12 step addiction recovery groups like Alcoholics Anonymous can be seen as some of the longest-running and most prolific resources of community-based support for people struggling with addiction and substance abuse issues in the U.S. The following study is the first-person account of the author, a social worker, attending an open meeting on the Chicago northside.
The author will analyze the structure and function of one 12-step addiction recovery groups through the lens of group work, evaluate the factors and dynamics of group psychotherapy, further examine the experience through relevant literature, and offer critical reflection on the experience of observing the group and implications for the worker’s own field of practice.
Setting for Addiction Recovery Groups
Name of Group/Meeting: Alcoholics Anonymous, “Experience, Strength, and Hope,” and open meeting.
Day, Time, and Length of Meeting: Friday, 6:00pm – 7:00pm
Place of Meeting: A Methodist Church in the Lakeview neighborhood of Chicago IL (an openly LGBTQ-friendly facility)
Participants – 32 total
Demographics: It is important to note that my observations of racial and gender presentations are inherently limited and based on my interpretation of phenotypes and gender expression. 25-65 years old by my estimation; all white save one black male and one Latino male; gender display was ⅔ masculine-presenting, ⅓ feminine-presenting; apparent diversity of socioeconomic class/status determined by attire and effects and some disclosure by participants; primarily members of the LGBTQ community; two individuals with canes suggesting variance in physical ability.
Assigned roles: Lead, Guest Lead, Literature & Collections person (all also members).
Assessment of Group Typology
According to Toseland and Rivas’s typology of treatment groups, the meeting I attended would be considered a treatment group. The group was formed for the distinct purpose of meeting members’ socioemotional needs and to “help members cope with stressful life events and revitalize existing coping abilities,” and the leaders were also members who shared the same condition, further defining it as a peer-led self-help group1.
Brief Summary of the Content and Structure of the Meeting
Set-up of space and mingle, welcome introduction by leader, moment of calm/silence, announcements, brief reading of the Mission Statement and Twelve Steps, full testimony by guest leader “Richard”, collections, immediate responses to guest leader testimony, optional floor time for newcomers/visitors, named opportunity for anyone in crisis or on precipice of drinking/using to speak/share, open floor, thanks and invitation to next week’s meeting, power circle, closing up of space with more mingling.
Assessment of the Addiction Recovery Groups
I found the general atmosphere to be very casual and warm, while imbued with a sense of purpose; many members moved through the space and set up the seating circles with bright familiarity. Some members were even possessed of certain charged enthusiasm, not unlike a team showing up to a sports field, almost as if there were an opponent to be faced down by team morale.
Cohesion appeared strong (noted exceptions to follow), as most members displayed “norms of non-judgemental acceptance and inclusiveness” by welcoming all other attendees in equal fashion and giving one another space to share experiences without interruption or retort.
Certain members seemed to have internally distracted dispositions, their apparent struggle, and guilt from within draping their features. There were two men, on different sides of the room, who sat in staid silence, neither moving nor speaking for the entirety of the meeting, refraining from the group’s chimes of welcome and affirmation and the closing power circle.
Leadership was comprised of peers who self-identified as alcoholics, were largely facilitators of empathic understanding and mutual aid; their functional roles seemingly limited to the introduction of the group, reading of the mission statement, giving designated space to those who may be in crisis or at immediate risk of relapse, and general time management3.
The Twelve Steps were read one at a time by different members who volunteered to do so. After the beginning testimony from the guest lead speaker, participation and communication were essentially in response, via raising of hands, with members identifying parallel patterns, feelings, and moments; contextual membranes through which to pass into their own monologs.
The Healing Process: Demonstration of Yalom’s Therapeutic Factors
Evaluating how the healing happens in addiction recovery groups is central to understanding the unique power and significance of group work. The psychiatrist and group psychotherapist Irvin D. Yalom identified eleven distinct beneficial elements or therapeutic factors that promote change and healing for group members. In my evaluation of the group, I observed evidence of all 11 of these factors, and the following is my observation of them in presence and degree:
- Instillation of Hope – Members commented that upon listening to others’ stories who were in more advanced stages of recovery, they felt that sobriety became more of a possibility for them; the group placed the goal within reach. As Yalom observed, “one of the great strengths of Alcoholics Anonymous is the fact that the leaders are all alcoholics–living inspirations to the others”.
- Universality – “Alcoholism, as an equal opportunity illness, does not discriminate – is not restricted to race, creed, or geography. At last, I was released from the bondage of uniqueness”. There was observable relief among listening members when another divulged feeling broken or insane, revealing both that they were not the only people to feel as such, and that they could share that in the group space. As one member said with quavering reprieve, “I know that no matter how hard it gets or how crazy I feel, I’m not alone,” as if mists were rising to reveal bridges between what were long thought to be isolated lands.
