title: Do adolescents affiliate with 12-step groups? A multivariate process model of effects.
abstract: OBJECTIVE
  Research with adolescents has revealed salutary effects for 12-step attendance on substance use outcomes, but no studies have examined the effects of 12-step affiliation, or active involvement, beyond simple measures of attendance. Prior research with adults has shown that measures of affiliation are more predictive than measures of attendance. This study (1) assessed attributes that may influence 12-step attendance and affiliation; (2) tested whether 12-step affiliation in the first 3 months posttreatment possessed unique predictive power above that attributable to attendance alone; and (3) examined the extent to which motivation, coping and self-efficacy measured at 3 months mediated the relation between 12-step affiliation and substance use outcome in the ensuing 3 months.
  
  
  METHODS
  Adolescent inpatients (N = 74, 62% female), who were aged 14-18 years (mean [SD] = 15.9 [1.19] years), were interviewed during treatment and at 3 and 6 months postdischarge.
  
  
  RESULTS
  More severely substance-involved youth were more motivated for abstinence and more likely to attend and affiliate with 12-step groups. A high degree of collinearity between 12-step attendance and affiliation suggested that those attending were also likely to be those actively involved. As a consequence, affiliation did not predict outcome over and above frequency of attendance. Motivation was found to influence the relationship between 12-step affiliation and future substance use outcome.
  
  
  CONCLUSIONS
  Given the widespread treatment recommendations for adolescent 12-step involvement, more study is needed to determine what kinds and what aspects of 12-step groups and fellowships are helpful to adolescent change efforts and what alternatives should be developed.
authors.affiliation: Veterans Affairs Palo Alto Healthcare System & Stanford University School of Medicine, Menlo Park, California 94025, USA. john.kelly4@med.va.gov
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
authors.forename: Mark G
authors.initials: MG
authors.lastname: Myers
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000436:Alcoholics Anonymous; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation*; D002140:California; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology; D010552:Personality Assessment; D011379:Prognosis; D020377:Self Efficacy; D012657:Self-Help Groups; D012933:Social Identification; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*