This expert consensus statement reviews evidence on the effectiveness of drug and alcohol self-help groups and presents potential implications for clinicians, treatment program managers and policymakers. Because longitudinal studies associate self-help group involvement with reduced substance use, improved psychosocial functioning, and lessened health care costs, there are humane and practical reasons to develop self-help group supportive policies. Policies described here that could be implemented by clinicians and program managers include making greater use of empirically-validated self-help group referral methods in both specialty and non-specialty treatment settings and developing a menu of locally available self-help group options that are responsive to client’s needs, preferences, and cultural background. The workgroup also offered possible self-help supportive policy options (e.g., supporting self-help clearinghouses) for state and federal decision makers. Implementing such policies could strengthen alcohol and drug self-help organizations, and thereby enhance the national response to the serious public health problem of substance abuse.
Self-help organizations are an important resource for addressing substance abuse, a serious public health problem that contributes to 500,000 deaths and over $400 billion in economic costs in the United States each year (Horgan, Skwara, Strickler, 2001). This white paper summarizes key research findings on addiction-related self-help groups and assesses their implications for direct service providers, treatment programs, state agencies and policymakers. This paper is drawn primarily from the conclusions of a workgroup of national experts on substance abuse self-help organizations that met November 6–7, 2001, in Washington, D.C. The information from the workgroup was supplemented by review of scientific publications, and by the comments of workgroup participants, observers, self-help group members, and other stakeholders on earlier drafts of this report.
1.1. Terminology
Addiction and addiction-related refer to all substance-related problems, including dependence on alcohol, illicit drugs, or nicotine, as well as being in a close relationship with a person who has such problems (e.g., a spouse or parent). Self-help group/organization refers to non-professional, peer-operated organizations devoted to helping individuals who have addiction-related problems. The term “mutual help group” is also sometimes used to reflect the fact that group members give and receive advice, encouragement, and support. Self-help groups do not charge fees and should not be equated with professional treatment services. Twelve-step organization refers to those self-help groups that rely on a particular philosophy of recovery that emphasizes the importance of accepting addiction as a disease that can be arrested but never eliminated, enhancing individual maturity and spiritual growth, minimizing self-centeredness, and providing help to other addicted individuals (e.g., sharing recovery stories in group meetings, sponsoring new members). Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are the best known of the subset of self-help organizations that rely on the 12 steps.
Addiction self-help organizations are a major resource for addicted individuals, as well as for those who treat addicted people, work with them, and care about them. Research to date suggests that self-help groups can be beneficial, but also cautions that we have much more to learn about how they work and how they can be supported through clinical, agency, and policy actions. The strategies presented herein are therefore a set of initial steps and are neither the final word nor a panacea. Yet they do hold significant promise of strengthening addiction self-help groups and thereby helping more individuals recover from drug and alcohol problems.
