12-Step Facilitation (TSF) interventions designed to enhance rates of engagement with 12-step mutual-help organizations (MHOs) have shown efficacy among adults, but research provides little guidance on how to adapt TSF strategies for young people.
Methods
To inform TSF strategies for youth, this study used qualitative methods to investigate the self-reported experiences of 12-step participation, and reasons for nonattendance and discontinuation among young adults (18–24 years; N = 302). Responses to open-ended questions following residential treatment were coded into rationally derived domains.
Results
Young adults reported that cohesiveness, belonging, and instillation of hope were the most helpful aspects of attending 12-step groups; meeting structure and having to motivate oneself to attend meetings were the most common aspects young adults liked least; logistical barriers and low recovery motivation and interest were the most common reasons for discontinued attendance; and perceptions that one did not have a problem or needed treatment were cited most often as reasons for never attending.
Conclusions
Findings may inform and enhance strategies intended to engage young people with community-based recovery-focused 12-step MHOs and ultimately improve recovery outcomes.
HackerK, WalkerDK. Achieving population health in accountable care organizations. Am J Public Health.2013;103:1163–1167.
6.
MoosRH, MoosBS. Long-term influence of duration and frequency of participation in Alcoholics Anonymous on individuals with alcohol use disorders. J Consult Clin Psychol. 2004;72:81–90.
KellyJF. Self-help for substance-use disorders: history, effectiveness, knowledge gaps, and research opportunities. Clin Psychol Rev.2003;23:639–663.
9.
KellyJF, YeterianJD. Empirical awakening: the new science on mutual help and implications for cost containment under health care reform. Subst Abus.2012;33:85–91.
10.
HumphreysK, MoosRH. Reduced substance-abuse-related health care costs among voluntary participants in Alcoholics Anonymous. Psychiatr Serv.1996;47:709–713.
11.
HumphreysK, MoosRH. Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study. Alcohol Clin Exp Res.2001;25:711–716.
12.
HumphreysK, MoosRH. Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes. Alcohol Clin Exp Res.2007;31:64–68.
13.
MundtMP, ParthasarathyS, ChiFW, SterlingS, CampbellCI. 12-Step participation reduces medical use costs among adolescents with a history of alcohol and other drug treatment. Drug Alcohol Depend.2012;126:124–130.
14.
WalitzerKS, DermenKH, BarrickC. Facilitating involvement in Alcoholics Anonymous during out-patient treatment: a randomized clinical trial. Addiction.2009;104:391–401.
15.
LittMD, KaddenRM, Kabela-CormierE, PetryNM. Changing network support for drinking: network support project 2-year follow-up. J Consult Clin Psychol.2009;77:229–242.
KahlerCW, ReadJP, RamseySE, StuartGL, McCradyBS, BrownRA. Motivational enhancement for 12-step involvement among patients undergoing alcohol detoxification. J Consult Clin Psychol.2004;72:736–741.
18.
ToniganJS, ConnorsGJ, MillerWR. Participation and involvement in Alcoholics Anonymous. In: Babor T, DelBoca F, eds.Treatment Matching in Alcoholism. Cambridge University Press, UK:2003;184–204.
19.
DennisM, GodleySH, DiamondG, TimsFM, BaborT, DonaldsonJ, FunkR. The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials. J Subst Abuse Treat.2004;27:197–213.
20.
SinhaR, EastonC, KempK. Substance abuse treatment characteristics of probation-referred young adults in a community-based outpatient program. Am J Drug Alcohol Abuse. 2003;29:585–597.
21.
Substance Abuse and Mental Health Services Administration. Results From the 2011 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2012. NSDUH Series H-44, HHS Publication No. (SMA) 12-4713.
22.
KellyJF, StoutRL, SlaymakerV. Emerging adults’ treatment outcomes in relation to 12-step mutual-help attendance and involvement. Drug Alcohol Depend.2013;129:151–157.
23.
LabbeAK, GreeneC, BergmanBG, HoeppnerB, KellyJF. The importance of age composition of 12-step meetings as a moderating factor in the relation between young adults’ 12-step participation and abstinence. Drug Alcohol Depend.2013;133:541–547.
