An enhanced delivery of 12-step facilitation, which includes active referral to volunteers in the community and integration with outpatient substance use treatment may be particularly effective for helping young adults maintain sobriety from stimulants.
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Emerging adulthood (ages 18-29) has the highest prevalence of substance use disorders compared with other age groups. However, emerging adults pose unique challenges in terms of substance use treatment. Prior studies on groups facilitating involvement in 12-step mutual help organizations have found conflicting results as to whether these 12-step facilitation interventions are as effective as Cognitive Behavioral Therapy (CBT) or other treatment modalities for younger adults. This study tested a 12-step facilitation approach enhanced by active peer linkages to meetings, which might be more effective way to engage emerging adults in 12-step meetings.
DESIGN: Two group randomized treatment trial comparing treatment as usual (TAU) to TAU integrated with STAGE-12 (Stimulant Abuser Groups to Engage in 12 Step) over eight weeks of active substance use treatment with six-month follow-up. Each week, a STAGE-12 group and individual session replaces one hour per week of TAU over the eight weeks of active treatment. For five of the eight weeks, STAGE-12 participants attended a group session, and for three weeks they attended an individual session.
SETTING: Intensive Outpatient Programs at ten community treatment programs across the US
PARTICIPANTS: 450 adults with a stimulant use disorder (using DSM-IV criteria) enrolled at one of the community treatment programs in intensive outpatient treatment. Age was analyzed as a continuous variable although reported comparing emerging adults (ages 18-29) vs older participants.
MEASUREMENT: Primary substance use outcome is number of self-reported days of stimulant drug use; secondary outcome is number of days of non-stimulant drug/alcohol use. Other outcome variables include days of Twelve-Step Meeting attendance and a measure of active involvement in 12-step groups by self-report questionnaire.
Younger participants showed a greater response to a STAGE-12 intervention to increase 12-step participation than older participants to maintain stimulant abstinence: The 20 year old participants were more likely than the 50 year old participants to remain abstinent from stimulants when comparing Stimulant Abuser Groups to Engage in 12 Step (STAGE-12) to treatment as usual (Odds ratio 4.128 vs 2.939). In fact, although STAGE-12 has been previously shown to increase the odds of abstinence, by age 46 and above, there is no statistically significant effect of STAGE-12 over treatment as usual for these older participants.
Of note, the increased utility of STAGE-12 for younger participants only holds for participants who achieved abstinence at the beginning of the study who then had a higher probability of maintaining abstinence. For the group of younger participants who did not achieve abstinence at the beginning of the trial, they actually had higher rates of stimulant use in follow-up in the STAGE-12 arm vs treatment as usual (perhaps using more once they had violated abstinence).
The benefits of STAGE-12 participation are moderated by increased involvement in 12-step groups: Younger participants in STAGE-12 compared to treatment as usual had a greater odds of active participation in 12-step mutual help organizations activities, beyond meeting attendance, than older participants in STAGE-12 compared to treatment as usual. Interestingly, meeting attendance per se was not shown to be a moderator of the differential effect of STAGE-12, rather the involvement beyond meeting attendance was increased in younger vs older participants in STAGE-12 vs treatment as usual.
This study tests a 12-step facilitation approach that incorporates an intensive referral component that actively connects participants with a 12-step volunteer in the community who arranges to attend a meeting with them. While this study cannot speak directly to why the 12-step facilitation was more helpful for young adults, it seems most likely this active linkage component may explain the findings showing 12-step facilitation increased the odds of abstinence in emerging adults, a group which had not previously been shown to benefit as much from 12-step facilitation as opposed to other interventions.
Establishing a connection between the participants and attendees at 12-step meetings may be contributing to social network changes, which may be more challenging for emerging adults because, on average, they have more individuals that misuse alcohol and other drugs in their networks than older adults. However, those who ended up using during the study were not benefited by the addition of STAGE-12 and had in fact, worse outcomes than treatment as usual. This may be explained by the 12-step emphasis on abstinence such that once abstinence is breached, there may be less emphasis on controlled use (an either-or mentality), known as the abstinence violation effect.
