A meta-review of the evidence on addiction recovery mutual help organizations

Mutual help organizations (MHOs) for alcohol and substance use disorders are peer-based programs offering recovery-specific social support. A wide-ranging, diverse body of published MHO literature examines their clinical and public health utility. We conducted a meta-review ("overview of reviews") to synthesize this evidence and identify trends, limitations, and gaps across existing syntheses.

We searched five electronic databases (August 2023) using tailored search strings to identify reviews of MHOs. We coded review characteristics and quality ratings (A Measurement Tool to Assess Systematic Reviews 2) in duplicate and quantified overlap of primary studies [corrected covered area (CCA)].

Twenty-five reviews (one scoping, 15 systematic, and 9 meta-analyses) were included, encompassing 163 111 participants and 645 unique primary studies, with minimal overlap (CCA = 1.76%). Overall methodological quality was mixed. Most reviews focused on 12-step MHOs/12-step facilitation (20; 80%), particularly Alcoholics Anonymous (13; 52%). Few focused on adolescents (2), individuals with co-occurring disorders (3), or Indigenous populations (1). Over half (56%) did not report race/ethnicity; those that did reported ranges from 0% to 81% White (M = 58.4%). Sex/gender was reported in 48% (M = 71.5% male). All meta-analyses examined alcohol and/or other substance use outcomes; some also assessed related outcomes, e.g. social connection, physical/mental health, education/employment, criminal justice involvement, and cost-effectiveness/healthcare utilization.

Despite numerous reviews, the synthesis literature is limited in methodological rigor, with a narrow focus on 12-step MHOs. Reporting of outcomes and demographic data is inconsistent, but improves over time. Given variation in individuals' recovery pathways, future syntheses should examine newer, non-12-step MHOs, distinct populations, and outcomes beyond alcohol/substance use behaviors.