Beyond Attendance: Social Anxiety and Psychiatric Concerns Predict Mutual-Help Group Involvement in a U.S. National...

Involvement in mutual-help groups (MHGs) is associated with positive alcohol recovery outcomes. Attendance is a first step to involvement, but barriers to attendance remain poorly understood, especially among second-wave (non-12-step) MHGs. This study aimed to describe the most common barriers to MHG attendance, describe variation in barriers across diverse MHG types, and identify attendance barrier domains associated with MHG involvement over a 12-month period.

Data were from the Peer Alternatives (PAL) Study 2021 Cohort, a longitudinal, online survey of second-wave and 12-step MHG participants (n = 531) with follow-ups at 6 and 12 months. Surveys measured MHG attendance barriers (11 items, 3 domains) and MHG involvement (5 items). We used adjusted generalized estimating equations to examine lagged associations between barrier subscale scores and MHG involvement at 6 and 12 months.

Social anxiety and psychiatric concerns were overall more highly endorsed than low motivation/perceived need and dislike of meeting attendees and content in the total sample and for each MHG except LifeRing. The most highly endorsed individual barrier to attendance was "I don't like crowds or large groups." Higher social anxiety and psychiatric concerns domain scores predicted lower MHG involvement at 6- and 12-month follow-ups in adjusted models (beta = -.09, 95% CI [-.18, -.01], p < .01), and this was the only barrier domain associated with MHG involvement.

Social anxiety and psychiatric concerns are salient barriers to attending a variety of MHG groups and to MHG involvement. Efforts to enhance MHG social experiences and the availability of groups for people with psychiatric concerns could improve MHG involvement.