Do social networks explain 12-step sponsorship effects? A prospective lagged mediation analysis.

Twelve-step mutual-help programs are among the most popular community-based programs available to help people with substance misuse problems (Emrick, Tonigan, Montgomery, & Little, 1993) and most treatment providers in the United States encourage 12-step participation (Kelly, Yeterian, & Myers, 2008). In general, prospective studies indicate that 12-step attendance is predictive of reductions in alcohol use (Emrick et al., 1993; Tonigan & Rice, 2010) and illicit drugs (Carroll et al., 2000; Gossop, Stewart, & Marsden, 2007; Timko, DeBenedetti, & Billow, 2006; Timko & Sempel, 2004; Toumbourou, Hamilton, U’Ren, Stevens-Jones, & Storey, 2002; Weiss et al., 2005; Witbrodt & Kaskutas, 2005; Worley et al., 2008). With the knowledge that 12-step participation is beneficial for many, but not all, substance abusers, funded 12-step investigations are now seeking to identify the active ingredients and mechanisms that account for increased abstinence among 12-step participants. One active ingredient in 12-step programs, sponsorship, is widely encouraged and has documented benefit in predicting increased abstinence. It has been reported in the Triennial Survey of Alcoholics Anonymous (AA, 2007), for example, that about 75% of members acquire a sponsor in the first 90 days of affiliation and prospective studies suggest that between 20% to 45% of 12-step affiliates have sponsors at nine and 12-month follow-ups (Humphreys & Moos, 2001; Kaskutas, Bond, & Humphreys, 2002; Tonigan, Connors, & Miller, 2003). By nearly all accounts, the role of the sponsor spans both 12-step program and fellowship domains (AA, 2005; Whelan, Marshall, Ball, & Humphreys, 2009). In addition to the primary task of guiding a newer member through the 12 steps, Morgenstern, Kahler, Frey, & Labouvie (1996) reported that having a sponsor predicted increased 12-step service work, reading 12-step literature, prayer, and advice-seeking from AA members. Twelve-step sponsorship also appears to be associated with increased access to the abstinence-based social support provided in 12-step fellowship. At the broadest level, Kelly and Moos (2003) reported that acquiring a sponsor during alcohol treatment predicted a higher probability of continuing to attend 12-step meetings. More narrowly, Rush (2002) found that, among female members of community-based AA, those with a sponsor perceived that they had greater personal and social support than did those without a sponsor. In addition, Majer et al. (2002) showed that, among participants receiving inpatient alcohol treatment, having a sponsor was significantly associated with a higher proportion of people in the social network either in recovery or abstinent from alcohol. Collectively, then, a majority of new 12-step affiliates acquire a sponsor during their early efforts to initiate behavior change, and it appears that having a sponsor more effectively engages new members into the prescribed practices of 12-step programs, e.g., 12-step work, meeting attendance, and the 12-step social network. In general, having a 12-step sponsor is predictive of reductions in substance use. Tonigan and Rice (2010), for instance, reported that 12-step affiliates who had sponsors were 3.6 times more likely to be abstinent from alcohol at 6 months relative to affiliates who did not have sponsors, even after controlling for participant motivation, concurrent substance use treatment, and 12-step meeting attendance. This finding is consistent with the work of other investigations of sponsorship during early 12-step affiliation (cf. Witbrodt & Kaskutas, 2005), and it is especially interesting to note that having a sponsor significantly increases the odds of abstinence at longer-term follow-up (Bond et al., 2003). In spite of strong evidence supporting the benefits of 12-step sponsorship the question remains, why is sponsorship effective? Several studies have shown that sponsorship and other indicators of AA involvement lead to increases in abstinence-based social support (George & Tucker, 1996; Humphreys, Finney, & Moos, 1994; Humphreys & Noke, 1997; Majer et al., 2002; Snow, Prochaska, & Rossi, 1994; Timko, Finney, & Moos, 2005; Witbrodt & Kaskutas, 2005). In addition, five studies using formal mediational analyses have found that social support for abstinence mediates or accounts for the pathway between composite measures of AA involvement and later abstinence (Bond et al., 2003; Humphreys, Mankowski, Moos, & Finney, 1999; Kaskutas et al., 2002; Kelly, Stout, Magill, & Tonigan, 2011; Laudet, Cleland, Magura, Vogel, & Knight, 2004). The composite measures of AA involvement in two of these studies addressed sponsorship. In the Bond et al. (2003) study, two of five items in the composite measure asked about 12-step sponsorship and in the Kaskutas et al. (2002) study, one of the seven items in the composite AA measure asked whether the participant was sponsored. Although not definitive, these studies are consistent with other reports that 12-step sponsorship mobilizes increased social networks supportive of abstinence, e.g., Majer et al. (2002) and Rush (2002). Using a prospective design, this study had two aims. We first sought to investigate change over time in the number of abstinent and in-recovery people in the social network of adults newly affiliated with 12-step programs. Second, we investigated whether the benefit of sponsorship could be explained by changes in the abstinence-based social network of the sponsee. Here, we applied Baron & Kenny's (1986) approach for assessing statistical mediation by investigating the temporal pathways between having a 12-step sponsor, the abstinence-based social network, and drinking reduction.