title: Twelve-Step affiliation and 3-year substance use outcomes among adolescents: social support and religious service attendance as potential mediators.
abstract: OBJECTIVE
  Twelve-Step affiliation among adolescents is little understood. We examined 12-Step affiliation and its association with substance use outcomes 3 years post-treatment intake among adolescents seeking chemical dependency (CD) treatment in a private, managed-care health plan. We also examined the effects of social support and religious service attendance on the relationship.
  
  
  METHODS
  We analyzed data for 357 adolescents, aged 13-18, who entered treatment at four Kaiser Permanente Northern California CD programs between March 2000 and May 2002 and completed both baseline and 3-year follow-up interviews.
  
  
  METHODS
  Measures at follow-up included alcohol and drug use, 12-Step affiliation, social support and frequency of religious service attendance.
  
  
  RESULTS
  At 3 years, 68 adolescents (19%) reported attending any 12-Step meetings, and 49 (14%) reported involvement in at least one of seven 12-Step activities, in the previous 6 months. Multivariate logistic regression analyses indicated that after controlling individual and treatment factors, 12-Step attendance at 1 year was marginally significant, while 12-Step attendance at 3 years was associated with both alcohol and drug abstinence at 3 years [odds ratio (OR) 2.58, P < 0.05 and OR 2.53, P < 0.05, respectively]. Similarly, 12-Step activity involvement was associated significantly with 30-day alcohol and drug abstinence. There are possible mediating effects of social support and religious service attendance on the relationship between post-treatment 12-Step affiliation and 3-year outcomes.
  
  
  CONCLUSIONS
  The findings suggest the importance of 12-Step affiliation in maintaining long-term recovery, and help to understand the mechanism through which it works among adolescents.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612-2403, USA. felicia.w.chi@kp.org
authors.forename: Felicia W
authors.initials: FW
authors.lastname: Chi
authors.forename: Lee A
authors.initials: LA
authors.lastname: Kaskutas
authors.forename: Stacy
authors.initials: S
authors.lastname: Sterling
authors.forename: Cynthia I
authors.initials: CI
authors.lastname: Campbell
authors.forename: Constance
authors.initials: C
authors.lastname: Weisner