Mutual-help Organizations Research Articles

Psychiatric comorbidity and 12-step participation: a longitudinal investigation of treated young adults.

Evidence indicates that 12-step mutual-help organizations (MHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), can play an important role in extending and potentiating the recovery benefits of professionally delivered addiction treatment among young adults with substance use disorders (SUD). However, concerns have lingered regarding the suitability of 12-step organizations for certain clinical subgroups, such as those with dual diagnosis (DD). This study examined the influence of diagnostic status (DD vs. SUD-only) on both attendance and active involvement (e.g., having a sponsor, verbal participation during meetings) in, and derived benefits from, 12-step MHOs following residential treatment. Young adults (N=296; 18 to 24years old; 26% female; 95% Caucasian; 47% DD [based on structured diagnostic interview]), enrolled in a prospective naturalistic study of SUD treatment effectiveness, were assessed at intake and 3, 6, and 12months posttreatment on 12-step attendance/active involvement and percent days abstinent (PDA). t-Tests and lagged, hierarchical linear models (HLM) examined the extent to which diagnostic status influenced 12-step participation and any derived benefits, respectively. For DD and SUD-only patients, posttreatment attendance and active involvement in 12-step organizations were similarly high. Overall, DD patients had significantly lower PDA relative to SUD-only patients. All patients appeared to benefit significantly from attendance and active involvement on a combined 8-item index. Regarding the primary effects of interest, significant differences did not emerge in derived benefit between DD and SUD-only patients for either attendance (p=0.436) or active involvement (p=0.062). Subsidiary analyses showed, however, that DD patients experienced significantly greater abstinence-related benefit from having a 12-step sponsor. Despite concerns regarding the clinical utility of 12-step MHOs for DD patients, findings indicate that DD young adults participate and benefit as much as SUD-only patients, and may benefit more from high levels of active involvement, particularly having a 12-step sponsor. Future work is needed to clarify how active 12-step involvement might offset the additional recovery burden of a comorbid mental illness on substance use outcomes.

The Twelve Promises of Alcoholics Anonymous: Psychometric measure validation and mediational testing as a 12-step specific mechanism of behavior change

BackgroundEmpirical support for the recovery utility of 12-step mutual-help organizations (MHOs) has led to increased investigation of how such organizations confer benefit. The Twelve Promises of Alcoholics Anonymous (AA) feature prominently in 12-step philosophy and culture and are one of the few documented explications of the cognitive, affective, and behavioral benefits that members might accrue. This study investigated the psychometric properties of a measure of AA's Twelve Promises and examined whether it mediated the effect of 12-step participation on abstinence. MethodYoung adults (N=302, M age 20.4 [1.6], range 18–25; 27% female; 95% White) enrolled in an addiction treatment effectiveness study completed assessments at intake and 3-, 6-, and 12-months post treatment including a 26-item, Twelve Promises Scale (TPS). Factor analyses examined the TPS’ psychometrics and lagged mediational analyses tested the TPS as a mechanism of behavior change. ResultsRobust principal axis factoring extraction with Varimax rotation revealed a 2-factor solution explaining 45–58% of the variance across three administrations (“Psychological Wellbeing”=26–39%; “Freedom from Craving=17–21%); internal consistency was high (alpha=.83–.93). Both factors were found to increase in relation to greater 12-step participation, but significant mediation was found only for the Freedom from Craving factor explaining 21–34% of the effect of 12-step participation in increasing abstinence. ConclusionsThe TPS shows potential as a conceptually relevant, and psychometrically sound measure and may be useful in helping elucidate the extent to which the Twelve Promises emerge as an independent benefit of 12-step participation and/or explain SUD remission and recovery.

The importance of age composition of 12-step meetings as a moderating factor in the relation between young adults’ 12-step participation and abstinence

BackgroundParticipation in 12-step mutual help organizations (MHO) is a common continuing care recommendation for adults; however, little is known about the effects of MHO participation among young adults (i.e., ages 18–25 years) for whom the typically older age composition at meetings may serve as a barrier to engagement and benefits. This study examined whether the age composition of 12-step meetings moderated the recovery benefits derived from attending MHOs. MethodYoung adults (n=302; 18–24 years; 26% female; 94% White) enrolled in a naturalistic study of residential treatment effectiveness were assessed at intake, and 3, 6, and 12 months later on 12-step attendance, age composition of attended 12-step groups, and treatment outcome (Percent Days Abstinent [PDA]). Hierarchical linear models (HLM) tested the moderating effect of age composition on PDA concurrently and in lagged models controlling for confounds. ResultsA significant three-way interaction between attendance, age composition, and time was detected in the concurrent (p=0.002), but not lagged, model (b=0.38, p=0.46). Specifically, a similar age composition was helpful early post-treatment among low 12-step attendees, but became detrimental over time. ConclusionsTreatment and other referral agencies might enhance the likelihood of successful remission and recovery among young adults by locating and initially linking such individuals to age appropriate groups. Once engaged, however, it may be prudent to encourage gradual integration into the broader mixed-age range of 12-step meetings, wherein it is possible that older members may provide the depth and length of sober experience needed to carry young adults forward into long-term recovery.

