Twelve-Step Facilitation in Non-specialty Settings

  • John F. Kelly
  • Barbara S. McCrady
Part of the Recent Developments in Alcoholism book series (RDIA, volume 18)


Participation in the twelve-step mutual-help organization, Alcoholics Anonymous, has proven to be an effective means of helping individuals with alcohol dependence achieve lasting sobriety. Although many patients choose to attend AA of their own accord, clinicians’ facilitation of AA involvement (“Twelve-Step Facilitation” [TSF]) has shown to substantially increase the likelihood that patients will become engaged with these freely available resources. Importantly, many individuals with alcohol dependence never seek help from addiction specialists, yet often encounter other health professionals due to alcohol-related physical or psychological problems providing an opportunity for intervention. However, for clinicians who do not specialize in addiction treatment, knowledge about what AA actually is and does is often lacking, and confidence in implementing TSF strategies is low. This chapter provides essential information for clinicians working in non-specialty settings who have little knowledge of, or experience with, AA or TSF, but who may wish to utilize proven strategies to augment existing interventions by helping educate, link, and engage patients with AA. Detailed information on the origins and specific elements of AA is provided along with recommended TSF approaches and strategies to aid the non-specialist in building effective interventions for patients with alcohol dependence.


Alcohol Dependence Alcoholic Anonymous Gambler Anonymous Project Match Oxford Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Alcoholics Anonymous (1939). Alcoholics Anonymous: The story of how thousands of men and women have recovered from alcoholism (1st ed.). New York: Alcoholics Anonymous World Services.Google Scholar
  2. Alcoholics Anonymous (1952). Twelve steps and twelve traditions. New York: Alcoholics Anonymous World Services.Google Scholar
  3. Alcoholics Anonymous (1953). Twelve steps and twelve traditions. New York: Alcoholics Anonymous World Services.Google Scholar
  4. Alcoholics Anonymous (1958). The A.A. preamble. New York: Alcoholics Anonymous World Services.Google Scholar
  5. Alcoholics Anonymous (1994). Questions and answers on sponsorship. New York: Alcoholics Anonymous World Services.Google Scholar
  6. Alcoholics Anonymous (2001). Alcoholics Anonymous: The story of how many thousands of men and women have recovered from Alcoholism (4th ed.). New York: Alcoholics Anonymous World Services.Google Scholar
  7. Alcoholics Anonymous (2005). 2004 Membership survey. New York: Alcoholics Anonymous World Services.Google Scholar
  8. Alcoholics Anonymous Boston Central Service. Retrieved September 14, 2007 from http://www.
  9. American Psychiatric Association (2006). Practice guideline for psychiatric evaluation of adults (2 nd ed.). Washington, DC: Author.Google Scholar
  10. Bond, J, Kaskutas, L. A, & Weisner, C. (2003). The persistent influence of social networks and Alcoholics Anonymous on abstinence. Journal of Studies on Alcohol, 64(4), 579–588.PubMedGoogle Scholar
  11. Brown, S. A. (1993). Recovery patterns in adolescent substance abuse. In G. A. Marlatt & J. S. Baer (Eds.), Addictive behaviors across the life span: Prevention, treatment, and policy issues (pp. 161–183). Newbury Park, CA: Sage Publications, Inc.Google Scholar
  12. Brown, S. A. (2001). Facilitating change for adolescent alcohol problems: A multiple options approach. In E. F. Wagner & H. B. Waldron (Eds.), Innovations in adolescent substance abuse intervention (pp. 169–187). Oxford, UK: Elsevier Science.Google Scholar
