Alcoholics Anonymous

137 Pages·2009·0.33 MB·English

Alcoholics Anonymous: Personal Stories, Relatedness, Attendance and Affiliation

by

Stephen Strobbe

A dissertation submitted in partial fulfillment
Of the requirements for the degree of
Doctor of Philosophy
(Nursing)
in the University of Michigan
2009

Doctoral Committee:

Professor Carol J. Boyd, Chair
Professor Kirk J. Brower
Associate Professor Bonnie M. Hagerty
Assistant Research Professor James A. Cranford
Professor Marcin Wojnar, Medical University of Warsaw, Poland
“The spiritual life is not a theory. We have to live it.”

Alcoholics Anonymous
© Stephen Strobbe
2009
To Lynn, Joseph, and David,

Who taught me how to write the best chapters in my personal story.

Love, Stephen

ii
Acknowledgements

A portion of this research was supported by the Fogarty International
Center/NIDA International Substance Abuse Research Program grant D43-TWO5818;
NIAAA grant R21 AA016104; the Polish Ministry of Science and Education grant
2PO5D 004 29. Dr. Strobbe was further supported by a research grant from the
International Nurses Society on Addictions (IntNSA), and a New Investigator Award
from the University of Michigan School of Nursing.
Sincere thanks to the all of the study participants in Poland for their generous
contributions of cooperation and time, as well as other members of the research team in
Warsaw, Poland, including Izabela Nowosad, Andrzej Jakubczyk, Anna Wnorowska,
Anna Klimkiewicz, Malgorzata Marusa, Aleksandra Konopa, and the medical staff at
“Kolska,” “Pruszkow,” “Petra,” and “Solec” Addiction Treatment Centers.
I would also like to thank Dr. Ernest Kurtz and Dr. Julia Seng for their thoughtful
and thorough reviews of the chapter on personal stories in the Big Book of Alcoholics
Anonymous. I wish to extend my deepest gratitude to each and every member of my
dissertation committee: Dr. Carol Boyd, Dr. Kirk Brower, Dr. Bonnie Hagerty, Dr. Jim
Cranford, and Dr. Marcin Wojnar. Your gifts of time, expertise, practical assistance,
support, patience, and encouragement will be fondly remembered. Carol, I imagine that I
will never forget the day when you proclaimed that I needed to get my Ph.D., and set this
whole crazy wheel in motion. My heartfelt thanks are yours.

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Table of Contents

Dedication ii

Acknowledgements iii

List of Figures vii

List of Tables viii

List of Appendices ix

Abstract x

Chapter

1. Introduction 1
Alcoholism as a Disease: A Brief History
Nursing Diagnosis in Relation to Alcohol Use Disorders
Alcoholics Anonymous as a Program of Recovery
Potential Application of Nursing Theory to AA
References

2. Personal Stories in the “Big Book” of Alcoholics Anonymous:
A Narrative Analysis 19
Introduction
In the Beginning: Storytelling in Alcoholics Anonymous
An Impulse to Narrate
Oral Narratives in Alcoholics Anonymous
Written Narratives in Alcoholics Anonymous
A Brief Orientation to Narrative Analysis
A Focused Review of the Literature
Positionality, Data Set, and Methods
Positionality: A Frame of Reference
Data Set: A Collection of Personal Stories
Methods: An Organic Process of Reflective Iteration
Findings: A Normative Model for Personal Stories in AA

iv
Thematic Content
First or Early Drinking
Alcoholic Regression
Hitting Bottom
Progress in the AA Program
Stable Sobriety
Discussion
Strengths and Limitations
What Makes a Good AA Story?
Implications: Clinical Care, Theory, and Research
References

3. Applying the Theory of Human Relatedness to Alcoholism
and Recovery in Alcoholics Anonymous 56
Introduction
Theory of Human Relatedness
Definition and Dimensions
States of Relatedness
Relatedness Competencies
Student of Life: An Exemplar
Analysis
Object: Alcohol
Others: Parents, and Mike
Parents
Mike
Spiritual Entities: God or a Higher Power
AA as a Group, Society and Environment
Discovery of Self
Discussion
References

4. Alcoholics Anonymous: Attendance, Affiliation,
and Drinking Outcomes in a Polish Treatment Sample 79
Introduction
Background
Alcohol Use in Poland
Alcoholics Anonymous in Poland
A Focused Review of the Literature
AA Attendance
AA Affiliation
Methods
Design
Participants
Setting
v
Measures
Analysis
Results
Discussion
References

5. Conclusion 107
Summaries of Individual Studies
Personal Stories in the “Big Book”
Applying the Theory of Human Relatedness
AA Attendance, Affiliation, and Drinking Outcomes
Synthesis
Future Research and Nursing Care
References

vi
List of Figures

Figure

1. Personal narratives are transformed and transformative over time 49

2. Normative model for personal stories of alcoholism and recovery
in Alcoholics Anonymous 50

3. States of relatedness 75
4. Study design 96
5. Conceptual model of study findings: AA attendance, affiliation,
and drinking outcomes in a Polish treatment sample 97

vii
List of Tables

Table

1. New personal stories in the fourth edition of Alcoholics Anonymous 51

2. Relatedness to referents in the Twelve Steps of Alcoholics Anonymous 76

3. Demographic and clinical characteristics of the baseline study sample 98

4. Comparison of characteristics between study completers (n=118)
and non-completers (n=36) at baseline (Time 1, or T1) 99

5. AA attendance and drinking outcomes: abstinence and no heavy drinking
(HD) among study completers (n=118) at baseline (T1), one month (T2),
and study completion (T3) 100

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