Mutual aid groups
Definition
Mutual aid groups (sometimes known as self-help or peer support groups) provide non-professional support to those who identify as sharing a similar problem. Members of mutual aid groups both give and receive support in regular group meetings that supplements or replaces the support offered by professional services.1 Mutual aid groups are independent, self-governing and institutionally autonomous; they may be local and unaffiliated, or part of a larger organisation. Mutual aid groups do not provide treatment.
Discussion
1. Mutual aid and institutional anonymity
Organisationally, mutual aid groups maintain independence from professional treatment services, although some meetings are hosted by various institutions and services. This organisational independence, or institutional anonymity is critical in terms of the efficacy of mutual aid as it:
Fig.1: Independence of mutual aid groups
Mutual aid groups do not compete in the treatment economy, so they are unencumbered by the corporate pressure to generate revenue, meet targets and compete for funding and resources. The subjection of treatment services to the demands of the free market effectively establishes individuals who access services as conduits for economic gain in the licit bioeconomy.
The capitalisation of the addict in the treatment economy binds those who cross the threshold into treatment to a system that does not privilege their interests. Rather, the need of the service or system to be profitable is paramount, and will tend to supersede the interests of the client.2 Mutual aid groups undermine this client-system interdependence and provide an alternative to the structures of power and knowledge that underpin professional services in the open market.
2. Mutual aid groups in the mental health recovery movement
The mental health recovery movement is now decades old yet continues to guide policy and practice. Mental health recovery has been a significant influence on emerging addiction recovery movements and the practice of mutual aid is privileged in both movements.3
Within mental health, mutual aid groups emerged as a point of resistance against the hegemony of professional knowledge wielded by the elite caste of psychiatric specialists. As Stewart notes:
Disenchanted with professional experts and perceiving both elitism and ineffectiveness within formal professional sectors, self help groups aimed to demystify and demonopolize professional expertise by shifting power to consumers and altering traditional roles of lay people and professional people.4
A rupture appeared in the fabric of mental health care. Vocal consumer and survivor mutual aid groups challenged the sovereignty of professional knowledge and in many cases rejected it outright. Dismissing institutional knowledge, people began to look to each other for support, nurturing, and healing. Mutual aid groups are the material expression of that turn to communal support. The singular uniqueness of the recovery journey is magnified when re-situated in a group context.
3. Referring to mutual aid groups
The independence and autonomy of mutual aid groups raises a number of questions for professionals wishing to refer their clients to them. Being independent, non-professional and self-governing, mutual aid groups are not required to accede to the same codes of accountability as public services and professional organisations.
The perceived risk of referral can be managed by nurturing a clear understanding between the client and professional as to the roles and responsibilities of the various elements in the referral pathway. The following protocol is a pragmatic and usefully simple starting point.5
Fig.2: Protocol for professionals making referrals to mutual aid groups.6
Referring clients to mutual aid groups is an opportunity for the interface between professional services and mutual aid groups to become more permeable, fortifying the integrity of the local recovery ecosystem. The following models illustrate two possible implementations at a service level.
Fig. 3: Referral model 1
Keyworker attends first session with client. [Note: the rules regarding attendance of those not directly seeking support will vary from group to group.]7
Fig. 4: Referral model 2
Keyworker refers client, client attends alone.
Client feeds-back and discusses experience with keyworker.
4. Conclusion: working together
Mutual aid groups and professional treatment services offer very different kinds of support for people with drug and alcohol problems. The limitations of professional services in the treatment of alcoholism was acknowledged as early as 1927.8 Although the quality and nature of treatment has evolved, there are domains of recovery that remain outside the purview of statutory and third sector provision. The nascent recovery movement in the UK is burgeoning in that exterior space.
The energy and diversity of grassroots recovery communities resist the homogenous regimes of professional addiction services and can be seen as a grass-roots response to unmet needs – this is the radical idea that lies at the heart of the recovery movement. Grassroots communities of recovery, in all their colorful heterogeneity, expand the horizons of therapeutic space – they are places where identities can be nurtured to a fuller, more integrated extent – places that contrast sharply with the dull monochrome and clinical sterility of the community-drugs team, GP’s surgery, or psychiatric consulting room.
Grassroots communities of recovery are places of potential, furnaces where self and selfhood are forged in the white heat of physical affinity, where the individual’s acceptance of the group, and the groups’ acceptance of the individual fortify the alloy of human uniqueness.9
This discussion is not intended to denigrate the support offered by professional services: they are absolutely critical elements of recovery. Rather, I hope to have highlighted the gap in provision that mutual aid groups fill and some of the mechanisms by which they do so. I have also attempted to demonstrate how services can reach into this vibrant ecology and both leverage and nurture these alternate sources of recovery knowledge for the benefit of their clients. The reciprocal suspicion that has characterised the relationship between services and mutual aid groups in the UK is being eclipsed by a more open and progressive attitude. This can only be a good thing for our communities and the individuals who turn to them for support.
Revision 1.1
Stephen Bamber, 9th March 2010
Recovery glossary | Mutual aid groups by Stephen Bamber is licensed under a Creative Common License.
