Involvement in Alcoholics Anonymous (AA) is known to be beneficial for adults, however, less is known about the effects and ways in which AA helps young adults recover from substance use disorder (SUD). Arguably, young adults face more recovery challenges than their older adult counterparts for several reasons. They are more likely to be exposed to alcohol and drug cues in social situations because the prevalence of substance use during this life stage is the highest of any developmental period. Additionally, those under 30 tend to be less interested in spirituality and religion, therefore, the spiritual focus of AA might be less appealing compared to older individuals. Compared to adults, those under 30 face different psychosocial stressors, too, including a more transient lifestyle, sexual and romantic challenges, and financial stressors.
The researchers examined whether young adults (18-29 yrs) benefit from AA attendance as much and in the same ways as those over age 30. The authors tested six different potential mediators of AA’s effects which were chosen because they were found to be mediators in previous AA studies with adults. They asked whether AA helped people recover via its ability to: increase individuals’ confidence in their ability to abstain in high risk social contexts, and when experiencing negative affect; to increase spiritual/religious practices; decrease depression symptoms; and, increase the number of pro-abstainers and decrease the number of pro-drinkers in individuals’ social networks. Data was from a 12-week outpatient treatment trial called Project MATCH, where participants were individuals with alcohol use disorder (N=1726). Participants in Project MATCH received either cognitive behavioral therapy (CBT), motivational enhancement therapy (MET) or 12-step facilitation therapy at one of nine outpatient clinics around the US. The authors compared young adults 18-29 yrs (n=266) with adults over 30 (n=1460) at 3-, 9- and 15-month follow-up points on two outcomes: percentage of days abstinent (PDA) and the number of drinks per drinking day (DDD).
At baseline, the young adult group was found to have less clinical severity (e.g. higher PDA, fewer DDD, and a lower number of prior alcohol treatments), lower religiousness and a stronger pro-drinking network compared to the older group. Both groups were found to benefit equally from AA attendance, however, the six mediators explained more of the effect that AA attendance has on PDA and DDD for those over 30 than young adults. This suggests that there are additional mediators for the relationship between AA attendance and the outcomes for those under 30, however, this study did not examine what those mediators may be.
Confidence in the ability to abstain in social situations and pro-drinking social networks were found to explain the effect of AA attendance on drinking outcomes for the young adult group. The indirect effects explained more of the drinking outcome variance in the older group even when accounting for similar attendance rates between the groups, therefore suggesting that there are additional pathways for the younger group that were not tested in this study. The authors speculate that other potential pathways include that AA attendance increases abstinence motivation for young adults, increased feelings of hope and belonging through membership, or a feeling of empowerment by attending meetings.
In Context
Young adults (18-29 years old) carry a disproportionate share of the SUD-related burden. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), more than 16% of young adults meet past-year criteria for an alcohol use disorder, about 1.5 times that of middle aged adults and twice that of older adults. AA attendance has been found to be equally beneficial for individuals over and under the age of 30. This is very good news, however, AA attendance seems to help these age groups in different ways. Another way of saying this is that these age groups use AA in different ways. AA attendance in older adults boosts the number of pro-abstinent members in their social network, whereas while younger adults, who are attending AA at a similar rate and who are also adding pro-abstinent members to their social network, are adding sober new social network members not from AA. Finding where those new pro-abstinent social network members are being added from is key, and more research is needed to further examine this. A barrier for some individuals under the age of 30 may be the lack of similar-aged peers in recovery and this is something that AA and other mutual-help groups have worked to overcome by holding youth focused meetings. AA and other mutual-help organizations (MHOs) are a low-cost resource for individuals in recovery. Additionally, some MHOs have meetings that are geared towards young adults. Developing pro-abstinent relationships for young adults may help to aid in recovery, though AA does not appear to help with this.