research on alcoholics anonymous and spirituality in addiction recovery

Research on Alcoholics Anonymous and Spirituality in Addiction Recovery

The Twelve-Step Program Model Spiritually Oriented Recovery Twelve-Step Membership Effectiveness and Outcome Research

• © 2008
• Lee Anne Kaskutas ,
• Marc Galanter

You can also search for this editor in PubMed   Google Scholar

• Discusses how spirituality places a unique role in addiction recovery
• Shows how and why 12-step groups work
• Includes supplementary material: sn.pub/extras

Part of the book series: Recent Developments in Alcoholism (RDIA, volume 18)

68k Accesses

247 Citations

30 Altmetric

This is a preview of subscription content, log in via an institution to check access.

Access this book

• Available as EPUB and PDF
• Read on any device
• Instant download
• Own it forever
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info
• Durable hardcover edition

Tax calculation will be finalised at checkout

Other ways to access

Licence this eBook for your library

Institutional subscriptions

About this book

Similar content being viewed by others.

Addiction and Twelve-Step Spirituality

The Twelve-Step Path? Mindfulness and Ethics in Buddhist Addiction Recovery Literature

The role of twelve-step-related spirituality in addiction recovery.

• Alcoholics Anonymous
• Recovery from Addiction
• Religion and alcoholism
• Spirituality and aa
• Spirituality and alcoholism
• Spirituality and healing
• epidemiology
• mindfulness
• religion and healing

Table of contents (23 chapters)

Front matter, the twelve-step program, introduction: the twelve-step program model of aa.

• Thomasina Borkman

The Twelve-Step Recovery Model of AA: A Voluntary Mutual Help Association

Twelve defining moments in the history of alcoholics anonymous.

• William L. White, Ernest Kurtz

The Impact of AA on Professional Treatment

• Valerie J. Slaymaker, Timothy Sheehan

The Impact of Alcoholics Anonymous on Other Substance Abuse-Related Twelve-Step Programs

• Alexandre B. Laudet

The Impact of AA on Non-Professional Substance Abuse Recovery Programs and Sober Living Houses

• Douglas L. Polcin, Thomasina Borkman

Spiritually Oriented Recovery

An overview of spirituality in aa (and recovery).

• Sarah E. Zemore

The Concept of Spirituality in Relation to Addiction Recovery and General Psychiatry

Kickbacks from helping others: health and recovery.

• Sarah E. Zemore, Maria E. Pagano

Issues in Measuring Spirituality and Religiousness in Alcohol Research

• Thomas Johnson, Elizabeth A.R. Robinson

Spirituality and Health: Empirically Based Reflections on Recovery

• Michelle J. Pearce, Clark M. Rivinoja, Harold G. Koenig

Spiritual Change in Recovery

• Gerard J. Connors, Kimberly S. Walitzer, J. Scott Tonigan

Mindfulness and Addiction

• Sharon H. Hsu, Joel Grow, G. Alan Marlatt

Twelve-Step Membership

Introduction.

• Lee Ann Kaskutas

Epidemiology of Alcoholics Anonymous Participation

• Lee Ann Kaskutas, Yu Ye, Thomas K. Greenfield, Jane Witbrodt, Jason Bond

Concerns About Dose and Underutilization of Twelve-Step Programs: Models, Scales, and Theory that Inform Treatment Planning

• Richard N. Cloud, J. B. Kingree

Bibliographic Information

Book Title : Research on Alcoholics Anonymous and Spirituality in Addiction Recovery

Book Subtitle : The Twelve-Step Program Model Spiritually Oriented Recovery Twelve-Step Membership Effectiveness and Outcome Research

Editors : Lee Anne Kaskutas, Marc Galanter

Series Title : Recent Developments in Alcoholism

DOI : https://doi.org/10.1007/978-0-387-77725-2

Publisher : Springer New York, NY

eBook Packages : Medicine , Medicine (R0)

Copyright Information : Springer-Verlag New York 2008

Hardcover ISBN : 978-0-387-77724-5 Published: 27 October 2008

Softcover ISBN : 978-1-4939-7908-0 Published: 27 March 2019

eBook ISBN : 978-0-387-77725-2 Published: 05 December 2008

Series ISSN : 0738-422X

Edition Number : 1

Number of Pages : XXV, 449

Topics : Psychiatry , Health Psychology , Clinical Psychology , Primary Care Medicine

• Publish with us

Policies and ethics

• Find a journal
• Track your research

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Spirituality and addiction: a research and clinical perspective

Affiliation.

• 1 Division of Alcoholism and Drug Abuse, NYU School of Medicine, New York, New York 10016, USA. [email protected]
• PMID: 16867923
• DOI: 10.1080/10550490600754325

Spirituality is a construct that has recently gained currency among clinicians because of its close association with twelve-step modalities and its perceived role in the promotion of meaningfulness in recovery from addiction. This article draws on studies from physiology, psychology, and cross-cultural sources to examine its nature and its relationship to substance use disorders. Illustrations of its potential and limitations as a component of treatment in spiritually oriented recovery movements like Alcoholics Anonymous, meditative practices, and treatment systems for the dually diagnosed are given.

PubMed Disclaimer

Similar articles

• The concept of spirituality in relation to addiction recovery and general psychiatry. Galanter M. Galanter M. Recent Dev Alcohol. 2008;18:125-40. doi: 10.1007/978-0-387-77725-2_8. Recent Dev Alcohol. 2008. PMID: 19115767 Review.
• Spirituality and addiction. Grodzicki J, Galanter M. Grodzicki J, et al. Subst Abus. 2005 Jun;26(2):1-4. doi: 10.1300/j465v26n02_01. Subst Abus. 2005. PMID: 16687364 No abstract available.
• Recovery, spirituality and psychotherapy. Drobin F. Drobin F. J Relig Health. 2014 Jun;53(3):789-95. doi: 10.1007/s10943-013-9800-4. J Relig Health. 2014. PMID: 24449135
• Preference for spirituality and twelve-step-oriented approaches among adolescents in a residential therapeutic community. Aromin RA, Galanter M, Solhkhah R, Bunt G, Dermatis H. Aromin RA, et al. J Addict Dis. 2006;25(2):89-96. doi: 10.1300/J069v25n02_12. J Addict Dis. 2006. PMID: 16785224
• A historical review of perceptions of key aspects of spirituality and religion within alcoholics anonymous. Feigenbaum JC. Feigenbaum JC. J Addict Nurs. 2013 Oct-Dec;24(4):229-36. doi: 10.1097/JAN.0000000000000004. J Addict Nurs. 2013. PMID: 24335770 Review.
• On the trail of Sisyphus - addiction as an existential neurosis? Unterrainer HF. Unterrainer HF. Front Psychiatry. 2023 Aug 24;14:1243792. doi: 10.3389/fpsyt.2023.1243792. eCollection 2023. Front Psychiatry. 2023. PMID: 37692306 Free PMC article.
• Habits and Routines of Adults in Early Recovery From Substance Use Disorder: Clinical and Research Implications From a Mixed Methodology Exploratory Study. Kitzinger RH Jr, Gardner JA, Moran M, Celkos C, Fasano N, Linares E, Muthee J, Royzner G. Kitzinger RH Jr, et al. Subst Abuse. 2023 Feb 11;17:11782218231153843. doi: 10.1177/11782218231153843. eCollection 2023. Subst Abuse. 2023. PMID: 36798446 Free PMC article.
• A Randomized Controlled Trial Evaluating the Effect of Tai Chi on the Drug Craving in Women. Wang M, Chen Y, Xu Y, Zhang X, Sun T, Li H, Yuan C, Li J, Ding ZH, Ma Z, Sun Y. Wang M, et al. Int J Ment Health Addict. 2022 Sep 13:1-13. doi: 10.1007/s11469-022-00917-8. Online ahead of print. Int J Ment Health Addict. 2022. PMID: 36119946 Free PMC article.
• Associations between classic psychedelics and nicotine dependence in a nationally representative sample. Jones G, Lipson J, Nock MK. Jones G, et al. Sci Rep. 2022 Jun 22;12(1):10578. doi: 10.1038/s41598-022-14809-3. Sci Rep. 2022. PMID: 35732796 Free PMC article.
• Associations between classic psychedelics and opioid use disorder in a nationally-representative U.S. adult sample. Jones G, Ricard JA, Lipson J, Nock MK. Jones G, et al. Sci Rep. 2022 Apr 7;12(1):4099. doi: 10.1038/s41598-022-08085-4. Sci Rep. 2022. PMID: 35393455 Free PMC article.

