Staying Sober through Service
A researcher finds that helping others might be the secret weapon in the fight against addiction.
BY JILL SUTTIE | MARCH 13, 2012
Victor M. was only 13 years old when his troubles with alcohol began. He stole bottles of hard liquor from his neighbor’s garage, enjoying how alcohol made him feel. Soon, he was drinking every day and using drugs, too.
Shortly after turning 21, he crashed a car during an alcohol-induced blackout. A judge ordered him to attend Alcohol Anonymous (AA) meetings, where recovering alcoholics encourage each other to become (and stay) sober by sharing personal stories and following AA’s famous 12-step model. When Victor attended his first AA meeting, he was terrified. “I didn’t say anything,” he says. “I just stared at the floor the whole time and left as soon as it was over.”
After completing his sentence, he soon returned to drinking. But two years later, when his girlfriend threatened to kick him out of their house and he realized he was about to become homeless, he came back to AA, this time as a full participant. He began signing up to do AA meeting chores, like making coffee or collecting books at the end of the meetings.
Five years later, he is still sober and reaching out to other addicts who are trying to kick their addiction. “It keeps me accountable and plugged in,” says Victor, now 26. “It gives me a sense of purpose.”
Maria Pagano, an addiction researcher at Case Western University, thinks Victor’s service to others might be the key to his 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 particular and sometimes surprising benefits of altruism for people battling alcoholism and drug 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 making coffee like Victor did—can significantly improve their chances of staying sober and avoiding relapse, among adults and adolescents alike.
Pagano’s research could not be more timely. Surveys and studies say that abuse of alcohol and narcotics is rising among young people like Victor, and at a time when social service budgets are being slashed, many addicts who enter expensive treatment programs relapse within 90 days of being discharged, leaving patients and their clinicians yearning for more effective treatment strategies. If getting addicts involved in helping their fellow sufferers is key to their recovery, as Pagano believes, it could revolutionize the treatment of alcohol and drug addictions.
Help others, help yourself
For years, people have found that helping others can have a profound impact on health and happiness. According to a 2010 survey on volunteering, 68 percent of the 4,582 American adults surveyed said that volunteering made them feel physically healthier, 73 percent said it lowered their stress levels, 77 percent said it improved their emotional health, and almost all respondents said it made them happier.
Other research supports these claims. In one 1999 study, published in the journal Social Science and Medicine, patients suffering from multiple sclerosis were trained to provide compassionate support to other sufferers through monthly phone calls. The patients who offered this kind of support showed improvements in self-confidence and self-esteem, and had lower levels of pain and depression. The authors of the study conclude that helping others provided the MS sufferers with a sense of meaning and a stronger social identity, which made handling their own disease easier.
Benefits like these are familiar to Stephen Post, the director of the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University and the author of The Hidden Gifts of Helping. Post says altruism can provide helpers with a sense of gratification, agency, and a feeling of inner warmth (known as the “helper’s high”), possibly because the brain releases more of the chemical dopamine. He points to research showing that when chronic pain patients serve as peer volunteers for others suffering from chronic pain, they experience lower levels of pain intensity, disability, and depression.
“When you are involved in helping others, it blocks off destructive emotions and impulses,” says Post. “You can’t be ruminating or feel hostile and bitter if you’re feeling moved by helping someone else.”
The strengths of depression
Pagano was familiar with the research on helping when she joined the faculty at Brown University and began working at the 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.”
She decided to explore the impact that helping others could have on people in recovery. She started by looking at data from one of the largest studies of addiction to date, with 1,726 participants. Though the study, run out of the University of Connecticut, was not focused on helping behavior specifically, 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 helpers avoided taking a drink in the 12 months following the 3-month treatment period, while only 22 percent of non-helpers stayed sober—a doubling effect rarely seen in social science research, she says.
In addition, when Pagano looked at the age, gender, income, work status, addiction severity level, and level of antisocial personality disorder of the participants in the study, she found that none of these characteristics predicted helping behavior.
“Someone from Yale to jail had an equal chance of being a helper,” she says.
Only one factor seemed related to helping: Those who were more depressed starting out were more likely to help. This seemed counterintuitive, 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 need to just rest,’” she says. But when she studied the effect of helping on clinical depression, she found that, about six months after doing service, people who had been depressed had their depression levels drop significantly—below the level of what’s clinically considered “depressed.”
Helping as habit
Thinking she might be onto something, 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 calling a fellow AA or NA member to encourage attendance, preparing the room for meetings, or becoming a sponsor—and also provides a five-point scale to measure one’s activity level under each service item.