Broadening the Base of Addiction Mutual-Help Organizations

Peer-led mutual-help organizations addressing substance use disorder (SUD) and related problems have had a long history in the United States. The modern epoch of addiction mutual help began in the postprohibition era of the 1930s with the birth of Alcoholics Anonymous (AA). Growing from 2 members to 2 million members, AA's reach and influence has drawn much public health attention as well as increasingly rigorous scientific investigation into its benefits and mechanisms. In turn, AA's growth and success have spurred the development of myriad additional mutual-help organizations. These alternatives may confer similar benefits to those found in studies of AA but have received only peripheral attention. Due to the prodigious economic, social, and medical burden attributable to substance-related problems and the diverse experiences and preferences of those attempting to recover from SUD, there is potentially immense value in societies maintaining and supporting the growth of a diverse array of mutual-help options. This article presents a concise overview of the origins, size, and state of the science on several of the largest of these alternative additional mutual-help organizations in an attempt to raise further awareness and help broaden the base of addiction mutual help.

Moderation Management: A Mutual-Help Organization for Problem Drinkers Who Are Not Alcohol-Dependent

Moderation Management (MM) is a mutual-help organization for problem drinkers who are not alcohol-dependent. MM members pursue a goal of moderate drinking as defined by specific guidelines for frequency and quantity of alcohol consumption. MM's program for change is based primarily on cognitive restructuring and behavioral self-control enhancement and has no inherent spiritual component. MM's definition of the “nondependent” problem drinker is based on the individual's ability to adhere to MM guidelines, which include an initial 30-day abstinence period followed by limits on daily consumption. MM's members, on average, are less alcohol-dependent and have higher social capital than individuals who participate in Alcoholics Anonymous or seek inpatient alcohol treatment. Although no longitudinal studies to date have examined the efficacy of MM, there are positive outcome data for similar cognitive and brief behavioral interventions delivered by health care professionals. Critics of MM claim the organization ...

Al-Anon Family Groups: Origins, Conceptual Basis, Outcomes, and Research Opportunities

Al-Anon Family Groups, commonly known as Al-Anon, is a mutual-help organization for relatives and friends of people misusing alcohol and other substances. We first summarize Al-Anon's history and current membership and then describe its theoretical basis and helping approach. We review evidence for Al-Anon's active ingredients and outcomes and present a conceptual model to guide future research. Research opportunities include understanding Al-Anon newcomers, specifying Al-Anon's active ingredients, and examining potential synergistic influences between Al-Anon participation and identified substance misusers’ participation in mutual-help groups such as Alcoholics Anonymous. We suggest that mutual-help and professional communities work together to facilitate early participation in Al-Anon by shortening the time between problem recognition and seeking help from the fellowship.

Mutual-Help Groups for Dually Diagnosed Individuals: Rationale, Description, and Review of the Evidence

ABSTRACT Mutual-help groups (MHGs), such as Alcoholics Anonymous (AA), have been shown to be helpful to a broad range of individuals suffering from substance use disorders (SUD). However, for the substantial number of SUD individuals suffering from co-occurring psychiatric conditions, purely substance-focused groups, such as AA, may not be as good a fit. Consequently, MHGs have emerged that focus more explicitly on both substance use and other psychiatric concerns. In this review, we describe, compare, and discuss the four largest “dual-focused” mutual-help organizations and examine the evidence for any incremental benefit they may offer dually diagnosed individuals. We also provide evidence-based recommendations for ways in which clinicians can facilitate patients’ participation in these groups.

The Effect of Professional Partnership on the Development of a Mutual‐help Organization

The effects of partnership between Schizophrenics Anonymous (SA, a mutual-help organization) and the Mental Health Association in Michigan (MHAM, a professionally staffed advocacy organization) on SA's growth and development were explored. Following the initiation of a formal partnership, SA groups were more available throughout the state, more likely to be associated with formal mental health settings, and less likely to have leaders who had been participants in other SA groups. Groups with consumer leaders had significantly greater longevity than groups with professional leaders. Changes in the organizational structure and process of SA were also identified. SA leaders reported that SA moved from a collective to a more bureaucratic structure. As a result, there was greater consistency, administrative capacity, and response capacity. This enhanced capacity came with costs reported by SA leaders. The leadership role of SA members became less defined. SA members expressed concerns about the more hierarchical structure of SA's organization, decreased consumer control, increased professional involvement in SA, and an excessive focus on group development as opposed to group maintenance. Mental Health Association in Michigan staff reported that MHAM was also impacted by the partnership, both with regard to internal functioning and external perception. Implications for effective partnerships between mutual-help and professional organizations are discussed.