Publication types

• Search in MeSH

Related information

Grants and funding.

• R01 DA10728/DA/NIDA NIH HHS/United States

LinkOut - more resources

Full text sources.

• Ovid Technologies, Inc.
• MedlinePlus Consumer Health Information
• MedlinePlus Health Information

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

UK Edition Change

• UK Politics
• News Videos
• Paris 2024 Olympics
• Rugby Union
• Sport Videos
• John Rentoul
• Mary Dejevsky
• Andrew Grice
• Sean O’Grady
• Photography
• Theatre & Dance
• Culture Videos
• Fitness & Wellbeing
• Food & Drink
• Health & Families
• Royal Family
• Electric Vehicles
• Car Insurance Deals
• Lifestyle Videos
• UK Hotel Reviews
• News & Advice
• Simon Calder
• Australia & New Zealand
• South America
• C. America & Caribbean
• Middle East
• Politics Explained
• News Analysis
• Today’s Edition
• Home & Garden
• Broadband deals
• Fashion & Beauty
• Travel & Outdoors
• Sports & Fitness
• Sustainable Living
• Climate Videos
• Solar Panels
• Behind The Headlines
• On The Ground
• Decomplicated
• You Ask The Questions
• Binge Watch
• Travel Smart
• Watch on your TV
• Crosswords & Puzzles
• Most Commented
• Newsletters
• Ask Me Anything
• Virtual Events
• Betting Sites
• Online Casinos
• Wine Offers

Thank you for registering

Please refresh the page or navigate to another page on the site to be automatically logged in Please refresh your browser to be logged in

Britain has an addiction crisis – is 12-step recovery the answer?

The tenets of alcoholics anonymous have been replicated across different forms of addiction treatment, while numerous studies have proven their effectiveness. so why do they remain misunderstood, asks anna wolfe, article bookmarked.

Find your bookmarks in your Independent Premium section, under my profile

Stay ahead of the curve with our weekly guide to the latest trends, fashion, relationships and more

Thanks for signing up to the lessons in lifestyle email.

D espite being the world’s most lethal substance, alcohol has become the most accessible and normalised drug of choice . What many don’t realise is that help is equally as accessible; it simply isn’t always suggested or, like addiction itself , fully understood.

Since its founding in 1935, the Alcoholics Anonymous 12-step model has been used as the basis of 30 other fellowships, including Gamblers Anonymous and Narcotics Anonymous. The realities of AA’s positive impact on the world are undeniable and immeasurable – but undiscussed. There isn’t a cure for alcoholism, but there is a solution that offers far more than abstinence . And it’s one the UK is in desperate need of.

Between them, the Priory Group’s Dr Niall Campbell and Dr Neil Brener have more than 53 years of psychiatric experience across the NHS and the private sector, with a speciality in addiction. They’ve seen it all, and seen the recent worsening of what Dr Brener calls the “violating illness”.

“I don’t know any addiction psychiatrist or therapist who would say rates aren’t on the rise,” Dr Campbell adds. “Addiction to not only drugs or alcohol, but sex, shopping, screens, gambling. It’s often combined. People start something and go onto something else.” (This is known as cross-addiction, and occurs because the substance or compulsive behaviours are merely symptoms of a bigger disorder.)

The data speaks for itself. Over the past three years, the UK has witnessed an 84 per cent increase in eating disorders, a 100 per cent rise in screen-based addictions, and an estimated 30 per cent surge in gambling addictions, with seniors being particularly affected. Recent headlines have highlighted even more troubling trends, too: drug-related deaths have risen by 80 per cent over the last decade, and deaths “ wholly attributable to alcohol ” hit a record high in 2022. More of us report struggling with depression, and recent news that one in four women are on antidepressants has drawn attention to a broader problem – the lure of quick fixes and a failure to treat root causes.

When untreated, addiction becomes a family affair. The NHS cites family members with poor mental health or substance misuse disorder as a critical cause of children forming addictions of their own later in life. While reports on the post-pandemic spike in drinking-related deaths are devastating, we won’t see the actual effects until children grow up. And we’re beginning to, with England topping the global chart for child alcohol use . “If you catch it early, you can have a wonderful life,” says behavioural psychologist Dr Samantha Duggan.

Most people have spiritual needs and a desire to connect with some purpose beyond ourselves. The need for community in healing or recovery processes is arguably part of this

Early intervention could save lives, but societal structures make such a thing a challenge. Shelter’s report on record child homelessness is concerning for a multitude of reasons. One, though, is that most homeless individuals have mental health disorders and/or substance abuse issues. England and Wales have the highest prison populations in Western Europe, with half of inmates battling drug addiction, fueling crimes like shoplifting and burglary. Failure to intervene leads to dire consequences, including further homelessness, imprisonment, and even fatalities.

False narratives surrounding what an addict “looks like” are also detrimental to individuals in denial, or those who would have sought help sooner. Professions with some of the highest rates of alcoholism are, in fact, law , healthcare and management. The reality is that “70 per cent of alcoholics go on functioning,” Dr Duggan says. “They get up, and they go to work. They just underperform.” People slip through the cracks.

“Most GPs and doctors have very little teaching on addiction,” says Dr Brenner. Eighty-two per cent of 600,000 dependent drinkers receive no help, and the NHS only handles acute cases. Short detox stints don’t work , and only 23 per cent of alcohol treatment referrals come from health services. Despite this, alcohol treatment costs the NHS over £3.5bn annually, with individuals with drinking problems occupying, Dr Brenner says, “20 per cent of hospital beds at any given time”.

We can’t measure the real impact of addiction, but the available information tells a story. “It’s a fatal illness that destroys the lives of patients and all around them,” says Dr Brener. It affects all corners of society: families, friends, workplaces, and health services, to name a few.

Many treatment options are available for individuals affected. Still, unlike 12-step fellowships, none are instantly accessible, free and can offer life-long support without relying on overwhelmed infrastructures. AA appears on the NHS support page, but it is misunderstood enough as a programme for Dr Brener to insist on his medical students’ exposure to groups during their training.

Likely because of the confusion that surrounds AA, many continue to advocate for its worth. In 2020, the Cochrane Collaboration – internationally recognised as the gold standard for evaluating the effects of any medicine or intervention in any area of healthcare – published a review on the effectiveness of AA. It gathered data from 150 scientists from 67 institutions, and found that “AA was as good as, and most often better than, other addiction treatments”. The review also found that AA is as effective as cognitive behavioural therapy, a finding supported by Dr Campbell, who emphasises AA’s additional benefits in emotional management and spirituality. “The power of group therapy, which has a very clear direction, is enormous, and AA exemplifies this,” he says.

Anonymity is integral to keeping members of AA safe, so we can’t quantify its positive impact. However, we know that without it, millions worldwide wouldn’t be sober today – not just sober but, as Dr Campbell says, “living a better life”. He adds: “Any addiction programme I respect would incorporate the fellowship.”

