Alcohol use disorder causes many harms for individuals, families, and communities, though most eventually resolve their alcohol problem through many types of recovery pathways. This study examined recovery processes among individuals who never attended addiction treatment.
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Though there are effective clinical treatments for alcohol use disorder (i.e., inpatient or residential treatment, outpatient treatment, FDA-approved medications, etc.), formal treatment engagement is consistently low (<10-15%) among U.S. adults with current alcohol use disorder. That said, most individuals with alcohol use disorder will resolve their alcohol problems, often doing so without the use of these specialty treatment services. For example, in a nationally representative sample of individuals who had resolved a prior problem with alcohol or drugs, the most utilized supports were community-based mutual-help group meetings (45%; e.g., Alcoholics Anonymous). In line with this finding, there is a substantial body of evidence showing Alcoholics Anonymous participation helps people reduce or quit drinking. Outside of more commonly attended mutual-help groups like Alcoholics Anonymous, there has been limited prior research on why and how individuals initiate and sustain alcohol use disorder recovery without the use of specialty treatment. This study sought to address this research gap by using an exploratory, qualitative approach to better understand the strategies employed by individuals who had resolved prior alcohol problems without the use of formal treatment, as well as the factors leading to their decision to attempt recovery without the use of specialty services.
The researchers used semi-structured individual interviews to gather qualitative responses from a sample of 65 adults aged 18 or older who self-identified as being in recovery or having resolved a prior alcohol problem without the use of formal treatment. Interviews were conducted in English or Spanish and via video or telephone calls to accommodate participants’ preferences. During interviews, participants were asked to respond to questions about their understanding of recovery, their history of help-seeking and strategies employed to quit or cut down on their drinking, and the role that their gender, race/ethnicity, and other identities play in recovery. Interviews were digitally recorded, transcribed, and reviewed for accuracy to remove any potential identifying information. To analyze the qualitative data, the researchers used a hybrid inductive-deductive approach, whereby deductive codes were established from the outset based on the interview guide questions and inductive codes were developed as a result of reviewing transcripts and noting emergent themes. To assess the relative importance of each coded theme, the researchers calculated the number of times each theme was referenced and the number of participants who mentioned each theme. They also examined how often coded themes co-occurred to explore how concepts might be related. When coding was near completion, the researchers presented a summary of findings to 6 interview participants and sought their feedback to further confirm or refine the findings.
Participants were recruited from a larger study conducted by the same research team which had used an online survey to collect data on demographics, substance use, and recovery-related variables. To be eligible for the present study, participants had to self-identify as being in recovery or having resolved a prior alcohol problem and that they had never used specialty alcohol treatment services. Results from this prior online assessment were used to describe the characteristics of the interview participants from the present study. Participants in the current study were majority male (59%), White (57%), 45 years of age or older (83%), and employed full- or part-time (63%). Most participants (85%) met lifetime criteria for severe alcohol use disorder (i.e., endorsed at least 6 out of 11 DSM-5 symptoms during a 12-month period). Slightly over half (57%) indicated abstinence was their alcohol use disorder recovery goal. Almost half (42%) had previously attended at least 10 or more mutual help-group meetings while 58% had little to no prior involvement with mutual help-groups (had attended 9 or fewer meetings in their lifetime). About one in three (31%) participants identified as being in recovery, recovering, or recovered, with those endorsing mutual-help group involvement being more likely to endorse a recovery identity than those with no/minimal mutual-help group involvement (52% vs. 16%).
There were many reasons for pursuing recovery without specialty treatment
Common reasons for not attending mutual-help group meetings or seeking specialty treatment included the belief that one could quit or reduce their drinking on their own, feeling they already had the necessary support for recovery in their lives, a lack of awareness of treatment and recovery service offerings, and stigma associated with seeking help. Specific to specialty treatment, individuals cited cost and lack of insurance coverage as significant barriers. Reasons for not wanting to attend mutual-help groups included disliking certain aspects of 12-step programs (e.g., Alcoholics Anonymous’ principles and traditions), difficulty relating to or forming social bonds with other group members, and social anxiety.
