12‐step programs for reducing illicit drug use

This Campbell systematic review examines the effectiveness of 12‐step programs in reducing the use of illicit drugs. The review summarises findings from 10 studies, nine of which were conducted in the United States. The main evidence presented in this review suggests that 12‐step programs for reducing illicit drug use are neither better nor worse than other interventions. This conclusion should be read with caution given the weakness of the evidence from the studies. The power to detect a difference between the 12‐step interventions and alternative psychosocial interventions was low and the estimated effect sizes were small. Many studies failed to adjust for the fact that the intervention is administered to groups, and so may overestimate effects. Given all these shortcomings, further evidence regarding the effectiveness of this type of intervention, especially in self‐help groups, is needed. Plain language summary 12‐step programs for reducing illicit drug use are neither better nor worse than other interventions Illicit drug abuse has serious and far‐reaching implications for the abuser, their family members, friends, and society as a whole. Preferred intervention programs are those that effectively reduce illicit drug use and its negative consequences, and are cost‐effective as well. Current evidence shows that overall, 12‐step programs are just as effective as alternative, psychosocial interventions. The costs of programs are, therefore, an important consideration. However, the strength of the studies is weak and further evidence regarding the effectiveness of 12‐step programs is needed. What is the aim of this review? This Campbell systematic review examines the effectiveness of 12‐step programs in reducing the use of illicit drugs. The review summarises findings from 10 studies, nine of which were conducted in the United States. What did the review study? Illicit drug abuse is a globally recognised problem leading to high human, social and economic costs. The 12‐step program, modelled on the approach of Alcoholics Anonymous and adopted by Narcotics Anonymous and others, aims for complete abstinence. The 12‐step approach is used both by self‐help groups and for professional treatment called Twelve Step Facilitation (TSF). This review examines the effectiveness of 12‐step programs in reducing the use of illicit drugs. Secondary outcomes considered are on criminal behaviour, prostitution, psychiatric symptoms, social functioning, employment status, homelessness, and treatment retention. What studies are included? Included studies assess 12‐step interventions for participants with illicit drug dependence using randomized controlled trials and quasi‐experimental studies. Study populations are participants who have used one or more types of illicit drugs, regardless of gender and ethnic background. A total of 10 studies consisting of 1,071 participants are included in the final evaluation. Nine of the studies were conducted in the United States, and one in the United Kingdom. The studies compare the 12‐step program to alternative interventions. Nine studies were included in meta‐analysis. What are the main results in this review? There is no difference in the effectiveness of 12‐step interventions compared to alternative psychosocial interventions in reducing drug use during treatment, post treatment, and at 6‐ and 12‐month follow‐ups. 12‐step programs combined with additional treatment did have a significant effect at 6‐month follow‐up, but this finding is based on few studies and is not found at 12‐month follow‐up. There is some evidence that 12‐step programs retain fewer of their participants than other programs, but the evidence has shortcomings. No effect was found on other secondary outcomes. What do the findings in this review mean? The main evidence presented in this review suggests that 12‐step programs for reducing illicit drug use are neither better nor worse than other interventions. This conclusion should be read with caution given the weakness of the evidence from the studies. The power to detect a difference between the 12‐step interventions and alternative psychosocial interventions was low and the estimated effect sizes were small. Many studies failed to adjust for the fact that the intervention is administered to groups, and so may overestimate effects. Given all these shortcomings, further evidence regarding the effectiveness of this type of intervention, especially in self‐help groups, is needed. How up to date is this review? The review authors searched for studies published until September 2016. This Campbell Systematic Review was published in February 2017. What is the Campbell Collaboration? The Campbell Collaboration is an international, voluntary, non‐profit research network that publishes systematic reviews. We summarise and evaluate the quality of evidence for social and economic policy, programs and practice. Our aim is to help people make better choices and better policy decisions. Executive summary Background The effects of substance dependence have serious implications for the individual, the family and friends of the substance dependent individual, and society at large. Practitioners and public health policy makers have an interest in finding effective treatments that are also cost‐effective. This review examined the effectiveness of 12‐step programs aimed at illicit drug dependent participants compared to no intervention, treatment as usual, and other interventions. Objectives The main objective of this review was to systematically evaluate and synthesise effects of 12‐step interventions for participants with illicit drugdependence against no intervention, treatment as usual, and alternative interventions. The primary outcome of interest was drug use. Secondary outcomes of interest comprised criminal behaviour, prostitution, psychiatric symptoms, social functioning, employment status, homelessness and treatment retention. Search methods An extensive search strategy was used to identify studies meeting inclusion criteria. We searched electronic bibliographic databases in January 2010, October 2011, July 2013, August 2015, and September 2016. Searches for this review were performed on multiple international and Nordic databases. In total 11 databases were searched including PsycInfo, SocIndex, and Medline. A substantial range of grey literature sources were searched including governmental repositories, targeted web sites and trial registers. We checked the reference lists of primary studies, hand‐searched relevant key journals, and searched the Internet using Google and Google Scholar. We also contacted researchers who had published in the area of 12‐step interventions. Neither language nor date restrictions were applied to the searches. The conclusions of this review are based on the most recent searches performed September 2016. Selection criteria Studies had to meet the following criteria in order to qualify for inclusion in the review: Intervention ‐ only studies that considered 12‐step interventions were eligible for inclusion. Study Design ‐ only studies using a RCT/QRCT design