WHAT PROBLEM DOES THIS STUDY ADDRESS?

While formal treatments for alcohol and other drug use disorders (referred to collectively as substance use disorder) remain underutilized – often due to barriers like lack of access, cost, and stigma – community-based mutual-help group participation is one of the most common means through which individuals resolve substance use problems. There is substantial evidence supporting the effectiveness for peer support groups (e.g., Alcoholics Anonymous) to support efforts to quit drinking, which work, in part, by helping people enhance their social networks to support recovery. Online, social network sites have precipitously increased in popularity. This trend, along with the physical distancing requirements from the COVID-19 pandemic, have helped mainstream online communities specifically to address substance use. These online recovery supports offer vast potential for increasing access to low or no-cost peer support, while counteracting barriers such as physical location, transportation, and time constraints.

Social media forums, or discussion-board based social media (e.g., on the platform Reddit), is one particular format of online recovery support with noteworthy increases in popularity. This is further evidenced by the listing of recovery-oriented social media forums in public resource guides published by national organizations like the Substance Abuse and Mental Health Services Administration. Though there is evidence suggesting individuals use online addiction recovery forums as part of their recovery efforts, whether the use of these forums promotes enhancements in social support and reductions in alcohol or other drug use has yet to be determined.

To date, studies on online addiction recovery forums generally characterize the types of content individuals share on a select few forums on Reddit (i.e., subreddits). These studies provide evidence that content generated in these online recovery communities mirrors the types of support exchanged in in-person group therapy and 12-step peer support groups, such as providing emotional support, feedback, and informational resources. However, the broader landscape of online addiction recovery forums that exist, as well as their unique features and engagement patterns, have not been examined. It will be critical moving forward to better understand the varying social-technological characteristics and user activity of online recovery forums if future research is to more fully capture any potential they have to promote positive recovery outcomes.

This systematic, cross-sectional, observational study characterized features and engagement activity of English-language online forums related to addiction recovery. Findings were translated into a publicly accessible interactive dashboard, enabling individuals to locate active online addiction recovery forums of interest.

HOW WAS THIS STUDY CONDUCTED?

The researchers employed a systematic process to search for, catalogue, and review online addiction recovery forums (N = 207). A codebook was developed to aid two trained coders in systematically characterizing features of the forums (e.g., focus on a specific substance, substance type, population, etc.) and to collect field notes. User engagement for each forum for which it was accessible was calculated in three ways (posts per week, responses per post, time between unique user engagements).

The team first identified potential forums through a combination of a) reviewing existing online recovery support resource guides from national organizations (e.g., American Society of Addiction Medicine, Substance Abuse and Mental Health Services Administration) and b) conducting Google searches using alcohol and drug-related keywords (e.g., “addiction online support group”). An online forum was defined as “an interactive website feature allowing three or more people to correspond via asynchronous text dialogue that remains on the website after leaving.” In this sense, a forum could be hosted on a stand-alone website or on an existing traditional social media site (e.g., Facebook, Reddit). To be eligible for inclusion in the study, the forum had to be publicly available and primarily intended for individuals attempting to quit or cut down on drinking, smoking/vaping, or other drug use.

Elements of each addiction recovery form were categorized in the following ways: (1) focus on a specific substance (yes/no) and type of substance focused on (alcohol/cannabis/nicotine/hallucinogens/stimulants/opioids/other), (2) population (gender, minoritized populations, spiritual/religious orientations, professions), (3) visibility (public/semi-public/private), (4) engageability (anyone can post/only logged in users can post), (5) content threading (responses could be organized hierarchically under other responses/responses could not be directly responded to); (6) content feedback (positive [e.g., likes and upvotes]/negative [e.g., downvotes]/complex [e.g., emojis]); (7) user profile (none/basic/detailed); (8) user labels (e.g., sobriety badges), (9) networking (peer networks allowing for following or friend features, hashtagging, @’ing); and (10) content moderation (listing of content moderators or description of content moderation policies).

User engagement was also calculated when possible, including posts per week (total number of forum posts in last 7 days; for those with 0 posts in last 7 days, last month number of posts was divided by 4), responses per post (only for those with >1 post in the last week), and time between unique user engagements.

WHAT DID THIS STUDY FIND?

The online addiction recovery forum landscape is diverse; forums span a range of websites, features, substances, and populations

Over half of the 207 identified online addiction recovery forums focused on general substance use (n=109; 52.7%); among the 98 forums focused on a specific substance, alcohol was the most common primary substance (44.9%). Though 1 in 5 forums were private, the majority (73.9%) of forums were fully publicly accessible. Only 8 forums required paid subscriptions to access content. Forums tailored to individuals possessing certain sociodemographic or professional characteristics exist, including for women, racial minorities, sexual and gender minorities, military veterans, and medical and mental health professionals. Forums intended for those who also participate in 12-step based programs (e.g., Alcoholics Anonymous, Narcotics Anonymous) and “second-wave” secular recovery organizations (e.g., SMART Recovery) were also identified. The sites that hosted the most online addiction recovery forums were the popular traditional social media sites Reddit (n=37) and Facebook (n=29), followed by supportgroups.com (n=19), and Quora, a question-and-answer site (n=17).

