Negotiating group membership in Alcoholics Anonymous: A critical qualitative inquiry

Abstract

Introduction Alcoholics Anonymous (AA) is an international mutual aid/peer-to-peer organisation designed to support anyone who wants to stop drinking alcohol. It is well-established that AA membership typically involves the adoption of a distinct “alcoholic” identity, with new members generally learning that they have no control over alcohol and need to perform specific AA-recommended actions to remain abstinent. Studies have demonstrated that the adoption of AA’s prototypical “alcoholic” identity can be an effective means of maintaining abstinence and improving overall wellbeing. However, critics have denounced AA for propagating a highly prescriptive narrative to understand the nature of problematic alcohol use and recovery. AA has also been frequently criticised for being underpinned by an outdated medical model of “alcoholism” and Christian ideology. Given the organisation’s contentiousness, there is a need for balanced research that considers and integrates the perspectives of both its defenders and critics. To better understand AA’s strengths and weaknesses, the overarching objective of this thesis was to critically explore varied individual experiences in AA. In particular, this thesis aimed to investigate the processes and outcomes of negotiating group membership in AA, including accepting, resisting, and/or rejecting AA ideology and practices. Methods To collate and critique the existing literature base, a systematic literature search and critical review of 21 qualitative interview studies with AA members was conducted (Chapter 2). Interviews with 11 ex-members of AA were then examined using an interactionist conception of “social career” involving conversion and deconversion as a guiding theoretical framework, exploring their experiences of integrating into AA and the reasons why they ultimately rejected AA ideology and practices (Chapter 3). Interviews with 15 AA members were interpreted with a “politics of belonging” theoretical lens, identifying the aspects of AA ideology and practices that were negotiable, as well as those that had to be adopted entirely to belong comfortably (Chapter 4). Finally, 19 prospective interviews conducted over 12-18 months examined the experiences of six AA members and were analysed using a “master narrative” theoretical perspective, highlighting both the benefits and costs of adopting AA ideology and practices (Chapter 5). Results The systematic review (Chapter 2) found that past qualitative interview studies in this field have mostly reported the positive experiences of members who had accepted AA ideology and practices. Common themes across the reviewed studies included that “alcoholics” are “powerless” over alcohol, need to hit “rock bottom” to achieve abstinence, and undergo positive personal changes as a result of their AA involvement. Results highlighted several issues with the methodological quality of the reviewed articles, including a lack of critical positioning in introductory literature reviews or researcher positionality statements. Prominent findings across the empirical studies (Chapters 3-5) related to members’ varied experiences accepting, resisting, or rejecting AA ideology and practices. While several small-scale components of AA ideology and practices were able to be modified or resisted by current members (e.g., constructing a personalised conception of a “higher power”), identifying as being powerless over alcohol was found to be a non-negotiable element of AA membership (Chapter 4). Findings also suggested that membership typically involves internalising the overarching narrative that “alcoholics” are emotionally and mentally sick (above and beyond problems with alcohol) and need AA to achieve and maintain wellness (Chapter 5). Ex-members reported ultimately rejecting various aspects of AA ideology and practices, such as the notions that they were powerless over alcohol, chronically sick, and needed to perform AA-recommended actions to maintain their recovery (Chapter 3). They commonly described AA’s understandings of “alcoholism” and approach to recovery as overpathologising, moralising, and detrimental to their sense of self and intellectual freedom. In contrast, most current members reported wholly positive experiences from accepting AA ideology and practices and valued their AA membership for supporting their abstinence, increasing their self-insight, and providing a routine of daily actions that enhanced their sense of wellbeing (Chapter 5). Findings additionally highlighted that the collective acceptance of AA ideology and practices within its peer-to-peer system can promote a level of conformity that can be constraining for individual members. Although identifying as having a shared disease of “alcoholism” generally provided a strong sense of belonging for members (Chapter 4), those who had left AA problematised the social forces that promoted the adoption of shared self-understandings and worldviews (Chapter 3). Ex-members discussed their integration into AA as a problematic “indoctrination” or “brainwashing” process and commonly sought assistance to “deprogram” from the beliefs they had adopted (Chapter 3). The analysis of current members’ responses similarly indicated that the internalisation of AA’s narrative within its peer-to-peer system can hinder members’ abilities to develop their own independence and individuality (Chapter 5). Overall, findings emphasised that the general acceptance of AA’s strong core narrative within the AA community can make it difficult for members to comfortably resist or reject aspects of AA, or to explore or embrace beliefs or behaviours that challenge AA. Conclusion This thesis enhances our understanding of how AA membership can be negotiated and the complexities and nuances inherent across individual experiences in AA. In particular, it illuminates key strengths and weaknesses of AA’s peer-to-peer structure and its strong core narrative that is internalised and embodied by members. It introduces a number of conceptual, practical, and ethical issues to consider, and highlights the importance of researching AA through theoretical frameworks that can produce balanced and critical analyses. Further research is required to more fully comprehend experiences in AA across larger and varied samples.