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Referral to Self-Help:
Clients' and Clinicians' Views

Principal Investigator: Alexandre Laudet, NDRI

Funding Source: National Institutes on Drug Abuse
Grant R03 DA13432

Funding period: 9/19/00-8/31/03

Specific Aims:

There is a growing interest in self-help groups (SHGs), particularly with the advent of managed care and consequent decreases in the intensity and length of services. Empirical studies indicate that self-help (SH) can help achieve positive outcomes for clients (less substance use and improved psychosocial functioning) both during and after treatment. Research points to the important role of treatment providers in involving clients with SHGs. As services become more limited, the extent to which the treatment system succeeds in engaging clients in SHGs will increasingly influence client outcomes. Although there is evidence that clinicians do refer many substance-abusing clients to SHGs, some - in particular, those with a co-occurring mental disorder - are much less likely to be referred. This may result in missed opportunities to provide clients with a potentially effective and much-needed lifelong resource for recovery. Further, clients are often ambivalent about SH and their concerns need to be addressed so as to promote engagement in SH. Self-help, and especially the 12-step program of recovery are often misunderstood; indeed, lack of information and understanding has been identified as "the most important factor in social workers' reluctance to refer clients to SHGs" (Kurtz & Cambon, 1987). While studies have explored clinicians' attitudes toward SH, little is known about where clinicians learn about SH, what they know, how they arrive at referral decisions or how referrals are made. Further, it appears that there has been no empirical investigation of the referral process itself. Factors that can contribute to maximizing clients' participation and involvement in SH need to be empirically studied.

The aims of the proposed study are:

  1. To determine where clinicians acquire their beliefs and attitudes about self-help so as to explore whether beliefs and attitudes about self-help differ according to their sources.
  2. To document empirically the process of referral to SH (including "matching rules") from both clinicians' and clients' perspectives, so as to identify missed opportunities (e.g., clients not referred, clients' ambivalence about SH) as well as miscommunication or lacunae in the process.
  3. To compare clinicians' and clients' views on self-help and on perceptions of the referral process.
  4. To generate hypotheses for a future study of the association between referral to SH and client outcomes.

Publications and Presentations:

Laudet, A. Attitudes toward 12 Step fellowships among substance abuse treatment clients and clinicians. Presented at the World Forum on Drugs, Dependencies and Society, Montreal, Sept. 22-27, 2002 and at the 130th Annual Meeting of the Amer. Public Health Association, Philadelphia, Nov. 2002.

Laudet, A. Individual and Attitudinal Correlates of 12-step Attendance Patterns among Substance Users in Outpatient Treatment. Poster presented at the 65th Annual Scientific Meeting of the CPDD, Bal Harbour, Florida, June 2003.

Laudet, A. (2000) Substance Abuse Treatment Providers' Referral to Self-Help: Review and Future Empirical Directions. International Journal of Self-Help and Self-care, 1(3), 195-207. View abstract

Laudet, A. (2003) Attitudes and beliefs about 12-step groups among addiction treatment clients and clinicians: Toward identifying obstacles to participation. Substance Use and Misuse, 38(14). 2017-2047.View abstract

Laudet, A. & White, W. (2005) An Exploratory Investigation of the Association between Clinicians’ Attitudes toward Twelve-step Groups and Referral Rates, Alcoholism Treatment Quarterly, 23(1).
View abstract
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