Participants used many strategies to aid their recovery, often in combination
Recovery activities most often mentioned by participants included changing contexts (69%), leveraging social connections (67%), mutual-help group participation (59%), engaging in rewarding activities (54%), self-reliance (51%), and embracing spirituality (49%). Participants often mentioned multiple strategies simultaneously with the most common co-occurrence being social connections and mutual help-groups.
Common themes related to changing contexts included intentional changes to participant’s physical and social environments to enhance boundaries related to alcohol (e.g., spending less time in bars or at parties, removing alcohol from living spaces, replacing old drinking buddies with new non-drinking social contacts such as mutual-help group meeting members). Social connections, including friends, family, peers in recovery had a positive impact on many participants’ recovery journeys. For example, having trusted friends and family to confide in and spending time with non-drinking peers (e.g., mutual help-group members) were referenced as important social connections.
For participants who mentioned the role of participating in mutual-help group meetings as a strategy bolstering their recovery, Alcoholics Anonymous participation was referenced most frequently. Participants specified that mutual-help groups helped to provide structure to their lives and connected them to peers. Similar to other recent studies on mutual-help, helpful aspects of peer connection included the value of shared experiences among individuals with similar life experiences, increased ability to receive social support from them, and opportunities to spend time with them outside of meetings to avoid social isolation.
Engaging in rewarding activities to help initiate or maintain recovery included themes related to participating in hobbies (e.g., housework and yardwork, traveling) and physical activity (e.g., going to the gym, running, cycling).
Themes related to spirituality included appealing to God for help through prayer and becoming involved with and spending time with people from church. Some individuals also mentioned the role that common life stage transitions played in their recovery. For example, some individuals credited aging or maturing as contributing to changes in their drinking. This was sometimes associated with major life events, such as getting married or becoming a parent.
Individuals who have resolved their prior alcohol problems without the use of specialty professional treatment – 60% of whom had little to no mutual-help experience – describe many reasons for making changes without seeking treatment. Findings also highlight a number of common strategies that individuals used to help quit or cut down on their drinking outside of specialty treatment.
The belief that one could quit or cut down on their drinking on their own was commonly cited as the reason for choosing not to seek specialty treatment or participate in mutual-help groups. These individuals without professional treatment and minimal or no mutual-help experience also felt they had existing support for recovery in their lives, lacked awareness about various treatment options available, and perceived stigma associated with seeking help.
Specialty treatment-specific barriers also included cost and lack of insurance coverage. Overall, these barriers to alcohol services mentioned by participants largely mirror those reported in nationally representative samples. Barriers to participation specific to mutual-help groups mentioned included disliking principles and traditions and the spiritual component of popular 12-step programs like Alcoholics Anonymous. At the same time, some individuals endorsed spirituality as a strategy that aided their efforts to initiate and sustain their recovery. Others made mention of difficulties connecting with other group members and social anxiety as reasons contributing to their desire not to attend mutual-help groups. Efforts to promote alternative mutual-help groups (e.g., SMART Recovery) and their online offerings may facilitate viable support options for those opposed to engaging with traditional 12-step mutual-help group offerings.
This study also found that a number of strategies were commonly employed by individuals to resolve their prior alcohol problems without using specialty treatment, including changing physical and social contexts, leveraging social support, mutual-help group participation, engaging in rewarding hobbies and activities, and spirituality. Additionally, findings highlight that these strategies were often used in combination with one another, such as mutual help-group participation, leveraging social support, and changing physical and social contexts. For example, many individuals mentioned that mutual help-group involvement led to the establishment of abstinence-supportive social contacts who they could relate to, receive recovery support from, and spend time with in pro-social activities outside of meetings. Spirituality was also referred to by many participants as playing an important role in their recovery. Overall, these findings resemble many of the key active ingredients theorized to promote the process of remission from alcohol use disorder and to operate within mutual-help groups, including those related to social control theory (e.g., bonding, cohesion, support), social learning theory (observation and imitation of peer models), and behavioral choice theory (i.e., involvement in rewarding alternative activities to alcohol use). Findings also line up with prior research demonstrating the effectiveness of Alcoholics Anonymous in helping individuals to quit drinking and to confer benefits to participants primarily through facilitating adaptive social network changes.
