About 150 miles northeast of IRETA’s office in Pittsburgh, Pennsylvania lies another city with a mighty industrial past and a premier hospital system: Cleveland, Ohio. There, Dr. Maria Pagano and her research team at Case Western Reserve University (CWRU) are exploring a well-known notion that has received minimal investigation in the research world, the therapeutic benefits of service for the treatment of addiction.

The project is called Helping Others Live Sober.  Dr. Pagano offered this simple summary of their findings: “Helping benefits the helper.”

It’s a conclusion that has emerged from a decade of research on the subject of service in 12-step, including a recently published article analyzing 10-year outcome data originally collected by the Principle Investigator J. Scott Tonigan of 148 subjects in recovery. The study was the first to explore meeting attendance, step-work, and AA-related Helping (AAH) and their concurrent influence on long term outcomes.

Its results showed that over 10 years:

  • AAH was associated with more percent-days abstinent (PDA)
  • AAH was associated with higher levels of interest in others (IIO)
  • Among the study subjects, step-work three years post-treatment was predictive of increased PDA after 10 years

Dr. Pagano came to CWRU by way of Brown University, where she was on faculty in the Department of Psychiatry and Human Behavior.

“At Brown, I noticed that no one was talking about the role of service in recovery,” she said. “So I decided to investigate it.”

And in order to research something, you have to measure it. For that, Dr. Pagano developed an instrument called the Service to Others in Sobriety (SOS) Scale. The scale’s 12 questions examine acts of good citizenship as a member of a 12-step program and AAH activities involving the transmission of one’s personal experience to another.

“Like a barometer,” the SOS assesses a person’s current level of service in the context of 12-step. Assessing service, Pagano said, is the natural first step toward increasing it.

“It’s like stepping on a scale when you’re trying to lose weight,” she said.

Pagano said her research suggests that service confers an immediate benefit to a patient with a substance use disorder and could be an essential part of a treatment plan. Integrating service assessment with the initial clinical assessment would not only help a clinician get a reading of a patient’s service involvement, but it could also suggest to patients ways of serving others that they haven’t considered.

Pagano said in that way, service maps fit perfectly into motivational interviewing.

“Service is free and you don’t need insurance or anything special to seek it out. It’s not a replacement for treatment or, in some cases, medication, but it’s an important component of helping to change addicted thinking.”

“One of the erroneous assumptions people often make is that you can only help another addict when you’ve ‘graduated,’ so to speak. When you’re well. Because of the therapeutic benefits of service, I think it should be made part of treatment from day one,” Pagano said.

The assertion that addicted people can immediately help other addicted people is a radical aspect of Dr. Pagano’s research, the idea that, in fact, “their experience has provided them with a skillset that is uniquely suited for helping a fellow sufferer.”

And again, helping others is shown to benefit the helper.

Dr. Pagano believes that these research findings could be applied widely in practice, especially because of its price tag.

“It’s free!” she said. “Service is free and you don’t need insurance or anything special to seek it out. It’s not a replacement for treatment or, in some cases, medication, but it’s an important component of helping to change addicted thinking.”

She and her research team are now concentrating on AAH among adolescents in recovery. They conducted a recent study that found AAH to be correlated with success in quitting cigarette smoking among youth in treatment.

Dr. Pagano is the current recipient of a career development award from the National Institute on Alcohol Abuse and Alcoholism to further her study of prosocial behaviors among adults and adolescents in addiction recovery.  She heads the “Helping Others” research project at CWRU.  More information is available at helpingotherslivesober.org