Shiori Tsutsumi1, Christine Timko2, Sarah E Zemore3. 1. Department of Social and Human Sciences, School of Environment and Society, Tokyo Institute of Technology, 2-12-1 Ookayama, Meguro-ku, Tokyo 152-8552, Japan. Electronic address: kato.s.az@m.titech.ac.jp. 2. Department of Veterans Affairs, Health Services Research & Development, 795 Willow Rd., Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA. Electronic address: ctimko@stanford.edu. 3. Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA. Electronic address: szemore@arg.org.
Abstract
BACKGROUND: Mutual-help alternatives for addiction are numerous, and research attests to the benefits of involvement in such alternatives. Yet, virtually nothing is known about affiliation patterns over time among 12-step alternatives. We investigated the patterns, correlates, and outcomes of transitions in affiliation (including changing groups and dropping out) within alternatives for alcohol problems. METHODS: We analyzed data from the Peer ALternatives for Addiction (PAL) Study, a longitudinal study comparing the nature and effectiveness of 12-step groups, WFS, LifeRing, and SMART (N = 647). First, using all data, we compared affiliation patterns over time across 12-step and 12-step alternative members at baseline. Second, analyzing exclusively 12-step alternative members at baseline, we compared baseline characteristics and 6-month outcomes of those who changed and dropped out of (vs. retained) their primary groups at 6 months. RESULTS: While drop-out rates were low, and similar, across groups, members of the alternatives were more likely (vs. 12-step) to change groups at 6 months, and transitioned predominantly to 12-step. Further, among the 12-step alternatives, both changing groups and dropping out was associated with lower group cohesion and satisfaction. Meanwhile, in multivariate analyses of 6-month outcomes, changing (vs. retaining) groups robustly predicted lower cohesion, higher negative affect, and lower quality of life, whereas dropping out was associated with lower odds of alcohol abstinence. CONCLUSIONS: While dropping out is known to be risky, changing groups is more common among the 12-step alternatives, and connotes risk of future problems that may be partially explained by dissatisfaction with the new group (usually 12-step).
BACKGROUND: Mutual-help alternatives for addiction are numerous, and research attests to the benefits of involvement in such alternatives. Yet, virtually nothing is known about affiliation patterns over time among 12-step alternatives. We investigated the patterns, correlates, and outcomes of transitions in affiliation (including changing groups and dropping out) within alternatives for alcohol problems. METHODS: We analyzed data from the Peer ALternatives for Addiction (PAL) Study, a longitudinal study comparing the nature and effectiveness of 12-step groups, WFS, LifeRing, and SMART (N = 647). First, using all data, we compared affiliation patterns over time across 12-step and 12-step alternative members at baseline. Second, analyzing exclusively 12-step alternative members at baseline, we compared baseline characteristics and 6-month outcomes of those who changed and dropped out of (vs. retained) their primary groups at 6 months. RESULTS: While drop-out rates were low, and similar, across groups, members of the alternatives were more likely (vs. 12-step) to change groups at 6 months, and transitioned predominantly to 12-step. Further, among the 12-step alternatives, both changing groups and dropping out was associated with lower group cohesion and satisfaction. Meanwhile, in multivariate analyses of 6-month outcomes, changing (vs. retaining) groups robustly predicted lower cohesion, higher negative affect, and lower quality of life, whereas dropping out was associated with lower odds of alcohol abstinence. CONCLUSIONS: While dropping out is known to be risky, changing groups is more common among the 12-step alternatives, and connotes risk of future problems that may be partially explained by dissatisfaction with the new group (usually 12-step).