A Systematic Review of Rates and Levels of Involvement and Substance Use Outcomes of LGBTQ Individuals In Mutual Help Groups

Background: LGBTQ individuals are more likely than their heterosexual and cisgender counterparts to experience alcohol and other substance use disorders. Currently, Mutual Help Groups (MHGs), such as Alcoholics Anonymous (AA), are the most common source of support for alcohol and other substance-related problems. Despite the pervasiveness of MHGs, only a modest body of research, and no known prior systematic reviews, have captured the rates/levels of involvement and substance use outcomes of LGBTQ individuals involved in MHGs. To fill this gap, this study aims to identify 1) rates and levels of MHG involvement and 2) substance use outcomes of MHG involvement among LGBTQ individuals, examining both differences between LGBTQ individuals and their heterosexual and cisgender counterparts and differences across subgroups of LGBTQ individuals.

Methods: The literature search primarily utilized five search engines. The inclusion criteria were (a) peer reviewed, (b) published in English since 1980, (c) provided at least one substance use outcome for LGBTQ individuals participating in a mutual-help/self-help group OR population-based estimate of rates or levels of involvement for LGBTQ individuals in a MHG OR comparison in rates or levels of involvement between sexual or gender identity groups. A team of researchers extracted the data and placed it into tables which were utilized for subsequent tabulations. The researchers conducted bias assessments for each included study.

Results: In this systematic review, we identified twelve articles that captured LGBTQ individuals’ rates/levels and substance use outcomes of MHG involvement. A small and limited body of research generally found sexual minority individuals to be as likely or more likely to participate in 12-Step programs relative to heterosexual respondents. An even more modest body of research suggests that greater involvement in 12-Step programs may be associated with greater reductions in substance use among sexual minority individuals relative to lesser involvement; due to the methodological limitations of these studies, significant caution should be utilized in interpreting these results. The most critical gaps identified in this review are the paucity of research exploring the rates/levels of participation and outcomes of LGBTQ individuals in alternative MHGs (e.g., SMART Recovery), minimal research exploring the involvement and outcomes of transgender and other gender diverse individuals, and differences in involvement and outcomes of LGBTQ subpopulations across intersecting identities. The review also identified significant methodological limitations in most of the included studies.

Discussion: This study fills an important gap by being the first known systematic review to explore the rates, levels, and outcomes of MHG participation for substance use for LGBTQ individuals. The findings tentatively suggest that participation in MHGs is likely beneficial for LGBTQ people. The significant gaps and methodological limitations of the studies included in this review highlight the importance of conducting future, methodologically rigorous studies that assess the experiences and outcomes of MHG participation for LGBTQ people, with an emphasis on alternative MHGs and the experiences and outcomes of transgender/gender diverse individuals and individuals holding multiple marginalized identities. Such information is critical for supporting marginalized populations in accessing the best available resources for addressing substance use-related challenges.