Substance abuse: What science tells us and what we should do about it

Dr. Rudolph Moos of Stanford University has conducted one of the longest outcome studies on record on the effects of treatment and 12-step group membership in a group of 628 men and women. The group was composed of men and women (49.7% and 50.3%), mostly Caucasian (80%) patients with an average age of 33.5 years and an average education of 13.1 years. Many (51%) were unemployed with an average income of $12,800 at the beginning of the study. The participants were followed at 1,3,8,16 years through a combination of mail and telephone surveys.

At the 16 year mark, 121 of the participants had died and the primary focus was on 461 of the 507 individuals who were followed on two or more occasions during the study. Some of the most significant findings of Dr. Moos’ project are:

  1. At the end of the first year of the study only 43% (N=99) of the participants who received no help were in remission while 62% of the treated participants were abstinent.
  2. At the 16 year mark only 43% of the treated group had experienced relapse while 61% of the “no help” group had relapsed.
  3. 67% of the group who attended AA in the first year of the program were still abstinent at the end of 16 years. Of those who attended AA in the second and third year of the study 72% remained abstinent.

The conclusions reached by the researchers reflect the data:

  1. Participants who received help (treatment and/or AA) were more likely to be in remission at three years than those who got no help.
  2. Relapse at three years was more prevalent among those participants who obtained no help in the first year of the study.

Dr. Moos also concluded that there were “protective factors” in treatment programs and AA membership that predicted remission and whose lack of predicted relapse:

  1. Abstinence oriented norms and models for participants to follow.
  2. Goal directed, social bonding that is monitored.
  3. Promotion of alternatives to substance use such as work, active leisure, and spiritual pursuits.
  4. Building clients’ self-confidence and coping skills.

References

Moos, R. (2006). Social contexts and substances use. In W.R. Miller & K.M. Carroll (eds.), Substance abuse: What science tells us and what we should do about it (pp.182-200). New York Guilford.

Moos, R. (2007). Theory-based active ingredients of effective treatments for substance use disorders. Drug and Alcohol Dependence (pp.88, 109-121).

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