An Outsider Looking In: My Student Experience at AA

Meeting at a church on a Friday night is not usual for most college students, but it is for the members of an Alcoholics Anonymous (AA) women's group in my hometown. A square room with windows, two couches, and an odd assortment of chairs, the space is the home for a vast array of women who meet weekly to discuss their addiction journey, as well as to both provide and receive support for their decision to remain sober.

An Outsider Looking In: My Student Experience at AA

Meeting at a church on a Friday night is not usual for most college students, but it is for the members of an Alcoholics Anonymous (AA) women's group in my hometown. A square room with windows, two couches, and an odd assortment of chairs, the space is the home for a vast array of women who meet weekly to discuss their addiction journey, as well as to both provide and receive support for their decision to remain sober.

My experience at the AA meeting began with a mix-up, not to be confused with a mixer. A classmate and I spoke first with the woman who was opening the door and greeting members as they arrived. I asked her if she was the group facilitator and she explained that she was just the attendant. I later discovered that the group was autonomous and had no true leader. I explained that we were students and she let us know that it was a closed group. While apologizing for the misinformed website and letting her know we'd try elsewhere, the attendant stopped me and said that they could ask the group if we could observe. She explained that as long as no one objected, we could stay.

The meeting opened with the leader for that week explaining that students were here, and asking for discussion. This was the first glimpse into the leadership and decision-making of the group. Collective leadership ran the decisions, with every member playing an equal part in voicing their opinion. While one member was chosen each week to facilitate, decisions were unanimous or majority-based depending on the topic. For this question, the decision had to be unanimous. The leader explained that if anyone objected, we would leave. It felt awkward as an outsider, but I imagine that for the group, the process felt good due to the inclusion of all members in the decision-making. The method was honest and open, with a few members expressing their opinion. As no one objected outright, we were allowed to stay and observe after introducing ourselves.

There were several supportive roles during the meeting in addition to the leader, which also appeared to rotate on a weekly basis. AA is based upon a number of tenets, including twelve steps and twelve traditions. The steps include the idea that AA founders "made a searching and fearless moral inventory of ourselves" and "when we were wrong promptly admitted it," amongst ideas of meditation, making amends, and seeking support through a higher power (Alcoholics Anonymous, 2007, pp. 60-61). The use of "we" in these statements helped to add to the feelings of group cohesiveness. The traditions state that the only requirement for membership is a desire to stop drinking, that AA is focused solely on promoting sobriety within an autonomous group, and that anonymity is of upmost importance (Alcoholics Anonymous, 2007). Members read aloud these steps and traditions, as well as an anonymity pledge. Their roles included the orienteer and coordinator by defining the purpose and goals of the group (Mohr, 2009). Meanwhile, the leader acted as the gatekeeper by guiding the members between different parts of the group and opening the floor for discussion (Mohr, 2009). Other members in the room played the role of followers by acknowledging the speakers and reciting certain parts of the meeting from memory, as well as participating in group customs (Mohr, 2009).

The AA meeting we attended was a speaker week, which meant that the majority of the time was spent listening to a particular member give a testimony of her journey with alcohol. According to Borg, James-Andrews, van Wormer, Wheeler, and Yeres, "a critical factor in the success of 12-step programs is the opportunity to share experiences with others who have suffered similar problems" (2010, p. 6). The speaker recounted her story with addiction which began as a teen and led her across several states and various relationships. The group processed the story in a positive way. I noticed several times when members laughed, smiled, and made brief supporting comments while she spoke. Rather than judge the events of her life, the group members seemed to connect in a personal way, relating her story to their own. The idea behind having a speaker relates to the concept of catharsis, which Mohr states "is the expression of feelings, especially those involving deep emotions" (2009, p. 254) Later, a member shared with me that "this is the kind of place where you can talk about things, and everyone just laughs...no judgment but support." This woman explained that she had stayed home from a Christmas party last year in order to come to the AA meeting. She had worried about how those who did attend the party would react to her absence. However, she added, she soon discovered that no one made a big deal of her absence, and attending the meeting instead of the party meant staying away from alcohol. Being able to talk about her emotions and experiences, receiving support, and the lack of judgment was a large part of her decision to keep coming to meetings.

