Women and the Twelve Steps of Alcoholics Anonymous: A Gendered Narrative

This paper examines how women “work” the twelve steps of Alcoholics Anonymous (AA) from a gendered perspective.

Feminist critics of AA have

• challenged the language of AA’s Twelve Steps,
• the spiritual nature of the steps, and
• the male-dominated culture of the Twelve-Step program.

This paper offers insight into how women in AA approach, interpret, and utilize the Twelve Steps to recover from alcoholism.

Through survey and narrative data, findings suggests

• that women working AA’s Twelve Steps become empowered and
• change for the better in spite of the male-dominated culture and language of the Twelve Steps and
• regardless of the difficulty they may have encountered in completing these steps.

In particular, the first three steps-the “surrender steps”-

• encourage women to let go of their alcoholic obsession and
• begin a spiritual path of recovery.

Steps Four through Nine require

• women to “clean house” and
• get rid of old self-destructive ways so that they may develop a new and stronger sense of self.

Finally, on completing Steps Ten through Twelve, women

• experience a spiritual awakening and
• then, in turn, “pass on” what they have learned from the Twelve Steps to other women in the program.

Woven throughout these women’s experiences is

• an acknowledgment of gender and
• the role it plays in how they work the Twelve Steps.

In the end, these women express a sense of personal empowerment that is particular to a gender-specific orientation to the Twelve Steps of AA.

Research; Jolene M. Sanders, Women and the Twelve Steps of Alcoholics Anonymous: A Gendered Narrative. Alcoholism Treatment Quarterly, Volume: 24 Issue: 3, 2006

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Early treatment response in alcohol dependence with extended-release naltrexone.

OBJECTIVE: We sought to determine the time course for onset of effect of intramuscular injectable extended-release naltrexone (XR-NTX), which has demonstrated efficacy for alcohol dependence.

METHOD: A post hoc analysis of a randomized, double-blind, placebo-controlled, multicenter study was conducted. In the study, actively drinking men and women who met DSM-IV-TR criteria for alcohol dependence were randomly assigned to receive injections of XR-NTX 380 mg (N = 205) or 190 mg (N = 210) or placebo (N = 209) every 4 weeks for 24 weeks. Patients also received 12 sessions of adjunctive standardized, low-intensity psychosocial intervention. Drinking data were analyzed by month and, during the first month, by day to explore the time course for onset of effect on heavy drinking days in patients receiving XR-NTX versus placebo. The study data were collected between February 2002 and September 2003.

RESULTS: During the first month following injection, patients receiving XR-NTX 380 mg had 37% fewer heavy drinking days versus placebo (p < .01). By day 2, a significant reduction in the median number of drinks consumed per day was observed in patients given XR-NTX 380 mg compared with placebo (p < .05). By day 3, XR-NTX 380 mg resulted in a significant reduction in the percentage of patients reporting heavy drinking compared with placebo (p < .05); this reduction was maintained throughout the study. A dose-response effect was observed, with intermediate results for XR-NTX 190 mg.

CONCLUSION: XR-NTX 380 mg provided a rapid onset of therapeutic effect in the first 2 days after the first injection that was sustained throughout the 24-week trial. Potential clinical implications of the rapid, early onset of effect of this medication’s delivery system for patients who are dependent on alcohol include facilitation of early engagement in treatment, motivation to continue treatment, and focus on the goals established in counseling.

Research; J Clin Psychiatry. 2008 Feb;69(2):190-5. Early treatment response in alcohol dependence with extended-release naltrexone. Ciraulo DA, Dong Q, Silverman BL, Gastfriend DR, Pettinati HM.

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• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
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Correlation between addictive behaviors and mental health in university students

Aims: The present study aims to clarify the relationships of addictive behaviors and addiction overlap to stress, acceptance from others and purpose in life.

Methods: A survey was conducted on 691 students at eight universities. The Eating Attitude Test-20 was used to identify students with food addiction or food addictive tendencies. The Kurihama Alcoholism Screening Test was used to identify students with alcohol addiction or alcohol addictive tendencies. The Fagerstrom Test for Nicotine Dependence was used to identify students with nicotine addictive tendencies or nicotine addiction. The Visual Analog Scale was used to assess stress and acceptance from others. The Purpose in Life Test was used to measure meaning and purpose in life.

