Outcomes of 12-Step Involvement Among Sexual and Gender Minority Individuals

BACKGROUND/PURPOSE:

Sexual and gender minorities (e.g., gay, lesbian, bisexual, transgender individuals; SGM) are more likely than heterosexual and cisgender individuals to experience symptoms of alcohol and other substance use disorders. Among the general population, 12-Step programs are the most common source of support for substance-related problems in the United States. Past research has found that sexual minorities may be more likely than heterosexuals to become involved with 12-Step programs, even after controlling for increased rates of substance use disorders among SGM; however, past research also suggests that SGM may experience barriers to effective 12-Step involvement due to concerns about homophobia/transphobia and tensions with religious program content. No known research has examined the substance use outcomes of SGM participating in 12-Step programs. This study aims to determine if higher levels of 12-Step involvement predict lower severity of substance use problems among SGM.

METHODS:

A national sample of 1,150 SGM endorsing having ever had a problem with alcohol or another drug participated in an online survey in 2021 through The PRIDE Study. Respondents self-reported demographics, severity of lifetime and past year alcohol and other substance use problems, and levels of lifetime 12-Step program involvement. Multiple regression was utilized to determine if higher levels of lifetime 12-Step involvement predict lower severity of past year substance use problems for SGM, controlling for lifetime severity of substance use problems and demographic characteristics. Alcohol and other substance use outcomes were modeled separately.

RESULTS:

Overall, 81% (n=933) of respondents endorsed a lifetime problem with alcohol, 50% (n=574) endorsed a lifetime problem with another substance, and 21% (n=242) endorsed lifetime 12-Step involvement. Higher levels of 12-Step involvement predicted lower past year alcohol (β=-0.532; SE=0.057, p<0.001; Cohen’s d=0.69) and other substance (β=-0.356; SE=0.078, p<0.001; Cohen’s d=0.49) use problem severity, controlling for lifetime alcohol and other substance use problem severity and demographic characteristics.

CONCLUSIONS/IMPLICATIONS:

This study fills an important gap by being the first national, quantitative study to examine substance use outcomes of 12-Step participation for SGM. The finding that higher levels of 12-Step involvement predict lower levels of past year alcohol and other substance use problem severity, even after controlling for lifetime alcohol and other substance use problem severity, suggests that 12-Step programs may be an effective resource for SGM. Given the pervasiveness of 12-Step programs and the high rates of substance use disorders among SGM, knowledge of outcomes of 12-Step programs is critical for supporting members of the SGM community struggling with substance use in making informed decisions about service utilization. This study is limited by its use of cross-sectional, self-reported data, which limits the potential for causal inference; future research should investigate substance use outcomes of 12-Step participation among SGM employing experimental and quasi-experimental designs that include active control conditions, facilitating the comparison of outcomes of 12-Step programs and other substance use interventions for SGM populations. Future research should identify which subpopulations of SGM are most likely to benefit from 12-Step participation and strategies that practitioners can employ to facilitate effective 12-Step involvement among their SGM clients.