“Aren’t you encouraging people to join a cult?“ somebody asked me at a conference. A lot of my recent research focuses on supporting people in recovery from Substance Use Disorders (SUDs – colloquially known as ‘alcoholism’ or ‘addiction’). Several of my projects in this space have looked at the role of technology in supporting engagement with 12-step groups, like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). I get a lot of flak and questions about this — sometimes researchers from other areas actively encourage me to drop this line of research. Many point to The Atlantic article on the topic of Alcoholics Anonymous, which positions 12-steps programs somewhere between a scam and a cult. I have this conversation so often that I thought I would write a blog post about it answering some of the questions that I frequently get.

[12-Step Programs Are for Recovery Maintenance]. “Are 12-step programs effective treatment for SUDs?” No, 12-step programs are not a medical treatment or a detox plan! However, most people with substance use disorders cannot just detox, spend a month or two in treatment and then expect to stay clean for the rest of their lives. Some sort of a maintenance program is necessary to avoid relapse and 12-steps is one example. Recovery maintenance may last for the rest of a person’s life. While not detox or treatment, 12-step program provide critical social support during and after treatment. Supporting maintenance is a particularly good entry point for technology because most of a recovering person’s program will be spent in this largely self-directed and unguided maintenance stage — scalable solutions are needed. There are many great opportunities for making technology that supports communication with a support network and behavior tracking/change, both of which are active research areas in HCI.

[12-Step Programs Help People Recover]. “Okay, do 12-steps work as a ‘maintenance program’?” Since 12-step programs are NOT treatment, we should not be comparing their effectiveness to treatment, but rather seeing whether people using 12-step programs as maintenance are more likely to stay in recovery than those who are not. It is incredibly difficult to investigate causality here because of cross-over effects (e.g., you can’t do an RCT assigning somebody NOT to go to AA — some people from the control group will still go). However, there are statistical ways of controlling for this. After controlling for crossover, the bottom line is that people who attend more meeting have more days of abstinence. There’s a really good video from Healthcare Triage that goes into the details of one study in this space and it’s findings here:

But, it is not at ALL surprising that a social support group would help people achieve behavior change! Peer support groups are also common for other behavior change, for example Weight Watchers meetings or the step-count competitions hosted by your FitBit app. This is why the NIH includes 12-step facilitation (encouraging people to go to meetings) as an important part of treatment programs. 12-steps are still part of best practice in helping people find a path to recovery.

[12-Step Programs Are Where People Are]. “But, why a 12-step maintenance program, why not something more science-based like SmartRecovery?” It would be so awesome if there were more social support alternatives and maintenance programs available to people in recovery. But there are only six SmartRecovery meetings listed for the entire state of Minnesota — only one in Minneapolis. Compare this to the hundreds of 12-step meetings (e.g., AA, NA) in the Twin Cities area. Working with people in recovery for the last five years, I have found that most people do leverage 12-step programs to some extent. For example, even when trying for a program-agnostic approach in a participatory design study with women in a sober home, many of their idea for supporting their own recovery connected to the practices of 12-step groups such as meeting attendance, service, and sponsorship. As a human-centered technologist, I believe in meeting people where they are. Right now, they are in 12-step groups and I’m not going to ignore that just because the field is also exploring other approaches. The cool thing is that many of the technical opportunities for supporting a variety of programs including 12-Step, SmartRecovery, Lifering, Women in Recovery, etc. are actually quite similar: all need help with grassroots organizing of meetings, helping people find meetings, building a strong support network, and leveraging online resources to offer meetings to more people (e.g., InTheRooms.org hosts all sorts of these meetings on the same site). If we can help solve these general problems, all social support recovery maintenance problems can benefit.

[12-Step Programs Are Grassroots]. “Okay, but even if it works for SOME people, some 12-step meetings are just terrible [insert personal story], how can you be part of that?” If you or your family member had a negative experience, I am really sorry to hear that! Anybody can start a 12-step meeting and each meeting has a different “flavor” based on the personalities of the people that attend. Some people may have a negative experience in a meeting (e.g., hear a very religious take on the program or hear somebody share a negative opinion about medically-assisted recovery) and are then turned off these programs for life! But, these opinions are not inherent parts of 12-step programs or traditions (and in fact, run counter to the principles of 12-step programs as stated in their literature). The mixed feelings that people have about how some 12-step groups run their meetings is exactly WHY we should engage to help people find better options. By providing a larger “marketplace” of available meetings, we can allow people to find groups that work for them. This is why a lot of our work focuses on helping people find new meetings, both in-person and online.

The Atlantic article was written as a response to people saying that AA/NA is the best or the only way to find recovery! That is not what I’m saying at all. Personally, I totally think that the Computer Science community should ALSO explore approaches that focus on preventing SUDs (e.g., VR for reducing perceptions of pain to reduce prescription opioids), harm reduction (e.g., apps for finding needle exchanges, locating nearby people with Naloxone to save somebody who is overdosing), medically-assisted treatment (e.g., data science to better understand effects of MATs), and cognitive behavior therapy approaches (e.g., CBT worksheet apps, thought reframing tools). We should be doing all of these things too (and, in fact my lab is involved in several of these initiative). There is so much work here and so much potential to do good! But, I am not going to brush off and ignore a powerful tool in the toolbox of a recovering person.

So, yes, my lab does not explicitly reject approaches that connect with 12-step groups. I’m not going to stop engaging with 12-step groups until more participants in our studies find alternatives that work for them. I am going to continue to build technology that helps people find recovery, whatever path they choose, without judgement.