Twelve-step program attendance and polysubstance use: interplay of alcohol and illicit drug use

The primary aim of this study was to advance understanding of the efficacy of 12-step programs by determining the temporal relationships between alcohol and illicit drug use among 12- step program affiliates.

A total of 253 early 12-step affiliates without extensive histories of Alcoholics Anonymous (AA) attendance were recruited from substance use treatment and community-based AA. A majority of the sample met criteria for a diagnosis of alcohol dependence, reported lifetime use of illicit drugs, and reported illicit drug use in the 90-day period before recruitment. After informed consent, participants were interviewed at intake and in 3-month increments for 1 year.

Preliminary analyses indicated that 12-step attendance was predictive of reductions in substance use and that such reductions were not moderated by illicit substance use disorder diagnosis or alcohol problem severity. Lagged hierarchical linear models indicated that illicit drug use was a robust predictor of later use of alcohol, although the frequency and intensity of drinking were contingent on whether participants sustained 12-step program affiliation. Alcohol use did not predict later illicit drug use among participants who sustained 12-step program participation.

Findings suggest that 12-step participation may serve as a protective factor after substance use occurs. Although our results suggest that the initiation of illicit drug use may undermine efforts to achieve and sustain abstinence from alcohol, our findings do not suggest that alcohol use necessarily mobilizes relapse across different substances among 12-step program affiliates.