Helping, spirituality and Alcoholics Anonymous

OBJECTIVE: The purpose of this study is to examine how helping activities and spirituality–perhaps key influences on sobriety–change over alcoholism recovery.

The study also explores interrelations among Alcoholics Anonymous (AA), helping and spirituality.

METHOD: Questionnaires were administered to recovering alcoholics (118 men, 80 women) recruited at AA and Women for Sobriety meetings, treatment programs and through personal connections. A helping scale measured Recovery Helping (8-item alpha = 0.78), Life Helping (12-item alpha = 0.62), and Community Helping (6-item alpha = 0.60). The Daily Spiritual Experiences scale assessed two components of spirituality identified by factor analysis: Theism and Self-Transcendence. Two components of an AA scale, Involvement and Achievement, were also treated separately on the basis of factor analysis.

RESULTS: Structural equation modeling revealed that

• longer sobriety predicted significantly more time spent on Community Helping,
• less time spent on Recovery Helping and
• higher levels of Theism, Self-Transcendence and AA Achievement.
• Model covariances revealed that both AA components were related to more Recovery Helping and higher Theism.
• Both spirituality components related to all forms of helping, with one exception.

CONCLUSIONS: The findings highlight important changes in helping with length of sobriety.

• As their sobriety accumulates, recovering alcoholics seem to devote less time to informal helping and more time to organized community projects–perhaps indicating evolving needs and abilities.
• The results also suggest roles for AA and spirituality in encouraging helping, and they indicate that some forms of spirituality relate to AA affiliation.

Future work might establish whether and when helping in different domains contributes to the maintenance of abstinence and to other drinking-related outcomes.

Research Report; Zemore SE, Kaskutas LA. J Stud Alcohol. 2004 May;65(3):383-91. Helping, spirituality and Alcoholics Anonymous in recovery.

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The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders.

We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers.

This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs.

Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees.

These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery.

Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities.

Research; Galanter M, Dermatis H, Bunt G, Williams C, Trujillo M, Steinke P. Assessment of spirituality and its relevance to addiction treatment. J Subst Abuse Treat. 2007 Oct;33(3):257-64.

See also;

• The Most Effective Form of Harm Reduction
• What About This Spiritual Awakening Thing?

Abstinence and well-being among members of alcoholics anonymous: Personal experience and social perceptions.

The subjective experience of well being was examined in abstinent Alcoholics Anonymous (AA) members. In addition, the social perceptions of an abstinent alcoholic’s well being were examined in three nonalcoholic French-Canadian samples:

• male police officers,
• Catholic nuns, and
• university women.

The lowest ratings of well being were reported by

• short-term abstinent AA members and
• university women,

The highest ratings were reported by Catholic nuns.

However, the level of well being among abstinent AA members was positively related to the length of abstention.

The three nonalcoholic groups evaluated an abstinent AA member more positively than a non-abstinent alcoholic.

These evaluations of an abstinent AA member converged with the AA members’ self-evaluations on the measure of well being.

Research; Kairouz, S.; Dibe, L. Abstinence and well-being among members of alcoholics anonymous: Personal experience and social perceptions. Journal of Social Psychology, 140(5):565-579, 2000

Professional Interventions That Facilitate 12-Step Self-Help Group Involvement

Facilitating patients’ involvement with 12-step self-help organizations, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), is often a goal of substance abuse treatment.

Twelve-step-facilitation (TSF) interventions have been found to be more effective than comparison treatments in increasing patients’ 12-step group involvement and in promoting abstinence.

Evaluations of TSF Interventions

One large study, known as Project MATCH, compared a TSF intervention with cognitive-behavioral (CB) therapy and motivational enhancement therapy (MET) among 1,726 patients (76 percent male) diagnosed with either alcohol abuse or dependence, including 774 inpatients who were beginning outpatient aftercare and 952 patients receiving outpatient care as their primary treatment.

• CB therapy focuses on teaching coping skills to reduce alcohol use (i.e., patients who use alcohol to cope with stress learn and practice alternative coping methods).
• In contrast, MET employs motivational strategies to mobilize patients’ internal resources for change.
• The TSF intervention in the Project MATCH study was a form of one-on-one professional counseling explicitly designed to work synergistically with AA and other 12-step groups.

Major Goals of 12-Step Facilitation Therapy

Acceptance

• Acceptance by patients that they suffer from the chronic and progressive illness of alcoholism
• Acceptance by patients that they have lost the ability to control their drinking
• Acceptance by patients that because there is no effective cure for alcoholism, the only viable alternative is complete abstinence from the use of alcohol

Surrender

• Acknowledgment on the part of the patient that hope for recovery (i.e., sustained sobriety) exists, but only by accepting the reality of loss of control and by having faith that some higher power can help the patient, whose own willpower has been defeated by alcoholism
• Acknowledgment by the patient that the fellowship of Alcoholics Anonymous (AA) has helped millions of alcoholics sustain their sobriety and that the patient’s best chances for success are to follow the AA path.