While specialty treatments for alcohol use disorder (i.e., inpatient or residential treatment, outpatient addiction treatment, medication-assisted treatment) are effective, they are underutilized due to various barriers such as lack of a perceived need for treatment, accessibility, cost, and stigma. Fortunately, there are many alternative pathways to recovery, including mutual help-groups and pathways where individuals use no services, either professional or non-professional. Millions of individuals who have resolved their prior alcohol problems do so without attending specialty treatment. Findings from this study highlight a number of common strategies that can aid recovery efforts alone or in combination, including changing physical and social contexts (e.g., spending less time in bars or at parties), leveraging social connections (e.g., having trusted friends and family to confide in), participating in mutual-help groups (e.g., Alcoholics Anonymous), engaging in rewarding activities (e.g., hobbies and exercise), and embracing spirituality (e.g., praying and getting involved with a church). These are similar for other drug use disorders besides alcohol as well as other behavioral addiction problems. For those who are reluctant or unwilling to seek specialty treatment or experiencing barriers to treatment, these alternative strategies to support their efforts to quit or cut down on their drinking may prove beneficial.
Soweid, L., Gilbert, P. A., Maharjan, G., Holdefer, P. J., Evans, S., & Mulia, N. (2024). “Everybody needs to find the best path for them”: Insights into recovery strategies of people who have not used specialty treatment for alcohol use disorder. Alcohol, Clinical & Experimental Research, 48(4), 743–754. doi.: 10.1111/acer.15287
l
Though there are effective clinical treatments for alcohol use disorder (i.e., inpatient or residential treatment, outpatient treatment, FDA-approved medications, etc.), formal treatment engagement is consistently low (<10-15%) among U.S. adults with current alcohol use disorder. That said, most individuals with alcohol use disorder will resolve their alcohol problems, often doing so without the use of these specialty treatment services. For example, in a nationally representative sample of individuals who had resolved a prior problem with alcohol or drugs, the most utilized supports were community-based mutual-help group meetings (45%; e.g., Alcoholics Anonymous). In line with this finding, there is a substantial body of evidence showing Alcoholics Anonymous participation helps people reduce or quit drinking. Outside of more commonly attended mutual-help groups like Alcoholics Anonymous, there has been limited prior research on why and how individuals initiate and sustain alcohol use disorder recovery without the use of specialty treatment. This study sought to address this research gap by using an exploratory, qualitative approach to better understand the strategies employed by individuals who had resolved prior alcohol problems without the use of formal treatment, as well as the factors leading to their decision to attempt recovery without the use of specialty services.
The researchers used semi-structured individual interviews to gather qualitative responses from a sample of 65 adults aged 18 or older who self-identified as being in recovery or having resolved a prior alcohol problem without the use of formal treatment. Interviews were conducted in English or Spanish and via video or telephone calls to accommodate participants’ preferences. During interviews, participants were asked to respond to questions about their understanding of recovery, their history of help-seeking and strategies employed to quit or cut down on their drinking, and the role that their gender, race/ethnicity, and other identities play in recovery. Interviews were digitally recorded, transcribed, and reviewed for accuracy to remove any potential identifying information. To analyze the qualitative data, the researchers used a hybrid inductive-deductive approach, whereby deductive codes were established from the outset based on the interview guide questions and inductive codes were developed as a result of reviewing transcripts and noting emergent themes. To assess the relative importance of each coded theme, the researchers calculated the number of times each theme was referenced and the number of participants who mentioned each theme. They also examined how often coded themes co-occurred to explore how concepts might be related. When coding was near completion, the researchers presented a summary of findings to 6 interview participants and sought their feedback to further confirm or refine the findings.