  13. Brown, S. A., & Ramo, D. E. (2006). Clinical course of youth following treatment for alcohol and drug problems. In H. Liddle & C. Rowe (Eds.), Adolescent substance abuse: Research and clinical advances(pp. 79–103). Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
  14. Crape, B. L., Latkin, C. A., Laris, A. S., & Knowlton, A. R. (2002). The effects of sponsorship in 12-step treatment of injection drug users. Drug and Alcohol Dependence, 65, 291–301.PubMedCrossRefGoogle Scholar
  15. Crits-Christoph, P., Siqueland, L., Blaine, J., Frank, A., Luborsky, L., Onken, L.S., et al. (1999). Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Archives of General Psychiatry, 56(6), 493–502.PubMedCrossRefGoogle Scholar
  16. Cross, G. M., Morgan, C. W., Mooney, A. J., Martin, C. A., & Rafter, J. (1990). Alcoholism treatment: A ten-year follow-up study. Alcoholism: Clinical and Experimental Research, 14(2), 169–173.CrossRefGoogle Scholar
  17. Connors, G. J., & Tonigan, J.S. (2001). A longitudinal model of intake symptomatology, A.A. participation and outcome: Retrospective study of the Project MATCH outpatient and aftercare samples. Journal of Studies on Alcohol, 62(6), 817–825.PubMedGoogle Scholar
  18. Drug Strategies (2003). Treating teens: A guide to adolescent drug programs. Washington, D.C.: Author.Google Scholar
  19. Emrick, C. D., Tonigan, J. S., Montgomery, H., & Little, L. (1993). Alcoholics Anonymous: What is currently known? In B. S. McCrady & W. R. Miller (Eds.), Research on Alcoholics Anonymous: Opportunities and alternatives (pp. 41–76). Piscataway, NJ: Rutgers Center of Alcohol Studies.Google Scholar
  20. Ferri, M., Amato, L., & Davoli, M. (2006). Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD005032. DOI: 10.1002/14651858.CD005032.pub2Google Scholar
  21. Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy to effectiveness transition. American Journal of Public Health, 93(8), 1261–1267.PubMedCrossRefGoogle Scholar
  22. Gorski, T., & Miller, M. (1992). Staying sober: A guide for relapse prevention. Staying Sober Workbook: A serious solution for the problem of relapse. Herald House: Independence Press.Google Scholar
  23. Harwood, H. (2000). Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update Methods and Data. Report prepared by the Lewin Group for the National Institute on Alcohol Abuse and Alcoholism.Google Scholar
  24. Horstmann, M. J., & Tonigan, J. S. (2000). Faith development in Alcoholics Anonymous: A study of two A.A. groups. Alcoholism Treatment Quarterly, 18(4), 75–84.CrossRefGoogle Scholar
  25. Howard, K. I., Lueger, R. J., Maling, M. S., & Martinovich, Z. (1993). A phase model of psychotherapy outcome: Causal mediation of change. Journal of Consulting and Clinical Psychology, 61, 678–685.PubMedCrossRefGoogle Scholar
  26. Humphreys, K. (1999). Professional interventions that facilitate 12-step self-help group involvement. Alcohol Research and Health, 23(2), 93–98.PubMedGoogle Scholar
  27. Humphreys, K. (2004). Circles of recovery: Self-help organizations for addictions. Cambridge, UK: Cambridge University Press.Google Scholar
  28. Humphreys, K., Kaskutas, L. A., & Weisner, C. (1998). The Alcoholics Anonymous Affiliation Scale: Development, reliability, and norms for diverse treated and untreated populations. Alcoholism: Clinical and Experimental Research, 22(5), 974–978.CrossRefGoogle Scholar
  29. Humphreys, K., Mankowski, E., Moos, R. H., & Finney, J. W. (1999). Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse? Annals of Behavioral Medicine, 21(1), 54–60.PubMedCrossRefGoogle Scholar
  30. Humphreys, K., & Moos, R. (2001). Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study. Alcoholism, Clinical and Experimental Research, 25(5), 711–716.PubMedCrossRefGoogle Scholar
  31. Humphreys, K., & Moos, R. H. (2007). Encouraging post-treatment self-help group involvement to reduce demand for continuing care services: Two-year clinical and utilization outcomes. Alcoholism: Clinical and Experimental Research, 31(1), 64–68.CrossRefGoogle Scholar
