12-step Groups Research Articles

Youth Participation in Mutual Support Groups: History, Current Knowledge, and Areas for Future Research

Mutual support groups have the potential to be a powerful support network for youth with substance use problems. There is a long history of youth being referred to and participating in these groups, yet research regarding the effectiveness of their participation is in its early stages. In recent years, a small but growing body of literature has been devoted to this topic. This article: (1) summarizes the history of youth involvement in mutual support groups; (2) reviews research on youth involvement in mutual support meetings and evidence of effectiveness; (3) describes implementation of and lessons learned from a pilot study that attempted to increase youth attendance and involvement with three types of 12-step groups; and (4) provides recommendations for future research related to mutual support groups and youth.

The Role of Connectedness in Relation to Spirituality and Religion in a Twelve-Step Model

The pervasive nature of substance abuse in the United States dictates that much of the research dollars and time is spent on clinical trials that measure anxiety reduction, medication management and the employing of behavioral models that stress gradual change. While these approaches use controls that can be studied and measured in the empirical sense, they often lack the important personal connections with the research participants. As these trials show less than hoped for efficacy, a new body of research is surfacing including spirituality, along with social supports as ways to aid recovery and reduce relapse. Many 12-step groups incorporate spirituality, as opposed to religion as a mainstay of an individual’s recovery effort. Spirituality is regularly mentioned across most twelve-step programs as an essential part of sustained and ongoing recovery. Practical definitions of spirituality have eluded researchers in part because they struggle to separate it from religion. While it may not be impossible to measure spirituality in an empirical sense, it may be possible to clarify what role spirituality plays in aiding sustained recovery and prevention of relapse into drug using behavior. We will suggest connectedness as an integral component in defining spirituality and demonstrate that in twelve-step recovery spirituality can be defined as gaining knowledge through connectedness to others.

Twelve‐Step attendance trajectories over 7 years among adolescents entering substance use treatment in an integrated health plan

This study examines 12-Step attendance trajectories over 7 years, factors associated with the trajectories, and relationships between the trajectories and long-term substance use outcomes among adolescents entering out-patient substance use treatment in a private, non-profit integrated managed-care health plan. Longitudinal observational study. Four Kaiser Permanente Northern California substance use treatment programs. A total of 391 adolescents entering treatment between 2000 and 2002 who completed at least one follow-up interview in year 1, and at least one during years 3-7, after treatment entry. Alcohol and drug use, 12-Step meeting attendance and activity involvement and post-treatment medical service utilization. Semiparametric group-based modeling identified three distinct 12-Step attendance trajectory groups over 7 years: low/no attendance (60%), early but not continued (26%) and continued (14%). There were lower proportions of males and of adolescents with prior substance use treatment experience in the low/no attendance group (P = 0.019 and P = 0.003, respectively). In addition, those in the low/no attendance group had lower perception on circumstances, motivation and readiness for treatment at baseline (P = 0.023). Multivariate logistic generalized estimating equation analyses found that those in the continued group were more likely to be abstinent from both alcohol and drugs during follow-ups than those in the low/no attendance group [odds ratio (OR) = 2.40, P = 0.003 and OR = 1.96, P = 0.026, respectively]. However, no differences in long-term outcomes were found between those in the other two groups. Robust connection with 12-Step groups appears to be associated with better long-term outcomes among adolescents with substance use disorders.

Commentary on Kelly et al. (2012): Multiple mediation-many mechanisms signal more questions

