Twelve‐Step affiliation and 3‐year substance use outcomes among adolescents: social support and religious service attendance as potential mediators

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Abstract
Aims  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.Design  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.Measures  Measures at follow‐up included alcohol and drug use, 12‐Step affiliation, social support and frequency of religious service attendance.Findings  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.

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