“Around the clock” support: 24/7 online Narcotics Anonymous meetings
Twelve-step mutual-help groups are empirically-supported resources used by millions of individuals in or seeking recovery, though far more is known about Alcoholics Anonymous than other groups. Recent efforts led to the establishment of 24/7 online Narcotics Anonymous meetings, offering seamless access to peer support. This study characterized people who attended these 24/7 online mutual-help meetings and examined their experiences with the novel meeting format.
In 2016, about 1 in 10 individuals who had resolved a previous significant alcohol or drug problem endorsed having used an online recovery support as part of their efforts. However, the COVID-19 pandemic and associated social distancing restrictions limiting access to in-person services catalyzed a paradigm shift that mainstreamed online recovery resources. Recognizing the need to support individuals in or seeking recovery at a time when in-person mutual-help meetings were not an option, Narcotics Anonymous members in New York banded together in March 2020 to establish ongoing 24/7 online mutual-help meetings accessible on the Narcotics Anonymous website. The online meetings are scheduled on an hourly basis whereby a rotation of individuals who have been in recovery for at least 6 months lead the meetings each hour. Thus, people can easily access an online Narcotics Anonymous meeting via the website any time of the day or night. The authors of the present study characterized participants in the 24/7 online meetings and compared participants’ experiences of 24/7 online meetings with their experiences of in-person Narcotics Anonymous meetings.
HOW WAS THIS STUDY CONDUCTED?
The Narcotics Anonymous website hosting the link to the 24/7 online mutual-help meetings also hosted a link to a voluntary anonymous survey assessment consisting of 33 questions. Survey responses were collected across 2 months (January and February 2023). No incentives were provided for completing the survey. Participants were asked about their geographic location, demographics, substance use, how effective they felt 24/7 online mutual-help meetings were, how effective they felt in-person meetings were, and whether they felt more comfortable in in-person or 24/7 online meetings. They were also asked (over the past 2 weeks) about the following: (1) how comfortable they felt at meetings; (2) how convenient they felt meetings were; (3) feelings of distress (average score based on feeling anxious, worried, depressed, or lack of pleasure); (4) social anxiety (assessed using 5 items based on social anxiety disorder criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition); (5) 12-step beliefs (4 items related to 12-step engagement); (6) relief of distress (average score based on feelings of loneliness, craving, depression, and uncertainty); and (7) perceived effectiveness of meetings to support abstinence. Responses were scored on a Likert scale ranging from 0 (fully disagree) to 4 (fully agree). Participants were also asked to report whether they had previously experienced a spiritual awakening (yes/no), had worked at least some of the 12 steps (yes/no), as well as the number of in-person meetings and 24/7 online meetings they had attended over the previous month. Finally, respondents were asked about the last time they used drugs and were categorized as either (1) abstinent for 1 month or longer or (2) still using drugs in the past month.
For each of three research questions, analyses divided participants into 2 groups for comparison. In the first analysis, they compared participants who had attended more 24/7 online mutual-help meetings in the past month to those who had attended more in-person meetings. In the second analysis, they compared those who indicated 24/7 online meetings were more supportive of their abstinence to those who reported that in-person meetings were more supportive. Third, they compared those who reported past-month drug use to those who reported at least 1 month of continuous abstinence.
A total of 530 participants completed the survey. Respondents were on average 44 years old and about two-thirds were female (65%). The most common primary problem substances reported by participants were cocaine or crack-cocaine (21%) and methamphetamine (21%), followed by alcohol (16%), heroin (12%), other opioids (11%), marijuana (7%), fentanyl (5%), stimulants (4%), and benzodiazepines (4%).
WHAT DID THIS STUDY FIND?
24/7 online mutual-help attendees feel they are valuable resources
Respondents attended more than 3 times as many online 24/7 meetings (14.9) over the previous month compared to in-person Narcotics Anonymous meetings (4.55). Though the online 24/7 meetings were started by local Narcotics Anonymous members in New York, study participants largely consisted of individuals in other areas of the United States (77%) and in other countries (13%), demonstrating the broad reach of the online mutual-help meeting format. Those who reported that they attended more 24/7 mutual-help meetings than in-person meetings and who perceived 24/7 meetings as more supportive of their abstinence had higher levels of agreement with statements regarding greater comfort and convenience of 24/7 online meetings compared to in-person meetings. It should first be noted that due to several biases present in the sampling approach used in this study – voluntary participation in a survey that provided no financial incentive to complete – results likely do not adequately represent the experiences of the broader population of individuals who participate in Narcotics Anonymous meetings more generally (see implications and limitations sections below).