Using very sophisticated multiple mediator analytical techniques, Kelly et al. [1] have shown empirically that the effects of Alcoholics Anonymous (AA) meeting attendance on abstinence are explained largely by changes that occur in members' social networks, namely: more abstinence influences and fewer heavy drinking influences (which together explain 40% of AA's effect in Project MATCH's aftercare sample and 64% of AA's effect in the less severe out-patient sample). A third mediator, a strengthening in ones' ability to say ‘no’ to drinking in social situations, further fleshes out a story of very effective peer learning in the AA context. The interplay between both negative and positive social networks (i.e. heavy drinkers and abstainers, respectively) is especially important, as it shows that AA works both by reducing the ‘wet’ influences and by increasing the ‘dry’ influences, with both phenomena occurring as the number of meetings increases. Treatment clients often ask whether they will have to jettison their existing friends and family who are heavy drinkers. Kelly et al. show that gains in abstinence can occur without such a seemingly drastic move, by adding only individuals to the network who are supportive of abstinence; but that any reduction in the number of heavy drinkers will yield even more abstinence. Complementing those findings, work on AA mediators from another study has found that having support for less drinking from non-AA members is not associated with abstinence, whereas such support from AA-based social network influences is [2]. This adds still more specificity regarding the type of network changes needed to sustain recovery, and suggests that treatment clients should cultivate a relationship with at least one AA member. One question that arises from my reading of their paper is their rationale for exploring both abstinence and heavy drinking outcomes in the context of AA effects, given that AA's goal is to help members stop drinking (and not to help them simply drink less heavily). Perhaps future analyses could be conducted among the out-patient sample (which was followed for a longer period) to determine whether reductions in heavy drinking lead ultimately to eventual abstinence (and whether that was mediated by subsequent AA attendance). This would be consistent with the now dominant view of a cyclic nature of recovery. Seeing the Kelly et al. results, one cannot help but wonder whether treatments can be developed that can yield similar gains in abstinence for those clients who are resistant to AA and other 12-Step groups. One approach to consider is 12-Step facilitation, such as Project MATCH's 12-Step facilitation [3], or the author's Making AA Easier/MAAEZ [4]. Another is network support facilitation, such as Litt's Network Support intervention [5] that does not rely exclusively on the 12-Step fellowship for the social network mechanism. Interesting mediational effects have been found for these approaches, and have included pro-abstinence influences (as was found here) as well as increases in having a 12-Step sponsor, doing service and feeling comfortable being around 12-Step groups [6,7]. I also encourage moderation analyses that can isolate mechanisms unique to particular subgroups known to be especially challenging to treat, such as those with high levels of prior treatment, prior AA or comorbid psychiatric severity. None.

Clinical service desires of medical cannabis patients

BackgroundMedical cannabis dispensaries following the social or hybrid model offer supplementary holistic services in addition to dispensing medical cannabis. Historically, alternative physical health services have been the norm for these dispensaries, including services such as yoga, acupuncture, or chiropractor visits. A clinical service dearth remains for medical cannabis patients seeking substance use, misuse, dependence, and mental health services. This study examined patient desires for various clinical services and level of willingness to participate in specific clinical services.MethodsAnonymous survey data (N = 303) were collected at Harborside Health Center (HHC), a medical cannabis dispensary in Oakland, CA. The sample was 70% male, 48% Caucasian and 21% African American. The mean male age was 38 years old and female mean age was 30. Sixty two percent of the male participants and 44% of the female participants are single. Sixteen percent of the population reported having a domestic partner. Forty six percent of the participants are employed full time, 41% have completed at least some college, and 49% make less than $40,000 a year.ResultsA significant portion of the sample, 62%, indicated a desire to participate in free clinical services at HHC, 34% would like more information about substances and use, and 41% want to learn more about reducing harms from substance use. About one quarter of the participants marked "would" or "likely would" participate in individual services such as consultation. Approximately 20% indicated "would" or "likely would" participate in psycho-educational forums, harm reduction information sharing sessions, online support groups, and coping, life, and social skills group. There was little interest in traditional NA/AA 12-step groups or adapted 12-step groups.ConclusionsDesired clinical services can be qualified as a combination of harm reduction, educational, skills-based, peer support and therapeutic individual and group services. Results suggest that medical cannabis patients seek more information about various substances, including cannabis. Dispensaries can help to decrease gaps in substance education and clinical services and fulfill unmet clinical desires. More research is necessary in additional medical cannabis dispensaries in different geographic settings with different service delivery models.

Perception of child neglect and psychopathology in a population-based sample of US adults