In addition to the readings and the speaker, there was an achievement portion of the meeting. One member received a chip for eight months of sobriety, while another announced her year anniversary without alcohol and was met with a cake. The system for rewards kept members feeling connected to the group, with senior members acting as mentors called "sponsors" who guided their newer counterparts toward these goals. Opening its arms to alcoholics in all stages of change helps keep the program one of voluntary choice rather than force. This illustrates a therapeutic component of the AA meetings described as an existential factor (Mohr, 2009).

One observation I made amongst the members was the demographics. Most of the women appeared to be middle-aged, with the youngest-looking woman stating that she was 28 years old. Those who embraced me and were willing to talk after the meeting concluded were mostly younger. Borg, et al. states reasoning behind the older demographic:

Quote
The most obvious reason may be its focus on adults. As mentioned above, adolescents do not display the level of addiction severity, or the long history of substance use, that adults may have accumulated. The presenters and participants attending AA/NA meetings are generally much older (the average participant is a 46-year-old Caucasian male) and discuss issues that youth simply do not relate to (such as child custody, divorce, and financial problems) (2010, p. 5).

I noticed that these issues were common themes in the story of the speaker; problems related to long-term relationships, career troubles, and business dilemmas, topics that many adolescents would have not yet encountered, were discussed in detail during her testimony. While the older women seemed attentive, with good eye contact and focus, some of the younger women seemed distracted and more apt to whisper to themselves at intervals. In addition, one of the younger women discussed graduating from college and having a new baby, experiences that are typical for a woman in her late twenties, and seemed excited by the idea that I had been a nursing student at the hospital where she'd delivered. I believe these observations support the idea that relation of life experiences is so critical to the group experience. Group members at different age levels or life stages may have more trouble connecting, which is why bridging the gaps between members is an important aspect to facilitating satisfaction and retention.

Years later, I look back on the meeting with fond memories. It changed the way I looked at addiction. It was no longer an evil faceless demon, or an episode of Cops. These were women who rotated between pouring their souls on the carpet and lifting up those of other members. They were mothers, sisters, grandmothers, aunts, daughters, and friends. Some were professionals, some were students, and some were unemployed. Despite their differences, they united in their common goal for a better life. Even for my experience being at a closed meeting, and technically closed to outsiders, we were greeted warmly and treated as part of the group. I was touched when we stood, held hands, and recited the Lord's Prayer because the women on either side of me squeezed my hands. I think it's essential to have support when you're struggling with addiction, as with any lifestyle change. AA is a prime example of how groups support sobriety in individuals if they are willing to follow a program and commit to changing their habits.

And it doesn't hurt that sometimes after the meeting, everyone has a piece of cake.

References

Alcoholics Anonymous. (2007). The twelve steps of alcoholics anonymous. Young people and A.A (pp. 60-61). New York, NY: Alcoholics Anonymous World Services, Inc.

Alcoholics Anonymous. (2007). The twelve traditions of alcoholics anonymous. Young people and A.A (pp. 62-63). New York, NY: Alcoholics Anonymous World Services, Inc.

Borg, M.L., James-Andrews, S., van Wormer, J., Wheeler, G., Yeres, S.A. (2010). Using "sober support" groups in your juvenile court. Technical Assistance Bulletin. National Council of Juvenile and Family Court Judges. Retrieved from http://www.ncjfcj.org/images/stories/dept/jfl/sobersupport.pdf

Mohr, W. (2009). Groups and group interventions. Psychiatric-mental health nursing: evidenced-based concepts, skills, and practices (pp. 241-260). Philadelphia, PA: Lippincott Williams & Wilkins.

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What a wonderful article! Well written, well informed. Do I perhaps see some addictions nursing in your future?