Organizações Voluntárias: informação para a conquista da cidadania 10.5007/1518-2924.2001v6n11p52

This paper analyses the role of information in social movements represented by voluntary non-governmental and mutual-help organizations in Florianópolis, Santa Catarina, Brazil. The study searches to identify the grade in which such organizations employ information to support the social inclusion of their associates, contributing (through informational proccesses) for their effective citizenship.

A 3‐Year Study of Addiction Mutual‐help Group Participation Following Intensive Outpatient Treatment

Addiction-focused mutual-help group participation is associated with better substance use disorder (SUD) treatment outcomes. However, little has been documented regarding which types of mutual-help organizations patients attend, what levels of participation may be beneficial, and which patients, in particular, are more or less likely to participate. Furthermore, much of the evidence supporting the use of these organizations comes from studies examining participation and outcomes concurrently, raising doubts about cause-effect connections, and little is known about influences that may moderate the degree of any general benefit. Alcohol-dependent outpatients (N=227; 27% female; M age=42) enrolled in a randomized-controlled telephone case monitoring trial were assessed at treatment intake and at 1, 2, and 3 years postdischarge. Lagged-panel, hierarchical linear models tested whether mutual-help group participation in the first and second year following treatment predicted subsequent outcomes and whether these effects were moderated by gender, concurrent axis I diagnosis, religious preference, and prior mutual-help experience. Robust regression curve analysis was used to examine dose-response relationships between mutual-help and outcomes. Mutual-help participation was associated with both greater abstinence and fewer drinks per drinking day and this relationship was not found to be influenced by gender, Axis I diagnosis, religious preference, or prior mutual-help participation. Mutual-help participants attended predominantly Alcoholics Anonymous and tended to be Caucasian, be more educated, have prior mutual-help experience, and have more severe alcohol involvement. Dose-response curve analyses suggested that even small amounts of participation may be helpful in increasing abstinence, whereas higher doses may be needed to reduce relapse intensity. Use of mutual-help groups following intensive outpatient SUD treatment appears to be beneficial for many different types of patients and even modest levels of participation may be helpful. Future emphasis should be placed on ways to engage individuals with these cost-effective resources over time and to gather and disseminate evidence regarding additional mutual-help organizations.

Bridging professional and mutual-help: An application of the transtheoretical model to the mutual-help organization

The authors suggest that the mental health system of the nation could benefit by more fully embracing the idea of mutual-help (i.e., self-help), and this collaboration could be facilitated by the utilization of a well-established clinical theory to elucidate the psychological processes at work within mutual-help organizations. The processes of change of the transtheoretical model is offered as one potential framework. This well-established model has been used to help psychologists better understand clinical and professional phenemonena, but, to date, has been used less frequently with non-professional interventions. This article applies the ten processes of change of the transtheoretical model to mutual-help organizations, focusing on four groups, including Alcoholics Anonymous (AA), Oxford House, GROW, and Schizophrenics Anonymous. The advantages of the transtheoretical model and its potential ability to act as a common language across clinical professionals and mutual-help organizations are discussed. In addition, advantages of bolstering the present mental health system using combinations of both forms of care along the recovery continuum are described.

Alcohol & drug abuse: A research-based analysis of the Moderation Management controversy.

Perhaps the biggest controversy of the 1990s in the U.S. alcohol treatment field concerned Moderation Management (MM), the only mutual-help organization to offer its members the goal of achieving moderate drinking. MM’s supporters argued that the option of this goal would attract problem drinkers who were not dependent on alcohol and not interested in abstinence-only organizations such as Alcoholics Anonymous (AA) and professionally operated 12-step treatment programs (1). In contrast, prominent figures in the treatment and research communities denounced MM as a “dangerous temptation to alcoholics” that was “built on the illusion” that alcoholics could return to controlled drinking (2). This debate only became more intense and bitter after MM’s founder, Audrey Kishline, left MM, joined AA, and several months later caused the deaths of two people in a horrific car accident while severely intoxicated (2). This column addresses the central debates about MM by summarizing the findings of a recently completed study of the organization, described in detail elsewhere (3), and other relevant research. Fundamental argument over MM MM’s primary text, Moderate Drinking (1), and AA’s Big Book (4) actually agree on several important points. Both books make explicit distinctions between problem drinkers who are able to return to controlled drinking and alcoholics. Both texts also concur that failure at the goal of moderate drinking indicates that a drinking problem is serious and is best addressed by abstinence. These shared assumptions have been supported in prospective studies showing that, broadly speaking, when problem drinkers recover, abstinence is more common among those who are highly dependent on alcohol, are male, are older, and are socially and economically unstable, whereas moderate drinking is more common among problem drinkers who do not belong to these sociodemographic groups— for example, young women with low levels of dependence (5–7). MM’s proponents differ from advocates of abstinence-only approaches in their views on who can be trusted to judge the difference between a moderation-bound problem drinker and an alcoholic rather than in their views on whether such a distinction exists. A large proportion of the 12-step treatment community in the United States has incorporated the psychodynamic concept of denial into its theory of alcoholism; AA’s texts describe alcoholics as having a grandiose penchant for overestimating their ability to control drinking (4). Thus many 12-step advocates fear that despite MM’s intention to serve only nondependent problem drinkers, the organization’s members are in fact alcoholics who are deceiving themselves into thinking that they can drink moderately. Severity of MM members’ alcohol problems

