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. Author manuscript; available in PMC: 2024 Mar 1.
Published in final edited form as: Psychol Addict Behav. 2022 Mar 10;37(2):228–234. doi: 10.1037/adb0000828

Online support for all: Examining participant characteristics, engagement, and perceived benefits of an online harm reduction, abstinence, and moderation focused support group for alcohol and other drugs

Frank J Schwebel 1,1, Daniel G Orban 1
PMCID: PMC9463399  NIHMSID: NIHMS1781318  PMID: 35266792

Abstract

Objective:

Online support groups for individuals with substance use disorders are regularly used yet little is known about participant engagement patterns. Preliminary research has examined utilization and perceived benefits of an abstinence-focused online social network. This study sought to extend these findings by examining participant characteristics, engagement, and perceived benefits of online support groups for individuals with broader personal substance use goals (Harm reduction, Abstinence, and Moderation Support (HAMS)).

Method:

HAMS members were invited to complete an online survey about their HAMS engagement (n=343). The average age of participants was 41.55 (SD=12.61) and most identified as White (93.9%), female (78.8%), and cisgender women (70.1%). Participants completed measures of HAMS participation, substance use goal, quantity/frequency of substance use, mental health history, negative substance use-related consequences, and quality of life.

Results:

Most participants (67.1%) reported a substance use moderation goal and alcohol was the most commonly used substance (91.6%). Participants most frequently reported visiting HAMS on Facebook (89.5%), visiting HAMS daily (39.2%) and visits typically lasted up to 30 minutes (86.1%). Most participants somewhat or strongly agreed HAMS helped them feel better about changing their use of drugs/alcohol (87.1%, M=4.41/5, SD=0.81), increased their motivation for changing their use of drugs/alcohol (89.2%, M=4.44/5, SD=0.77), and increased their self-efficacy in reaching/maintaining the substance use goals (85.1%, M=4.29/5, SD=1.05).

Conclusions:

Online support for broader personal substance use goals may be beneficial for individuals who seek to stop/limit their substance use. Online support is well-suited for obtaining quick, inexpensive access to support.

Keywords: harm reduction, substance use disorder, support groups, online support groups, ehealth

Introduction.

Although an estimated 21.2 million people in the United States need treatment for a substance use disorder (SUD), only 1 in 10 individuals receive treatment due to a lack of access to treatment providers (Substance Abuse and Mental Health Services Administration, Office of the Surgeon General, US Department of Health and Human Services, 2016). The National Institute on Drug Abuse (NIDA) 2016–2020 Strategic Plan highlighted the need to leverage technology-delivered interventions to expand the reach of treatment (NIDA, 2020). Additionally, technology-delivered interventions may provide an avenue to engage individuals who might otherwise be hesitant to seek traditional (e.g., in-person) treatment services.

The traditional “gold standard” SUD treatment goal has been complete abstinence, stemming from the Temperance Movement and Alcoholics Anonymous views on substance use and recovery (Davis & Rosenberg, 2013; Witkiewitz, Montes, et al., 2020). This single-minded approach may deter individuals with different goals from seeking treatment or cause them to terminate treatment prematurely. In recent years, studies have examined other markers of recovery (e.g., health, life satisfaction, and functioning; Wilson et al., 2016; Witkiewitz, Pearson, et al., 2020) and alternative definitions of recovery that do not require abstinence and incorporate other metrics of well-being have been proposed (e.g., Witkiewitz, Montes, et al., 2020).

Mutual help/support groups for addiction such as Alcoholics Anonymous (AA) have existed since the 1930s and have greatly influenced the treatment of SUD (White & Kurtz, 2008). Social support networks have been identified as an AA mechanism of behavior change and are considered a vital component of AA effectiveness (Groh et al., 2008; Kelly et al., 2011). AA meetings are traditionally held in-person but in recent years meetings have moved online (Nash, 2020). This transition has occurred partly out of necessity to extend the reach of treatment services in large rural countries (e.g., Russia; Lyytikäinen, 2017) and these efforts have been hastened globally as a result of the COVID-19 pandemic (Bergman et al., 2021). Although little is known regarding the effects of meeting in-person compared to online, online social groups have emerged as a low-cost, easily accessible, and beneficial resource for a wide-range of challenges (Maher et al., 2014) including depression (Breuer & Barker, 2015), grief (Varga & Paulus, 2013), weight loss maintenance (Ufholz, 2020), physical activity (Foster et al., 2010), smoking (Shahab & McEwen, 2009), and substance misuse (Bergman et al., 2017). Other studies have found that online video-based support may be less effective than in-person support for SUD (Barrett & Murphy, 2020) but still are considered an important source of support (Barrett & Murphy, 2020; Kosok, 2006).