- Imparting information – In both the mingling surrounding the group session and during, I observed many members inquiring about and offering advice about rehabilitation facilities, hospitals, and hobbies and activities to mitigate loneliness and stave off the temptation to drink or use. Members seemed more free and comfortable with this after the meeting, once the atmosphere had lifted emotionally but the feelings of security and group bond were charged from a positive session.
- Altruism – This factor, elucidated by Rosenberg as members feeling that “by improving their own competence in handling the situation, they are also improving the competence of other group members and perhaps the social conditions of the group as a whole,” was most evident in the donation of members fiscally toward the group (as A.A. is an economically independent entity) and leaders in their volunteership to facilitate and organize, so that the group may continue to function for the benefit of any who have need of it. The presence of members who have been long sober and developed healthy and successful life trajectories suggests that they continue to attend to serve as beacons of encouragement and living examples of the success of the program. While A.A. is an ongoing group with the idea that membership is lifelong (as is the capacity for addiction), these members are there “for the others who are still lost or struggling with their Steps” as one member put it. This correlates directly to Yalom’s instillation of hope factor.
- The corrective recapitulation of the primary family group – Disrupted family trajectories and patterns of dysfunction, estrangement, and conflict were cited in nearly all of the member testimonies given. With regard to the group’s supportive effect for those coping with such family issues, more than one member expressed how A.A. had become a “home away from home,” or “the family that knows them best.” In this, the group served to mitigate or fulfill losses in members’ primary family systems, though no reestablishment of family roles seemed apparent.
- Development of socializing techniques – Most notably, the group seemed to exhibit and reinforce demeanors of empathy and non-judgement. More than one member commented on how being able to speak so freely about their hardships and mistakes to people who neither moralized nor patronized them helped them realize how their own reactions and responses could be measured and adjusted; this is indicative of the cultivation of emotional intelligence intrinsic to this factor. One corrective development that I witnessed occurred during mingling after the official meeting, when one member approached a newer one about the latter’s profuse swearing during his sharing. The concerned member first empathized with the anger and frustration of the second, then suggested that it might be more helpful to try to describe his feelings using vivids and similes, so that he may be better received.
- Imitative behavior – There were protocols and decorum utilized by everyone, such as how members introduced themselves and were greeted by the group, with all identifying as alcoholics before they shared. While these were more normative establishments, they seemed to set the stage for imitative behavior. Newer members repeatedly used expressions and terminology originally employed by the group lead and guest lead who were the first to speak and disclose. By taking cues from those members more “attuned to the group process,” newer members were able to further develop communication patterns and engage in therapeutic participation.
- Interpersonal learning – This was not in abundance, as the majority of member to member dialogue was in relating to points in one another’s stories and conditions. The group seemed to refrain from exchanging advice. Rather, the testimonies of those in recovery and sobriety contained choices or methods that were laid out as what had proven successful for them, passively offered up to the consideration of listening members. Other than brief reviews of the Twelve Steps, there were no specific techniques of success taught by anyone.
- Group cohesiveness – As noted earlier, there was a palpable warmth and sense of belongingness, both expressed and subtly implied by the group dynamic, suggesting the sense of “we-ness” or solidarity, and strong member attraction to the group2. As cohesiveness is “necessary for other group therapeutic factors to operate,” the appearance of the other factors as this author has accounted for them, and the degree to which they appeared, suggests that cohesion was in substantial effect2. Cohesion as the “precondition of change… a strong and positive bond which in itself disconfirms depressive beliefs” emerged with the lowering of a sense of alienation between groups members and was underscored by the amplification of universality2,5.
- Catharsis – Many members who chose to speak did so with great candor, sparing what seemed no exposure of emotional viscera. In fact, catharsis appeared to function as a primary force of propulsion of the group process; with each member who disclosed in vulnerable earnesty, there were visibly more responses and affirmative motions from the group, and the emotional intensity rose to a veritable climax. Their stories were often accompanied by great emotional outpouring, many staggering in their speech over their powerful recollections of grief, anguish, and helplessness.
- Existential factors – There were expressions of existential isolation such as “I feel like God has abandoned me.” Being staggered by disrupted identities with relation to large-scale frames of existence such as the spiritual or cosmic was a recurring theme. Even those in recovery were met with difficult feelings about their life trajectories; as one member put it, “sobriety is like waking up out of a dream or haze, and I find myself suddenly old and behind on life.”