Life Stories of Moderation Management Mutual Help Group Members

This study analyzed life story themes of 30 Moderation Management (MM) members. MM is the only mutual-help organization in the U.S. that supports problem drinkers who wish to moderate their alcohol consumption. Qualitative interview data indicated that MM involvement was often precipitated by a conscious rejection of the 12-step philosophy espoused in Alcoholics Anonymous and in many professional treatment programs. In particular, MM members did not believe that their problem drinking was a disease manageable only through abstinence or that they needed to surrender control to a spiritual “higher power” for recovery. In contrast, the MM world view, which emphasizes self-control and choice, seemed to better match the experience, values and preferred self-narratives of this high-functioning sample of white, middle-class, well-educated Americans.

Assessing the social networks of people with psychiatric disability from multiple perspectives.

The study uses a sample of 97 new members of a mutual-help organization for the seriously mentally ill and 97 of their significant others (61 family members and 36 friends) to examine 1) the degree to which respondents' perceptions of dyadic relationships can be corroborated by network members and 2) the relationship of congruence of perception between respondent-network member pairs, characteristics of respondents' social networks and self-reported symptoms and social adjustment. Results showed strong variability in the degree to which respondents' perceptions were corroborated by network members, with a higher degree of corroboration for factual information such as face-to-face contact than for global aspects of dyadic relationships. Congruence of perception between respondents and family was associated with respondents' feelings of satisfaction about the quality of network ties and better psychological and social functioning. In contrast, congruence of perception between respondents and friends was related to a sense of involvement from ones network, but unrelated to respondents' mental health. The advantages of multiple perspectives data in studying the social ties of people with psychiatric disability are discussed.

Factors affecting the birth and death of mutual-help groups: the role of national affiliation, professional involvement, and member focal problem.

Examined the predictive relationship of three variables to the birth and death of mutual-help groups for a statewide New Jersey sample of 3,152 groups over a 2-year period. The three variables studied were group affiliation with a national mutual-help organization, local professional involvement in group activities, and group members' type of focal problem. Log-linear logit analysis revealed that the best-fitting model included Affiliation Status x Professional Involvement, and Affiliation Status x Focal Problem interactions. Among unaffiliated groups, professional involvement was related to lower group mortality, while among affiliated groups it was related to higher group mortality. Unaffiliated behavior control groups had higher odds for mortality and for birth than either unaffiliated life stress groups or unaffiliated medical groups. Among main effect findings, unaffiliated groups had consistently higher odds for birth than affiliated groups. The implications for research and action are discussed.

Recent developments in crisis intervention and the promotion of support service

A model of Primary Prevention is presented, based upon recent developments in the author's explorations, and upon the animal and human stress research literature. The main elements involve the multifactorial reverberation over time among past biopsychosocial hazards, individual competence, crisis reactions to current stress, and psychosocial supports. Methods of preventive intervention are described in detail. These include crisis methods: anticipatory guidance and preventive intervention; and support systems methods: providing and orchestrating professional support, convening a support group for a target individual, organizing a mutual-help couple, recruiting a panel of natural helpers, fostering development of mutual-help organizations, and supporting the supporters.

Whom do mutual-help groups help? A typology of members.

A total of 1,677 members of GROW, a mutual-help organization, were surveyed about the reasons they joined GROW and their perceptions of its effectiveness in meeting their needs. The organization was founded 30 years ago to enhance the rehabilitation of former mental patients, but it now includes members who have never been treated for mental illness. Cluster analysis of the survey data revealed five distinct groups of members. One group sought relief of symptoms, while others sought a supportive community, help in recovering from trauma, help in coping with bereavement, or the opportunity to help others. The interests of the different types of members in GROW, and in other mutual-help organizations, may be at odds because some members may need social support that encourages change (facilitative support), while others may need social support that provides stable relationships (palliative support).

Community treatment of the mentally ill: the promise of mutual-help organizations.

Community treatment of the mentally ill: the promise of mutual-help organizations.