Sexual and gender minority individuals (e.g., gay, lesbian, bisexual, transgender individuals; SGMI) 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 (e.g., Alcoholics Anonymous) are the most common source of support for substance use problems in the United States. Small, qualitative studies suggest that SGMI experience barriers to involvement in 12-Step programs due to experiences of heterosexism, cis-sexism, and religious trauma. Despite this, sexual minority individuals are no less likely than heterosexual individuals to initiate involvement in 12-Step programs (no known data has examined rates of 12-Step participation among transgender individuals). SMART Recovery, a cognitive-behavioral mutual help program for addictive behaviors, has been posited as a promising alternative to 12-Step programs for SGMI, but no known research has examined the experiences of SGMI in SMART Recovery. This study aims to compare the experiences of SGMI in 12-Step programs and SMART Recovery.
A national sample of 1,730 SGMI endorsing a lifetime history of problems with alcohol or another substance participated in an online survey in 2021 through The PRIDE Study. Respondents self-reported demographic information and lifetime 12-Step and SMART Recovery participation; they also responded to open-ended prompts about their experiences in each program. Thematic analysis was used to determine what participants liked and disliked about their experiences in 12-Step programs and SMART Recovery; responses were then compared across the two programs.
Overall, 20.7% (n=358) of participants had participated in 12-Step programs, 3.5% (n=60) in SMART Recovery, and 3.2% (n=55) in both programs. Participants in 12-Step programs described community, including connection to the LGBTQ+ community, and availability of meetings as the most valuable aspects of the program. Many participants described the religious content and the rigidity of the program as primary barriers to engagement. Participants in SMART commonly reported attending SMART because of challenges with 12-Step programs. In contrast to 12-Step programs, participants in SMART appreciated the secular nature and flexibility of the program as well as the program’s focus on evidence-based tools. However, participants expressed that SMART meetings are often unavailable, and the SMART community, including its extremely limited LGBTQ+ community-specific spaces, is less active and impactful than in 12-Step programs.
12-Step programs serve as the predominant mutual help resource for SGMI experiencing challenges with substance use; however, a small proportion of SGMI participants participate in SMART Recovery, often after rejecting 12-Step programs. Though participants expressed benefits and drawbacks of both programs, these experiences with eachs were distinct and often opposite, with 12-Step programs offering a widely available resource and robust community and SMART offering a rich set of tools and flexible program. These findings highlight the importance of expanding the availability of SMART Recovery and suggest that both programs may be a promising referral option for SGMI experiencing challenges with substance use. Practitioners should assess client preferences for services and make referral recommendations aligned with preferences for community engagement, tools, flexibility, secular versus spiritual approaches, and program availability.