Most participants attending 24/7 online meetings appear to already be in stable recovery
Across the entire sample, most participants (86%) had previously attended in-person mutual-help meetings and 3 out of 4 (75%) had attended prior 24/7 online mutual-help meetings. Most participants reporting having previously had a spiritual awakening (82%). More than half (52%) reported presently having a sponsor and nearly 1 in 3 (29%) had served as a sponsor themselves. Relatively few study participants (8%) reported any drug use over the previous month. Those who had been abstinent for at least 1 month went to more than 3 times as many 24/7 meetings and 4 times as many in-person meetings in the last month, were more likely to have sponsored others, and experienced significantly less craving than those who had used drugs in the past month.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
The 24/7 mutual-help meetings examined in this study started as a local effort among Narcotics Anonymous participants in New York, though Narcotics Anonymous members from across the globe attended these meetings. Participants in the 24/7 online mutual-help meetings who completed the survey were highly involved in these meetings, attending an average of almost 15 meetings a month; the vast majority felt comfortable at 24/7 meetings, felt the online meeting format made it convenient to attend, and perceived that the 24/7 meetings were effective at promoting abstinence. Additionally, participants attended an average of between 4 to 5 in-person Narcotics Anonymous meetings a month, suggesting these individuals may be using online and in-person meetings as supplemental to one another.
However, because the survey was made available only to those already accessing the 24/7 online meetings and there was no compensation for participating, it may be that the sample consists of participants who have had more positive experiences in the 24/7 online meetings. For example, those for whom the online format has been more helpful are more likely to continue to access the 24/7 online meetings and fill out the survey. Results may fail to account for individuals who tried the 24/7 online meetings in the years leading up to the 2 months of data collection in 2023 but who stopped attending them because they felt they were unhelpful or were dissatisfied with the format in some way. Also, because the sample of participants primarily consisted of those with stable prior involvement in Narcotics Anonymous, results may not represent those who are new to 12-step recovery or who may be less receptive to 12-step based approaches. Finally, because the sample consists solely of those who had accessed 24/7 online meetings, it does not adequately represent populations of individuals in or seeking recovery from substance use problems who do not have access to technology or who simply may not prefer digital tools to support their efforts.
Additionally, the authors did not statistically control for variables such as primary substance, gender, age, race/ethnicity, to account for what might explain participants’ perceptions of online versus in-person mutual-help meetings. For example, women may be less likely than men to engage with digital recovery supports and, among those with digital recovery support participation, less likely to attend an online meeting. Severity also matters; those with more clinical challenges (e.g., more alcohol use disorder symptoms) tend to attend both in-person and online when both are available. By including other variables in analyses, future studies can examine (or control statistically for) what individual factors might be explaining any differences between those who prefer online to in-person meetings.
Nevertheless, findings in this study add to the body of evidence suggesting online recovery supports are being widely used as a resource for many individuals attempting to initiate or maintain recovery from substance use disorder. For example, many in or seeking recovery are using traditional social network sites (e.g., anonymous online forums like Reddit) and recovery-specific social network sites (e.g., InTheRooms.com) as a part of their recovery efforts. It has also been shown that the types of social support shared between users of these online recovery platforms resemble those found in in-person group therapy and 12-step mutual-help groups. However, there is still a dearth of studies evaluating the effectiveness for participating in digital recovery supports to promote positive recovery-related outcomes, limiting the ability to recommend the use of these resources. If shown to be effective, 24/7 online mutual-help meetings and other online recovery supports could provide value as low-threshold, freely accessible adjunctive recovery support to supplement in-person offerings.
As previously mentioned, the sampling approach used in this study is likely to reflect a select sample of individual particularly enthusiastic about online mutual-help meetings. Consequently, findings may be skewed and generalizability to the broader population of Narcotics Anonymous members is limited. Future studies could incorporate more rigorous sampling approaches, whereby participants are recruited from diverse Narcotics Anonymous settings, including both online and in-person meetings.