relationship between substance use and use disorders and religiosity. These studies are largely limited to adolescent or young adult populations in the United States and use proxies for religiosity that have not been validated. Only one study (to our knowledge) uses DSM-IV current diagnostic criteria for alcohol and drug abuse/dependence. No study explores DSM-IV current nicotine dependence. This study explores the relationship between religiosity and multiple substance-related outcomes in an adult Israeli sample using a clearly defined and understood religiosity construct. Methods: Household residents selected from the Israeli Population Registry (n = 1349) were interviewed. Multivariate logistic regression was used to investigate the association between religiosity and 2 types of outcomes: current substance use and current substance use disorders. Demographic covariates were controlled. Results: Self-reported level of religiosity was inversely related to current nicotine, alcohol, and drug use. Secular individuals were more likely than religious individuals to have current nicotine dependence (AOR = 1.92; CI, 1.15-3.21) and alcohol use disorders (AOR = 2.73; CI, 1.26-5.94). Among alcohol users, alcohol use disorders (AOR = 2.33; CI, 1.06-5.12) remained significantly associatedwith religiosity; however, this did not occur for nicotine or drugs. Conclusions: Theeffectof religiosityshouldbestudiedfurther tounderstand its associations with specific substances, especially among substance users, and withinvariouscultures andreligions.Additionally, clinicians shouldbeawareof the effect of religiosity when providing services to clients, as some studies of Alcoholics Anonymous 12-step groups have shown that spirituality is an important component of treatment. Limitations of the study design include data collection by self-report rather than by observation and cross-sectional data that reduce the ability to determine causal direction. Public Health Relevance: Understanding possible protective mechanisms of religiosity, such as social support, social acceptance and inclusion, and a relationship with a “higher authority,” could lead to greater understanding of the etiology of substance use disorders and, eventually, the development of public health policies and clinical interventions.

Postelection violence, posttraumatic stress, and comorbidity of behavioral and emotional problems among Kenyan youth

relationship between substance use and use disorders and religiosity. These studies are largely limited to adolescent or young adult populations in the United States and use proxies for religiosity that have not been validated. Only one study (to our knowledge) uses DSM-IV current diagnostic criteria for alcohol and drug abuse/dependence. No study explores DSM-IV current nicotine dependence. This study explores the relationship between religiosity and multiple substance-related outcomes in an adult Israeli sample using a clearly defined and understood religiosity construct. Methods: Household residents selected from the Israeli Population Registry (n = 1349) were interviewed. Multivariate logistic regression was used to investigate the association between religiosity and 2 types of outcomes: current substance use and current substance use disorders. Demographic covariates were controlled. Results: Self-reported level of religiosity was inversely related to current nicotine, alcohol, and drug use. Secular individuals were more likely than religious individuals to have current nicotine dependence (AOR = 1.92; CI, 1.15-3.21) and alcohol use disorders (AOR = 2.73; CI, 1.26-5.94). Among alcohol users, alcohol use disorders (AOR = 2.33; CI, 1.06-5.12) remained significantly associatedwith religiosity; however, this did not occur for nicotine or drugs. Conclusions: Theeffectof religiosityshouldbestudiedfurther tounderstand its associations with specific substances, especially among substance users, and withinvariouscultures andreligions.Additionally, clinicians shouldbeawareof the effect of religiosity when providing services to clients, as some studies of Alcoholics Anonymous 12-step groups have shown that spirituality is an important component of treatment. Limitations of the study design include data collection by self-report rather than by observation and cross-sectional data that reduce the ability to determine causal direction. Public Health Relevance: Understanding possible protective mechanisms of religiosity, such as social support, social acceptance and inclusion, and a relationship with a “higher authority,” could lead to greater understanding of the etiology of substance use disorders and, eventually, the development of public health policies and clinical interventions.

The Attachment and Clinical Issues Questionnaire (ACIQ): Scale Development

ABSTRACT In line with dynamic systems and dialectical theories of development, it was theorized that a psychopathology such as an addiction could have several causes (equifinality) and that more specific diagnoses and treatments of the most salient clinical issues for individuals coming from different developmental paths could increase the success rates of most therapies. Further, the issues from a developmental dynamic systems perspective should include not only individual clinical issues, but also relational, familial, peer, and organizational functioning. The Attachment and Clinical Issues Questionnaire (ACIQ) was developed as a research and clinical instrument relevant to these concerns. The 29 scales were based on naturalistic observations of patients in treatment and 12-step groups, attachment theory, and the clinical literature dealing with the addictions. The attachment scales were taken from classic attachment theory but, in line with more recent formulations, included relations to mother, father, and partner. Study 1 found the ACIQ to have good coefficient alphas (.79), and factor analyses revealed that the eight factors loaded on different attachment figures and sets of clinical issues rather than attachment styles per se. Study 2 found test–retest reliability to be, on average, .79. The results were in line with the developmental hypothesis that partner and father attachments are different than attachments to mother, and that family and peer relations as well as clinical issues need to be considered separately.

