none of the organizational
climate scales.
In the U.S. data, treatment participa-
tion was significantly related to counselor
ratings of low program needs, perceived
level of influence in their program, and
clarity of mission. Counselor rapport was
associated with low program and train-
ing needs, high resources (for offices,
drinking outcome, concludes research
published recently in the Journal of Con-
sulting & Clinical Psychology.
Researcher Mark D. Litt and colleagues
at the University of Connecticut Health
Center, Farmington, reached this conclu-
staffing, equipment, and Internet), more
perceived balance, and all six of the orga-
nizational climate scales (positively for
mission, cohesion, autonomy, commu-
nication, openness to change, and nega-
tively for stress).
Study limits
The number of U.K. programs avail-
able was only 44, which is relatively small
in size and may have had restrictive
effects on the results of the program-level
aggregate analyses conducted. In addi-
tion, it may have accentuated the weight
of smaller agencies in the correlational
analyses.
Authors conclusions
These findings contribute to an inter-
national evidence base for using com-
mon assessments to measure patient and
staff needs and functioning dynamics.
The data indicate that staff attitudes in
England, as in the United States, have
influences on patient responsiveness to
treatment.
The authors conclude that by aggre-
gating patient scores within programs,
meaningful measures can be calculated
based on these assessments for mon-
itoring clinical patterns and response,
emerging patient needs, and program
evaluations.
Jointly supported by a NIH/NIDA MERIT Award
grant and the NHS/NTA.
Simpson D, Rowan-Szal GA, Joe GW, et al.:
Relating counselor attributes to client engage-
ment in England. J Subst Abuse Treat 2009;
36:313320. E-mail Grace A. Rowan-Szal at
g.szal@tcu.edu.
Suggested readings:
Fuller BE, Rieckmann T, Nunes EV, et al.: Organiza-
tional readiness for change and opinions toward
treatment innovations. J Subst Abuse Treat 2007;
33:183192.
sion after analyzing 27-month posttreat-
ment outcomes of alcohol-dependent
patients treated in the Network Support
Project, an intervention designed to help
patients change their social support net-
works to include people who would be