Despite the demonstrated benefits of 12-step participation during recovery, the 12-step approach may not be a good fit for everyone. This study compares the effectiveness of secular mutual help organizations to 12-step groups.
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The efficacy of 12-step groups has been amply demonstrated, and they are the most commonly sought recovery support including both professional and non-professional services. Nevertheless, a large proportion of those with alcohol use disorder never attend 12-step mutual-help, or do not maintain involvement with such groups long enough for participation to be beneficial. This might be due in part to a poor match between the individual and the 12-step program philosophy, which emphasizes, complete abstinence, and spiritual and emotional growth, and may be perceived to have a religious slant by some.
Secular mutual help organizations have not been as well studied but could be a viable alternative for individuals interested in community-based recovery engagement and are not interested in 12-step groups. A head-to-head comparison of different mutual help organizations with different philosophical approaches might help determine whether different approaches are equivalent in effectiveness.
This is a naturalistic longitudinal comparative study over 12 months (the Peer Alternatives in Addiction or PAL study) that compared abstinence and alcohol and drug use outcomes in members of different mutual help organizations.
Outcomes for members of 12-step groups were compared previously to members of secular groups such as Women for Sobriety (WFS), LifeRing and SMART Recovery. This was a survey-based study of a total of 647 adults with a lifetime alcohol use disorder, with surveys administered at baseline (in 2015), 6 month and 12 month follow-up.
The initial cohort of respondents completing the baseline surveys was 1064 cases, which was ‘scrubbed’ to eliminate suspicious and inconsistent cases, leaving 647 participants included in the study. The participants at enrollment had attended in person one of the groups studied (12-step, WFS, LifeRing or SMART) within the prior 30 days. Of note, the participants included a range of recovery times as the study was not limited to those in early recovery. Surveys measured mutual help participation, substance use, psychiatric and clinical variables, current alcohol recovery goal and demographics. The response rate at six months was 81% and at 12 months was 83%, with those lost to follow-up more likely to have lower lifetime alcohol use disorder symptom counts.
An alcohol goal of lifetime total abstinence and higher group involvement at baseline were both strongly associated with better outcomes: Of note, 12-step participants reported the highest levels of having lifetime total abstinence goal, and the authors’ baseline study shows that the 12-step members show higher rates of in-person attendance than the other 3 groups studied. Thus 12-step participants would be favored to show the highest success rates. However, the difference across the four types of support groups was non-significant for LifeRing (as compared with 12-step) or small (for Women For Sobriety and SMART). Participants with a lifetime total abstinence goal had 5.2 times the odds of obtaining alcohol abstinence and 3.7 times the odds for obtaining total abstinence at the 12-month time point.
All four groups showed high success rates: (> 75% reported no problematic drinking and >55% reported total abstinence at 12 months regardless of primary group affiliation). That being said, the abstinence rates for SMART Recovery was statistically lower at the six month time point, and lower for both SMART and Women For Sobriety at the 12-month time point as compared with 12-step participants. However, when analyzed by primary group involvement at the six-month time point, the results tentatively suggest equivalent efficacy for Women For Sobriety, LifeRing and SMART when compared to 12-step groups.
Alcohol recovery goals varied across the groups: Lifetime abstinence for all substances of misuse was the reported goal for 72% of the 12-step members, 67% of the Women For Sobriety members, 58% of LifeRing members, and only 40% for SMART Recovery members. When the model used in this study was adjusted for baseline alcohol recovery goal, the baseline group affiliation effects on outcomes became non-significant.
Other predictors of better substance use outcomes: older age, married status, fewer alcohol use disorder symptoms over the past 12 months, fewer past-12 month drug problems, fewer psychiatric symptoms/severity, and no substance use disorder treatments in the past 12 months.
There is much research support for participation in 12-step groups as a part of recovery. However, the benefits of 12-step participation may apply also to other mutual help groups, including the secular groups analyzed here. Having an abstinence goal and strong group involvement, regardless of the group type, are the strongest predictors of sobriety. Having a broader range of groups shown to be effective in recovery will likely allow better matching between participant and group, thus increasing group involvement, a key mediator of the efficacy of mutual help group participation.
