Process and outcome changes with relapse prevention versus 12-Step aftercare programs for substance abusers

Aims Presumptive support was sought for mechanisms of action whereby two conceptually distinct aftercare programs, relapse prevention (RP) and 12-Step facilitation (TSF), impact upon substance abusers. Patients and design Adults who had just completed intensive treatment were assigned randomly to either RP (n = 61) or TSF (n = 70) aftercare programs. Setting Three residential treatment facilities. Interventions Trained counselors delivered to small groups a manualized aftercare program which focused either upon the utilization of cognitive-behavioral processes to orchestrate change through an individualized treatment plan (i.e. RP) or which sought to facilitate utilization of AA's 12 Steps (i.e. TSF). Measurements Process measures developed specifically to quantify either: (a) the changes in self-efficacy process in RP or (b) the utilization of AA's principles in TSF, as well as psychosocial and substance abuse indices were administered to all patients pre- and post-aftercare and at 6-month follow-up. Findings A significant relationship between changes in measures of self-efficacy for RP participants as well as a trend for a relationship between process-specific change for TSF participants partially satisfied the first condition for presumptive support. The fact that the intervention-specific mediators covaried with several outcome indices, and that removal of such mediators attenuated prediction of outcome met, respectively, the second and third conditions for presumptive support. Conclusion Carefully orchestrated RP and TSF aftercare programs yield process changes that are related positively to improved outcome.