While most UK rehabs use the 12-step model, securing a spot in NHS-funded residential care can be challenging, with waiting times extending to several months depending on funding distribution and local authorities. Run entirely by alcoholics, AA is grassroots, self-governed, non-professional and self-supporting. There’s no hierarchy; people come and go as they please and choose their sponsor, and everything in the programme is a “suggestion” rather than a necessity. Anybody can set up a meeting, and it’s run entirely on voluntary donations. There’s even a limit to the amount an individual can give. It isn’t affiliated with sects, denominations, politics, organisations or institutions. The focus remains solely on the individual.

The steps help individuals accept what they can’t control and take action where they can. They write a moral inventory, acknowledge the possible harm they’ve caused, and make amends. It’s a constant opportunity for growth and exercising compassion for themselves and all around them.

‘Seventy per cent of alcoholics go on functioning. They get up, and they go to work. They just underperform’

A cornerstone of the program is spirituality. “Professionals often misunderstand 12-step programmes as religious,” says Dr Duggan. While “God” is featured in the literature, it can refer to anything from nature to the support group itself. Members of all beliefs, including agnostics, participate. According to Dr Brener, while spirituality isn’t “totally necessary”, it is “helpful” in the process. Others, such as Dr Naomi Thompson, sociology lecturer at Goldsmiths University, tells me that many of us crave a feeling of belonging, whether religious in nature or not. “Researchers in the sociology of religion have found people who identify as non-religious rarely see themselves as non-spiritual,” she says. “My own research suggests most people have spiritual needs and desire to connect with some purpose beyond ourselves. The need for community in healing or recovery processes is arguably part of this.”

The second cornerstone to AA is giving back. The group’s primary aim is “to help other alcoholics to achieve sobriety”. It fosters unconditional support where individuals feel understood and cared for. People get help and then go on to help others, something that’s proven to make us all happier .

AA won’t be for everybody, and sobriety isn’t a certainty. Addiction is a complex condition, and relapse is part of many individuals’ journeys. What remains certain is the door to AA never gets shut, and there’s a simple programme available that’s helped millions of people live better lives for almost 90 years. It offers more than abstinence: friends who become family, a roadmap for navigating life’s inevitable challenges, and a profound sense of reassurance that everything – whether or not you first believe it – will eventually fall into place.

You can contact AA at www.alcoholics-anonymous.org.uk

Join our commenting forum

Join thought-provoking conversations, follow other Independent readers and see their replies

Subscribe to Independent Premium to bookmark this article

Want to bookmark your favourite articles and stories to read or reference later? Start your Independent Premium subscription today.

New to The Independent?

Or if you would prefer:

Want an ad-free experience?

Hi {{indy.fullName}}

• My Independent Premium
• Account details
• Help centre

An official website of the United States government

Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

In Crisis? Call or Text 988

Your browser is not supported

Switch to Chrome, Edge, Firefox or Safari

Recovery and Recovery Support

SAMHSA's  working definition of recovery  defines recovery as a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. Recovery signals a dramatic shift in the expectation for positive outcomes for individuals who experience mental and substance use conditions or the co-occurring of the two.

On March 1, 2022, President Biden announced his administration’s  strategy to address our nation’s mental health crisis  as outlined in the 2022 Presidential Unity Agenda. To meet this goal, SAMHSA collaborated with federal, state, tribal, territorial, and local partners including peer specialists to develop the  National Model Standards for Peer Support Certification .

2 in 3 adults who ever had a mental health problem considered themselves to be recovering or in recovery.

7 in 10 adults who ever had a substance use problem considered themselves to be recovering or in recovery.

50.2 million American adults considered themselves to be in recovery from their substance use and/or mental health problems.

Guiding Principles

Hope, the belief that these challenges and conditions can be overcome, is the foundation of recovery. A person’s recovery is built on his or her strengths, talents, coping abilities, resources, and inherent values. It is holistic, addresses the whole person and their community, and is supported by peers, friends, and family members.

The process of recovery is highly personal and occurs via many pathways. It may include clinical treatment, medications, faith-based approaches, peer support, family support, self-care, and other approaches. Recovery is characterized by continual growth and improvement in one’s health and wellness and managing setbacks. Because setbacks are a natural part of life, resilience becomes a key component of recovery.

The Four Major Dimensions of Recovery

• Health  - Overcoming or managing one’s disease(s) or symptoms - for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medication if one has an addiction problem- and for everyone in recovery making informed, healthy choices that support physical and emotional well-being
• Home  - Having a stable and safe place to live
• Purpose -  Conducting meaningful daily activities, such as a job, school volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society
• Community  - Having relationships and social networks that provide support, friendship, love, and hope

Recovery Newsroom

Get the latest announcements on SAMHSA’s effort to address recovery support. Access the latest news, upcoming events, and more .

Join Our Mailing List

Recovery Funding

• Statewide Consumer Network Grant FY22
• National Consumer and Consumer Supporter Technical Assistance Grant FY20
• Statewide Family Network Program FY22
• Building Communities of Recovery FY22
• Recovery Community Services Program FY20
• Enhancement and Expansion of Treatment and Recovery Services for Adolescents, Transitional Aged Youth, and their Families FY18
• Fiscal Year 2024 Innovative Coordinated Access and Mobility Notice of Funding Opportunity
• Notice of Special Interest (NOSI): Strategies to Address Stigmatizing Beliefs and Policies Affecting People Who Use Drugs
• Peer Recovery Center of Excellence
• Consumer Supporter Technical Assistance Center – The Family Cafe
• Doors to Wellbeing
• National Empowerment Center TAC
• Peer Support Coalition of Florida
• YouthMOVE Peer Center
• National Family Support Technical Assistance Center
• Tribal Training and TAC
• National Harm Reduction TAC
• National Recovery Month
• Best Practices for Recovery Housing
• Recovery Summit Executive Summary (PDF | 351 KB)
• SAMHSA Inclusion Policy (PDF | 195 KB)
• Allowable Recovery Support Services RSS Expenditures through the SUBG and the MHBG (PDF | 464 KB)
• Recovery from Substance Use and Mental Health Problems Among Adults in the United States (PDF | 439 KB)
• Building New Horizons: Opening Career Pathways for Peers with Criminal Justice Backgrounds - SMI Adviser
• Consumer Operated Services Program EBP Toolkit
• Other Recovery Publications

Get the latest announcements on SAMHSA’s effort to address recovery support. Access the latest news, upcoming events, and more.

• Recovery to Practice Webinars
• I Don't Know How To: Parent Series
• Recovery Month Equity Week Webinars
• SAMHSA Tribal Recovery Summit 2023

Peer Support Webinars

• Striving and Thriving among Certified Peer Specialists (1 hour, 4 minutes)

Recovery Exchange Webinars

• Recovery Exchange Meeting - April 2024 (56 minutes)
• Recovery Exchange Meeting - December 2023 (1 hour, 3 minutes)
• Region 3 Community Meeting (PDF | 733 KB)
• Region 5 Community Meeting (PDF | 1.3 MB)
• Peers and Psychiatry in Dialogue - Meeting Summary (PDF | 461 KB)
• Recovery Research Technical Expert Panel - Executive Summary & Report (PDF | 1.1 MB)
• Peer Possibilities: National Peer Workforce Summit - Executive Summary and Meeting Report (PDF | 640 KB)
• Peer-Operated Warm Lines Technical Experts Panel - Executive Summary and Meeting Report (PDF | 471 KB)
• Lifting Lived Experience Across Criminal Justice Settings - Executive Summary and Report (PDF | 665 KB)
• Digital Recovery Support Innovations Technical Expert Panel Executive Summary & Report (PDF | 635 KB)
• The Intersection of Recovery Housing & Housing First— A Dialogue on Collaboration and Partnership (PDF | 700 KB)
• Collegiate Recovery Executive Summary & Report (PDF | 813 KB)

'I was killing myself': San Francisco program giving alcohol to addicts may save lives

SAN FRANCISCO – The toll of homelessness and decades of substance abuse is evident in Bruce and Lisa, two clients of San Francisco’s controversial Managed Alcohol Program, from her missing teeth and gravelly voice to his bloodshot eyes.