Participants were recruited from a larger study conducted by the same research team which had used an online survey to collect data on demographics, substance use, and recovery-related variables. To be eligible for the present study, participants had to self-identify as being in recovery or having resolved a prior alcohol problem and that they had never used specialty alcohol treatment services. Results from this prior online assessment were used to describe the characteristics of the interview participants from the present study. Participants in the current study were majority male (59%), White (57%), 45 years of age or older (83%), and employed full- or part-time (63%). Most participants (85%) met lifetime criteria for severe alcohol use disorder (i.e., endorsed at least 6 out of 11 DSM-5 symptoms during a 12-month period). Slightly over half (57%) indicated abstinence was their alcohol use disorder recovery goal. Almost half (42%) had previously attended at least 10 or more mutual help-group meetings while 58% had little to no prior involvement with mutual help-groups (had attended 9 or fewer meetings in their lifetime). About one in three (31%) participants identified as being in recovery, recovering, or recovered, with those endorsing mutual-help group involvement being more likely to endorse a recovery identity than those with no/minimal mutual-help group involvement (52% vs. 16%).
There were many reasons for pursuing recovery without specialty treatment
Common reasons for not attending mutual-help group meetings or seeking specialty treatment included the belief that one could quit or reduce their drinking on their own, feeling they already had the necessary support for recovery in their lives, a lack of awareness of treatment and recovery service offerings, and stigma associated with seeking help. Specific to specialty treatment, individuals cited cost and lack of insurance coverage as significant barriers. Reasons for not wanting to attend mutual-help groups included disliking certain aspects of 12-step programs (e.g., Alcoholics Anonymous’ principles and traditions), difficulty relating to or forming social bonds with other group members, and social anxiety.
Participants used many strategies to aid their recovery, often in combination
Recovery activities most often mentioned by participants included changing contexts (69%), leveraging social connections (67%), mutual-help group participation (59%), engaging in rewarding activities (54%), self-reliance (51%), and embracing spirituality (49%). Participants often mentioned multiple strategies simultaneously with the most common co-occurrence being social connections and mutual help-groups.
Common themes related to changing contexts included intentional changes to participant’s physical and social environments to enhance boundaries related to alcohol (e.g., spending less time in bars or at parties, removing alcohol from living spaces, replacing old drinking buddies with new non-drinking social contacts such as mutual-help group meeting members). Social connections, including friends, family, peers in recovery had a positive impact on many participants’ recovery journeys. For example, having trusted friends and family to confide in and spending time with non-drinking peers (e.g., mutual help-group members) were referenced as important social connections.
For participants who mentioned the role of participating in mutual-help group meetings as a strategy bolstering their recovery, Alcoholics Anonymous participation was referenced most frequently. Participants specified that mutual-help groups helped to provide structure to their lives and connected them to peers. Similar to other recent studies on mutual-help, helpful aspects of peer connection included the value of shared experiences among individuals with similar life experiences, increased ability to receive social support from them, and opportunities to spend time with them outside of meetings to avoid social isolation.
Engaging in rewarding activities to help initiate or maintain recovery included themes related to participating in hobbies (e.g., housework and yardwork, traveling) and physical activity (e.g., going to the gym, running, cycling).
Themes related to spirituality included appealing to God for help through prayer and becoming involved with and spending time with people from church. Some individuals also mentioned the role that common life stage transitions played in their recovery. For example, some individuals credited aging or maturing as contributing to changes in their drinking. This was sometimes associated with major life events, such as getting married or becoming a parent.
Individuals who have resolved their prior alcohol problems without the use of specialty professional treatment – 60% of whom had little to no mutual-help experience – describe many reasons for making changes without seeking treatment. Findings also highlight a number of common strategies that individuals used to help quit or cut down on their drinking outside of specialty treatment.
The belief that one could quit or cut down on their drinking on their own was commonly cited as the reason for choosing not to seek specialty treatment or participate in mutual-help groups. These individuals without professional treatment and minimal or no mutual-help experience also felt they had existing support for recovery in their lives, lacked awareness about various treatment options available, and perceived stigma associated with seeking help.
Specialty treatment-specific barriers also included cost and lack of insurance coverage. Overall, these barriers to alcohol services mentioned by participants largely mirror those reported in nationally representative samples. Barriers to participation specific to mutual-help groups mentioned included disliking principles and traditions and the spiritual component of popular 12-step programs like Alcoholics Anonymous. At the same time, some individuals endorsed spirituality as a strategy that aided their efforts to initiate and sustain their recovery. Others made mention of difficulties connecting with other group members and social anxiety as reasons contributing to their desire not to attend mutual-help groups. Efforts to promote alternative mutual-help groups (e.g., SMART Recovery) and their online offerings may facilitate viable support options for those opposed to engaging with traditional 12-step mutual-help group offerings.