Bergman and colleagues (2017) examined the impact of a recovery- and abstinence-focused online social networking site. They found that the social networking site effectively delivered web-based resources and created online ‘communities’ to support changes to alcohol and other drug use. The authors theorized that the mechanism for these changes is through the exposure to role models and conversations which increase recovery motivation and access to recovery tools leading to better outcomes. However, the study focused on individuals who were abstinent from drugs or working toward abstinence and it is possible this does not encompass the entire range of change goals. Thus, it is important to examine social networking site and online support groups that are not primarily AA/abstinence-oriented.

The Harm reduction, Abstinence, and Moderation Support (HAMS; www.hams.cc) group began as a private forum-based support group for changing alcohol use in 2007. Since then, it has expanded to focus on other substances and has multiple active Facebook groups in addition to the original forum-based support. HAMS also provides other services such as a chat room, email group, and live meetings. Members can post messages in any of the HAMS groups and receive feedback/support from other members and moderators. In addition, the HAMS website includes articles with resources to support changing alcohol use behavior. HAMS resources are free, available online, and accessible 24 hours per day (with internet access).

The purpose of this study was to extend the Bergman and colleagues (2017) study by describing the demographics and clinical characteristics of HAMS members, examining HAMS engagement, and examining perceived benefits of HAMS. We also explored whether engagement and outcomes differed based on self-reported substance use goal. Because analyses were exploratory, no hypotheses were proposed.

Method.

Procedure.

Current HAMS members, who were 18 years of age or older and who used HAMS for a current or past substance use problem were recruited to complete the online survey. HAMS moderators pinned (e.g., message displayed above other messages) an Institutional Review Board (IRB) approved recruitment message across all HAMS groups for 6+ weeks. Data were collected using Qualtrics survey software between March and August 2021. Participants were offered the opportunity to receive a $10 electronic gift card for completing the survey. Median completion time was 24.7 minutes. This study was approved by the University of New Mexico IRB.

Measures.

HAMS participation.

We used a modified version of the ordinal scales created by Bergman and colleagues (2017) to assess past 90-day frequency of HAMS visits (0 = never, 5 = several times per day), time spent visiting HAMS per day (1 = just a few minutes, 5 = more than 3 hours). Participants reported on lifetime and past 90-day engagement with HAMS support tools from a list (e.g., post a message in the Facebook group; see Figure 1). Participants also responded to four items assessing perceived benefit of HAMS on changing their substance use behavior, craving, substance use behavior change self-efficacy, and substance use change motivation on a 5-point response scale (1 = strongly disagree, 5 = strongly agree).

Figure 1.

Figure 1.

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Proportion of HAMS engagement during the past 90 days by treatment goal

Note. DB = Discussion board. FB = Facebook. SG = Support group.

Substance use goal.

We used a single item to assess participants’ substance use goal (excluding nicotine/tobacco). Goals were classified as either a total abstinence goal (“Currently abstaining from all drugs/alcohol”), partial abstinence goal (“Currently abstaining from one or more substances but not all”), moderation goal (“I am working toward or am successfully setting limits/moderating my drug/alcohol use”), or no limits goal (“I am using drugs/alcohol without limits or restrictions”). Participants who reported an abstinence goal were asked how long they have been abstinent and what substance(s) they were abstaining from. Participants with a partial abstinence goal were asked what substances they are and are not abstaining from. Participants with a moderation goal were asked what substances they are moderating their use of and how they quantify their moderation goal (e.g., use episodes, use quantity, number of use days). Participants with a no limit goal were asked what substances they are using without limits.

Substance use, psychiatric and mental health history.

