Substance Use–Focused Mutual-Help Groups: Processes and Outcomes

Alcoholics Anonymous

Alcoholics Anonymous is a fellowship with the primary purpose of helping individuals with alcohol-related problems maintain sobriety. It is structured around the 12 Steps (e.g., admission of powerlessness over alcohol, belief in a higher power) and 12 Traditions (e.g., an emphasis on the common welfare and recognition that personal recovery depends on Alcoholics Anonymous unity). (See www.aa.org/pdf/products/p-42_abriefguidetoaa.pdf for the Twelve Steps and Twelve Traditions.) Other key aspects of Alcoholics Anonymous involve open and closed group meetings and literature that describes Alcoholics Anonymous, shares its tenets, and provides guidance to recovering individuals. Estimated Alcoholics Anonymous membership is about 1,300,000 members and 60,000 groups in the United States, and about 2,041,000 members and 115,000 groups worldwide; about 38% of the members are women (see www.aa.org ).

Narcotics Anonymous and Cocaine Anonymous

Narcotics Anonymous is a fellowship of recovering individuals with drug use disorders. It grew out of and is similar to Alcoholics Anonymous in that it provides a structured support network in which members share information about overcoming addiction and living productive, drug-free lives through adherence to the 12 Steps and 12 Traditions. Narcotics Anonymous encourages complete abstinence from all drugs, including alcohol, but, like Alcoholics Anonymous, accepts the use of prescribed medications for psychiatric and medical disorders. Narcotics Anonymous has about 63,000 weekly meetings in more than 130 countries worldwide; about 76% of the members are Caucasian and 43% are women (see www.na.org ).

Cocaine Anonymous is a fellowship open to individuals who want to stop using cocaine, including crack cocaine and other mind-altering substances. Its program of recovery was adapted from Alcoholics Anonymous and uses the 12-step recovery approach. There are an estimated 30,000 members and more than 2000 groups (see www.ca.org ).

Secular Organizations for Sobriety

Secular Organizations for Sobriety provides support for individuals who seek to achieve and maintain sobriety, a forum to express thoughts and feelings about recovery, and a nonreligious or secular approach that does not depend on the 12 Steps or 12 Traditions. Members are expected to acknowledge their addiction and take responsibility for achieving and maintaining sobriety. Members tend to be well-educated individuals who have been in professional treatment and have attended and continue to attend Alcoholics Anonymous. The majority of the members are men (see www.secularsobriety.org ).

SMART Recovery

SMART Recovery (or Self-Management and Recovery Training) espouses a rational treatment orientation and focuses on teaching individuals new coping skills and more logical ways of thinking and acting. Using trained facilitators in about 2000 groups, it emphasizes practical methods of changing maladaptive behavior rather than a 12-step or spiritual approach. SMART Recovery’s 4-point program includes: (1) building and maintaining motivation to abstain; (2) learning how to cope with urges; (3) managing thoughts, feelings, and behavior; and (4) balancing momentary and enduring satisfactions (see www.smartrecovery.org ). A comparison of three groups of SMART Recovery participants—those only attending meetings in person, those using only a web application of the program, and those attending meetings and employing the web application—found that these interventions were equally effective. That is, participants in all three groups were significantly more likely at follow-up to be abstinent and to have fewer drinking- and substance-related problems.

Moderation Management

Moderation Management construes problem drinking as a habit that can be controlled by applying principles of cognitive-behavioral therapy in the context of a network of supportive peers. It provides an alternative to the spiritually oriented disease model of traditional 12-step mutual-help groups and to an abstinence goal; it allows members a choice of abstinence or moderate drinking goals. Moderation Management members tend to emphasize the value of self-control, insight, personal responsibility and choice, and rationality. Most Moderation Management members are Caucasian; they tend to be married, college educated, and employed, and more than half are women (see www.moderation.com ).

LifeRing

LifeRing Secular Recovery is an organization of people who share practical experiences and sobriety support, embracing what works for each individual. LifeRing believes that each individual has the desire to find lasting sobriety, thought of as the Sober Self. With addiction, the Sober Self has been submerged, but still exists. People also have an Addict Self that tries to control decision-making and leads to substance use. LifeRing supports efforts to strengthen the Sober Self and weaken the Addict Self by sharing advice, understanding, and encouragement. It is thought to work by positive social reinforcement. The membership is primarily male (57%), white (96%), college educated (91%), and not religious (56%) ( www.lifering.org ).