Alcoholics Anonymous: History
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Marcin Wnuk

Involvement in Alcoholics Anonymous (AA) is an important psychosocial factor for the recovery of alcohol-dependent individuals. Little is known about the mechanism underlying the relationship between involvement in AA and subjective well-being.

  • involvement in Alcoholics Anonymous
  • hope
  • meaning in life

1. Introduction

In Poland, alcohol abuse and addiction cause serious social, economic, and health-related problems. The general rate at which alcohol is consumed each year per capita has been increasing since 1999 [1], as have the numbers of individuals using alcohol in a risky and problematic way. In Poland, there are about 800,000 alcohol-dependent individuals and about 2–2.5 million citizens who abuse alcohol [2]. One method of support for alcohol-dependent individuals in Poland is participation in Alcoholics Anonymous (AA). This method of addressing alcoholism is based on the completion of a spiritual 12-step programme [3] and a philosophy of alcohol addiction as a deadly, chronic, progressive, and multifaceted disease negatively affecting the social, physical, mental, emotional and spiritual aspects of life [4]. The roots of this self-help movement come from the United States and date back to 1935.
In Poland, AA meetings have been organised since 1974 [5]. Currently, there are 2300 meetings per week [6]. In the literature one can find well-established discussions about the effectiveness of this form of therapy for individuals with alcohol dependence [7][8][9]. Some studies have indicated involvement in AA as an effective way of alcohol-dependence recovery [10][11][12][13][14][15].
Little is known about the spiritual mechanism underlying the relationship between involvement in AA and subjective well-being. The aim of this entry was to test the beneficial role of existential well-being in the indirect relationship between involvement in AA and the subjective well-being in a sample of individuals with alcohol dependence from Poland. In the literature, there is a lack of research regarding predictors of subjective well-being among participants of self-help groups. Most researchers have focused on abstinence duration or reduced drinking as a recovery indicators. Contrary to most recent studies, subjective well-being was used as a recovery indicator instead of abstinence duration or reduced drinking. It is due to the fact that abstinence is not the same phenomenon as sobriety. Abstinence exclusively refers to the symptoms of the disease, while sobriety is something deeper, manifesting in emotional and mental dimensions, being an expression of sobriety [16]. Existential well-being [17][18] is another construct than subjective well-being [19], but both of them are strictly related. It finds reflections in Seligman’s [20] model of happiness approaches for a meaningful and purposeful life as one of three ways to achieve subjective well-being. Additionally, in Frankl’s conception [21] finding meaning in life facilitates fulfillment and satisfaction.

2. Involvement in AA and Recovery from Alcohol Addiction

Involvement in AA results in positive alcohol outcomes for many AA participants.
In a study by Walitzer, Dermen, and Barrick [22] among the patients included a group of directive approach to facilitating AA in comparison to the other two groups. Involvement in AA and meeting attendance were positively related to the percentage of days abstinent.
Greenfield and Tonigan’s research [23] spiritual step work predicted the percentage of days abstinent. In another longitudinal study, the duration in AA correlated positively with abstinence, social functioning, and self-efficacy and was negatively related to depression and drinking problems [24]. In a sample of young adults participating in AA, serving as a sponsor and level of affiliation were associated with lower anxiety [25]. In a McKellar, Stewart, and Humphreys [26] study, one-year-posttreatment levels of AA involvement predicted lower alcohol-related problems at the two-year follow-up.
Some studies have proven that having a spiritual awakening as a result of AA engagement has a positive outcome, such as alcohol and drug abstinence [27], fewer depressive symptoms [28], predicting continuous sobriety [29], as well as being less likely to report a craving for alcohol [28]. In a MATCH project AA attendance, number of steps completed, and identifying oneself as an AA member were identified as predictors of one-year post-treatment drinking outcomes [11].
Having a sponsor is an important part of involvement in AA and of connecting with the recovery process. According to recent studies, having a sponsor was associated with longer abstinence [30][31][32], and lesser psychiatric severity [33].
Some authors have tried to find a mechanism of beneficial influence of AA involvement on the recovery process. In most studies the effectiveness of recovery is measured by abstinence or reduction in rate of using alcohol.
In the longitudinal study conducted among individuals with alcohol dependence [34], AA affiliation reduced drinking and drug use indirectly via self-efficacy, motivation, and active coping.
Recovery mechanisms were explored by using potential mediators between AA attendance and alcohol consumption by Kelly et al. [35]. Among aftercare patients, AA attendance indirectly improved the percentage of days abstinent via positive social self-efficacy, spiritual/religious practices, pro-abstinence social networks, and pro-drinking social networks. In the same group of patients, mediators between AA attendance and reduced drinks per drinking day were positive social self-efficacy, negative affect, spiritual/religious practices, depression, and pro-drinking social networks. Among outpatients, relationships between AA attendance and reduced drinks per drinking day as well as percentage of days abstinent were mediated by pro-abstinence social networks, pro-drinking social networks, and positive social self-efficacy [35]. In Blonigen et al. [36]), longer AA participation duration was related to decreased impulsivity (from baseline to one year), which in turn led to a reduction in alcohol-use problems, improvement in social support, improvement in self-efficacy to resist drinking as well as improvement in emotional discharge coping. In their longitudinal research, Kaskutas et al. [36] proved that involvement in AA both directly and indirectly—through support from other AA participants—influenced lower alcohol consumption and less severe problems. This effect was noticed both at the start and after 30 days of abstinence. Besides social and cognitive mechanisms of change as a result of involvement in AA, the literature also describes a spiritual mechanism of change. According to this mechanism, involvement in AA has a positive, indirect influence on reducing alcohol consumption through spirituality/religiousness [37][38][39][40]. Spirituality and religiousness are similar and overlapping constructs, but spirituality is a wider conception includes religiousness as one form of express spirituality [41]. The spiritual growth of AA participants is based on AA involvement and/or religiousness. These forms can be used for religiously inclined individuals, but for religious skeptics, agnostics, and atheists, involvement in AA as a secular way of developing spirituality is preferred. According to Kurtz and White [42], this first mechanism of spiritual growth called secular spirituality emphasizes the role of secular values, and the second one—religious spirituality, focuses on religious values. The spiritual mechanism was tested using involvement in AA as a manifestation of secular spirituality, which through existential well-being [17][18] is related to subjective well-being.
It is possible that existential variables (such as meaning in life and hope) as an effect of involvement in AA may lead to subjective well-being. It can be treated as a parallel spiritual mechanism to that revealed in recent studies.