Consistent with AA’s philosophy, TSF therapists presented alcohol dependence as a disease with spiritual, emotional, and physical components and emphasized that the disease could be arrested but not cured through permanent abstinence from alcohol.

Also consistent with AA’s approach, patients were strongly urged, but neither ordered nor forced, to attend AA meetings and to maintain a journal describing their reactions to the meetings.

At both 1- and 3-year follow ups, patients in all three conditions (i.e., CB therapy, MET, and TSF therapy) had improved significantly on drinking related (e.g., number of drinks per day and drinking consequences), psychological (e.g., depressive symptoms), and life-functioning (e.g., days of employment) outcomes.

Table one; Posttreatment 12-step self-help group involvement of 2,045 substance-dependent veterans treated by 12-step or cognitive-behavioral programs.

As predicted, TSF therapy was significantly more effective than either CB therapy or MET in increasing AA involvement, as indicated by the frequency of such patient behaviors as attending meetings, having and serving as a sponsor, following the 12 steps, and considering oneself an AA member.

In addition, TSF therapy was more effective than the other two treatments in promoting abstinence. For example, at the 3-year follow up, 36 percent of TSF patients in the outpatient group reported being abstinent for the previous 3 months, compared with about 25 percent of outpatients in the CB therapy and MET treatment conditions. This result is consistent with the goals of TSF therapy and with AA, neither of which views moderate drinking as an acceptable or attainable goal for alcohol dependent people.

Research report; Keith Humphreys. Professional Interventions That Facilitate 12-Step Self-Help Group Involvement Alcohol Research & Health, Vol. 23, No. 2, 1999

Dimensions of social interaction among sober female participants in Alcoholics Anonymous.

The peer-led, voluntary fellowship, Alcoholics Anonymous (AA), remains the predominant model for treatment within the field of substance abuse treatment and attainment of sobriety.

The social support network of AA has been documented as a powerful factor in the achievement of sobriety. However, for whom and in what manner does this social support network work?

This study examined the dimensions of

• perceived group,
• perceived personal, and overall
• perceived social support among 125 sober female members of AA using the Social Support Network Inventory (SSNI).

Of the SSNI’s five dimensions (available, practical, emotional, reciprocal, and sobriety-related social support), reciprocal support was the strongest contributor to group social support.

Those women who had a sponsor scored significantly higher in total social support and personal support.

Availability was the strongest contributor to both personal and overall perceived social support.

These findings indicate that availability and sponsorship are significant components of a supportive environment among women in sobriety.

Rush, M.M. Perceived social support: Dimensions of social interaction among sober female participants in Alcoholics Anonymous. Journal of the American Psychiatric Nurses Association, 8(4):114-119, 2002.

A qualitative study of Alcoholics Anonymous members and South Asian men.

The spiritual aspect of recovery for people with drinking problems was explored in a comparative analysis of South Asian men recovering from drink problems and white members of Alcoholics Anonymous (AA).

In-depth semi-structured interviews were carried out with participants to explore significant factors that assisted recovery. Interviews were analyzed using grounded theory. Ten participants in total were interviewed; 5 were South Asian men receiving individual and/or group counseling with South Asian therapists either in an NHS or non-statutory specialist alcohol treatment service, and 5 were white members of AA.

Models of recovery for the two groups were developed and are presented.

Spirituality and religion played an important role in the experiences of recovery described by AA and South Asian participants respectively.

For AA participants their experiences reflected those described in AA’s Big Book although concepts such as that of a Higher Power were complex and multilayered, with spirituality just one, albeit significant, aspect.

South Asian participants generally underwent a re-affirmation of existing beliefs rather than the conversion type of experience described by AA participants.

The findings are discussed in relation to implications for service delivery and development and directions for future research.

Morjaria, A.; Orford, J. Role of religion and spirituality in recovery from drink problems: A qualitative study of alcoholics anonymous members and South Asian men. Addiction Research and Theory, 10(3):225-256, 2002.

The Spirituality of Imperfection: Storytelling and the Search for Meaning by Ernest Kurtz, Katherine Ketcham Read more about this title…

Helping other Alcoholics and Relapse

The specific mechanisms of Alcoholics Anonymous (AA) that mobilize and sustain behavior change are poorly understood.

