Substance Use Treatment Among Veterans: Self-Help's Impact before, during, or Both

Background and Purpose: Self-help groups, including 12-step programs for substance use disorder (SUD), offer no-cost, accessible support that can complement formal treatment, particularly benefiting veterans through community, structure, and purpose. Yet, the differential impact of self-help group attendance on treatment outcomes for veterans remains underexplored. This study aimed to 1) Investigate the relationship between attendance in self-help groups 30 days before substance use treatment and treatment outcomes, including changes in primary substance use and discharge type (planned discharge or dropped/terminated from treatment). 2) Examine the relationship between attendance in self-help groups during substance use treatment and treatment outcomes, including changes in primary substance use and discharge type (planned discharge or dropped/terminated from treatment).

Methods: Research objectives were achieved through secondary data analysis using the 2019 Treatment Episode Dataset-Discharge (TEDS-D) dataset. TEDS-D contains annually collected data on adolescent and adult discharges from state-funded substance use treatment providers. A sample of adult veteran admissions with no prior substance use treatment who were in outpatient treatment for at least 30 days was used for analyses. We used descriptive statistics, crosstabulations, and two multivariable logistic regression models. Model 1 analyzed changes in primary substance use frequency at discharge, while Model 2 examined discharge type including planned discharge or dropped/terminated from treatment.

Results: Among the sample (N=5,593), 59.20% did not attend self-help in the 30 days prior to admission or discharge, while 17.84% attended prior to both. 6.24% attended prior to admission only, and 16.72% attended prior to discharge only. Compared to veterans who did not attend self-help in the 30 days prior to admission or discharge, those who attended prior to discharge only had 1.89 times the odds of reduced use or sustained no use at discharge versus increased or sustained use when controlling for the other variables in the model (AOR= 1.89, z = 5.83, p < .001) with a 95% CI [ 1.53, 2.35]. Additionally, compared to veterans who did not attend self-help in the 30 days prior to admission or discharge, those who attended before discharge had 3.67 times higher odds of having a planned discharge relative to dropping out or being terminated from treatment when controlling for the other variables in the model (AOR= 3.67, z = 8.70, p < .001) with a 95% CI [2.74, 4.92].

Conclusion and Implications: The findings of this study highlight the significant positive impact of self-help group attendance on SUD treatment outcomes among veterans. Attendance during treatment is particularly beneficial compared to no attendance. Study results suggest that engagement with self-help groups throughout treatment is vital to improving outcomes. The study could not distinguish between specific types of self-help groups involved, such as 12-step programs, peer support, or other mutual aid groups. Additionally, while the results are promising, they do not establish causality. Further research is necessary to explore how different forms of self-help impact treatment outcomes and understand how self-help attendance supports recovery among veterans.