+ Page 47 + ---------------------------------------------------------------------------- ####### ######## ######## ########### ### ### ## ### ## # ### # Interpersonal Computing and ### ### ## ### ## ### Technology: ### ### ## ### ### An Electronic Journal for ### ######## ### ### the 21st Century ### ### ### ### ### ### ### ## ### ISSN: 1064-4326 ### ### ### ## ### July, 1994 ####### ### ######## ### Volume 2, Number 3, pp. 47-56 --------------------------------------------------------------------------- Published by the Center for Teaching and Technology, Academic Computer Center, Georgetown University, Washington, DC 20057 Additional support provided by the Center for Academic Computing, The Pennsylvania State University, University Park, PA 16802 This article is archived as KING IPCTV2N3 on LISTSERV@GUVM ---------------------------------------------------------------- ANALYSIS OF ELECTRONIC SUPPORT GROUPS FOR RECOVERING ADDICTS Storm King Introduction ESGs are a type of virtual community. Virtual communities are a new phenomena. They are groups of people that exchange ideas and information through the posting of messages on electronic bulletin boards (BBSs), by sending email to a common list of recipients and by exchanging private email. This fast growing phenomena is being used by many people to fulfill, in part, their need for a community of peers (Rheingold 92). Addicts in recovery have formed ESGs on many local and international networks. Very little is known about the therapeutic value they receive from exchanging ideas this way. According to Sparks (1992), it is known that recovering addicts using ESGs receive "24 hour availability, selective participation in entering and responding to messages, anonymity and privacy, immediate and/or delayed responding, and recording of transmissions." This is very different from traditional support groups . At meetings of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) members typically share only once, or not at all, during the hour they are together as a group. + Page 48 + There are advantages and disadvantages to the sharing of recovery tools and experiences via ESGs. Among the advantages are the thoughtfulness of the replies to issues that recovering addicts face in common. Writing can be different from spoken conversation in that thoughts can be formed more slowly and edited more carefully. The experiences and personal triumphs, as they are expressed in written form, may seem more powerful and clearer than similar messages shared in person at a meeting of AA or NA. This descriptive study was designed to get a overall feel for how ESGs function and to answer the following questions. To what extent do addicts using ESGs feel it helps them to remain drug free? Does long term participation in ESGs result in a significant improvement in an addicts program of recovery? What is the nature of the benefit, if any, that participants feel they receive? Methods To determine the therapeutic value of ESGs for recovering addicts, a survey questionnaire (see table 1) was posted to the ESGs on Prodigy and sent to a list server subscribed to by 50 members of the recovery community. In addition, a list of participants on Prodigy and the UseNet group alt.recovery was compiled by noting who had written to the ESG for a few days in early March, 1994, and emailing the questionnaire to them. There was no way to determine how many people read the posted survey, and did not reply to it. At this time there is no way to determine how many "lurkers", (the cyberspace term for people that read but never respond in writing), there are in the various ESGs that use a BB format. The response rate for the emailed survey was 30 percent. Among the questions asked were ones that revealed the total time a respondent had used the ESG, and whether or not the respondent had ever contacted other members they met on the ESG by phone, postal mail or in person. To determine if participants felt they benefited from ESG use a question was asked about the + Page 49 + amount they felt ESG involvement had improved their program of recovery. The suggested response was four choices; none, a little, moderately and a great deal. To determine the nature of this benefit, three questions addressed their frequency of using the ESG to seek advice, to give advice or to seek support. the suggested replies were; never, a few times, many times and almost every time. Demographic information was solicited. Correlations for all variables were compiled. The recovery ESGs available on Prodigy were studied intensively for this report. They are listed on Prodigy under the Medical Support section. There is an alcohol abuse BB and a drug abuse BB. Some recovering addicts are participants in both forums. The alcohol abuse BB has many more participants than the drug abuse one. A participant may choose to read notes, to reply to a note on a subject, to reply to a reply, to start a new note on that subject, or to create a new subject. To determine the overall usage of the Prodigy alcohol abuse BB, a count was made of the notes posted for a 30 day period in October, 1993. The same BB was counted again for 30 days in March, 1994 to determine if the usage rate had changed. Results In the initial 30 day observation period of the alcohol abuse BB on Prodigy, there were 473 different notes posted on 82 different subjects and 3,179 replies posted to these notes. In the follow-up observation 4 months later, there were 649 notes posted on 149 different subjects, with 4750 replies to those notes, for an increase in the usage rate of 32.4%. Seventy one people responded to the survey, 39 men and 31 women (one person did not give their gender). The average age was 38.4, with a range of 22 to 60. Sixty percent of respondents reported being married. The average number of months that respondents reported being a member of a ESG was 7.5, with a range of .2 to 30. The average hours per week of ESG usage was 3.8, with a range of .8 to 15. + Page 50 + The average reported months in recovery was 68, with a range from .5 to 240. The amount of time the respondents to this survey reported