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- Keith Humphreys and Julian Rappaport, “Researching self-help/mutual aid groups and organizations: many road, one journey”, Applied and Preventative Psychology”, 3, 1993, p. 217 (217-231). ↩
- Stephen Bamber, “Rethinking community: Addiction, recovery and globalisation“, Paper presented at the 12th International EWODOR symposium, Stirling, 2009, pp. 2-4 (1-8). ↩
- See Stephen Bamber (2009), “Revolution in the Head”, The Art of Life Itself, <http://www.theartoflifeitself.org/2009/11/23/revolution-in-the-head/>, accessed 9th April 2010, for an overview of the thematic links between the mental health and addiction recovery movements. ↩
- Miriam J. Stewart, “Professional Interface With Mutual Aid Groups”, Social Science and Medicine, Vol. 31, No. 10, 1990, p. 1143 (1143-1158. ↩
- For more detailed expositions see Keith Humphreys, Circles of Recovery, Cambridge University Press, Cambridge, 2004, Chapter 5. Humphreys also offers a thorough review of the diversity and effectiveness of mutual aid groups in this volume. ↩
- From Linda Kurtz and Ernie Kurtz, “Guide to the development of mutual aid groups”, available http://www.bhrm.org/Guide.htm. ↩
- For example, 12-step groups such as Alcoholics Anonymous and Narcotics Anonymous operate both “open” and “closed meetings”. ↩
- By Carl Jung in his treatment of Rowland Hazard. See William L. White and Ernest Kurtz, “Twelve Defining Moments in the History of Alcoholics Anonymous”, p. 39, in Marc Galanter and Lee Ann Kaskutas (eds), Research on Alcoholics Anonymous and spirituality in addiction recovery, Recent Developments in Alcoholism, Volume 18, Springer, 2008. ↩
- Bamber, 2010, p. 8 ↩
{ 10 comments… read them below or add one }
Excellent work, Steve…
London NA convention this weekend so a real buzz down here. It’s gratifying to see so many of my compatriots showing up down here…. more and more at each event.
Keep up the good work
nickm x
Thanks for the kind words Nick. Hope you had a good weekend with friends. Although I’m not a member of NA or any 12-step fellowship, from working with those that are I know that the regional and national conventions are real highlights. Again, it’s that sense of communality that evokes such exuberance, I think. S.
Good stuff, I’m always putting across the point that language can both empower or dis-empower a person as to what ever they’re trying to achieve especially in the world of recovery, words that need to be personal to the addict are alien, I’d appreciate your opinion on my Blog “Behaviours and Issues” on wired-in where I’ve humbly tried to explain the difference, nowhere near as good as you at this academia stuff, bit it’s paramount we understand what’s happening in our recovery.
Don’t be fooled by the academic writing Tony: it’s mostly only good for communicating obscure ideas to other academics…. You’re absolutely right re. empowerment and dis-empowerment. Will pop over to Wired In and take a look later today. S.
Stephen I am involved in SMART Recovery we have recently completed a pilot project with Alcohol Concern which was independently evaluated by Prof Susanne McGregor also Laura Graham has evaluated the non-pilot sites if you would like to see the reports I will arrange it.
I am also interested in the benefits professionals and clients gain from having a PSG assertively linked as you describe in fig 3 & 4. I feel this is a real oppurtunity to increase our attendances and profiles and in Sheffield this has played a big part in breaking down the “stigma” some workers display towards PSG.
Sure – would be interested to see the reports, thanks. Glad you’ve found this useful.
“Stigma” is a strong word…. as John points out below, there can sometimes be a coherent professional rationale for not linking in with non-professional mutual aid groups. That being said, ignorance (as in lack of knowledge or understanding) abounds on both sides.
In a litigious culture of risk-aversion, professionals (in any public service) are often reduced to taking the safest possible course of action. In the AOD field, we are almost obsessive about avoiding risk. The irony is, of course, that recovery – in its broadest sense, absolutely demands risk. The question then becomes – for those that are bound by clinical governance – How can we manage risk more effectively? The referral protocol above is one very simple way of managing the risks associated with referring to a non-professional group. Here, the onus is on the individual professional to be knowledgeable about the group they are referring to. S.
Stephen, it’s important that this stuff is written down so that people have a clear and shared understanding of definitions – so well done.
It falls to me as usual to ask the difficult question. We all know people who have found a bit of stability after entering treatment -often a treatment they have been contemplating for years- who have subsequently run into someone in NA who has given them a hard time about their being on methadone. Unfortunately these messages can seem pretty unsupportive. I would understand if professionals struggle because they fear that clients will be endangered in this sort of environment – and it’s not NA that has to account for drug deaths amongst those with whom their members have had contact.
The question is – Do you really believe that large numbers of addictions professionals are going to make referrals to NA? or maybe my question is … Do you realise that a large number of professionals are never going to make a referrals to NA – and actually in the framework within which they operate, this may be a sound professional decision.
Hi John.
Thanks for the response. I touched on your concluding questions in my response to Carl, above.
I’ll respond to the hugely important point you raise re. anti-medication bias later today, or early tomorrow.
Thanks again. S.
John,
Sadly, there is a tendency to marginalise those who are in medication assisted recovery. As well as cultural attitudes that emerge from NA, here in the UK this is augmented by vocal anti-methadone rhetoric in the press and amongst (some) members of the recovery movement. There is a cloud of myths, misunderstandings and misconceptions regarding methadone and other substitute prescribing surrounding this issue. I have witnessed the denigration of those on methadone on a number of occasions – and have experienced it myself. Some years ago, whilst on a substitute prescription, I was told counselling would be of no benefit to me until I stopped taking methadone.
As I often point out, we are in the process of defining the boundaries of our own conceptualisations of recovery here in the UK, so the airing of the various positions is useful. Interestingly, a similar debate is happening over in the US. A forthcoming series of papers by William White and Lisa-Mojer Torres tackles this issue in a typically comprehensive manner. Something to watch out for – appearing later this year.
I’m planning writing more on this soon – please do comment further. I welcome dialogue as it helps me to focus and develop my own thinking.
S.
What a breath of fresh air in educated and referenced recovery literature, I thank you. Any similiar links especially in Australia would be appreciated.
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