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Does AA work for young people?

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Young drinkerResearchBlogging.orgEvidence has accumulated over the last couple of decades of the association between attendance at Alcoholics Anonymous and improved drinking outcomes, including abstinence. AA is sometimes seen as an organisation that is better suited to older drinkers seeking sobriety than to folk under thirty, though there are in fact young people’s meetings in various large cities. Nevertheless, AA’s own data suggest that only 13% of members are under 30. Is that because AA has little to offer younger folk? Does AA work for young people and if so, does it work in the same ways as for adults over 30?

Are young drinkers different?

The authors of a new paper lay out some reasons that might distinguish younger drinkers from older drinkers:

  • Lack of interest in spirituality
  • Less severity of addiction
  • Exposed to greater environmental cues to drink
  • Different stressors (relationships, housing etc)
  • Use of illicit primary drugs

What did the researchers do?`

Took a look at the Project Match data. This poor dataset has been worked to death, but only because it is such a rich mine of information. They compared 266 adults under 30 with 1726 over 30. All had attended 12 weeks of outpatient treatment and were then followed up at 3, 9 and 15 months post-treatment. They recorded percentage of days abstinent and number of drinks on a drinking day as outcome measures.

What did they find?

The two groups were not the same at baseline. The younger group had less clinical severity, lower religiousness and a stronger pro-social drinking network. About a quarter of each group had ever attended AA prior to treatment, but the younger group attended less often. In both groups however the effects of AA  attendance on drinking outcomes were significant, but this did not significantly differ across age groups. At 15 months follow up fewer younger adults than adults aged 30+ were abstinent (30.4% vs. than 39%), but among those who were not completely abstinent, the younger group were drinking less often.

Is AA working in the same way in both groups?

This was harder to answer. The mechanisms that seem to work for older adults seem to work for younger adults too, but there was less certainty in younger adults about the size of the effect. The authors were left with the conclusion that there might be unidentified pathways that work in younger adults. If these could be identified they may ‘provide novel treatment targets for younger adults seeking to recover’ from alcohol use disorders. They speculated what those pathways might be:

  • AA attendance ‘improves recovery motivation’
  • AA attendance creates hope, cohesiveness and belonging
  • AA attendance creates a sense of agency or of taking control of one’s disorder

Conclusions

“Our findings indicate that AA attendance is significantly, positively, and similarly strongly related to positive drinking outcomes in younger adults as it is in adults aged 30+. The mechanisms by which this positive effect is brought about, however, are less well explained by previously identified pathways This finding suggests that other mechanisms are at work in younger adults that, once identified, could provide novel treatment targets for younger adults seeking to recover from AUD.” [Alcohol Use Disorders]

Reflections

The arbitrary cut off of 30 years of age in the study means that we never really get a true picture of ‘young people’. If they’d gone for under 25s the study would have packed more punch. The authors take this on the chin: the numbers weren’t great enough to focus on such a sub-sample. Correlation is not causation of course and as is pointed out, the Project Match data is now an older adult itself. Populations and cultures change and the data, if gathered today, might be quite different.

It was interesting to note that whether younger people were religious/spiritual or not had no bearing on drinking outcomes. In a separate study a couple of years back, Marc Galanter found that the overwhelming majority of young people who were long term members of AA reported ‘a spiritual awakening’. In this study spirituality did not seem to mediate drinking outcomes, though neither did lack of spirituality seem to be a barrier to AA attendance.

This study backs up other research suggesting AA attendance is beneficial to subgroups of drinkers. Here are some of the relevant studies:

  • Acceptable to “special groups” e.g. elderly, young, women, (Timko 2008)
  • Atheists less likely to join AA, but those that do get same outcomes as believers. (Tonigan, 2003, 2007)
  • Women do better than men (Krentzman et al 2013)
  • Benefits extend to those with dual diagnosis (Bogenschutz, 2007)
  • AA attendance benefits regardless of ethnicity (Project Match 1998)

It does look as if young people benefit from AA membership and whatever mechanisms are at the heart of this benefit, it seems likely that at least some of them will also be at play in Narcotics Anonymous, Cocaine Anonymous and SMART Recovery too.

Hoeppner, B., Hoeppner, S., & Kelly, J. (2014). Do young people benefit from AA as much, and in the same ways, as adult aged 30+? A moderated multiple mediation analysis Drug and Alcohol Dependence DOI: 10.1016/j.drugalcdep.2014.07.023

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