It is now generally accepted that AA and other 12-step groups contribute to better substance use outcomes for those who are addicted to alcohol and/or drugs and choose to attend them. Nevertheless, most individuals do not sustain regular involvement in 12-step groups, even when 12-step participation is the focus of treatment. Meanwhile, involvement in 12-step alternatives is substantial and appears to be growing. The largest such alternatives include Women for Sobriety (WFS), Self-Management and Recovery Training (SMART), LifeRing, and Secular Organization for Sobriety (SOS). Yet, research relating to the effectiveness of 12-step alternatives is almost non-existent, and there are no known longitudinal studies on group members. Research on the effectiveness of the various alternatives is important to enhancing the integration of formal treatment with appropriate alternatives, improving referral practices, and informing courts and other legal bodies (e.g., EAP programs) involved in mandating substance abuse treatment, as well as the general population. The current study will thus capitalize on a very large, recent, national study of individuals in recovery from an alcohol and/or drug problem to follow respondents recruited from 12-step groups (N=261) and their alternatives (N=390;total N=651) and measure mutual help group involvement and recovery outcomes. Respondents will complete a First Follow-up survey and additional follow-ups at 6 and 12 months (Second and Third Follow-ups). Our primary aim is to test whether associations between mutual help group involvement and recovery outcomes (such as abstinence and quality of life) differ across mutual help groups (Aim 2). We will also compare respondents identifying WFS, SMART, LifeRing, and SOS as their primary mutual help group to 12-step members on demograpcharhics, clinical severity, and nature of involvement (Aim 1), and examine predictors of group satisfaction and drop-out/declining involvement across mutual help groups (Aim 3). Despite some small subgroups, we expect generally sufficient numbers within each group to facilitate comparisons between individual 12-step alternatives and AA. The current study should, in the short term, contribute to the knowledge base on the benefits and limits of specific mutual help groups, and may lead to more focused study of one or more promising alternative(s) to AA and to study designs that can best address questions of effectiveness, such as randomized trials. Ultimately, the current line of research could support both the growth of effective mutual help groups and the recovery of the many individuals who may be willing to use them. This proposal responds to PA-13-161 (Alcohol Use Disorders: Treatment, Services Research, and Recovery, NIAAA), soliciting research on behavioral and pharmacological treatment for alcohol use disorders.

Public Health Relevance

Hazardous alcohol and drug use are leading causes of avoidable mortality. Alongside AA, there is now a host of mutual help groups that are available to help individuals address their substance use problems, and that are particularly appealing because they can be used before, during, after, and instead of formal treatment. Yet, little is known about the alternatives to AA. The current study would provide much-needed information on the nature and effectiveness of WFS, SMART, LifeRing, and SOS in addressing addiction. By doing so, the study could extend the menu of options that providers and patients consider when developing a treatment plan, thus enhancing the likelihood that patients affiliate with a supportive peer network and maintain better outcomes. This in turn may ultimately contribute to the growth and availability of 12-step alternatives.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Exploratory/Developmental Grants (R21)
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Health Services Research Review Subcommittee (AA)
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Hagman, Brett Thomas
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United States
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