title: Youth recovery contexts: the incremental effects of 12-step attendance and involvement on adolescent outpatient outcomes.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. jkelly11@partners.org
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
authors.forename: Karen
authors.initials: K
authors.lastname: Urbanoski
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000436:Alcoholics Anonymous; D000437:Alcoholism / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D000553:Ambulatory Care / Q000523:psychology / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020127:Recovery of Function; D012944:Social Support; D013695:Temperance / Q000523:psychology / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult