Maryhaven, drug abuse treatment center located in Columbus, OH combines a core commitment to 12-step principles and practices with the use of scientifically derived treatment interventions. Treatment goals include abstinence from substance abuse, patient engagement and progress in 12-step activities, and strong patient affiliation with 12-step organizations within the community. The 12-step process of change includes consciousness-raising, social liberation, emotional arousal, self-reevaluation, commitment, countering, environmental control, reward, and helping relationships. Twelve-step oriented providers like Maryhaven are dedicated to this approach and are not looking to research for replacements. While these treatments are effective at achieving their primary goals of 12-step organization affiliation and alcohol and other drug abstinence, there is little understanding of the processes of these programs. Some patients do not have an optimal response to current practices. It is difficult to predict who will benefit from 12-step organizations. Empirical investigation into improving these programs is lacking. Some of the questions about 12-step approaches that remain to be investigated are the optimum duration, the best way to maintain involvement, annual addiction checkups, and the structure of these checkups and booster sessions. Conducting research on 12-step organizations presents many barriers to investigators. Treatment programs that incorporate the 12 steps into their approach are readily available for investigation. Many are eager to incorporate improvements that are compatible with their basic approach and treatment goals. Research for treatment improvement has been conducted on how 12-step facilitation compares in effectiveness to typical drug treatment; the mechanisms of change; and meeting attendance. A review of the 12-step related treatment research suggests a number of areas where parallels in clinical observations and empirical investigations suggest possibilities for improving 12-step related treatment. 23 references