Background and Aims
Integration of 12-step philosophy and practices is common in adolescent substance use disorder (SUD) treatment programs, particularly in North America. However, although numerous experimental studies have tested 12-step facilitation (TSF) treatments among adults, no studies have tested TSF-specific treatments for adolescents. We tested the efficacy of a novel integrated TSF.
Design
Explanatory, parallel-group, randomized clinical trial comparing 10 sessions of either motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT; n=30) or a novel integrated TSF (iTSF; n=29) with follow-up assessments at 3-, 6-, and 9-months following treatment entry.
Setting
Outpatient addiction clinic in the USA.
Participants
Adolescents (N=59; M age=16.8 [1.7]; range 14-21; 27% female; 78% White).
Intervention and comparator
The iTSF integrated 12-step with motivational and cognitive-behavioral strategies, and was compared with state-of-the-art MET/CBT for SUD.
Measurements
Primary outcome: percent days abstinent (PDA); Secondary outcomes: 12-step attendance, substance-related consequences, longest period of abstinence, proportion abstinent/mostly abstinent, psychiatric symptoms.
Findings
Primary Outcome: PDA was not significantly different across treatments (b=0.08,CI95%-0.08 to 0.24, p=.33; Bayes Factor=0.28). Secondary Outcomes: During treatment, iTSF patients had substantially greater 12-step attendance, but this advantage declined thereafter (b=-0.87; CI95% -1.67 to 0.07, p=.03). iTSF did show a significant advantage at all follow-up points for substance-related consequences (b=-0.42; CI95% -0.80 to -0.04, ps <.05; effect size range d=0.26 to 0.71). Other secondary outcomes did not differ significantly between treatments but effect sizes tended to favor iTSF. Across the entire sample, greater 12-step meeting attendance was associated significantly with longer abstinence during (r=0.39, p=.008), and early following (r=0.30, p=.049), treatment.
Conclusion
Compared with motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), in terms of abstinence, a novel integrated 12-step facilitation treatment for adolescent substance use disorder (iTSF) showed no greater benefits, but did show benefits in terms of 12-step attendance and consequences. Given widespread use of combinations of 12-step, MET, and CBT in adolescent community outpatient settings in North America, iTSF may provide an integrated evidence-based option that is compatible with existing practices.
