Recovery-oriented mutual self-help groups can aid recovery from substance use disorders (SUDs) and facilitate personal growth through self-exploration and peer support. Although these groups are not a part of professional treatment, they can provide a rich source of support for recovery and complement other treatment. Mutual self-help groups provide a forum and opportunity for individuals in recovery to connect with others who have similar experiences and goals, allowing them to build relationships within a substance-free support network. These groups are typically free, anonymous, and easily accessible; as such, these groups can be readily available over the long-term trajectory of recovery. Mutual self-help groups include a variety of programs, with 12-step programs (e.g., Alcoholics Anonymous, AA; or Narcotics Anonymous, NA) and Self-Management and Recovery Training (SMART Recovery) being the most common ones.
Clinicians who are knowledgeable about community-based recovery programs may be more successful in referring patients to these programs. Different meetings have different energies or dynamics to them, and clinicians should encourage patients to attend several different meetings to identify the ones that feel most comfortable for them or where they find connection with the other members. It may be helpful to inform patients that each meeting is unique and has its own character; if a patient has a negative experience in a particular meeting, he or she should try attending one or more different meetings to find the ones that feel right.
Twelve-Step Recovery Programs
Twelve-step recovery programs involve meetings in various public settings and follow 12 steps (refer to Resource Box 1) that guide individuals in their recovery. Alcoholics Anonymous is the largest 12-step program that addresses alcohol use; Narcotics Anonymous is focused on substance use (any kind of substance use, including alcohol). Twelve-step meetings are usually readily available, often multiple times per day (into the night), depending on geographic location. Meetings generally run from 60 to 90 minutes and are chaired by a 12-step group member. During the meeting, members who choose to do so share experiencesone person at a timerelated to their recovery, while others in the group listen. Public sharing of experience is voluntarysome members find benefit in just listening. An individual can become a member of a 12-step program simply by expressing a desire to stop using.
Twelve-step programs have a general spiritual foundation, but do not require any specific spiritual or religious background for participation. They usually encourage members to look outside themselves for a strength (a higher power), which each member defines for himself or herself. Limited research suggests that spiritual or religious involvement can be a protective factor against SUDs and relapse.[1,4] It is important to clarify that these groups are spiritual but not religious, as some patients may be uncomfortable with participation in 12-step groups if they view them to be religiously oriented; such a perception can constitute a barrier preventing patients from exploring these groups.
In addition to 12-step programs for those with SUDs, similar programs are available for the families and friends of the affected individuals; for example, Al-Anon (or Nar-Anon) or Alateen can become a source of support and valuable resource for adult and younger family members, respectively.Refer to Resource Boxes 1-3 for additional information on 12-step programs.
Self-Management and Recovery Training (SMART Recovery) self-help groups
SMART Recovery relies on a scientifically-oriented approach and can provide an alternative to spiritually focused 12-step self-help groups. It provides support for recovery from all addictions, both chemical (e.g., alcohol or drugs) and behavioral (e.g., gambling). SMART Recoverys focus is on building and maintaining motivation for successful recovery; coping with urges; managing thoughts, feelings, and behaviors; and living a balanced life (refer to Resource Box 2 for a link to SMART Recoverys website).
Research evidence for recovery-oriented mutual self-help groups
It has been shown that those who self-selected to engage in mutual self-help programs benefited most; whereas those who were coerced did not show similar gains. Therefore it is important to encourage and support patient interest in these groups. Research evidence supports the efficacy of recovery-oriented mutual self-help groups, especially 12-step programs. Participation in mutual self-help groups can improve outcomes in SUDs.[8-13] Both the frequency of meeting attendance and the level and duration of involvement in prescribed 12-step activitiesespecially during the earlier stages of recoveryhave been linked to better recovery outcomes, especially abstinence (Table 1).[9,10,12,14]
Table 1. One-Year Abstinence Rates by AA Meeting Frequency
|AA Meeting Frequency