Clarity and Effectiveness of Purpose and the Use of Time
The peer leader stated very clearly at the outset that the meeting served as a place for members to share their personal accounts of experience, strength, and hope, so that other members who feel deficient in those qualities may feel they are not alone and glean a sense of possibility, and others still may have their strengths reinforced and be encouraged on their path to recovery.
The participants of these addiction recovery groups showed great priority and respect for this purpose in the use of time, which seemed to require only nominal management from the peer leader. There were no breaks or disruptions in the flow of the meeting.
Assessment of the stage of the group’s development using Garland, Jones, Kolodny’s Five Stage Model of Group Development
Garland, Jones, and Kolodny found that groups pass through a series of five stages distinguished by the dynamics and functioning of the group and the presence of key group features6. A consideration of the stages of group development can assist group workers and clinicians in further determining the cohesiveness of a group and implications for the tasks of the group and the facilitator.
These meetings are designed to be ongoing, with members coming and going, attending as they wish. The addiction recovery group follows a fixed format that remains perpetual and does not seek to focus on any one stage of recovery or Step (though one group member disclosed to me that there are closed meetings designated for those specific stages).
By my perception, there were no apparent exercises or motions used to signify a collective stage of development, and due to the anonymity and open format of the group, I anticipated a pre-affiliative stage.
However, I assessed the addiction recovery group to be in the stage of differentiation, for the following reasons. The group organized itself efficiently and without rigid role systems, with nearly all members contributing to the set-up, break-down and observation of the different sections of the meeting.
I had no idea who the leader was or if there even was one until he softly introduced himself once everyone was seated, which occurred precisely at the posted meeting time.
Members introduced themselves to new attendees and greeted each other by name in a pronounced manner, which served to assert their personhood and acknowledge that each individual made the choice to attend. Aside from the leader reading the official literature and managing the time, the group essentially led itself. Cohesion seemed strong, as I have further extrapolated throughout this work.
Member behavior included good communication and again, an almost shared leadership or management of the decorum and process of the meeting, as they were collectively invested in its sound running. The identity of the addiction recovery group appeared unanimous with only a few tentative members, suggesting the establishment of the Group Internal.
Further Consideration of the Literature
To garrison my perspective and analysis of the 12-step model, I looked further into the literature. The A.A. group demonstrated several of Rosenberg’s characteristics of a support group, beginning with the homogeneity of the problem by identifying the common stress of alcohol abuse between them, including the lead and guest lead.
One interesting and repeat correlation revealed by several LGBTQ members was between the formation of their drinking habits around the few outlets for the expression of their sexual orientation; “we couldn’t be gay in our daily lives, and the only places we had to go were the gay bars, so drinking became a part of trying to find love and companionship,” as the guest lead recalled. In this, we observe Rosenberg’s assertion that members are “better seen as victims of a negative ecobiological system,” in which “an environment setting unsuited to [their] personality structure creates a situation the tends to be pathogenic and stressful”.
The practice of members introducing themselves while self-identifying as addicts before speaking, and going on to divulge their personal struggles and damages in the wake of addiction embodies the “confessional” support group characteristic, whereby they obtain a better sense of comfort and cohesion, simultaneously alleviating feelings of stigmatization while building an entity of majority within the space.
This is reinforced by the common language characteristic of the group as every member, regardless of the state of ailment or recovery pronounces their alcoholism and reflects upon it using the Twelve Steps as articulations of status.
My experience confirmed many of the attestations from the article “How Alcoholics Anonymous Works” from The Harvard Mental Health Letter, particularly those with emphasis on universality and the reframing of members’ social identity7. Via powerful threads of universality and normalization of doubts, veteran members modeled vulnerability and healing for newer members, affirming that “as in any self-help or group therapy program, listening to others helps people to realize that they are not alone in their troubles and enables them to correct false ideas about themselves”.
This mitigation of obstinate self-loathing, hopelessness and existential loneliness via connective rather than forcefully corrective seemed the cornerstone of recovery and the attraction of members to the group, a turning point in their sense of possibility about being connected to others through their experience with alcohol but without drinking.
By this the group exhibited social exchange theory, as through initiating and responding to interactions, members gain something of value such as approval (as in for the choice to attend, for lengths of sobriety) and “act to increase the positive consequences” of group interaction.
Many postures and expressions throughout the session strongly reflected this testament; “I had been preached to, analyzed, cursed, and counseled, but no one had ever said, “I identify with what’s going on with you. It happened to me and this is what I did about it”.