Engagement varies widely, with forums hosted on popular, traditional social media sites receiving the most engagement.

Of the 207 online addiction recovery forums, only 98 (47.3%%) were active weekly with a median of 10 posts per week, 4 responses per post, and 27 days between unique user engagements. Nearly half (n=94; 45.4%) of the identified forums were completely inactive over the last month, meaning there had not been any new posts within the last 30 days. The most active forum was Reddit’s r/StopDrinking forum with 1,992 posts per week, followed by r/Leaves (n=637), Facebook’s “Narcotics Anonymous Recovery Group” (n=530), r/QuittingKratom (n=324), and r/ StopSmoking (n=308).

It is worth noting that all 5 forums representing those with the most posts per week were located on either Reddit or Facebook, with 4 out of the 5 located on Reddit. These 5 forums accounted for almost half (47.0%) of all past-week posts across all 207 forums included in the study. One forum, r/StopDrinking, accounted for nearly 1 out of every 4 posts documented across all forums and demonstrated the fastest time interval between unique user interactions (1.5 minutes). Similarly, 4 out of the 5 forums with the fastest time interval between unique user interactions existed on Reddit or Facebook, with 3 out of the 5 being on Reddit.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

Findings from this study demonstrate the wide array of online addiction recovery forums that exist. These forums vary widely in terms of their characteristics and features (e.g., public vs. private), substances addressed (e.g., general, alcohol, opioids, etc.), and intended populations (e.g., general, women, racial minorities, sexual and gender minorities, military veterans, medical and mental health professionals, etc.). This finding indicates there are a number of options for individuals affected by alcohol and other drug use disorder to choose from to find online community tailored to their individual needs. However, online addiction recovery forums also varied widely in terms of their engagement and finding a community resonating with one’s personalized needs must also be balanced with engagement preferences. Almost half of the 207 platforms evaluated in this study were completely inactive over the past month, and thus, may provide little to no value to an individual in or seeking recovery. However, many forums hosted on popular traditional social media sites like Reddit and Facebook are quite active, several of which received hundreds of posts per week and had low lag times (less than 30 minutes) between unique user engagements. For example, r/StopDrinking accounted for 1,992 posts in the past week at the time the study was conducted with a time of 1.5 minutes between unique user interactions. Findings from this study were incorporated into an interactive addiction recovery forum dashboard, allowing individuals to locate and filter forums based off of level of engagement (posts per week), and by specific substance, features, and population focus.

One conclusion that can be drawn from this study is that digital recovery supports, including online addiction recovery forums, are being widely used. Reddit forums appeared to be particularly active and represented the majority of forums receiving the highest levels of engagement. These “subreddits”, the term used to describe a Reddit forum which can be identified with an “r/” tagged at the beginning of the forum’s web URL (e.g., r/StopDrinking is publicly available at https://www.reddit.com/r/stopdrinking/), allows for user anonymity, which may be particularly appealing to individuals in or seeking recovery given the sensitive nature of sharing about one’s alcohol and other substance use and stigma associated with substance-related conditions. Also, Reddit’s public nature enables individuals who may be contemplating making changes to their substance use behaviors to passively engage with content (“lurk”) before making a decision to actively engage. Previous studies of Reddit forums have shown that the types of social support exchanged among users mirrors the support found in in-person group therapy and 12-step peer support groups, and digital recovery supports have been theorized to confer benefits to participants in a similar manner as in-person offerings. However, the lack of clinical studies evaluating the effectiveness for online addiction recovery forums to support efforts to quit or cut down on substance use hinders any ability to recommend the use of these platforms, which if proven to be helpful, could have vast potential for scaling access to recovery-related social support.

BOTTOM LINE

Online addiction recovery support forums differ substantially in terms of their characteristics and user activity. Many online addiction recovery forums have not had any new posts in the last month, while several forums hosted on popular social media sites like Reddit and Facebook receive hundreds of posts per week. The researchers who conducted this study incorporated their findings into an interactive, publicly available tool that can help to navigate through these complexities with regard to platform affordances and engagement to help individuals in or seeking recovery to find a forum that is tailored to their individual needs and preferences. Nonetheless, whether and how the use of these online recovery support forums confer benefits to participants with regard to their substance use remains unknown and warrants further funding and investigation. Given evidence suggesting many individuals are already engaging with online addiction recovery forums for giving and receiving social support during their recovery efforts, results supporting (or refuting) their recommendation as evidence-based supports would add clarity for individuals in or seeking recovery and treatment professionals working with these individuals. If shown to be beneficial for recovery-related outcomes, online addiction recovery support forums could scale low-threshold, low- or no-cost recovery support.

CITATIONS

Colditz, J. B., Hsiao, L. H., Bergman, B. G., Best, D. W., Hulsey, E. G., Sidani, J. E., Rollman, B. L., & Kraemer, K. L. (2024). Characteristics and engagement among English-language online forums for addiction recovery available in the US. Internet Interventions, 35, 100708. doi: 10.15585/mmwr.mm7306a2