Recent research suggests AA works as well for young people as it does for older adults, although maybe in different ways. Referring to 12-step mutual aid is embodied in our National Clinical Guidelines, National Drugs Policies and by NICE. Getting people to go is a different story as a leaflet and a recommendation has a very low impact rate. There are evidenced ways to get people there more effectively. So what about young people and 12-step? Well, researchers have taken a detailed look at how young people respond to 12-step participation, reasons for not going and reasons for discontinuation. The results make for interesting reading.
Advantages of 12-step engagement
The authors start out by laying out the evidence for beneficial outcomes of participating in 12-step mutual aid:
Studies in the addiction treatment field have shown that participation in 12-step mutual-help organizations (MHOs) following treatment, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), is related to higher rates of remission from substance use disorder (SUD) and simultaneous reduction in health care costs.
They point out that while several studies support the benefits of 12-step participation, they don’t provide much in the way of guidance in how to get people there and keep them engaged more effectively.
The authors set out four questions to be answered through the study:
- What do young adults find most helpful about attending 12-step MHOs?
- What do young adults like least about attending 12-step meetings?
- What reasons do young adults report for discontinuing 12-step group attendance?
- If a young adult never attended a 12-step meeting, what are some of the reasons for not attending?
Young people involved
The study recruited 302 young adults (18-24 years) going into a residential treatment programme in the USA. Almost three quarters were male. Patients were interviewed on admission, on discharge and at 3, 6 and 9 months post discharge with good follow-up rates.
The most commonly reported “drug of choice” was alcohol (28.1%) and marijuana (28.1%), followed by heroin or other opiates (22.2%), cocaine or crack (12.3%), and amphetamines (6.0%). Small proportions reported benzodiazepines (2.0%), hallucinogens (1.0%), or ecstasy (1.0%) as their drug of choice.
Young people and 12-step
Around a third of the young people had been to a 12-step meeting on entry to treatment. What about on follow-up? At the 3-month follow-up assessment, 87.6% of the sample (n=212) attended at least one 12-step meeting in the past three months, 81.0% of the sample (n=175) attended at least one meeting in the three months prior to the 6-month follow-up assessment, and 75.5% of the sample (n=162) attended at least one meeting in the three months prior to the 12-month follow-up assessment.
What was most helpful?
- Removing a sense of isolation
- Validating experiences
- A sense of belonging, acceptance and validation
- Installation of hope (being inspired/encouraged by another member who has a similar problem).
- Altruism (members help and support each other).
12-step specific responses were rare leading the authors to conclude that ‘general group therapy factors were more important to these young adults in early recovery/post-treatment.’
What did they like least?
- Meeting structure (length, repetition)
- Having to motivate oneself to get there
Interestingly, less than 1% of young people found meetings unhelpful.
Why did they stop going?
- Logistical barriers (e.g. lack of transport)
- Low recovery motivation and interest
Why did some never attend?
- Didn’t need treatment
- Don’t have a problem
Key quotes from the paper
“These findings are in line with research that has found that the social aspect of MHOs is associated with long-term abstinence by increasing positive types of support and promoting engagement in larger recovery networks”
“Clinicians can highlight that 12-step specific content was rarely cited as a reason for discontinuing 12-step attendance among young adults”
“Findings may inform and enhance strategies intended to engage young people with community-based recovery focused 12-step MHOs and ultimately improve recovery outcomes”
If the study were repeated in the UK, then I think we would see that less than a third ‘had ever’ been to a mutual aid meeting on entry to treatment. My estimate would be less than 5%. We know that there is often a broken bridge between treatment and recovery communities. Then there is the fact that differences in culture mean that we can’t simply translate this research across the Atlantic.
It’s encouraging that the vast majority of young people found 12-step meetings to be of help in recovery. Some of the obstacles the research uncovered can be tackled as the paper suggests. Unfortunately prejudices against 12-step mutual aid continue in the UK even in the face of the strength of the evidence and professional attitudes can and do act as a barrier to access.
Despite cultural discrepancy, this study should encourage us to try harder to get young clients in treatment engaged with 12-step mutual aid.
Labbe, A., Slaymaker, V., & Kelly, J. (2014). Toward Enhancing Twelve-Step Facilitation among young people: A systematic qualitative investigation of Young Adults’ 12-step Experiences Substance Abuse DOI: 10.1080/08897077.2014.950001