that they had been drug free ranged from a few weeks to 20 years, with an average of just over 5.5 years. The average of the Likert scale report of improvement in recovery program due to ESG participation, where 1 equaled the lowest and 4 the highest amount, was 2.9. Fifty-eight percent of survey respondents reported they had made contact with others they met on the ESG, by phone, postal service mail or in person. This contact variable showed a significant positive correlation with the length of time a respondent reported being in recovery (.40 p<.01) and the number of months of ESG use (.44 p<.001). A significant positive correlation was found between the number of hours per week a respondent reported that they used the ESG and the amount they reported that ESG use improved their program of recovery (.46 p<.01). Improvement in recovery program was also positively correlated with total months of BB use (.40 p<.001) and with the reported frequency that respondents used the BB to seek advice (.46 p<.001). Discussion The positive correlation between ESG usage rates and the reported improvement in recovery program seem to indicate that a large number of addicts have found a beneficial resource, possibly unduplicated by other means. It appears that the regular, frequent contact with members from widely separated backgrounds and experiences available on ESGs can significantly improve one's ability to remain drug free. It must be noted that almost all respondents to the survey reported that they use ESGs to supplement regular attendance at NA or AA. It may be that the tools many addicts use to remain drug free (access to emotional support, feeling a part of a peer group) are very complementary to the advantages of ESGs. The selective participation and the 24 hour availability provide a means of recovery enhancement not found elsewhere, however. + Page 51 + The positive correlation between the number of months a person reported being a member of a recovery ESG and making contact with other members by phone, postal mail or in person raises the interesting question of what the exact value of such a geographically extended network of friends is for one's recovery effort. It is possible that members who live in isolated, rural communities are using ESGs to greatly expand their access to emotional support. This survey result indicates that the longer one is a member of a ESG the more likely one is to include some members of that ESG in activities associated with close friendship. The positive correlation between the frequency of advice seeking and the reported improvement in recovery program raises a interesting question about the nature of recovery from addiction in general. Do people who utilize others as resources have a better chance of finding lasting recovery? Is the willingness to seek advice an indicator of successful treatment outcome? It is possible that some members of ESGs find it easier to solicit advice by means of their computer terminal than in person. The extent and exact nature of the population of addicts who participate worldwide on local and national recovery ESGs is unknown, but it is large and growing rapidly. From newcomers to people with many years drug free, addicts with computers are discovering a means of getting and giving emotional support and of exchanging information that seems to complement their meeting attendance and other recovery tools. As a common interest group among others on these networks, the addict ESG is unique. Many other ESGs exist for various medical conditions and participants support each other in getting treatment. Recovery from addiction often requires peer support for it to be successful. Addicts who exchange stories, information and emotional support by computer are not just engaged in an adjunct to their therapy, that activity is a part of their therapy. + Page 52 + Some recent notes point out the uniqueness of this format for recovery from drug abuse. One young man shared that he had relapsed after 8 years drug free and that he was having a hard time getting the feelings back that he had got before from the meetings he attended. He expressed the hope that this ESG would fill a missing gap in his recovery program and allow him to remain drug free more comfortably. A young lady wrote in to say her parents had printed out some of the conversations on the drug BB for her to read, hoping it would stimulate her and assist her to avoid another relapse. A person brand new to recovery wrote in to express that he felt alone in the meetings and that he had trouble asking for help there. He expressed his opinion that posting a note asking for assistance felt safer. Participating in the ESGs can be confusing. Some conversations will have many participants, others only a few. Some subjects are of wide general interest, others are not. An example of a wide interest subject would be the topic of relapse. When someone writes in to seek help on a recent or feared relapse back to drug use, the replies and responses can literally pour in. Other times someone may start a new subject just to request advice on finding a meetings where they plan to go on vacation, and will generally receive a few replies. To provide additional insight into how these ESGs help a person stay off drugs, I conducted an interview with James K., one of the more active members of the drug abuse ESG on Prodigy. James is also a chemical dependency counselor. He has been a member of this virtual community for over a year. The interview was conducted by email. "Why do I use the ESG? I do it for personal and professional reasons. I like talking with the CD (chemical dependency) counselors about professional issues. I like to share ideas with addicts from different regions, with different amounts of time, and different recovery experiences. By this sharing of ideas my own recovery is enhanced and my understanding of NA in particular is increased." + Page 53 + "What are my feelings for my friends in the ESG? I have come to both like (and love) and dislike many people here. I have seen many come and go here during the past year, some of them became friends and