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.

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. 

Helping as habit

“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.” 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 r 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.

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. 

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.”

“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.”

Sharing sobriety