Zemore, S. E., Lui, C., Mericle, A., Hemberg, J., & Kaskutas, L. A. (2018). A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD. Journal of substance abuse treatment, 88, 18-26.
l
The efficacy of 12-step groups has been amply demonstrated, and they are the most commonly sought recovery support including both professional and non-professional services. Nevertheless, a large proportion of those with alcohol use disorder never attend 12-step mutual-help, or do not maintain involvement with such groups long enough for participation to be beneficial. This might be due in part to a poor match between the individual and the 12-step program philosophy, which emphasizes, complete abstinence, and spiritual and emotional growth, and may be perceived to have a religious slant by some.
Secular mutual help organizations have not been as well studied but could be a viable alternative for individuals interested in community-based recovery engagement and are not interested in 12-step groups. A head-to-head comparison of different mutual help organizations with different philosophical approaches might help determine whether different approaches are equivalent in effectiveness.
This is a naturalistic longitudinal comparative study over 12 months (the Peer Alternatives in Addiction or PAL study) that compared abstinence and alcohol and drug use outcomes in members of different mutual help organizations.
Outcomes for members of 12-step groups were compared previously to members of secular groups such as Women for Sobriety (WFS), LifeRing and SMART Recovery. This was a survey-based study of a total of 647 adults with a lifetime alcohol use disorder, with surveys administered at baseline (in 2015), 6 month and 12 month follow-up.
The initial cohort of respondents completing the baseline surveys was 1064 cases, which was ‘scrubbed’ to eliminate suspicious and inconsistent cases, leaving 647 participants included in the study. The participants at enrollment had attended in person one of the groups studied (12-step, WFS, LifeRing or SMART) within the prior 30 days. Of note, the participants included a range of recovery times as the study was not limited to those in early recovery. Surveys measured mutual help participation, substance use, psychiatric and clinical variables, current alcohol recovery goal and demographics. The response rate at six months was 81% and at 12 months was 83%, with those lost to follow-up more likely to have lower lifetime alcohol use disorder symptom counts.
An alcohol goal of lifetime total abstinence and higher group involvement at baseline were both strongly associated with better outcomes: Of note, 12-step participants reported the highest levels of having lifetime total abstinence goal, and the authors’ baseline study shows that the 12-step members show higher rates of in-person attendance than the other 3 groups studied. Thus 12-step participants would be favored to show the highest success rates. However, the difference across the four types of support groups was non-significant for LifeRing (as compared with 12-step) or small (for Women For Sobriety and SMART). Participants with a lifetime total abstinence goal had 5.2 times the odds of obtaining alcohol abstinence and 3.7 times the odds for obtaining total abstinence at the 12-month time point.
All four groups showed high success rates: (> 75% reported no problematic drinking and >55% reported total abstinence at 12 months regardless of primary group affiliation). That being said, the abstinence rates for SMART Recovery was statistically lower at the six month time point, and lower for both SMART and Women For Sobriety at the 12-month time point as compared with 12-step participants. However, when analyzed by primary group involvement at the six-month time point, the results tentatively suggest equivalent efficacy for Women For Sobriety, LifeRing and SMART when compared to 12-step groups.
Alcohol recovery goals varied across the groups: Lifetime abstinence for all substances of misuse was the reported goal for 72% of the 12-step members, 67% of the Women For Sobriety members, 58% of LifeRing members, and only 40% for SMART Recovery members. When the model used in this study was adjusted for baseline alcohol recovery goal, the baseline group affiliation effects on outcomes became non-significant.
Other predictors of better substance use outcomes: older age, married status, fewer alcohol use disorder symptoms over the past 12 months, fewer past-12 month drug problems, fewer psychiatric symptoms/severity, and no substance use disorder treatments in the past 12 months.
There is much research support for participation in 12-step groups as a part of recovery. However, the benefits of 12-step participation may apply also to other mutual help groups, including the secular groups analyzed here. Having an abstinence goal and strong group involvement, regardless of the group type, are the strongest predictors of sobriety. Having a broader range of groups shown to be effective in recovery will likely allow better matching between participant and group, thus increasing group involvement, a key mediator of the efficacy of mutual help group participation.