Following this, the Harvard article goes on to state that members who “made more friends who were members, attended more meetings, and talked more often with a sponsor,” and who spent time “helping others during 12-step facilitation (providing moral support, sharing experiences, and giving advice about jobs, housing, and staying sober)” experienced greater ease with abstinence and fewer relapses into abuse.
Glassman’s Humanistic Values 1 & 2 describe group work’s emphasis on the inherent worth and capacities of members and their responsibility for and to one another; “the norm for building cooperative rather than competitive relations in the group fosters member’s collective abilities to create a caring and supportive social milieu poised to facilitate member change”8.
This phenomenon is further echoed in an anonymous testimony from the group’s official text, “they said I needed to identify, not compare. Identifying was trying to see how I was like the people I was with. Comparing was looking for differences, usually seeing how I was ‘better’ than others”.
My experience connected to this strongly through the joint testimony of a member and their sponsor (another member further along in the recovery process), in which both affirmed greater feelings of empowerment and conviction about themselves and the program.
This dynamic described factors of mutual aid, imparting information, and altruism, wherein the sponsored is given hope and advice by a relationship with the sponsor, who in turn enjoys the positive repercussions of altruism.
In this, both members collaborate in their purpose through a symbiotic relationship; neither wishes to disappoint the other, and they share responsibility for one another’s strength against the temptation or compulsion to drink.
The reframing of social identity and the cultivation of social collateral to be put against the environs and situations outside of the group that impose risks of drinking seemed crucial to the staying power of the group’s beneficial effects. Some members lamented the loss of their social lives as they removed themselves from persons and places of risk in the pursuit of sobriety.
However, with their identity given anchorage in the support group, many other members stated that they required less social lubrication and social capital in drinking settings, garrisoning their confidence and security against social pressures or influences to imbibe.
This substantiates the Harvard article’s assertion that “members who continue to keep company with drinking friends are [not] less likely to recover”. “AA is called a fellowship for good reason. It provides a social activity that can be a substitute for drinking. Members make new friends and learn new ways to cope with cravings”.
One member shared that they felt stronger in facing challenges and temptations outside of the group because of the foundation of support they had established within it, echoing a voice from the Alcoholics Anonymous text: “in A.A. I faced the pervasive ‘we’ of the Twelve Steps and gradually realized that I can separate and protect my sobriety from outside hazards only inasmuch as I rely on the sober experience of other A.A. members and share their journey through the steps of recovery”.
Part Two: Reflection on These Addiction Recovery Groups
As a social worker, I recognize the transactional nature of change – that is, that reparative transformation is a relationship that impacts both on the client and the worker – and importance of developing and harnessing my consciousness of the impressions of this study upon me.
Cultivating my own process of reflection alongside my scientific and academic pursuits is intrinsic to accessing the yields of learning and growth, and the expansion of empathic faculties in conjunction with critical discourse. The following is my reflection on the potential value and influence of this group on my personal and professional aspirations.
How I felt as an Attendee at the Meeting
I have to admit, I felt like a bit of an imposter, as it was such an intimate and vulnerable space, in which I was not a participant and did not share universality.
I felt at first conflicted about telling members I was there as a student, but the few I did tell seemed no less encouraging in their suggestion that I attend further meetings.
Beyond that, I felt as though I were witnessing an undressed, unglossed haven of suffering and hope; a microculture of strivance and support in a space created by and for those who would identify with such experiences.
Impression of Positive Impacts
I was first amazed by how smoothly the group flowed like they became the sum of their parts, a single organism in their assembly and maintenance of the space and atmosphere.
In that cohesion, they were then safe to bear their own unique state. The sanctity of the space as indicated by the disclosure and candor of members’ self-accounting. Admissions to having done harm to themselves and others, of having behaved in ways that would likely be rebuked or met with extreme prejudice in open society were calmly absorbed by the quiet warmth of the circle.
Witnessing the permission to be vulnerable, in both agonizing through spirals of self-destruction and doubt as well as sharing nascent hopes and proud counts of sober days no matter how few, and to disclose with whatever emotional constituent was felt necessary was a riveting experience.
Considerations for Improvement of the Group
I’m not sure I have any at present, as their structures and processes are evidently effective and hold powerful capacities for success. I suppose that as a newcomer, and one only vaguely familiar with A. A., I was hoping that there would be more formal coverage of the Twelve Steps, or more interplay between the personal stories and the organization’s literature to highlight the process of these addiction recovery groups.
As an aside, I found the donations collection, which happened in the middle of the session, to be disruptive and with the literature officer counting the money immediately adjacent to the group, perhaps a bit distasteful.
