American Journal of Community Psychology

, Volume 29, Issue 4, pp 537–563 | Cite as

Individual and Contextual Predictors of Involvement in Twelve-Step Self-Help Groups After Substance Abuse Treatment

  • Eric S. Mankowski
  • Keith Humphreys
  • Rudolf H. Moos


Drawing on ecological and narrative theories of self-help groups, this study tests a multilevel model predicting self-help group involvement among male veterans who received inpatient substance abuse treatment. Following K. Maton (1993), the study moves beyond the individual-level of analysis to encompass variables in the treatment and post-treatment social ecology. Surveys administered to patients (N = 3,018) and treatment staff (N = 329) assessed these predictor domains and self-help group involvement 1 year after discharge. A hierarchical linear model fit to the data indicates that greater involvement in 12-step groups after discharge is predicted by the compatibility between personal and treatment belief systems. The implications of these findings for efforts to facilitate transitions between inpatient professional treatment and community-based self-help groups are discussed.

self-help substance abuse hierarchical linear model veterans 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd Ed. rev.). Washington, DC: Author.Google Scholar
  2. Antze, P. (1976). The role of ideologies in peer psychotherapy organizations: Some theoretical considerations and three case studies. Journal of Applied Behavioral Science, 12, 323–346.Google Scholar
  3. Bishop, M. F. (1996). Rational-emotive behavior therapy and two self-help alternatives to the 12-Step model. In A. M. Washton (Ed.), Psychotherapy and substance abuse: A practitioner's handbook (pp. 141–160). New York: Guilford Press.Google Scholar
  4. Bryk, A. S., & Raudenbush, S. W. (1992). Hierarchical linear models in social and behavioral research: Applications and data analysis methods. Newbury Park, CA: Sage.Google Scholar
  5. Collins, R. L., Emont, S. L., & Zywiak, W. H. (1990). Social influence processes in smoking cessation: Postulating predictors of long-term outcome. Journal of Substance Abuse, 2, 389–403.Google Scholar
  6. Connors, G. J., Tonigan, J. S., & Miller, W. R. (1996). A measure of religious background and behavior for use in behavior change research. Psychology of Addictive Behaviors, 10, 90–96.Google Scholar
  7. 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). New Brunswick, NJ: Rutgers University Press.Google Scholar
  8. Felner, R. D., Ginter, M., & Primavera, J. (1982). Primary prevention during school transitions: Social support and environmental structure. American Journal of Community Psychology, 10, 277–290.Google Scholar
  9. Gottlieb, B. H., & Peters, L. (1991). A national demographic portrait of mutual aid group participants in Canada. American Journal of Community Psychology, 19, 23–23.Google Scholar
  10. Gump, B. G., & Kulik, J. A. (1997). Stress, affiliation, and emotional contagion. Journal of Personality and Social Psychology, 72, 305–319.Google Scholar
  11. Hanson, M., Foreman, L., Tomlin, W., & Bright, Y. (1994). Facilitating problem drinking clients' transition from inpatient to outpatient care. Health & Social Work, 19, 23–28.Google Scholar
  12. Hedeker, D., & Gibbons, R. D. (1996). MIXREG:Acomputer program for mixed-effects regression analysis with auto correlated errors. Computer Methods and Programs in Biomedicine, 49, 229–252.Google Scholar
  13. Hedeker, D., McMahon, S. D., Jason, L. A., & Salina, D. (1994). Analysis of clustered data in community psychology: With an example from a worksite smoking cessation project. American Journal of Community Psychology, 22, 595–616.Google Scholar
  14. Hohman, M., & LeCroy, C. W. (1996). Predictors of adolescent AA affiliation. Adolescence, 31, 339–352.Google Scholar
  15. Humphreys, K. (1996).World view change in Adult Children of Alcoholics/Al-Anon self-help groups: Reconstructing the alcoholic family. International Journal of Group Psychotherapy, 46, 255–263.Google Scholar
