The guide below is aimed at professionals who want to support the development and utilization of mutual support groups.  This guide to utilizing mutual aid groups was developed by Linda and Ernie Kurtz.  Linda Kurtz, D.P.A., is the author of Self-help and Support Groups: A Handbook for Practitioners; Ernest Kurtz, Ph.D., authored Not God: A History of Alcoholics Anonymous and is co-author of The Spirituality of Imperfection.

It is not easy to capture the value of self-help groups through quantitative, empirical studies. But some researchers have partnered with self-help groups to find appropriate methods of evaluation. What follows summarizes the extant research.

Extensive evaluations using before-after measures, comparison groups, and time-series designs, have found that more intense and longer term participation in a wide variety of self-help/mutual-aid groups contributes to better outcomes. These outcomes include reduced psychiatric symptoms, reduced use of professional services, increased coping skills, increased life satisfaction, and shorter hospital stays. Members of health-related groups reported better adjustment, more effective coping skills, higher self- esteem, and improved acceptance of the illness than self-assessments of less active and nonmembers (Kyrouz, Humphreys and Loomis (2002) Kyrouz, Humphreys and Loomis (This article is in Adobe Acrobat. Acrobat Reader can be obtained, free, at Emotions Anonymous.) For specifics, see this study, the results of which are summarized in the next five paragraphs:

1. Patients DISCHARGED FROM A PSYCHIATRIC HOSPITAL who participated in a Community Network Development (CND) Program required one-half as much re-hospitalization, ten months after discharge, as a comparable group of non-participating ex-patients. CND ex-patients also required one-third as many patient days of re-hospitalization (7 vs. 25 days) and a significantly smaller percentage of them needed to continue to attend Community Mental Health Centers and other mental health agencies for services (48% vs 74%).

2. VOLUNTEER LEADERS IN RECOVERY, INC., a self-help group for people who have been treated for mental health problems (half of whom had been hospitalized for mental illness) rate their overall satisfaction with life and health, as well as their satisfaction with work, leisure, and community as high, equivalent to the general public's levels of satisfaction.

3. CHILDREN OF PARENTS WITH DRINKING PROBLEMS who participated in Alateen, a self-help group sponsored by Al-Anon, suffered less emotional and social disturbance than peers who did not belong.

4. Participants in a national self-help group for parents of young drug and alcohol abusers -- (PRIDE - Parent Resources Institute for Drug Education) -- reported that their participation was associated with improvement in their children's DRUG PROBLEM. A majority of the participants also reported improvements in their children's general discipline problems and in adjustment outside the home.

5. Participating in a self-help group for FAMILIES OF PSYCHIATRIC PATIENTS reduced the family's sense of burden. Members found the group helpful because it provided them with information about schizophrenia and coping strategies that professionals did not provide. Participation also helped parents to develop supportive social bonds with others who were experiencing similar problems.

Recent studies by reputable researchers have supported 12-STEP GROUP effectiveness (Project Match Research Group, 1997). A multi-state, rigorous research project funded by the NIAAA contrasted outcomes of three treatment conditions, one of which was 12-Step facilitation. The sole objective of 12- Step facilitation was to connect with and reinforce use of community AA. Findings showed that persons who received this treatment approach were as successful in reaching treatment goals as those who received the two other professional treatments. Another study found that individuals treated in a 12-Step-oriented program have higher levels of engagement with 12-Step programs and 64% lower utilization of professional mental health services than patients treated where there was little emphasis on 12-Step principles and involvement. (Humphreys, K. & Moos, R. (2001). Can encouraging substance abuse patients to participate in self-help group reduce demand for health care? A quasi-experimental study. Alcoholism: Clinical and Experimental Research, 25 [5] (May 2001), 711-716.)

All studies suggest that success in any program correlates with more intense mutual help involvement. Therefore, encourage your client to become as active as possible. A listing of indicators of involvement intensity appears below and can be reached directly from the "Contents" list.

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Encouraging Local Group Development

1. Don't Re-invent the Wheel
Find a national group that already exists and request a starter packet or "how to" guide. Ask nearby group leaders to help.         Attend meetings of that association in other locations to get a feel for how they operate; borrow from their successful techniques.

2. Find a Suitable Meeting Place and Time
Try to obtain free meeting space at a local church, library, community center, hospital, or social service agency. Chairs should be arranged in a circle; avoid a lecture set-up. Consider holding initial meetings in members' homes. Also, try to set a convenient time for people to remember the meeting, e.g., the first Tuesday of the month or every Tuesday at 7:30 p.m.

3. Publicize and Run your First Public Meeting
To reach potential members, consider where they might go to seek help and get the word out to those persons and places. Don't start before you have a core group of committed founders. The first meeting should be arranged so that there will be ample time for you and other core group members to describe your interest and work, while allowing others the opportunity to share their view of how they would like to see the group function. Identify common needs the group can address. Make plans for the next meeting; have an opportunity for people to talk and socialize informally after the meeting.