Garrett, S. B., Doyle, S. R., Peavy, K. M., Wells, E. A., Owens, M. D., Shores-Wilson, K., … & Donovan, D. M. (2018). Age differences in outcomes among patients in the “Stimulant Abuser Groups to Engage in 12-Step”(STAGE-12) intervention. Journal of substance abuse treatment, 84, 21-29.
l
Emerging adulthood (ages 18-29) has the highest prevalence of substance use disorders compared with other age groups. However, emerging adults pose unique challenges in terms of substance use treatment. Prior studies on groups facilitating involvement in 12-step mutual help organizations have found conflicting results as to whether these 12-step facilitation interventions are as effective as Cognitive Behavioral Therapy (CBT) or other treatment modalities for younger adults. This study tested a 12-step facilitation approach enhanced by active peer linkages to meetings, which might be more effective way to engage emerging adults in 12-step meetings.
DESIGN: Two group randomized treatment trial comparing treatment as usual (TAU) to TAU integrated with STAGE-12 (Stimulant Abuser Groups to Engage in 12 Step) over eight weeks of active substance use treatment with six-month follow-up. Each week, a STAGE-12 group and individual session replaces one hour per week of TAU over the eight weeks of active treatment. For five of the eight weeks, STAGE-12 participants attended a group session, and for three weeks they attended an individual session.
SETTING: Intensive Outpatient Programs at ten community treatment programs across the US
PARTICIPANTS: 450 adults with a stimulant use disorder (using DSM-IV criteria) enrolled at one of the community treatment programs in intensive outpatient treatment. Age was analyzed as a continuous variable although reported comparing emerging adults (ages 18-29) vs older participants.
MEASUREMENT: Primary substance use outcome is number of self-reported days of stimulant drug use; secondary outcome is number of days of non-stimulant drug/alcohol use. Other outcome variables include days of Twelve-Step Meeting attendance and a measure of active involvement in 12-step groups by self-report questionnaire.
Younger participants showed a greater response to a STAGE-12 intervention to increase 12-step participation than older participants to maintain stimulant abstinence: The 20 year old participants were more likely than the 50 year old participants to remain abstinent from stimulants when comparing Stimulant Abuser Groups to Engage in 12 Step (STAGE-12) to treatment as usual (Odds ratio 4.128 vs 2.939). In fact, although STAGE-12 has been previously shown to increase the odds of abstinence, by age 46 and above, there is no statistically significant effect of STAGE-12 over treatment as usual for these older participants.
Of note, the increased utility of STAGE-12 for younger participants only holds for participants who achieved abstinence at the beginning of the study who then had a higher probability of maintaining abstinence. For the group of younger participants who did not achieve abstinence at the beginning of the trial, they actually had higher rates of stimulant use in follow-up in the STAGE-12 arm vs treatment as usual (perhaps using more once they had violated abstinence).
The benefits of STAGE-12 participation are moderated by increased involvement in 12-step groups: Younger participants in STAGE-12 compared to treatment as usual had a greater odds of active participation in 12-step mutual help organizations activities, beyond meeting attendance, than older participants in STAGE-12 compared to treatment as usual. Interestingly, meeting attendance per se was not shown to be a moderator of the differential effect of STAGE-12, rather the involvement beyond meeting attendance was increased in younger vs older participants in STAGE-12 vs treatment as usual.
This study tests a 12-step facilitation approach that incorporates an intensive referral component that actively connects participants with a 12-step volunteer in the community who arranges to attend a meeting with them. While this study cannot speak directly to why the 12-step facilitation was more helpful for young adults, it seems most likely this active linkage component may explain the findings showing 12-step facilitation increased the odds of abstinence in emerging adults, a group which had not previously been shown to benefit as much from 12-step facilitation as opposed to other interventions.
Establishing a connection between the participants and attendees at 12-step meetings may be contributing to social network changes, which may be more challenging for emerging adults because, on average, they have more individuals that misuse alcohol and other drugs in their networks than older adults. However, those who ended up using during the study were not benefited by the addition of STAGE-12 and had in fact, worse outcomes than treatment as usual. This may be explained by the 12-step emphasis on abstinence such that once abstinence is breached, there may be less emphasis on controlled use (an either-or mentality), known as the abstinence violation effect.
