Concerns About Dose and Underutilization of Twelve-Step Programs: Models, Scales, and Theory that Inform Treatment Planning

  • Richard N. Cloud
  • J. B. Kingree
Part of the Recent Developments in Alcoholism book series (RDIA, volume 18)


Researchers have observed that a majority of addicted persons who are encouraged and facilitated by treatment providers to attend twelve-step (TS) programs either drop out or sporadically use twelve-step programs following treatment. This is troubling given considerable evidence of TS program benefits associated with regular weekly attendance and ubiquitous reliance by treatment professionals on these programs to provide important support services. This chapter reviews and advances theory of TS utilization and dose that is supported by prior research, multivariate models, and scales that predict risk of TS meeting underutilization. Advancing theory should organize and clarify the process of initial utilization, guide intervention development, and improve adherence of TS program referrals, all of which should lead to improved treatment planning and better outcomes. Three theories are integrated to explain processes that may influence TS program dose: the health belief model, self-determination theory (motivational theory), and a person-in-organization cultural fit theory. Four multidimensional scales developed specifically to predict participation are described. Implications for practice and future research are considered in a final discussion. Information contained in this chapter raises awareness of the need for TS-focused treatments to focus on achieving weekly attendance during and after treatment.


Motivational Interview Health Belief Model Involvement Scale Specific Health Service Meeting Attendance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Kent School of Social WorkUniversity of LouisvilleLouisville
  2. 2.Department of Public Health SciencesClemson UniversityClemson

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