Mutual support (also called self-help) groups are an important part of recovery from substance use disorders (SUDs). Mutual support groups exist both for persons with an SUD and for their families or significant others and are one of the choices an individual has during the recovery process.
Mutual Support Groups
Mutual support groups are nonprofessional groups comprising members who share the same problem and voluntarily support one another in the recovery from that problem.1 Although mutual support groups do not provide formal treatment, they are one part of a recovery-oriented systems-of-care approach to substance abuse recovery. By providing social, emotional, and informational support for persons throughout the recovery process,1 mutual support groups help individuals take responsibility for their alcohol and drug problems and for their sustained health, wellness, and recovery.
The most widely available mutual support groups are 12-Step groups, such as Alcoholics Anonymous (AA), but other mutual support groups such as Women for Sobriety (WFS), SMART Recovery® (Self-Management and Recovery Training), and Secular Organizations for Sobriety/Save Our Selves (SOS) are also available.
Twelve-Step groups emphasize abstinence and have 12 core developmental “steps” to recovering from dependence.2 Other elements of 12-Step groups include taking responsibility for recovery, sharing personal narratives, helping others, and recognizing and incorporating into daily life the existence of a higher power. Participants often maintain a close relationship with a sponsor, an experienced member with long-term abstinence, and lifetime participation is expected.2,3 AA is the oldest and best known 12-Step mutual support group.
There are more than 100,000 AA groups worldwide and nearly 2 million members.2
The AA model has been adapted for people with dependence on drugs and for their family members. Some groups, such as Narcotics Anonymous (NA) and Chemically Dependent Anonymous, focus on any type of drug use. Other groups, such as Cocaine Anonymous and Crystal Meth Anonymous, focus on abuse of specific drugs. Groups for persons with co-occurring substance use and mental disorders also exist (e.g., Double Trouble in Recovery; Dual Recovery Anonymous).
Other 12-Step groups—Families Anonymous, Al-Anon/Alateen, Nar-Anon, and Co-Anon—provide support to significant others, families, and friends of persons with SUDs.
Twelve-Step meetings are held in locations such as churches and public buildings. Metropolitan areas usually have specialized groups, based on such member characteristics as gender, length of time in recovery, age, sexual orientation, profession, ethnicity, and language spoken.4 Attendance and membership are free, although people usually give a small donation when they attend a meeting.2
Meetings can be “open” or “closed”―that is, anyone can attend an open meeting, but attendance at closed meetings is limited to people who want to stop drinking or using drugs.2,3 Although meeting formats vary somewhat, most 12-Step meetings have an opening and a closing that are the same at every meeting, such as a 12-Step reading or prayer. The main part of the meeting usually consists of
- members sharing their stories of dependence, its effect on their lives, and what they are doing to stay abstinent,1,2,5 (2) the study of a particular step or other doctrine of the group, or (3) a guest speaker.5
Twelve-Step groups are not necessarily for everyone. Some people are uncomfortable with the spiritual emphasis and prefer a more secular approach.1,6,7 Others may not agree with the 12-Step philosophy that addiction is a chronic disease, thinking that this belief can be a self-fulfilling prophesy that weakens the ability to remain abstinent.1,7 Still others may prefer gender- specific groups.7,8
Mutual support groups that are not based on the 12-Step model typically do not advocate sponsors or lifetime membership. These support groups offer an alternative to traditional 12-Step groups, but the availability of in-person meetings is more limited than that of 12-Step programs (see individual group descriptions below). However, many offer literature, discussion boards, and online meetings.
Women for Sobriety (WFS)
WFS is the first national self-help group solely for women wishing to stop using alcohol and drugs. The program is based on Thirteen Statements that encourage emotional and spiritual growth, with abstinence as the only acceptable goal.1,8,9 Although daily meditation is encouraged, WFS does not otherwise emphasize God or a higher power.1,9 The nearly 300 meetings held weekly are led by experienced, abstinent WFS members and follow a structured format, which includes reading the Thirteen Statements, an introduction of members, and a moderated discussion.
