Selected Papers of William L. White www.williamwhitepapers.com Collected papers, interviews, video presentations, photos, and archival documents on the history of addiction treatment and recovery in America. Citation: Kelly, J. & White, W. (2012) Broadening the base of addiction recovery mutual aid. Journal of Groups in Addiction & Recovery, 7(2-4), 82-101. Posted at www.williamwhitepapers.com Broadening the Base of Addiction Recovery Mutual Aid John F. Kelly, PhD and William L. White, MA Abstract mutual help options. This article presents a concise overview of the Peer-led mutual help organizations origins, size, and state of the science addressing substance use disorder on several of the largest of these (SUD) and related problems have had alternative additional mutual help a long history in the United States. organizations in an attempt to raise The modern epoch of addiction further awareness and help broaden mutual help began in the post- the base of addiction mutual help. prohibition era of the 1930s with the birth of Alcoholics Anonymous (AA). Keywords: Mutual help; mutual aid; self Growing from two members to two help; Alcoholics Anonymous; narcotics million members, AA’s reach and anonymous; SMART recovery; Secular influence has drawn much public organization for Sobriety; Women for health attention as well as Sobriety; Moderation Management. increasingly rigorous scientific investigation into its benefits and 1. Introduction mechanisms. In turn, AA’s growth and success has spurred the At first glance, the notion of development of myriad additional individuals with serious, objectively mutual help organizations. These verifiable, cognitive and social impairments alternatives may confer similar being able to facilitate life-saving changes in benefits to those found in studies of similarly impaired individuals may seem a AA, but have received only peripheral little incongruous; from a derisory attention. Due to the prodigious standpoint, a clear case of “the blind leading economic, social, and medical burden the blind”. It is therefore striking to observe attributable to substance-related that peer led mutual-help organizations problems and the diverse comprised of such individuals have been experiences and preferences of those shown to facilitate the same kinds of salutary attempting to recover from SUD, behavior changes as trained professionals there is potentially immense value in (Humphreys & Moos, 2001; Humphreys & societies’ maintaining and supporting Moos, 2007; Moos & Moos, 2006; Timko, the growth of a diverse array of Moos, Finney, & Lesar, 2000; Timko, williamwhitepapers.com 1 Sempel, & Moos, 2003). A potential reason originating under the auspices of a quasi- for at least some of these mutual help group religious organization known as the Oxford benefits may lie in the humorous quip Group (Alcoholics Anonymous, 1957; frequently expressed within recovery circles, Oxford Group, 1933) and operating at a “We may be sick, but we’re not all sick on the grass-roots community level, AA’s language same day”. and concepts also have profoundly In the addiction field, examples of influenced our professional clinical mutual help organizations have been well approaches to addressing alcohol and other known, even synonymous with addiction drug problems (McElrath, 1997; Roman & recovery for more than 200 years (White, Blum, 1999; White, 1998), and its philosophy 1998). Alcoholics Anonymous (AA) is by far and concepts have imbued our broader the largest and most recognized and its size language and culture (Travis, 2009). and impact have garnered much public AA’s growing influence and purported health and research attention (Emrick, success at facilitating long-term addiction Tonigan, Montgomery, & Little, 1993; Kelly & recovery has garnered increasing public Yeterian, 2012; Tonigan, Toscova, & Miller, health and scientific scrutiny (Ferri, Amato, & 1996). However, many other mutual help Davoli, 2006; Institute of Medicine, 1990; organizations have emerged since AA McCrady & Miller, 1993). In terms of its began, either inspired by, or in opposition to, verifiable impact, hundreds of published it. These AA alternatives have received only studies, many in top scientific journals, have limited attention, but due to their similar supported the beneficial effects of AA in social orientation and group format may helping alleviate alcohol and other drug confer benefits comparable to those of AA. problems. This body of scientific literature Given the diverse experiences and has been summarized in narrative reviews preferences of individuals seeking recovery as well as quantitatively, through rigorous from substance use disorder and the meta-analyses (Emrick, et al., 1993; Ferri, et valuable role that mutual help