Modeling therapeutic response to 12-step treatment: optimal responders, nonresponders, and partial responders

Findings from alcohol treatment studies have had limited impact on clinical practice, in part because they have failed to accurately model treatment factors. This study attempted to model initial response to 12-step substance abuse treatment using a treatment theory-guided evaluation paradigm. A theory-guided measure of 12-step behaviors was constructed. Participants (N = 103) from two traditional substance abuse treatment programs were assessed at intake, discharge, and 1 month after discharge from intensive treatment. Results indicated that the measure of 12-step behaviors had adequate psychometric properties, and a one-factor solution best fit the data. Participants demonstrated substantial variability in their initial response to treatment. A cluster analysis of 12-step behaviors yielded three distinct groups of responders: optimal responders, partial responders, and nonresponders. Descriptive features and differences in relapse rates for groups are reported. Implications for matching patients to 12-step treatment and for clarifying the specific effects of this widely used treatment model are discussed.