Twelve Steps, Two Factors: Coping Strategies Moderate the Association Between Craving and Daily 12-Step Use in a College Recovery Community

Background: Affiliating with 12-step groups appears to reduce relapse risk. By relying on between-person designs, extant research has been unable to examine daily mechanisms through which 12-step group affiliation contributes to recovery. Objectives: To examine the daily use and factor structure of the 12 steps and intrapersonal predictors and moderators of 12-step use. To determine whether the 12 steps were used in response to daily craving and, if so, which steps and in what contexts. Methods: Data comprised 1304 end-of-day diary data entries from 55 young adults collected in 2008 from members of a college recovery community, combined with person-level baseline measures. Exploratory factor analysis examined the factor structure, and multi-level models examined both day-level and person-level predictors and moderators of step use, including meeting attendance, drug and alcohol dependence, social support, and coping strategies. Results: Analyses produced two factors: Everyday steps, comprising surrender and maintenance steps, and action steps. Moderation analyses revealed that only action steps were significantly associated with craving, suggesting that craving can spur their use, but only among individuals pursuing certain general strategies for coping with stress: Separate median-split models produced significant associations between craving and action steps only among individuals high in avoidance, high in support-seeking, and/or low in problem-solving. Conclusions/Importance: This is the first study to empirically discern a 2-factor structure underlying the 12 steps, and to show that the two sets of steps are used in different contexts. The study also illustrates the value of person-centered approaches to recovery research and practice.