This study also found that a number of strategies were commonly employed by individuals to resolve their prior alcohol problems without using specialty treatment, including changing physical and social contexts, leveraging social support, mutual-help group participation, engaging in rewarding hobbies and activities, and spirituality. Additionally, findings highlight that these strategies were often used in combination with one another, such as mutual help-group participation, leveraging social support, and changing physical and social contexts. For example, many individuals mentioned that mutual help-group involvement led to the establishment of abstinence-supportive social contacts who they could relate to, receive recovery support from, and spend time with in pro-social activities outside of meetings. Spirituality was also referred to by many participants as playing an important role in their recovery. Overall, these findings resemble many of the key active ingredients theorized to promote the process of remission from alcohol use disorder and to operate within mutual-help groups, including those related to social control theory (e.g., bonding, cohesion, support), social learning theory (observation and imitation of peer models), and behavioral choice theory (i.e., involvement in rewarding alternative activities to alcohol use). Findings also line up with prior research demonstrating the effectiveness of Alcoholics Anonymous in helping individuals to quit drinking and to confer benefits to participants primarily through facilitating adaptive social network changes.
While specialty treatments for alcohol use disorder (i.e., inpatient or residential treatment, outpatient addiction treatment, medication-assisted treatment) are effective, they are underutilized due to various barriers such as lack of a perceived need for treatment, accessibility, cost, and stigma. Fortunately, there are many alternative pathways to recovery, including mutual help-groups and pathways where individuals use no services, either professional or non-professional. Millions of individuals who have resolved their prior alcohol problems do so without attending specialty treatment. Findings from this study highlight a number of common strategies that can aid recovery efforts alone or in combination, including changing physical and social contexts (e.g., spending less time in bars or at parties), leveraging social connections (e.g., having trusted friends and family to confide in), participating in mutual-help groups (e.g., Alcoholics Anonymous), engaging in rewarding activities (e.g., hobbies and exercise), and embracing spirituality (e.g., praying and getting involved with a church). These are similar for other drug use disorders besides alcohol as well as other behavioral addiction problems. For those who are reluctant or unwilling to seek specialty treatment or experiencing barriers to treatment, these alternative strategies to support their efforts to quit or cut down on their drinking may prove beneficial.
Soweid, L., Gilbert, P. A., Maharjan, G., Holdefer, P. J., Evans, S., & Mulia, N. (2024). “Everybody needs to find the best path for them”: Insights into recovery strategies of people who have not used specialty treatment for alcohol use disorder. Alcohol, Clinical & Experimental Research, 48(4), 743–754. doi.: 10.1111/acer.15287
l
Though there are effective clinical treatments for alcohol use disorder (i.e., inpatient or residential treatment, outpatient treatment, FDA-approved medications, etc.), formal treatment engagement is consistently low (<10-15%) among U.S. adults with current alcohol use disorder. That said, most individuals with alcohol use disorder will resolve their alcohol problems, often doing so without the use of these specialty treatment services. For example, in a nationally representative sample of individuals who had resolved a prior problem with alcohol or drugs, the most utilized supports were community-based mutual-help group meetings (45%; e.g., Alcoholics Anonymous). In line with this finding, there is a substantial body of evidence showing Alcoholics Anonymous participation helps people reduce or quit drinking. Outside of more commonly attended mutual-help groups like Alcoholics Anonymous, there has been limited prior research on why and how individuals initiate and sustain alcohol use disorder recovery without the use of specialty treatment. This study sought to address this research gap by using an exploratory, qualitative approach to better understand the strategies employed by individuals who had resolved prior alcohol problems without the use of formal treatment, as well as the factors leading to their decision to attempt recovery without the use of specialty services.
