Using the Consolidated Framework for Implementation Research (CFIR) to explore mutual-help group implementation challenges in college recovery programs

Mutual-help groups (MHGs) are an effective resource in improving health for emerging adults in addiction recovery. Collegiate recovery programs (CRPs) have the infrastructure to support mutual help meeting implementation for this high-risk priority population for substance misuse. Despite their established role as an addiction recovery resource, the implementation of MHGs within CRPs is inconsistent and highly variable across institutions. To address this gap, we explored barriers and facilitators to planning and implementing MHGs within CRPs. We conducted qualitative interviews with 18 program director and college administrator participants from five CRPs across the United States in 2023. The guide focused on four domains of the Consolidated Framework for Implementation Research 2.0: Innovation, Inner Setting, Outer Setting, and Individuals. Thematic analysis was conducted using an iterative coding approach to identify key facilitators and barriers to MHG implementation. Four cross-cutting themes shaped MHG implementation within CRPs: (1) recovery-aligned leadership and facilitation, (2) institutional positioning and infrastructure, (3) sustainability and resourcing, and (4) inclusivity and pathway fit. Across these themes, leadership advocacy and lived-experience credibility facilitated implementation, while limited staffing capacity constrained delivery. MHGs were more accessible when embedded within visible campus infrastructure aligned with student success priorities. In addition, domain level facilitators included the credibility and perceived effectiveness of MHGs (Innovation), strong institutional support from high-level leaders (Individuals), donor engagement and established recovery spaces that fostered peer connections (Inner Setting), and alignment of CRPs with broader university missions related to student retention and well-being (Outer Setting). Barriers included concerns about the accessibility and inclusivity of traditional 12-Step models (Innovation), administrative misalignment with development offices (Inner Setting), and limited institutional awareness and funding instability (Outer Setting). Implementation strategies to enhance MHG adoption in CRPs include diversifying MHG offerings, integrating CRPs into university financial structures, strengthening external treatment and recovery housing partnerships, and fostering inclusive recovery environments. Addressing these barriers could enhance accessibility and sustainability of MHGs, ultimately improving recovery support for college students with substance use disorders.