  32. Humphreys K., & Noke, J. M. (1997). The influence of posttreatment mutual help group participation on the friendship networks of substance abuse patients. American Journal of Community Psychology, 25, 1–16.PubMedCrossRefGoogle Scholar
  33. Institute of Medicine (1990). Broadening the base of treatment for alcohol problems. Washington, DC: National Academy Press.Google Scholar
  34. Kaskutas, L. A., Bond, J., & Humphreys, K. (2002). Social networks as mediators of the effect of Alcoholics Anonymous. Addiction, 97(7), 891–900.PubMedCrossRefGoogle Scholar
  35. Kelly, J. F. (2001). Do adolescents affiliate with 12-step groups? A multivariate process model of effects. Dissertation Abstracts International, 62(3B). AAT 3007131.Google Scholar
  36. Kelly, J. F. (2003). Self-help for substance use disorders: History, effectiveness, knowledge gaps & research opportunities. Clinical Psychology Review, 23(5), 639–663.PubMedCrossRefGoogle Scholar
  37. Kelly, J. F. (2005). We may all be sick, but we’re not all sick on the same day: 70 years of mutual-help for addictions. American Association for Marriage and Family Therapy, 23, 14–17.Google Scholar
  38. Kelly, J. F., Humphreys, K. N., & Kahler, C. W. (2006). Non-attendance and dropout from 12-step mutual-help groups: Preliminary validation of the REASONS Questionnaire. Alcoholism: Clinical Experimental Research, 30(6s1), 1A–300A.CrossRefGoogle Scholar
  39. Kelly J. F., Humphreys K. N., Youngson H. (2004). Mutual aid groups. In Alcohol and drug problems: A practical guide for counsellors (3rd ed). Toronto: Centre for Addiction and Mental Health.Google Scholar
  40. Kelly, J. F., & Moos, R. H. (2003). Dropout from 12-step self-help groups: Prevalence, predictors and counteracting treatment influences. Journal of Substance Abuse Treatment, 24(3), 241–250.PubMedCrossRefGoogle Scholar
  41. Kelly, J. F., & Myers, M. G. (2007). Adolescents’ participation in Alcoholics Anonymous and Narcotics Anonymous: Review, implications, and future directions. Journal of Psychoactive Drugs, 39(3), 259–269.Google Scholar
  42. Kelly, J. F., Myers, M. G., & Brown, S. A. (2000). A multivariate process model of adolescent 12-step attendance and substance use outcome following inpatient treatment. Psychology of Addictive Behaviors, 14(4), 376–389.PubMedCrossRefGoogle Scholar
  43. Kelly, J. F., Myers, M. G., & Brown, S. A. (2005). The effects of age composition of 12-step groups on adolescent 12-step participation and substance use outcome. Journal of Child & Adolescent Substance Abuse, 15(1), 67–76.CrossRefGoogle Scholar
  44. Kelly, J. F., Myers, M. G., & Rodolico, J. (2008). What do adolescents think about 12-step groups? Perceptions and experiences of two A.A.-exposed clinical samples. Journal of Substance Abuse, 29(2), 53–62.Google Scholar
  45. Kelly, J. F., Stout, R., Zywiak, W., & Schneider, R. (2006). A 3-year study of addiction mutual-help group participation following intensive outpatient treatment. Alcoholism: Clinical and Experimental Research, 30, 1381–1392.CrossRefGoogle Scholar
  46. Kelly, J. F., & Yeterian, J. (2008). Mutual-help groups. In W. O’Donohue & J. R Cunningham (Eds.), Empirically supported adjunctive therapies (pp. 61–105). New York: Elsevier.Google Scholar
  47. Kurtz, E. (1979/1991). Not-God: A history of Alcoholics Anonymous. Center City, MN: Hazelden.Google Scholar
  48. Longabaugh, R., Wirtz, P. W., Zweben, A., & Stout, R. L. (1998). Network support for drinking, Alcoholics Anonymous and long-term matching effects. Addiction, 93 (9), 1313–1333.PubMedCrossRefGoogle Scholar
  49. Longabaugh, R., Zweben, A., Locatsro, J. S. & Miller, W. R. (2005). Origins, issues and options in the development of the combined behavioral intervention. Journal of Studies on Alcohol, 66 (Suppl. 15), 179–187.Google Scholar
