FAITH-BASED SELF-HELP GROUPS COST-EFFECTIVE AND EFFICIENT IN TREATING
SUBSTANCE ABUSE, RESEARCHERS SAY

Inpatient substance abuse treatment programs emphasizing the spiritually
oriented "12-step" approach to addiction save money and promote abstinence
more effectively than treatment programs that emphasize practical coping
skills, say researchers at the School of Medicine.

Graduates from the 12-step-oriented programs slice their long-term health
care costs by more than half by turning to community-based self-help groups
rather than to professional mental health services for support in the year
after discharge, say the researchers. They are also significantly more
likely to remain abstinent in the year following their treatment.

"Groups like Alcoholics Anonymous and Narcotics Anonymous are taking a huge
burden off of the health care system," said Keith Humphreys. "We found that
addiction treatment programs are more effective and less expensive when
they link patients to spiritually-based self-help groups."

Humphreys, assistant professor of psychiatry and behavioral sciences, is
the lead author of the study published in the May issue of Alcoholism:
Clinical and Experimental Research. Humphreys is also the associate
director of the Program Evaluation and Resource Center at the VA Palo Alto
Health Care System in Menlo Park.

Although one quarter of all deaths in this country are caused by alcohol,
tobacco or illegal drugs, funding for substance abuse treatment programs
nationwide has decreased dramatically in recent years, according to Humphreys.

"Most mental health treatment professionals are being asked to do more and
more with less and less," he said. Humphreys and co-author Rudolf Moos
investigated whether free community-based support groups could stand in for
professional mental health treatment, reducing health care cost without
compromising patient outcome.

Humphreys studied 1,774 low-income, substance-dependent men who had been
enrolled in inpatient substance abuse treatment programs at 10 Department
of Veteran Affairs medical centers around the country. Five of the programs
strongly emphasized the 12-step approach to addiction - a spiritually
oriented philosophy that urges individuals to take responsibility for their
actions and ask for help from God in conquering their dependency. These
programs frequently hold Alcoholics Anonymous or Narcotics Anonymous
meetings on-site, and refer to the "Big Book" -an inspirational text that
complements the 12 steps.

The remaining five programs used an approach called cognitive-behavioral
therapy that concentrates on teaching individuals coping skills to avoid
relapse. These programs, which emphasized a medical and scientific approach
to addiction treatment, spent only about seven percent of treatment time
discussing the 12-step approach. The men in the study were evenly divided
between the two types of programs.

Humphreys paired up men from the two programs whose mental health care
costs in the year preceding treatment were similar. He then compared the
mental health care costs between the men in the year following discharge.
He found that those men that had been enrolled in cognitive-behavioral
programs had total mental health care costs that were about $4,700 higher
than those that had been enrolled in 12-step oriented programs, even though
their starting values were similar.

The cost difference was due to the fact that the men who were enrolled in
the 12-step oriented approach were significantly more likely to attend
meetings of community based self-help groups after discharge, and were less
likely to call on traditional medical professionals to help them avoid
relapsing.

The 12-step oriented programs were not only cost-efficient, they were also
effective - nearly 46 percent of the men who had been in these programs
were abstinent one year after discharge, compared to 36 percent of those
treated in cognitive-behavioral programs. This may be in part due to the
fact that staff members in the 12-step oriented treatment programs are more
likely to be recovering addicts who strongly endorse the 12-step treatment.

"They tend to be people who really believe in the approach that they're
teaching," said Humphreys. "They are more likely to say 'I can help you
overcome your cocaine addiction, because I overcame one.'" Once the
patients of these programs are discharged, they can call on self-help group
members and sponsors that they met during their treatment, creating a
mutual support network that can in some ways mirror that provided by
professional counselors.

The study suggests that it may be beneficial for treatment programs around
the United States to incorporate more of the 12-step philosophy into their
substance abuse therapies, and to increase their efforts to link their
patients with community-based self-help groups after discharge.

"In the current health care climate, a clinical strategy that reduces the
ongoing health care costs of substance abuse patients by 64 percent while
also promoting good outcome deserves serious attention," conclude Humphreys
and Moos in the paper.

The study was funded by the Department of Veterans Affairs Mental Health
Strategic Health Group, the Health Services Research and Development
Service, and a VA Young Investigator Award for Humphreys.

Rudolph Moos is a professor of psychiatry and behavioral health sciences at
Stanford University Medical Center and the director of the VA Center for
Health Care Evaluation.