OBJECTIVE: The clinical practice guidelines for substance use disorders from the American Psychiatric Association (APA) recommend referral of some patients to self-help groups. The purpose of this study was to determine current patterns of referral to self-help groups in substance abuse treatment programs in the United States and compare them with referral recommendations in APA guidelines. METHODS: Directors of all 389 substance abuse treatment programs in the Department of Veterans Affairs health care system completed a mailed survey on posttreatment self-help referral practices. RESULTS: Survey responses indicated that a large proportion of substance abuse patients were referred to Alcoholics Anonymous (79.4 percent), with other self-help organizations receiving a smaller but significant number of referrals. Referrals to 12-step self-help organizations were more common in programs that endorsed a 12-step treatment orientation and that employed a higher proportion of staff members in recovery from substance use disorders. Consistent with APA practice guidelines, clinicians were less likely to make a referral to a 12-step self-help group if a patient was an atheist, had a comorbid psychiatric disorder, or had less severe substance abuse problems. In deciding whom to refer to self-help groups, clinicians also considered other variables that are not addressed in current practice guidelines, such as age and previous involvement in 12-step groups. CONCLUSIONS: Clinicians make extensive use of self-help groups for their patients, as recommended in APA practice guidelines. However, some differences between current practice and recommended practice warrant further investigation.