Young adults, social networks, and recovery: An investigation of changes in close social ties and their role as a mediator of 12-step participation

First published: 10 May 2019 | Last updated: 20 May 2019



John F. Kelly

Center for Addiction Medicine Departments of Psychiatry Massachusetts General Hospital and Harvard Medical School, Boston, MA

Robert L. Stout

Decision Sciences Institute Providence, Rhode Island

M. Claire Greene

Center for Addiction Medicine Departments of Psychiatry Massachusetts General Hospital and Harvard Medical School, Boston, MA

Valerie Slaymaker

Hazelden Foundation, Center City MN


Corresponding Author: John F. Kelly, Ph.D., Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, 60 Staniford Street, Boson, MA 02114. Email:; Tel: 617-643-1980; Fax: 617-643-1998

Institution of Origin: Massachusetts General Hospital, Boston, MA 02114


This work was supported by the NIAAA Grant Number: 1R21AA018185-01A2

No conflicts of interest exist.



Aims: Research with adults indicates individuals with substance use disorder (SUD) benefit from participation in mutual-help organizations (MHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), via adaptive social network change. Given the greater dearth of sobriety-conducive and sobriety-supportive social contexts during young adulthood, however, these 12-step-facilitated social changes may be more important during this life-stage, but have not been investigated as a mechanism of behavior change. Greater knowledge would enhance understanding of recovery-related change and inform the specificity of continuing care recommendations for young adults. Design: A naturalistic prospective cohort study of residential treatment effectiveness. Lagged hierarchical linear models (HLMs) and mediational analyses tested whether 12-step participation conferred recovery benefits via social network changes controlling for confounds. Participants: Emerging adults (N=302; aged 18-24yrs; 26% female; 95% White; 51% comorbid [SCID-derived] axis I disorders). Measures: Participants assessed at intake, 3, 6, and 12 months on 12-step attendance and involvement, social network variables, and substance use (Percent Days Abstinent [PDA]; Percent Days Heavy Drinking [PDHD]). Findings and Conclusions: High risk peers were common at treatment entry, but this changed substantially and beneficially post-treatment. Parents’ and siblings’ substance use status also changed but to a lesser degree. While both 12-step participation and recovery-supportive peer network changes were observed independently and related to better outcomes, social network change was unrelated to 12-step participation and, thus, not found to mediate its influence on outcome. In sum, young adult 12-step participation was found to confer recovery benefit; yet, while promoting social network change, 12-step MHOs may be less able to provide social network change, directly, for young adults, perhaps because similar-aged peers are less common in MHOs. Further research is needed to discover alternative mechanisms by which young adults benefit from 12-step MHOs.

Keywords: young adults; social networks; Alcoholics Anonymous; 12-step.


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John Kelly