The researchers used semi-structured individual interviews to gather qualitative responses from a sample of 65 adults aged 18 or older who self-identified as being in recovery or having resolved a prior alcohol problem without the use of formal treatment. Interviews were conducted in English or Spanish and via video or telephone calls to accommodate participants’ preferences. During interviews, participants were asked to respond to questions about their understanding of recovery, their history of help-seeking and strategies employed to quit or cut down on their drinking, and the role that their gender, race/ethnicity, and other identities play in recovery. Interviews were digitally recorded, transcribed, and reviewed for accuracy to remove any potential identifying information. To analyze the qualitative data, the researchers used a hybrid inductive-deductive approach, whereby deductive codes were established from the outset based on the interview guide questions and inductive codes were developed as a result of reviewing transcripts and noting emergent themes. To assess the relative importance of each coded theme, the researchers calculated the number of times each theme was referenced and the number of participants who mentioned each theme. They also examined how often coded themes co-occurred to explore how concepts might be related. When coding was near completion, the researchers presented a summary of findings to 6 interview participants and sought their feedback to further confirm or refine the findings.
Participants were recruited from a larger study conducted by the same research team which had used an online survey to collect data on demographics, substance use, and recovery-related variables. To be eligible for the present study, participants had to self-identify as being in recovery or having resolved a prior alcohol problem and that they had never used specialty alcohol treatment services. Results from this prior online assessment were used to describe the characteristics of the interview participants from the present study. Participants in the current study were majority male (59%), White (57%), 45 years of age or older (83%), and employed full- or part-time (63%). Most participants (85%) met lifetime criteria for severe alcohol use disorder (i.e., endorsed at least 6 out of 11 DSM-5 symptoms during a 12-month period). Slightly over half (57%) indicated abstinence was their alcohol use disorder recovery goal. Almost half (42%) had previously attended at least 10 or more mutual help-group meetings while 58% had little to no prior involvement with mutual help-groups (had attended 9 or fewer meetings in their lifetime). About one in three (31%) participants identified as being in recovery, recovering, or recovered, with those endorsing mutual-help group involvement being more likely to endorse a recovery identity than those with no/minimal mutual-help group involvement (52% vs. 16%).
There were many reasons for pursuing recovery without specialty treatment
Common reasons for not attending mutual-help group meetings or seeking specialty treatment included the belief that one could quit or reduce their drinking on their own, feeling they already had the necessary support for recovery in their lives, a lack of awareness of treatment and recovery service offerings, and stigma associated with seeking help. Specific to specialty treatment, individuals cited cost and lack of insurance coverage as significant barriers. Reasons for not wanting to attend mutual-help groups included disliking certain aspects of 12-step programs (e.g., Alcoholics Anonymous’ principles and traditions), difficulty relating to or forming social bonds with other group members, and social anxiety.
Participants used many strategies to aid their recovery, often in combination
Recovery activities most often mentioned by participants included changing contexts (69%), leveraging social connections (67%), mutual-help group participation (59%), engaging in rewarding activities (54%), self-reliance (51%), and embracing spirituality (49%). Participants often mentioned multiple strategies simultaneously with the most common co-occurrence being social connections and mutual help-groups.
Common themes related to changing contexts included intentional changes to participant’s physical and social environments to enhance boundaries related to alcohol (e.g., spending less time in bars or at parties, removing alcohol from living spaces, replacing old drinking buddies with new non-drinking social contacts such as mutual-help group meeting members). Social connections, including friends, family, peers in recovery had a positive impact on many participants’ recovery journeys. For example, having trusted friends and family to confide in and spending time with non-drinking peers (e.g., mutual help-group members) were referenced as important social connections.
For participants who mentioned the role of participating in mutual-help group meetings as a strategy bolstering their recovery, Alcoholics Anonymous participation was referenced most frequently. Participants specified that mutual-help groups helped to provide structure to their lives and connected them to peers. Similar to other recent studies on mutual-help, helpful aspects of peer connection included the value of shared experiences among individuals with similar life experiences, increased ability to receive social support from them, and opportunities to spend time with them outside of meetings to avoid social isolation.
Engaging in rewarding activities to help initiate or maintain recovery included themes related to participating in hobbies (e.g., housework and yardwork, traveling) and physical activity (e.g., going to the gym, running, cycling).