Attachment Avoidance and Anxiety as Predictors of 12-Step Group Engagement

Twelve-step mutual help groups such as Alcoholics Anonymous (AA) rely heavily on social interactions and support to reduce drinking, but little is known about how individual differences in social behavior tendencies, such as adult attachment, affect 12-step group engagement and resulting benefits. This prospective study investigated relationships between the anxiety and avoidance dimensions of adult attachment and subsequent 12-step meeting attendance, program behaviors, sponsorship, and alcohol use. Early 12-step group affiliates (N = 253) were recruited from community-based AA and from outpatient treatment. Participants completed baseline interviews that included the Relationship Questionnaire, measures of motivation and professional treatment, and measures of 12-step meeting attendance, practices, and sponsorship. Follow-up interviews were conducted at 3, 6, 9, 12, 18, and 24 months. At baseline, participants reported elevated attachment anxiety relative to a college population. Lagged analyses demonstrated that, as predicted, high attachment avoidance was related to lower rates of 12-step meeting attendance, practice of behaviors prescribed by 12-step organizations, and lower probability of acquiring a sponsor. Attachment anxiety did not predict any of these aspects of subsequent 12-step group engagement. Contrary to predictions, baseline attachment avoidance did not moderate the relationship between early sponsorship and alcohol use. Findings support the hypothesis that social demands of behaviors prescribed by 12-step groups may deter high-avoidance individuals from fully engaging in them. Perhaps because of instability in attachment avoidance in this population, however, baseline attachment avoidance did not predict drinking outcomes or moderate sponsor benefits.

How Practice and Science Are Balanced and Blended in the NIDA Clinical Trials Network: The Bidirectional Process in the Development of the STAGE-12 Protocol as an Example

Background: Bidirectional, collaborative partnerships between academic researchers and practitioners have been a fundamental vehicle to achieve the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) goal of improving outcomes of community-based drug treatment. These partnerships blend clinical perspectives of practitioners and methodological expertise of researchers working together to address clinically meaningful issues through randomized clinical trials conducted in community treatment settings. Objectives: Bidirectionality is a guiding principle of the CTN, but its operationlization at the practical level in protocol development and implementation has not been articulated. This descriptive article presents the development of one protocol as an example and model of this bidirectional, collaborative, iterative partnership between researchers and practitioners. Methods: This article illuminates several specific issues encountered while developing STAGE-12, a behavioral intervention to facilitate 12-step mutual support group involvement, as well as the rationale for decisions taken to resolve each. Results: The STAGE-12 protocol was successfully developed through a series of decisions taking into account both design factors and clinical practice needs and realities, thus maintaining a balance between methodological rigor and generalizability. Conclusion: The review demonstrates the process by which research and practice have been blended in protocol development, exemplifying the underlying principle of bidirectionality, a key element in the success of the NIDA CTN. Scientific Significance: Bidirectional partnerships as derived in the CTN, employing a hybrid model of efficacy-effectiveness research, are capable of designing and implementing protocols that are both methodologically rigorous and clinically meaningful, thus increasing likelihood of adoption and eventual improvement in public health.

Behavioral Couples Therapy for Alcoholism and Drug Abuse

Behavioral Couples Therapy (BCT) is designed for married or cohabiting individuals seeking help for alcoholism or drug abuse. BCT sees the substance-abusing patient together with the spouse or live-in partner. Its purposes are to build support for abstinence and to improve relationship functioning. BCT promotes abstinence with a “recovery contract” that involves both members of the couple in a daily ritual to reward abstinence. BCT improves the relationship with techniques for increasing positive activities and improving communication. BCT also fits well with 12-step or other self-help groups, individual or group substance-abuse counseling, and recovery medications. Research shows that BCT produces greater abstinence and better relationship functioning than typical individual-based treatment and reduces social costs, domestic violence, and emotional problems of the couple's children. Thus, research evidence supports wider use of BCT. It is hoped that this article and new print and Web-based resources on how to implement BCT will lead to increased use of BCT to the benefit of substance-abusing patients and their families.

12-Step Involvement and Treatment Outcomes Among Young Women With Substance Use Disorders

The extent to which young women with substance use disorders (SUDs) affiliate with Alcoholics Anonymous (AA) or other 12-Step groups is currently unclear. This administrative data analysis examined 12-Step involvement and its impact on outcome during the first 6 months following treatment among a sample of young adults attending 12-step–based residential treatment. Young women were just as likely as similar-aged young men to attend 12-Step meetings and engage in prescribed 12-Step practices like getting a sponsor. Frequency of meeting attendance predicted abstinence status and number of drinking days at 6 months in women, whereas 12-Step experiences (e.g., getting a sponsor, considering oneself an AA member) predicted drinking days in men. The results contribute to knowledge of SUDs and their treatment among women in their late teens and early twenties, a population that has been quite understudied in the literature.

