Substance Abuse Counseling Doesn't Work For Teens. But Can AA?
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Substance Abuse Counseling Doesn’t Work For Teens. But Can AA?


This post was originally published on August 28, 2014.

Every year, some 320,000 people between the ages of 15 and 29 die each year from alcohol abuse. Traditionally, alcohol counseling based on brief motivational interviewing sessions has been viewed as an effective approach to fighting this problem. But new research shows that drug and alcohol counseling doesn’t help young people as much as we thought.

These grim findings come courtesy of Oxford Brookes University, where researchers conducted 66 trials with 17,900 people under age 25 who were at high risk for alcohol abuse. Some of the participants received just one individual counseling session, while others attended a series of group sessions over a span of four months. After following up with the subjects, researchers found the participants who received counseling averaged 12.2 drinks per week versus 13.7 for those without counseling—not exactly a huge lifestyle change.

Counseling Ain’t Curing

Not only did counseling fail to significantly reduce the young subjects’ total weekly drinks, but it also made little impact on how many days of the week they hit the bottle. Subjects who received counseling drank an average of 2.57 days a week, while those with no counseling averaged 2.74 days. Those numbers seemed low, so I did the math—that’s four or five drinks each day, more like weekend partying than bona fide alcoholic behavior. But that’s neither here nor there—the point is that the counseling didn’t seem to affect their habits.

As lead researcher David Foxcroft put it, “The results suggest that for young people who misuse alcohol there is no substantial, meaningful benefit of motivational interviewing. There may be certain groups of young adults for whom motivational interviewing is more successful in preventing alcohol-related problems. But we need to see larger trials in these groups to be able to make any firm conclusions.”

Of course, alcohol is far from the only substance young people are prone to abuse. But there’s bad new on this front as well: two different studies released last month indicated that interventions and counseling do little to curb drug use. Researchers at Boston University split 500 people who had screened positive for substance abuse into three groups. The first two groups each received a different type of counseling while the third group went without. Yet as in the alcohol study, all three groups fared equally poorly six months later. These findings were corroborated by an unrelated JAMA study.

So, What about AA?

Well, so much for that. If we’re to conclude that brief counseling is virtually useless for young people, what about AA groups, which, let’s be honest, tend to disproportionally consist of older adults? A new study suggests that while AA can help young people stay sober, only certain aspects of the program seem to really click with the under-30 set—which may explain why they comprise just 13% of AA members.

To measure the disconnect between AA and young people, Harvard researchers examined 2,000 adults in a 12-week treatment program, 300 of which were between the ages of 18 and 29. Every three weeks following treatment, the participants reported their meeting attendance, spiritual practices, depression, and of course, whether they were still sober. Even though the young adults attended the same number of meetings as their older counterparts, more of them had resumed drinking. After 15 months, 30% of those under 30 stayed sober as opposed to 39% of those over 30. While that’s not a huge difference, it does reflect that youth can diminish some of the program’s sticking power.

All the Cool Kids Aren’t Doing It

Harvard psychologist Bettina Hoeppner, who headed up the AA study, highlighted some key challenges younger alcoholics face that make it harder to stay sober in AA. For one, younger people have shorter addiction histories, so they have less to share and sometimes struggle to identify with the life experiences of older members. I can relate to this. While sitting in a room with people who have been clean and sober longer than I’ve been alive is impressive, it’s also weirdly alienating, especially when they start talking about their children, spouses, mortgages and other foreign concepts.

Young people also face far more social pressure to drink. This is true—before I got sober I couldn’t imagine that a 20-something could have any friends or any fun without drinking. These differences make it harder for young people to connect with the people and principles of AA—which perpetuates the problem of too few young people in the rooms.

Making AA Hip

To pinpoint which elements of AA were working for young people—and which were not— the researchers broke AA’s benefits down into six key skills. Older alcoholics in recovery reported finding most of these components helpful, including coping with negative emotional setbacks and embracing spirituality. But for younger members, AA’s benefits came down to just two: getting to socialize with other abstainers and learning how to turn down a drink in risky social situations.

Hoeppner hopes these findings will enable AA to better cater to younger people, who suffer higher rates of substance abuse than any other age group. But the best way to attract 20-somethings to AA would be to simply have more young faces at meetings.

“If you are a young adult struggling with substance use, try AA,” Hoeppner urges. “Don’t let the fact that you’ll likely be among the few younger people there deter you…It’s not for everyone, but it can help.”

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About Author

Erica Larsen AKA Eren Harris blogs at Whitney Calls and Clean Bright Day. Their writing has also been published on Salon, Selfish, Violet Rising and YourTango. They live in Los Angeles with their husband and their enormous cat.