Results were compared between students with addictive behaviors, with addictive tendencies and without addictive behaviors.

Results: Significant differences among the three groups were observed for stress, acceptance from others, and Purpose in Life scores for students with food and nicotine addiction, but no significant differences existed in relation to alcohol addiction.

In addition,

• 28.8% of students displayed addictive behaviors in one of the three areas (food, alcohol or nicotine),
• 8.5% displayed addictive behaviors in two of the three areas, and
• 0.4% had addictive behaviors in all three areas.

Significant differences existed in stress and acceptance from others among students with one addictive behavior, >/=two addictive behaviors and no addictive behaviors.

However, no significant differences existed in Purpose in Life scores with respect to overlapping addictions.

Conclusion: The results suggest a relationship between mental health, addictive behaviors and overlapping addiction among university students.

Okasaka Y, Morita N, Nakatani Y, Fujisawa K. Correlation between addictive behaviors and mental health in university students Psychiatry Clin Neurosci. 2008 Feb;62(1):84-92.

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A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS.

Abstract:

Since the 1970s, much of the public treatment system in California has been based on a social model orientation to recovery for alcoholics, but there has been minimal research on program outcomes.

This article reports on follow-up interviews conducted with a representative sample of 722 people who had entered treatment about a year earlier in public and private programs, including publicly-funded social model detoxification and residential programs, and clinical model programs in hospitals and HMO clinics.

Social model clients came to treatment with more severe legal and employment problems, whereas those seeking treatment at clinical programs reported more severe family problems.

At follow-up, clients at both types of programs reported attending a similar number of Alcoholics Anonymous (AA) meetings, but social model clients reported going to more Narcotics Anonymous (NA) meetings and being involved in more AA activities.

Social model clients were less likely than clinical model clients to report problems with alcohol or drugs at follow-up, but the odds of reporting other problems (e.g., medical, psychological, legal, family/social) were similar.

The program effect for better alcohol outcomes at the social model programs was partially explained by their clients’ higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems.

Social networks supportive of abstinence also were predictive of reporting no alcohol problems at follow-up.

In contrast, subsequent detoxification treatment events between baseline and follow-up were associated with a higher odds of reporting alcohol, drug, psychiatric and family/social problems at follow-up.

These findings are consistent with the growing body of literature reporting higher rates of abstinence among those who are able to construct more positive social networks, and who attend and become involved in 12-step programs during and following treatment.

It is important that these results be replicated, as they suggest that social model programs are successful in engaging their clients in AA activities and in NA meeting attendance, and could represent for some an effective alternative to clinical model treatment programs.

Lee Ann Kaskutas, Lyndsay Ammon, Constance Weisner. A Naturalistic Comparison Of Outcomes At Social And Clinical Model Substance Abuse Treatment Programs. International Journal of Self Help and Self Care. Issue: Volume 2, Number 2 / 2003-2004 Pages: 111 – 133

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The concepts, principles, practices, and suggested 12 steps to recovery of the 12-step recovery approach to treating addictive disorders are examined.

Twelve-step recovery approaches are complex, multidimensional, biopsychosocial, and spiritual programs widely available in the United States and some other countries to people with addictive disorders, their family members, and significant others.

it has not been widely recognized that these programs are complex programs for living and address many issues other than alcohol and drug consumption.

Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Al-Anon, Alateen, and other 12-step recovery groups have flourished for the better part of the twentieth century, whereas many other treatment approaches have been tried and abandoned.

Although much discussion has centered on their spiritual emphasis, 12-step recovery approaches are clearly psychosocial recovery programs in which many important features entirely consistent with

• behavior modification,
• recent cognitive therapies,
• modern social learning theories,
• social psychology, and
• sociology are very much in evidence.

Although many people are aware that 12-step recovery approaches are designed to deal specifically with drinking and drug misuse, it has not been widely recognized that these programs are complex programs for living and address many issues other than alcohol and drug consumption.

By JACK Wallace. In: P.J. Ott, R.E. Tarter, and R.T. Ammerman (Eds.), Sourcebook On Substance Abuse: Etiology Epidemiology, Assessment, and treatment. Allyn & Bacon 1999.