Intensive referral to 12-step dual-focused mutual-help groups

Background: This study implemented and evaluated procedures to help clinicians effectively refer dually diagnosed (substance use and psychiatric disorders) patients to dual-focused mutual-help groups (DFGs).Methods: Using a cohort cyclical turnover design, individuals with dual diagnoses beginning a new outpatient mental health treatment episode (N=287) entered a standard- or an intensive-referral condition. Participants provided self-reports of 12-step mutual-help (DFG and substance-focused group [SFG]) attendance and involvement and substance use and psychiatric symptoms at baseline and six-month follow-up. The intensive referral intervention focused on encouraging patients to attend DFG meetings.Results: Compared to patients in the standard condition, those in the intensive referral intervention were more likely to attend and be involved in DFGs and SFGs, and had less drug use and better psychiatric outcomes at follow-up. Attending more intensive-referral sessions was associated with more DFG and SFG meeting attendance. More need fulfillment in DFGs, and more readiness to participate in SFGs, were associated with better alcohol and psychiatric outcomes at six months. However, only 23% of patients in the intensive-referral group attended a DFG meeting during the six-month follow-up period.Conclusions: The intensive referral intervention enhanced participation in both DFGs and SFGs and was associated with better six-month outcomes. The findings suggest that intensive referral to mutual-help groups focus on its key components (e.g., linking patients to 12-step volunteers) rather than type of group.

Bipolar Illness, God, and Object Relations: The Treatment of M

This article explores the concomitant change in one client's object relations and his image of God that occurred in the context of psychoanalytically oriented psychotherapy. The case demonstrates the benefit of long-term psychoanalytically oriented treatment to help an individual with major mental illness to heal emotionally, mentally, and spiritually. The client, who suffers from bipolar I disorder, experienced significant developmental mastery as he moved from the paranoid/schizoid position to the depressive position (developmental stages conceptualized by theorists Melanie Klein and Douglas Fairbairn). In addition, the psychotherapy mitigated the effects of homonegativity on M's self-image and his experience of his homosexuality. Through our work, the client began to see and interact with this clinical social worker, others, and the God of his understanding, in a more realistic and healthy manner. M's participation in a 12-Step group and his adherence to its beliefs augmented changes he made through psychotherapy. Through a long-term psychoanalytically oriented psychotherapy and involvement in Al-Anon meetings, the client's belief in a punishing God shifted toward a more benevolent one—a God who had a plan for his life that was revealed through the transformation of his suffering. In summary, M's object relations changed toward a greater balance of emotions and development of more textured relationships, including his relationship toward himself and God.

12-step self-help group participation as a predictor of marijuana abstinence

This study examined the associations between 12-step self-help group participation following substance abuse treatment and abstinence from marijuana use at 1-, 2-, and 5-years post-treatment. These associations were examined among 1288 male patients of the Department of Veterans Affairs who used marijuana within the 3 months prior to admission to treatment and discontinued use at treatment discharge. Consistent with expectation, 12-step self-help group attendance during the 3 months prior to each follow-up was significantly related to corresponding rates of abstinence at each follow-up time point. Additionally, 12-step self-help group attendance predicted more distal marijuana abstinence and recent attendance added to the prediction. Subsidiary analyses indicated that self-help attendance was important both for the maintenance of marijuana abstinence and for the re-initiation of abstinence after a relapse. Results are discussed in relation to better understanding the role of 12-step self-help group attendance in the initiation and maintenance of marijuana abstinence.

Social Recovery, Social Capital, and Drug Courts

Drug courts were established for criminal offenders whose primary offense is related to drug use. As an alternative to incarceration, the drug court incorporates drug treatment with close judicial supervision. A team approach includes the judge, public defender, case workers and/or treatment providers, and a coordinator. Traditional drug court treatment programs offer therapeutic approaches that include mandatory counseling, 12-step (self-help) group meetings, attendance at regular court sessions, random drug testing, and, in some cases, life skills training (Nolan 2003). Some drug courts place particular emphasis on furthering participants' education and their job skills. In these examples, employment and education are seen as important treatment outcomes (Leukefield 2007; Deschenes 2009). Adding services to drug court programs such as employment and educational resources and increasing the number of residential treatment beds also improves retention rates for participation and helps contain recidivism rates (Deschenes 2009). Most studies find drug court participants to have substantially lower re-arrest rates than comparison samples, with recidivism as low as 27 percent compared to 70 percent for drug offenders who did not participate in a drug court program (Belenko 1998; May 2008).