Zemore, S. E., Lui, C., Mericle, A., Hemberg, J., & Kaskutas, L. A. (2018). A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD. Journal of substance abuse treatment, 88, 18-26.
l
The efficacy of 12-step groups has been amply demonstrated, and they are the most commonly sought recovery support including both professional and non-professional services. Nevertheless, a large proportion of those with alcohol use disorder never attend 12-step mutual-help, or do not maintain involvement with such groups long enough for participation to be beneficial. This might be due in part to a poor match between the individual and the 12-step program philosophy, which emphasizes, complete abstinence, and spiritual and emotional growth, and may be perceived to have a religious slant by some.
Secular mutual help organizations have not been as well studied but could be a viable alternative for individuals interested in community-based recovery engagement and are not interested in 12-step groups. A head-to-head comparison of different mutual help organizations with different philosophical approaches might help determine whether different approaches are equivalent in effectiveness.
This is a naturalistic longitudinal comparative study over 12 months (the Peer Alternatives in Addiction or PAL study) that compared abstinence and alcohol and drug use outcomes in members of different mutual help organizations.
Outcomes for members of 12-step groups were compared previously to members of secular groups such as Women for Sobriety (WFS), LifeRing and SMART Recovery. This was a survey-based study of a total of 647 adults with a lifetime alcohol use disorder, with surveys administered at baseline (in 2015), 6 month and 12 month follow-up.
The initial cohort of respondents completing the baseline surveys was 1064 cases, which was ‘scrubbed’ to eliminate suspicious and inconsistent cases, leaving 647 participants included in the study. The participants at enrollment had attended in person one of the groups studied (12-step, WFS, LifeRing or SMART) within the prior 30 days. Of note, the participants included a range of recovery times as the study was not limited to those in early recovery. Surveys measured mutual help participation, substance use, psychiatric and clinical variables, current alcohol recovery goal and demographics. The response rate at six months was 81% and at 12 months was 83%, with those lost to follow-up more likely to have lower lifetime alcohol use disorder symptom counts.
An alcohol goal of lifetime total abstinence and higher group involvement at baseline were both strongly associated with better outcomes: Of note, 12-step participants reported the highest levels of having lifetime total abstinence goal, and the authors’ baseline study shows that the 12-step members show higher rates of in-person attendance than the other 3 groups studied. Thus 12-step participants would be favored to show the highest success rates. However, the difference across the four types of support groups was non-significant for LifeRing (as compared with 12-step) or small (for Women For Sobriety and SMART). Participants with a lifetime total abstinence goal had 5.2 times the odds of obtaining alcohol abstinence and 3.7 times the odds for obtaining total abstinence at the 12-month time point.
All four groups showed high success rates: (> 75% reported no problematic drinking and >55% reported total abstinence at 12 months regardless of primary group affiliation). That being said, the abstinence rates for SMART Recovery was statistically lower at the six month time point, and lower for both SMART and Women For Sobriety at the 12-month time point as compared with 12-step participants. However, when analyzed by primary group involvement at the six-month time point, the results tentatively suggest equivalent efficacy for Women For Sobriety, LifeRing and SMART when compared to 12-step groups.
Alcohol recovery goals varied across the groups: Lifetime abstinence for all substances of misuse was the reported goal for 72% of the 12-step members, 67% of the Women For Sobriety members, 58% of LifeRing members, and only 40% for SMART Recovery members. When the model used in this study was adjusted for baseline alcohol recovery goal, the baseline group affiliation effects on outcomes became non-significant.
Other predictors of better substance use outcomes: older age, married status, fewer alcohol use disorder symptoms over the past 12 months, fewer past-12 month drug problems, fewer psychiatric symptoms/severity, and no substance use disorder treatments in the past 12 months.
There is much research support for participation in 12-step groups as a part of recovery. However, the benefits of 12-step participation may apply also to other mutual help groups, including the secular groups analyzed here. Having an abstinence goal and strong group involvement, regardless of the group type, are the strongest predictors of sobriety. Having a broader range of groups shown to be effective in recovery will likely allow better matching between participant and group, thus increasing group involvement, a key mediator of the efficacy of mutual help group participation.
Zemore, S. E., Lui, C., Mericle, A., Hemberg, J., & Kaskutas, L. A. (2018). A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD. Journal of substance abuse treatment, 88, 18-26.
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