He once dropped a bottle of gin and then sucked the spilled liquid off the floor with a straw, desperate for the alcohol. She recently ventured out of the residential program’s building in search of additional booze and promptly wound up in a hospital with a broken arm she still can’t explain.

One fact they’re both clear on: Without the innovative city venture, they would be dead by now.

Under MAP, as the initiative is known, up to 20 homeless people with severe alcohol use disorder are housed in a former hotel and given predetermined doses of liquor at specific intervals.

It’s not exactly happy hour at the corner bar. The drinks, dispensed by nurses as a form of medication, are meant to prevent the clients from becoming overly intoxicated while avoiding the worst effects of withdrawal, which may lead to seizures and can be fatal for those physically dependent on alcohol.

The need goes well beyond San Francisco. The Centers for Disease Control and Prevention says about 178,000 Americans die every year of excessive alcohol use.

MAP focuses on a small subset of the homeless population with the most severe alcoholism – a group that drains a disproportionate share of the city’s emergency resources – and it has drawn fire from critics who contend San Francisco is spending millions of dollars enabling addiction.

Bruce and Lisa offer a counterpoint.

“Before I came to MAP, I was drinking my breakfast, lunch and dinner. I couldn’t even walk. I was a total mess,’’ said Bruce, 65, who along with Lisa spoke on condition their last names not be used because of safety concerns. “MAP has helped me take my medications, make my appointments. I wouldn’t be doing all that if it wasn’t for this program. They saved my life.’’

Said Lisa, 62: “I was killing myself. I would have been dead for sure if they had not taken me in.’’

'Science is very strong' in showing benefits

The notion of a famously liberal city providing free drinks to alcoholics has made for easy fodder in some conservative circles , with “taxpayer-funded’’ vodka played up in headlines. Officials with San Francisco’s Department of Public Health say clients and staffers have been harassed in person and online by right-wing media outlets whose personnel have approached them during outings and taken photos through the closed building’s windows.

Dr. Paul Linde, a substance abuse expert and longtime city resident, concedes that "on the face of it, to the average person this does seem nuts.''

But Linde, a professor emeritus at the University of California, San Francisco, who provided psychiatric emergency services at S.F. General Hospital for 24 years, said there’s solid science behind the idea of limiting the damage caused by addiction.

MAP relies on harm reduction , a model that emphasizes decreasing the negative effects of substance use without requiring abstinence . Linde said harm reduction is better understood in relation to intravenous drug use that can lead to communicable diseases such as AIDS, hepatitis C and other infections. He believes the concept also is applicable to alcohol abuse, which can result in liver, heart and brain damage in addition to an increased risk of cancer.

“The science is very strong in showing physical health, mental health and quality of life benefits from reducing and not needing to stop,’’ said Linde, adding that patients on harm reduction typically drop their substance use by 50% to 75%. “From a public health perspective this program makes a ton of sense. It’s not just the alcohol, it’s the contact and the social support that’s there, and the door is always open for more traditional treatment if people want it.’’

Traditional treatment, espoused by Alcoholics Anonymous and the Salvation Army, among others, is based on abstinence. Linde said that focus sometimes leads to a rigid mentality among those whose lives have benefited from absolute sobriety and see it as the only way to overcome alcohol use disorder (AUD).

Recovery possible without abstinence, NIAAA says

Two years ago, the National Institute on Alcohol Abuse and Alcoholism changed its definition of recovery, and it no longer requires abstinence. “An individual may be considered ‘recovered’ if both remission from AUD and cessation from heavy drinking are achieved and maintained over time,’’ the institute says on its website, defining such “cessation’’ as having no more than 14 drinks a week for men and seven for women, with limits on the daily amounts.

Linde, now a medical director for the telehealth care provider Ria Health , said some of his patients thrived by going through the AA program and others floundered.

“AA is terrific for some people. AA has saved countless lives,’’ Linde said. “It’s a wonderful model, but only if it’s a good fit for the individual. It’s not the only way to recover from alcohol use disorder. It’s one way.’’

There are plenty of skeptics about San Francisco’s embrace of harm reduction, including its mayor, London Breed. In February, Breed said the approach was ineffective and was “making things far worse’’ when it comes to the city’s soaring fentanyl-related deaths.

But Breed has not cut MAP’s $5 million yearly budget, and her spokesman Jeff Cretan said via e-mail that the program helps the city keep some of its most problematic people “off the streets and indoors, while trying to get them connected to more services.’’

Better uses for the money?

Krystyl Wright, a licensed clinical social worker and psychotherapist with Diamond Recovery Group based in Los Angeles, said she would prefer to see the money assigned to MAP spent on treatment for more people, especially the most vulnerable, including those without health insurance or stable housing.

“I am not in total disagreement with harm reduction,” Wright said. “But I am concerned because alcoholism is an addiction. … I see (MAP) as enabling, and if we’re thinking of bringing this to Los Angeles, I pray we keep it as a pilot program. … I don’t think this is a one-off solution.”

Lisa and Bruce said they've tried to quit drinking before without success. They both acknowledge past drug use – crack and crystal meth for her, meth and IV drugs for him. Bruce, who has been at MAP for five months after years of bouncing from one emergency room to another, said he hasn’t injected drugs in more than 10 years.

“That was easier to quit than alcohol. The alcohol, that’s the beast of all beasts,’’ said Bruce, who has battled drinking problems for 45 years and ultimately wants to achieve sobriety. “MAP has helped me somewhat get rid of that beast. Some of the medication I’m taking, I don’t have the cravings I used to have.’’

Health officials say that though versions of MAP were used elsewhere as part of isolation and quarantine efforts during the COVID-19 pandemic, San Francisco is the first city to implement the model permanently. Fifty-five clients have gone through the treatment − they're expected to stay at least a year − and they're offered medication and therapy in addition to the drinks, which can be beer, wine or vodka.

Lisa joined MAP in its infancy during the early days of the pandemic in 2020, when officials trying to keep the city’s large homeless population safe placed them in hotels and motels. Some who were addicted to alcohol were provided liquor to allay their cravings and head off withdrawal. The surprising success of that endeavor begat the current undertaking.

At the time, Lisa said she was consuming more than a fifth of gin a day. She’s now down to four standard daily drinks.

“I would drink myself into a seizure and then fall and have somebody call an ambulance,’’ she said. “And then when I’d wake up in the morning, if I didn’t have a drink I’d have a seizure then. Since I’ve been at MAP all my seizures have stopped.’’

Major reduction in use of emergency services

Dara Papo, director of the health department’s Whole Person Integrated Care, oversees MAP, which began as a pilot program modeled after similar efforts in Canada and Europe.

Papo is aware MAP’s $5 million price tag and unorthodox approach make it a magnet for criticism. She points to the 2022 internal analysis that found the city saved $1.7 million over six months through a drastic reduction in emergency room visits (73%), emergency medical system activations (65%) and hospitalizations (45%) from frequent users of services enrolling in MAP.

Just as much as that, Papo highlights the human connections made by people who have regained “dignity they did not have when they were frequently found lying on the sidewalk in their own bodily waste.’’

A recent example featured a man who had transitioned to an abstinence-based program and, when stopping by to provide an update on his progress, shared the news that he had restored relations with his adult children and met a grandchild he didn’t know he had. In May, Bruce and other clients joined staffers in a birthday celebration for Lisa.

Papo lists caring for clients in a humane way, reducing use of emergency services and benefitting the community – through increased EMS availability and less interaction with distressed addicts – as three keys for MAP’s success.