Themes related to spirituality included appealing to God for help through prayer and becoming involved with and spending time with people from church. Some individuals also mentioned the role that common life stage transitions played in their recovery. For example, some individuals credited aging or maturing as contributing to changes in their drinking. This was sometimes associated with major life events, such as getting married or becoming a parent.
Individuals who have resolved their prior alcohol problems without the use of specialty professional treatment – 60% of whom had little to no mutual-help experience – describe many reasons for making changes without seeking treatment. Findings also highlight a number of common strategies that individuals used to help quit or cut down on their drinking outside of specialty treatment.
The belief that one could quit or cut down on their drinking on their own was commonly cited as the reason for choosing not to seek specialty treatment or participate in mutual-help groups. These individuals without professional treatment and minimal or no mutual-help experience also felt they had existing support for recovery in their lives, lacked awareness about various treatment options available, and perceived stigma associated with seeking help.
Specialty treatment-specific barriers also included cost and lack of insurance coverage. Overall, these barriers to alcohol services mentioned by participants largely mirror those reported in nationally representative samples. Barriers to participation specific to mutual-help groups mentioned included disliking principles and traditions and the spiritual component of popular 12-step programs like Alcoholics Anonymous. At the same time, some individuals endorsed spirituality as a strategy that aided their efforts to initiate and sustain their recovery. Others made mention of difficulties connecting with other group members and social anxiety as reasons contributing to their desire not to attend mutual-help groups. Efforts to promote alternative mutual-help groups (e.g., SMART Recovery) and their online offerings may facilitate viable support options for those opposed to engaging with traditional 12-step mutual-help group offerings.
This study also found that a number of strategies were commonly employed by individuals to resolve their prior alcohol problems without using specialty treatment, including changing physical and social contexts, leveraging social support, mutual-help group participation, engaging in rewarding hobbies and activities, and spirituality. Additionally, findings highlight that these strategies were often used in combination with one another, such as mutual help-group participation, leveraging social support, and changing physical and social contexts. For example, many individuals mentioned that mutual help-group involvement led to the establishment of abstinence-supportive social contacts who they could relate to, receive recovery support from, and spend time with in pro-social activities outside of meetings. Spirituality was also referred to by many participants as playing an important role in their recovery. Overall, these findings resemble many of the key active ingredients theorized to promote the process of remission from alcohol use disorder and to operate within mutual-help groups, including those related to social control theory (e.g., bonding, cohesion, support), social learning theory (observation and imitation of peer models), and behavioral choice theory (i.e., involvement in rewarding alternative activities to alcohol use). Findings also line up with prior research demonstrating the effectiveness of Alcoholics Anonymous in helping individuals to quit drinking and to confer benefits to participants primarily through facilitating adaptive social network changes.
While specialty treatments for alcohol use disorder (i.e., inpatient or residential treatment, outpatient addiction treatment, medication-assisted treatment) are effective, they are underutilized due to various barriers such as lack of a perceived need for treatment, accessibility, cost, and stigma. Fortunately, there are many alternative pathways to recovery, including mutual help-groups and pathways where individuals use no services, either professional or non-professional. Millions of individuals who have resolved their prior alcohol problems do so without attending specialty treatment. Findings from this study highlight a number of common strategies that can aid recovery efforts alone or in combination, including changing physical and social contexts (e.g., spending less time in bars or at parties), leveraging social connections (e.g., having trusted friends and family to confide in), participating in mutual-help groups (e.g., Alcoholics Anonymous), engaging in rewarding activities (e.g., hobbies and exercise), and embracing spirituality (e.g., praying and getting involved with a church). These are similar for other drug use disorders besides alcohol as well as other behavioral addiction problems. For those who are reluctant or unwilling to seek specialty treatment or experiencing barriers to treatment, these alternative strategies to support their efforts to quit or cut down on their drinking may prove beneficial.
Soweid, L., Gilbert, P. A., Maharjan, G., Holdefer, P. J., Evans, S., & Mulia, N. (2024). “Everybody needs to find the best path for them”: Insights into recovery strategies of people who have not used specialty treatment for alcohol use disorder. Alcohol, Clinical & Experimental Research, 48(4), 743–754. doi.: 10.1111/acer.15287
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