The cross-sectional nature of this study also represents a further limitation, in that long-term effects of participation in 24/7 online mutual-help meetings could not be evaluated. Future research adopting a longitudinal study design would allow for the assessing the effectiveness of participation in 24/7 online mutual-help meetings, including if and how 24/7 meetings can be effectively used in combination with other in-person and online services.
BOTTOM LINE
The 24/7 online Narcotics Anonymous meetings format is a novel approach to an easily accessible, recovery resource. The 24/7 online mutual-help meetings are being used by individuals across the globe and participants feel the meetings are comfortable, convenient, and supportive of their abstinence. However, this was a select group of participants likely to have pre-existing positive attitudes toward online services and more rigorous studies needed to evaluate their effectiveness.
For individuals and families seeking recovery: Narcotics Anonymous 24/7 online meetings are readily accessible substance use disorder recovery support at any time day or night. These online mutual-help meetings are being widely used by individuals across the country with a variety of substance use histories, and many participants feel the meetings are comfortable, convenient, and supportive of their abstinence. If you are interested in or seeking recovery and looking for a free and immediately available support that can be accessed from the comfort of your own home, this option might be worth considering. These meetings can also be incorporated into a mixed routine of in-person and online meetings, if for example, you have time constraints like personal and family obligations (e.g., work, childcare) or are traveling. However, it is worth noting that there is not yet evidence establishing the effectiveness of online recovery meetings to promote recovery-related benefits.
For treatment professionals and treatment systems: If shown to be helpful for promoting reductions in substance use and other recovery-related benefits, online mutual-help meetings might be worth adding to the menu of services offered to patients interested in finding additional support. These meetings could be particularly helpful to individuals who live in areas with limited access to in-person mutual-help meetings or for those we need support outside of regular meeting times or in between sessions, as 24/7 mutual-help meetings are available around the clock. Online mutual-help meetings might also be preferred by some individuals who experience discomfort or anxiety in face-to-face settings.
For scientists: While this study adds to a growing body of research highlighting how individuals are using online recovery supports, evaluations of their effectiveness remain scant. More experimental studies incorporating rigorous longitudinal designs will be crucial to better understand whether and for whom standalone online mutual-help meetings might be effective for enhancing recovery-related outcomes, as well as the comparative effectiveness of online and in-person meetings. Such studies could also seek to better understand how online mutual-help meetings can be successfully integrated with in-person modalities to maximize benefits and to understand how varying combinations might be more or less beneficial for certain subgroups.
For policy makers: Evidence suggesting individuals are using online recovery supports to help quit or cut down on substance use continues to mount. However, there has yet to be a concerted effort to clinically test their effectiveness for enhancing recovery-related outcomes. Increased funding to support rigorously designed longitudinal studies, such as randomized controlled trials, could serve to catalyze a better understanding of if and how online recovery supports confer benefits to participants and what combinations of online and in-person support are most beneficial (and for whom). If shown to be effective, online mutual-help meetings could increase access to recovery support in a cost-effective manner and serve to reduce the burden of alcohol and drugs on society.
In 2016, about 1 in 10 individuals who had resolved a previous significant alcohol or drug problem endorsed having used an online recovery support as part of their efforts. However, the COVID-19 pandemic and associated social distancing restrictions limiting access to in-person services catalyzed a paradigm shift that mainstreamed online recovery resources. Recognizing the need to support individuals in or seeking recovery at a time when in-person mutual-help meetings were not an option, Narcotics Anonymous members in New York banded together in March 2020 to establish ongoing 24/7 online mutual-help meetings accessible on the Narcotics Anonymous website. The online meetings are scheduled on an hourly basis whereby a rotation of individuals who have been in recovery for at least 6 months lead the meetings each hour. Thus, people can easily access an online Narcotics Anonymous meeting via the website any time of the day or night. The authors of the present study characterized participants in the 24/7 online meetings and compared participants’ experiences of 24/7 online meetings with their experiences of in-person Narcotics Anonymous meetings.
HOW WAS THIS STUDY CONDUCTED?
