Second-wave mutual-help groups: Examining effectiveness for individuals with alcohol use disorders in the longitudinal, U.S. national PAL Study cohorts.

BACKGROUND

Second-wave mutual-help groups (MHGs) for addiction (e.g., SMART Recovery) are prevalent and promising, but limited studies have examined their effectiveness. We examined 1) the comparative effectiveness of second-wave MHGs for supporting alcohol use disorder recovery and 2) correlates of MHG involvement.

METHODS

Data were pooled from the Peer ALternatives for Addiction (PAL) Study 2015 and 2021 Cohorts (N = 1152), which recruited adults via collaboration with MHG directors and recovery-related organizations. Eligibility criteria included U.S. residence, lifetime alcohol use disorder, and past-30-day in-person/online attendance at Women for Sobriety, LifeRing, SMART, and/or a 12-step group. Surveys were administered at baseline, 6 months, and 12 months (response rates=81-88 %), and assessed MHG choice (defined using attendance), MHG involvement (5-item scale; e.g., regular/home group, volunteering/service) and alcohol outcomes (below).

RESULTS

In lagged, multivariate generalized estimating equations, greater MHG involvement strongly predicted higher odds of alcohol abstinence (OR=2.62, p<.001), lower odds of alcohol problems (OR=0.39, p<.01), and fewer drinking days (IRR=0.12, p<.001) at follow-ups. MHG choice was unrelated to outcomes either alone or in interaction with MHG involvement, suggesting comparable effectiveness for all second-wave MHGs (vs. 12-step). Predictors of greater MHG involvement included older age, a total abstinence (vs. other) goal, and 2015 (vs. 2021) Cohort.

CONCLUSIONS

Findings suggest comparable effectiveness for the targeted second-wave alternatives (vs. 12-step) among community members attending MHGs, indicating that alcohol service providers, courts, and policymakers should consider referring to and supporting these alternatives. Still, variation in SMART's program across time and geography suggests caution in interpreting the results for SMART.