  50. Mäkela K. (1996) Alcoholics Anonymous as a mutual-help movement: A study in eight societies. Madison, WI: University of Wisconsin Press.Google Scholar
  51. McCrady, B. S. (1994). Alcoholics Anonymous and behavior therapy: Can habits be treated as diseases? Can diseases be treated as habits? Journal of Consulting and Clinical Psychology, 62(6), 1159–1166.PubMedCrossRefGoogle Scholar
  52. McCrady, B. S., & Irvine, S. (1989). Mutual aid groups. In R. K. Hester & W. R. Miller (Eds.), Handbook of alcoholism treatment approaches (pp. 153–169). New York: Pergamon Press.Google Scholar
  53. McElrath, D. (1997). The Minnesota model. Journal of Psychoactive Drugs, 29(2), 141–144.PubMedCrossRefGoogle Scholar
  54. Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford Press.Google Scholar
  55. Moos, R. (2007). Theory-based active ingredients of effective treatments for substance use disorders. Drug and Alcohol Dependence, 88, 109–121.PubMedCrossRefGoogle Scholar
  56. Moos, R., & Moos, B. (2004). Long-term influence of duration and frequency of participation in Alcoholics Anonymous on individuals with alcohol use disorders. Journal of Consulting and Clinical Psychology, 72, 81–90.PubMedCrossRefGoogle Scholar
  57. Morgenstern, J., & Bates M. E. (1999). Effects of executive treatment. Journal of Studies on Alcohol, 60, 846–855.PubMedGoogle Scholar
  58. Morgenstern, J., Labouvie, E., McCrady, B. S., Kahler, C. W., & Frey, R. M. (1997). Affiliation with Alcoholics Anonymous after treatment: A study of its therapeutic effects and mechanisms of action. Journal of Consulting and Clinical Psychology, 65(5), 768–777.PubMedCrossRefGoogle Scholar
  59. Nealon-Woods, M. A., Ferrari, J. R., & Jason, L. A. (1995). Twelve-step program use among Oxford House residents: Spirituality or support in sobriety? Journal of Substance Abuse, 7, 311–318.PubMedCrossRefGoogle Scholar
  60. Nowinski, J., Baker, S., & Carroll, K. (1995). Twelve step facilitation therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. Project MATCH Monograph Series, Vol. 1. Rockville, MD: National Institute on Alcoholism and Alcohol Abuse. (NIH Pub. No. 94-3722. 1995).Google Scholar
  61. Olmstead, T., White, W. T., & Sindelar, J. L. (2004). The impact of managed care on substance abuse treatment services. Health Services Research, 39(2), 319–344.PubMedCrossRefGoogle Scholar
  62. Ouimette, P. C., Moos, R. H., & Finney, J. W. (1998). Influence of outpatient treatment and 12-step group involvement on one-year substance abuse treatment outcomes. Journal of Studies on Alcohol, 59(5), 513–522.PubMedGoogle Scholar
  63. Owen, P. L., Slaymaker, V., Tonigan, J. S., McGrady, B. S., Epstein, E. E, Kaskuatas, L. A., et al. (2003). Participation in A.A.: Intended and unintended change mechanisms. Alcoholism: Clinical and Experimental Research, 27, 524–532.CrossRefGoogle Scholar
  64. Oxford Group (1933). What is the oxford group? London: Oxford University Press.Google Scholar
  65. Pagano, M. E., Friend, K. B., Tonigan, J. S., & Stout, R. (2004). Sponsoring others in Alcoholics Anonymous and avoiding a drink in the first year following treatment: Findings from Project MATCH. Journal of Studies on Alcohol, 65, 766–773.PubMedGoogle Scholar
  66. Pettinati, H. M., Weiss, R. D., Dundon, W., Miller, W. R., Donovan, D., Ernst, D. B., et al. (2005). A structured approach to medical management: A psychosocial intervention to support pharmacotherapy in the treatment of alcohol dependence. Journal of Studies on Alcohol, 66 (Suppl. 15), 170–178.Google Scholar
  67. Prochaska, J. O., & DiClemente C. C. (1982). “Transtheoretical therapy: Toward a more integrative model of change.” Psychotherapy: Theory, Research and Practice 19(3): 276–288.CrossRefGoogle Scholar
