Alcoholics Anonymous: Personal Stories, Relatedness, Attendance and Affiliation by Stephen Strobbe A dissertation submitted in partial fulfillment Of the requirements for the degree of Doctor of Philosophy (Nursing) in the University of Michigan 2009 Doctoral Committee: Professor Carol J. Boyd, Chair Professor Kirk J. Brower Associate Professor Bonnie M. Hagerty Assistant Research Professor James A. Cranford Professor Marcin Wojnar, Medical University of Warsaw, Poland “The spiritual life is not a theory. We have to live it.” Alcoholics Anonymous © Stephen Strobbe 2009 To Lynn, Joseph, and David, Who taught me how to write the best chapters in my personal story. Love, Stephen ii Acknowledgements A portion of this research was supported by the Fogarty International Center/NIDA International Substance Abuse Research Program grant D43-TWO5818; NIAAA grant R21 AA016104; the Polish Ministry of Science and Education grant 2PO5D 004 29. Dr. Strobbe was further supported by a research grant from the International Nurses Society on Addictions (IntNSA), and a New Investigator Award from the University of Michigan School of Nursing. Sincere thanks to the all of the study participants in Poland for their generous contributions of cooperation and time, as well as other members of the research team in Warsaw, Poland, including Izabela Nowosad, Andrzej Jakubczyk, Anna Wnorowska, Anna Klimkiewicz, Malgorzata Marusa, Aleksandra Konopa, and the medical staff at “Kolska,” “Pruszkow,” “Petra,” and “Solec” Addiction Treatment Centers. I would also like to thank Dr. Ernest Kurtz and Dr. Julia Seng for their thoughtful and thorough reviews of the chapter on personal stories in the Big Book of Alcoholics Anonymous. I wish to extend my deepest gratitude to each and every member of my dissertation committee: Dr. Carol Boyd, Dr. Kirk Brower, Dr. Bonnie Hagerty, Dr. Jim Cranford, and Dr. Marcin Wojnar. Your gifts of time, expertise, practical assistance, support, patience, and encouragement will be fondly remembered. Carol, I imagine that I will never forget the day when you proclaimed that I needed to get my Ph.D., and set this whole crazy wheel in motion. My heartfelt thanks are yours. iii Table of Contents Dedication ii Acknowledgements iii List of Figures vii List of Tables viii List of Appendices ix Abstract x Chapter 1. Introduction 1 Alcoholism as a Disease: A Brief History Nursing Diagnosis in Relation to Alcohol Use Disorders Alcoholics Anonymous as a Program of Recovery Potential Application of Nursing Theory to AA References 2. Personal Stories in the “Big Book” of Alcoholics Anonymous: A Narrative Analysis 19 Introduction In the Beginning: Storytelling in Alcoholics Anonymous An Impulse to Narrate Oral Narratives in Alcoholics Anonymous Written Narratives in Alcoholics Anonymous A Brief Orientation to Narrative Analysis A Focused Review of the Literature Positionality, Data Set, and Methods Positionality: A Frame of Reference Data Set: A Collection of Personal Stories Methods: An Organic Process of Reflective Iteration Findings: A Normative Model for Personal Stories in AA iv Thematic Content First or Early Drinking Alcoholic Regression Hitting Bottom Progress in the AA Program Stable Sobriety Discussion Strengths and Limitations What Makes a Good AA Story? Implications: Clinical Care, Theory, and Research References 3. Applying the Theory of Human Relatedness to Alcoholism and Recovery in Alcoholics Anonymous 56 Introduction Theory of Human Relatedness Definition and Dimensions States of Relatedness Relatedness Competencies Student of Life: An Exemplar Analysis Object: Alcohol Others: Parents, and Mike Parents Mike Spiritual Entities: God or a Higher Power AA as a Group, Society and Environment Discovery of Self Discussion References 4. Alcoholics Anonymous: Attendance, Affiliation, and Drinking Outcomes in a Polish Treatment Sample 79 Introduction Background Alcohol Use in Poland Alcoholics Anonymous in Poland A Focused Review of the Literature AA Attendance AA Affiliation Methods Design Participants Setting v Measures Analysis Results Discussion References 5. Conclusion 107 Summaries of Individual Studies Personal Stories in the “Big Book” Applying the Theory of Human Relatedness AA Attendance, Affiliation, and Drinking Outcomes Synthesis Future Research and Nursing Care References vi List of Figures Figure 1. Personal narratives are transformed and transformative over time 49 2. Normative model for personal stories of alcoholism and recovery in Alcoholics Anonymous 50 3. States of relatedness 75 4. Study design 96 5. Conceptual model of study findings: AA attendance, affiliation, and drinking outcomes in a Polish treatment sample 97 vii List of Tables Table 1. New personal stories in the fourth edition of Alcoholics Anonymous 51 2. Relatedness to referents in the Twelve Steps of Alcoholics Anonymous 76 3. Demographic and clinical characteristics of the baseline study sample 98 4. Comparison of characteristics between study completers (n=118) and non-completers (n=36) at baseline (Time 1, or T1) 99 5. AA attendance and drinking outcomes: abstinence and no heavy drinking (HD) among study completers (n=118) at baseline (T1), one month (T2), and study completion (T3) 100 viii