The Narcotics Anonymous website hosting the link to the 24/7 online mutual-help meetings also hosted a link to a voluntary anonymous survey assessment consisting of 33 questions. Survey responses were collected across 2 months (January and February 2023). No incentives were provided for completing the survey. Participants were asked about their geographic location, demographics, substance use, how effective they felt 24/7 online mutual-help meetings were, how effective they felt in-person meetings were, and whether they felt more comfortable in in-person or 24/7 online meetings. They were also asked (over the past 2 weeks) about the following: (1) how comfortable they felt at meetings; (2) how convenient they felt meetings were; (3) feelings of distress (average score based on feeling anxious, worried, depressed, or lack of pleasure); (4) social anxiety (assessed using 5 items based on social anxiety disorder criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition); (5) 12-step beliefs (4 items related to 12-step engagement); (6) relief of distress (average score based on feelings of loneliness, craving, depression, and uncertainty); and (7) perceived effectiveness of meetings to support abstinence. Responses were scored on a Likert scale ranging from 0 (fully disagree) to 4 (fully agree). Participants were also asked to report whether they had previously experienced a spiritual awakening (yes/no), had worked at least some of the 12 steps (yes/no), as well as the number of in-person meetings and 24/7 online meetings they had attended over the previous month. Finally, respondents were asked about the last time they used drugs and were categorized as either (1) abstinent for 1 month or longer or (2) still using drugs in the past month.
For each of three research questions, analyses divided participants into 2 groups for comparison. In the first analysis, they compared participants who had attended more 24/7 online mutual-help meetings in the past month to those who had attended more in-person meetings. In the second analysis, they compared those who indicated 24/7 online meetings were more supportive of their abstinence to those who reported that in-person meetings were more supportive. Third, they compared those who reported past-month drug use to those who reported at least 1 month of continuous abstinence.
A total of 530 participants completed the survey. Respondents were on average 44 years old and about two-thirds were female (65%). The most common primary problem substances reported by participants were cocaine or crack-cocaine (21%) and methamphetamine (21%), followed by alcohol (16%), heroin (12%), other opioids (11%), marijuana (7%), fentanyl (5%), stimulants (4%), and benzodiazepines (4%).
WHAT DID THIS STUDY FIND?
24/7 online mutual-help attendees feel they are valuable resources
Respondents attended more than 3 times as many online 24/7 meetings (14.9) over the previous month compared to in-person Narcotics Anonymous meetings (4.55). Though the online 24/7 meetings were started by local Narcotics Anonymous members in New York, study participants largely consisted of individuals in other areas of the United States (77%) and in other countries (13%), demonstrating the broad reach of the online mutual-help meeting format. Those who reported that they attended more 24/7 mutual-help meetings than in-person meetings and who perceived 24/7 meetings as more supportive of their abstinence had higher levels of agreement with statements regarding greater comfort and convenience of 24/7 online meetings compared to in-person meetings. It should first be noted that due to several biases present in the sampling approach used in this study – voluntary participation in a survey that provided no financial incentive to complete – results likely do not adequately represent the experiences of the broader population of individuals who participate in Narcotics Anonymous meetings more generally (see implications and limitations sections below).
Most participants attending 24/7 online meetings appear to already be in stable recovery
Across the entire sample, most participants (86%) had previously attended in-person mutual-help meetings and 3 out of 4 (75%) had attended prior 24/7 online mutual-help meetings. Most participants reporting having previously had a spiritual awakening (82%). More than half (52%) reported presently having a sponsor and nearly 1 in 3 (29%) had served as a sponsor themselves. Relatively few study participants (8%) reported any drug use over the previous month. Those who had been abstinent for at least 1 month went to more than 3 times as many 24/7 meetings and 4 times as many in-person meetings in the last month, were more likely to have sponsored others, and experienced significantly less craving than those who had used drugs in the past month.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
The 24/7 mutual-help meetings examined in this study started as a local effort among Narcotics Anonymous participants in New York, though Narcotics Anonymous members from across the globe attended these meetings. Participants in the 24/7 online mutual-help meetings who completed the survey were highly involved in these meetings, attending an average of almost 15 meetings a month; the vast majority felt comfortable at 24/7 meetings, felt the online meeting format made it convenient to attend, and perceived that the 24/7 meetings were effective at promoting abstinence. Additionally, participants attended an average of between 4 to 5 in-person Narcotics Anonymous meetings a month, suggesting these individuals may be using online and in-person meetings as supplemental to one another.
