Alcoholics Anonymous: Personal Stories, Relatedness, Attendance and Affiliation.

Abstract

Alcohol misuse is a global health risk. Alcoholics Anonymous (AA) maintains a worldwide presence, with more than 2 million members and 110,000 groups in over 180 countries. Researchers and clinicians have become increasingly interested in mechanisms of action that contribute to positive outcomes in this “spiritual program of action,” but few have applied a theoretical framework to these efforts. In this three-paper dissertation, the nursing Theory of Human Relatedness (THR) was used to inform or direct qualitative, theoretical, and quantitative inquiries. First, a set of personal stories from the fourth edition of Alcoholics Anonymous was examined. Using methods derived from narrative analysis, a normative model was proposed. The overall storyline followed classical literary conventions for tragedy and comedy, incorporating regressive, progressive, and stable narratives. Prototypical stages (first or early drinking, alcoholic regression, hitting bottom, progress in the AA program, and stable sobriety) were embedded in a subjective, evaluative function over time. In a second paper, THR was applied to alcoholism and recovery in AA. The organizing construct was relatedness, an individual’s level of involvement with persons, objects, environments, or spiritual entities, and the concurrent level of comfort associated with that involvement. Detailed analysis of an exemplar, and a survey of other personal stories, suggested that THR has the potential to serve as a unifying theory in the study of alcoholism and recovery in AA. Finally, a prospective, longitudinal study was conducted in Warsaw, Poland. Patients were assessed at baseline, one month, and 6-12 months for AA meeting attendance, affiliation, and alcohol consumption. Outcomes were obtained from 118 of 154 participants, 77% of the baseline sample. AA attendance alone did not predict improved drinking outcomes. In contrast, self-report of a spiritual awakening (one of the affiliation items) was significantly associated with abstinence, and the absence of any heavy drinking. Spiritual awakening was further associated with a number of other AA-related behaviors, collectively referred to as affiliation. Greater AA affiliation increased the likelihood of having had a spiritual awakening which, in turn, predicted improved drinking outcomes. Affiliation items were aligned with the core construct and concepts from the Theory of Human Relatedness.