24.
DelucchiKL, MatzgerH, WeisnerC. Alcohol in emerging adulthood: 7-year study of problem and dependent drinkers. Addict Behav.2008;33:134–142.
25.
KellyJF, BrownSA, AbrantesA, KahlerCW, MyersM. Social recovery model: an 8-year investigation of adolescent 12-step group involvement following inpatient treatment. Alcohol Clin Exp Res.2008;32:1468–1478.
26.
KellyJF, MyersMG, RodolicoJ. What do adolescents exposed to Alcoholics Anonymous think about 12-step groups?Subst Abus.2008;29:53–62.
27.
KellyJF, WhiteWL. Broadening the base of addiction mutual-help organizations. J Groups Addict Recover.2012;7:82–101.
28.
KellyJF, KahlerCW, HumphreysK. Assessing why substance use disorder patients drop out from or refuse to attend 12-step mutual help groups: the “REASONS” questionnaire. Addict Res Theory.2010;18:316–325.
29.
McElrathD. The Minnesota Model. J Psychoactive Drugs.1997;29:141–144.
30.
RomanPM, JohnsonJA. National Treatment Center Study Summary Report: Private Treatment Centers.Athens, GA: University of Georgia, Institute for Behavioral Research; 2004.
31.
Substance Abuse and Mental Health Services Administration. Results From the 2008 National Survery on Drug Use and Health: National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2009. NSDUH Sercies H-36, HHS Publication No (SMA) 09-4434.
32.
KellyJF, UrbanoskiKA, HoeppnerBB, SlaymakerV. Facilitating comprehensive assessment of 12-step experiences: a multidimensional measure of mutual-help activity. Alcohol Treat Q.2011;29:181–203.
33.
YalomID. The Theory and Practice Of Group Psychotherapy.4th ed. New York: Basic Books; 1995
34.
HayesAF, KrippendorffK. Answering the call for a standard reliability measure for coding data. Commun Methods Meas.2007;1:77–89.
35.
GrohDR, JasonLA, KeysCB. Social network variables in alcoholics anonymous: a literature review. Clin Psychol Rev.2008;28:430–450.
36.
KellyJF, GreeneMC. Where there's a will there's a way: a longitudinal investigation of the interplay between recovery motivation and self-efficacy in predicting treatment outcome. Psychol Addict Behav. 2013; 28(3):928–934.
37.
KellyJFGreeneMC. Beyond motivation: initial validation of the commitment to sobriety scale. J Subst Abuse Treat.2014;46:257–263.
38.
StoutR, DelBocaFK, CarbonariJ, RychtarikR, LittMD, CooneyNL. Primary treatment outcomes and matching effects: outpatient arm. In: BaborTF, DelBocaFK, eds. Treating Matching in Alcoholism.Cambridge, UK: Cambridge University Press; 2003:105–134.
39.
CarrollKM, BallSA, NichC, . Motivational interviewing to improve treatment engagement and outcomes in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug Alcohol Depend.2006;81:301–312.
40.
Substance Abuse and Mental Health Services Administration. Results From the 2012 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. NSDUH Series H-46, HHS Publication No. (SMA) 13-4795.
41.
Institute of Medicine. Broadening the Base of Treatment for Alcohol Problems.Washington, DC: National Academy Press; 1990.
42.
SissonRW, MallamsJH. The use of systematic encouragement and community access procedures to increase attendance to Alcoholics Anonymous and Al-Anon meetings. Am J Drug Alcohol Abuse.1981;8:371–376.
43.
TimkoC, DeBenedettiA. A randomized controlled trial of intensive referral to 12-step self-help groups: one-year outcomes. Drug Alcohol Depend.2007;90:270–279.
44.
Institute of Medicine: Broadening the base of treatment for alcohol problems. Washington, DC: National Academy Press; 1990.
45.
Sisson RW, Mallams JH. The use of systematic encouragement and community access procedures to increase attendance to Alcoholics Anonymous and Al-Anon meetings. Am J Drug Alcohol Abuse. 1981;8:371–376.