However, because the survey was made available only to those already accessing the 24/7 online meetings and there was no compensation for participating, it may be that the sample consists of participants who have had more positive experiences in the 24/7 online meetings. For example, those for whom the online format has been more helpful are more likely to continue to access the 24/7 online meetings and fill out the survey. Results may fail to account for individuals who tried the 24/7 online meetings in the years leading up to the 2 months of data collection in 2023 but who stopped attending them because they felt they were unhelpful or were dissatisfied with the format in some way. Also, because the sample of participants primarily consisted of those with stable prior involvement in Narcotics Anonymous, results may not represent those who are new to 12-step recovery or who may be less receptive to 12-step based approaches. Finally, because the sample consists solely of those who had accessed 24/7 online meetings, it does not adequately represent populations of individuals in or seeking recovery from substance use problems who do not have access to technology or who simply may not prefer digital tools to support their efforts.
Additionally, the authors did not statistically control for variables such as primary substance, gender, age, race/ethnicity, to account for what might explain participants’ perceptions of online versus in-person mutual-help meetings. For example, women may be less likely than men to engage with digital recovery supports and, among those with digital recovery support participation, less likely to attend an online meeting. Severity also matters; those with more clinical challenges (e.g., more alcohol use disorder symptoms) tend to attend both in-person and online when both are available. By including other variables in analyses, future studies can examine (or control statistically for) what individual factors might be explaining any differences between those who prefer online to in-person meetings.
Nevertheless, findings in this study add to the body of evidence suggesting online recovery supports are being widely used as a resource for many individuals attempting to initiate or maintain recovery from substance use disorder. For example, many in or seeking recovery are using traditional social network sites (e.g., anonymous online forums like Reddit) and recovery-specific social network sites (e.g., InTheRooms.com) as a part of their recovery efforts. It has also been shown that the types of social support shared between users of these online recovery platforms resemble those found in in-person group therapy and 12-step mutual-help groups. However, there is still a dearth of studies evaluating the effectiveness for participating in digital recovery supports to promote positive recovery-related outcomes, limiting the ability to recommend the use of these resources. If shown to be effective, 24/7 online mutual-help meetings and other online recovery supports could provide value as low-threshold, freely accessible adjunctive recovery support to supplement in-person offerings.
As previously mentioned, the sampling approach used in this study is likely to reflect a select sample of individual particularly enthusiastic about online mutual-help meetings. Consequently, findings may be skewed and generalizability to the broader population of Narcotics Anonymous members is limited. Future studies could incorporate more rigorous sampling approaches, whereby participants are recruited from diverse Narcotics Anonymous settings, including both online and in-person meetings.
The cross-sectional nature of this study also represents a further limitation, in that long-term effects of participation in 24/7 online mutual-help meetings could not be evaluated. Future research adopting a longitudinal study design would allow for the assessing the effectiveness of participation in 24/7 online mutual-help meetings, including if and how 24/7 meetings can be effectively used in combination with other in-person and online services.
BOTTOM LINE
The 24/7 online Narcotics Anonymous meetings format is a novel approach to an easily accessible, recovery resource. The 24/7 online mutual-help meetings are being used by individuals across the globe and participants feel the meetings are comfortable, convenient, and supportive of their abstinence. However, this was a select group of participants likely to have pre-existing positive attitudes toward online services and more rigorous studies needed to evaluate their effectiveness.
For individuals and families seeking recovery: Narcotics Anonymous 24/7 online meetings are readily accessible substance use disorder recovery support at any time day or night. These online mutual-help meetings are being widely used by individuals across the country with a variety of substance use histories, and many participants feel the meetings are comfortable, convenient, and supportive of their abstinence. If you are interested in or seeking recovery and looking for a free and immediately available support that can be accessed from the comfort of your own home, this option might be worth considering. These meetings can also be incorporated into a mixed routine of in-person and online meetings, if for example, you have time constraints like personal and family obligations (e.g., work, childcare) or are traveling. However, it is worth noting that there is not yet evidence establishing the effectiveness of online recovery meetings to promote recovery-related benefits.