This study examined the relationship between helping other alcoholics in AA and relapse in the year following treatment for alcohol use disorders. Data were derived from a longitudinal investigation of the efficacy of three behavioral treatments for alcohol abuse and dependence (Project MATCH). Probabilities of time to alcohol relapse were calculated using Kaplan-Meier survival estimates. Proportional hazards regressions, with control for number of AA meetings attended, were conducted to determine whether the likelihood of relapse was lower for those who were helping other alcoholics.

those who were helping other alcoholics . . . were significantly less likely to relapse in the year following treatment

Age was the only demographic characteristic that distinguished participants involved in helping other alcoholics; those who were helping other alcoholics were, on average, 3 years older than those who were not helping alcoholics and were significantly less likely to relapse in the year following treatment, independent of the number of AA meetings attended.

Thus recovering alcoholics who help other alcoholics (mutual-help) maintain long-term sobriety after formal treatment are better able to maintain their own sobriety.

The authors conclude that clinicians who treat substance abuse disorders should encourage their clients to help other recovering alcoholics to stay sober.

Research report; Pagano ME, Friend KB, Tonigan JS, and Stout RL. Helping other alcoholics in alcoholics anonymous and drinking outcomes: Findings from Project MATCH. Journal of Studies on Alcohol 65(6):766-773, November 2004.

Six-month changes in spirituality, religiousness, and heavy drinking in a treatment-seeking sample.

OBJECTIVE: This descriptive and exploratory study investigated change in alcoholics’ spirituality and/or religiousness (S/R) from treatment entry to 6 months later and whether those changes were associated with drinking outcomes.

METHOD: Longitudinal survey data were collected from 123 outpatients with alcohol use disorders (66% male; mean age = 39; 83% white) on 10 measures of S/R, covering behaviors, beliefs, and experiences, including the Daily Spiritual Experiences and Purpose in Life scales. Drinking behaviors were assessed with the Timeline Followback interview. Alcoholics Anonymous (AA) participation and attendance were also measured.

RESULTS: Over 6 months, there were statistically significant increases in half of the S/R measures, specifically the Daily Spiritual Experiences scale, the Purpose in Life scale, S/R practices scale, Forgiveness scale, and the Positive Religious Coping scale.

There were also clinically and statistically significant decreases in alcohol use.

• Multiple logistic regression analyses showed that increases in Daily Spiritual Experiences and in Purpose in Life scores were associated with increased odds of no heavy drinking at 6 months, even after controlling for AA involvement and gender.

CONCLUSIONS: In the first 6 months of recovery, many dimensions of S/R increased, particularly those associated with behaviors and experiences. Values, beliefs, self-assessed religiousness, perceptions of a Higher Power, and the use of negative religious coping did not change.

Increases in day-to-day experiences of spirituality and sense of purpose/meaning in life were associated with absence of heavy drinking at 6 months, regardless of gender and AA involvement.

The results of this descriptive study support the perspective of many clinicians and recovering individuals that changes in alcoholics’ S/R occur in recovery and that such changes are important to sobriety.

Robinson EA, Cranford JA, Webb JR, Brower KJ. Six month changes in spirituality religiousness and heavy drinking in a treatment-seeking sample. J Stud Alcohol Drugs. 2007 Mar;68(2):282-90.

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A popular aid is the Just for Today card that AA and Al-anon members carry in their pocket or purse and refer to when thinking of a drink or they are disturbed by a life event.

• Just for today I will try to live through this day only, and not tackle all my problems at once. I can do something for twelve hours that would appall me if I felt that I had to keep it up for a lifetime.
• Just for today I will be happy. This assumes to be true what Abraham Lincoln said, that most folks are as happy as they make up their minds to be.
• Just for today I will adjust myself to what is, and not try to adjust everything to my own desires. I will take my luck as it comes, and fit myself to it.
• Just for today I will try to strengthen my mind. I will study. I will learn something useful. I will not be a mental loafer. I will read something that requires effort, thought and concentration.
• Just for today I will exercise my soul in three ways: I will do somebody a good turn, and not get found out; if anybody knows of it, it will not count. I will do at least two things I don’t want to do just for exercise. I will not show anyone that my feelings are hurt; they may be hurt, but today I will not show it.
• Just for today I will be agreeable. I will look as well as I can, dress becomingly, keep my voice low, be courteous, criticize not one bit. I won’t find fault with anything, nor try to improve or regulate anybody but myself.
• Just for today I will have a program. I may not follow it exactly, but I will have it. I will save myself from two pests: hurry and indecision.
• Just for today I will have a quiet half hour all by myself and relax. During this half hour, sometime, I will try to get a better perspective of my life.
• Just for today I will be unafraid. Especially I will not be afraid to enjoy what is beautiful and to believe that as I give to the world, so the world will give to me.

A pocket sized version of this is available at most 12-Step meetings such as Alcoholics Anonymous or Al-Anon

Download a PDF copy to printout and give to your patients.

Attached Files:

• just-for-today.pdf (21 KB)