The Contribution of Self-Help Groups to the Mental Health/Substance Use Services System

  • Thomas J. Powell
  • Brian E. Perron


Self-help groups provide an immense amount of service, which mental health professionals do not adequately understand or coordinate with their services. Epidemiological surveys have documented the profiles of self-help users, the amount of self-help use, and the association between self-help use and professional services. The large majority of self-help users use professional services sometimes as a gateway into professional services, other times concurrently with professional service or as aftercare following a course of professional services. The hallmark features of self-help groups: their use of the experiential perspective, referent power, and reciprocal helping relationships are contrasted with professional mental health services. The essential elements of effective referrals to self-help groups are discussed. At another level, the chapter also discusses the organizational supports necessary for effective collaboration between self-help groups and professional services. While the boundaries between mental health services and self-help groups must be respected, both parties have much to gain by entering into more extensive community partnerships.


Professional Service National Comorbidity Survey Professional Treatment National Comorbidity Survey Replication Social Security Disability Insurance 
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  1. Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. American Psychologist, 58, 5–14.PubMedCrossRefGoogle Scholar
  2. Alcoholics Anonymous. Alcoholics Anonymous membership survey 2007. Retrieved February 7, 2009
  3. Aron, L., Honberg, R., & Duckworth, K. et al. (2009). Grading the States 2009: A report on America’s health care system for adults with serious mental illness. Arlington, VA: National Alliance on Mental Illness.Google Scholar
  4. Baum, J. A. C. (1996). Organizational ecology. In S. P. Clegg, C. Hardy & W. Nord (Eds.), Handbook of organization studies (pp. 77–114). London/Thousand Oaks, CA: Sage.Google Scholar
  5. Borkman, T. J. (1990). Experiential, professional, and lay frames of reference. In T. J. Powell (Ed.), Working with self-help (pp. 3–30). Silver Spring, MD: National Association of Social Workers.Google Scholar
  6. Borman, L. D. (1979). Characteristics of development and growth. In M. A. Lieberman, & L. D. Borman (Eds.), Self-help groups for coping with crisis (pp. 13–42). San Francisco: Jossey Bass.Google Scholar
  7. Brown, L. D. (2009). Making it sane: Using narrative to explore theory in a mental health consumer-run organization. Qualitative Health Research, 19(2), 243–257.PubMedCrossRefGoogle Scholar
  8. Brown, S. L., Nesse, R. M., Vinokur, A. D., & Smith, D. M. (2003). Providing social support may be more beneficial than receiving it: Results from a prospective study of mortality. Psychological Science, 14(3), 320–328.PubMedCrossRefGoogle Scholar
  9. Chappel, J. N., & DuPont, R. L. (1999). Twelve-step and mutual-help programs for addictive disorders. The Psychiatric Clinics of North America, 22(2), 425–446.PubMedCrossRefGoogle Scholar
  10. Chesler, M. A. (1990). The “dangers” of self-help groups. In T. J. Powell (Ed.), Working with self-help (pp. 301–324). Silver Spring, MD: National Association of Social Workers.Google Scholar
  11. Chinman, M. J., Kloos, B. O., Maria O’Connell, M., & Davidson, L. (2002). Service providers views of psychiatric mutual support groups. Journal of Community Psychology, 30, 349–366.CrossRefGoogle Scholar
  12. Cohen, E., Feinn, R., Arias, A., & Kranzler, H. R. (2007). Alcohol treatment utilization: Findings from the national epidemiologic survey on alcohol and related conditions. Drug & Alcohol Dependence, 86(2–3), 214–221.CrossRefGoogle Scholar
  13. Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. (2006). Improving the quality of health care for mental and substance-use conditions: Quality chasm series. Washington, D.C.: Institute of Medicine, National Academies.Google Scholar
  14. Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D., & Tebes, J. K. (1999). Peer support among individuals with severe mental illness: A review of the evidence. Clinical Psychology-Science & Practice, 6(2), 165–187.CrossRefGoogle Scholar