All participants were asked to report the primary and secondary (if applicable) substance they use(d). Participants who reported any goal other than a total abstinence goal were asked to report on the quantity and frequency of their past 30-day substance use using a modified version of the Daily Drinking Questionnaire (DDQ; Collins et al., 1985). Frequency of alcohol and cannabis use, peak consumption, and frequency of heavy use as well as number of drinks/grams consumed each day for a typical week were assessed using a single item. A standard drink/grams of cannabis chart was provided to aid in responding to the alcohol/cannabis use items. Participants also reported on their past clinical treatment experiences and psychiatric medication history (see Table 1).

Table 1.

Overall clinical characteristics and clinical characteristics by substance use goal

Overall Total abstinence goal Partial abstinence goal Moderation goal No limit goal
Substance use goal N = 343 n = 41 n = 49 n = 226 n = 21
Primary substance used (lifetime)
 Alcohol 306 (91.6%) 39 (95.1%) 37 (75.5%) 211 (94.6%) 19 (90.5%)
 Cannabis 14 (4.2%) 0 (0.0%) 6 (12.2%) 7 (3.1%) 1 (4.8%)
 Prescription opioids 3 (0.9%) 1 (2.4%) 0 (0.0%) 2 (0.9%) 0 (0.0%)
 Other 11 (3.3%) 1 (2.4%) 6 (12.3%) 3 (1.4%) 1 (4.8%)
Secondary substance used (lifetime)
 Not applicable (e.g., only used one) 128 (39.0%) 20 (51.3%) 9 (18.8%) 93 (42.1%) 6 (30.0%)
 Alcohol 22 (6.7%) 1 (2.6%) 9 (18.8%) 11 (5.0%) 1 (5.0%)
 Cannabis 94 (28.7%) 7 (17.9%) 11 (22.9%) 67 (30.3%) 9 (45.0%)
 Cocaine 31 (9.5%) 4 (10.3%) 6 (12.5%) 19 (8.6%) 2 (10.0%)
 Other 53 (16.1%) 7 (17.9%) 13 (27%) 31 (14.0%) 2 (10.0%)
Treatment history (lifetime)
 Inpatient SUD treatment 86 (35.1%) 21 (56.8%) 22 (55.0%) 38 (24.8%) 5 (33.3%)
 Outpatient SUD treatment 114 (46.3%) 26 (70.3%) 30 (75.0%) 53 (34.4%) 5 (33.3%)
 Detoxification services 72 (29.4%) 19 (51.4%) 21 (52.5%) 29 (19.0%) 3 (20.0%)
 Sober living 24 (9.8%) 7 (18.9%) 8 (20.0%) 8 (5.3%) 1 (6.7%)
 Outpatient mental health treatment 147 (60.7%) 21 (56.8%) 28 (71.8%) 89 (58.9%) 9 (60.0%)
Alcohol use disorder medication (lifetime) 75 (30.9%) 14 (37.8%) 16 (40.0%) 43 (28.5%) 2 (13.3%)
 Current 26 (34.7%) 4 (28.6%) 5 (31.3%) 17 (39.5%) 0 (0.0%)
Opioid agonist medication (lifetime) 8 (3.3%) 0 (0%) 4 (10.3%) 3 (2.0%) 1 (6.7%)
 Current 6 (75.0%) 0 (0%) 4 (100%) 2 (66.7%) 0 (0.0%)
Opioid antagonist medication (lifetime) 23 (9.5%) 4 (10.8%) 9 (23.1%) 9 (6.0%) 1 (6.7%)
 Current 7 (30.4%) 1 (25.0%) 3 (33.3%) 3 (33.3%) 0 (0.0%)
Medication for depression (lifetime) 183 (75.6%) 26 (70.3%) 34 (87.2%) 110 (72.8%) 13 (86.7%)
 Current 107 (58.5%) 14 (53.8%) 20 (58.8%) 65 (59.1%) 8 (61.5%)
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Note. Six participants did not report their substance use goal. Summing individual cells may not equal overall column total due to missingness. Percentage reported excludes missing responses.

Negative substance use-related consequences.

