Mutual Help Alternatives for Alcohol Problems: Benefits and Causal Mechanisms

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ABSTRACT Rationale: Mutual help groups represent an important and unique resource on the recovery care continuum, and Alcoholics Anonymous and other 12-step groups have been well-studied and found to be highly effective. Yet, very little is known about the nature and effectiveness of mutual help alternatives for addiction. This is a critical gap because 12-step groups remain unappealing for most people with substance use disorders (SUDs), even following 12-step facilitation interventions, and because those deterred by 12-step groups may be attracted to alternatives. Understanding 12-step alternatives is also important because a sizeable minority of people with SUDs are mandated to treatment, and numerous higher courts have ruled that mandating 12-step attendance violates First Amendment rights, stipulating that mandated attendance is permissable only given secular options. Accordingly, the current R01 proposes a national, longitudinal study of the largest known secular, abstinence- based alternatives to 12-step groups: Women for Sobriety (WFS), LifeRing Secular Recovery (LifeRing), and SMART Recovery (SMART). Approach: Our NIAAA-funded R21 was the first longitudinal, comparative study of 12-step groups and 12-step alternatives, and surveyed U.S. adults with lifetime alcohol use disorders attending WFS, LifeRing, SMART, and 12-step groups. This R01 will capitalize on and extend our R21 data by adding 800 new cases collected using parallel protocols and measures, permitting us to combine data. Data will be collected at baseline via collaboration with mutual help group directors and IntheRooms, an online meeting hub for those in recovery. Follow-ups will be collected at 6 and 12 months. Leveraging these well-powered data, we will 1) examine associations between both in-person and online involvement and substance use outcomes over time. We incorporate study of online involvement because extremely little is known on this topic, and because online resources have great potential where meeting access is limited. We will also 2) compare mechanisms of action across mutual help groups, testing a novel theory of behavior change—the Affect, Cognition, Motivation, and social Engagement in recovery (ACME) model—designed to predict sustained recovery. Tests will help determine whether 12-step alternatives have common or distinct mechanisms of action, and will inform interventions for SUDs broadly. Finally, we will 3) examine participant-level moderators of the benefits of mutual help involvement, informing treatment tailoring. In anticipation of this R01, R21 surveys included most key measures. Innovation and Significance: Evidence on 12-step alternatives is severely lacking: Other than our team’s R21, there are no published longitudinal, comparative studies of 12-step groups and secular alternatives. Results of this study, led by experts in mutual help groups for addiction, will contribute substantially to understanding whether, when, and why mutual help alternatives are effective. Findings should inform court referrals and treatment planning, and may enhance the growth of effective alternatives. Results may also help to identify core drivers of recovery that can be targeted in diverse interventions for SUDs.