Page 1 of 17http://spider.apa.org/ftdocs/ccp/1997/april/ccp652230.html 10/12/2000Journal of Consulting and Clinical Psychology1997, Vol. 65, No. 2, 230-240Copyright 1997 by the American Psychological Association 0022-006X/$3.00 Twelve-Step and Cognitive-Behavioral Treatment for Substance Abuse A Comparison of Treatment Effectiveness Paige Crosby OuimetteProgram Evaluation and Resource Center and HSR & D John W. FinneyProgram Evaluation and Resource Center and HSR & D Rudolf H. MoosProgram Evaluation and Resource Center and HSR & D Paige Crosby Ouimette, Program Evaluation and Resource Center and HSR & D, Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; John W. Finney and Rudolf H. Moos, Program Evaluation and Resource Center and HSR & D, Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, and Stanford University Medical Center. This project benefited from the cooperation and efforts of an impressive number of individuals. Paul Errera, Thomas Horvath, Richard Suchinsky, and Karen Boies provided helpful guidance and support from the Department of Veterans Affairs Mental Health Strategic Health Group at the Veterans Affairs National Headquarters, Washington, DC. At each of the participating Veterans Affairs Medical Centers, (VAMCs) local coordinators organized the local data collection process, hired local staff, and resolved various local problems, and project assistants collected extensive data on patients at intake, discharge, and follow-up. These individuals and their VAMC locations were as follows: Nancy D'Abadie, Colin Quinn, Karen Drexler, and Faheemah Muhammad, Atlanta, Georgia; James Robyak and Timothy Shaver, Bay Pines, Florida; Laure Buydens, John Toma, and Michael Rothman, Brooklyn, New York; Kay Manley, Norman Kruedelbach, Loreen Rugle, Ronald Campbell, Alex Olivera, and Bart Vrtunski, Cleveland, Ohio; Michael Clayton, Marilyn Krabbe, and Susan Nunamaker, Danville, Illinois; Usha Malkerneker and Karen Scanlan, Hines, Illinois; Jan Campbell and Gretchen Young, Kansas City, Missouri; Jeffrey Wilkins and Martha Lewis, (West) Los Angeles, California; Paul Mushala, Robert Murray, Ervin "Buddy" Wright, and Sandra Scott, Memphis, Tennessee; Carl Isenhart, Daniel Silversmith, and Steve Van Krevelen, Minneapolis, Minnesota; Robert Malow, Jose Pena, Patricia Sutker, Lester Barnett, Stacey Cunningham, Dee Martin, and Alicia Borges, New Orleans, Louisiana; Frank Crow and Cheryl Keesee, Richmond, Virginia; and Rex Turner, Steve Ross, Harold Price, Lisa Himonas, and Tracy Hed, Salt Lake City, Utah. At the Program Evaluation and Resource Center, several dedicated individuals provided invaluable assistance on this project: Peg Maude-Griffin helped to develop and initiate the project, and Charlotte Noyes coordinated the project thereafter; Courtney Ahrens, Michelle Birch, Adam Coutts, Kristian Gima, Todd McCallum, Jennifer Noke, Katrine VanderWeide, and Amy Wender monitored data collection, managed data, and performed statistical analyses. This evaluation would not have been possible without the cooperation of almost 3,700 veterans. We express our gratitude to these veterans for their participation and commitment to improving substance abuse treatment for other veterans. Keith Humphreys and Kathleen Schutte provided helpful comments on this article. Correspondence may be addressed to Paige Crosby Ouimette, Menlo Park Division (152),Veterans Affairs Palo Alto Health Care System,795 Willow Road,Menlo Park,California,94025,Page 2 of 17http://spider.apa.org/ftdocs/ccp/1997/april/ccp652230.html 10/12/2000Received: April 9, 1996 Revised: August 3, 1996 Accepted: August 28, 1996 ABSTRACTThe comparative effectiveness of 12-step and cognitive-behavioral (C-B) models of substance abuse treatment was examined among 3,018 patients from 15 programs at U.S. Department of Veterans Affairs Medical Centers. Across program types, participants showed significant improvements in functioning from treatment admission to a 1-year follow-up. Although 12-step patients were somewhat more likely to be abstinent at the 1-year follow-up, 12-step, C-B, and combined 12-Step-C-B treatment programs were equally effective in reducing substance use and improving most other areas of functioning. The finding of equal effectiveness was consistent over several treatment subgroups: Patients attending the "purest" 12-step and C-B treatment programs, and patients who had received the "full dose" of treatment. Also, patients with only substance abuse diagnoses, those with concomitant psychiatric diagnoses, and patients who were mandated to treatment showed similar improvement at the 1-year follow-up, regardless of type of treatment received. These data provide important new evidence supporting the effectiveness of 12-step treatment. In the U.S. health care system, growing emphasis is being placed on monitoring treatment outcomes and identifying effective mental health treatment. The field of substance abuse treatment has similarly moved toward outcome accountability ( Miller et al., 1995 ). Unfortunately, the most widely used substance abuse intervention, the 12-step program, has little comparative research on its effectiveness in either professional or mutual help settings. However, studies of participation in 12-step groups as part of aftercare (e.g., Emrick, Tonigan, Montgomery, & Little, 1993 ; Tonigan, Toscova, & Miller,1996 ) support the association of 12-step treatment or involvement with abstinence. In contrast, numerous evaluations of cognitive-behavioral (C-B) interventions for addictive behaviors have been conducted and support its effectiveness relative to alternative and control treatments (e.g., Finney & Monahan, 1996 ; Holder, Longabaugh, Miller, & Rubonis, 1991 ; Miller et al., 1995 ). Accordingly, a comparison of 12-step and C-B substance abuse programs provides a rigorous test of 12-step treatment effectiveness. To date, there have been only two controlled trials comparing 12-step and C-B interventions; one focused on alcohol-dependent outpatients ( Project MATCH ResearchGroup, 1996 ) and the other on cocaine-dependent outpatients ( Wells, Peterson, Gainey, Hawkins, &Catalano, 1994 ). No comparison of these interventions as they occur in the natural clinical situation with a broad range of patients has been conducted. This article presents data from a naturalistic multisite evaluation of substance
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