organizations al., 2006; Humphreys, et al., 2004; have been shown to play, raising the profile Kaskutas, 2009; Kelly, 2003; Kownacki & of a broader array of available mutual help Shadish, 1999; Tonigan, et al., 1996; White, options may enhance the chances of 2009). AA participation is associated with recovery for more people. To this end, the producing and maintaining salutary changes purpose of this article is to describe six of the in alcohol and other drug use that are on par largest addiction recovery mutual help AA with professional interventions while alternatives: SMART Recovery, Secular simultaneously reducing reliance on Organization for Sobriety, Moderation professional services and thus lowering Management, LifeRing, Women for Sobriety, related health care costs (Humphreys & and Celebrate Recovery. We begin by Moos, 2001; Humphreys & Moos, 2007; providing a brief review of the growth and Humphreys, et al., 2004; Kelly & Yeterian, impact of AA followed by a summary of the 2012). Despite some earlier concerns origins, growth, size and reach, and state of regarding AA’s ability to cater effectively to the science on these alternative recovery women, young people, people of color, those mutual help organizations. with co-morbid psychiatric illnesses, and non-religious/spiritual persons, research has 2.1 Alcoholics Anonymous found that AA confers similar benefits to AA experienced an inconspicuous women as men (Del Boca & Mattson, 2001; beginning in Akron, Ohio, amid the post- Kelly, Stout, Zywiak, & Schneider, 2006); to prohibition era of the 1930’s. AA has since young people (Alford, Koehler, & Leonard, grown from two members to more than two 1991; Chi, Kaskutas, Sterling, Campbell, & million members in 2011, and has been Weisner, 2009; Kelly, Brown, Abrantes, adapted and successfully assimilated into a Kahler, & Myers, 2008; Kelly, Dow, Yeterian, variety of cultures globally (Alcoholics & Kahler, 2010; Kelly, Myers, & Brown, Anonymous, 2001; Mäkela, 1996). Despite 2000; Kennedy & Minami, 1993) to many williamwhitepapers.com 2 (e.g., Ouimette, et al., 2001; Timko, Sutkowi, enhance patient outcomes in randomized Cronkite, Makin-Byrd, & Moos, 2011), but controlled investigations (Kahler, Read, not all, persons with psychiatric conditions Ramsey & Brown, 2004; Kaskutas, 2009; (e.g., those with severe social impairments Litt, Kadden, Kabela-Cormier, & Petry, 2009; and/or psychotic spectrum illness Project MATCH Research Group, 1997; (Bogenschutz & Akin, 2000; Kelly, McKellar, Sisson & Mallams, 1981; Timko & & Moos, 2003; Noordsy, Schwab, Fox, & DeBenedetti, 2007; Timko, Debenedetti, & Drake, 1996; Tomasson & Vaglum, 1998); Billow, 2006; Walitzer, Dermen, & Barrick, and to those individuals who are non or less 2009) and, consequently, TSF is now an religious/spiritual (Kelly, et al., 2006; “empirically supported treatment” as defined Winzelberg & Humphreys, 1999). by the American Psychological Association Additional anecdotal concerns have and US federal agencies. centered around AA’s position on potentially With the emergence and increasing helpful medications. In general, surveyed AA availability of illicit substances, addiction to members have been found to be supportive drugs other than alcohol has become more of the use of psychotropic (e.g., anti- prevalent. This led to adaptations of AA’s depressants, anti-psychotics) and relapse formula to address the needs of individuals prevention medications (e.g., naltrexone, addicted to drugs other than alcohol. The acamprosate, disulfiram), although there largest among these is Narcotics may be a vocal minority who oppose it Anonymous founded in 1953, which (Meissen, Powell, Wituk, Girrens, & Arteaga, addresses all substances, but other 12-step 1999; Rychtarik, Connors, Dermen, & based organizations soon emerged focusing Stasiewicz, 2000; Tonigan & Kelly, 2004). on specific substances, such as Potsmokers However, it is unclear whether this Anonymous (1968), Pills Anonymous oppositional minority is specific to AA (1975), Marijuana Anonymous (1989), membership or is a more general facet of Cocaine Anonymous (1982), Nicotine individuals attempting to recover; at least Anonymous (1985), and Crystal Meth one study of alcohol dependent individuals Anonymous (1994). With the increased found that AA participation was unrelated to acknowledgement of the overlap between opposition to the use of medications co-morbid psychiatric disorders and SUD (Tonigan & Kelly, 2004). Given the (e.g., (Regier, Narrow, & Rae, 1990) “dual- importance of this issue, however, AA itself focused” mutual help organizations have has published a pamphlet on this matter in emerged providing support for both sets of which it states that it is plainly wrong to deny problems simultaneously (e.g., Dual any