We used the 50-item Inventory of Drug Use Consequences (InDUC; Tonigan & Miller, 2002) to assess the lifetime number of negative substance use-related consequences experienced by participants. Participants responded whether they had ever experienced a wide-range of negative substance use-related consequences (“The quality of my work has suffered because of my drinking or drug use”). Items were summed to create a total score representing the total number of lifetime negative consequences experienced at least once.

Quality of life.

We used the 26-item World Health Organization Quality-of-Life Scale-BREF (WHOQOL-BREF; WHOQOL Group, 1998) to assess participants’ perceived quality of life during the past 2 weeks in physical health (“Do you have enough energy for everyday life?”), psychological (“To what extent do you consider your life to be meaningful?”), social (“How satisfied are you with your personal relationships?”), and environmental (“To what extent do you have the opportunity for leisure activities?”) domains of functioning. Items were responded to with varying 5-point scales (1 = very poor; very dissatisfied; not at all to 5 = very good; very satisfied; an extreme amount) depending on the question. Items in each subscale were averaged.

Data cleaning.

Of the 387 individuals who clicked the survey link, 23 did not complete any questions. Of the 364 remaining individuals, 10 were excluded for not being a HAMS member or for not being a HAMS member for their own substance use problem. Of the 354 remaining individuals, 11 surveys were excluded from the final analysis due to having a duplicate IP address as another survey completion (the first survey completed was retained). This resulted in a final analytic sample of 343 participants.

Analytic plan.

For Aims 1–3, we used descriptive statistics. In order to compare outcomes across treatment goals, we conducted a series of one-way ANOVAs. A Tukey-Kramer test was used to examine significant differences and to account for the unequal sample sizes across conditions. Given the exploratory nature of the study, an a priori decision was made to set alpha to .05 for the series of one-way ANOVAs. This decision was made to balance Type I error rate and statistical power. Study materials and analysis code are available via email from the corresponding author.

Results.

HAMS demographics.

Among the final analytic sample (N = 343), the average age was 41.55 years (SD = 12.61). Most participants were female (78.8%) and identified as cisgender women (70.1%). Most participants identified as White (93.9%), 5.8% identified as Hipanic/Latino, 3.2% identified as “Other”, 2.9% identified as American Indian/Alaska Native, 1.2% identified as Black, and 0.9% identified as Asian. 98.6% of participants owned a smartphone. Most participants (66.2%) were introduced to HAMS via social media. Some participants were introduced to HAMS via friends/family, another support group, therapist, treatment facility, or media (15.0% total). The remaining participants discovered HAMS by “other” means (18.9%).

A majority of participants (67.1%) reported working toward setting limits or moderating their substance use (i.e., moderation goal); 14.5% reported abstaining from one or more substances but not all (i.e., partial abstinence goal); 12.2% reported abstaining from all substances (i.e., total abstinence goal); and 6.2% reported no limits/restrictions on their substance use (i.e., no limits goal). Alcohol (91.6%) was the most frequently reported primary substance participants used. Cannabis (28.7%) was the most frequently reported secondary substance currently or previously used. During the past month, alcohol (49.3%) and cannabis (24.4%) were most frequently reported as being used, followed by prescription sedatives (8.7%).

Among participants who reported a total abstinence goal, 65.9% were abstinent for less than 1 year, whereas 34.1% were abstinent more than 1 year (maximum reported: 9 years). The substance most individuals identified as abstaining from was alcohol (54.8%).

Participants with a partial abstinence goal reported abstaining from the following substances at a relatively similar rate: alcohol (11.6%), cocaine (11.6%), heroin (8.0%), methamphetamine (8.0%), MDMA/“ecstasy”/“molly” (7.6%), prescription opioids (7.6%), cannabis (7.1%), prescription stimulants (7.1%), synthetic cannabinoids (e.g., “Spice”) (6.7%), prescription sedatives (6.7%), bath salts (6.7%), hallucinogens (5.8%), and over-the-counter cold medicine (5.8%). Individuals with a partial abstinence goal reported primarily continuing to use cannabis (33.8%), alcohol (28.6%), prescription sedatives (13.0%), and hallucinogens (10.4%).