  15. Davison, K. P., Pennebaker, J. W., & Dickerson, S. S. (2000). Who talks? the social psychology of illness support groups: The human asset. American Psychologist, 55(2), 205–217.PubMedCrossRefGoogle Scholar
  16. Department of Health and Human Services Public Health Service. (1988). Surgeon general’s workshop on self-help and public health. Health resources and services administration, Bureau of maternal and child health and resource development, Publication no. 224–250. Washington DC.: U. S. Government Printing Office.Google Scholar
  17. Depression and Bipolar Support Alliance (DBSA). Peer specialist training. Retrieved 2/13/2009
  18. Donaldson, L. (2001). The contingency theory of organizations. Thousand Oaks, CA: Sage.Google Scholar
  19. Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7, 117–140.CrossRefGoogle Scholar
  20. Fiorentine, R., & Hillhouse, M. P. (2000). Drug treatment and 12-step program participation: The additive effects of integrated recovery activities. Journal of Substance Abuse Treatment, 18(1), 65–74.PubMedCrossRefGoogle Scholar
  21. Freimuth, M. (2000). Integrating group psychotherapy and 12-step work: A collaborative approach. International Journal of Group Psychotherapy, 50(3), 297.PubMedGoogle Scholar
  22. French, J. R. P., & Raven, B. (1959). The bases of social power. In D. Cartwright (Ed.), Studies in social power (pp. 150–167). Ann Arbor, MI: Institute for Social Research, University of Michigan.Google Scholar
  23. Gitterman, A., & Shulman, L. (2005). Mutual aid groups, vulnerable and resilient populations, and the life cycle. New York: Columbia University Press.Google Scholar
  24. Goldstrom, I. D., Campbell, J., Rogers, J. A., Lambert, D. B., Blacklow, B., Henderson, M. J., et al. (2006). National estimates for mental health mutual support groups, self-help organizations, and consumer-operated services. Administration and Policy in Mental Health, 33(1), 92–103.PubMedCrossRefGoogle Scholar
  25. Hardiman, E. R., & Segal, S. P. (2003). Community membership and social networks in mental health self-help agencies. Psychiatric Rehabilitation Journal, 27(1), 25–33.PubMedCrossRefGoogle Scholar
  26. Hatch, M. J., & Cunliffe, A. L. (2006). Organization theory: Modern, symbolic, and postmodern perspectives. Oxford: Oxford University Press.Google Scholar
  27. Heracleous, L. (2004). Boundaries in the study of organization. Human Relations, 57(1), 95–103.CrossRefGoogle Scholar
  28. Humphreys, K., & Moos, R. H. (2007). Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: Two-year clinical and utilization outcomes. Alcoholism: Clinical and Experimental Research, 31(1), 64–68.CrossRefGoogle Scholar
  29. Humphreys, K., Mavis, B., & Stofflemayr, B. (1991). Factors predicting attendance at self-help groups after substance abuse treatment: Preliminary findings. Journal of Consulting and Clinical Psychology, 59(4), 591–593.PubMedCrossRefGoogle Scholar
  30. Humphreys, K. (1997). Clinicians’ referral and matching of substance abuse patients to self-help groups after treatment. Psychiatric Services, 48(11), 1445–1449.PubMedGoogle Scholar
  31. Humphreys, K. (1999). Professional interventions that facilitate 12-step self-help group involvement. Alcohol Research and Health, 23(2), 93–98.PubMedGoogle Scholar
  32. Humphreys, K., Mavis, B. E., & Stoffelmayr, B. E. (1994). Are twelve step programs appropriate for disenfranchised groups? Evidence from a study of posttreatment mutual help involvement. Prevention in Human Services, 11(1), 165–179.Google Scholar
  33. Humphreys, K., Wing, S., McCarty, D., Chappel, J., Gallant, L., Haberle, B., et al. (2004). Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. Journal of Substance Abuse Treatment, 26(3), 151–158.PubMedCrossRefGoogle Scholar
  34. Kessler, R. C., Zhao, S., Katz, S. J., Kouzis, A. C., Frank, R. G., Edlund, M., et al. (1999). Past-year use of outpatient services for psychiatric problems in the national comorbidity survey. American Journal of Psychiatry, 156(1), 115–123.PubMedGoogle Scholar
  35. Kessler, R., Mickelson, K. D., & Zhao, S. (1997). Patterns and correlates of self-help group membership in the United States. Social Policy, 27(3), 27–46.Google Scholar
  36. Kurtz, L. F. (1985). Cooperation and rivalry between helping professionals and members of AA. Health & Social Work, 10(2), 104–112.Google Scholar