“The endgame is stabilization and greater health and wellness,’’ Papo said. “We have some people that have chosen recovery. We have people that have gone from 18 drinks a day to two. They’re not sober, but they’re able to function having two drinks a day.’’

Can't walk in off the street and get a drink

Papo also corrected some misconceptions about the program, saying only staffers and clients are allowed in the facility – no one can just wander in for a free pop. She noted clients are referred to MAP and screened upon intake, then given an individualized care plan.

And while the department offers other rehabilitation services with the goal of abstinence, Papo said MAP has been most effective at stabilizing those with chronic, severe alcoholism, who commonly reduce their consumption even if they don’t quit drinking altogether. Also, department officials say, none of the booze used in the program is purchased with taxpayer dollars.

The San Francisco Fire Department has endorsed MAP, saying in a statement that its members know well how frequently chronic alcoholics require emergency services – some of them daily – and calling the initiative “an incredibly impactful intervention’’ in reducing unnecessary calls.

“Since MAP’s inception in 2020, our Department has seen a marked decrease in EMS utilization from this small but highly vulnerable population,’’ the statement said.

Vitka Eisen, CEO of HealthRIGHT 360 – a San Francisco nonprofit that advocates for treatment of substance use disorder – said some alcoholics will ingest hand sanitizer or mouthwash to avoid withdrawal if they can’t access liquor.

Gary McCoy, the organization’s vice president, can relate. McCoy, 45, said his use of heroin, meth and alcohol caused him to shuttle between homelessness and jail until finding sobriety – and sticking with it − through a harm reduction program more than 14 years ago. He sees the approach as a valuable tool to get addicts into recovery and eventually abstinence but realizes the backlash it can evoke.

“That's the problem with stigma,’’ McCoy said. “When you start bringing your morals into things, you forget to look at the bigger picture, and the data and the research that support programs like this.’’

More From Forbes

The most inclusive recovery communities for professionals who don’t drink.

• Share to Facebook
• Share to Twitter
• Share to Linkedin

People made of wood holding hands in a circle.

It can be hard to go to work events or spend time with colleagues outside of work when you don’t drink. Happy hour, holiday parties, hanging out after a long day— all of these things come with the expectation to drink. However, Americans are cutting down on alcohol like never before. According to a 2023 Gallup study , 38% of Americans don’t drink at all. Millions of people are reevaluating their relationship with alcohol.

There are so many benefits to putting down the bottle, whether you’re in recovery or just want to live a healthier lifestyle. Maybe you binge drink every weekend. Or you might even black out at times and forget what you did or said. You could be feeling overworked and underpaid so you drink after work to suppress your pain. For me, drinking was about numbing pain associated with sexual assault trauma. As someone who blacked out on weekends for years, so much was done to me when I couldn’t consent— or talk at all. In 2019 I decided I had enough of blacking out and waking up in unfamiliar places.

And I’m not alone. Some Americans decide to quit drinking due to alcohol nearly destroying or ending their lives. Like me, serious alcoholics realize that they have two choices: to quit drinking or to die. For many alcoholics to drink is to die, a concept I learned about from Alcoholics Anonymous (AA). But that doesn’t apply to everyone. It was five years ago when I was going to multiple in-person and online AA meetings every day.

I was working part-time as a social media manager and lost interest in my job. Work was like a hobby and recovery became my job. I started spending so much time with people in AA and avoiding people who weren’t alcoholics, who AA members call “normies.” AA became the foundation of my recovery and I will be forever grateful for what “the program” has taught me. After much consideration I have decided to only attend AA meetings once or twice a week.

I am exhausted from being muted during online meetings for speaking about how racism and queerphobia were part of the reason I drank. I once said in a chat in an online meeting that “race pertains to drinking for some people.” I was kicked out of the meeting almost immediately. In AA there is something called “outside issues.”

Best High-Yield Savings Accounts Of 2024

Best 5% interest savings accounts of 2024.

The founders, who were two white men, created a rule where there are certain subjects that shouldn’t be discussed in AA meetings. This usually includes politics, racism, sexism, queerphobia, etc. Every meeting has its own rules [group conscience] which means a meeting host or co-host can silence someone if they talk about things like racism. That’s why I’ve started to explore recovery spaces that are more inclusive. Here are a few alternatives to AA that professionals who don’t drink may want to consider.

White Bison [Wellbriety]

White Bison is a Colorado-based recovery, sobriety, addiction prevention, and wellness learning resource for Native American people. I have attended White Bison meetings and genuinely felt safe. The community is geared towards anyone in recovery who has Native ancestry. Despite my Native roots going super far back, predominantly Native people in recovery encouraged me to attend some White Bison meetings. It was one of the most welcoming recovery spaces I’ve ever been in.

White Bison doesn’t come with pressure to believe in a higher power in order to stay alcohol-free. Also, when I went to White Bison, I didn’t receive inappropriate comments about my hair, skin color, race, or sexual orientation. I highly recommend White Bison for people of color with Native ancestry because (for the most part) members don’t say that there is one way to recover. There are a lot of people who genuinely believe twelve step programs are the only way to stop drinking. When in reality, there are countless communities and collectives that successfully help people quit substances while taking an inclusive approach to recovery.

Served Up Sober

Served Up Sober founder Shari Hampton is a seasoned recovery coach based in Southern California. From providing tools to people in recovery to offering individual recovery coaching to hosting workshops, Hampton moves with purpose and intention. As a Black woman she recognized the need for more inclusive recovery spaces. That’s why she founded Served Up Sober, a holistic healing space for women of color in recovery.

Hampton doesn’t just offer one-on-one sessions. Served Up Sober has had events in the past to bring people of color in recovery together. The healing space even helped me. I had relapsed, was depressed, and didn’t feel like I had a future. I messaged back and forth with her and fully felt seen and heard for the first time in recovery. I highly recommend working with her to move towards a place of self acceptance and self love.

Recovery Dharma

Recovery Dharma is one of the most celebrated recovery communities in the country. The peer led movement was founded based on Buddhist teachings. Some of the meetings include meditation, something that really helped me when I struggled with severe anxiety at the beginning of the pandemic. I was recently introduced to BIPOC meetings and feel a deep sense of relief. BIPOC Recovery Dharma is a great space for those who want to experience a decolonized approach to recovery. And the statement below from Recovery Dharma’s site perfectly captures the community’s mission.

“Recovery Dharma is a peer-led movement and community that is unified by our trust in the potential of each of us to recover and find freedom from the suffering of addiction. We believe that the traditional Buddhist teachings, often referred to as the Dharma, offer a powerful approach to healing from addiction and living a life of true freedom,” it says on the organization’s site. It continues as follows.

“We believe that recovery means empowerment, and we support each other as partners walking the path together. We believe that recovery is rooted in finding our own inner wisdom and individual journeys,” it reads. Recovery Dharma isn’t a program, it’s a space for collective healing. I believe that allowing people to go on their own spiritual journeys, free of judgment or peer pressure, is more helpful and healing for someone in recovery than being told only one belief system will help them refrain from using substances.

And know this— all of the communities on this list encourage members to find themselves through a decolonized approach to remaining drug and alcohol free. If twelve step programs aren’t for you, don’t worry. Check out more the inclusion focused recovery communities I mentioned above. It may feel a little scary to venture away from conventional twelve step programs.

If you’re a professional who is in recovery , don’t give up on sobriety or sober curiosity because you don’t like AA. Try different recovery groups with a quick google search. Know that removing alcohol from your life will benefit you in your professional and personal life. So, keep looking for alternative recovery communities until you come across a meeting where you feel safe, seen, and heard. You won’t just find your people, you’ll probably find yourself too.

• Editorial Standards
• Reprints & Permissions

Join The Conversation

One Community. Many Voices. Create a free account to share your thoughts. 