4. Future Meeting Tasks
Establish the purpose of the group. Is the purpose clear? Groups often focus upon providing emotional support, practical information, education, and sometimes advocacy.

Also determine any basic guidelines your group will have for meetings (e.g., insure that group discussions are confidential, non-judgmental, and informative).

Membership: Who can attend meetings and who cannot? Do you want membership limited to those with the problem? Will there be membership dues? If so, how much?

Meeting Format: How will the meeting be structured? How much time will be devoted to business affairs, discussion, planning future meetings, socializing? What topics will be selected? Can guest speakers be invited? If the group grows too large, consider breaking down into smaller sub-groups of 7 to 12.

Roles and Responsibilities: Continue to share and delegate the work and responsibilities in the group. Who will be the phone contact for the group? Do you want officers? Consider additional roles members can play in making the group work. In asking for volunteers, it is sometimes easier to first ask the group what specific tasks they think would be helpful.

Phone Network: Many groups encourage the exchange of telephone numbers or an internal phone list to provide help to members between meetings. Ask your membership if they would like this arrangement.

Use of Professionals: Consider using professionals as advisors, consultants, or speakers to your groups, and as sources of continued referrals and information.

Projects: Always begin with small projects, then work your way up to more difficult tasks.

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Problems and Pitfalls In Working With Mutual-Aid Groups

1. Taking Over the Peer Helper Role
Do not do for the client what the community can do. Assist your clients to find peers who can help them instead of keeping clients dependent on you. Think of your role as one of linking your clients to a life of continuing growth, not as merely a treatment provider who will produce a finished product at the end of your treatment plan.

2. Over-identification with Resistance
Beware of over-identifying with your client's resistance to attending meetings. You must be firm in insisting that the need for lifestyle change includes finding a new support system.

3. Problems with Religion
One common problem with AA/NA affiliation is objection to the religious atmosphere in some 12-Step groups. It is important to be knowledgeable about the differences between spiritual and religious and to read the chapter in the Big Book, "We Agnostics" (AA, 1976). Some groups are more openly religious than others. AA's beginnings were rooted in evangelical Protestantism, but its teachings are compatible with Catholicism, Judaism, and Islam. For example, there is an organization called JACS (Jewish Alcoholics, Chemically Dependent Persons and Significant Others) headquartered in New York City that helps Jewish addicts understand the 12-Step program as compatible with Judaism. They can be contacted at JACS, 850 Seventh Ave., New York, NY 10019. Phone: (212)397-4197. Web: http://www.jacsweb.org

4. Gender Issues
Women often express discomfort about AA/NA groups, although this difficulty is diminishing as more women are becoming AA members. The most recent survey indicates that one-third of members are women (AA, 1999). One way to help a woman client adjust to AA is to link her to an all-women's group or to a group with a large number of women in attendance. It is also appropriate to help the client learn to deal with male prejudice and sexist comments.

5. Discomfort in groups
An important characteristic of successful members is capacity for group dependency. One researcher found that people with high affiliation needs bond quickly with groups, whereas those with low affiliation needs do not. Some people described themselves as "loners" or "misfits." For such people integration into the mutual-aid social world can be more difficult. Those who pay attention to what is said in meetings and read the literature are able to participate more and to engage in dyadic relationships within groups. Continued attendance allows the less extroverted members to become involved and develop a sense of belonging. A dyadic relationship is often required before the less sociable person is able to be involved in an AA group.

6. Lack of transportation and other logistical barriers
Such things as no transportation and other barriers to attendance need to be considered and resolved. Rides can be obtained to deal with transportation problems. One definition of an AA meeting is simply "one drunk talking to another." Anywhere you can find one other person who has a story to tell, you can find a meeting. Thus, your client might find someone who he or she can talk to in person or by telephone at times when a regular meeting is not available.

7. Working at Cross Purposes With the Group
One of the biggest problems that can occur when a professional's client belongs to a peer support group is the possibility that what you are doing with your client may be undermined by peer helpers. This happens most often with the issue of the use of medication for psychiatric disorders. While it is true that addicts tend to use chemicals to solve their problems, it is also true that some addicts need medications of various kinds. An AA pamphlet states, "It becomes clear that just as it is wrong to enable or support any alcoholic to become re-addicted to any drug, it's equally wrong to deprive an alcoholic of medication which can alleviate or control other disabling physical and/or emotional problems" (AA, 1984, p. 13). Despite this warning in AA's own literature, some newcomers may be instructed by peer helpers not to use their medications. You can do two things to remedy this. First, you can obtain the AA brochure quoted above and share it with your clients. Secondly, you can recommend to your clients that they not discuss medications in their groups or informally with the friends they meet in AA or NA.

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Indicators of Mutual Help Involvement