The Views and Experiences of Drug and Alcohol Treatment Professionals and People Seeking Recovery from Substance Dependency, that Influence Referral To, and Attendance at Twelve Step Groups in the UK: A Systematic Review of Qualitative Studies

Abstract

Background: There is a high level of drug related mortality and morbidity in the UK. Although treatment is effective in reducing harm, funding cuts combined with unmet demand present significant public health challenges. Twelve-step groups (TSGs) are an approach to treatment that can improve recovery outcomes and reduce healthcare costs. This review examined the factors that influence referral to and attendance at TSGs in the UK, through the views and experiences of drug and alcohol treatment professionals (DATPs) and people seeking recovery from substance dependency (PSRFSD).

Methods: A qualitative systematic review was undertaken. A literature search was conducted on Medline, PsycInfo, Web of Science and CINAHL matching relevant eligibility criteria from inception to February 2021. The search strategy was developed using a PICo framework. Inclusion criteria were primary studies of qualitative data undertaken in the UK. Quality of the included studies was appraised using the CASP (2018) Qualitative Checklist. Analysis of the studies was conducted by utilising Thematic Synthesis (Thomas and Harden, 2008).

Results: Five studies were included in the review. The heterogeneity of study aims within the review provided a diverse range of evidence, illustrating similarities and differences within the themes across both review populations. There were no significant concerns about the quality of included studies. Three analytical themes emerged: ‘benefits’, ‘concerns’, and ‘knowledge’. There were many reported ‘benefits’ of TSGs. Many of the ‘concerns’ and gaps in ‘knowledge’ about TSGs were shared between DATPs and PSRFSD, with the main exception of risk, which was limited to DATPs. Some contributing factors to ‘concerns’ related to gaps in ‘knowledge’. 

Conclusions: This review provided the first synthesis of the views and experiences of both review populations on this topic in the UK. It emerged that there are both positive and negative influencing factors shared across both populations and some key differences. Varying levels of knowledge and understanding about twelve-step recovery were apparent. This lack of clarity may disable both review populations from making informed decisions as to whether TSG attendance might be helpful. Improved knowledge, through training, could assist DATPs to provide consistent advice, guidance and twelve-step facilitation (TSF). Recommendations are made for training content, revised practitioner guidance, and improved TSF, where appropriate.