John F. Kelly, Ph.D. , Mass. General Hospital
Adolescents can benefit from 12-step involvement
Adolescents who misuse alcohol and other drugs to the point where they need treatment must contend with costly and limited options for youth-specific care, as well as high relapse rates following treatment. Mutual-help groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are widely available but little research has addressed their benefits for adolescents. An assessment of 12-step meetings and recommended activities has found that attendance, participation, and finding a sponsor promote greater abstinence among adolescents.
Results will be published in the July 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
"Most substance use disorder (SUD) treatment is short-term and relapse rates post-discharge are typically high without continued support," explained John F. Kelly, associate director of the Center for Addiction Medicine at Massachusetts General Hospital, and associate professor in psychiatry at Harvard Medical School. "Mutual-help organizations such as AA and NA can help fill this gap, providing free and flexible long-term recovery support in the communities in which people live."
Kelly and his co-author assessed 127 adolescent outpatients (95 males, 32 females) aged 14-19 years old – who were enrolled in a naturalistic study of treatment effectiveness – at intake as well as at three, six, and 12 months later. Effects of the youths' attendance and active involvement in activities, such as contact with their sponsor, on their subsequent abstinence were tracked over time.
"We found that about one quarter to one third of the youth attended AA/NA throughout the year-long study period following treatment, and that more meeting attendance was associated with significantly better substance use outcomes – particularly attending meetings at least once per week or more," said Kelly. "Importantly, youth who also were in contact with an AA or NA sponsor or who participated verbally during AA/NA meetings had an even better outcome over and above the positive effects from merely attending. These findings support the common clinical recommendation that individuals should 'go to meetings, get a sponsor, and get active.' This is the first evidence to support this common clinical recommendation among young people."
Kelly suggested that medical practitioners, counselors, and other clinicians can enhance the likelihood that youth will attend and participate in AA/NA by encouraging or facilitating their attendance early in treatment.
"Starting an on-site NA or AA young person's meeting is another good idea," he added. "Not all youth will be motivated to attend, but the more severely substance-involved ones will be more likely to give meetings a try and these are the ones most likely to benefit. It is also a good idea to facilitate a good match between the patient's primary substance, cannabis/other drugs or alcohol, and the mutual-help organization to which they are being referred, Marijuana Anonymous, NA, or AA. Not doing this can lead to a poor initial match, which can be difficult to overcome."
Kelly said that one of the key elements to success in 12-step involvement is the creation of a personal connection between the patient and an existing community AA or NA member.
"This community member can then make introductions, answer questions, and generally act as an initial guide and onsite facilitator," he said. "This is probably the most significant part of ensuring that young people get to their first meeting and have a positive experience – it's hard for anyone to walk in 'cold' to a large AA or NA meeting. Another possibility is for parents or counselors to take adolescents to meetings or to arrange to meet them at meetings to help facilitate attendance and engagement. Once there, young people report that they like the camaraderie and social affiliation offered at meetings; they appreciate knowing that they are not the only ones suffering from addiction problems, and they report liking the attention, care, and support they get at meetings."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. The co-author of the ACER paper, "Youth Recovery Contexts: The Incremental Effects of 12-Step Attendance and Involvement on Adolescent Outpatient Outcomes," was Karen Urbanoski of the Center for Addiction Medicine at the Massachusetts General Hospital, and Harvard Medical School. The study was funded by the National Institute on Alcohol Abuse and Alcoholism. This release is supported by the Addiction Technology Transfer Center Network at http://www.ATTCnetwork.org.