  37. Kurtz, L. F. (1997). Self-help and support groups: A handbook for practitioners. Thousand Oaks, CA: Sage.Google Scholar
  38. Magura, S. (2007). The relationship between substance user treatment and 12-step fellowships: Current knowledge and research questions. Substance Use & Misuse, 42(2–3), 343–360.CrossRefGoogle Scholar
  39. Magura, S., Laudet, A. B., Mahmood, D., Rosenblum, A., & Knight, E. (2002). Adherence to medication regimens and participation in dual-focus self-help groups. Psychiatric Services, 53(3), 310–316.PubMedCrossRefGoogle Scholar
  40. Majer, J., Jason, L., North, C., Ferrari, J., Porter, N., Olson, B., et al. (2008). A longitudinal analysis of psychiatric severity upon outcomes among substance abusers residing in self-help settings. American Journal of Community Psychology, 42(1–2), 145–153.PubMedCrossRefGoogle Scholar
  41. Maton, K. I. (1988). Social support, organizational characteristics, psychological well-being, and group appraisal in three self-help group populations. American Journal of Community Psychology, 16(1), 53–77.PubMedCrossRefGoogle Scholar
  42. McLellan, A. T. (2008). Evolution in addiction treatment concepts and methods. In M. Galanter, H. D. Kleber, M. Galanter & H. D. Kleber (Eds.), The American psychiatric publishing textbook of substance abuse treatment (4th ed., pp. 93–108). Arlington, VA: American Psychiatric Publishing, Inc.Google Scholar
  43. Meissen, G. J., Mason, W. C., & Gleason, D. F. (1991). Understanding the attitudes and intentions of future professionals towards self-help. American Journal of Community Psychology, 19(5), 699–714.PubMedCrossRefGoogle Scholar
  44. Meissen, G., Powell, T. J., Wituk, S. A., Girrens, K., & Arteaga, S. (1999). Attitudes of AA contact persons toward group participation by persons with a mental illness. Psychiatric Services, 50(8), 1079–1081.PubMedGoogle Scholar
  45. Meissen, G., Wituk, S., Warren, M., & Shepherd, M. (2000). Self-help groups and managed health care: Obstacles and opportunities. International Journal of Self-Help and Self-Care, 1 (2), 201–210.CrossRefGoogle Scholar
  46. Meyer, J. W., & Rowan, B. (1977). Institutionalized organizations: Formal structure as myth and ceremony. The American Journal of Sociology, 83(2), 340–363.CrossRefGoogle Scholar
  47. Meyer, J. W. (1986). Institutional and organizational rationalization in the mental health system. In W. R. Scott, & B. L. Black (Eds.), The organization of mental health services. Beverly Hills, CA: Sage Publications.Google Scholar
  48. Miller, N. S. (1994). Treating coexisiting psychiatric and addictive disorders: A practical guide. Center City, MN: Hazelden Educational Materials.Google Scholar
  49. Moos, R. H. (2007). Theory-based processes that promote the remission of substance use disorders. Clinical Psychology Review, 27(5), 537.PubMedCrossRefGoogle Scholar
  50. Moos, R. H., & Timko, C. (2008). Outcome research on 12-step and other self-help programs. In M. Galanter, H. D. Kleber, M. Galanter & H. D. Kleber (Eds.), The American Psychiatric Publishing Textbook of Substance Abuse Treatment (4th ed., pp. 511–521). Arlington, VA: American Psychiatric Publishing, Inc.Google Scholar
  51. Mowrer, O. H. (1984). The mental health professions and mutual-help program: Co-optation or collaboration. In A. Gartner, & F. Riessman (Eds.), Self-help revolution (pp. 139–154). New York: Human Sciences Press Inc.Google Scholar
  52. Murray, E., Burns, J., See-Tai, S., Lai, R., & Nazareth, I. (2005). Interactive health communication applications for people with chronic disease. Cochrane Database of Systematic Reviews, 4, 1–70.Google Scholar
  53. Narrow, W. E., Regier, D. A., Rae, D. S., Manderscheid, R. W., & Locke, B. Z. (1993). Use of services by persons with mental and addictive disorders: Findings from the national institute of mental health epidemiologic catchment area program. Archives of General Psychiatry, 50(2), 95–107.PubMedCrossRefGoogle Scholar
  54. Norcross, J. C. (2006). Integrating self-help into psychotherapy: 16 practical suggestions. Professional Psychology-Research and Practice, 37(6), 683–693.CrossRefGoogle Scholar
  55. Nowinski, J., & Baker, S. (1992). The twelve-step facilitation handbook: A systematic approach to early recovery from alcoholism and addiction. New York: Lexington Books.Google Scholar