For treatment professionals and treatment systems: If shown to be helpful for promoting reductions in substance use and other recovery-related benefits, online mutual-help meetings might be worth adding to the menu of services offered to patients interested in finding additional support. These meetings could be particularly helpful to individuals who live in areas with limited access to in-person mutual-help meetings or for those we need support outside of regular meeting times or in between sessions, as 24/7 mutual-help meetings are available around the clock. Online mutual-help meetings might also be preferred by some individuals who experience discomfort or anxiety in face-to-face settings.
For scientists: While this study adds to a growing body of research highlighting how individuals are using online recovery supports, evaluations of their effectiveness remain scant. More experimental studies incorporating rigorous longitudinal designs will be crucial to better understand whether and for whom standalone online mutual-help meetings might be effective for enhancing recovery-related outcomes, as well as the comparative effectiveness of online and in-person meetings. Such studies could also seek to better understand how online mutual-help meetings can be successfully integrated with in-person modalities to maximize benefits and to understand how varying combinations might be more or less beneficial for certain subgroups.
For policy makers: Evidence suggesting individuals are using online recovery supports to help quit or cut down on substance use continues to mount. However, there has yet to be a concerted effort to clinically test their effectiveness for enhancing recovery-related outcomes. Increased funding to support rigorously designed longitudinal studies, such as randomized controlled trials, could serve to catalyze a better understanding of if and how online recovery supports confer benefits to participants and what combinations of online and in-person support are most beneficial (and for whom). If shown to be effective, online mutual-help meetings could increase access to recovery support in a cost-effective manner and serve to reduce the burden of alcohol and drugs on society.
In 2016, about 1 in 10 individuals who had resolved a previous significant alcohol or drug problem endorsed having used an online recovery support as part of their efforts. However, the COVID-19 pandemic and associated social distancing restrictions limiting access to in-person services catalyzed a paradigm shift that mainstreamed online recovery resources. Recognizing the need to support individuals in or seeking recovery at a time when in-person mutual-help meetings were not an option, Narcotics Anonymous members in New York banded together in March 2020 to establish ongoing 24/7 online mutual-help meetings accessible on the Narcotics Anonymous website. The online meetings are scheduled on an hourly basis whereby a rotation of individuals who have been in recovery for at least 6 months lead the meetings each hour. Thus, people can easily access an online Narcotics Anonymous meeting via the website any time of the day or night. The authors of the present study characterized participants in the 24/7 online meetings and compared participants’ experiences of 24/7 online meetings with their experiences of in-person Narcotics Anonymous meetings.
HOW WAS THIS STUDY CONDUCTED?
The Narcotics Anonymous website hosting the link to the 24/7 online mutual-help meetings also hosted a link to a voluntary anonymous survey assessment consisting of 33 questions. Survey responses were collected across 2 months (January and February 2023). No incentives were provided for completing the survey. Participants were asked about their geographic location, demographics, substance use, how effective they felt 24/7 online mutual-help meetings were, how effective they felt in-person meetings were, and whether they felt more comfortable in in-person or 24/7 online meetings. They were also asked (over the past 2 weeks) about the following: (1) how comfortable they felt at meetings; (2) how convenient they felt meetings were; (3) feelings of distress (average score based on feeling anxious, worried, depressed, or lack of pleasure); (4) social anxiety (assessed using 5 items based on social anxiety disorder criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition); (5) 12-step beliefs (4 items related to 12-step engagement); (6) relief of distress (average score based on feelings of loneliness, craving, depression, and uncertainty); and (7) perceived effectiveness of meetings to support abstinence. Responses were scored on a Likert scale ranging from 0 (fully disagree) to 4 (fully agree). Participants were also asked to report whether they had previously experienced a spiritual awakening (yes/no), had worked at least some of the 12 steps (yes/no), as well as the number of in-person meetings and 24/7 online meetings they had attended over the previous month. Finally, respondents were asked about the last time they used drugs and were categorized as either (1) abstinent for 1 month or longer or (2) still using drugs in the past month.
For each of three research questions, analyses divided participants into 2 groups for comparison. In the first analysis, they compared participants who had attended more 24/7 online mutual-help meetings in the past month to those who had attended more in-person meetings. In the second analysis, they compared those who indicated 24/7 online meetings were more supportive of their abstinence to those who reported that in-person meetings were more supportive. Third, they compared those who reported past-month drug use to those who reported at least 1 month of continuous abstinence.
