For clinicians treating clients with addictions who don’t seem to be an ideal fit for traditional 12-Step groups, new research begins to shed light on the viability of alternative mutual help groups.
A study conducted by the Alcohol Research Group and published in the current issue of the Journal of Substance Abuse Treatment is the first step in the group’s process to educate clinicians on alternative groups. The study describes the profile and participation characteristics of alternative groups compared to 12-Step participants. Alternative groups studied include: Women for Sobriety (WFS), LifeRing and SMART Recovery (SMART).
“At the moment, we know very little about alternatives to 12-Step groups,” the study’s lead author, Sarah E. Zemore, PhD, tells Addiction Professional. “Clinicians such as service providers, social workers and the public in general really need to have good evidence on what the alternatives are—because there are now a number of them and many of them are growing—and which are effective so they can make appropriate referrals.
“My sense is that many clinicians are open to alternatives and they’re not dogmatic about AA, but they don’t know about alternatives. There’s a lack of information on these alternatives, not only on their efficacy, but just on their existence—what the program structure is, what the program’s philosophy is, what the membership looks like.”
In the case of SMART, the program is based on a philosophy that the solution for overcoming addiction lies within and needs development, whereas the 12-Steps is rooted in the necessity of a higher power and outside support, says Tom Horvath, PhD, ABPP, who concluded a 20-year run as the president of SMART Recovery at the end of December. He continues to serve as president of Practical Recovery, a self-empowering addiction treatment system in San Diego.
Among the research group’s findings:
- Those participants whose primary group was LifeRing or SMART were less likely than those whose primary group was a 12-Step group to endorse a goal of lifetime total abstinence. (WFS and 12-Step share similar philosophies in regards to total abstinence.) The overarching philosophy of each group, Zemore clarifies, is that abstinence is the most appropriate recovery goal, and that while all members may not accept or endorse this goal, all groups covered in the study are abstinence-oriented.
- In-person meeting attendance levels are lower for alternative group participants. Zemore says she attributes this to fewer meeting options being available. Horvath backs this up, noting there are just 35 SMART meetings held in the San Diego area compared to about 2,000 12-Step meetings.
- Alternative group members show higher levels of satisfaction and cohesion compared to 12-Step members. This is important, Zemore says, because cohesion and satisfaction have tended to be strongly related to better outcomes in other studies.
A common misnomer regarding 12-Step programs and mutual help alternatives is that they are an either/or proposition, Zemore says. In fact, 20% to 30% of those in the study whose primary group was an alternative were also attending 12-Step group meetings.
With this baseline data in place, Zemore says her group’s future research will focus on the efficacy of alternative programs.
“AA literature is deep and rich, and we know that AA does work, who it works for and how it works,” Zemore says. “We really need to be as rigorous in looking at these alternatives. It will be important to their growth.”