Forbes Community Guidelines

Our community is about connecting people through open and thoughtful conversations. We want our readers to share their views and exchange ideas and facts in a safe space.

In order to do so, please follow the posting rules in our site's  Terms of Service.   We've summarized some of those key rules below. Simply put, keep it civil.

Your post will be rejected if we notice that it seems to contain:

• False or intentionally out-of-context or misleading information
• Insults, profanity, incoherent, obscene or inflammatory language or threats of any kind
• Attacks on the identity of other commenters or the article's author
• Content that otherwise violates our site's  terms.

User accounts will be blocked if we notice or believe that users are engaged in:

• Continuous attempts to re-post comments that have been previously moderated/rejected
• Racist, sexist, homophobic or other discriminatory comments
• Attempts or tactics that put the site security at risk
• Actions that otherwise violate our site's  terms.

So, how can you be a power user?

• Stay on topic and share your insights
• Feel free to be clear and thoughtful to get your point across
• ‘Like’ or ‘Dislike’ to show your point of view.
• Protect your community.
• Use the report tool to alert us when someone breaks the rules.

Thanks for reading our community guidelines. Please read the full list of posting rules found in our site's  Terms of Service.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Int J Environ Res Public Health

The Beneficial Role of Involvement in Alcoholics Anonymous for Existential and Subjective Well-Being of Alcohol-Dependent Individuals? The Model Verification

Associated data.

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy of the participants.

Involvement in Alcoholics Anonymous (AA) is an important psychosocial factor for the recovery of alcohol-dependent individuals. Recent studies have confirmed the beneficial role of involvement in AA for abstinence and reduction in drinking alcohol. Little is known about the mechanism underlying the relationship between involvement in AA and subjective well-being. This study aims to verify whether in a sample of Polish AA participants involvement in AA is indirectly related to subjective well-being through existential well-being consisting of hope and meaning in life. The achieved results have confirmed that involvement in AA is positively related to existential well-being, which in turn positively predicts subjective well-being including life satisfaction as well as positive and negative affect. It was confirmed that AA involvement in self-help groups indirectly via existential well-being is related to subjective well-being. Theoretical and practical implications were discussed.

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 study 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.

It means that existential well-being is a significant factor in achieving happiness, operationalized as subjective well-being. Recent research has confirmed that existential well-being aspects, such as a meaning in life and hope as a consequence of spiritual growth, lead to subjective well-being [ 22 , 23 ], consisting of life satisfaction and positive and negative affect [ 19 ].

2. Review of Literature

2.1. 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 [ 24 ] 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 [ 25 ] 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 [ 26 ]. In a sample of young adults participating in AA, serving as a sponsor and level of affiliation were associated with lower anxiety [ 27 ]. In a McKellar, Stewart, and Humphreys [ 28 ] 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 [ 29 ], fewer depressive symptoms [ 30 ], predicting continuous sobriety [ 31 ], as well as being less likely to report a craving for alcohol [ 30 ]. 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 [ 32 , 33 , 34 ], and lesser psychiatric severity [ 35 ].

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 [ 36 ], 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. [ 37 ]. 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 [ 37 ]. In Blonigen et al. [ 38 ]), 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. [ 38 ] 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 [ 39 , 40 , 41 , 42 ]. Spirituality and religiousness are similar and overlapping constructs, but spirituality is a wider conception includes religiousness as one form of express spirituality [ 43 ]. 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 [ 44 ], 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. In this study, 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.

2.2. 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 [ 45 ], substance use [ 46 ], alcohol and drug abuse [ 47 , 48 , 49 , 50 ], sedative use [ 51 ], smartphone and internet addiction [ 52 , 53 ], gambling [ 54 ], as well as substantially higher likelihood of future drug misuse [ 55 ]. For example, in a sample of students from Romania, meaning in life protected against drug and sedative use as well as unsafe sex [ 56 ].

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 [ 57 , 58 , 59 , 60 , 61 , 62 ]. 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 [ 41 ]. 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 [ 63 ]. Among AA participants from Great Britain, completion of steps 4 and 5 as well as involvement in AA correlated positively with existential well-being [ 60 ].

Much research has emphasised on the significant role of purpose and meaning in life in individuals with alcohol dependence recovery [ 57 , 64 , 65 , 66 , 67 ]. 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 [ 68 ].

2.3. 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 [ 69 , 70 , 71 , 72 ] or positive emotion [ 73 , 74 , 75 ]. Others have conceptualised hope from the perspective of positive psychology as a strength of character [ 76 ]. Hope-focused intervention is a significant issue in the area of substance abuse counselling [ 77 ]. Hope is predictive of entering substance abuse treatment [ 78 ] and during therapy of facilitating the ease of the required changes and return to health [ 79 ]. Additionally, hope is a factor in reducing the risk of relapse [ 80 ].

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 [ 81 ].

Recent research has confirmed that hope is an important factor for the recovery and well-being of individuals with alcohol dependence [ 82 , 83 , 84 , 85 ]. In Gutierrez’s study [ 64 ] meaning in life via hope indirectly reduced alcohol and drug use. Mathis et al. [ 83 ] 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 [ 86 , 87 ].

Among AA individuals, hope measured by the Herth Hope Index correlated positively with evaluation of life and correlated negatively with the level of stress [ 86 ]. 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 [ 87 ].

3. Material and Methods

3.1. participants.

The participants of the study were 70 individuals addicted to alcohol, attending AA meetings in Poland. The subjects gave their consent to take part in the study. The surveys were distributed by the psychologist during AA meetings and collected during the next meeting after being completed at home.

3.2. Measures

The following tools were used: the Herth Hope Index (HHI), the Purpose in Life Test (PIL), Positive and Negative Affect Schedule (PANAS), Alcoholics Anonymous Involvement Scale (AAIS) and one-item measures regarding length of being in AA, abstinence duration, quantity of completed steps within a 12-step programme, frequency of being at AA meetings, as well as frequency of being chairman at AA meetings.

Affiliation with AA. The Alcoholics Anonymous Involvement Scale (AAIS) was used to assess lifetime AA attendance [ 88 ]. AAI consists of 13 items related to involvement in AA attendance and activities, including considering oneself to be a member of AA, going to 90 meetings in 90 days, celebrating an AA birthday, having and/or being a sponsor, having a spiritual awakening, etc. Participants responded either “Yes” or “No”. Additionally, participants were asked about steps completed in alcohol treatment, about steps “worked”, about quantity of meetings attended in the last year, and total number of meetings ever attended. In the research, questions were asked regarding participation in any alcohol treatment, spiritual awakening as a consequence of involvement in AA, total number of meetings, and number of steps “worked”. Additionally, participants were asked about frequency of being chairman at AA meetings during the last year.

Steps quantity. One item measure was used to verify this. Participants declared how many steps they had completed from the 12-step programme.

Hope. The Herth Hope Index (HHI) consists of 12 items and is a measure of hope. Respondents rate each item on a 4-point Likert scale, from 1—strongly disagree, to 4—strongly agree [ 89 ]. The reliability of this measure assessed as Cronbach’s α was 0.97 [ 90 ]; its test-retest reliability was 0.91 [ 89 ].

Meaning in life. The Purpose in Life Test (PIL) consists of 20 items concerning meaning in life, which subjects respond to by indicating a field on the continuum ranging from 1 to 7, where 7 represents the maximum level of meaning in life and 1 represents the minimum level. The score is computed by adding up the responses to all items. The higher the score, the stronger the satisfaction of the need for meaning in life; the lower the score, the greater the existential frustration. The reliability of this test measured as Pearson’s r coefficient was 0.82; with the Spearman-Brown correction, it was 0.90 [ 50 ].

