Adolescent Substance Abuse Treatment Clinicians' Self-Help Meeting Referral Practices and Adolescent Attendance Rates‪.‬

Many substance abuse treatment providers expose adolescents to self-help concepts, most notably in the 12-Step tradition, in two main ways: by incorporating 12-Step work and philosophy to varying degrees into their treatment approaches (Jainchill 2000) and/or by recommending attendance at 12-Step meetings during and after treatment (Bukstein 1995). One indication of the popularity of 12-Step concepts was demonstrated by a survey of 144 adolescent substance abuse treatment programs in the United States. This survey revealed that while 70% of programs offered services that combined different approaches to treating substance problems, the 12-Step model was the most widely implemented one, used to some extent by 66% of all the programs (Drug Strategies 2003). Despite frequent referrals to 12-Step meetings, survey data estimate that adolescents comprise a very small percentage (less than 3%) of the membership of three common self-help groups (Alcoholics Anonymous 2005; Cocaine Anonymous World Services 2006; Narcotics Anonymous World Services 2005). Only a limited number of studies have investigated the clinical effectiveness of this traditionally adult-oriented approach with youths. Some evidence indicates that 12-Step based treatment assists adolescents in reducing substance use (Winters et al. 2000; Kennedy & Minami 1993; Alford, Koehler & Leonard 1991) and that adolescents who participate in 12-Step meetings after inpatient treatment maintain lower levels of substance use and/or higher rates of abstinence than adolescents who do not (Kelly, Myers & Brown 2001, 2000; Hsieh, Hoffman & Hollister 1998; Kelly & Myers 1997; Brown 1993; Kennedy & Minami 1993; Alford, Koehler & Leonard 1991; Brown, Mott & Myers 1990). While two such studies identified self-help meeting attendance as one of the most powerful discriminators of abstinence up to six and 12 months after discharge from treatment (Hsieh, Hoffman & Hollister 1998; Kennedy & Minami 1993), conclusions from this research are limited because of the small number of studies, a focus on adolescents discharged from residential or inpatient treatment only, nonexperimental designs, and measurement of 12-Step meeting involvement solely in terms of attendance rather than other dimensions of involvement (such as obtaining a sponsor, reading literature, and working the steps). A detailed review of these study findings and limitations can be found in an article by Kelly and Myers (2007). No studies were found that investigated adolescent participation in other self-help meetings, such as Women for Sobriety or Secular Organization for Sobriety.