4 - A different perspective on change in self-help organizations: spirituality, identity, life stories, friendship networks, and politicization

Summary

Moving beyond the treatment-outcome perspective

The previous chapter concluded that participation in addiction-related self-help groups can promote improvement on important clinical outcomes, for example reduced substance abuse, psychopathology, and medical comorbidities. From some perspectives, inquiry should stop here, because the likely value of self-help groups as a treatment for substance abuse has been established. However, the clinical treatment-evaluation perspective on self-help groups is a necessary but insufficient lens through which to understand the effects of self-help group involvement. Self-help organizations resemble professional treatments in some respects, but they also have unique aspects that can influence members in ways not typically associated with healthcare interventions, and indeed some members who have already resolved their substance-abuse problem seek out self-help groups specifically for these other benefits (Kaskutas, 1994, 1996a). This chapter evaluates the implications of this reality for outcomes that are not usually considered part of the clinical treatment-evaluation perspective.

A focus upon such outcomes follows naturally from the recognition that, in many ways, self-help organizations are more akin to communities than to treatments. Individuals participate in them for indefinite periods, structure social activities around them, actively work to keep them in existence, make friends within them, and so forth. In the process, members encounter a philosophy and set of values that some scholars termed the “mutual-help organization's “ideology”” (e.g., Antze, 1979; Cerclé, 1984; Kassel & Wagner, 1993; Suler, 1984).