(see Poster Gallery) Mutual-Help Group Participation for Substance Use Problems in the US: Correlates and Trends from 2002-2018

Background and Purpose: Mutual-help groups (MHGs) are an integral component of the substance use disorder (SUD) treatment system in the U.S., and growing evidence suggests that they are effective and cost-effective for SUD-related problems. However, not much is known about the MHG participation patterns in the U.S. Using data from a nationally representative survey, the present study aimed to examine the prevalence and psycho-social-behavioral correlates of MHG participation of US adults with SUD.

Method: Using the National Survey on Drug Use and Health (NSDUH) data, we estimated the annual participation rates and examined the psycho-social-behavioral correlates of MHG participation using logistic regression. This study utilized the combined 2002−2018 NSDUH data to present the trends of MHG participation for substance use recovery support since 2002. For estimating prevalence rates of MHG participation in sociodemographic subgroups and testing psycho-social-behavioral correlates, our analytic sample included 17,777 adults who were interviewed between 2015 and 2018 and reported past-year SUD. Focusing on years 2015−2018 was intended to provide the most up-to-date information on MHG participants and to use comparable measures since a major survey redesign of the NSDUH took place in 2015.

Results: Among US adults reporting a past-year SUD, 4.8−7.4% of men and 4.4−6.7% of women participated in MHGs for recovery from substance use problems between 2002 and 2018. No significant linear trends of MHG participation were found. Adults with SUD who were middle-aged (26-34 or 35-64; reference group: 18-25), had lower education (less than college; reference group: college or higher), reported an annual household income of <$20,000 or $20,000-$39,999 (reference group: $75,000+), or were unemployed or not in the labor force (reference group: employed) were more likely to report MHG participation. Additionally, those who identified as Black (reference group: White) or had lower English proficiency (not well/not at all; reference group: very well/well) were less likely to report MHG participation. In terms of the psycho-social-behavioral correlates of MHG participation, higher odds of MHG participation were significantly associated with major depressive episodes, serious psychological distress, theft, violent attack, drug selling, arrest/booking, and drug arrest/booking. Correlates showing the strongest associations with MHG participation were drug-related arrest, arrest, theft, and drug selling.

Conclusions and Implications: MHGs continue to be an integral de facto component of the substance use treatment system in the US, with participation rates remaining relatively stable over the past two decades. Perhaps because MHGs are a free and easily accessible recovery support option, they were attended more by individuals with lower SES (lower education, lower income, and unemployed or not in the labor force). However, we did not find a significant difference in MHG participation between insured and uninsured individuals with SUD. In addition, while this study did not find gender gaps in MHG participation, participation disparities were found among young adults, Black Americans, and less acculturated adults with SUD, indicating a need to improve the engagement efforts with these populations.