Effects of Twelve Step Groups on Co-Morbid Substance Abuse and Depression

Comments 5 Standard

(tldr: 12 steps groups are more effective for depressed alcoholics in the long run than therapy, depressed drug users show no significant difference between either treatment. I got full points on this for my psychology 101 class and I’m ridiculously proud. The five page paper is under the read more tag)

Research Topic and Hypothesis

The subject of this mediational study is twelve-step groups and the potential effect they have on people suffering from both substance abuse and depression. The hypothesis asks if the rate of a person’s substance abuse and depression can be reduced by twelve step meeting attendance, and if it can be lowered by the meetings, if their degree of depression will lessen. Both groups, the experimental group that attended twelve step meetings and the control group that didn’t, received group cognitive behavioral therapy and pharmacological help.

Independent and Dependent Variables

The independent variable is the utilization of twelve step groups by the members of the study, and the dependent variable is their self-rated mental wellness and degree of abstinence from substance abuse.


Twelve step groups have long been touted as a solution to substance abuse, but people are strongly divided on their effectiveness. My first theory is that all three factors – therapy, twelve step meetings, and medication will work together to decreased substance abuse, and then provide better mental stability. My second theory is that cognitive behavioral therapy and medication combined is not quite effective as all three combined.

Summary of Literature

This hypothesis of this study attributes the cause of depression to substance abuse, rather than the other way around. It is my personal opinion that depression generally precedes substance abuse. However, both are present in the individuals in the study, and it makes no real difference which is treated first – if one is reduced, theoretically, so will the other. Therefore, if the substance abuse is lessened by treatment, so will the depression.

The authors of this study go about answering their question with the experimental method, subjecting one group-called the experimental group to a certain treatment, while the control group does not receive the treatment. This is a fairly common method of research, as it allows for a direct conclusion to be drawn. The methods of treatment for both groups are antidepressants, and cognitive behavioral therapy, which uses researched techniques to challenge beliefs and therefore change behavior.

The authors assumed that the cognitive behavioral therapy only group would come out ahead, but it turned out that those who also attended twelve step meetings stayed off alcohol longer, but those who used drugs did equally well with or without twelve step meetings after nine months-initially, the group who went to meetings did better.

Test and Sample Population

Surveys were used to obtain results for this study. Candidates were initially polled on gender, age, length of education, current employment status, marital status, presence of post-traumatic stress disorder, and if they were dependent on stimulants, alcohol, or marijuana. During the study, at three month intervals, for a total of nine months, the patients were asked if they attended twelve step meetings or not, and they were asked to score their depression on the Hamilton scale.

The population of the study were 209 military veterans, and were over 90% male, on average age 49, had a high school education, and were mostly unemployed and unmarried. 90% were dependent on alcohol, 54% were dependent on stimulants, and 20% were dependent on marijuana. Slightly under 40% were suffering from post-traumatic stress disorder.

Ethical Concerns

No ethical concerns are listed in this study. All groups received treatment for their mental illness, and were well-treated. There may be potential concerns due to treatment being through Veteran’s Administration hospitals, as there could be a conflict of interest, 3.06, in terms of overstating the effectiveness of treatment. Informed consent to therapy as mentioned in 10.01 and informed consent in general in accordance to 3.10 was obtained.

Psychology Perspective

In terms of psychology, I predicted that the twelve step group will come out ahead of the cognitive behavioral only group because twelve step groups provide a healthy peer group, positive role models. They also provide encouragement for psychological and behavioral change. Twelve step groups also provide positive reinforcement for time spent sober through coins or key tags (A.A, N.A.), and group recognition as well.


There is a negative correlation between the independent and dependent variable- the group that attended twelve step meetings had a 23.4% lower amount of depression when compared to the group that only got behavioral therapy. However, there was a difference in the effectiveness of stopping alcohol and drug use-a 15.7% lower recurrence of drinking was recorded, but drug users in both groups showed no significant difference in amount of use at the end of the study.


The mental health benefits of attending twelve step meetings are well-recorded for both groups in this study, to the surprise of the authors. However, twelve step meetings only show definite decreases in the amount of alcohol used, and drug users showed no significant decrease whether they attended twelve step meetings or not.


TSF = Twelve Step Facilitation

ICBT – Intensive Cognitive Behavioral Therapy



Worley, M. J., Tate, S. R., & Brown, S. A. (2012). Mediational relations between 12- Step attendance, depression and substance use in patients with comorbid substance dependence and major depression. Addiction, 107(11), 1974-1983. doi:10.1111/j.1360-0443.2012.03943.x

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