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Open Access Highly Accessed Research article

The courage to change: Patient perceptions of 12-Step fellowships

John-Kåre Vederhus1*, Christine Timko23, Øistein Kristensen1 and Thomas Clausen14

Author affiliations

1 Addiction Unit, Sørlandet Hospital HF, Kristiansand, Norway

2 Center for Health Care Evaluation, Department of Veterans Affairs Health Care System, Palo Alto, CA, USA

3 Stanford University Medical Center, Stanford, CA, USA

4 Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway

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Citation and License

BMC Health Services Research 2011, 11:339  doi:10.1186/1472-6963-11-339

Published: 15 December 2011

Abstract

Background

From a health services perspective, peer-based resources merit special attention. Participation in self-help fellowships, like the Twelve Step Groups (TSGs), have been shown to improve outcomes of patients with substance use disorder (SUD) and they represent a valuable adjunct to the SUD treatment system. This study investigated the relationship between patient perceptions of TSGs and the intent to participate in TSGs after receiving detoxification treatment.

Methods

We included 139 patients that entered a detoxification unit (detox) in Kristiansand, Norway. We analyzed factors associated with the intention to participate in TSGs post-discharge with contingency tables and ordinal regression analysis.

Results

Forty-eight percent of patients had participated in TSGs before entering detox. Respondents saw more advantages than disadvantages in TSG participation, but only 40% of patients showed high intentions of participating in TSGs post-discharge. A high intention to participate in TSGs was most strongly correlated with the notion that participation in TSGs could instill the courage to change. In a multivariate analysis, the perception that TSGs were beneficial was the strongest factor related to a high intention of TSG participation after treatment.

Conclusions

Our findings increased the understanding of factors most likely to influence decisions to attend TSGs in SUD treatment contexts with uncommon TSG participation. Our results suggested that the majority of patients may be sufficiently influenced by highlighting the potential gains of TSG participation. Treatment programs that do not focus on self-help group attendance during and after treatment should consider implementing facilitative measures to enhance utilization of these fellowships.