have demonstrated efficacy in randomized-controlled trials in promoting alcohol abstinence. A systematic review published in 2017 found that twelve-step programs for reducing illicit drug use are neither better nor worse than other interventions. Criticism In the past, some medical professionals have criticized 12-step programs as "a cult that relies on God as the mechanism of action" and as lacking any experimental evidence in favor of its efficacy. Ethical and operational issues had prevented robust randomized controlled trials from being conducted comparing 12-step programs directly to other approaches. More recent studies employing non-randomized and quasi-experimental studies have shown 12-step programs provide similar benefit compared to motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT), and were more effective in producing continuous abstinence and remission compared to these approaches. Confidentiality The Twelve Traditions encourage members to practice the spiritual principle of anonymity in the public media and members are also asked to respect each other's confidentiality. This is a group norm, however, and not legally mandated; there are no legal consequences to discourage those attending twelve-step groups from revealing information disclosed during meetings. Statutes on group therapy do not encompass those associations that lack a professional therapist or clergyman to whom confidentiality and privilege might apply. Professionals and paraprofessionals who refer patients to these groups, to avoid both civil liability and licensure problems, have been advised that they should alert their patients that, at any time, their statements made in meetings may be disclosed. Cultural identity One review warned of detrimental iatrogenic effects of twelve-step philosophy and labeled the organizations as cults, while another review asserts that these programs bore little semblance to religious cults and that the techniques used appeared beneficial to some. Another study found that a twelve-step program's focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity. Another study asserts that the prior cultural identity may not be replaced entirely, but rather members found adapted a bicultural identity. See also Addiction recovery groups Drug rehabilitation Effectiveness of Alcoholics Anonymous Group psychotherapy List of twelve-step groups Self-help groups for mental health Recovery model References Further reading Scholarly publications Alcohol abuse Drug rehabilitation Spirituality Support groups