SMART Recovery helps individuals become free from dependence on any substance. Dependence is viewed as a learned behavior that can be modified using cognitive-behavioral approaches. Its four principles are to (1) enhance and maintain motivation to abstain, (2) cope with urges, (3) manage thoughts, feelings, and behaviors, and (4) balance momentary and enduring satisfactions. At the approximately 300 weekly group meetings held worldwide, attendees discuss personal experiences and real-world applications of these SMART Recovery principles. SMART Recovery has online meetings and a message board discussion group on its web site.10
Secular Organization for Sobriety/Save Our Selves (SOS)
SOS considers recovery from alcohol and drugs an individual responsibility separate from spirituality and emphasizes a cognitive approach to maintaining lifelong abstinence.1,11 Meetings typically begin with a reading of the SOS Guidelines for Sobriety and introductions, followed by an open discussion of a topic deemed appropriate by the members.12 However, because each of the approximately 500 SOS groups is autonomous,13 the meeting format may differ from group to group. SOS also has online support groups, such as the SOS International E-Support Group (https://groups.yahoo.com/neo/groups/%20sossaveourselves/info) and the SOS Women E- Support Group (https://groups.yahoo.com/neo/groups/SOSWomen/info).13
LifeRing Secular Recovery
Originally part of SOS, LifeRing is now a separate organization for people who want to stop using alcohol and drugs. The principles of LifeRing are sobriety, secularity, and self-help. LifeRing encourages participants to develop a unique path to abstinence according to their needs and to use the group meetings to facilitate their personal recovery plan.14 LifeRing meetings are relatively unstructured; attendees discuss what has happened to them in the past week, but some meetings focus on helping members create a personal recovery plan. Although there are fewer than 100 meetings worldwide, LifeRing has a chat room, e-mail lists, and an online forum that provide additional support to its members.14
Mutual Support Groups
For People Who Have a Substance Use Disorder
- Alcoholics Anonymous: http://www.aa.org
- Chemically Dependent Anonymous: http://www.cdaweb.org
- Cocaine Anonymous: https://ca.org
- Crystal Meth Anonymous: http://crystalmeth.org
- Heroin Anonymous: http://heroinanonymous.org
- LifeRing Secular Recovery: http://lifering.org
- Marijuana Anonymous: https://marijuana-anonymous.org
- Narcotics Anonymous: http://www.na.org
- Secular Organizations for Sobriety/Save Our Selves: http://www.sossobriety.org
- SMART Recovery: http://www.smartrecovery.org
- Women for Sobriety: http://www.womenforsobriety.org
For People With Co-Occurring Disorders
- Dual Recovery Anonymous: http://www.draonline.org
For Families, Friends, and Significant Others
- Al-Anon/Alateen: http://www.al-anon.org
- Co-Anon: http://www.co-anon.org
- Families Anonymous: http://www.familiesanonymous.org
- Nar-Anon: http://www.nar-anon.org
The Effectiveness of Mutual Support Groups
Research on mutual support groups indicates that active participation in any type of mutual support group significantly increases the likelihood of maintaining abstinence.6 Previous research has shown that participating in 12-Step1,15,16,17,18 or other mutual support groups15,19,20,21 is related to abstinence from alcohol and drug use. An important finding is that these abstinence rates increase with greater group participation.15,22,23 Persons who attend mutual support groups have also been found to have lower levels of alcohol- and drug-related problems.21,24
Another benefit of mutual support group participation is that “helping helps the helper.” Helping others by sharing experiences and providing support increases involvement in 12-Step groups, which in turn increases abstinence18,25 and lowers binge drinking rates among those who have not achieved abstinence.18
Notes1. Humphreys, K. (2004).Circles of recovery: Self-help organizations for addictions . London: Cambridge University
2. Alcoholics Anonymous World Services. (n.d.). Alcoholics Anonymous World Services Web Retrieved November 16, 2007, from http://www.aa.org
3. Narcotics Anonymous World Services. (n.d.). Narcotics Anonymous World Services Web Retrieved November 16, 2007, from http://www.na.org
4. Schulz, J. E. (2003). Twelve Step programs and other recovery-oriented interventions. In A. Graham, T. K. Schultz, M. F. Mayo-Smith, R. K. Ries, & B. B. Wilford (Eds.), Principles of addiction medicine, Third Edition (pp. 941−954). Chevy Chase, MD: American Society of Addiction Medicine, Inc.
