title: Twelve-Step attendance trajectories over 7 years among adolescents entering substance use treatment in an integrated health plan.
abstract: OBJECTIVE
  This study examines 12-Step attendance trajectories over 7 years, factors associated with the trajectories, and relationships between the trajectories and long-term substance use outcomes among adolescents entering out-patient substance use treatment in a private, non-profit integrated managed-care health plan.
  
  
  METHODS
  Longitudinal observational study.
  
  
  METHODS
  Four Kaiser Permanente Northern California substance use treatment programs.
  
  
  METHODS
  A total of 391 adolescents entering treatment between 2000 and 2002 who completed at least one follow-up interview in year 1, and at least one during years 3-7, after treatment entry.
  
  
  METHODS
  Alcohol and drug use, 12-Step meeting attendance and activity involvement and post-treatment medical service utilization.
  
  
  RESULTS
  Semiparametric group-based modeling identified three distinct 12-Step attendance trajectory groups over 7 years: low/no attendance (60%), early but not continued (26%) and continued (14%). There were lower proportions of males and of adolescents with prior substance use treatment experience in the low/no attendance group (P = 0.019 and P = 0.003, respectively). In addition, those in the low/no attendance group had lower perception on circumstances, motivation and readiness for treatment at baseline (P = 0.023). Multivariate logistic generalized estimating equation analyses found that those in the continued group were more likely to be abstinent from both alcohol and drugs during follow-ups than those in the low/no attendance group [odds ratio (OR) = 2.40, P = 0.003 and OR = 1.96, P = 0.026, respectively]. However, no differences in long-term outcomes were found between those in the other two groups.
  
  
  CONCLUSIONS
  Robust connection with 12-Step groups appears to be associated with better long-term outcomes among adolescents with substance use disorders.
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: Cynthia I
authors.initials: CI
authors.lastname: Campbell
authors.forename: Stacy
authors.initials: S
authors.lastname: Sterling
authors.forename: Constance
authors.initials: C
authors.lastname: Weisner
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000534:rehabilitation; D000553:Ambulatory Care / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D005260:Female; D006788:Hospitals, Voluntary; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D012495:San Francisco; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D013695:Temperance / Q000706:statistics & numerical data; D016896:Treatment Outcome