Digital mutual help groups for problematic alcohol use: characteristics, contexts, and commitment

Mutual Help Groups (MHGs) such as Alcoholics Anonymous can enhance recovery from problematic alcohol use. However, they can also present barriers related to physical access, stigma, and ideological conflicts. The emergence of digital MHGs has presented opportunities for individuals to more conveniently and discretely engage in peer support. As this is an evolving area of research, a scoping review was conducted to characterize extant studies of digital MHGs for problematic alcohol use. Five mobile applications and 15 web-based platforms were directly studied, though several were found to be inactive or unavailable. Randomized trials were insufficient to establish effectiveness of digital MHG participation in enhancing recovery outcomes, though active digital MHG engagement was associated with favorable recovery trajectories in longitudinal analyses. Descriptively, recovery processes were characterized by participants engaging in reciprocal support, solidifying community ties, and developing recovery-centric identities. However, little has been comprehensively reported about patterns and contexts of engagement that typify such processes among new users of popular digital MHGs. To contextualize patterns of digital MHG engagement, I collected two years of observational data from Reddit’s /r/stopdrinking (SD) community and benchmarked forum activity, evaluated technical features, and identified contexts of engagement using quantitative and qualitative methods. SD was highly active and responsive, with cohesive rules and customs (e.g., common maxims, daily check-ins). Among 1,556 annotated posts, content reflected diverse motivations for change (e.g., mental, physical, and social concerns). Users commonly expressed cravings and directly asked for feedback and support. Based on multivariable models including supervised linguistic classifiers, expressing these contexts within the first week was not associated with sustained engagement among 18,517 new forum users. Above-average posting and commenting, and setting up a Sober Badge day counter in the first week, significantly predicted sustained weekly engagement through 4- and 13-weeks. Such committed engagement was identified in a minority (1-5%) of new forum users. Future studies should identify individual differences that can motivate initial commitment to digital MHG engagement as well as recovery trajectories associated with such involvement. This will allow for well-scoped trials and development of evidence-based recommendations for using popular digital MHGs in alcohol recovery contexts