Mutual-help groups (MHGs), including 12-step programs like Alcoholics Anonymous and newer alternatives like SMART Recovery and Refuge Recovery, are widely used to support alcohol recovery. While attendance at these groups is associated with positive recovery outcomes, many people face barriers to participating. A new study examined what prevents people from attending these groups and staying involved over time.
The Study
Researchers surveyed 531 participants in various mutual-help groups as part of the Peer Alternatives (PAL) Study in 2021, with follow-up surveys at 6 and 12 months. The study included participants from both traditional 12-step programs and newer, non-12-step alternatives (called “second-wave” MHGs). Participants answered questions about barriers to attending meetings and their level of involvement in the groups.
The researchers examined 11 different barriers to attendance, grouped into three domains: social anxiety and psychiatric concerns, low motivation or perceived need, and dislike of meeting attendees and content.
Key Findings
Social anxiety and psychiatric concerns emerged as the most commonly reported barriers to attendance, both overall and for each type of mutual-help group except LifeRing. The single most highly endorsed barrier across all groups was “I don’t like crowds or large groups.”
When researchers examined which barriers predicted actual involvement in mutual-help groups over time, they found that social anxiety and psychiatric concerns were the only barrier domain significantly associated with lower involvement at both the 6-month and 12-month follow-ups. People who reported higher levels of social anxiety and psychiatric concerns showed less involvement in their mutual-help groups over the year.
The other barrier domains (low motivation/perceived need and dislike of meeting attendees and content) were not significantly associated with involvement levels over time.
What This Means
The findings reveal that social anxiety and mental health concerns represent significant obstacles not just to attending mutual-help groups initially, but to maintaining involvement over time. This is important because sustained involvement, not just occasional attendance, is what tends to support long-term recovery.
The researchers suggest that efforts to address these barriers could improve participation in mutual-help groups. This might include enhancing the social experiences within groups to make them less intimidating for people with social anxiety, and increasing the availability of groups specifically designed for people dealing with psychiatric concerns alongside their recovery.
The study also highlights that simply encouraging people to attend meetings may not be enough if the social and psychiatric barriers that prevent meaningful involvement are not addressed. Understanding and accommodating the needs of people with social anxiety and other mental health challenges could help more people benefit from the support these groups offer.
Martinez, P., Delk, J., Mericle, A. A., Timko, C., & Zemore, S. E. (2025). Beyond Attendance: Social Anxiety and Psychiatric Concerns Predict Mutual-Help Group Involvement in a U.S. National Longitudinal Survey. Journal of Studies on Alcohol and Drugs. https://doi.org/10.15288/jsad.24-00393