Alcohol was the most frequently identified substance participants with a moderation (74.7%) or no limit (47.6%) goal reported using. Cannabis was the second most frequently identified substance participants with a moderation (11.5%) or no limit (23.8%) goal reported using. In terms of participant definitions of moderated use, number of days using a substance (75.7%) or quantity (“amount”) consumed of a substance (61.1%) were most commonly reported.

In terms of lifetime substance use treatment history, 46.3% reported ever receiving outpatient services; 29.4% reported ever receiving alcohol or drug detoxification services; 35.1% reported ever receiving inpatient/residential treatment; and 9.8% reported ever living in a halfway house, sober dorm, or other sober living environment. In terms of lifetime mental health treatment history, 60.7% reported ever receiving outpatient mental health services.

Most participants reported not taking medication for alcohol use disorder and only 26 participants reported currently taking medications for alcohol use disorder. A similar pattern was observed for medications for opioid use disorder with only 6 participants reporting current medication for opioid use disorder use. However, 75.6% of participants reported ever taking an antidepressant and 58.5% of those individuals reported currently taking one.

HAMS engagement.

Participants most frequently reported visiting HAMS daily (39.2%) or several times per day (25.1%) and their visit typically lasted a few minutes (46.9%) to about 30 minutes (37.5%). Participants primarily accessed HAMS via their cellphone (M = 63.3%, SD = 39.5) and 39.6% accessed HAMS exclusively via cellphone. In terms of engagement with HAMS during the past 90 days, the most common methods of engagement on Facebook were by reading a Facebook group post (87.5%), posting in the Facebook group (60.3%), or posting a status update (32.3%). On the HAMS forum, reading a discussion board post (37.0%) and posting on the discussion board (26.1%) were the most common engagement methods. Other ways participants interacted with the HAMS Facebook groups and forum included posting a sending an individual chat or message (18.3%) and posting a photo (12.8%) (see Table 2 for overall engagement and engagement by substance use goal rates). A minority of participants reported not engaging with HAMS in any of the ways assessed by the measure (1.9%).

Table 2.

HAMS overall engagement and engagement by substance use goal

Overall Total abstinence goal Partial abstinence goal Moderation goal No limit goal
HAMS Logons N = 343 n = 41 n = 49 n = 226 n = 21
 Never 6 (1.7%) 1 (2.5%) 1 (2.4%) 3 (1.8%) 1 (6.3%)
 Once/twice per month or less 16 (6.1%) 4 (10.0%) 5 (12.2%) 6 (3.6%) 1 (6.3%)
 Approximately once per week 20 (7.6%) 1 (2.5%) 4 (9.8%) 14 (8.4%) 1 (6.3%)
 Several times per week 52 (19.8%) 15 (37.5%) 4 (9.8%) 28 (16.9%) 5 (31.3%)
 Daily 103 (39.2%) 13 (32.5%) 19 (46.3%) 66 (39.8%) 5 (31.3%)
 Several times per day 66 (25.1%) 6 (15.0%) 8 (19.5%) 49 (29.5%) 3 (18.8%)
Time spent on HAMS
 Just a few minutes 120 (46.9%) 24 (61.5%) 16 (40.0%) 74 (45.7%) 6 (40.0%)
 Approximately 30 minutes 96 (37.5%) 12 (30.8%) 16 (40.0%) 62 (38.3%) 6 (40.0%)
 Approximately 1 hour 29 (11.3%) 3 (7.7%) 4 (10.0%) 20 (12.3%) 2 (13.3%)
 1–3 hours 10 (3.9%) 0 (0%) 4 (10.0%) 5 (3.1%) 1 (6.7%)
 3+ hours 1 (0.4%) 0 (0%) 0 (0%) 1 (0.6%) 0 (0.0%)
HAMS engagement
 Read discussion board post 95 (37.0%) 15 (37.5%) 13 (35.1%) 65 (39.6%) 2 (12.5%)
 Posted on discussion board 67 (26.1%) 9 (22.5%) 10 (27.0%) 46 (28.0%) 2 (12.5%)
 Read Facebook group post 225 (87.5%) 34 (85.0%) 34 (91.9%) 144 (87.8%) 13 (81.3%)
 Posted to Facebook group 155 (60.3%) 26 (65.0%) 26 (70.3%) 94 (57.3%) 9 (56.3%)
 Posted a status update 83 (32.3%) 15 (37.5%) 12 (32.4%) 52 (31.7%) 4 (25.0%)
 Posted a photo 33 (12.8%) 6 (15.0%) 3 (8.1%) 23 (14.0%) 1 (6.3%)
 “Attend” a live online video meeting 12 (4.7%) 1 (2.5%) 1 (2.7%) 9 (5.5%) 1 (6.3%)
 Participated in a live online video meeting 12 (4.7%) 1 (2.5%) 2 (5.4%) 8 (4.9%) 1 (6.3%)
 Group chat 16 (6.2%) 1 (2.5%) 3 (8.1%) 9 (5.5%) 3 (18.8%)
 Individual chat or message 47 (18.3%) 17 (7.5%) 4 (10.8%) 33 (20.1%) 3 (18.8%)
 Read an email support group message 13 (5.1%) 2 (5.0%) 3 (8.1%) 8 (4.9%) 0 (0.0%)
 Sent or responded to an email support group message 12 (4.7%) 3 (7.5%) 3 (8.1%) 6 (3.7%) 0 (0.0%)
 Other 5 (1.9%) 0 (0%) 2 (5.4%) 2 (1.2%) 1 (6.3%)
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Note. Six participants did not report their substance use goal. Summing individual cells may not equal overall column total due to missingness. Percentage reported excludes missing responses.

Perceived benefits.

In terms of HAMS participation benefits, participants somewhat or strongly agreed that HAMS participation helped them feel better about changing their use of drugs and alcohol (87.1%; M = 4.41/5; SD = 0.81), increased their motivation for reducing harm, moderating, or abstaining from drugs and alcohol (89.2%; M = 4.44/5; SD = 0.77), increased their self-efficacy in maintaining their substance use goals (85.1%; M = 4.29/5; SD = 0.91). Similarly, slightly more than half of participants felt HAMS participation helped decrease their cravings for drugs and alcohol (somewhat agree or strongly agree) (54.3%; M = 3.78/5; SD = 1.05). Over three-quarters of participants strongly agreed that they would be sorry if HAMS shut down (76.7%; M = 4.66; SD = 0.71). In general, participants reported somewhat or strong agreement that they feel supported by the HAMS community (82.4%; M = 4.25/5; SD = 0.95) and very or totally safe (72.1%; M = 3.91/5; SD = 0.91) engaging with the HAMS online support group community.

Substance Use Goal and Outcomes.

There were two significant differences observed between substance use goal and outcomes. The first difference observed was in psychological health (F(3, 218) = 2.65, p <.05). A post-hoc Tukey-Kramer test showed that participants with a total abstinence goal had significantly higher levels of psychological health than participants with a moderation goal (p < .05). There also was a significant difference observed in lifetime negative substance use-related consequences (F(3, 212) = 4.25, p < .01). A post-hoc Tukey-Kramer test showed that participants with a moderation goal experienced significantly fewer lifetime negative substance use-related consequences than participants with a partial abstinence goal (p < .01). Differences in engagement rate by substance use goal are presented in Figure 1.

Discussion.

This study sought to extend findings on engagement with an abstinence focused online social network by Bergman and colleagues (2017) by examining participant characteristics, engagement, and perceived benefits of an online support group for individuals with a broad range of personal substance use goals (e.g., harm reduction, abstinence, moderation). Participants regularly engaged with HAMS and our results are similar to Bergman and colleagues’ (2017), suggesting that online support groups and social network sites may be an important self-help support tool for individuals with any personal substance use goal.

Although HAMS began as an online forum-based support group, participants reported greater engagement with the Facebook support groups. Participants mainly read or posted messages in the groups but also reported using individual chat/messaging options to communicate with other group members. Participants were primarily female, similar to findings by Kosok (2006). This might suggest that online support is particularly beneficial for females who often have less free time as a result of working the “second shift” (Hochschild & Machung, 2012). HAMS participants generally reported strong, positive beliefs about the impact of HAMS participation, including support in changing their substance use behavior, substance use behavior change self-efficacy, and substance use behavior change motivation. Although the HAMS participation has the least perceived benefit on cravings, a majority of participants still reported a positive benefit of HAMS on craving. Importantly, most participants reported feeling safe and supported while engaging with HAMS support. These results are in contrast to those of Barrett et al. (2020) who found in-person support to be more effective. Given the perceived benefits of HAMS participation, it appears that HAMS is a useful self-directed self-help tool for individuals who are interested in stopping, limiting, or decreasing harm from their substance use. HAMS might also provide an alternative for individuals who live in rural areas and have limited access to care (e.g., Lyytikäinen, 2017) or for individuals who need inexpensive or free care. HAMS might also be useful as short-term support for individuals who are on a waitlist for in-person treatment.

The statistical analyses revealed two significant differences between substance use goal and outcomes. The first indicated that individuals with a total abstinence goal reported significantly greater psychological health than individuals with a moderation goal. This may suggest the participants have created a social network of supportive abstinence-focused individuals (Muller et al., 2017) or perhaps is an indicator that the participants with an abstinence goal are well on their way to recovery (Kelly et al., 2018). The second was in lifetime negative substance use-related consequences. Participants with a moderation goal experienced fewer lifetime negative consequences than those in the abstinence condition. This might suggest participants who have experienced fewer negative substance use-related consequences are more likely prefer to moderate their use rather than abstaining.

Limitations.

Study results should be interpreted while accounting for limitations. First, the study is cross-sectional and causal inferences cannot be made. The sample size was modest and may not generalize to all HAMS members. Although efforts were made to recruit a representative sample (e.g., pinned recruitment post), it is possible participants tended to engage more with HAMS. In addition, a large proportion of participants were White and results may not generalize. Analytically, an a priori decision to not use an alpha correction was made due to the exploratory nature of the research. Caution is recommended in interpreting significant results. Some of the measures used were based on measures created or adapted by Bergman and colleagues (2017) and to our knowledge have not had extensive psychometric validation work done. Lastly, there are potential environmental limitations to access online support groups and treatment services. For example, certain places may have limited or inconsistent internet access and individuals accessing the internet via mobile device, may have data plan limits.

Conclusion.

This study suggests that a harm reduction, abstinence, and moderation focused online support group may have utility for individuals who are interested in stopping or limiting their substance use, expanding on prior work examining an abstinence-focused online social network site. HAMS members appear to engage with online HAMS support regularly and extensively. Furthermore, most HAMS members felt they had derived substantial benefit from HAMS participation. Most HAMS services are free and available online at all hours of the day. HAMS might be a particularly useful service for individuals with barriers to care (e.g., location, finances) or who are interested in a support group that is not only focused on an abstinence goal. Further work is needed to understand other metrics of HAMS engagement (e.g., use HAMS to find additional support, to support others they know), and the mechanisms by which HAMS helps improve substance use-related outcomes.

Public Health Significance Statements.

  • This cross-sectional study indicates an online support group for individuals with harm reduction, abstinence, and moderation substance use goals helps individuals feel better about changing their use, increases their motivation for changing their use, and increases their self-efficacy to achieve/maintain their substance use goals based on self-report.

  • This study offers support for non-abstinence goals being preferable for some individuals who are seeking to change their substance use.

  • Online support groups for individuals seeking support for their substance use might be particularly beneficial for individuals with limited access to treatment services or who need quick/inexpensive access to support.

Acknowledgements.

We would like to thank Dr. Brandon Bergman for sharing measures from his study which greatly inspired this study. We would like to thank Mr. Kenneth Anderson for allowing us to recruit from the HAMS online support groups. Finally, the authors would like to thank all the HAMS members who participated in this study.

This research was supported in part by a research grant (T32 AA018108) from the National Institute on Alcohol Abuse & Alcoholism (NIAAA). FJS is supported by a training grant (T32 AA018108) from the NIAAA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIAAA or National Institute of Health.

Footnotes

Partial results from this study have been submitted as a poster abstract to the 45th Annual RSA Scientific Meeting.

Data availability:

Materials and analysis code for this study are available by emailing the corresponding author.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Materials and analysis code for this study are available by emailing the corresponding author.

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