I would feel better about collections taking place at the conclusion of the session when ideally feelings of loyalty to the group and its needs would be highest, and concerns for money be less likely to disturb the socioemotional focus of the group purpose.
Comments on the potential value of such groups for my personal and professional aspirations, and the field of social work as a whole
With my primary social work interest focused on developing therapy and counseling for sexual minorities, non-traditional partnerships and alternative family constructs, I am set before the task of building a community of individuals and small groups (couples, partnerships, families) in question, and creating a safe space for individuals to willfully explore their economies of sex and intimacy in a non-judgemental setting and to normalize their feelings of dissociation and deviance from predominate models.
The often deep vulnerability intrinsic to sharing one’s intimate desires, particularly when they are in strong contrast to prevailing value systems, might be better met in a space populated with others who share similar calls of exploration or discomfort within established conventions.
With great consideration of Yalom’s therapeutic factors and the amplifying powers of cohesion and mutual aid, this task may be better undertaken in a setting of peers who, because of their common stress, will be more apt to normalize one another’s fears, confusion, and sense of disconnect from surrounding sociocultural validity.
With peer-led support, the endeavor to cultivate connectedness through empathic links in individual accounts, could dispel feelings of isolation and begin generating a force of social capital between group members, effectively establishing their own sense of community.
Concluding Comments and Afterthoughts
What was most amazing to me was that from one opening testimony, the addiction recovery groups were put into motion, with very little need for any formal guiding structure save time management.
The guest lead’s testimony served as a thematic array of experience, running the gamut of loss, relapse, anger, desperation, relent, hope, and growth to which members were able to latch to their own experience, and from there launch their own confessions and revelations. I was watching a chain of vignettes unfold in front of me, with even the most somber soliloquy casting sparks of experience into the space that enkindled others to speak to the conditions of addiction and recovery.
I was watching a chain of vignettes unfold in front of me, with even the most somber soliloquy casting sparks of experience into the space that enkindled others to speak to the conditions of addiction and recovery.
I find myself curious about the pervasive spiritual context in which the program is framed. The mission statement of A.A. makes no mention of religious imperatives, and even clearly asserts the Fellowship’s non-affiliation with any denomination or institution9. However, “God,” named as such, features prominently in the Twelve Steps, the official guiding principles of the program. In fact, steps three, five, six, seven, and eleven outline in no uncertain terms a member’s reckoning with and admission to God, requesting that God removes their personal defects and shortcomings.
These culminate in the final twelfth step, defined by “spiritual awakening”9 and the charge of carrying the message to other alcoholics, which reads to me as a form of evangelism. It seems to me that the focus on relinquishing control to a Higher Power serves to subsume the ego in the wake of a perfect guiding, omniscient entity to clear the way for growth and place a member’s deep needs for forgiveness and elevation within an idealized form.
I wonder about the possible phenomena of members shifting their addiction from substance to religion, and if so, what unique risks might that entail? By members’ submission of the quality of their conduct to an intangible yet willful, interpositional god-being, reading their (and others’) recovery as relative to their alignment to an external, supernatural force, how will that inform their interpretation of consequence? What then will be expected of that being’s conduct in response or affirmation? What will it mean for the tenability of a member’s sober identity if they experience a crisis of faith? This experience has helped me come into greater awareness and contact with aspects of my own bias as a worker, and edges of growth in working with spirituality as part of a wholeness model of human experience and healing. I find myself called to work on my own triggers of countertransference and practice due diligence in processing my reactions in supervision and pursuing greater understanding through research and consulting literature on spirituality in social work practice and addiction psychology.
With this in mind, it is important to note that even when a member expressed deficiencies in their spiritual correlation of healing, or even flatly doubted the existence of a relevant religious power, they were met with no disappointment, no proselytizing, not even an awkward pause. The energy and flow did not seem to be disturbed in the least; if anything, some gave gentle nods and soft affirmations. Essentially, the expressor was simply allowed. In all, group cohesion, empathic reception, maintenance of non-judgemental norms and respect for personal arrival within the scheme of healing seemed to trump concern for even the expressly sacred component of program’s tenets.
My final thought is on how the shared vulnerability of A.A. members and the equalizing forces of their joint struggle and exploration may inform my approach as a worker. Irvin Yalom, in his video “The Art of Psychotherapy” speaks to the measure of equal partnership in the therapeutic alliance between worker and client, wherein both parties struggle, wonder, and explore together to arrive at new discoveries. I found this therapeutic concept, while doubtless challenging to establish, balance, and maintain, to be profoundly humanizing and a more truly collaborative process. Perhaps there are elements one may take from a peer-led support group such as Alcoholics Anonymous.