LGBTQ SMART Recovery Meeting Facilitators' Perspectives on Serving LGBTQ Participants

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 support resource. Though SMART Recovery has been proposed as a promising intervention for LGBTQ individuals and SMART Recovery meetings offered specifically for LGBTQ people have emerged in recent years, little is known about the challenges, goals, and approaches of these groups, particularly as understood by LGBTQ SMART Recovery meeting facilitators. As an important step in filling these gaps, this study aimed to explore the perspectives of facilitators of LGBTQ SMART Recovery meetings about how to best meet the needs of LGBTQ SMART Recovery participants and the support that they need to better serve their LGBTQ participants.

Method: Data was collected through interviews with nine LGBTQ SMART Recovery meeting facilitators. The research team used a structured interview guide for data collection; questions focused on the strengths and limitations of SMART Recovery’s current approaches to supporting LGBTQ participants, modifications that the facilitators make to standard SMART Recovery practices for LGBTQ meetings, and challenges and opportunities for improvement for LGBTQ SMART Recovery meetings. Interviews were conducted via Zoom, recorded, and transcribed. The research team applied a thematic analysis approach to the data, conducting initial coding separately before meeting and mapping themes.

Results: Interviews with facilitators revealed heterogeneous perspectives on how LGBTQ SMART meetings should be tailored to meet the needs of participants, with some facilitators articulating that these issues were outside of the scope of the program and others identifying a myriad of adaptation approaches, including tools targeting LGBTQ identity-specific challenges; discussions about how general mental health challenges that contribute to addictive behaviors (e.g., grief, shame) may be experienced differently by LGBTQ people; incorporation of multi-level understandings of addiction among LGBTQ people. While facilitators noted that LGBTQ SMART meetings were generally well integrated into local LGBTQ-focused institutions due to the efforts of individual facilitators, facilitators highlighted the need for the SMART Recovery program to engage in more intentional community-building efforts with LGBTQ-focused institutions. Facilitators also described the desire for greater institutional support from SMART Recovery for LGBTQ meetings, such as more robust recruitment efforts, official verbiage to describe the underlying rationale and priorities of LGBTQ meetings, guidance on how to best facilitate safety for LGBTQ participants, and regular meetings for facilitators of LGBTQ meetings to share challenges and effective facilitation strategies.

Discussion: This study fills an important gap by being the first known study of the perspectives of facilitators of LGBTQ SMART Recovery meetings. Participants described a variety of approaches for tailoring these meetings to better meet the needs of LGBTQ participants and opportunities for the SMART Recovery program to support their efforts. Future research is necessary to determine the acceptability, feasibility, and effectiveness of the proposed approaches with LGBTQ SMART Recovery participants.