Call for regulation to protect people with substance use disorder from exploitative marketing practices on social media

People seeking online support for addiction recovery may encounter cynical marketing by the addiction treatment industry that sometimes prioritizes financial gain over clients’ health and well-being, according to a study of public discourse around substance use recovery on Twitter.

Among people trying to quit or reduce their use of alcohol or other substances, engagement with clinical treatment remains low. More typically, people with alcohol use disorder (AUD) or other substance use disorders (SUDs) seek community-based mutual-help groups (such as Alcoholics Anonymous, Narcotics Anonymous, or SMART Recovery).

Since the COVID-19 pandemic, online recovery supports have become a central piece of recovery efforts for many. Forums that offer access to peer support and accountability include virtual mutual-help group meetings, social networking sites focused on recovery, and traditional social media (e.g., Reddit).

For the study published in Alcohol: Clinical and Experimental Research, U.S. investigators examined how Twitter, a social network site since renamed X, was used for AUD and SUD recovery support.

The researchers used large-scale data analytics to collect tweets posted in English during 2022 that contained certain keywords and hashtags relating to substance use recovery (e.g., #recovery, #sober, #wedorecover, #alcoholicsanonymous, #harmreducation). They retained 186,460 tweets addressing 18 relevant topics.

A random 100 tweets from each topic group—1,800 posts—were manually examined and categorized by certain attributes, including source and theme. After filtering for relevance and other criteria, the researchers used statistical analysis to explore the attributes and themes of 1,132 tweets on substance use recovery.

These tweets were posted by individuals in or seeking recovery (42%), the addiction treatment industry (21%), general individuals including politicians and celebrities (13%), health organizations (9%), health-related individuals such as clinicians (6%), and news organizations (3%). Content posted by people in or seeking recovery typically aimed to provide emotional support to others, celebrate a sobriety milestone, express gratitude, or acknowledge mutual-help group participation.

Sociopolitical commentary—in 15% of posts—advocated for harm reduction strategies and policy change. However, 1 in 5 tweets featured marketing content, primarily from addiction treatment industry accounts. Of those, 9 in 10 promoted purported treatments, services, and products (e.g., inpatient treatment centers, sober houses, detox programs, counseling, medications, and self-help books), including approaches not supported by scientific evidence.

The study highlights a critical need to regulate addiction-related marketing practices on social media, researchers concluded. While Twitter was commonly used to provide or receive support around recovery and to advocate for beneficial policies and strategies, the substantive presence of addiction treatment industry content presented a risk to people seeking guidance.

Previous research has highlighted ethical issues in the addiction treatment industry’s misrepresentation of its services online, including predatory marketing and fraudulent practices. In combination with the tendency of social networking platforms and search engines to prioritize commercial interests over the risk of harm to users, the nature of addiction industry social marketing could erode trust in treatment, reinforce barriers to evidence-based services, and contribute to poor outcomes.