  68. Project MATCH Research Group. (1993). Project MATCH (Matching Alcoholism Treatment to Client Heterogeneity): Rationale and methods for a multisite clinical trial matching patients to alcoholism treatment. Alcoholism: Clinical Experimental Research, 17(6), 1130–1145.Google Scholar
  69. Roman, P. M., & Blum T. C. (1998). National treatment center study. Athens, GA: University of Georgia.Google Scholar
  70. Room, R., & Greenfield, T. (1993) Alcoholics Anonymous, other 12-step movements and psychotherapy in the US population, 1990. Addiction, 88(4), 555–562.PubMedCrossRefGoogle Scholar
  71. Rychtarik, R. G., Connors, G. J., Dermen, K. H., & Stasiewicz, P. R. (2000). Alcoholics Anonymous and the use of medications to prevent relapse: An anonymous survey of member attitudes. Journal of Studies on Alcohol, 61(1), 134–138.PubMedGoogle Scholar
  72. Sisson, R. W., & Mallams, J. H. (1981). The use of systematic encouragement and community access procedures to increase attendance at Alcoholic Anonymous and Al-Anon meetings. American Journal of Drug and Alcohol Abuse, 8(3), 371–376.PubMedCrossRefGoogle Scholar
  73. Smart R.G., & Mann, R. E. (1993). Recent liver cirrhosis declines: Estimates of the impact of alcohol abuse treatment and Alcoholics Anonymous. Addiction, 88(2), 193–198.PubMedCrossRefGoogle Scholar
  74. Substance Abuse and Mental Health Services Administration. (2006). Results from the 2005 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-30, DHHS Publication No. SMA 06-4194). Rockville, MD.Google Scholar
  75. Timko, C., DeBenedetti, A., & Billow, R. (2006). Intensive referral to 12-step self-help groups and 6-month substance use disorder outcomes. Addiction, 101(5), 678–688.PubMedCrossRefGoogle Scholar
  76. Timko, C., Moos, R. H., Finney, J. W., & Lesar, M. D. (2000). Long-term outcomes of alcohol use disorders: Comparing untreated individuals with those in Alcoholics Anonymous and formal treatment. Journal of Studies on Alcohol, 6(4), 529–540.Google Scholar
  77. Tonigan, J. S. & Kelly, J. F. (2004). Beliefs about A.A. and the use of medications: A comparison of three groups of A.A.-exposed alcohol dependent persons. Alcoholism Treatment Quarterly, 22(2), 67–78.CrossRefGoogle Scholar
  78. Tonigan, J. S., Miller, W. R., & Schermer, C. (2002). Atheists, agnostics, and Alcoholics Anonymous. Journal of Studies on Alcohol, 63, 534–541.PubMedGoogle Scholar
  79. Tonigan, J. S., Toscova, R., & Miller, W. R. (1996). Meta-analysis of the literature on Alcoholics Anonymous: Sample and study characteristics moderate findings. Journal of Studies on Alcohol, 57(1), 65–72.PubMedGoogle Scholar
  80. Veterans Health Administration. (2001). Management of substance use disorders in the primary and specialty care. Washington, DC: Office of Quality and Performance and the Veterans Affairs and Department of Defense Development Work Group.Google Scholar
  81. Winzelberg, A., & Humphreys, K. (1999). Should patients’ religiosity influence clinicians’ referral to 12-step self-help groups? Evidence from a study of 3018 male substance abuse patients. Journal of Consulting and Clinical Psychology, 67, 790–794.PubMedCrossRefGoogle Scholar
  82. Yalom, I. D. (1995). Theory and practice of group psychotherapy. New York: Basic Books.Google Scholar
  83. Zweben, J. E. (1995). The therapist’s role in early and ongoing recovery. In S. Brown & I. D. Yalom (Eds.), Treating alcoholism. San Francisco, CA: Jossey-Bass.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Associate Director, Massachusetts General HospitalCenter for Addiction Medicine and Harvard Medical SchoolBostonUSA
  2. 2.Professor of Psychology, Director, Center on Alcoholism, Substance Abuse, and Addictions (CASAA)University of New MexicoAlbuquerqueUSA

Personalised recommendations