Sourcebook on Substance Abuse: Etiology, Epidemiology, Assessment, and Treatment by Peggy J. Ott, Ralph E. Tarter, Robert T. Ammerman Read more about this title…

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Work Stress and Alcohol Use

Employees who drink heavily or who abuse or are dependent on alcohol can undermine a workforce’s overall health and productivity.

To better understand the reasons behind employee abusive drinking and to develop more effective ways of preventing problem drinking in the workforce, researchers have developed a number of paradigms that guide their research.

One such paradigm is the alienation/stress paradigm, which suggests that employee alcohol use may be a direct or indirect response to physical and psychosocial qualities of the work environment. Although in the alcohol literature, work alienation and work stress traditionally have been treated as separate paradigms, compelling reasons support subsuming the work-alienation paradigm under a general work-stress paradigm.

Researchers have developed several models to explain the relationship between work stress and alcohol consumption:

• the simple cause-effect model,
• the mediation model,
• the moderation model, and
• the moderated mediation model.

Of these, the moderated mediation model particularly stands out, because it simultaneously addresses the two fundamental issues of how and when work stressors are related to alcohol use.

Recent research supports a relation of work related stressors to elevated alcohol consumption and problem drinking. Future research should focus on the relation between work stressors and alcohol use among adolescents and young adults, because they are just entering the workforce and are the most likely to engage in heavy drinking. Longitudinal studies also are needed to better explain the relation between work stress and alcohol use.

By Michael R. Frone, Ph.D. Alcohol Research & Health, Vol. 23, No. 4, 1999

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From: University of Utah, Genetics Science Learning Center.

This website – which is highly interesting, informative, and entertaining — delivers interactive and print-based resources, free of charge, on the neurobiological actions of substances of abuse: heroin, cocaine, methamphetamine, marijuana, LSD, ecstasy, and alcohol. The presentations primarily depict how drugs interact with dopamine neurotransmitters within the brain’s reward pathway. The influences of genetics on addiction are also discussed. Although the simplified mechanisms of drug action and other influences depict only part of the story, even experienced practitioners will find the material of interest as a refresher.

Particularly entertaining yet informative, and well worth a look, is the “Mouse Party,” which takes an interactive look inside the brains of animated mice on drugs, exploring molecular mechanisms of addiction. It provides a small glimpse into the chemical interactions at the synaptic level that cause drug users to feel “high” and want to repeat drug-abusing behaviors.

• Go to the Mouse Party
• Section on How Drugs Alter Brain Reward Pathways
• Main Page on Genetics of Addiction
• Some animations require the Adobe Flash Player (available free at Adobe)

The Science of Addiction: From Neurobiology to Treatment by Carlton K. Erickson Read more about this title…

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Children who love sweets more likely to be alcoholics

A sweet tooth may make you more likely to become an alcoholic, doctors have found.

While a liking for sweets has long been observed among heavy drinkers, researchers were uncertain whether it was caused, or preceded, by years of high alcohol intake.

Now a study has suggested that a sweet tooth may indicate a genetic predisposition to heavy drinking. Researchers tested 163 social drinkers and found those with the sweetest tooth were two and a half times more likely to have a family history of alcoholism.

The sweet-loving drinkers were identified by asking them to rate a series of sugar solutions for sweetness and palatability. The researchers from Mount Sinai School of Medicine in New York say a simple taste test of this kind could eventually be used to check whether children were predisposed to alcoholism.

Dr Alexei Kampov-Polevoy led the research, published in the journal Alcoholism: Clinical and Experi- mental Research. He said the link between sugar and alcohol in some people was likely to be due to a genetic abnormality in the brain.

"Pleasurable reactions to both alcohol and sweet substances are regulated by the same mechanism, namely the brain’s opioid system," Dr Kampov-Polevoy said. "Activation of this system results in increased consumption of both alcohol and sweets, while blockade of this system causes the opposite effect.

"We believe that children of alcoholics have a genetic abnormality of the brain opioid system, which leads to an increased sensitivity to the rewarding effects of alcohol."

The findings could pave the way for the testing of children to help to gauge their risk of developing alcoholism in adulthood.

Dr Kampov-Polevoy said: "A sweet-preference test is a simple and benign test that can be done at any age. If our findings are confirmed, a test may help to identify an individual at risk for the development of alcoholism early in life, way before the first drink.

