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A naturalistic comparison of outcomes at social and clinical model substance abuse treatment programs

Since the 1970s, much of the public treatment system in California has been based on a social model orientation to recovery for alcoholics, but there has been minimal research on program outcomes. This article reports on follow-up interviews conducted with a representative sample of 722 people who had entered treatment about a year earlier in public and private programs, including publicly-funded social model detoxification and residential programs, and clinical model programs in hospitals and HMO clinics. Social model clients came to treatment with more severe legal and employment problems, whereas those seeking treatment at clinical programs reported more severe family problems. At follow-up, clients at both types of programs reported attending a similar number of Alcoholics Anonymous (AA) meetings, but social model clients reported going to more Narcotics Anonymous (NA) meetings and being involved in more AA activities. Social model clients were less likely than clinical model clients to report problems with alcohol or drugs at follow-up, but the odds of reporting other problems (e.g., medical, psychological, legal, family/social) were similar. The program effect for better alcohol outcomes at the social model programs was partially explained by their clients’ higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems. Social networks supportive of abstinence also were predictive of reporting no alcohol problems at follow-up. In contrast, subsequent detoxification treatment events between baseline and follow-up were associated with a higher odds of reporting alcohol, drug, psychiatric and family/social problems at follow-up. These findings are consistent with the growing body of literature reporting higher rates of abstinence among those who are able to construct more positive social networks, and who attend and become involved in 12-step programs during and following treatment. It is important that these results be replicated, as they suggest that social model programs are successful in engaging their clients in AA activities and in NA meeting attendance, and could represent for some an effective alternative to clinical model treatment programs.

Authors: Kaskutas LA; Ammon L; Weisner C

Int J Self Help Self Care. 2004;2(2):111-133.

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