Life satisfaction. The Cantril Ladder [ 91 ] is a well-known measure used to verify life satisfaction. It consists of one question in which the respondent evaluates his overall satisfaction with life on a scale from 0 (minimum) to 10 (maximum). It was used from future perspective (for the five years). This tool has satisfied psychometrics properties. Czapiński used this scale during a two month interval, obtaining a reliability score of 0.76 [ 92 ]. In another project the coefficient of reliability at a two year interval measured, 0.65 [ 93 ].

Positive and negative affect. The Positive and Negative Affects Schedule (PANAS) consists of 10 statements related to positive emotional states and another 10 concerning negative ones. Each question is graded from 1 = a little or none to 5 = very frequently. A higher score on the positive affect dimension indicates greater levels of positive affect, and a higher score on the negative affect dimension reflects a greater level of negative affect. Participants were asked to assess their emotional state based on how often they related to particular questions up to the weekend before the survey. According to studies, the reliability of the scale varied from α = 0.86 to 0.89 for the positive affect and α = 0.84 to 0.85 for the negative affect [ 94 ].

3.3. Conceptual Model

Given the existing research that links AA involvement and well-being, the current study aimed to understand further how AA involvement is related to subjective well-being among AA participants from Poland. A conceptual model of subjective well-being was tested as an indirect result of AA involvement through an existential well-being latent variable consisting of meaning in life and hope. According to Diener’s concept, subjective well-being refers to cognitive and affective well-being dimensions operationalized as a person’s cognitive and affective evaluations of life [ 19 ]. In a study, subjective well-being was the latent variable which consisted of life satisfaction as a cognitive indicator and effective indicators regarding positive and negative emotions (for example excited, guilty, hostile, upset, proud, etc.) experienced over the past week.

Existential well-being is a secular dimension of spiritual well-being [ 17 ]. MacDonald’s [ 18 ] definition of existential well-being was used as a spirituality dimension as expressed through a sense of meaning and purpose in life, and a perception of self as being competent to successfully cope with the difficulties of life and limitations of human existence. Meaning in life and hope are components of existential well-being, which includes realizing values, having goals, controlling one’s destiny, and finding self-acceptance [ 95 ]. Involvement in AA was the latent variable consisting of aggregate responses with dichotomous items from AAIS [ 88 ] and, separately, two items regarding frequency of AA attendance in the last year and frequency of being chairman in the last year.

3.4. Statistical Analyses

All statistical analyses were conducted using IBM SPSS Statistics software (Version 27.0, Chicago, IL, USA). Structural equation modelling (SEM) was used to investigate the relations between involvement in Anonymous Alcoholics and subjective well-being by exploring the role of existential well-being.

The maximum likelihood method of SEM was used to validate the measurement models and the structural equation models. It was due that all values of skewness were between −2 and +2 and kurtosis between −7 and + 7 (see Table 1 ), which meant that their distribution is closed to normal distribution [ 96 ].

Demographics variables ( n = 70).

The research model assumed that involvement in AA is indirectly related to subjective well-being through existential well-being.

Structural models were tested by applying path analysis to investigate the relationships among the latent variables such as involvement in AA, existential well-being, and subjective well-being. Models were tested using multiple goodness-of-fit indices, as recommended by Brown [ 97 ], including the root mean square error of approximation (RMSEA), the comparative fit index (CFI), and goodness-of-fit index (GFI). For the RMSEA, values less than 0.08, and ideally below 0.05, were used to indicate an adequate and reasonable fit to the data [ 98 ]. Values of 0.90 or greater, and ideally above 0.95, were used to indicate good model fits for the CFI [ 98 , 99 ].

The level of NFI should exceed 0.90 [ 100 ]. Due to the relatively small sample size, the Bollen-Stine bootstrapping method for 5000 samples resamples, and 95% interval confidence [ 101 ]. Both bias-corrected (BC) percentile method for 95% confidence intervals were derived. When the values of upper level (UL) and lower level (LL) does not include a 0, the test statistic is significantly different from zero [ 102 ].

4.1. Descriptive Statistics

Statistics of demographic variables are presented in Table 1 . Most of the study participants were men with secondary and vocational education. On average they have stayed in abstinence longer than six years and have participated in AA longer than eight years. Their mean quantity of completed steps was also relatively high.

Descriptive statistics of measurable variables are presented in Table 2 .

Descriptive statistics ( n = 70).

PANAS positive—positive affect from Positive and Negative Affect Schedule, PANAS negative—negative affect from Positive and Negative Affect Schedule, PIL—Purpose in Life Test, AAI—Alcoholics Anonymous Involvement Scale, HHI—Hertz Hope Index. (Source: author’s research).

Results of the correlation coefficients are shown in Table 3 .

Correlation matrix ( n = 70).

* p ≤ 0.05. ** p ≤ 0.01. (Source: author’s research).

4.2. Model Verification

The results of path analysis were presented in Figure 1 .

Path analysis results. Note: The standardized regression coefficients are presented. ** p < 0.01, *** p < 0.001. (Source: author’s research).

According to the achieved results, all values of fit model indicators have confirmed that the model was well fitted to the data RMSEA = 0.025 (90% CI [0.000, 0.112]), GFI = 0.932, CFI = 0.992, chi 2 = 19.78, df = 19, p = 0.409 [CMIN/ df = 1.041]). The RMSEA value was less than required for ideal fitting 0.05 [ 98 ]. The level of CFI exceeded 0.95 [ 98 ] and the values of CMIN/ df statistics, based on the chi-square statistic, were lower than the required standard of—2 or 3 [ 103 ]. Additionally using the Bollen–Stine bootstrap method ( p = 0.423) we confirmed that the model was well fitted to the data.

The standardised direct effect of involvement in AA on existential well-being was statistically significant (CI 95% [0.058; 0.649], beta = 0.375, p < 0.05)—the same as the standardised direct effect of existential well-being on subjective well-being (CI 95% [0.740; 0.994], beta = 0.896, p < 0.01). The model revealed a statistically significant indirect effect between involvement in AA and subjective well-being through existential well-being (CI 95% [0.073; 0.590], beta = 0.336, p < 0.05). This means that greater involvement in AA among individuals with alcohol dependence leads to higher existential well-being, which in turn is related to a higher level of positive affect and anticipated life satisfaction as well as a lower level of negative affect.

5. Discussion

The aim of this study was to test the positive role of existential well-being in the indirect relationship between involvement in AA and subjective well-being in a sample of individuals with alcohol dependence from Poland. The obtained results confirmed that involvement in AA is indirectly related to subjective well-being via existential well-being, consisting of meaning in life and hope.

According to recent research, the positive role of involvement in AA in the recovery process of individuals with alcohol dependence has been confirmed [ 30 , 31 , 33 , 38 ].

Recent studies have indicated that involvement in AA influenced recovery was mostly measured as abstinence and reduced alcohol use through the social and spiritual change mechanisms [ 103 ]. The relationships between involvement in AA and abstinence and alcohol use indicators were mediated through social networks and social support [ 34 , 37 , 38 , 104 , 105 , 106 ], self-efficacy [ 36 , 37 ], motivation and active coping [ 36 ], as well as spirituality/religiousness [ 40 , 41 , 42 ]. The achieved results have confirmed that another mechanism underlies the relationship between involvement in self-help groups and subjective well-being among the alcohol-addicted exists.

In this spiritual mechanism, a positive role fills existential well-being, which connects AA involvement with subjective well-being. Consistent with recent research, it has been proven that involvement in AA could be a facilitator for finding meaning in life [ 57 , 58 , 59 , 60 , 61 , 62 ] and hope [ 81 ] for alcohol-dependent individuals, which in turn is positively related to well-being [ 82 , 83 , 84 , 86 ]. The idea that meaning in life, as well as hope, are important factors in the recovery of individuals with alcohol dependence is present both in the theory and practice of counselling [ 77 , 107 ].

