Twelve Reasons Why We Need to Find Alternatives to Alcoholics Anonymous:

Obvious benefits but hidden costs: A critical exploration of the impact of adopting the "master narrative" in Alcoholics Anonymous

INTRODUCTION

New members of Alcoholics Anonymous (AA) typically acquire a distinct "alcoholic" identity, including AA-specific understandings of their "alcoholism" and what it means to be in recovery. Although much qualitative research on AA has presented the experiences of members who have embraced this identity and have been wholly praising of AA, other theorists have been strongly critical of the organization, often arguing that it emulates a cult. To contribute towards reconciling these competing bodies of research, the current study aimed to critically explore the impact of adopting AA's master narrative.

METHODS

The study involved 19 prospective, in-depth semi-structured interviews with six AA members recruited from meetings across Sydney, Australia. Data were analyzed thematically using a master narrative theoretical framework.

RESULTS

The study identified three core components of AA's master narrative: (1) Powerlessness over alcohol ("alcoholics" are powerless over alcohol); (2) Internalized pathologization ("alcoholics" are mentally and emotionally sick, above and beyond their problems with alcohol); and (3) AA as the only solution for wellness (involvement in AA is the necessary requirement for "alcoholics" to become and remain well). Although most participants emphasized the positive experiences from internalizing the AA narrative, our analysis also revealed potentially negative ramifications of this narrative on their self-conceptions and worldviews that were seemingly unrecognized by participants themselves.

CONCLUSIONS

The master narrative framework facilitated a critical and balanced exploration of AA members' experiences. Although AA's master narrative is valuable for members, it could also carry costs that need to be mitigated by resources both inside and outside of AA.

The "alcoholic other": Harmful drinkers resist problem recognition to manage identity threat

OBJECTIVE

Harmful drinkers represent an important Alcohol Use Disorder (AUD) group in public health terms, accounting for significant health and social costs. However, harmful drinkers are characterized by low problem recognition; they tend to construct their drinking identity as positive and problem-free, actively setting themselves apart from the stigmatised 'alcoholic other'. As such, harmful drinkers rarely engage in treatment and represent an important opportunity for lower threshold interventions and self-change. The present study sought to explore AUD problem framing and stigma effects on problem recognition.

METHODS

Harmful drinkers without perceived addiction experience recruited online (n = 244, 54% male, 46% female, 96% British) were randomised to one of six conditions comprising beliefs about alcohol problems (control, continuum, binary disease model) and stigma (stigma, non-stigma), and completed measures relating to problem recognition.

RESULTS

As predicted, results found that harmful drinkers exposed to binary disease model beliefs and stigmatising language had significantly lower problem recognition than those in other conditions. However, no support was found for the prediction that continuum beliefs would be associated with higher problem recognition. Results suggest that the interaction of binary disease model beliefs and stigma prompted alcoholic label avoidance.

CONCLUSION

These findings suggest that problem framing has important consequences for harmful drinkers. Implications for behaviour change amongst harmful drinkers through mechanisms of problem framing and identity are discussed.

An Apologetic Interpretation of Alcoholics Anonymous (AA): Timeless Wisdom, Outdated Language

BACKGROUND

The Twelve Steps of Alcoholics Anonymous (AA) has proven to be an effective aid in recovery for many people with alcohol use disorder. While constructive criticisms of AA can be beneficial to the organization, other criticisms have merely served as rhetorical devices intent on discrediting the 12-step approach.

OBJECTIVES

This paper examines six prominent critiques of AA, paying special attention to the premises, tone, and factual basis of the statements. Interpretations grounded in AA literature are offered to address claims or critiques around prominent themes, which are organized into two main classes: purported causes of alcoholism and factors maintaining alcoholism.

RESULTS

Findings reveal tenuous statements in the AA literature that appear contradictory and thereby invite a misreading. These statements, some of which misrepresent the tenets of AA and its founders, underscore certain vocal criticisms that are not entirely unfounded. While many pages of the AA literature are imbued with timeless wisdom, even the most apologetic interpretations-distilled into benefit-of-the-doubt renderings-largely falter in defending the nature of the language that originated in the early 1900s at odds with 21st century understandings of alcohol use disorder. Conclusions/Importance: The AA literature essentially presents a valid target for critics, fueling resistance to this free community-based resource that may prevent people who could benefit from AA from seeking the help of the 12-steps.