"With advanced knowledge, it will be easier to develop effective preventive measures. As with any other disease in the world, alcoholism is easier to prevent than to treat."

David Overstreet, of the Bowles Centre for Alcohol Studies, University of North Carolina, said: "These studies imply that a person whose relatives are alcoholics may be at greater risk of alcoholism if he or she likes sweets."

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Exploring patterns of remission from alcohol dependence with and without Alcoholics Anonymous in a population sample.

Narratives provided by former heavy drinkers have indicated that respondents who attended the self-help fellowship Alcoholics Anonymous (AA) experienced more abrupt resolutions than respondents who never attended AA.

This study explored the extent to which this difference in resolution pattern exists in a representative sample of individuals remitted from a lifetime diagnosis of alcohol dependence.

The study used the 1990-1991 Mental Health Supplement to the Ontario Health Survey, a household survey that assessed the prevalence of psychiatric disorders, including alcohol dependence, among 9,953 respondents in Ontario.

Bivariate analyses were conducted comparing the characteristics for the 268 remitted alcohol-dependent respondents who had;

• never attended AA (n = 189),
• attended but not in the last year (n = 46), or
• attended in the past 12 months (n = 33).

There appeared to be a difference in the abruptness of resolution among those respondents who had remitted from alcohol dependence.

That is, respondents who had attended AA were more likely to have ended their heaviest drinking period and to have experience their last symptom at roughly the same age, as compared with those who did not attend AA.

The latter group displayed greater differences in the ages at which they experienced these two markers of remission, perhaps indicating a more gradual “drift” out of alcohol problems.

Research; Cunningham, J.A.; Breslin, F.C. Exploring patterns of remission from alcohol dependence with and without Alcoholics Anonymous in a population sample. Contemporary Drug Problems, 28(4):559-566, 2001. (166942)

Dying to Drink: Confronting Binge Drinking on College Campuses by Henry Wechsler, Bernice Wuethrich Read more about this title…

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Alcohol-dependent patients attempting and not attempting suicide: a comparison.

Background:

Alcohol dependence is a psychiatric disorder associated with an increased risk of suicidal behaviour. This is also associated with an increased number of suicide risk factors.

Objective:

The current study examined the sociodemographic and clinical characteristics of a number of alcohol-dependent patients who attempted suicide.

Methods:

We studied a consecutive series of 377 alcohol-dependent patients in our in-patient clinics. Their alcohol-use histories were assessed through semi-structured interviews. The Suicidal Behaviors Questionnaire, the Childhood Trauma Questionnaire, the Michigan Alcoholism Screening Test and the Hamilton Depression Rating Scale were administered to all patients. Serum total cholesterol levels, mean corpuscular volume, the liver enzymes gamma glutamyl transferase, aspartate aminotransferase and alanine aminotransferase were routinely measured. In the statistical analyses, Student’s t-test and chi-squared tests were applied.

Results:

• Of the 377 alcohol-dependent patients, 89 (23.6%) had histories of attempted suicide.
• Thirty-four (42.5%) of the 80 female alcohol-dependent patients and
• 55 (18.5%) of the 297 male alcohol-dependent patients had attempted suicide;
• this gender difference was statistically significant (2 = 27.7, P < 0.001).
• A greater proportion of the suicide attempters than of the non-attempters met the Diagnostic Statistical Manual IV criteria for another psychiatric disorder (60.6%, n = 54, vs. 40.6%, n = 117; 2 = 14.8; df = 6; P < 0.05).
• The difference of total cholesterol levels between female (mean = 144.0, SD = 58.3; mean = 158.0, SD = 83.9; t = 4.5; P < 0.05) and male (mean = 133.7, SD = 50.5; mean = 163.6, SD = 69.7; t = 11.7; P < 0.01) attempters and non-attempters was statistically significant.

Conclusion: These results suggest that suicide attempts in alcohol-dependent patients are associated with more profound biopsychosocial pathology and decreased serum cholesterol levels.

Research; Pektas O; Mirsal H; Kalyoncu A; Ünsalan N; Beyazyürek M. Alcohol-dependent patients attempting and not attempting suicide: a comparison. Acta Neuropsychiatrica, August 2004, vol. 16, no. 4, pp. 204-211(8). Alcohol-dependent patients attempting and not attempting suicide: a comparison.

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