Ambivalent attendees: Transitions in group affiliation among those who choose a 12-step alternative for addiction

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.

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.

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.

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).