Effectiveness of online mutual-help group attendance for adults with alcohol use disorders in the pooled, longitudinal, U.S. National PAL Study cohorts.

PURPOSE: Online mutual-help group (MHG) meetings have exploded, yet it remains unclear whether online attendance is effective. We examined how MHG attendance mode (online only, in-person only, or both) related to alcohol outcomes, hypothesizing poorer outcomes for online-only (vs. in-person only) attendance via lower MHG involvement. We also explored whether MHG attendance mode moderated associations between involvement and outcomes.

METHODS

Data were from the U.S. Peer ALternatives for Addiction (PAL) Study, with baselines in 2015 and 2021 (N = 1152) and 6- and 12-month follow-ups. Participants reported lifetime AUD and attending a 12-step and/or second-wave MHG for an alcohol problem of their own in the prior 30 days at baseline. Surveys assessed past-30-day MHG attendance mode and involvement (5-item scale); outcomes included alcohol abstinence, alcohol problems, and heavy drinking (dichotomized). Analyses were lagged causal mediation models testing the natural indirect effects (NIEs) of MHG attendance mode on subsequent outcomes via MHG involvement, also examining exposure-mediator interactions.

RESULTS

Across outcomes and as hypothesized, significant NIEs emerged between online-only (vs. in-person only) attendance and worse alcohol outcomes via lower involvement (ps<.01). Results showed equivalent outcomes for those attending via both modes (vs. in-person only), and effects of MHG involvement on outcomes were comparable across MHG attendance mode.

CONCLUSIONS

People attending MHG meetings for an AUD exclusively online may experience diminished benefits due to their lower overall involvement. While online-only attendees who are highly involved may fare well, high involvement may be difficult to achieve in online contexts. Thus, incorporating in-person attendance is probably optimal.