  16. Humphreys, K. (1997). Clinicians' referral and matching of substance abuse patients to self-help groups after treatment. Psychiatric Services, 48, 1445–1449.Google Scholar
  17. Humphreys, K., Dearmin-Huebsch, P., Finney, J. W., & Moos, R. H. (1999). A comparative evaluation of substance abuse treatment: V. Substance abuse treatment can enhance the effectiveness of self-help groups. Alcoholism: Clinicial and Experimental Research, 23, 558–563.Google Scholar
  18. Humphreys, K., Finney, J. W., & Moos, R. H. (1994). Applying a stress and coping framework to research on mutual help organizations. Journal of Community Psychology, 22, 312–327.Google Scholar
  19. Humphreys, K., Greenbaum, M. A., Noke, J. M., Finney, J. W. (1996). Reliability, validity, and normative data for a short version of the Understanding of Alcoholism Scale. Psychology of Addictive Behaviors, 10, 38–44.Google Scholar
  20. Humphreys, K., Mankowski, E. S., Moos, R. H., & Finney, J. W. (1999). Enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse. Annals of Behavior Medicine, 21, 54–60.Google Scholar
  21. Humphreys, K., Mavis, B., & Stofflemayr, B. (1991). Factors predicting attendance at self-help groups after substance abuse treatment: Preliminary findings. Journal of Consulting and Clinical Psychology, 59, 591–593.Google Scholar
  22. Humphreys, K., & Noke, J. M. (1997). The influence of post-treatment mutual help group participation on the friendship networks of substance abuse patients. American Journal of Community Psychology, 25, 1–6.Google Scholar
  23. Humphreys, K., Noke, J. M., & Moos, R. H. (1996). Recovering substance abuse staff members' beliefs about addiction. Journal of Substance Abuse Treatment, 13, 75–78.Google Scholar
  24. Humphreys, K., & Woods, M. D. (1993). Researching mutual help group participation in a segregated society. The Journal of Applied Behavioral Science, 29, 181–201.Google Scholar
  25. Kennedy, M., & Humphreys, K. (1994). Understanding worldview transformation in members of mutual help groups. Prevention in Human Services, 11, 181–198.Google Scholar
  26. Kessler, R., Mickelson, K. D., & Zhao, S. (1997). Patterns and correlates of self-help group membership in the United States. Social Policy, 27, 27–46.Google Scholar
  27. Luke, D. A., Roberts, L., & Rappaport, J. (1993). Individual, group context, and individual-group fit predictors of self-help group attendance. Journal of Applied Behavioral Science, 29, 216–238.Google Scholar
  28. Mankowski, E. S., Maton, K. I., Burke, C. K., Hoover, S. A., & Anderson, C.W. (2000). Collaborative research with a men's organization: Psychological impact, group functioning, and organizational growth. Book chapter to appear in: E. Barton (Ed.), Mythopoetic perspectives of men's healing work: An anthology for therapists and others (pp. 183–203). Westport, CT: Greenwood Press.Google Scholar
  29. Mankowski, E. S., & Rappaport, J. (1995). Stories, identity and the psychological sense of community. In R. S. Wyer, Jr. (Ed.), Advances in social cognition, Vol. 8 (pp. 211–226). Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
  30. Marlatt, G. A., Curry, S., & Gordon, J. R. (1988). A longitudinal analysis of unaided smoking cessation. Journal of Consulting and Clinical Psychology, 56, 715–720.Google Scholar
  31. Maton, K. I. (1989). Towards an ecological understanding of mutual help groups: The social ecology of “fit”. American Journal of Community Psychology, 17, 729–753.Google Scholar
  32. Maton, K. (1993). Moving beyond the individual-level of analysis in mutual help group research. The Journal of Applied Behavioral Science, 29, 272–286.Google Scholar
  33. McKay, J. R., McLellan, A. T., Alterman, A. I., Cacciola, J. S., Rutherford, M. J., & O'Brien, C. P. (1998). Predictors of participation in aftercare sessions and self-help groups following completion of intensive outpatient treatment for substance abuse. Journal of Studies on Alcohol, 59, 152–162.Google Scholar
  34. McLellan, A. T., Alterman, A. I., Cacciola, J., Metzger, D., & O'Brien, C. P. (1992). A quantitative measure of substance abuse treatment programs: The Treatment Services Review. The Journal of Nervous and Mental Disease, 180, 101–110.Google Scholar
