The Meaning and Function of Twelve-Step Mutual-Help Groups During Recovery: A 10-Year Qualitative Follow-Up of Persons Treated for Substance Use Problems in Sweden

Abstract

Background: Twelve-step treatment for substance use problems is a commonly employed intervention in both international and Swedish contexts. An advantage of twelve-step treatment is the possibility of continuing support for the recovery process through participation in mutual-help groups such as Alcoholics and Narcotics Anonymous also after a time-limited intervention. Despite the long-standing establishment of twelve-step-based interventions in Sweden, limited knowledge remains regarding long-term perspectives of recovery processes, particularly with respect to first-person experiences. In the present article, the first-person experiences of the meaning and function of twelve-step-based mutual-help groups for long-term recovery are investigated. Methods: Semi-structured qualitative interviews with 24 individuals who had completed twelve-step treatment for substance use problems 10 years ago and who had used 12-step-based mutual-help groups during recovery. During the analysis, a perspective on power emerged as central, and Foucault’s conceptualizations of disciplinary and pastoral power, as well as subjectification, were found to be analytically fruitful in examining how the twelve-step philosophy operates as a normative practice in which individuals’ self-understanding is shaped through specific techniques. Results: The majority (n = 18) described consistent participation in mutual-help groups during the follow-up period; some (n = 6) had resumed attending meetings after a period of absence. For those with consistent participation, meaning and function were described in terms of safety and predictability, continued recovery, identity formation and friendship. The smaller group brought forward social reasons and life crises as motives for returning to attending meetings. Conclusions: In the analysis, participants describe the significance of mutual-help groups in their lives, often highlighting the social context and support in dealing with life’s difficulties. Some view meetings as necessary for maintaining recovery from substance use problems. Many portray the function of mutual-help groups as primarily social (e.g., friendships and social interaction) or as a source of shared support for psychological well-being, that is, functions not directly related to prior substance use problems. From a Foucauldian perspective on disciplinary and pastoral power, these accounts appear aligned with twelve-step philosophy. However, the need for community, friendship, and support is universal and here provided within this framework. The findings highlight the importance of ensuring access to such support and social contexts for individuals in recovery who are not comfortable within a twelve-step framework.