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National Institute on Drug Abuse -  NIDA NOTES
Focus on Treatment Research
Volume 14, Number 5 (December, 1999)

Adding More Counseling Sessions and 12-Step Programs Can Boost Drug Abuse Treatment Effectiveness

By Robert Mathias, NIDA NOTES Staff Writer

Drug abuse treatment programs can significantly increase the likelihood that patients will stay in treatment and remain abstinent by offering them more group and individual counseling opportunities and encouraging them to participate in complementary 12-step programs, such as Narcotics Anonymous, according to NIDA-supported research.

A series of studies by Dr. Robert Fiorentine of the University of California, Los Angeles (UCLA) and his colleagues from the UCLA Drug Abuse Research Center has been looking at how individual treatment components affect patient outcomes. One study found that patients who attended more group and individual counseling sessions had significantly lower levels of drug use during and after treatment than those who participated less frequently. Even among patients who completed the treatment program, those who participated more frequently in counseling had lower rates of relapse than those who participated less.

Increasing Counseling Opportunities

Dr. Fiorentine then examined whether treatment programs could improve their effectiveness by providing more opportunities for patients to participate in counseling. This study assessed the treatment outcomes of 330 patients in 26 Los Angeles outpatient programs. Seventeen programs had added treatment services and increased counseling opportunities by hiring additional counselors.

Even minimal increases in counseling opportunities may produce impressive gains in treatment outcomes.

This study found that patients in the enhanced programs attended about four more group counseling sessions and one more individual counseling session each month than did patients in comparison programs. Patients in enhanced programs also used drugs 40 percent less than did patients in comparison programs in the 6 months following an initial in-treatment assessment; in the last month, they used drugs 60 percent less. When the researchers examined whether patient characteristics or other treatment services provided by enhanced programs may have affected these results, they found that the frequency of patients' participation in individual and group counseling accounted for virtually all of the differences in post-treatment drug use.

This study suggests that even minimal increases in counseling opportunities may produce impressive gains in treatment outcomes, the researchers note. By hiring only one or two additional counselors, enhanced programs could reduce their counselors' caseloads and offer more group and individual counseling sessions, Dr. Fiorentine says. "It was only a few more sessions per week but, since patient attendance in these sessions often depends on session availability, it made a difference," he says.

Adding 12-Step Programs

Because many patients in Los Angeles area treatment programs attend 12-step programs either on their own or as part of their treatment regimen, Dr. Fiorentine and his colleagues also examined the relationship between participation in such programs and the effectiveness of drug abuse treatment. One study found that patients who attended at least one 12-step meeting per week after completing drug abuse treatment had much lower levels of drug use than those who participated less frequently or not at all. In this study, the researchers interviewed 262 patients in 26 Los Angeles area drug abuse treatment programs during treatment and 6 and 24 months later. Almost half of these patients had attended a 12-step meeting in the 6 months preceding the last interview.

During this 6-month period, only about 22 percent of weekly 12-step participants had used an illicit drug. By contrast, 44 percent of those who attended 12-step programs less than once a week or not at all during that period had used an illicit drug. Additional analyses indicated that the more favorable outcomes of frequent 12-step participants could not be attributed to differences in motivation or to other posttreatment activities, such as attending other aftercare programs. Weekly 12-step participants did score slightly higher than nonparticipants on a scale of self-reported measures of recovery motivation. However, statistical analyses indicated the differences in motivation accounted for little if any of the more favorable outcomes for frequent 12-step participants. The important difference between the two groups was not recovery motivation but at least weekly 12-step participation, the researchers say.

12 Step Program Trends

This study's findings suggest that 12-step programs can serve as a useful and inexpensive aftercare resource that can help many patients to maintain abstinence from drugs and alcohol after they complete drug abuse treatment, say the researchers.

Findings from another study by Dr. Fiorentine indicate that participation in 12-step programs before and during drug abuse treatment also may benefit patients' treatment engagement and recovery. In this study, more than two-thirds of 419 patients who entered outpatient treatment programs in Los Angeles during a 2-month period were attending 12-step meetings in the 3 months before they entered treatment. About 45 percent were attending meetings at least once a week.

Patients who attended 12-step meetings regularly before entering drug abuse treatment stayed in treatment longer and were more likely to complete the treatment program and participate in posttreatment 12-step programs, the study found. Moreover, an assessment conducted 8 months after the initial intake interview showed that patients who attended 12-step meetings at least once a week while they were participating in conventional drug abuse treatment had significantly higher rates of abstinence than patients who participated in only one or the other of those programs.

These findings suggest an "additive effect" on the recovery process from concurrent participation in drug abuse treatment and 12-step programs, Dr. Fiorentine says. "You get a better outcome with both than if you do either alone," he concludes.


Fiorentine, R. After drug treatment: Are 12-step programs effective in maintaining abstinence? American Journal of Drug and Alcohol Abuse 25(1):93-116, 1999.

Fiorentine, R. and Anglin, M.D. Does increasing the opportunity for counseling increase the effectiveness of outpatient drug treatment? American Journal of Drug and Alcohol Abuse 25(3):369-382, 1997.

Fiorentine, R. and Anglin, M.D. More is better: Counseling participation and the effectiveness of outpatient drug treatment. Journal of Substance Abuse Treatment 13:341-348, 1996.

Fiorentine, R. and Hillhouse, M. Drug treatment and twelve-step program participation: The additive effects of integrated recovery activities. Journal of Substance Abuse Treatment, in press.

NIDA NOTES - Volume 14, Number 5

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