What you could personally take away from this exerience is peoples' abilities to cope in the most distressing situations. Which in turn can help you in your practice. They say "take what you need and throw the rest away". Best of luck to you, and I enjoyed that you focused on what makes AA work.

Specializes in FMF CORPSMAN USN, TRUAMA, CCRN.

excellent article. addiction nursing can be very rewarding. i worked for several years in a detox setting, and in what was considered the "newcomers" group, and thoroughly enjoyed my time there. this time was spent working with the homeless alcoholics and crack addicts when they were first coming down from their "drug of choice.” sure, there were lots of disappointments, but overall the time i spent there was surprisingly gratifying. i would highly recommend it as a career choice.

Is there any empirical evidence that, after a year, Alcoholics Anonymous is more effective than any other method — or no method? The organization refuses to release any data on the subject.

There was an article in the British Journal of Psychology on the subject in 1976 ("The efficacy of Alcoholics Anonymous: The elusiveness of hard Data"). As far as I know, the hard data is still lacking. Some studies have show that after 1 or 2 years, AA is not particularly effective.

Specializes in Oncology.
There was an article in the British Journal of Psychology on the subject in 1976 ("The efficacy of Alcoholics Anonymous: The elusiveness of hard Data"). As far as I know, the hard data is still lacking. Some studies have show that after 1 or 2 years, AA is not particularly effective.

1976 was an awfully long time ago. I think that commitment to any kind of support group is better than nothing. When you're asking about effectiveness, you have to define what you mean. Do you mean sobriety, decreased usage, more responsibility, increased mood, no crimes - what? I would say that those I've seen participate in the program have stated that they were able to remain sober and fell back into addiction once they quit attending meetings.

This wasn't really the point of the article, though. It was about how I came to see that addiction is a complex situation and those who suffer from substance abuse are still people, not the monsters that media normally make them out to be, and that support groups can be a place for these people to thrive. There is a lot of information about AA because that's the particular meeting that I attended, but it wasn't necessarily the focal point for me. Having been a part of support groups myself over the years, I feel that there is a lot to be gained from them. But it's probably a situation where you get out of it what you put into it.

Specializes in Alzheimer's, Geriatrics, Chem. Dep..

Nice job, pretty astute observations based on my 20+ years in AA :) and does AA work? well it has for me and a number of my peers, but I have not been a member for about 5 years; I still apply a lot of the principles to my life however.

Specializes in Psych ICU, addictions.

I know people that have been sober for 30+ years with AA, and people who have been sober for 30+ years without AA. It works for many, but I'll admit it's not the answer for everyone. Only the alcoholic themselves can decide if AA works for them.

1976 was an awfully long time ago.

Indeed it was, and the folks who run AA have not released any of their internal information on the effectiveness of their program since then, as far as I know. In fact, the evidence for the effectiveness of 12-step programs in general is think indeed.

I think that commitment to any kind of support group is better than nothing. When you're asking about effectiveness, you have to define what you mean. Do you mean sobriety, decreased usage, more responsibility, increased mood, no crimes - what? I would say that those I've seen participate in the program have stated that they were able to remain sober and fell back into addiction once they quit attending meetings.

The vast majority of people who join AA and similar programs join because alcoholism is affecting their lives negatively or very badly. How many participants, after a year in the program, and after a year beyond that, were at the point where they were functioning in a way that alcohol use wasn't impairing their lives?

From what I read a few years ago, the result of AA was no better than other programs, and no better than doing nothing at all, on average.

This wasn't really the point of the article, though. It was about how I came to see that addiction is a complex situation and those who suffer from substance abuse are still people, not the monsters that media normally make them out to be, and that support groups can be a place for these people to thrive. There is a lot of information about AA because that's the particular meeting that I attended, but it wasn't necessarily the focal point for me. Having been a part of support groups myself over the years, I feel that there is a lot to be gained from them. But it's probably a situation where you get out of it what you put into it.

