ment self-help groups predicted better outcome among a group of cocaine or alcohol dependent veterans in a day hospital rehabilitation program. Timko et al., (1994) found that more AA attendance was associated with better 1-year outcomes among previously untreated problem drinkers regardless of whether they received inpatient, outpatient, or no other treatment. Finally, a recent review of the literature on the impact of self-help programs concluded that greater participation was generally associated with better alcohol and psychosocial outcomes, although the magnitude of the effects tended to vary as a function of the quality of the study and whether patients were treated in inpatient or outpatient settings (Tonigan et al., 1996).

There has been less research in the use of self-help organizations among cocaine and/or opiate dependent patients. However, a recent study of cocaine patients participating in outpatient counseling and psychotherapy showed that while only 34% attended a cocaine anonymous (CA) meeting, 55% of those who did became abstinent as compared with only 38% of those who did not attend CA.

In contemporary addiction treatment, AA has become synonymous with the last part of rehabilitation—aftercare. Virtually all alcohol dependence rehabilitation programs and most cocaine dependence rehabilitation programs refer patients to AA programs with instructions to get a sponsor, "share and chair" at meetings, and to attend 90 meetings in 90 days as a continued commitment to sobriety. Thus, while the research studies done to date have generally suggested that the peer support component of rehabilitation is valuable, it is also difficult to sort out the extent to which AA attendance constitutes an active ingredient of successful treatment and/or the extent to which it is simply a marker of general treatment compliance and commitment to abstinence.

In this regard, several investigators have studied the relationship of completing various 12-step processes during the course of rehabilitation, to relapse following treatment. Morgenstern and colleagues reported that patients who adopted more of the attitudinal and behavioral tenets of the 12-step model of rehabilitation such as admission of powerlessness, acceptance of a higher power, commitment to AA, and agreement that alcoholism is a disease, were no more (or less) likely to relapse following treatment than patients who had adopted very few of the 12-step tenets by the end of the rehabilitation treatment (Morgenstern et al., 1997). At the same time, two general tenets found in all rehabilitation models—greater commitment to abstinence and greater intention to avoid high risk situations—did predict a lower likelihood of relapse (Morgenstern et al., 1997). In another analysis from the same study, greater affiliation with AA following treatment predicted better outcomes. AA affiliation was in turn positively associated with self-efficacy, motivation, and coping efforts, which were themselves signifi-