Existing research has confirmed that Frankl’s tragic optimism [ 21 ] could be used as an explanatory symbol of recovery for individuals with alcohol dependence participating in AA. Representatives of this group have found themselves in tragic situations because of their alcohol dependence, yet are able to transform their circumstances into something meaningful despite pain and suffering, finding that life has meaning and purpose, and fostering and maintaining hope. According to the obtained results, the antecedent of their existential well-being was involvement in AA. This variable explained only 14.06% of the variance of existential well-being, suggesting existence of spiritual [ 64 , 108 ], as well as other sources of meaning in life and hope [ 109 , 110 ]. Existential well-being explained 80.28% of subjective well-being, confirming the crucial role of purpose and meaning in life as well as hope in the process of recovery for alcohol-dependent participants in AA meetings. On the one hand, this could mean that existential well-being and subjective well-being are the same or overlapping constructs, or these are the elements of the other more wider conception of general well-being. On the other hand, existential well-being observed variables, such as meaning in life and hope, were only moderately correlated with observed variables of subjective well-being, such as life satisfaction as well as positive and negative affect. This was the proof that there are other but overlapping constructs or indicators of other variables.

The role of existential well-being in the relationship between AA involvement and subjective well-being can be explained based on the idea of “spiritual transformation” proposed by Neff and MacMaster [ 111 ] as well as the instillation of hope. Both of these phenomena have emphasised the relevant role of social learning [ 112 ]. According to Neff and MacMaster [ 111 ], social learning among Alcoholics Anonymous participants facilitates a “spiritual transformation” that influences their behavioural change. In this spiritual transformation process, some spiritual mechanisms, such as a changing perception of God, increased meaning in life, openness to forgiveness, an increase in self-acceptance, increased use of positive coping mechanisms, and increased integration into social circles are involved. The same function facilitates finding meaning in life, as religion can play with the philosophy of AA and 12-step programmes [ 3 , 4 ]. Like religion, the philosophy of AA and the set of rules functioning in self-help groups can constitute a comprehensive framework for perceiving, understanding, and evaluating experiences, and can organise and orient the behaviours of individuals with alcohol dependence [ 113 , 114 ]. In other words, in individuals for whom AA philosophy is an important value, this importance translates into an attitude in life manifesting itself in a specific perception of reality, the emotional attitude to it, and the behaviour towards it. Additionally, like other religious meaning systems, it can influence the formation of goals for self-regulation [ 115 , 116 ].

Receiving the new philosophy of life and building a stable identity as an alcohol dependent individual provides the chance for change and transformation, finding purpose and meaning in life, and supplies the tools necessary to achieve this goal. Additionally, it gives hope for a better life based on the examples of other sober and contented members of AA groups who personify this hope. The instillation of hope decreases a sense of aloneness and increases self-esteem; the realization that one’s personal experience can be of value to others decreases negative affect and increases the sense of belonging and human connectedness [ 102 ].

The role of hope as a result of AA involvement leading to recovery of alcohol-dependent patients can be explained based on the Farran, Wilken, and Popovich [ 73 ] model. The first of the four main attributes is called the processes of experiencing; it assumes that an individual with alcohol dependence should accept his disease experiences as part of “being”. This is consistent with the first step of the 12 Step Programme, emphasising powerlessness towards alcohol and lack of control in his use [ 3 ].

The attribute of spiritual hope is demonstrated by the premise that something higher exists or believing in something that cannot as of yet be proven [ 73 ], and corresponds with the second-step expectation that there is a power greater than the alcoholic that could restore his or her sanity [ 3 ] The rational-thinking aspect of hope presumes the existence of aims, e.g., regaining the connection to one’s past, present, and future and in maintaining control over one’s life [ 73 ]. This aspect of hope has a reflection in Alcoholics Anonymous’ primary purposes, such as staying sober. Only sobriety allows individuals with alcohol dependence to restore their lives and take control over them [ 4 ].

Hope in its relational aspect refers to bonding feeling with others. It seems that this forms the basis for achieving unity at AA. The sharing of common aims, mutual understanding, and trust are fundamental for shaping relationships with others. According to Yalom [ 79 ], hope is based on being aware of the similarities of life’s experiences with others. AA’s structure leads to identifying with those other AA members who now demonstrate appropriate behaviour upon which one’s own behaviour and attitudes can be modelled.

The research yields some theoretical and practical implications. First of all, in a sample of individuals with alcohol dependence from Poland participating in AA, the existence of another recently explored spiritual mechanism [ 29 , 40 , 41 , 42 ] of indirect impact of involvement in AA on subjective well-being mediated by existential well-being was confirmed. This means that practitioners, therapists, and counsellors should engage patients with an alcohol addiction diagnosis to participate in AA meetings as an effective way to cope with dependence. It is recommended to create therapeutic programmes and interventions focusing on inducing, facilitating, and promoting hope and meaning in life as an effective way to achieve the subjective well-being of alcohol-addicted patients. This kind of solution could constitute an additional therapeutic offer addressed to alcohol-dependent patients.

6. Limitation and Future Research

The conducted study has some limitations.

Generalizability of the results is limited to alcohol-dependent individuals from Poland participating in AA. The research sample was homogeneous with regards to religious denomination. All participants had a Roman Catholic affiliation. The mean of abstinence duration for participants was relatively long, which means that they can be treated as addicts with stable abstinence.

The conducted study had a cross-sectional, not longitudinal, character. The cross-sectional model of research gives the possibility to interpret the direction of identified relationships between variables but not from the causation perspective. The alternative direction between research variables was not examined, which means that the potential role of subjective well-being as a consequence of involvement in AA and the antecedent of existential well-being should not be excluded. Additional research in the longitudinal model is necessary to investigate the relationships examined from the cause-and-effect perspective and confirm their directions.

The sample study was relatively small, and the bootstrapping method was used as a good solution in case of normally distributed variables. The small sample size was why it did not add to model-controlled variables.

The research encompassed relationships between latent variables, which are not observed variables. It means that results can be interpreted only as associations between latent variables, which could differ from connections between observed variables.

Because these findings must be interpreted as applying to Roman Catholics affiliated with AA from Poland, additional research is needed to investigate the confirmed model among representatives of another religious denominations, agnostics and atheists, alcoholics of other races, as well as in another cultural contexts. AA is a worldwide mutual self-help group, but it does not mean that there is a universal model of recovery due to involvement in self-help groups through existential well-being.

Future research should take into consideration religious facets of functioning, which are important predictors of participants’ meaning in life and hope. For more complexity, other results of involvement in AA, such as social support [ 34 , 37 ] or self-efficacy [ 36 , 37 ] should be incorporated. It is important to check which aspects of AA involvement are the strongest predictors of meaning in life and hope.

It would be interesting to verify the indirect impact of AA involvement on subjective well-being through hope and meaning in life using a bi-dimensional model of meaning in life [ 117 ]. Using other measures of well-being, quality of life and health—especially regarding not only psychological but additional social and physical spheres of life—could give interesting results.

In the future, research samples should be bigger and selected for alcohol-dependent individuals who have recently started their AA participation and do not yet experience a stable abstinence. It seems to be important to test whether this model is useful when the dependent variable is abstinence or frequency of alcohol use. A bigger sample could give an opportunity to verify if sex, religious involvement, other addictions, or diseases play a moderating role between involvement in AA and meaning of life/hope. In addition, it is important to verify whether the presented model of recovery could be employed to other self-help groups dedicated to both substance and behavioural addictions, such as drug addicts, gamblers, sex addicts, workaholics, etc.

7. Conclusions

The conducted study has confirmed the benefits resulting from involvement in AA. Engagement in this form of support of alcohol-dependent individuals from Poland was positively connected with existential well-being, which in turn positively related to subjective well-being.

This study was funded by author sources.

Institutional Review Board Statement

Ethical review and approval were waived for this study, due to non-potential harming influence.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The author declares no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.