What Did We Learn from Our Study on Sober Living Houses and Where Do We Go from Here?

Lack of a stable, alcohol- and drug-free living environment can b e a serious obstacle to sustained abstinence. Destructive living environments can derail recovery for even highly motivated individuals. Sober living houses (SLHs) are alcohol- and drug-free living environments for individuals attempting to abstain from alcohol and other drugs. They are not licensed or funded by state or local governments and the residents themselves pay for costs. The philosophy of recovery emphasizes 12- Step group attendance and peer support. We studied 300 individuals entering two different types of SLHs over an 18-month period. This article summarizes our published findings documenting resident improvement on measures of alcohol and drug use, employment, arrests, and psychiatric symptoms. Involvement in 12-Step groups and characteristics of the social network were strong predictors of outcome, reaffirming the importance of social and environmental factors in recovery. This article adds to our previous reports by providing a discussion of implications for treatment and criminal justice systems. We also describe the next steps in our research on SLHs, which will include: (1) an attempt to improve outcomes for residents referred from the criminal justice system and (2) a depiction of how attitudes of stakeholder groups create a community context that can facilitate and hinder the legitimacy of SLHs as a recovery modality.

What They Want

Objectives Although a variety of therapies exist for the treatment of substance use disorders, little emphasis is placed on allowing individuals to choose their own treatment trajectories. Considering the preference of a person for the type of substance abuse treatment; he or she would want to be made to feel important and in allowing the person to feel autonomous, which may impact the overall motivation for substance abuse behavior change. Methods The investigators assessed 51 country detention facility inmates recently arrested on drug-related or alcohol-related charges, examining the motivational factors and treatment preference when presented with 2 hypothetical treatments. Results The findings showed that the group was relatively evenly split in terms of the percent choosing each treatment. Furthermore, individuals who reported preferring an abstinence-based philosophy of treatment had higher levels of readiness to change than those choosing a harm reduction philosophy. Conclusions The results of this study have implications for developing brief interventions that could help facilitate the entry of motivated substance users into 12-step groups.

Perceptions of 12-Step Interventions Among UK Substance-Misuse Patients Attending Residential Inpatient Treatment in a UK Treatment Setting

In spite of a considerable evidence base suggesting the benefits of participation in Alcoholics Anonymous and other 12-step fellowships, most studies have been conducted in the United States. Preliminary studies have suggested that clients in addiction treatment in the United Kingdom may be more ambivalent about 12-step groups, and the current article examines barriers and pathways to engagement in 12-step recovery support groups for 125 drug and alcohol users (84.5% of the total sample) attending an inpatient detoxification unit in Birmingham, England. Two-thirds (69.4%) reported prior attendance at 12-step meetings, but current levels of affiliation were low and significant barriers to 12-step meeting attendance were identified. Barriers to participation include the perceived religious components of 12-step meetings, prior negative experiences in 12-step meetings, failure to identify with group members, and difficulties simultaneously participating in both 12-step meetings and structured treatment.

Stigma and Treatment for Alcohol Disorders in the United States

Among a nationally representative sample of adults with an alcohol use disorder, the authors tested whether perceived stigmatization of alcoholism was associated with a lower likelihood of receiving alcohol-related services. Data were drawn from a face-to-face epidemiologic survey of 34,653 adults interviewed in 2004-2005 who were aged 20 years or older and residing in households and group quarters in the United States. Alcohol abuse/dependence was diagnosed by using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, version (AUDADIS-IV). The stigma measure used was the Perceived Devaluation-Discrimination Scale. The main outcome was lifetime intervention including professional services and 12-step groups for alcohol disorders. Individuals with a lifetime diagnosis of an alcohol use disorder were less likely to utilize alcohol services if they perceived higher stigma toward individuals with alcohol disorders (odds ratio = 0.37, 95% confidence interval: 0.18, 0.76). Higher perceived stigma was associated with male gender (β = -0.75; P < 0.01), nonwhite compared with non-Hispanic white race/ethnicity, lower income (β = 1.0; P < 0.01), education (β = 1.48; P < 0.01), and being previously married (β = 0.47; P = 0.02). Individuals reporting close contact with an alcohol-disordered individual (e.g., relative with an alcohol problem) reported lower perceived stigma (β = -1.70; P < 0.01). A link between highly stigmatized views of alcoholism and lack of services suggests that stigma reduction should be integrated into public health efforts to promote alcohol treatment.