Mediational relations between 12-Step attendance, depression and substance use in patients with comorbid substance dependence and major depression
Article first published online: 10 AUG 2012
© 2012 The Authors. Addiction © 2012 Society for the Study of Addiction
Volume 107, Issue 11, pages 1974–1983, November 2012
How to Cite
Worley, M. J., Tate, S. R. and Brown, S. A. (2012), Mediational relations between 12-Step attendance, depression and substance use in patients with comorbid substance dependence and major depression. Addiction, 107: 1974–1983. doi: 10.1111/j.1360-0443.2012.03943.x
- Issue published online: 5 OCT 2012
- Article first published online: 10 AUG 2012
- Accepted manuscript online: 11 MAY 2012 07:37AM EST
- Manuscript Accepted: 4 MAY 2012
- Manuscript Revised: 9 JAN 2012
- Manuscript Received: 4 NOV 2011
- Department of Veterans Affairs
- Veterans Health Administration
- Office of Research and Development
- Clinical Sciences Research and Development
- Alcohol dependence;
- cognitive-behavioral therapy;
- drug dependence;
- 12-Step meetings;
- twelve-step facilitation
Among patients with substance dependence and comorbid major depressive disorder (MDD) receiving treatment in a controlled trial, we examined if group differences in depression were mediated by 12-Step involvement, and if the effects of 12-Step involvement on future alcohol and drug use were mediated by reductions in depression.
Controlled trial of Twelve-Step facilitation (TSF) and integrated cognitive–behavioral therapy (ICBT), delivered in out-patient groups for 6 months with adjunct pharmacotherapy.
Out-patient dual diagnosis clinic in Veteran's Affairs Healthcare Center.
Veterans (n = 209) diagnosed with alcohol, stimulant or marijuana dependence and substance-independent MDD.
Twelve-Step attendance and affiliation, depression severity, percentage of days drinking and percentage of days using drugs assessed at baseline and months 3, 6 and 9.
In multi-level analyses greater 12-Step meeting attendance predicted lower depression and mediated the superior depression outcomes of the TSF group, explaining 24.3% of the group difference in depression. Independent of treatment group, lower depression severity predicted lower future alcohol use and mediated the effects of 12-Step meetings, explaining 15.7% of their effects on future drinking. Controlled, lagged models indicated these effects were not confounded by current substance use, suggesting that depression had unique associations with 12-Step meeting attendance and future drinking.
For patients with substance dependence and major depressive disorder, attendance at 12-Step meetings is associated with mental health benefits that extend beyond substance use, and reduced depression could be a key mechanism whereby 12-Step meetings reduce future drinking in this population.