Twelve step organizations such as Alcoholics Anonymous and Narcotics Anonymous are free, community-based fellowships. Such organizations are the most widely sought recovery management options, surpassing professional treatment. The emerging evidence base suggests that involvement in such organizations is associated with positive substance-related outcomes (e.g., abstinence). Relatively speaking, however, far less is known about whether or not involvement is associated with other meaningful psychosocial constructs. The current study examined gratitude, meaning in life, life satisfaction, personal growth, and various other recovery and psychosocial constructs in a sample of self-identified NA members (N = 128) from 26 U.S. states, ranging in age from 22 to 64 years. The primary aim of the present study was to psychometrically evaluate and refine four distinct positive psychology instruments (i.e., Gratitude Questionnaire (GQ – 6), Meaning in Life Scale (MLQ), Satisfaction With Life Scale (SWLS), Personal Growth Initiative Scale (PGIS)). The current study contained three phases. First, the psychometric properties of each instrument were examined within an Item Response Theory measurement framework. The Rating Scale Model was used to evaluate the each instrument using WINSTEPS 3.74.01. With the exception of the Meaning in Life Questionnaire (which did not conform to an IRT measurement model), each instrument was iteratively refined based on statistical and clinical considerations, resulting in the collapse of response options and the removal of poorly fitting items. These refinements improved the psychometric properties of each instrument, resulting in a more reliable, accurate, and efficient way to measure gratitude, life satisfaction, and personal growth in clinical samples. Second, items from the GQ – 6, SWLS, and PGIS were examined concurrently using the PROC IRT procedure in SAS to explore whether the constructs were distinct from one another. Results provide support that gratitude, life satisfaction, and personal growth are unique and distinct constructs. Last, the study examined several recovery-related correlates of gratitude, life satisfaction, and personal growth. Hierarchical regression models assessed whether abstinence duration and other recovery-related variables accounted for significant incremental variance in gratitude, life satisfaction, and personal growth, over and above several covariates. As a block, abstinence duration and recovery predictors accounted for significant incremental variance in all of the constructs. These data suggest ongoing recovery involvement in 12-step organizations may be associated with positive outcomes beyond abstinence. Limitations and directions for future research are discussed.

Substance use disorders (SUDs) affect a significant portion of the population and are noteworthy public health concerns. Mutual help organizations (MHOs) such as Alcoholics Anonymous and Narcotics Anonymous are considered evidence-based practices for SUDs. Despite a growing body of research examining mechanisms of change in MHOs, relatively few investigations of 12-step organizations have been theory-driven. Theory-based models of recovery provide a more comprehensive view of the range of individual factors affecting individuals in recovery and how and why they might engage in recovery-related behaviors. Stress and coping theory fills a gap in explaining how improvements occur as a result of MHO recovery engagement from a bio-psycho-social perspective. Although some recovery program-related mechanisms of change in MHOs have proven to be important factors in promoting long-term recovery from SUDs, fewer studies have examined what factors may influence participation in recovery practices. Using a sample of community-based Narcotics Anonymous members from 26 U.S. states, the relationships between stress and engagement in various recovery practices are examined from the perspective of a psychobiological, SUD-specific stress and coping framework. It is hypothesized that the relationship between stress and recovery practice engagement is moderated by abstinence duration, such that individuals at lower levels of abstinence duration would have fewer coping resources to mitigate stress and therefore would evidence a greater association between stress and engagement in higher levels of recovery practices. Results indicated the stress-recovery practice involvement relationship was not moderated by abstinence duration, and stress was not significantly associated with any recovery practices. However, helpfulness of social support received from individuals in recovery, abstinence duration, neuroticism, and substance use severity all significantly predicted recovery practice involvement. Gaining additional understanding of mechanisms that influence recovery involvement will allow clinicians and researchers to enhance interventions and facilitate involvement in beneficial aspects of recovery programs.

Approximately 10% of adults living in the United States meet criteria for a Substance Use Disorder. Although 12-step groups are considered evidence-based practices for substance use problems, an understanding of the underlying mechanisms by which they facilitate recovery practices remains in its infancy. The purpose of the current study was to explore whether attachment could be considered a possible mediator of the effects of recovery practices on positive psychosocial outcomes. Participants (N = 112) were self-identified NA members from 26 U.S. states who completed an online survey assessing attachment style, psychosocial sense of community, psychological well-being, and various other recovery and psychosocial constructs. Results indicated a number of recovery-related practices emerged as significant predictors of secure attachment, over and above covariates. For example, higher levels of home group comfort were associated with increased probability of secure attachment classification (by self-report). In general, psychological sense of community did not significantly predict secure attachment, over and above covariates. Although attachment predicted psychological well-being in univariate models, it generally failed to predict psychological well-being in models that included covariates and recovery-related predictors. Theoretically, these data suggest that functional social support variables are primary recovery-related predictors implicated in NA-involvement, above and beyond other structural social support variables. This further suggests that attachment-related dimensions of 12-step interventions may be integral to recovery outcomes.