title: Young adults, social networks, and addiction recovery: post treatment changes in social ties and their role as a mediator of 12-step participation.
abstract: BACKGROUND
  Social factors play a key role in addiction recovery. Research with adults indicates individuals with substance use disorder (SUD) benefit from mutual-help organizations (MHOs), such as Alcoholics Anonymous, via their ability to facilitate adaptive network changes. Given the lower prevalence of sobriety-conducive, and sobriety-supportive, social contexts in the general population during the life-stage of young adulthood, however, 12-step MHOs may play an even more crucial recovery-supportive social role for young adults, but have not been investigated. Greater knowledge could enhance understanding of recovery-related change and inform young adults' continuing care recommendations.
  
  
  METHODS
  Emerging adults (N = 302; 18-24 yrs; 26% female; 95% White) enrolled in a study of residential treatment effectiveness were assessed at intake, 1, 3, 6, and 12 months on 12-step attendance, peer network variables ("high [relapse] risk" and "low [relapse] risk" friends), and treatment outcomes (Percent Days Abstinent; Percent Days Heavy Drinking). Hierarchical linear models tested for change in social risk over time and lagged mediational analyses tested whether 12-step attendance conferred recovery benefits via change in social risk.
  
  
  RESULTS
  High-risk friends were common at treatment entry, but decreased during follow-up; low-risk friends increased. Contrary to predictions, while substantial recovery-supportive friend network changes were observed, this was unrelated to 12-step participation and, thus, not found to mediate its positive influence on outcome.
  
  
  CONCLUSIONS
  Young adult 12-step participation confers recovery benefit; yet, while encouraging social network change, 12-step MHOs may be less able to provide social network change directly for young adults, perhaps because similar-aged peers are less common in MHOs. Findings highlight the importance of both social networks and 12-step MHOs and raise further questions as to how young adults benefit from 12-step MHOs.
authors.affiliation: Center for Addiction Medicine Departments of Psychiatry Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
authors.affiliation: Pacific Institute for Research and Evaluation, Providence, Rhode Island, United States of America.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Stout
authors.affiliation: Center for Addiction Medicine Departments of Psychiatry Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: M Claire
authors.initials: MC
authors.lastname: Greene
authors.affiliation: Hazelden Foundation, Center City, Minnesota, United States of America.
authors.forename: Valerie
authors.initials: V
authors.lastname: Slaymaker
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017008:Negotiating; D012307:Risk Factors; D060756:Social Networking; D012944:Social Support; D019966:Substance-Related Disorders / Q000523:psychology* / Q000534:rehabilitation*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult