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. Author manuscript; available in PMC: 2023 Nov 11.
Published in final edited form as: Addict Res Theory. 2022 Nov 11;30(3):207–212. doi: 10.1080/16066359.2021.1999935

Understanding recovery Capital in relation to categorical 12-Step involvement and abstinence social support

John M Majer a, Leonard A Jason b, Ted J Bobak b
PMCID: PMC9585994  NIHMSID: NIHMS1810921  PMID: 36275074

Abstract

Background:

Although recovery capital represents various resources for persons recovering from substance use disorders, measures of this construct examine components that might not necessarily reflect the recovery goals of individuals who base their recovery through involvement in 12-step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). It is not clear whether 12-step involvement is related to recovery capital, particularly among individuals living in recovery homes who utilize social networks of recovering peers for their recovery. Thus, categorical involvement in a set of 12-step activities was examined in relation to recovery capital and abstinence social support.

Methods:

Differences in terms of general (recovery capital scores, retention rates) and abstinence-specific (abstinence social support) resources were examined in relation to recovery home residents who were (n = 395) and were not (n = 232) categorically involved in their 12-step recovery.

Results:

Residents with categorical 12-step involvement reported significantly higher levels of recovery capital and abstinence social support, and there was no significant difference observed in retention rates between residents who were/were not categorically involved in 12-step groups.

Conclusions:

Findings suggest community resources such as recovery homes and categorical involvement in 12-step groups are important recovery capital components that help individuals who use a 12-step approach to their recovery. Recovery capital among those involved with 12-step fellowships such as AA and NA should be assessed by examining abstinence-specific components such as representative involvement in 12-step groups and social support that is abstinence-specific.

Keywords: Recovery capital, categorical 12-step involvement, abstinence social support, recovery homes, Oxford House

Recovery from substance use disorders is best achieved when important individual (e.g. self-efficacy, hope, financial stability), social and community (e.g. social support, safe living environments, community involvement) needs are addressed (SAMHSA 2012). Such a holistic approach to recovery is likely to increase an individual’s recovery capital (i.e. personal, social, and community resources) and sustain one’s ongoing recovery from substance misuse (Best et al. 2021). Individual resources might include self-esteem (Tafarodi and Milne 2002), life satisfaction (Laudet and White 2008), self-efficacy and quality of life (Jason et al. 2021) whereas social embeddedness (Jason et al. 2020), social learning (Moos 2007) and involvement in various community activities (Granfield and Cloud 2001) exemplify social and community components. However, little is known about recovery capital among those pursing an abstinence-based, 12-step approach to their recovery.

Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are 12-step fellowships that provide members the opportunity to develop recovery capital by engaging in behaviors to maintain continuous abstinence. Investigators such as Humphreys et al. (2020) have examined the relationship of substance and use 12-step meeting attendance, but duration rather than frequency of attendance might be a better measure in relation to long-term outcomes (Moos and Moos 2004). There is empirical and theoretical basis to support the claim that examining rates of 12-step meeting attendance limits our understanding of 12-step groups and their effects. Research studies have demonstrated involvement in 12-step activities improves substance use outcomes independent of meeting attendance (Montgomery et al. 1995; Weiss et al. 2005; Timko and DeBenedetti 2007; Majer et al. 2011) and involvement in several abstinence-specific activities with recovering peers (Laudet and White 2008) has been found to be related to increased recovery outcomes.

Theoretically, involvement in AA and NA is best understood when participation across 12-step activities is concurrent and consistent with 12-step philosophy (Alcoholics Anonymous 2001; NA, 2008). Unfortunately, most research investigations do not conceptualize 12-step involvement in this manner and use measures that consist of items that are neither direct activities nor relevant to new members, include meeting attendance as a scoring item, and/or calculate summary scores from these measures (Humphreys et al. 1998; Timko et al. 2006; Rynes and Tonigan 2012; Tonigan et al. 2018; Costello et al. 2019) that inflate or decrease true scores of involvement in any one activity 12-step members are encouraged to engage in, categorically. Research has demonstrated a categorical approach (compared to summary score approaches to measuring 12-step involvement) to be a better predictor of abstinence outcomes at one-year in a national sample of recovery home residents (Majer et al. 2011) and to have separate effects from treatment conditions in predicting the likelihood of complete abstinence at two-years in a randomized clinical trial (Majer et al. 2013).

Although being categorically involved in 12-step activities is likely to be a meaningful factor related to recovery capital among individuals engaged in a 12-step approach, recovery capital theory was not conceived in the goal of maintaining abstinence (Cloud and Granfield 2008) or utilizing abstinence-based groups such as AA/NA (Granfield and Cloud 2001). However, some investigators have examined recovery capital in relation to abstinence. The inclusion of abstinence-based domains such as substance use and sobriety when measuring recovery capital (Groshkova et al. 2013) reflects the 12-step recovery aim of abstinence from alcohol and illicit drugs. Studies using such measures have demonstrated recovery capital to have important treatment implications for increasing retention and developing ongoing post-treatment recovery pathways among individuals whose recovery involves abstinence (Cano et al. 2017; Sanchez et al. 2020).

Conceptualizing recovery capital in a manner that includes abstinence has been criticized for a lack of alignment with recovery capital theory (Bowen et al. 2020) and would not be appropriate for understanding recovery gains/barriers among individuals engaged in a harm-reduction approach to recovery. Likewise, applying a recovery capital conceptualization devoid of abstinence-specific domains/components to 12-step members would limit our understanding of resources that sustain their recovery pathways. Our understanding of recovery capital is limited by a lack of consistency in terms of how recovery capital is operationalized and measured, whereas some studies point to the need to examine community-level and various socio-cultural domains regarding the population being studied (Hennessy 2017).

For example, Jason et al. (2021) examination of recovery home residents found recovery capital at the home-level (i.e. aggregated recovery factor scores among residents within each recovery home) to be a better predictor of attrition than residents’ individual-level of recovery capital, whereas differences between individual and home-level measures of coping resources were observed in relation to psychiatric severity (Porcaro et al. 2021). Community-level factors such as the social context of recovery homes extend our understanding of recovery capital. However, other community and socio-cultural factors such as involvement in 12-step groups and social support specific to abstinence have been demonstrated to predict recovery outcomes (Kaskutas et al. 2002), and there is a need to understand recovery capital in this context.

It is unclear whether recovery capital that is not abstinence-specific is directly associated with 12-step involvement. Identifying factors associated with recovery capital among those pursuing a 12-step approach to their recovery would have important research implications in terms understanding aspects of recovery capital for this population in addition to identifying factors that might inform treatment objectives among practitioners. The present investigation examined recovery capital among a sample of recovery homes residents who were involved in AA and NA groups. We hypothesized residents who were categorically involved in 12-step groups would report higher levels of recovery capital. In addition, we explored whether 12-step involvement was related to differences in other recovery resources that were general (retention rates in a recovery home) and abstinence-specific (abstinence social support).

Methods

Sample

The present study is a secondary analysis of data from the parent study (Jason et al. 2021). Participants (n = 666) were individuals recovering from substance use disorders living in Oxford House recovery homes in the United States. Just over half (51%) of the sample were male and reported a mean age of 37.0 years (SD = 10.5). In terms of ethnicity, most were White (78.8%), Latinx (10%), African American (8.5%), or other ethnicities (2.7%). Residents reported an average length of stay in their recovery home of 11.4 months (SD = 12.6).

Procedures

Data were collected from Oxford Houses located in the United States (North Carolina, Texas, and Oregon) through the help of Oxford House statewide organizations. Oxford House statewide organizations are well-developed in these states, and they facilitated communication with Oxford House residences about their potential participation in the present investigation. Designing the present investigation to include participants residing in different geographical regions afforded support regarding the generalizability of findings. Field staff assembled lists of Oxford Houses to approach in terms of participant recruitment attempts, and (house elected) presidents of each Oxford House were asked to introduce the study to prospective participants by reading a description of it from a script provided by the investigators. Afterwards, houses voted to decide whether to participate and those that agreed to participate (by majority vote) were accepted into the study. The first thirteen houses (from each state) approached and consented to participate were accepted into the study, and three more houses were added for a total of 42 houses. The vast majority of residents approached from these houses agreed to participate, yielding a sample that was representative of Oxford House residents in terms of many sociodemographic characteristics except for gender as more women were represented in the present investigation. Residents agreed to participate after being engaged in a process of informed consent and they received financial incentives ($20) for their involvement. This study was reviewed and approved by the DePaul University Institutional Review Board.

Recruitment efforts were staggered over a two-year period. Data were collected every four months, across seven assessment intervals (waves), and Oxford House residents were permitted to enter the study at any time during this two-year period. This design permitted a maximum of six possible follow-up waves available for observing length of stay rates which were determined by each participant’s last reported follow-up wave, whereas some residents completed only one wave of surveys. The study was introduced to potential participants (n = 714) and just over 93% of those approached consented to participate (n = 666). A total of 627 cases were available for data analyses due to missing data.

Instruments

Recovery capital

Our measure of recovery capital was based on confirmatory factor analyses (described in Jason et al. 2021) of established measures that examined eight types of resources (stress, quality of life, wages, self-efficacy, hope, self-esteem, social support, and sense of community) that found one latent factor fit, with higher scores indicating greater recovery capital. Factor loadings and factor variances were significant (p<.001). There were four strong indicators with standardized loadings that ranged in absolute value from .59 to .71 (self-esteem, hope, quality of life, and stress) and four weaker indicators with standardized loadings that ranged in absolute value from .18 to .49 (social support, self-efficacy, sense of community and wages). The total factor variance partition was 72%.

Categorical 12-step involvement

The Alcoholics Anonymous Affiliation Scale (AAAS; Humphreys et al. 1998) is a nine-item measure used to assess categorical involvement in 12-step groups (regardless of AA or NA affiliation) by scoring four items of representative 12-step activities (having a sponsor, reading 12-step literature, doing service work, and calling other members for help). These items were selected because they represent recovery-related behaviors new members are commonly encouraged to take in early recovery. Two AAAS items not used in the present study involve lifetime/recent 12-step meeting attendance rates, whereas three AAAS items are neither direct activities (e.g. identifying as a ‘member,’ having had a ‘spiritual awakening’) nor relevant to new members (being a ‘sponsor’ to others). Participants who had endorsed all four items were considered categorically involved (CAT group) whereas participants who endorsed three or less of these items were not categorically involved (NCAT group). The AAAS has been calculated using these four items (Majer et al. 2011, 2013), and the internal reliability of the AAAS in the present study was good (Cronbach’s alpha = .76)

Abstinence social support

The Important People Inventory (IP, Clifford et al. 1992), a measure revised from the Important People and Activities Inventory (Clifford and Longabaugh 1991) was used to assess abstinence social support. Participants described important persons of their social network (within the past 6 months), rating them on a 5-point Likert scale that distinguished nonusers from substance users, and this resulted in computing a percentage of the four most important persons (dividing the number of persons identified as being abstinent or in recovery by the sum total of persons identified) consistent with previous investigations (Zywiak et al. 2002, 2009; Epstein et al. 2018). The internal reliability of the IP in the present study was good (Cronbach’s α = 79).

Sociodemographic information

Information was collected including participants’ age, gender, race/ethnicity, and recovery home retention rates in terms of lengths of stay.

Data analysis

A one-way multivariate analysis of covariance (MANCOVA) was conducted to test for differences in recovery resources (i.e. recovery capital, retention rates, abstinence social support) while controlling for ethnicity (because of the disproportionate cases across ethnicity categories) in relation to one factor: categorical 12-step involvement (groups coded 0=NCAT, 1=CAT). Using a priori test in G*Power, power (1-β err probability) was estimated at 0.98 for a large effect size (f2 = 0.23) when α err probability = 0.05, sample size = 104, with number of groups = 2 and number of predictors = 1. A pairwise deletion approach was used in calculating analyses. Participants with missing data (<6%) were excluded from analyses. Little’s MCAR test revealed that cases were missing completely at random, X2 (34) = 40.91, p = .19.

Results

Differences between participants who reported categorical 12-step involvement (CAT group; n=395) or not (NCAT group; n=232) were examined though a one-way MANCOVA in relation to recovery capital and other recovery resources. Results from the MANCOVA test demonstrated a significant main effect for categorical 12-step involvement, Wilks’ λ (3, 622) = .96, p<.001, ηp2 = .04. Follow-up ANOVA tests and estimated means of this model revealed participants who were categorically involved reported significantly higher levels of recovery capital [M = .28 vs. .15; SE = .04, .06; F (1, 624) = 3.88, p<.05, ηp2 = .01], and abstinence social support [M = .53 vs. .37; SE = .02, .03; F (1, 624) = 20.84, p<.01, ηp2 = .03] compared to participants who were not categorically involved. No significant differences were observed between groups in terms of retention rates. Ethnicity was not a significant covariant of the model, and there was no significant interaction effect (categorial 12-step involvement by ethnicity) when we entered ethnicity into the model as a factor.

Discussion

Significantly higher levels of recovery capital were observed among residents with categorical 12-step involvement, consistent with previous investigations that observed high levels of personal recovery resources among individuals who were categorically involved in Alcoholics Anonymous or Narcotics Anonymous for their recovery (Majer et al. 2010, 2012). Residents in the present study who were categorically involved in 12-step groups also reported significantly higher levels of abstinence social support, suggesting a social learning basis for their recovery gains whereby categorical 12-step involvement entails connecting with community peers interactively unlike meeting attendance that would not necessarily involve such active participation. These results suggest categorical 12-step involvement empowers members with both general and abstinence-specific resources. Taken together, these findings are consistent with research that has shown the relationship between abstinence social support provided in clinical settings and the use of AA/NA as a recovery resource (Sells et al. 2006), demonstrating ‘active ingredients’ (i.e. abstinent social norms, recovering network members/role models, participation in various 12-step activities) of abstinence-oriented recovery observed in effective professional treatments (Moos 2007) occur in community-based settings through representative 12-step involvement.

Recovery capital might be better understood when considering abstinence-specific social components for individuals recovering through 12-step groups. Although peer support networks for persons recovering from substance use disorders are found in 12-step groups (Kaskutas et al. 2002; Groh et al. 2011), our findings suggest these naturally occurring, community-based peer support networks are instrumental in helping individuals connect to and become involved with 12-step recovery, consistent with clinical research that found the use of 12-step volunteers in clinical settings to be a key element related to 12-step involvement (Timko et al. 2006). In addition, our findings support the notion that abstinence social support is an aspect of recovery capital that should be considered when examining various social and community resources used to sustain recovery among recovery home residents involved with 12-step groups.

Differences in recovery home retention rates in relation to 12-step involvement were not significant in the present study, suggesting pathways toward community reintegration that involve social and community resources for recovery home residents vary in relation to individual needs (Best et al. 2021) and are not necessarily linear. Rather, our findings draw attention to the complexities in understanding social support among persons engaged in a 12-step approach to recovery in that affiliation with a culture of recovering peers who embrace abstinence as a necessary first step (Gueta and Addad 2015) is an important indicator of recovery capital found in both abstinence-based recovery homes and 12-step groups, whereas reflective appraisal of the consequential benefits to one’s 12-step involvement is another abstinence-based component that encourages personal growth (Moghanibashi-Mansourieh et al. 2020). Thus, our findings speak to the importance of assessing recovery capital in relation to abstinence social support and 12-step involvement that are likely experienced on multiple (social, home environment, extended community) levels in addition to the individual level among those engaged in 12-step recovery.

Although examining recovery capital and abstinent social support in relation to categorical 12-step involvement has important research and treatment implications, there are some limitations to the present investigation. For instance, the present investigation did not examine relationships over time. Investigations with repeated measures of categorical 12-step involvement and abstinence social support would increase our understanding of how recovery capital differs across various recovery domains over time (Laudet and White 2008). Although affiliation and identification with other recovering peers who embrace an abstinence-first approach to recovery is an important cultural element of abstinence social support for 12-step members, other cultural and sub-cultural elements (e.g. gender, comorbidity, use of medications) were not critically examined in the present study and would likely have an impact on interpersonal relationships. Investigations comprised of both recovery home residents and individuals not living in recovery homes who are involved in 12-step groups would help us better understand the impact recovery home living might have on the development of recovery capital. Furthermore, comparative investigations using different recovery capital measures that include and do not include abstinence-based recovery capital components (e.g. Assessment of Recovery Capital, Groshkova et al. 2013; Recovery Assessment Scale, Cale et al. 2015; Strengths and Barriers Recovery Scale, Best et al. 2020) are needed to better understand recovery capital among persons living in abstinence-based recovery homes attending 12-step groups.

Finally, results in the present investigation highlight the need for researchers to use representative operational definitions and measures when investigating individuals who choose a particular recovery pathway such as a 12-step approach to their recovery. Such measures would be contra-indicated for those taking a harm-reduction approach to their recovery (and vice versa). This would be achieved by conceptualizing recovery in ways that reflect 12-step members’ practices such as measuring rates of complete abstinence from both alcohol and illicit substances (as opposed to measuring rates of recent and specific substances used) regardless of AA or NA affiliation, concurrent involvement in several representative 12-step behaviors as opposed to endorsement of any individual 12-step activity (e.g. being a sponsor) and/or averaging involvement across such activities by the use of summary scoring methods, and conceptualizing recovery capital using social components that have a direct bearing on the abstinence-first aim of AA and NA fellowships such as having ‘clean’ and ‘sober’ friends (i.e. abstinent social support network members) and not merely general types of social support. In addition, future investigations utilizing more representative measures of 12-step involvement would be instrumental in identifying factors that might influence one’s 12-step recovery.

Implications

Recovery capital is a fluid concept that is proportionate to the individual’s recovery goals. There are various personal, social and community resources that should be considered in assessing whether one’s recovery capital facilitates ongoing recovery. For individuals whose recovery is based in a 12-step, abstinence-based model, recovery capital should include their involvement in 12-step groups and abstinent-specific resources such as abstinence social support. Overall, findings in the present investigation demonstrate the need for considering categorical involvement in 12-step groups and abstinence social support when examining recovery capital among individuals who take a 12-step approach in their recovery.

Funding

The authors appreciate the financial support from the National Institute on Alcohol Abuse and Alcoholism [grant number AA022763].

Footnotes

Ethical approval

The authors of this manuscript have been personally and actively involved in work leading to this report and hold themselves responsible (jointly and individually) for its content. All applicable and relevant ethical safeguards ensuring participant protection have been met throughout the process of the study in accordance with the Farmington Consensus and the Declaration of Helsinki.

Disclosure of interest

No potential conflict of interest was reported by the author(s).

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