Why do some avoid 12-step groups during addiction recovery?

Research shows that substance use disorder (SUD) patients who attend 12-step mutual help groups such as Alcoholics Anonymous experience reduced healthcare costs and better outcomes. However, many individuals with SUD never attend 12-step meetings, while others who attend initially do not follow through. The reasons for non-attendance and dropout of 12-step meetings have not been thoroughly studied. Kelly, Kahler, and Humphreys asked, “Why do individuals stop attending 12-step groups (and why do others refuse to attend meetings in the first place)?” (2009). These researchers suggest that the questions are important because 12-step groups are almost universally recommended as a component of drug rehab, addiction treatment and long-term addiction recovery.

The researchers developed and tested a measure of reasons for non-participation and dropout of 12-step groups among 60 male veterans with a median age of 49 who were undergoing treatment for SUD. The participants completed a brief assessment about their prior experiences with mutual self help groups such as Alcoholics Anonymous. Results indicated that co-morbid psychiatric issues and, to a lesser degree, spiritual concerns were particularly important reasons for non-attendance or dropout.
This study is important because a similar measure could serve as a screening tool to predict non-attendance or dropout of 12-step meetings. In these situations, practitioners might refer individuals to non-12-step mutual help groups such as SMART Recovery.
Twelve-step groups such as Alcoholics Anonymous (AA) revolve around spirituality and faith in a higher power. Individuals who do not believe in a higher power may not feel comfortable attending 12-step mutual help groups, given that belief in a higher power is the foundation of groups such as AA. Attendees at 12-step groups are asked to admit their powerlessness over their SUD, which also may not fit with the individual’s understanding of their own behavior.
SMART Recovery, on the other hand, has a scientific rather than spiritual foundation. Incorporating cognitive behavior therapy and motivational interviewing into self-help group sessions, SMART Recovery focuses on self-reliance in recovery rather than powerlessness. As another important difference, 12-step groups see SUD as a disease, while SMART Recovery participants are free to accept this view of addiction or not. Many SMART Recovery participants view addictive behaviors as a bad habit, or a maladaptive behavior. Regardless of participant beliefs about addiction, SMART Recovery discourages use of the labels “alcoholic” or “addict.”
The study also found that co-morbid psychiatric issues often prevent individuals from attending 12-step groups. Individuals with social anxiety, for instance, may not feel comfortable attending meetings where they are “put in the spotlight” and asked to speak, as is the case at 12-step meetings. One study suggested that SMART Recovery, rooted in cognitive behavioral therapy, may be more effective than 12-step programs for addressing co-morbidity for some individuals (Brooks & Penn, 2003).
The current study by Kelly, Kahler, and Humphreys was limited to 60 veterans with a median age of 49. Future studies that examine other demographics might offer different results. For example, a survey of younger individuals might show a higher rate of spiritual concerns as a reason for avoiding 12-step group meetings, because younger people often have less developed interest in spirituality. Further research may assist clinicians in suggesting mutual help groups that are more likely to benefit individuals in addiction recovery. However, at present, and perhaps indefinitely, the best approach to choosing a mutual help group for addiction recovery, for individuals willing to consider attending a mutual help group, is for the individual to sample the available groups (either face to face or online) and to continue attending the group or groups which seem most helpful.
References
 
Brooks AJ, Penn PE. Comparing treatments for dual diagnosis: Twelve-step and self-management and recovery training. American Journal of Drug and Alcohol Abuse. 2003; 29(2): 359-383.
Kelly JF, Kahler CW, Humphreys K. Assessing why substance use disorder patients drop out from or refuse to attend 12-step mutual-help groups: The “REASONS” questionnaire. Addiction Research and Theory. 2009, 01 October.