A total of 530 participants completed the survey. Respondents were on average 44 years old and about two-thirds were female (65%). The most common primary problem substances reported by participants were cocaine or crack-cocaine (21%) and methamphetamine (21%), followed by alcohol (16%), heroin (12%), other opioids (11%), marijuana (7%), fentanyl (5%), stimulants (4%), and benzodiazepines (4%).
WHAT DID THIS STUDY FIND?
24/7 online mutual-help attendees feel they are valuable resources
Respondents attended more than 3 times as many online 24/7 meetings (14.9) over the previous month compared to in-person Narcotics Anonymous meetings (4.55). Though the online 24/7 meetings were started by local Narcotics Anonymous members in New York, study participants largely consisted of individuals in other areas of the United States (77%) and in other countries (13%), demonstrating the broad reach of the online mutual-help meeting format. Those who reported that they attended more 24/7 mutual-help meetings than in-person meetings and who perceived 24/7 meetings as more supportive of their abstinence had higher levels of agreement with statements regarding greater comfort and convenience of 24/7 online meetings compared to in-person meetings. It should first be noted that due to several biases present in the sampling approach used in this study – voluntary participation in a survey that provided no financial incentive to complete – results likely do not adequately represent the experiences of the broader population of individuals who participate in Narcotics Anonymous meetings more generally (see implications and limitations sections below).
Most participants attending 24/7 online meetings appear to already be in stable recovery
Across the entire sample, most participants (86%) had previously attended in-person mutual-help meetings and 3 out of 4 (75%) had attended prior 24/7 online mutual-help meetings. Most participants reporting having previously had a spiritual awakening (82%). More than half (52%) reported presently having a sponsor and nearly 1 in 3 (29%) had served as a sponsor themselves. Relatively few study participants (8%) reported any drug use over the previous month. Those who had been abstinent for at least 1 month went to more than 3 times as many 24/7 meetings and 4 times as many in-person meetings in the last month, were more likely to have sponsored others, and experienced significantly less craving than those who had used drugs in the past month.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
The 24/7 mutual-help meetings examined in this study started as a local effort among Narcotics Anonymous participants in New York, though Narcotics Anonymous members from across the globe attended these meetings. Participants in the 24/7 online mutual-help meetings who completed the survey were highly involved in these meetings, attending an average of almost 15 meetings a month; the vast majority felt comfortable at 24/7 meetings, felt the online meeting format made it convenient to attend, and perceived that the 24/7 meetings were effective at promoting abstinence. Additionally, participants attended an average of between 4 to 5 in-person Narcotics Anonymous meetings a month, suggesting these individuals may be using online and in-person meetings as supplemental to one another.
However, because the survey was made available only to those already accessing the 24/7 online meetings and there was no compensation for participating, it may be that the sample consists of participants who have had more positive experiences in the 24/7 online meetings. For example, those for whom the online format has been more helpful are more likely to continue to access the 24/7 online meetings and fill out the survey. Results may fail to account for individuals who tried the 24/7 online meetings in the years leading up to the 2 months of data collection in 2023 but who stopped attending them because they felt they were unhelpful or were dissatisfied with the format in some way. Also, because the sample of participants primarily consisted of those with stable prior involvement in Narcotics Anonymous, results may not represent those who are new to 12-step recovery or who may be less receptive to 12-step based approaches. Finally, because the sample consists solely of those who had accessed 24/7 online meetings, it does not adequately represent populations of individuals in or seeking recovery from substance use problems who do not have access to technology or who simply may not prefer digital tools to support their efforts.
Additionally, the authors did not statistically control for variables such as primary substance, gender, age, race/ethnicity, to account for what might explain participants’ perceptions of online versus in-person mutual-help meetings. For example, women may be less likely than men to engage with digital recovery supports and, among those with digital recovery support participation, less likely to attend an online meeting. Severity also matters; those with more clinical challenges (e.g., more alcohol use disorder symptoms) tend to attend both in-person and online when both are available. By including other variables in analyses, future studies can examine (or control statistically for) what individual factors might be explaining any differences between those who prefer online to in-person meetings.
