A peer support group for substance problems is a regular meeting of people who share a commitment to recovery, tell their own stories, hold each other accountable and keep what is said private, as in Alcoholics Anonymous and similar groups. It needs no trained therapist, only someone to keep order and enforce ground rules, but it is not a place to manage dangerous withdrawal and it should not force anyone to attend.
Peer support groups are meetings in which people with a shared substance problem support one another’s recovery.
What The Evidence Says
Mutual-help groups based on the twelve-step model have been studied for alcohol use, and reviews of the evidence (a Cochrane review of Alcoholics Anonymous and twelve-step facilitation; my recollection of its conclusion and not checked for this guide) have found them as effective as, or in some measures better than, other treatments at supporting abstinence, with the strongest evidence for alcohol. Evidence for other substances is less clear. Other models exist, including secular ones. Much of the benefit appears to come from belonging, shared experience and a sober community.
Format
- Regular meeting at a fixed time and place, weekly or more often, open to anyone with a substance problem who wants to attend.
- Shared commitment to recovery or to reducing harm. Decide whether the group requires abstinence or is open to those still using, and say so.
- Personal stories. Members talk about their own experience, without advice-giving to others.
- Support and accountability. Members say what they intend and report back.
- Confidentiality. What is said stays in the room; see Confidentiality & Trust for limits.
- Simple opening and closing so that the meeting is predictable.
- A time-keeper or convenor, who keeps order, ensures everyone can speak, and enforces the rules. The convenor need not be an expert or a leader; the role can rotate.
Ground Rules
- One person speaks at a time
- No interruption or cross-talk
- No judgement
- No advice unless asked
- No pressure to speak; passing is allowed
- No graphic detail of use, which can trigger cravings
- Not attending intoxicated
- Privacy
What A Group Cannot Do
- Manage withdrawal. A person in alcohol or sedative withdrawal needs nursing and watching, not a meeting; see Withdrawal Management.
- Treat severe mental illness or suicidal crisis; see When Grief Becomes Dangerous.
- Replace individual support. Combine with an accountability partner; see Accountability Partners.
- Demand that everyone stop at once. A group should never press a heavy daily drinker to stop suddenly.
Adapting It
- Mixed substance groups can work but share a focus on recovery.
- Women’s, youth and family groups may attract those who would not speak otherwise.
- Include family members in a separate group.
- Alternatives to spiritual language for those who do not share it.
- Walking meetings or shared work for people who find sitting talk hard.
Common Mistakes
- Using the group as a place to expose or shame.
- Allowing one voice to dominate.
- Making attendance compulsory for all.
- Treating a member who relapses as a failure of the group.
- Leaders who lecture.
What’s Next
- Learn next: Accountability Partners — the one-to-one counterpart
- Combine with: Group Processing Sessions — design cautions for any group on hard subjects