Combining the practices and philosophies of 12-step treatment programs, such as Alcoholics Anonymous (AA), with the motivational/cognitive-behavioral therapies currently being used to treat substance use disorders appears to produce better results in young people than the traditional program alone, according to a new study published in the journal Addiction.
It is common for drug treatment programs in the U.S. to link young patients to mutual-help organizations like AA, Narcotics Anonymous (NA), or Marijuana Anonymous (MA). But there has been no well-defined treatment protocol combining 12-step approaches with motivational enhancement/cognitive-behavioral therapies — and no evidence evaluating the effectiveness of such a pairing.
“In countries like the U.S., the greatest health risks for young people by far are from alcohol or other drug use,” said study leader John Kelly, Ph.D., director of the Recovery Research Institute in the Massachusetts General Hospital (MGH) Department of Psychiatry.
“Cognitive-behavioral and motivational programs are evidence-based, popular approaches for addressing youth substance-use disorder, and now these data suggest that integrating these approaches with 12-step philosophy and practices can further help reduce the impact of substance use in their lives and potentially facilitate higher rates of abstinence.”
The new intervention is based on motivational/cognitive-behavioral approaches but incorporates information from the kinds of discussions featured in 12-step program meetings.
“While all adolescents can improve when they receive well-articulated substance-use disorder treatment, we showed that adding a 12-step component to standard cognitive-behavioral and motivational strategies produced significantly greater reductions in substance-related consequences during and in the months following treatment,” said Kelly.
“It also produced higher rates of 12-step meeting participation, which was associated with longer periods of continuous abstinence.”
“Given the prevalence of substance-use disorders among young people, having treatments that are both effective and cost-effective — linking patients to free and ubiquitous community resources — is needed and welcome.”
The study involved 59 participants aged 14 to 21 who met substance-use disorder criteria and had been actively using within the past 90 days. Participants were randomly assigned to either a standard motivational enhancement/cognitive behavioral program or the Integrated Twelve-Step Facilitation (iTSF) program.
Both programs featured 10 consecutive weekly sessions; two individual sessions with a therapist and eight group sessions. The motivational enhancement/cognitive-behavioral approach was designed to enhance adolescents’ motivation for change towards remission and recovery. Sessions focused on teaching and practicing cognitive-behavioral relapse prevention and coping skills and included setting and reporting on weekly treatment goals.
Group sessions for the iTSF group included discussions of topics such as changing social networks and reducing relapse risk. Two of the sessions featured young members of NA or MA who shared their own experiences with addiction and recovery.
“That peer-to-peer aspect was probably the most powerful in disabusing young people of the negative stereotypes they often hold about 12-step members and about recovery more broadly,” says Kelly. “Similar-aged peers who are in recovery seemed much better able to capture the attention of participants than clinic staff.”
Along with the weekly reports at their sessions, the young people were formally evaluated at the onset of the study and then three, six, and nine months later. By the end of the study, both groups showed similar improvements in the primary outcome, percent days abstinent.
However, participants in the iTSF group had greater attendance at 12-step meetings during the three months that included the intervention. This group also reported significantly fewer substance-related consequences, things like feeling unhappy, guilty, or ashamed because of their substance use; neglecting responsibilities; taking risks; having money problems; damaging relationships with family and friends, and having under-the-influence accidents.
The fact that the higher rate of 12-step attendance among the iTSF participants was not maintained after the intervention program may indicate the need for a longer treatment program or regular, follow-up visits.
“We want to replicate and extend the testing of this treatment even further to determine the benefits of longer term care,” Kelly said.
“We know that the transition to adulthood is fraught with relapse risks for young people recovering from a substance-use disorder, so some kind of regular but brief ‘clinical recovery check-up,’ like what is common for other chronic conditions like diabetes or hypertension, could improve outcomes.”
Source: Massachusetts General Hospital