Nevertheless, findings in this study add to the body of evidence suggesting online recovery supports are being widely used as a resource for many individuals attempting to initiate or maintain recovery from substance use disorder. For example, many in or seeking recovery are using traditional social network sites (e.g., anonymous online forums like Reddit) and recovery-specific social network sites (e.g., InTheRooms.com) as a part of their recovery efforts. It has also been shown that the types of social support shared between users of these online recovery platforms resemble those found in in-person group therapy and 12-step mutual-help groups. However, there is still a dearth of studies evaluating the effectiveness for participating in digital recovery supports to promote positive recovery-related outcomes, limiting the ability to recommend the use of these resources. If shown to be effective, 24/7 online mutual-help meetings and other online recovery supports could provide value as low-threshold, freely accessible adjunctive recovery support to supplement in-person offerings.
As previously mentioned, the sampling approach used in this study is likely to reflect a select sample of individual particularly enthusiastic about online mutual-help meetings. Consequently, findings may be skewed and generalizability to the broader population of Narcotics Anonymous members is limited. Future studies could incorporate more rigorous sampling approaches, whereby participants are recruited from diverse Narcotics Anonymous settings, including both online and in-person meetings.
The cross-sectional nature of this study also represents a further limitation, in that long-term effects of participation in 24/7 online mutual-help meetings could not be evaluated. Future research adopting a longitudinal study design would allow for the assessing the effectiveness of participation in 24/7 online mutual-help meetings, including if and how 24/7 meetings can be effectively used in combination with other in-person and online services.
BOTTOM LINE
The 24/7 online Narcotics Anonymous meetings format is a novel approach to an easily accessible, recovery resource. The 24/7 online mutual-help meetings are being used by individuals across the globe and participants feel the meetings are comfortable, convenient, and supportive of their abstinence. However, this was a select group of participants likely to have pre-existing positive attitudes toward online services and more rigorous studies needed to evaluate their effectiveness.
For individuals and families seeking recovery: Narcotics Anonymous 24/7 online meetings are readily accessible substance use disorder recovery support at any time day or night. These online mutual-help meetings are being widely used by individuals across the country with a variety of substance use histories, and many participants feel the meetings are comfortable, convenient, and supportive of their abstinence. If you are interested in or seeking recovery and looking for a free and immediately available support that can be accessed from the comfort of your own home, this option might be worth considering. These meetings can also be incorporated into a mixed routine of in-person and online meetings, if for example, you have time constraints like personal and family obligations (e.g., work, childcare) or are traveling. However, it is worth noting that there is not yet evidence establishing the effectiveness of online recovery meetings to promote recovery-related benefits.
For treatment professionals and treatment systems: If shown to be helpful for promoting reductions in substance use and other recovery-related benefits, online mutual-help meetings might be worth adding to the menu of services offered to patients interested in finding additional support. These meetings could be particularly helpful to individuals who live in areas with limited access to in-person mutual-help meetings or for those we need support outside of regular meeting times or in between sessions, as 24/7 mutual-help meetings are available around the clock. Online mutual-help meetings might also be preferred by some individuals who experience discomfort or anxiety in face-to-face settings.
For scientists: While this study adds to a growing body of research highlighting how individuals are using online recovery supports, evaluations of their effectiveness remain scant. More experimental studies incorporating rigorous longitudinal designs will be crucial to better understand whether and for whom standalone online mutual-help meetings might be effective for enhancing recovery-related outcomes, as well as the comparative effectiveness of online and in-person meetings. Such studies could also seek to better understand how online mutual-help meetings can be successfully integrated with in-person modalities to maximize benefits and to understand how varying combinations might be more or less beneficial for certain subgroups.
For policy makers: Evidence suggesting individuals are using online recovery supports to help quit or cut down on substance use continues to mount. However, there has yet to be a concerted effort to clinically test their effectiveness for enhancing recovery-related outcomes. Increased funding to support rigorously designed longitudinal studies, such as randomized controlled trials, could serve to catalyze a better understanding of if and how online recovery supports confer benefits to participants and what combinations of online and in-person support are most beneficial (and for whom). If shown to be effective, online mutual-help meetings could increase access to recovery support in a cost-effective manner and serve to reduce the burden of alcohol and drugs on society.