A place for addicted people to thrive? That is indeed the question. AA's 12-step approach is one of many — a particular type of support group.

I wish they would release their data. I am concerned about AA's effectiveness just as I'd be concerned about the effectiveness of a pharmaceutical for which the manufacturer was unwilling to release data.

AA apparently "fails for the vast majority of people who who try it." ("Secrets of AA: After 75 Years, We Don't Know How It Works, " Wired, 23 June 2010) Also, a certain percentage of an addicted population will spontaneously quit abusing their substance of choice (the British government has some good data from their program to supply pharmaceutical-grade heroin and sterile syringes to addicts.) An article from the Atlantic Wire refers to the Wired article, but seems to begin with the assumption that AA is effective.

AA has publicly-accessible archives, but I don't think they contain much objective data on the effectiveness of their program.

Specializes in Peds/outpatient FP,derm,allergy/private duty.

[color=#2f4f4f]decembergrad2011 - i understand the vantage point you are taking here (it's not intended to compare the effectiveness of aa vs other treatments). your article was thorough and well-written, and really related the immediacy of your experience there and i'm quite certain the warm and accepting feelings you felt from the group were reciprocated, as they sensed you were not there to judge, but to learn and observe. i've attended open meetings with family members, and had a similar experience. thanks!

Specializes in Oncology.
The vast majority of people who join AA and similar programs join because alcoholism is affecting their lives negatively or very badly. How many participants, after a year in the program, and after a year beyond that, were at the point where they were functioning in a way that alcohol use wasn't impairing their lives?

From what I read a few years ago, the result of AA was no better than other programs, and no better than doing nothing at all, on average.

A place for addicted people to thrive? That is indeed the question. AA's 12-step approach is one of many — a particular type of support group.

I wish they would release their data. I am concerned about AA's effectiveness just as I'd be concerned about the effectiveness of a pharmaceutical for which the manufacturer was unwilling to release data.

AA apparently "fails for the vast majority of people who who try it." ("Secrets of AA: After 75 Years, We Don't Know How It Works, " Wired, 23 June 2010) Also, a certain percentage of an addicted population will spontaneously quit abusing their substance of choice (the British government has some good data from their program to supply pharmaceutical-grade heroin and sterile syringes to addicts.) An article from the Atlantic Wire refers to the Wired article, but seems to begin with the assumption that AA is effective.

AA has publicly-accessible archives, but I don't think they contain much objective data on the effectiveness of their program.

I guess I'm curious as to what you suggest to those with substance abuse in place of support groups. Are you suggesting that no treatment, no support, and no addiction education is better? Do we as nurses say, "AA has no proven efficacy, so it's a waste of your time"?

To my knowledge, AA is a free resource that requires nothing from their participants except honesty, commitment to sobriety, and meeting attendance. Even the Big Book is available online free of charge. It may not be perfect, but it's a support system that is accessible to the general public. I read the Wired article, and I agree that the biggest factor in why it works for some people (and not all) is due to the group dynamic. However, how many people can afford private group therapy in a country that is chronically under- and uninsured? NAMI groups exist, but their facilities are not everywhere. AA is available almost everywhere in the US with a wide variety of meeting days, places, and times. In my city, there are meetings every day of the week ranging from morning to night and in everywhere from churches to schools to community centers. A participant could relocate and find a new group fairly easily. This is why I am supportive of their program.

Unlike pharmaceuticals, support groups do not run the risk of causing physical side effects. That's why I personally would have a problem with a manufacturer refusing to release information about their product. I would worry that they are suppressing information that could harm the general public. I think mental health is extremely important, but I honestly cannot see a problem with a weekly meeting that requires little more than your attendance.

Personally, I am not an alcoholic, nor have I participated in AA beyond my experience written here. I can only go off of what I have been told by patients in my very limited experience. I truly wish to learn as much as I can, but I haven't yet seen how it's bad. It's not a perfect solution. But nothing in life is - even our most advanced medical treatments have their limits and fail for patients in the best of circumstances.