One size doesn't fit all: a thematic analysis of interviews with people who have stopped participating in Narcotics Anonymous in Norway

BACKGROUND

For persons with substance use disorders (SUDs), 12-step groups (TSGs) are the most available and used peer-based recovery resource, worldwide. However, disengagement is common, and attrition may partly be due to practices and procedures within these groups that are unacceptable to a portion of the population with SUDs. Our overall aim was to identify problematic issues related to Narcotics Anonymous (NA) participation in Norway, to inform addiction professionals' strategies when referring persons to addiction-related self-help groups (SHGs).

METHODS

In this qualitative study, we interviewed ten individuals who had previously participated regularly in NA for at least 6 months, to examine their reasons for disengagement. We interpreted the interviews using thematic analysis.

RESULTS

We identified three themes: (1) 'The model did not fit', either the strategies utilized in NA (e.g., meeting format and step working) or NA's explanatory model of addiction, (2) 'Negative experiences spurred frustration', and (3) 'The safe place can become a cage'. The respondents believed that a main aim of recovery was reintegration into society, such that SHG participation should not be an end goal, but rather a platform for normalization back into society. Despite their negative experiences and strong critique, respondents still regarded NA as a valuable recovery resource, but pointed out that one size does not fit all.

CONCLUSION

Addiction professionals should recognize possible problems related to TSG participation, to help prevent negative experiences and possible harms to individuals. Professionals should also inform individuals about alternative support groups, to help them find the recovery resource best suited to them.

Endorsement of the "firewater myth" affects the use of protective behavioral strategies among American Indian and Alaska Native students

Belief in an American Indian/Alaska Native (AI/AN) specific biological vulnerability (BV) to alcohol problems (aka the "firewater myth") has been found to be associated with worse alcohol outcomes among AI/AN college students who drink, despite also being associated with greater attempts to reduce drinking. In the current study, we examined the associations of belief in a BV and belief that AI/AN people have more alcohol problems with the use of alcohol protective behavioral strategies (PBS) among AI/AN college students. PBS examined, as measured by the Protective Behavioral Strategies Scale-20, included manner of drinking, limiting/stopping drinking, and serious harm reduction strategies. Participants were college students who identified being AI/AN (n = 137) and had drank in the past month, and were selected from a larger multi-site study on PBS. Mediation models revealed that greater belief in a BV and belief that AI/AN people have more alcohol problems were both negatively associated with manner of drinking, which in turn was associated with greater past month alcohol use and alcohol consequences. These beliefs were not significantly associated with other PBS. Consistent with prior research with other student populations, both manner of drinking and limiting/stopping drinking were associated with less alcohol use and all three domains of PBS were directly associated with fewer alcohol consequences. The results suggest that these beliefs regarding AI/AN people and alcohol negatively affect the use of strategies aimed at avoiding drinking behavior that can lead to rapid drinking and a higher blood alcohol content, contributing to alcohol consequences.

Why Information Matters: Examining the Consequences of Suggesting That Pedophilia Is Immutable

In this study, the impact of suggesting that pedophilia is immutable on a man's specific self-efficacy for modifying his sexual interest in children was examined in 94 men with a sexual interest in children. The participants were selected from differing contexts and included non-forensic patients, forensic patients, and participants from the Internet. Randomly distributed to two conditions, the mutable condition group received the information that experts consider pedophilia to be modifiable, whereas the immutable condition group received the information that experts consider pedophilia to be stable. Afterward, the participants' levels of specific self-efficacy for modifying their sexual interest in children were assessed. Non-forensic participants in the mutable condition reported higher levels of specific self-efficacy than those in the immutable condition. No differences in specific self-efficacy were revealed for the forensic and Internet participants when comparing the mutable and immutable conditions. It would appear appropriate to avoid generalized and absolute statements about the (im)mutability of sexual interest in children, as scientific research on this topic remains insufficient. Furthermore, given the present results, such statements might have serious consequences for an individual's belief in being able to change his sexual interest in children.

Interaction of Motivation and Social Support on Abstinence among Recovery Home Residents

BACKGROUND AND AIMS

The impetus to abstain from alcohol and drugs is especially robust when individuals seek help. However, motivation to continue abstinence during ongoing recovery is less understood. The present study assessed how social support interacted with motivation to affect abstinence over an 18-monthe time period.

