Recovery Ramblings

In 2014 I carried out a detailed review of the evidence for addictions mutual aid, which you can download from that link. Proffessor John F. Kelly, PhD. and William White added supportive commentaries to the document and Proffessor Keith Humphreys blogged supportively about the paper as well.

###Extracts Mutual Aid is the process of giving and receiving non-clinical and non-professional help to achieve long-term recovery from addiction. Mutual Aid groups are composed of people who share the same problem, give and receive support as part of the group, are organised by members, value experiential knowledge and charge no fees. Mutual Aid is usually considered to be a distinct activity from informal peer support and ‘Recovery Community Organisations’.

Although there is an extensive body of research into Mutual Aid, most studies are methodologically weak, typically describing correlations without the ability to infer causation. This has led some commentators to conclude that there is little or no evidence for this form of support. We conclude that this is an out-dated position. The increasing numbers of higher quality studies, along with extensive corroborative research supports more robust conclusions. There is strong evidence that participation in Mutual Aid groups improves recovery outcomes and evidence that greater levels of participation are associated with better outcomes.

There is strong evidence that ‘abstinence supportive’ social networks are critical to recovery and evidence that the ability of Mutual Aid to improve such networks is a key mechanism of effect for these groups. The ability of Mutual Aid to build abstinent social network is an important advantage over treatment services and Mutual Aid is able to confer this benefit for many years after the end of an episode of treatment.

Other key mechanisms of effect are likely to be similar to those for treatment services, such as coping skills, motivation and self-efficacy.

There is strong evidence that treatment services can and should improve engagement of their service users with Mutual Aid and the evidence is consistent with the ‘Facilitating Access to Mutual Aid’ model developed by Public Health England. There are strong grounds to believe that this approach will improve treatment outcomes and save health and treatment costs.

For most people who currently approach treatment services, Mutual Aid is not an effective replacement for treatment and the combination of treatment plus Mutual Aid is likely to be better than either alone.

It is appropriate to be concerned that Mutual Aid might become seen as way to replace necessary professional treatment with a free alternative. This would be misguided, dangerous and do a great disservice to the Mutual Aid organisations.

There is emerging evidence that coerced attendance is counter-productive, leading to worse outcomes than treatment as usual. Policy makers should be cautious about mass coercion through the criminal justice system and keep in mind that such strategies in the USA are driven by a lower availability of treatment rather than evidence of effectiveness.

There is emerging evidence that an increased range of options in Mutual Aid will improve recovery outcomes by enabling a closer match between group ethos and individual values. This evidence is not strong enough to recommend ‘matching’ individuals based on their beliefs. Prominent researchers have wisely argued for the availability of a diverse array of mutual-help options, suggesting that individuals try different groups and find one where they feel most able to be actively involved.

It is highly plausible that the evidence described in this report will generalise to the UK and apply to a range of 12-step and none 12-step Mutual Aid groups. It is plausible that many of these findings will also apply to other forms of peer support and recovery communities. ###Recommendations The following recommendations derive from the analysis of this report; though also borrow from an important working group consensus statement.

1. Treatment services should use robust Mutual Aid group referral methods, such as the FAMA framework produced by Public Health England.
   Treatment services should encourage service users to try different models of Mutual Aid and find what works for them.
   
2. Treatment services should adopt the principle of ‘information parity’, so service users are informed about all the Mutual Aid options available.
   
3. Commissioners and treatment services should expand choice and access to Mutual Aid in the criminal justice system, supported housing and other intervention settings.
4. Commissioners should consider how treatment services can be incentivised to improve service user engagement with Mutual Aid.
5. Commissioners should also consider how to encourage referrals to Mutual Aid in generic health care settings, especially primary care.
6. Commissioners should be discouraged from using Mutual Aid as a replacement for specialist treatment services.
7. Commissioners and treatment services should support opportunities for family members of people struggling with addictions to be involved in Mutual Aid. There are significant deficits in the evidence base. Further research is particularly urgent on the following questions:
8. The effectiveness of FAMA interventions in the UK context.
9. The relative efficacy or appropriateness of structured Mutual Aid Facilitation in the UK context and compared to more simple FAMA interventions.
10. Exploration of matching effects, whether certain client characteristics are associated with better outcomes through different mutual aid programmes.  

Get the full review here. You can freely distribute without further permission.