3. Improved Meaning of Life as a Potential Mechanism of Change Associated with AA Involvement

Meaning in life seems to buffer the influence of the risks of alcohol and drug abuse and is an important factor facilitating recovery from addiction. Use of alcohol and psychoactive substances, as well as involvement in other compulsive behaviours such as surfing the internet, gambling, and sex activity, can be a way to cope with the “existential vacuum” as a state of feeling of meaninglessness, hopelessness, senselessness, boredom, and anhedonia [21], leading to dependency. Researchers have indicated that the problem with finding purpose and meaning in life is related to alcohol use [43], substance use [44], alcohol and drug abuse [45][46][47][48], sedative use [49], smartphone and internet addiction [50][51], gambling [52], as well as substantially higher likelihood of future drug misuse [53]. For example, in a sample of students from Romania, meaning in life protected against drug and sedative use as well as unsafe sex [54].
Some authors have confirmed that involvement in self-help fellowships among individuals with alcohol and drug dependence is an effective way to find meaning in life [55][56][57][58][59][60]. For example, in a longitudinal study conducted among 364 individuals diagnosed with alcohol dependence, participating in AA resulted in a significant increase in their meaning in life over a 30-month period [39]. In a sample of Narcotics Anonymous (NA) members from the US, participation in NA comfort affected with the home group and involvement in NA services predicted their purpose in life [61]. Among AA participants from Great Britain, completion of steps 4 and 5 as well as involvement in AA correlated positively with existential well-being [58].
Much research has emphasised on the significant role of purpose and meaning in life in individuals with alcohol dependence recovery [55][62][63][64][65]. For example, in longitudinal research on outcomes from a MATCH project, higher initial levels of purpose in life and increases in purpose in life over time were related with lower initial levels of temptation to drink and decreases in the temptation to drink over time. Decreases in purpose in life were also significantly associated with greater intensity and frequency of drinking and greater drinking-related consequences at the 15-month follow-up [66].

4. Improved Hope as a Potential Mechanism of Change Associated with AA Involvement

Many approaches to hope have been presented. Some authors indicate that hope is a character trait [67][68][69][70] or positive emotion [71][72][73]. Others have conceptualised hope from the perspective of positive psychology as a strength of character [74]. Hope-focused intervention is a significant issue in the area of substance abuse counselling [75]. Hope is predictive of entering substance abuse treatment [76] and during therapy of facilitating the ease of the required changes and return to health [77]. Additionally, hope is a factor in reducing the risk of relapse [78].
In the literature there is no research regarding the role of involvement in self-help groups in developing or maintaining hope among individuals with alcohol dependence. The results of one available paper indicated that in a sample of people with dual diagnoses of mental and substance use disorders, involvement in self-help groups led to hope, which influenced health-promoting behaviours [79].
Recent research has confirmed that hope is an important factor for the recovery and well-being of individuals with alcohol dependence [80][81][82][83]. In Gutierrez’s study [62] meaning in life via hope indirectly reduced alcohol and drug use. Mathis et al. [81] have indicated that hope predicted drug abstinence at an eight-month follow-up. Additionally, in a sample of AA participants from Poland and participants in Sex and Love Addicted Individuals (SLAA), hope was positively related to different measures of well-being [84][85].
Among AA individuals, hope measured by the Herth Hope Index correlated positively with evaluation of life and correlated negatively with the level of stress [84]. Among SLAA participants, hope improved the desire to live, passion for life and feeling of happiness on a few recent days, as well as satisfaction with friends, health, perspective on the future, life achievements, ways of spending of free time, and satisfaction with sex [85].

This entry is adapted from the peer-reviewed paper 10.3390/ijerph19095173

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