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.”
With a grant from the John Templeton Foundation and funding from National Institute on Alcohol Abuse and Alcoholism, Pagano used the SOS to look at 200 adolescents undergoing treatment for alcoholism or drug addiction at a facility 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 treatment groups, getting along with others, and academic performance, among other behaviors.
In addition, Pagano found that those adolescents who entered the program with higher levels of religiosity—defined as exposure over one’s lifetime to formal religious practices—were more likely to benefit from treatment through AA or NA. However, it appeared that helping behaviors explained that finding; in other words, alcoholics with religious backgrounds seemed to do better in AA because of their propensity to want to help others, not because of religious beliefs, per se.
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.
“These are the findings I get most excited about,” says Pagano.
According to Post, Pagano’s analysis makes a significant contribution to the research that shows adolescents benefit from helping others. Studies on high school service learning programs, for example, have shown that teens who participate in service learning do better in school, are less involved in criminal behavior, and report feeling happier. But Pagano’s research is unique and cutting edge, says Post, because no one has really studied helping in the context of healing from addictions.
“Anecdotally, AA folks recognized the benefits of service in AA, but they hadn’t studied it at all,” says Post. “Maria Pagano’s bringing good science to this and creating an incredible database.”
Pagano believes that helping others improves an adolescent’s chances of sobriety because it diminishes the self-absorption and egocentrism associated with the disorder.
Victor’s story illustrates how service can shift one’s focus from oneself to others. “Before becoming sober, I was miserable, angry, and upset,” he says. “There were only about 15 minutes a day where I didn’t want to die or kill myself.”
But making connections to others through AA made the difference in his recovery.
“Something as simple as showing someone how to make a pot of coffee and asking them to come back can be a huge part of sobriety,” he says.
It’s still unclear precisely how helping might impact sobriety. But according to Stephanie Brown, a researcher at Stony Brook University who studies altruism, helping people with whom we share a special kinship, such as alcoholics in AA, may activate the same brain circuits that light up when parents care for their offspring. Research on mammals has shown that activating this circuit decreases stress, strengthens immune systems, and inhibits centers in the brain affiliated with hoarding or other selfish behaviors—the same brain regions, Brown says, that are involved in human addictions. The reduced craving and lower feelings of entitlement seen in Pagano’s research may result from this same brain kind of brain activity.
Pagano believes that helping within AA rather than outside of it gives addicts who help others a “bigger bang for the buck.” She notes that many addicts possess a “built-in forgetter”—a part of themselves that, once they get sober, wants to forget how much alcohol has ruined their lives or hurt those around them. Trying to help others stay sober and watching their struggles can help a newly sober alcoholic remember his or her trials more clearly and recommit to remaining sober.
“You apparently value your sobriety more when you share with others about what your life is like now,” says Pagano.
Post says that in mutual aid organizations like AA, people feel they have a special competence in helping, having been there themselves.
“Helpers in AA have the sense that, by staying dry, they are helping other people along the path,” he says. “Besides, helping others reminds the alcoholic of how thin the line is between recovery and relapse.”
Making service part of treatment
With mounting evidence for the benefits of helping others, Pagano believes service within AA or NA should be viewed as an integral part of treatment for alcoholics and drug addicts. She wants to see her SOS instrument become available as an assessment tool for clinicians, providing information about a patient’s current helping behavior as well as suggesting areas where they could increase that behavior.
A benefit of focusing on helping and service, she says, is that anyone can do it. It doesn’t require a lot of introspective work, which Pagano claims can be difficult for most newly sober alcoholics, who are often in too much of a fog. What’s more, helping others in AA is free and doesn’t cost anything, unlike therapy.
“This is a no-brainer,” she says. “I believe it’s as essential as, say, medication-assisted therapy.”
Pagano hopes to do a larger, randomized control trial to prove that helping others directly causes people to get sober. She’d also like to study how helping others decreases cravings for alcohol—for example, does it decrease depression, increase self-esteem, or relieve social anxiety?
Victor is sure that helping his fellow sufferers has changed his life and allowed him to remain sober. Since he’s become involved with AA, he has made friends in the community and improved his relationships with his family. Currently, he is in charge of organizing a weekly AA meeting, where he arrives early to set up and make sure others know how to run the meeting.
And, he claims, he is much happier for it.
“I get to watch guys get better—there’s nothing better than that,” he says. He pauses a moment before adding, “Watching a family get back together again—it’s the greatest gift AA has given me.”