Sociology, Department of


Date of this Version



Patient Education and Counseling 101 (2018), pp. 79–84.

doi: 10.1016/j.pec.2017.07.012


U.S. Government Work


Objective: A multisite field trial testing whether improved outcomes associated with intensive referral to mutual help groups (MHGs) could be maintained after the intervention was adapted for the circumstances and needs of rural veterans in treatment for substance use disorder (SUD). Methods: In three Veterans Affairs treatment programs in the Midwest, patients (N = 195) received standard referral (SR) or rural-adapted intensive referral (RAIR) and were measured at baseline and 6-month follow-up. Results: Both groups reported significant improvement at 6 months but no significant differences between SR and RAIR groups in MHG participation, substance use, addiction severity, and posttraumatic stress symptoms. Inconsistent delivery of the intervention resulted in only one-third of the RAIR group receiving the full three sessions, but this group reported significantly greater 6-month abstinence from alcohol than those receiving no sessions. Conclusion: Further research should explore implementation problems and determine whether consistent delivery of the intervention enhances 12-step facilitation. Practice implications: The addition of rural-specific elements to the original intensive referral intervention has not been shown to increase its effectiveness among rural veterans.