Youth Recovery Contexts: The Incremental Effects of 12-Step Attendance and Involvement on Adolescent Outpatient Outcomes

Authors

  • John F. Kelly,

    Corresponding author
    • Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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  • Karen Urbanoski

    1. Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Reprint requests: Dr. John F. Kelly, Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, 60 Staniford Street, Boston, MA 02114; Tel.: 617-643-1980; Fax 617-643-1998; E-mail: jkelly11@partners.org

Abstract

Background

A major barrier to youth recovery is finding suitable sobriety-supportive social contexts. National studies reveal most adolescent addiction treatment programs link youths to community 12-step fellowships to help meet this challenge, but little is known empirically regarding the extent to which adolescents attend and benefit from 12-step meetings or whether they derive additional gains from active involvement in prescribed 12-step activities (e.g., contact with a sponsor and other fellowship members). Greater knowledge in this area would enhance the efficiency of clinical continuing care recommendations.

Methods

Adolescent outpatients (N = 127; M age 16.7; 75% male; 87% white) enrolled in a naturalistic study of treatment effectiveness were assessed at intake and 3, 6, and 12 months later using standardized assessments. Mixed-effects models, controlling for static and time-varying confounds, examined the concurrent and lagged effects of 12-step attendance and active involvement on abstinence over time.

Results

The proportion attending 12-step meetings was relatively low across follow-up (24 to 29%), but more frequent attendance was independently associated with greater abstinence in concurrent and, to a lesser extent, lagged models. An 8-item composite measure of 12-step involvement did not enhance outcomes over and above attendance, but separate components did; specifically, greater contact with a 12-step sponsor outside of meetings and more verbal participation during meetings.

Conclusions

The benefits of 12-step participation observed among adult samples extend to adolescent outpatients. Community 12-step fellowships appear to provide a useful sobriety-supportive social context for youths seeking recovery, but evidence-based youth-specific 12-step facilitation strategies are needed to enhance outpatient attendance rates.

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