I miss them. I spend more time here on the BB reading than writing. Whether you count the time just reading or reading and writing, I spend as much if not more time here with addicts than I do with addicts face to face." (James K., 93) Conclusions Electronic Support Groups for recovering addicts are a new phenomenon. They offer the addict another means of support, a source of information and a feeling of belonging to a nationwide virtual community. Their use is growing rapidly. The advantages of this electronic format are numerous and represent an addition to the standard tools used to achieve and maintain abstinence from drugs. The level of concern for each other shown by participants who have never seen or heard each other is a phenomenon that begs future study. The therapy inherent in the exchange of experience, strength and hope on these ESGs seems to be real, valuable, and, in many ways, unique to this format. One question raised by the present study is whether or not ESGs could be recommended by addiction treatment facilities as a way of introducing some particularly shy clients to others in recovery. If so, can a way be found to determine which clients would be most likely to benefit from this approach? How much of such a clients need for a peer support group could be filled this way? Some people become extremely nervous when called on to do any public speaking. Yet, active participation in AA and NA require speaking to what are sometimes very large groups. If addicts fearful of this were encouraged to participate in an ESG, would the writing of messages to a group, and the subsequent feed back they received, help overcome this fear? + Page 54 + I have documented cases of addicts who became willing to give up a destructive drug habit for the first time after witnessing the conversations between members of a recovery ESG. The frequency of this type of initial exposure to treatment for addiction is as yet unknown. Occasionally the BB is used by non-addicts seeking advise about how to deal with a family member still using drugs. The replies to these notes usually constitute a referral to programs designed to help family members of addicts, but a lot of experience with this problem is shared too. The psychology of virtual communities in general and of recovery ones in particular is a subject that contains many unknowns. How can their value to users who only read and never respond be assessed? Are there leaders in such recovery communities and, if so, how is such status achieved? "The therapeutic value of one addict helping another is without parallel" (NA Basic Text, 84). Only now, more and more addicts are helping each other by means of a modem. This increase will certainly continue, as addicts share with others not yet on-line the value they have found there. Common Terms and Acronyms in Recovery ESGs Flame war: A heated debate FTF: face to face, as in a live meeting ((((name))))) : Electronic hugs for person named Lurker: Term for someone that reads and never writes. Very Big Grin :) Smiley face, indicates humor. IRL: In real life. IMHO: In my humble opinion. IMNSHO: In my not so humble opinion + Page 55 + Table 1. Survey Questions Very little is known about the value of these bulletin boards in helping people achieve recovery. I am asking for anyone who is in recovery to answer these questions so that I may submit the results for publication. Your responding will be taken as permission to be included in this study. ALL RESPONSES WILL BE KEEP STRICTLY CONFIDENTIAL. Private replies are encouraged. The results will be posted here after I have collected and summarized the responses. 1 How long have you been using this BB? 2 How many times per week do you use it? 3 How many minutes do you usually spend each time your logged on here reading or writing to this BB? 4 Have you ever made contact with BB members through phone, postal service or in person? 5 How much do you feel that your program of recovery has improved through the use of this BB? (not at all, a little, moderately, a great deal) 6 How often have you written here asking for advice? (never, a few times, many times, almost every time) 7 How often have you written here just to feel supported? (never, a few times, many times, almost every time) 8 How often have you written here to give advice? (never, a few times, many times, almost every time) 9 How long have you been clean and sober? 10 How many meetings of AA or NA do you attend per week? Please include your age, race, sex, marital status and economic status. Just list the question number and your answer. Thank you very much Storm + Page 56 + References James K. Interview done on 11/28/93 by email using Prodigy Interactive Service. Narcotics Anonymous 1984 by World Service Office, Inc., Van Nuys, CA Rheingold, Howard "Cold Knowledge and Social Warmth", Newsweek, September 6, 1993 p 49 Rheingold, Howard "A Slice of Life in My Virtual Community", Published electronically in the Well. @well.sf.ca.us 1992 Sparks, Susan N., "Exploring Electronic Support Groups". American Journal of Nursing, December 1992, p 62 ---------------------------------------------------------------- BIOGRAPHICAL NOTE: Storm King graduated from the University of Hawaii, Hilo in 1994 and is currently enrolled at the Pacific Graduate School of Psychology in Palo Alto, CA. His interest in this subject is both personal and professional. As a Chemical Dependency counselor, now seeking a Ph. D. in Clinical Psychology, he plans to use electronic support groups in the treatment of addiction. --------------------------------------------------------------------------- Interpersonal Computing and Technology: An Electronic Journal for the 21st Century Copyright 1994 Georgetown University. Copyright of individual articles in this publication is retained by the individual authors. Copyright of the compilation as a whole is held by Georgetown University. It is asked that any republication of this article state that the article was first published in IPCT-J. Contributions to IPCT-J can be submitted by electronic mail in APA style to: Gerald Phillips, Editor IPCT-J GMP3@PSUVM.PSU.EDU