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Process and Outcome Changes with Relapse Prevention Versus 12-Step Aftercare Programs for Substance Abusers

NCJ Number
Addiction Volume: 97 Issue: 6 Dated: June 2002 Pages: 677-689
Thomas G. Brown; Peter Seraganian; Jacques Tremblay; Helen Annis
Date Published
June 2002
13 pages
This study explored the presumptive support for the mechanisms mediating the effectiveness of two conceptually different aftercare programs upon substance abusers.
Certain steps are followed to establish presumptive support for hypothesized mechanisms of action of cognitive-behavioral treatment (CBT). When two treatments are compared, three conditions need to be met: (1) process changes occur following participation in the intervention; (2) outcomes covary with process changes; and (3) entry of process change as a covariate in a predictive model reduces unexplained outcome variance. The programs were relapse prevention (RP) and 12-Step facilitation (TSF). The RP aftercare program involved 10 scheduled weekly sessions of a manualized treatment process with 3 counseling stages. The 12-Step facilitation aftercare approach is grounded in the Alcoholics Anonymous (AA) conception of alcoholism as a disease of the spirit, mind, and body. Participants were recruited from newly admitted, adult, male and female patients at three treatment centers in the Montreal region. Adults who had just completed intensive treatment were assigned randomly to either RP or TSF aftercare programs. Measurements were either of the changes in self-efficacy process in RP or the utilization of AA’s principles in TSF. Psychosocial and substance abuse indices were administered to all patients pre- and post-aftercare and at 6-month follow-up. A significant relationship was found between changes in measures of self-efficacy for RP participants as well as a trend for a relationship between process-specific change for TSF participants. This partially satisfied the first condition for presumptive support. The fact that the intervention-specific mediators co-varied with several outcome indices met the second condition for presumptive support. The removal of such mediators diminished prediction of outcome and met the third condition for presumptive support. It is concluded that carefully orchestrated RP and TSF aftercare programs yield process changes that are related positively to improved outcome. 4 tables, 44 references