Degree Name

Doctor of Philosophy


School of Psychology


Background: Mutual support groups are one of the world’s most commonly used forms of addiction recovery support. Participation has been associated with reduced substance use and abstinence. There is, however, limited empirical understanding of how suitable or beneficial group participation is for Indigenous peoples in similarly colonised countries (Australia, New Zealand, Canada, United States of America, Hawaii). This thesis aims to improve our understanding of the cultural utility of mainstream addiction recovery mutual support group programmes for Indigenous peoples. The SMART Recovery programme will be used as a case study with Indigenous Australia as a cultural milieu.

Methods: This thesis presents findings from three published empirical studies. In Study 1: a PRISMA-informed systematic literature review was performed to determine the number, nature, and scope of internationally available evidence on Indigenous people’s experiences of and outcomes associated with attending mutual support groups. Study 2: used an Indigenous-lensed multi-methods research design to explore: 1) How Indigenous Australian facilitators (n=10) and group members (n=11) experience SMART Recovery and utilise it as a recovery resource; and 2) If the SMART Recovery programme components and operational process are culturally suitable and helpful. In Study 3: a three-round Delphi synthesised with Indigenous research methods was conducted to: 1) Obtain expert opinion on the cultural utility of the Indigenous SMART Recovery handbook; 2) Gain consensus on areas in the SMART Recovery programme that require cultural modification; and 3) Seek advice on how modifications could be implemented in future programme design and delivery.

Results: Study 1 revealed a paucity of empirical knowledge on the acceptability and outcomes of addiction recovery mutual support groups for Indigenous peoples of Australia, New Zealand, Canada, United States of America and Hawaii. Study 2 offers first insights into how Indigenous peoples in Australia perceive and use SMART Recovery. Based on their experiences, a range of culturally informed programme modifications were suggested to enhance its cultural utility. Study 3 confirmed that cultural modifications are needed to enhance the cultural utility of SMART Recovery for Indigenous Australian contexts. An expert panel reached consensus on five key programme modifications and developed a set of strategies to help SMART Recovery integrate these into future programme planning and design. Study 2 and 3 also demonstrated the promise of two innovative research methodologies that could be used to involve Indigenous peoples in the design and evaluation of mainstream mutual support group programmes without added burden to personal, community and/or professional obligations.

Conclusions: This thesis presents the first series of studies to investigate the cultural utility of mainstream mutual support groups for Indigenous peoples. Findings suggest that culturally appropriate language, culture-based programme activities and less rigid group delivery formats would enhance suitability and helpfulness of existing programmes as a recovery resource for Indigenous peoples. Thesis findings have implications for future planning and development of SMART Recovery and other mutual support groups like 12-steps programmes. There is an urgent need to extend this research to Indigenous peoples of New Zealand, Canada, United States of America, and Hawaii – whose perspectives are not yet documented in the peer-reviewed mutual support group literature.



Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.