Helping others helps adolescent helpers reduce cravings for alcohol and drugs

Case Western Reserve study published in November issue of Journal of Studies on Alcohol and Drugs also highlights the influence of religious practices on treatment response

A new study of teens undergoing substance abuse treatment finds helping others helps the adolescent helper by reducing cravings for alcohol and drugs, a major precipitator of relapse. These novel findings stem from the "Helping Others" study (http://helpingotherslivesober.org) led by Maria Pagano, PhD, associate professor of psychiatry at Case Western Reserve University School of Medicine.

Results of this large investigation involving 195 substance dependent juvenile offenders reveal that helping others in 12-step programs significantly improves adolescent treatment response. Featured in the November issue of the Journal of Studies on Alcohol and Drugs, this study also shows that youth service participation mediates the influence of lifetime religious practices on treatment outcomes.

"Our findings indicate that service participation in 12-step programs can reduce the craving symptoms experienced by adolescents in treatment for alcohol and or drug addiction," Dr. Pagano says. "Similarly, we found that substance-dependent adolescents with greater religious backgrounds participate more during treatment in 12-step programs of recovery, which leads to better health outcomes."

This observational, longitudinal study is the first to examine the relationship between adolescent 12-step participation during treatment, lifetime religiosity, and clinical outcomes, replicating findings shown among adults in Dr. Pagano's prior collaborative research.

Funded by the John Templeton Foundation, the investigation comprised 93 boys and 102 girls, ages 14-18, court-referred for residential treatment at New Directions, the largest adolescent residential treatment facility in Northeast Ohio. The majority were marijuana dependent (92%) with comorbid alcohol dependence (60%). Participants were interviewed within the first 10 days of treatment and two months later at treatment discharge. Outcomes assessed included urine toxicology screens, alcohol/drug craving symptoms, clinical characteristics, and global psychosocial functioning.

Controlling for background characteristics and clinical severity, Dr. Pagano and colleagues found that Alcoholics Anonymous and Narcotics Anonymous-related helping, as part of treatment, improved four of seven outcomes. These included reductions in two types of craving symptoms, reduced narcissistic entitlement, and improved psychosocial functioning. Higher lifetime religious practices, such as prayer, worship, and meditation, were associated with higher service participation during treatment, which in turn, led to better outcomes.

"Because most religions encourage altruistic behaviors, youths entering treatment with greater religious backgrounds may have an easier time engaging in service in 12-step programs of recovery," Dr. Pagano explains. "In turn, youth entering treatment with low or no religious background may require greater 12-step facilitation or a different approach to derive equal benefit from treatment."

Adolescent addiction has increased dramatically in the past decade at a time when treatment resources are dwindling. Craving for alcohol and drugs is a major precipitator of relapse and can linger long after the detoxification period. While newly developed medications can block cravings, they are not approved for use with adolescents. Service participation is a natural, no-cost behavioral approach that can reduce adolescents' craving symptoms as they adjust to a sober lifestyle.

This study examined end-of-treatment outcomes. Dr. Pagano's continued research in this area will investigate the impact of AA/NA-related helping on post-treatment health outcomes.