  56. Perron, B. E., Mowbray, O. P., Glass, J. E., Delva, J., Vaughn, M. G., & Howard, M. O. (2009). Differences in service utilization and barriers among African Americans, Hispanics, and Caucasians with drug use disorders. Substance Abuse Treatment, Prevention, and Policy, 4, 1–10 (electronic).Google Scholar
  57. Pistrang, N., Barker, C., & Humphreys, K. (2008). Mutual help groups for mental health problems: A review of effectiveness studies. American Journal of Community Psychology, 42(1), 110–121.PubMedCrossRefGoogle Scholar
  58. Powell, T., & Perron, B. E. (2010). Self-help groups and mental Health/Substance use agencies: The benefits of organizational exchange. Substance Use & Misuse, 45 Google Scholar
  59. Powell, T. J. (1990). Self-help, professional help, and informal help: Competing or complementary systems? In T. J. Powell (Ed.), Working with self-help (pp. 31–49). Silver Spring, MD: National Association of Social Workers.Google Scholar
  60. Powell, T. J., Hill, E. M., Warner, L., Yeaton, W., & Silk, K. R. (2000). Encouraging people with mood disorders to attend a self-help group. Journal of Applied Social Psychology, 30(11), 2270–2288.CrossRefGoogle Scholar
  61. Powell, T. J., Yeaton, W., Hill, E. M., & Silk, K. R. (2001). Predictors of psychosocial outcomes for patients with mood disorders: The effects of self-help group participation. Psychiatric Rehabilitation Journal, 25(1), 3–11.PubMedCrossRefGoogle Scholar
  62. Project MATCH Research Group: Allen, J., Anton, R. F., Babor, T. F., Carbonari, J., Carroll, K. M., Connors, G. J., et al. (1998). Matching alcoholism treatments to client heterogeneity: Project Match three-year drinking outcomes. Alcoholism-Clinical and Experimental Research, 22(6), 1300–1311.Google Scholar
  63. Raven, B. H. (1988). Social power and compliance in health care. In S. Maes, C. D. Spielberger, P. B. Defares & I. G. Sarason (Eds.), Topics in health psychology (pp. 229–244). New York: Wiley.Google Scholar
  64. Raven, B., Schwarzwald, J., & Koslowsky, M. (1998). Conceptualizing and measuring a Power/Interaction model of interpersonal influence. Journal of Applied Social Psychology, 28(4), 307–332.CrossRefGoogle Scholar
  65. Ries, R. K., Galanter, M., & Tonigan, J. S. (2008). Twelve-step facilitation. In M. Galanter, H. D. Kleber, M. Galanter & H. D. Kleber (Eds.), The American psychiatric publishing textbook of substance abuse treatment (4th ed., pp. 373–386). Arlington, VA US: American Psychiatric Publishing, Inc.Google Scholar
  66. Riessman, F. (1965). The helper-therapy principle. Social Work, 10(2), 27–32.Google Scholar
  67. Riessman, F., David. (1995). Redefining self-help. San Francisco: Jossey Bass.Google Scholar
  68. Roberts, L. J., Salem, D., Rappaport, J., Toro, P. A., Luke, D. A., & Seidman, E. (1999). Giving and receiving help: Interpersonal transactions in mutual-help meetings and psychosocial adjustment of members. American Journal of Community Psychology, 27(6), 841–868.PubMedCrossRefGoogle Scholar
  69. Sagarin, E. (1969). Odd man in: Societies of deviants in America. New York: Quadrangle.Google Scholar
  70. Salem, D. A., Reischl, T. M., Gallacher, F., & Randall, K. W. (2000). The role of referent and expert power in mutual help. American Journal of Community Psychology, 28(3), 303–324.PubMedCrossRefGoogle Scholar
  71. Salem, D., Reischl, T., & Randall, K. (2008). The effect of professional partnership on the development of a mutual-help organization. American Journal of Community Psychology, 42(1–2), 179–191.PubMedCrossRefGoogle Scholar
  72. Salzer, M. S., Rappaport, J., & Segre, L. (2001). Mental health professionals’ support of self-help groups. Journal of Community & Applied Social Psychology, 11(1), 1–10.CrossRefGoogle Scholar
  73. Salzer, M. S., Rappaport, J., & Segre, L. (1999). Professional appraisal of professionally led and self-help groups. American Journal of Orthopsychiatry, 69(4), 536–540.PubMedCrossRefGoogle Scholar
  74. Schacter, S. (1959). The psychology of affiliation. Stanford, CA: Stanford University Press.Google Scholar
  75. Schmid, H. (2004). Organization-environment relationships: Theory for management practice in human service organizations. Administration-in-Social-Work, 28(1), 97–113.CrossRefGoogle Scholar
  76. Schubert, M. A., & Borkman, T. J. (1991). An organizational typology for self-help groups. American Journal of Community Psychology, 19(5), 769–787.PubMedCrossRefGoogle Scholar
