June 2, 2008 While Alcoholics Anonymous (AA) has existed for more than 70 years, and is the most commonly sought source of help for alcohol-related problems in the United States, there is little "hard scientific evidence" showing that AA and Narcotics Anonymous (NA) can improve substance-use outcomes. This study examined how helpful AA and NA may be for adolescents, finding long-term benefits even though many youth discontinue attendance after time.
"It is difficult to evaluate the efficacy of mutual-help organizations like AA through randomized controlled experiments because the AA 'intervention,' being a community organization based on anonymity, cannot be directly under the control of the researcher in the usual way," explained John F. Kelly, associate director of the MGH-Harvard Center for Addiction Medicine at Massachusetts General Hospital, and assistant professor in psychiatry at Harvard Medical School.
Yet their popularity and cost-effectiveness cannot be denied, added Kelly, also the study's corresponding author.
"AA and NA are explicitly focused on abstinence and addiction recovery, they are widely available across most communities, they provide entry to a social network of recovery-specific support and sober events that can be accessed 'on demand' -- particularly at times of high-relapse risk such as evenings and weekends, the services are free, and AA/NA can be attended as intensively, and for as long, as individuals desire," he said.
However, he added, despite growing evidence that adults benefit from AA and NA, little is known about how these abstinence-focused organizations help youth, and what is known lacks scientific rigor.
"This knowledge gap is particularly noteworthy given that adolescents and young adults face more barriers to AA and NA than older adults and yet appear to be referred there just as frequently by treatment providers," said Kelly. "Youth tend to have less severe addiction problems, on average, and consequently do not feel a strong need to stop using alcohol and/or drugs. 'Why should they bother to go to abstinence-oriented organizations like AA and NA, and would they benefit even if they did go?'" These are the questions Kelly and his colleagues wanted to address.
The researchers recruited 160 adolescent inpatients (96 males, 64 females), with an average age of 16 years, who were enrolled at two treatment centers in California having a focus on abstinence and based on a 12-step model. The study participants' length of stay ranged from four to six weeks, after which they were re-assessed on a number of clinical variables at six months, and one, two, four, six, and eight years.
"We found that most of the youth attended at least some AA/NA meetings post-treatment," said Kelly. "Those patients with severe addiction problems and those who believed they could not use alcohol/drugs in moderation attended the most. The NA and AA focus on abstinence/recovery probably resonates better with these more severely dependent individuals who also typically need ongoing support."
Even though many of the youth discontinued AA/NA after time, they nonetheless appeared to benefit from attendance.
"We found that patients who attended more AA and/or NA meetings in the first six months post-treatment had better longer term outcomes, but this early participation effect did not last forever -- it weakened over time," said Kelly. "The best outcomes achieved into young adulthood were for those patients who continued to go to AA and/or NA. In terms of a real-world recovery metric, we found that for each AA/NA meeting that a youth attended they gained a subsequent two days of abstinence, independent of all other factors that were also associated with a better outcome."
A little can go a long way, he added. "During the first six months post-treatment," said Kelly, "even small amounts of AA/NA participation -- such as once per week -- was associated with improved outcome, and three meetings per week was associated with complete abstinence. This suggests youth may not need to attend as frequently as every day, sometimes recommended clinically, to achieve very good outcomes."
Kelly believes that part of the reason for the success of AA/NA among adolescents who attend meetings is related to their developmental needs.
"Given the need for social affiliation and peer-group acceptance outside of the family at this stage of life, peers can exert strong influence on the behavior of young people," he noted. "When you couple this fact with the reality that most adolescents and young adults are experimenting with, or heavily using, alcohol and other drugs, it may be hard to find suitable peer contexts that can facilitate recovery. In fact, we know that most youth relapses are connected with social contexts where alcohol/drugs are present; unlike adults, youth rarely relapse alone. So, organizations such as AA/NA may provide support, and encourage and provide alternatively rewarding sober social activities."
The study was funded by the National Institute on Alcohol Abuse and Alcoholism.
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