By Adam Marion, LCSW, Vice President of Outpatient Services, Pinnacle Treatment Centers
Most people in the U.S. know about social support groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) and their role in the treatment of alcohol and substance use disorders. In the eyes of the general population, social support groups go hand in hand with recovery. So much so, they’re almost synonymous. If you choose someone at random out in the world and ask them what people do when they want to stop drinking or using drugs, they’ll probably say,
“I guess they would go to AA or NA meetings at first. Then if they still can’t quit, they probably need to go to a full-time rehab or something like that.”
And, for the most part, they’re correct: that’s the way it works. People who struggle with alcohol or substance use disorders often have their first experience with recovery as a guest at an AA or NA meeting.
They may have a lightbulb moment and seek additional professional support, they may find that AA/NA is sufficient support and continue their recovery journey there, or they may dislike the environment, leave, and never come back.
Others encounter social support groups for the first time while they’re in a residential, partial hospitalization, or intensive outpatient program. The 12-Step approach, invented by AA and adapted by NA, has long been accepted by the addiction treatment community as an effective component in the treatment and recovery process, and most treatment centers, including Pinnacle’s eight residential centers, use 12-step programs or elements of the 12-steps in their programs.
While the 12-Step approach is the most well-known and widely accepted mode of social support for alcohol and substance use disorders, it’s not the only one. Over the past 20 years, non-12-step programs like SMART Recovery and Refuge Recovery have developed alternate, yet equally viable, social support programs for people in recovery.
Let’s back up, though, and answer an important question:
What, exactly, is recovery?
Defining Recovery: Ask Betty
We’re talking about Betty Ford, of course, of the Hazelden Betty Ford Foundation, the de facto matriarch of alcohol and substance abuse treatment and recovery in the U.S. It’s vital to define what recovery means, because at the moment, in the context of the opioid crisis, there’s a serious debate raging about Medication-Assisted Treatment (MAT) and whether an individual using medication such as methadone or buprenorphine is really in recovery or simply exchanging one addiction for another.
We’re not going to dive into the minutiae of that discussion here – that’s a subject for another post, entirely. We will, however, offer the Betty Ford definition of recovery, then discuss the three aspects of recovery defined as essential by the Betty Ford Consensus Panel on Recovery: functional recovery, personal recovery, and social recovery. Once we present that information, you can decide for yourself whether you think people in MAT programs are in recovery.
First, the definition. The Ford Panel defines recovery as:
“…a voluntary maintained lifestyle characterized by sobriety, personal health, and citizenship.”
They go on to clarify what sobriety means in the context of recovery:
“Although sobriety is considered to be necessary for recovery, it is not considered as sufficient. Recovery is recognized universally as being multidimensional, involving more than simply the elimination of substance use.”
Now, for a definition of functional recovery, personal recovery, and social recovery:
- Functional Recovery means the remission of symptoms of an alcohol or substance use disorder.
- Personal Recovery means getting a job and coping with daily life demands.
- Social Recovery means developing strong and supportive social networks.
We said we’d let you decide on the MAT question, but we can’t help ourselves: we’re going to weigh in. From where we sit, the multidimensional aspect of recovery – including functional recovery, personal recovery, and social recovery – renders moot the question of whether an individual in a MAT program is technically sober or not. If an individual achieves functional, personal, and social recovery, then we consider that person to be in recovery, and for all practical purposes, we’d also consider that person to be living a sober life.
With that said, we’ll move on to the subject at hand: the social aspect of recovery.
What is Social Support and Why Does it Work?
Decades of data show that social support programs like AA, NA, SMART Recovery, and Refuge Recovery dramatically increase the likelihood an individual will maintain long-term, sustainable recovery and sobriety.
In the article “Outcome Research on 12-Step and Other Self-Help Programs,” published by the American Psychiatric Press in 2008, researchers identified four key ingredients that explain what makes social support programs effective.
Social supports provide:
- Goal direction and structure. One of the primary things a social support group offers – both for those who enter and complete formal treatment and those who don’t – is a clear framework within which an individual can pursue their main objective: recovery. For people who’ve been in rehab, social support groups create a connection to and continuation of the work they did while in treatment, as well as an opportunity to consolidate and add to the positive gains they made. For people who’ve never been in rehab, social support groups might be the sum total of structured recovery they experience. It’s where they learn the language of recovery, meet recovery peers, and learn the coping skills they need to manage their lives without alcohol or drugs.
- Recovery-oriented social activities. When people with addiction problems quit drinking or doing drugs, they learn quickly they need to find new ways to spend their time. Drinkers hang out in bars, marijuana users hang out with other marijuana users – but what do people in recovery do? Social support groups organize activities and outings that answer that question. They encourage members of their community to get out in the world. They show them how to socialize, interact, and have fun without intoxicants – things that many people who struggle with addiction have often forgotten how to do.
- Recovery-oriented role models. In order to change their behavior, people need to see examples of what that change looks like. For people in recovery, that means they need to see, hear, and interact with other people in recovery – preferably those with some recovery success who are a little further down the road than they are. Social support groups create daily situations in which those new to recovery can spend time with those experienced in recovery. Sometimes those more experienced individuals become sponsors – the AA/NA version of a mentor – and play a formal role in the recovery journey of the novice, helping them manage the ups and downs of sobriety. These peer relationships form the core of a social support network and often become lifelong friendships. For many people in recovery, a robust recovery peer group is what stands between them and relapse. When they’re having a bad day and their coping skills are wearing thin, a real conversation with a recovery peer or sponsor can get them through the day and back on track.
- A place to improve coping skills and build self-confidence. The give-and-take between members of a social support group helps people in recovery on many levels. Practically speaking, support meetings are places where people can learn new coping skills, stress management tactics, and pick up helpful tips for managing triggers. On a personal level, support groups give people in recovery access to a social group with shared goals and values. This experience contributes to a sense of belonging, fosters a sense of shared purpose, and ultimately, increases self-belief, self-confidence, and self-esteem.
Be Early and Be Consistent
We have three more points to make about the role of social support groups in recovery from alcohol and substance use disorders. First, we want people in recovery to know they don’t have to become incredibly social people if they’re not all that social in the first place: evidence shows that adding just one non-drinking or drug-free friend can increase the likelihood of treatment success.
Second, research conducted at Harvard University shows that attending social support groups in the first three months after treatment is associated with more successful recovery in the year following treatment.
Finally, additional research shows that people who attend social support meetings once a week or more tend to be have greater success in recovery than people who attend infrequently or do not attend support group meetings at all.
The takeaway from all of this information about social support groups is straightforward: if you’re in recovery, participating in social support groups increases your chances at long-term, sustainable sobriety.
If the 12-step model doesn’t work for you, that’s okay. You can try SMART Recovery or Refuge Recovery. Both offer the social and community benefits of AA and NA, but without the 12 steps and from a slightly different spiritual perspective. The point here – especially if you’re just beginning your recovery journey – is not what program you choose. The point is simply that you choose a program and participate. Start soon, attend consistently over time, and you’ll experience the benefits of a social network that supports you in your efforts to live a life free of alcohol and drugs.
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