Evaluating substance abuse treatment process models: I. Changes on proximal outcome variables during 12-step and cognitive-behavioral treatment

Objective: This article provides data on the early linkages in the treatment process chains that are thought to underlie two prevalent approaches to substance abuse treatment-traditional 12-step treatment and cognitive-behavioral treatment. The focus is on the during-treatment changes on "proximal outcomes" that, according to the treatment theory underlying each modality, patients are supposed to undergo or achieve in order to experience a positive "ultimate outcome." Method: In all, 3,228 men receiving treatment in 15 Department of Veterans Affairs substance abuse treatment programs were assessed at treatment entry and at or near discharge from inpatient programs that had desired lengths of stay of 21-28 days. Results: Between intake and discharge, patients in 12-step programs improved more than did C-B patients on proximal outcome variables assumed to be specific to 12-step treatment (e.g., attending 12-step meetings, taking steps), whereas patients in cognitive-behavioral programs made no greater change (and in a few cases, less change) than did 12-step patients on proximal outcome variables assumed to underlie cognitive-behavioral treatment (e.g., self-efficacy, coping skills). Conclusions: These findings suggest that the proximal outcomes thought to be specific to cognitive-behavioral treatment are actually general proximal outcomes of both 12-step and cognitive-behavioral treatment.