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Mediational relations between 12-Step attendance, depression and substance use in patients with comorbid substance dependence and major depression


Correspondence to: Sandra A. Brown, University of California, San Diego, MC 0043 La Jolla, CA 92093-0043, USA. E-mail:



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.

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