Although 12 Step groups are still the most numerous and popular method of self-help recovery, there are many individuals who may be put off it, for a number of different reasons. Some find the emphasis on spirituality difficult, others prefer a more clinical and scientific approach.

Some women have found male majority in many 12 step groups also quite tricky. In the light of this, many other forms of self-help groups have emerged, including SMART recovery, Lifering ( secular recovery ) and Women for Sobriety.

Being a member of AA has long been associated with the better recovery outcomes. In a 2014 National Institute of Health-funded study this was clearly demonstrated:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558837/#!po=36.5385
Interestingly, one of their observations was that “Consistent with prior work (6–8,15,16,62), results showed direct effects of meeting attendance and AAH ( AA related Helping ) on greater abstinence across time, but not a differential benefit of TSF” ( Twelve Step Facilitated counselling ).

What this would appear to imply is that introducing people to AA meetings was helpful but explaining the 12 steps as a counsellor in a clinic, appears to have little benefit. This has big implications for clinics and counsellors who focus their work in this way.

Until now, there has been no formal evidence of the comparative effectiveness of alternative groups.
The Public Health Institute in America has just published a research paper in the Journal of Substance Abuse Treatment which does just this:
http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(17)30490-7/abstract
They have been able to report that all the groups were equally effective when the goal of abstinence was the same.

What this implies for us clinically is that if someone has a block to the 12 steps, we will help them best if we introduce them to other recovery groups where they might identify more easily.

It is also interesting to note that SMART recovery had a lower abstinence rate when you factor in people’s motivation for abstinence.Looking more closely at this, I wonder if it has something to do with a valuable core therapy module contained in SMART known as Motivational Enhancement Therapy.

It holds that more people can be helped if you engage with them at all levels of motivation. If people are immediately put off any form of engagement, there is no way to influence them. MET is then used to help them move gradually towards greater motivation for total abstinence but it doesn’t start off from there.

I think sometimes professionals mistake this apparent lack of insistence on abstinence as a lack of an abstinent goal whereas it is much more about *how* they help people get there. MET, on its own, has a fantastic track record of effectiveness. The largest ever psychological study tested MET CBT and Twelve Step Facilitation, head to head.

( Project MATCH ) Each had broadly similarly good results but, in line with their methodology, there were only half as many MET sessions delivered as in the CBT or TSF groups. I know I’m drifting off here onto something of a side note, but if you are interested in learning more about how MET works then there is an excellent publication which explains the skills that were taught and used in project MATCH which you can read here: https://pubs.niaaa.nih.gov/publications/projectmatch/match02.pdf

In summary, these two recent NIH studies would seem to imply that clinics and clinicians need to do more than just explain the 12 steps to their clients. It’s more valuable to help clients develop a desire to have a lifetime goal to remain abstinent ( increases recovery chances 5x ) and to find any support group they feel comfortable in, to help achieve this goal.