  35. McPherson, J. M. (1983). An ecology of affiliation. American Sociological Review, 48, 519–532.Google Scholar
  36. Meissen, G. J., Gleason, D. F., & Embree, M. G. (1991). An assessment of the needs of mutual-help groups. American Journal of Community Psychology, 19, 427–442.Google Scholar
  37. Moos, R. H. (1987). Person-environment congruence in work, school, and health care settings. Journal of Vocational Behavior, 31, 231–247.Google Scholar
  38. Moos, R. H., Finney, J. W., & Cronkite, R. (1990). Alcoholism treatment: Context process, and outcome. New York: Oxford University Press.Google Scholar
  39. Moos, R. H., Finney, J. W., Ouimette, P. C., & Suchinsky, R. T. (1999). A comparative evaluation of substance abuse treatment: I. Treatment orientation, amount of care, and 1-year outcomes. Alcoholism: Clinical and Experimental Research, 23, 529–536.Google Scholar
  40. Moos, R. H., & Moos, B. S. (1994). Life Stressors and Social Resources Inventory: Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  41. Moyers, T. B., & Miller, W. R. (1993). Therapist conceptualizations of alcoholism: Measurement and implications for treatment decisions. Psychology of Addictive Behaviors, 7, 238–245.Google Scholar
  42. Nealon-Woods, M. A., Ferrari, J. R., & Jason, L. A. (1995). Twelve-step program use among Oxford House Residents: Spirituality or social support in sobriety? Journal of Substance Abuse, 7, 311–318.Google Scholar
  43. Ogborne, A. C. (1993). Assessing the effectiveness of Alcoholics Anonymous in the community: Meeting the challenges. In B. S. McCrady & W. R. Miller (Eds.), Research on Alcoholics Anonymous: Opportunities and alternatives (pp. 339–356). New Brunswick, NJ: Rutgers University Press.Google Scholar
  44. Ouimette, P. C., Finney, J. W., & Moos, R. H. (1997). Twelve-step and cognitive-behavioral treatment for substance abuse: A comparison of treatment effectiveness. Journal of Consulting and Clinical Psychology, 55, 230–240.Google Scholar
  45. 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, 513–522.Google Scholar
  46. Pargament, K. I. (1986). Refining fit: Conceptual and methodological challenges. American Journal of Community Psychology, 14, 677–684.Google Scholar
  47. Peyrot, M. (1985). Narcotics Anonymous: Its history, structure, and approach. International Journal of the Addictions, 20, 1509–1522.Google Scholar
  48. Rappaport, J. (1993). Narrative studies, personal stories, and identity transformation in the mutual help context. The Journal of Applied Behavioral Science, 29, 239–256.Google Scholar
  49. Rosenthal, R., & Rubin, D. B. (1982). A simple, general purpose display of magnitude of experimental effect. Journal of Educational Psychology, 74, 166–169.Google Scholar
  50. Sherif, M., & Sherif, C. (1953). Groups in harmony and tension. New York: Harper & Row.Google Scholar
  51. Swindle, R. W., Peterson, K. A., Paradise, M. J., & Moos, R. H. (1995). Measuring substance abuse program treatment orientations: The Drug and Alcohol Program Treatment Inventory. Journal of Substance Abuse, 7, 61–78.Google Scholar
  52. Tonigan, J. S., Connors, G. J., & Miller, W. R. (1996). Alcoholics Anonymous Involvement (AAI) Scale: Reliability and norms. Psychology of Addictive Behaviors, 10, 75–80.Google Scholar
  53. Trickett, E. J., Kelly, J. G., & Vincent, T. A. (1985). The spirit of ecological inquiry in community research. In E. C. Susskind & D. C. Klein (Eds.), Community research: Methods, paradigms, and applications (pp. 283–333). New York: Praeger.Google Scholar
  54. Weisner, C., Greenfield, T., & Room, R. (1995). Trends in the treatment of alcohol problems in the US general population, 1979–1990. American Journal of Public Health, 85, 55–60.Google Scholar

Copyright information

© Plenum Publishing Corporation 2001

Authors and Affiliations

  • Eric S. Mankowski
    • 1
  • Keith Humphreys
    • 2
  • Rudolf H. Moos
    • 2
  1. 1.Portland State UniversityUSA
  2. 2.Veterans Affairs Palo Alto Health Care System;Stanford University School of MedicineUSA

Personalised recommendations