Updates

Updates

William L. White is a prolific writer who has written or co-written 18 books and hundreds of articles, research reports and book chapters on addiction and recovery. In a February 2016 post on his website, he and Dr. John Kelly, Associate Professor of Psychiatry in Addiction Medicine at Harvard Medical School, take a look at a style of recovery not often examined despite its potential to add important information to the recovery conversation.

In the post, White and Kelly review the existing data on those who use a ‘disengaged style’ of recovery. This term refers to those who attend 12-Step or other mutual aid meetings in the initial phase of their recovery from alcohol use disorder (AUD), but eventually disengage from attending meetings even as they continue sustained recovery.

White and Kelly quote Alcoholics Anonymous (AA) co-founder Bill Wilson, who stated in 1969 that in addition to the active members of AA, there are hundreds of thousands of “recovered AA’s on the sidelines who do not get caught up in the active statistics, people who have remained for the greater part sober, who are carrying AA attitudes and practices and philosophies into the community life.” White and Kelly say this illustrates that there are a number of individuals who successfully use the ‘disengaged’ or ‘positive disengagement’ style of recovery to maintain AUD remission.

A 2005 study examining AA involvement after treatment for alcoholism found that for those who were heavily involved in AA in their early recovery years, but whose attendance at AA meetings had dropped drastically five years later, the rate of abstinence was 79% at one year follow-up and about 60% at year three and year five follow-up. This suggests that while there may be some risk to disengaging from a mutual recovery group, there is also a high level of abstinence even after disengagement. The research team concluded, “…contrary to AA lore, many who connect only for a while do well afterwards.”

Another 2005 study which looked for similar effects in Narcotics Anonymous, Cocaine Anonymous, and other 12-Step groups, found that for a group of people who did not regularly attend 12-Step meetings but who did participate in related activities, such as sponsorship contact and reading literature from the 12-Step programs, their recovery outcomes were similar to those of people who regularly attended 12-Step meetings. The results of this study suggest that active 12-Step participation was more important than meeting attendance.

White and Kelly note the lack of studies on long-term outcomes and sustainability of recovery for those with a disengaged recovery style but draw some preliminary conclusions from the scant data that has been collected on this topic:

  • Reducing or discontinuing attendance at mutual aid meetings over time does not necessary lead to total withdrawal from all affiliated activities and support. Studies such as those outlined above have shown that those with “positive disengagement” – who start their recovery through participation in AA and similar groups and eventually disengage from meetings – may still utilize other parts of mutual aid programs to successfully maintain their recovery (such as using program concepts and principles to help guide daily decision-making, daily recovery-focused centering rituals, reading program literature, having a recovery mentor, helping others).
  • Since it is unclear how many people follow this path in their recovery, and what makes it successful for some and not for others, additional research on this population is needed. Further studying those who choose a disengaged style of recovery could help determine the importance of attending meetings versus the impact of integrating the philosophy and tools of a mutual aid group into a person’s recovery.
  • Meetings, whether continually utilized by an individual or not, remain an important part of recovery. Not only do they offer ongoing support to those who desire it, but those who are committed to participating in meetings assure the continuation of the survival of mutual aid organizations, ensuring that they will exist for future generations in need of help.

White and Kelly point out that while formal studies are scarce which examine the various ways people choose to begin, and then maintain, their recovery and their impact on long-term sobriety, there is a large body of collected data that could be tapped into to further investigate this area. They also suggest avenues for further research going forward.

The authors conclude, “As a field, we have been so obsessed with mapping pathways into substance use disorders that we have neglected the comparable and inestimable value of mapping the pathways through which such disorders are successfully resolved or self-managed over the life course. As long-tenured researchers in this area, we continue to be awed by the diversity of such pathways and styles of recovery and their variability over time.”