A comparative evaluation of substance abuse treatment: II. Linking proximal outcomes of 12-Step and cognitive-behavioral treatment to substance use outcomes

This study examines the linkages in the treatment process chains that are t hought to underlie two prevalent approaches to substance abuse treatment, t raditional 12-Step treatment and cognitive-behavioral treatment. The focus is on the "proximal outcomes" specified by the two treatment approaches and their relation to "ultimate" substance use outcomes assessed at a 1-year f ollow-up. A total of 2687 men who received treatment in 15 Department of Ve terans Affairs substance abuse treatment programs were assessed at treatmen t entry, at or near discharge, and at a 1-year follow-up. Based on the resu lts of factor analyses, composite proximal outcomes variables were construc ted to assess 12-Step cognitions, 12-Step behaviors, cognitive-behavioral b eliefs, substance-specific coping, and general coping. Correlation analyses indicated that some of the proximal outcome composites assessed at treatme nt discharge were linked to 1-year outcomes, but the relationships were wea k (r = .09 to .15). At follow-up, the cross-sectional relationships between the proximal outcome composites and two substance use outcomes were strong er, but still modest in magnitude (r = .16 to .39). The weak predictive fin dings suggest some mechanism is needed to sustain treatment-induced change on proximal outcomes so that positive ultimate outcomes can be achieved mor e frequently, in this regard, participation in continuing care was associat ed with enhanced maintenance of treatment gains on proximal outcomes. Howev er, the modest cross-sectional relationships between proximal and substance use outcomes at follow-up suggest that the theories; on which 12-Step and cognitive-behavioral substance abuse treatments are based are not sufficien tly comprehensive.