Garrett, S. B., Doyle, S. R., Peavy, K. M., Wells, E. A., Owens, M. D., Shores-Wilson, K., … & Donovan, D. M. (2018). Age differences in outcomes among patients in the “Stimulant Abuser Groups to Engage in 12-Step”(STAGE-12) intervention. Journal of substance abuse treatment, 84, 21-29.
l
Emerging adulthood (ages 18-29) has the highest prevalence of substance use disorders compared with other age groups. However, emerging adults pose unique challenges in terms of substance use treatment. Prior studies on groups facilitating involvement in 12-step mutual help organizations have found conflicting results as to whether these 12-step facilitation interventions are as effective as Cognitive Behavioral Therapy (CBT) or other treatment modalities for younger adults. This study tested a 12-step facilitation approach enhanced by active peer linkages to meetings, which might be more effective way to engage emerging adults in 12-step meetings.
DESIGN: Two group randomized treatment trial comparing treatment as usual (TAU) to TAU integrated with STAGE-12 (Stimulant Abuser Groups to Engage in 12 Step) over eight weeks of active substance use treatment with six-month follow-up. Each week, a STAGE-12 group and individual session replaces one hour per week of TAU over the eight weeks of active treatment. For five of the eight weeks, STAGE-12 participants attended a group session, and for three weeks they attended an individual session.
SETTING: Intensive Outpatient Programs at ten community treatment programs across the US
PARTICIPANTS: 450 adults with a stimulant use disorder (using DSM-IV criteria) enrolled at one of the community treatment programs in intensive outpatient treatment. Age was analyzed as a continuous variable although reported comparing emerging adults (ages 18-29) vs older participants.
MEASUREMENT: Primary substance use outcome is number of self-reported days of stimulant drug use; secondary outcome is number of days of non-stimulant drug/alcohol use. Other outcome variables include days of Twelve-Step Meeting attendance and a measure of active involvement in 12-step groups by self-report questionnaire.
Younger participants showed a greater response to a STAGE-12 intervention to increase 12-step participation than older participants to maintain stimulant abstinence: The 20 year old participants were more likely than the 50 year old participants to remain abstinent from stimulants when comparing Stimulant Abuser Groups to Engage in 12 Step (STAGE-12) to treatment as usual (Odds ratio 4.128 vs 2.939). In fact, although STAGE-12 has been previously shown to increase the odds of abstinence, by age 46 and above, there is no statistically significant effect of STAGE-12 over treatment as usual for these older participants.
Of note, the increased utility of STAGE-12 for younger participants only holds for participants who achieved abstinence at the beginning of the study who then had a higher probability of maintaining abstinence. For the group of younger participants who did not achieve abstinence at the beginning of the trial, they actually had higher rates of stimulant use in follow-up in the STAGE-12 arm vs treatment as usual (perhaps using more once they had violated abstinence).
The benefits of STAGE-12 participation are moderated by increased involvement in 12-step groups: Younger participants in STAGE-12 compared to treatment as usual had a greater odds of active participation in 12-step mutual help organizations activities, beyond meeting attendance, than older participants in STAGE-12 compared to treatment as usual. Interestingly, meeting attendance per se was not shown to be a moderator of the differential effect of STAGE-12, rather the involvement beyond meeting attendance was increased in younger vs older participants in STAGE-12 vs treatment as usual.
This study tests a 12-step facilitation approach that incorporates an intensive referral component that actively connects participants with a 12-step volunteer in the community who arranges to attend a meeting with them. While this study cannot speak directly to why the 12-step facilitation was more helpful for young adults, it seems most likely this active linkage component may explain the findings showing 12-step facilitation increased the odds of abstinence in emerging adults, a group which had not previously been shown to benefit as much from 12-step facilitation as opposed to other interventions.
Establishing a connection between the participants and attendees at 12-step meetings may be contributing to social network changes, which may be more challenging for emerging adults because, on average, they have more individuals that misuse alcohol and other drugs in their networks than older adults. However, those who ended up using during the study were not benefited by the addition of STAGE-12 and had in fact, worse outcomes than treatment as usual. This may be explained by the 12-step emphasis on abstinence such that once abstinence is breached, there may be less emphasis on controlled use (an either-or mentality), known as the abstinence violation effect.
Garrett, S. B., Doyle, S. R., Peavy, K. M., Wells, E. A., Owens, M. D., Shores-Wilson, K., … & Donovan, D. M. (2018). Age differences in outcomes among patients in the “Stimulant Abuser Groups to Engage in 12-Step”(STAGE-12) intervention. Journal of substance abuse treatment, 84, 21-29.
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