METHODS

A sample of 289 residents entering residential recovery homes were recruited and followed at 6-, 12-, and 18-months. Motivation was measured as the perceived costs and benefits of abstinence. Five social influence measures were used to assess interactive effects with costs and benefits on abstinence.

RESULTS

Perceived costs and benefits of abstinence were robust predictors of abstinence over the 18 month assessment period. Two social support factors interacted with perceived benefits to influence abstinence: 12-step involvement and number of persons in the social network.

CONCLUSION

Suggestions are made for recovery services to influence perceived costs, benefits, and social network characteristics.

Buprenorphine Treatment and 12-step Meeting Attendance: Conflicts, Compatibilities, and Patient Outcomes

This analysis examines patient experiences and outcomes with 12-step recovery group attendance during buprenorphine maintenance treatment (BMT), two approaches with traditionally divergent philosophies regarding opioid medications for treatment of opioid use disorder. Using quantitative (n = 300) and qualitative (n = 20) data collected during a randomized trial of counseling services in buprenorphine treatment, this mixed-methods analysis of African Americans in BMT finds the number of NA meetings attended in the prior 6 months was associated with a higher rate of retention in BMT (p < .001) and heroin/cocaine abstinence at 6 month follow-up (p = .005). However, patients whose counselors required them to attend 12-step meetings did not have better outcomes than patients not required to attend such meetings. Qualitative narratives highlighted patients' strategies for managing dissonant viewpoints on BMT and disclosing BMT status in community 12-step meetings. Twelve-step meeting attendance is associated with better outcomes for BMT patients over the first 6 months of treatment. However, there is no benefit to requiring meeting attendance as a condition of treatment, and clinicians should be aware of potential philosophical conflicts between 12-step and BMT approaches.

The twelve-step recovery model of AA: a voluntary mutual help association

Alcoholism treatment has evolved to mean professionalized, scientifically based rehabilitation. Alcoholics Anonymous (AA) is not a treatment method; it is far better understood as a Twelve-Step Recovery Program within a voluntary self-help/mutual aid organization of self-defined alcoholics. The Twelve-Step Recovery Model is elaborated in three sections, patterned on the AA logo (a triangle within a circle): The triangle's legs represent recovery, service, and unity; the circle represents the reinforcing effect of the three legs upon each other as well as the "technology" of the sharing circle and the fellowship. The first leg of the triangle, recovery, refers to the journey of individuals to abstinence and a new "way of living." The second leg, service, refers to helping other alcoholics which also connects the participants into a fellowship. The third leg, unity, refers to the fellowship of recovering alcoholics, their groups, and organizations. The distinctive AA organizational structure of an inverted pyramid is one in which the members in autonomous local groups direct input to the national service bodies creating a democratic, egalitarian organization maximizing recovery. Analysts describe the AA recovery program as complex, implicitly grounded in sound psychological principles, and more sophisticated than is typically understood. AA provides a nonmedicalized and anonymous "way of living" in the community and should probably be referred to as the Twelve-Step/Twelve Tradition Recovery Model in order to clearly differentiate it from professionally based twelve-step treatments. There are additional self-help/mutual aid groups for alcoholics who prefer philosophies other than AA.

United Kingdom substance misuse treatment workers' attitudes toward 12-step self-help groups

Research has highlighted the benefits of professional substance misuse treatment workers facilitating their clients' involvement in 12-step self-help groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). This study used a cross-sectional survey design to explore the attitudes of substance misuse treatment staff working in the English West Midlands region toward AA and NA and the 12-step philosophy. A total of 346 treatment workers responded (71%). Fewer than 10% used the 12-step model in their treatment work, and only a third felt that their clients were generally suited to AA or NA. Fewer than half (46%) said that they were likely to recommend that their clients attend a self-help group meeting. Staff with nursing qualifications were more likely to have a positive attitude toward AA/NA than their non-nursing colleagues, and there was a statistically significant association between the level of reported spirituality of the workers and the likelihood of them recommending to clients that they attend AA or NA meetings. These results highlight differences in the role of AA/NA within the substance misuse treatment system in the United Kingdom and that in the United States; possible explanations are discussed.