A Thematic Analysis of LGBTQ Participants' Perspectives on a Cognitive-Behavioral Substance Use Intervention: Lessons from a Feasibility Trial of SMART Recovery

Background: LGBTQ individuals are more likely than their heterosexual and cisgender counterparts to experience alcohol and other substance use disorders. Currently, mutual help groups, such as Alcoholics Anonymous (AA), are the most common source of support for alcohol and other substance-related problems. In recent years, SMART Recovery, a cognitive-behavioral mutual help group for addiction has become an increasingly common addiction support resource, and emerging evidence supports the effectiveness of SMART Recovery among the general population. Though SMART Recovery has been proposed as a promising intervention for LGBTQ individuals, little is known about the needs, experiences, and outcomes of LGBTQ people in SMART Recovery. As an important step in filling these gaps, this study aims to examine LGBTQ SMART Recovery participants’ perspectives on the strengths and limitations of the program in engaging them and addressing their challenges with substance use.

Method: Data was collected through a feasibility trial of online SMART Recovery groups offered for LGBTQ individuals. Following their participation in a 12-session online SMART Recovery program, eleven LGBTQ individuals experiencing challenges with substance use participated in an hour-long interview. The research team used a structured interview guide for data collection; questions focused on experiences of SMART Recovery, the modality, and the LGBTQ-specific composition of the groups. Interviews were conducted via Zoom, recorded, and transcribed. The research team applied a thematic analysis approach to the data, conducting memo-writing and initial coding separately before meeting and mapping themes.

Results: The research team identified three themes characterizing participants’ experiences with the program: Trust, Accessibility, and Community. Participants described a reciprocal trust between themselves and the program, wherein participants reported trusting the program due to its explicitly evidence-based nature and believing that the program trusted participants by fostering self-determination (e.g., encouraging participants to select their own recovery goals (i.e., abstinence vs. moderation) and encouraging participants to determine the components of the program that were most valuable for them). Participants identified a range of ways the program offered accessibility, including the benefits of subtitles and the chat feature for hearing-impaired and neurodivergent participants, connection to a diverse LGBTQ community for participants in rural environments, and overcoming barriers to physically accessing recovery spaces including transportation and chronic health and mobility challenges. Lastly, participants highlighted the importance of engaging with community, particularly LGBTQ community, and expressed a desire for additional opportunities to engage with community.

Conclusions: This study fills an important gap by being the first known study of the perspectives of LGBTQ individuals in SMART Recovery. Overall, participants described trust, accessibility, and community as important elements of their engagement and progress with the program, highlighting a desire for LGBTQ-specific recovery spaces. Future research is necessary to establish estimates of the effectiveness of SMART Recovery for diverse members of the LGBTQ community, considering differences in effectiveness across race/ethnicity, gender identity, sexual orientation, and type and severity of substance use challenge. It may also be valuable to explore how SMART Recovery and other substance use interventions can expand trust, accessibility, and community for LGBTQ individuals.