Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Alcohol Clin Exp Res. 2012 Jul;36(7):1219-29. doi: 10.1111/j.1530-0277.2011.01727.x. Epub 2012 Apr 17.
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.
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.
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.
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.
青少年康复的一个主要障碍是寻找合适的戒酒支持性社会环境。全国性研究表明，大多数青少年成瘾治疗计划将青少年与社区 12 步同好会联系起来，以帮助应对这一挑战，但实际上青少年参加 12 步会议的程度以及他们是否从积极参与规定的 12 步活动（例如，与赞助商和其他同好会成员的联系）中获得额外收益知之甚少。在这方面有更多的知识将提高临床持续护理建议的效率。
参加治疗效果自然研究的青少年门诊患者（N = 127；M 年龄 16.7；75%男性；87%白人）在入组时和 3、6 和 12 个月后使用标准化评估进行评估。混合效应模型，控制静态和时变混杂因素，考察了 12 步参与的同期和滞后效应对随时间变化的戒酒效果。
在随访过程中，参加 12 步会议的比例相对较低（24%至 29%），但更频繁的出席与同期和在较小程度上滞后模型中的更大戒酒率独立相关。12 步参与的 8 项综合措施与出席无关，但会增强结果，但单独的组成部分确实如此；具体来说，在会议之外与 12 步赞助商的更多接触以及在会议期间更多的口头参与。
在成人样本中观察到的 12 步参与的益处扩展到青少年门诊患者。社区 12 步同好会似乎为寻求康复的青少年提供了一个有用的戒酒支持性社会环境，但需要基于证据的青少年特定的 12 步促进策略来提高门诊出勤率。
