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Narcotics Anonymous
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==Effectiveness== The first sophisticated outcome studies of NA were conducted in the early 1990s in London, England. The first study found a roughly linear relationship between the length of membership and abstinence with reduced anxiety and increased self-esteem<ref>{{Cite journal |last1=Christo |first1=George |last2=Franey |first2=Christine |date=April 1995 |title=Drug users' spiritual beliefs, locus of control and the disease concept in relation to Narcotics Anonymous attendance and six-month outcomes |url=https://linkinghub.elsevier.com/retrieve/pii/0376871695011036 |journal=Drug and Alcohol Dependence |language=en |volume=38 |issue=1 |pages=51β56 |doi=10.1016/0376-8716(95)01103-6 |pmid=7648997 |via=Elsevier Science Direct|url-access=subscription }}</ref> While the NA sample had higher anxiety than the non-addicted comparison groups, these levels were equivalent for those with three or more years of membership, which is consistent with the hypothesis that NA membership reduces anxiety as well as substance use. This study also, contrary to the authors' expectations, found that spiritual beliefs and disease concept beliefs were not prerequisites for attendance of NA and even if these beliefs were adopted they were not found to cause external attributions for previous drug use or possible future lapse events. A study of the early experience of new NA members in Victoria Australia in 1995 interviewed 91 members initially and 62 (68%) after 12 months and found that higher self-help participation as measured by service role involvement, step work, and stable meeting attendance, in the 12 months before the follow-up was associated with a four-fold reduction in levels of hazardous drug and alcohol use, less illicit income and sickness benefits and higher emotional support at reinterview.<ref>{{Cite journal |last1=Toumbourou |first1=John Winston |last2=Hamilton |first2=Margaret |last3=U'Ren |first3=Alison |last4=Stevens-Jones |first4=Pru |last5=Storey |first5=Gordon |date=July 2002 |title=Narcotics Anonymous participation and changes in substance use and social support |journal=Journal of Substance Abuse Treatment |language=en |volume=23 |issue=1 |pages=61β66 |doi=10.1016/S0740-5472(02)00243-X|pmid=12127470 |doi-access=free }}</ref> One approach is to provide professional 12-step facilitation (TSF) either in an individual or group setting. TSF sessions are designed to introduce the patient to 12-step concepts and facilitate the entry of the patient into community-based 12-step programs. It must be emphasized that TSF is not NA, it is an implementation of 12-step program elements by a professional counsellor. NA recommends 12 step work with another member who has worked the steps. One study, sponsored by NIDA,<ref>Crits-Christoph P, Siqueland L, Blaine J, Frank A, Luborsky L, Onken LS, Muenz LR, Thase ME, Weiss RD, Gastfriend DR, Woody GE, Barber JP, Butler SF, Daley D, Salloum I, Bishop S, Najavits LM, Lis J, Mercer D, Griffin ML, Moras K, Beck AT. "Psychosocial treatments for cocaine dependence": National Institute on Drug Abuse Collaborative Cocaine Treatment Study. ''Arch Gen Psychiatry''. 1999 Jun;56(6): 493β502.</ref> randomly assigned people using cocaine into four groups, individual drug counseling plus group drug counseling (GDC), cognitive therapy plus GDC, supportive expressive therapy plus GDC, or GDC alone. Individual drug counseling was based on the 12-step philosophy. Group drug counseling was designed to educate patients about the stages of recovery from addiction, to strongly encourage participation in 12-step programs, and to provide a supportive group atmosphere for initiating abstinence and an alternative lifestyle. Nearly 500 patients participated in the study. The results suggested that all four treatment conditions resulted in similar reductions in cocaine use with the IDC + GDC group (TSF) more effective than the other three groups. One issue with this study is that there was significant attrition of patients, with significantly larger numbers of dropouts from the TSF groups than from the others. === Fiorentine 1999 === Fiorentine 1999 was a 24-month longitudinal study measuring the effectiveness of [[Alcoholics Anonymous]] and NA. Like other longitudinal studies, it shows a strong correlation between 12-step attendance and being both clean from drugs and sober from alcohol: People who went to 12-step meetings in the study had about a 75% success rate. In more detail, at the 24-month follow up, 77.7% of people who went to one or more meetings a week self-reported being clean; urinalysis was very close to that figure, showing some 76.4% of the regular attendees being clean. For participants who did not regularly go to meetings, the self-reported figure for being abstinent was 56% and the drug test showed 57.9% being clean. The self-reported figures for excessive alcohol use were similar: 74.8% of regular 12-step attenders self-reported being completely sober, but only 40% of people who did not go to 12-step meetings claimed to be sober. Urinalysis showed 96.6% of people regularly going to meetings as sober, in contrast to the 88.9% of people who did not go to meetings once a week or more whose urine sample was alcohol-free. The report then sees if 12-step meetings have a specific effect (in other words, if there is [[Correlation does not imply causation|causation or merely correlation]]) by using statistical analysis to compare participants self-reported level of motivation, 12-step attendance, and successfully getting clean and sober. The result of this observation was that "Weekly or more frequent 12-step participants are 1.59 times more likely than less-than-weekly participants to maintain abstinence after controlling for the differences in recovery motivation measured by the scale."<ref name="Fiorentine1999">{{Cite journal|year=1999|last1=Fiorentine|first1=Robert|title=After Drug Treatment: Are 12-Step Programs Effective in Maintaining Abstinence?|journal=Am J Drug Alcohol Abuse|volume=25|issue=1|pages=96β116|pmid=10078980|doi=10.1081/ADA-100101848}}</ref>
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