Category Archives: Relapse

Melissa Killeen

Ever since I walked into the rooms, I heard the phrase “Service keeps you sober.” I already knew I was a helping type of person, in fact in my addiction it was called being a rescuer. So I stayed away from service for the first few years. When I was ready to do service, I remember desperately waiting the required three months of sobriety to chair my first meeting. Then praying to receive special dispensation to be a meeting list coordinator at the Intergroup/Regional level, because I only had six months, not the required one year of sobriety. I learned why service kept me sober. It occupies the time I would be spending acting out with doing good things. Well, that’s what I thought.

Service might be the key to staying sober

Maria Pagano, an addiction researcher at Case Western University, thinks service to others might be the key to staying sober. In recent years, a growing body of research has found that helping others brings measurable physical and psychological benefits to the helper. Building on this work, Pagano is exploring the surprising benefits of altruism for people battling addiction. Her studies have shown that addicts who help others, even in small ways—such as calling other AA members to remind them about meetings or setting up chairs before a meeting—can significantly improve their chances of staying sober and avoiding relapse.

Surveys and studies say that abuse of alcohol and narcotics is rising among young people  and drug-related deaths have doubled among middle-class whites. Many addicts who exit treatment programs relapse within the first 90 days of being discharged, leaving treatment professionals yearning for more effective treatment strategies. If getting addicts to do service is key to their recovery, as Pagano believes, it could revolutionize the addictions treatment field.

Pagano was familiar with the research on helping when she joined Brown University’s Center for Alcohol and Addiction Studies Center in 2002. As she learned more about the different treatments for addiction, she was surprised that there seemed to be no one looking at the role of doing service.

“It was all about what services to give these suffering patients,” she says, “and nothing about getting them active or about how their own experiences about getting sober and being sober can be useful to others.”

Addicts help their recovery by helping other people

She decided to explore the impact that helping others could have on people in recovery. Looking at data from one of the largest studies of addiction to date, with 1,726 participants, conducted by the University of Connecticut, Pagano was able to measure it by looking at how many study participants became AA sponsors or completed the 12th step of AA, which involves helping others in recovery.

When she compared helpers to non-helpers in AA, she found that 40 percent of the addicts that did service or the “helpers” avoided taking a drink in the 12 months following their stay at treatment facility, while only 22 percent of “non-helpers” stayed sober. These results have rarely been seen in addiction treatment studies before.

In fact, age, gender, income, work status, addiction severity level, or level of antisocial personality disorder of the participants in the study didn’t matter. None of these characteristics predicted helping behavior. “Someone from Yale to jail had an equal chance of being a helper,” Pagano says.

Only one factor seemed related to helping; those who were more depressed starting out in their recovery were more likely to help. This seemed counter-intuitive, given that depressed people often suffer from lethargy and a sense of helplessness. But according to Pagano, this is exactly the kind of thinking about depression that gets recovery therapists in trouble.

“In the treatment field, we have this notion that says, ‘Oh, don’t ask too much of the client, especially if they’re depressed. They just need to rest,’” she says. But when she studied the effect of helping on clinical depression, she found that, after six months of doing service, people who had been depressed had their depression levels drop significantly—below the level of what’s clinically considered “depressed.”

Pagano and her colleagues devised a more precise measure of helping behavior called the SOS (Service to Others in Sobriety) scale for use in future studies. This scale lists 12 helping behaviors that are built into AA and Narcotics Anonymous (NA) meetings—like picking up the phone and calling a fellow AA or NA member, contacting someone to encourage meeting attendance, setting up chairs before the meetings, or becoming a sponsor.

Maria Pagano’s research suggests addicts help their recovery by helping other people. “This is a no-brainer,” she says. “It’s as essential as medication-assisted therapy.”

You can’t be ruminating or feeling bitter if you’re feeling moved by helping someone else.

With a grant from the John Templeton Foundation and funding from the National Institute on Alcohol Abuse and Alcoholism, Pagano used the SOS scale to look at 200 adolescents undergoing treatment for alcoholism or drug addiction in Northern Ohio. Her results showed that kids with higher helping scores on the SOS had significantly lower cravings for alcohol and narcotics, reduced feelings of entitlement, and higher “global functioning”—a measure used by clinicians to reflect participation in groups, getting along with others, and academic performance, among other behaviors.

In fact, Pagano found that even risk factors like having alcoholic or drug-addicted parents, learning problems, physical disabilities, or additional psychiatric diagnoses didn’t change the effect of helping others; helping still had a positive impact.

Pagano’s analysis makes a significant contribution to the research that shows adolescents benefit from helping others. Pagano’s research is unique and cutting edge, because no one has really studied helping in the context of recovering from addictions.

AA folks recognized the benefits of service in AA, but there was no research to back it up. Maria Pagano is bringing good science to this age old-slogan “Service keeps you sober”.

Resources used in this blog

Learn more about Maria Pagano’s work on her website, Helping Others Live Sober.

Pagano, M. E., Kelly, J. F., Scur, M. D., Ionescu, R. A., Stout, R. L., Post, S. G. (2013). Assessing Youth Participation in AA-Related Helping: Validity of the Service to Others in Sobriety (SOS) Questionnaire in an Adolescent Sample. American Journal on Addictions 22(1), 60-66.

Pagano, M.E., Post, S.G., & Johnson, S.M. (2011). Alcoholics Anonymous-Related Helping and the Helper Therapy Principle. Alcoholism Treatment Quarterly 29(1), 23-34.

Pagano, M.E., Krentzman, A.R., Onder, C.C., Baryak, J.L., Murphy, J.L., Zywiak, W.H., & Stout, R.L. (2010). Service to Others in Sobriety (SOS). Alcoholism Treatment Quarterly 28(2), 111-127. PMC3050518.

Pagano, M.E., Zemore, S.E., Onder, C.C., & Stout, R.L. (2009). Predictors of initial AA-related helping: Findings from Project MATCH. Journal of Studies on Alcohol and Drugs 70(1), 117-125. PMC2629624.