5. Garrett, F. (n.d.). Your first AA meeting: An unofficial guide for the perplexed. Retrieved November 16, 2007, from http://www.bma-wellness.com/papers/First_AA_Meetinghtml
6. Atkins, R. G., & Hawdon, J. E. (2007). Religiosity and participation in mutual-aid support groups for addiction. Journal of Substance Abuse Treatment, 33(3), 321−331.
7. Kitchin, H. A. (2002). Alcoholics Anonymous discourse and members’ resistance in a virtual community: Exploring tensions between theory and practice. Contemporary Drug Problems, 29, 749−778.
8. Kaskutas, L. A. (1994). What do women get out of self-help? Their reasons for attending Women for Sobriety and Alcoholics Anonymous. Journal of Substance Abuse Treatment, 11(3), 185−195.
9. Women for Sobriety. (n.d.). Women for Sobriety Web Retrieved November 16, 2007, from http://www. womenforsobriety.org
10. SMART Recovery. (n.d.). Frequently asked questions about SMART Recovery®. Retrieved November 16, 2007, from http://www.smartrecovery.org/resources/faqhtm
11. Secular Organizations for Sobriety/Save Our Selves. (2000). An overview of SOS: A self-empowerment approach to recovery. Hollywood, CA:
12. Secular Organizations for Sobriety/Save Our Selves. (2000). SOS guidebook for group leaders. Hollywood, CA:
13. Secular Organizations for Sobriety/Save Our Selves. (n.d.). Secular Organizations for Sobriety/Save Our Selves Web Retrieved November 28, 2007, from http://www.sossobriety.org
14. LifeRing. (n.d.). Welcome to LifeRing: LifeRing in a nutshell. Oakland, CA: LifeRing Service Center.
15. Kelly, J. F., Stout, R., Zywiak, , & Schneider, R. (2006). A 3-year study of addiction mutual-help group participation following intensive outpatient treatment. Alcoholism: Clinical and Experimental Research, 30(8), 1381−1392.
16. Laudet, A. B., Cleland, C. M., Magura, S., Vogel, H. S., & Knight, E. L. (2004). Social support mediates the effects of dual- focus mutual aid groups on abstinence from substance use. American Journal of Community Psychology, 34(3/4), 175−185.
17. Witbrodt, J., & Kaskutas, L. A. (2005). Does diagnosis matter? Differential effects of 12-Step participation and social networks on abstinence. American Journal of Drug and Alcohol Abuse, 31(4), 685−707.
18. Zemore, S. E., Kaskutas, L. A., & Ammon, L. N. (2004). In 12-Step groups, helping helps the helper. Addiction, 99(8), 1015−1023.
19. Connors, G. J., & Dermen, K. H. (1996). Characteristics of participants in secular organizations for sobriety (SOS). American Journal of Drug and Alcohol Abuse, 22(2), 281–295.
20. Kaskutas, L. A. (1996). A road less traveled: Choosing the “Women for Sobriety” program. Journal of Drug Issues, 26(1), 77−94.
21. Humphreys, K., & Moos, R. H. (2007). Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: Two-year clinical and utilization outcomes. Alcoholism: Clinical and Experimental Research, 31(1), 64−68.