Washington, June 2 : A new study suggests that help programmes for people suffering from alcohol- and narcotics-related problems, known as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), may be beneficial for adolescents also if they attend them.
"It is difficult to evaluate the efficacy of mutual-help organizations like AA through randomized controlled experiments because the AA 'intervention,' being a community organization based on anonymity, cannot be directly under the control of the researcher in the usual way," said John F. Kelly, associate director of the MGH-Harvard Center for Addiction Medicine at Massachusetts General Hospital, and assistant professor in psychiatry at Harvard Medical School.
But still, he added, the popularity and cost-effectiveness of such programmes could not be denied.
"AA and NA are explicitly focused on abstinence and addiction recovery, they are widely available across most communities, they provide entry to a social network of recovery-specific support and sober events that can be accessed 'on demand' - particularly at times of high-relapse risk such as evenings and weekends, the services are free, and AA/NA can be attended as intensively, and for as long, as individuals desire," said Dr. Kelly, the corresponding author of the study reported online at OnlineEarly.
The researcher, however, conceded that little was know about bow such abstinence-focused organizations could help youth.
"This knowledge gap is particularly noteworthy given that adolescents and young adults face more barriers to AA and NA than older adults and yet appear to be referred there just as frequently by treatment providers. Youth tend to have less severe addiction problems, on average, and consequently do not feel a strong need to stop using alcohol and/or drugs. 'Why should they bother to go to abstinence-oriented organizations like AA and NA, and would they benefit even if they did go?'" said Kelly.
With a view to addressing such questions, Kelly and his colleagues recruited 160 adolescent inpatients (96 males, 64 females), with an average age of 16 years, who were enrolled at two treatment centres in California having a focus on abstinence and based on a 12-step model.
The study participants' length of stay ranged from four to six weeks, after which they were re-assessed on a number of clinical variables at six months, and one, two, four, six, and eight years.
"We found that most of the youth attended at least some AA/NA meetings post-treatment. Those patients with severe addiction problems and those who believed they could not use alcohol/drugs in moderation attended the most. The NA and AA focus on abstinence/recovery probably resonates better with these more severely dependent individuals who also typically need ongoing support," said Kelly.
The researchers observed that while many of the youth discontinued AA/NA after time, they still appeared to benefit from attendance.
"We found that patients who attended more AA and/or NA meetings in the first six months post-treatment had better longer term outcomes, but this early participation effect did not last forever - it weakened over time. The best outcomes achieved into young adulthood were for those patients who continued to go to AA and/or NA. In terms of a real-world recovery metric, we found that for each AA/NA meeting that a youth attended they gained a subsequent two days of abstinence, independent of all other factors that were also associated with a better outcome," said Kelly.
A little can go a long way, he added. "During the first six months post-treatment, even small amounts of AA/NA participation - such as once per week - was associated with improved outcome, and three meetings per week was associated with complete abstinence. This suggests youth may not need to attend as frequently as every day, sometimes recommended clinically, to achieve very good outcomes," he added.
He said that the reason for the success of AA/NA among adolescents who attend meetings could be partly related to their developmental needs.
"Given the need for social affiliation and peer-group acceptance outside of the family at this stage of life, peers can exert strong influence on the behaviour of young people. When you couple this fact with the reality that most adolescents and young adults are experimenting with, or heavily using, alcohol and other drugs, it may be hard to find suitable peer contexts that can facilitate recovery. In fact, we know that most youth relapses are connected with social contexts where alcohol/drugs are present; unlike adults, youth rarely relapse alone. So, organizations such as AA/NA may provide support, and encourage and provide alternatively rewarding sober social activities," he said.