  77. Scott, W. R. (2005). Institutional theory: Contributing to a theoretical research program. In K. G. Smith, & M. A. Hitt (Eds.), Great minds of management: The process of theory development (2nd ed., pp. 460–484). New York: Oxford University Press.Google Scholar
  78. Scott, W. R. (2003). Organizations: Rational, natural, and open systems. Upper Saddle River, NJ: Prentice Hall.Google Scholar
  79. Scott, W. R. (2001). Institutions and organizations (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
  80. Seligman, M. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50(12), 965–974.PubMedCrossRefGoogle Scholar
  81. Shepherd, M. D., Schoenberg, M., Slavich, S., Wituk, S., Warren, M., & Meissen, G. (1999). Continuum of professional involvement in self-help groups. Journal of Community Psychology, 27(1), 39–53.CrossRefGoogle Scholar
  82. Timko, C., & Debenedetti, A. (2007). A randomized controlled trial of intensive referral to 12-step self-help groups: One-year outcomes. Drug & Alcohol Dependence, 90(2–3), 270–279.CrossRefGoogle Scholar
  83. Timko, C., Debenedetti, A., & Billow, R. (2006). Intensive referral to 12-step self-help groups and 6-month substance use disorder outcomes. Addiction, 101(5), 678–688.PubMedCrossRefGoogle Scholar
  84. Toro, P., Zimmerman, M., Seidman, E., Reischl, T., Rappaport, J., Luke, D., et al. (1988). Professionals in mutual help groups: Impact on social climate and members’ behaviour. Journal of Consulting and Clinical Psychology, 56(4), 631–632.PubMedCrossRefGoogle Scholar
  85. United States Public Health Service (USPHS), Office of the Surgeon General (OSG), Center for Mental Health Services (CMHS), & National Institute of Mental Health (NIMH.). (2000). Mental health A Report of the Surgeon General. Washington, DC: Department of Health and Human Services.Google Scholar
  86. Wang P. S., Lane, M., Olfson, M., Pincus H., A., Wells K., B., & Kessler R., C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 629–640.PubMedCrossRefGoogle Scholar
  87. Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 603–613.PubMedCrossRefGoogle Scholar
  88. Wang, P. S., Berglund, P., & Kessler, R. C. (2000). Recent care of common mental disorders in the United States: Prevalence and conformance with evidence-based recommendations. Journal of General Internal Medicine, 15(5), 284–292.PubMedCrossRefGoogle Scholar
  89. Warner, L., Silk, K., Yeaton, W. H., Bargal, D., Janssen, J., & Hill, E. M. (1994). Psychiatrists’ and patients’ views on drug information and medication compliance. Hospital and Community Psychiatry, 45(12), 1235–1237.PubMedGoogle Scholar
  90. Watkins, P. L., & Clum, G. A. (2008). Handbook of self-help therapies. New York: Routledge.Google Scholar
  91. White, W., & Kurtz, E. (2005). The varieties of recovery experience: A primer for addiction treatment professionals and recovery advocates. International Journal of Self Help and Self Care, 3(1), 21–61.CrossRefGoogle Scholar
  92. White, W. L. (1998). Slaying the dragon: The history of addiction treatment and recovery in America. Bloomington, IL: Chestnut Health Systems/Lighthouse Institute.Google Scholar
  93. World Health Organization (WHO), (2001). The world health report 2001 – mental health: New understanding, new hope. Retrieved online January 23, 2009 from
  94. Wilson, J. (1995a). How to work with self-help groups: Guidelines for professionals. Hants: Arena/Ashgate Publishing.Google Scholar
  95. Wilson, J. (1995b). Two worlds: Self-help groups and professionals. London: Venture Press.Google Scholar
  96. Wituk, S., Ealey, S., Brown, L., Shepherd, M., & Meissen, G. (2005). Assessing the needs and strengths of self-help groups: Opportunities to meet health care needs. International Journal of Self Help & Self Care, 3(1–2), 103–116.CrossRefGoogle Scholar
  97. Wituk, S., Shepherd, M. D., Slavich, S., Warren, M. L., & Meissen, G. (2000). A topography of self-help groups: An empirical analysis. Social Work, 45(2), 157–165.PubMedCrossRefGoogle Scholar
  98. Wituk, S. A., Tiemeyer, S., Commer, A., Warren, M., & Meissen, G. (2003). Starting self-help groups: Empowering roles for social workers. Social Work with Groups, 26(1), 83–92.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Thomas J. Powell
    • 1
  • Brian E. Perron
    • 1
  1. 1.School of Social WorkUniversity of MichiganAnn ArborUSA

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