Individuals who seek strong recovery support but don't see themselves as a fit in 12-Step meetings will likely be heartened by results of the first longitudinal study comparing 12-Step groups with three secular alternatives. The study concluded that active involvement in mutual-help groups produces equivalent benefits in substance use outcomes, regardless of which group the recovering individual chooses.
The study's lead author emphasizes that the results of a single study should not be over-interpreted. But the co-founder of the most prominent alternative support organization in the U.S. cannot hide his strong enthusiasm for the data that are now published in the Journal of Substance Abuse Treatment.
“If you're in SMART Recovery, this is about as big a week as it gets,” A. Thomas Horvath, PhD, who is also president of the Practical Recovery treatment facility in Southern California, tells Addiction Professional.
Those who have sought to grow organizations that offer recovering individuals an alternative to Alcoholics Anonymous (AA) and its derivatives believe these findings will give an important boost to a secular recovery support component that has gone under-researched—and that, in some circles, has been marginalized.
Horvath describes the perceptual shift that he thinks this research will bring about. “Rather than presuming that AA is the best until somebody proves otherwise, the presumption should be that all groups are equal until proven otherwise,” he says.
Format, results of study
The Peer Alternatives in Addiction study comprised three waves of data collection (baseline, 6-month follow-up and 12-month follow-up), comparing alcohol and drug use outcomes among participants in 12-Step groups, SMART Recovery, Women for Sobriety and LifeRing Secular Recovery.
To be included in the study, individuals had to confirm attendance at one of the support groups in the past 30 days. Participants from the secular support organizations were recruited with help from the executives of the three organizations, while 12-Step attendees were recruited via advertisements posted on the online meeting hub In the Rooms.
Study participants were asked to report their overall meeting attendance in the past 30 days and to state if they had a primary/regular group, if they had a sponsor or close friend that they could rely on in their group, if they had led/facilitated a group meeting, and if they had done service or volunteer work at a meeting. These variables were used to measure recovery group affiliation and recovery group involvement.
Participants also were asked at each stage of the study to state their overall recovery goal from among five options, along a spectrum ranging from total lifetime abstinence at one end to controlled substance use at the other.
The preliminary analysis found that having an alcohol goal of lifetime abstinence and having higher primary group involvement at baseline were associated with better outcomes. It also found that those who identified SMART Recovery as their primary group had lower odds of both alcohol abstinence and no alcohol problems at 12 months.
However, when the researchers adjusted for all possible confounding factors, it was discovered that this difference for SMART Recovery was based on the fact that fewer SMART Recovery members had articulated total abstinence as their primary goal. The multivariate analysis concluded that there was no difference in efficacy between the secular alternatives and the 12-Step groups.
In essence, what the researchers utlimately found was that active involvement in a support group, not any particular component of the particular group's content, was what conferred the benefits to the participant.
Study lead author Sarah E. Zemore, PhD, senior scientist and director of training at the Alcohol Research Group, tells Addiction Professional that a substantial body of research has demonstrated large effect sizes for AA. But because other research has shown that comparatively few people who complete formal treatment end up sticking with AA over the long term for support, it is important to examine the efficacy of alternatives to 12-Step.
“When you go to public treatment, you're getting AA,” says Zemore. “But at the same time, there should be more options.”
Another noteworthy finding in this research is that of higher participant satisfaction and cohesion in the alternative groups compared to 12 Step. Zemore speculates that this could stem from the fact that some 12-Step participants had no other viable options for recovery support. It is also possible that some were mandated to attend 12-Step meetings, as often can be the case for justice-involved individuals.
Zemore says she will be seeking funding for additional research into alternatives to 12-Step support. She would like to examine the mechanisms of action in groups such as SMART, Women for Sobriety and LifeRing. “We really don't know why these alternatives work,” she says.
Ultimately, a randomized trial comparing the support groups would be ideal, she indicates. It also would be important to determine whether facilitating choice among groups would represent a sound strategy for improving recovery outcomes.
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