A Phenomenological Study: Exploring the Meaning of Spirituality in Long-term Recovery in Alcoholics Anonymous

ABSTRACT

Recovery in Alcoholics Anonymous (A.A.) is framed within a broad notion of spirituality, in which members are encouraged to nurture personal concepts of spirituality. An interpretative phenomenological analysis (IPA), semi-structured interview study was conducted, to explore the role of spirituality for five members of A.A. with long-term recovery (LTR) from alcohol use disorder (AUD). Three higher-order themes, conceptualizing spirituality as a secular and existential phenomenon were identified. The study highlights the role of secular spirituality as a coping mechanism in LTR, demonstrating that A.A. can be an effective treatment for individuals wishing to recover from AUD, regardless of their belief systems.

KEYWORDS:

• Alcoholics Anonymous
• alcohol use disorder
• behavior change
• interpretative phenomenological analysis
• long-term recovery
• secular spirituality

Introduction

Alcoholics Anonymous (A.A.) is often referred to by many researchers in the field of alcohol use disorder (AUD) as a spiritual program (e.g. Krentzman, Strobbe, Harris, Jester, & Robinson, 2017; Kurtz & White, 2015; Vaillant, 1983). Associated with better health outcomes, e.g. cancer (Puchalski, 2012), heart disease (Naghi, Philip, Phan, Cleenewerck, & Schwarz, 2012), improved mental health (Hadzic, 2011; Moreira-Almeida, Koenig, & Lucchetti, 2014), pain tolerance/severity, and post-surgery recovery (Rosmarin, Wachholtz, & Ai, 2011), it is widely accepted that spirituality can play an important role in health care. Spirituality is particularly effective in palliative care (Steinhauser et al., 2017), and is also associated with improved quality of life (QOL; Moreira-Almeida et al., 2014). Additionally, the meaning that spirituality gives to a person’s life (Park, 2007) can inform healthcare professionals how patients use spirituality as a coping strategy for their mental and physical well-being (Puchalski, 2001). The notion has been advanced that spirituality can be considered within part of Engel’s (1977) biopsychosocial model (Katerndahl, 2008; Saad, De Medeiros, & Mosini, 2017).

In seeking to define spirituality, a review summary of 265 books and papers on addiction and spirituality recognized a bias favoring a TwelveStep and Christian conceptualization of spirituality (Cook, 2004). This is not surprising, considering the majority of publications reviewed were North American, and highlights the importance of considering the cultural context of research into spirituality, as Americans tend to be more religious than British people (Evans, 2018; Fahmy, 2018) who constitute the cohort in the current study. Cook’s (2004) working definition of spirituality positions spirituality as an important and fundamental human quality, “concerned with matters of meaning and purpose in life, truth and values” (p. 99). Assuming a similar epistemological position, a Consensus Conference, which included among others, physicians, nurses, and psychologists, defined spirituality as a phenomenon that gives purpose and meaning to a person’s life and relatedness “to the moment, to self, to others, to nature, and to the significant or sacred” (Puchalski et al., 2009, p. 887).

From its inception, A.A. has viewed AUD from a holistic perspective, by considering the impact that excessive alcohol consumption can have on the individual physically, psychologically, emotionally, and spiritually (Kurtz, 2002), placing a particular emphasis on the spiritual dimension, referring to it as a “spiritual malady” (Alcoholics Anonymous World Services [AAWS], 2001, p. 64). A.A.’s emphasis on the spiritual domain was first conceptualized after the post-detoxification experience of A.A.’s founder Bill Wilson, which he had interpreted as a transcendental event. Wilson’s epiphanous moment, however, may have been of a hallucinatory nature, induced by either alcoholic delirium tremens (Markel, 2010), or Atropa belladonna (deadly nightshade), known to have hallucinogenic properties (Bevacqua & Hoffman, 2010; Markel, 2010); the belladonna regime was part of the treatment in 1934, in Towns Hospital, New York, where Wilson was being treated. Influenced by William James’ (1985) The varieties of religious experience, and by Carl Jung, with whom he corresponded and credited as being instrumental in the foundation of A.A. (Speaking of Jung, 2015), Wilson was convinced his experience, which he described as being “caught up into an ecstasy” (AAWS, 1957, p. 62–63), was essential to recovery. Wilson later became aware that not everybody had such transformational and life-changing experiences, so in order to make A.A. more inclusive, he reconsidered his original position and proposed that a personal concept of spirituality, a “spiritual awakening”, could lead to a change in personality, “sufficient to bring about recovery from alcoholism” (AAWS, 2001, p. 567).

The majority of research on spirituality in A.A. has focused on investigating spirituality from a quantitative perspective (e.g., Kaskutas, Kaskutas, Bond, & Weisner, 2003; Krentzman, Cranford, & Robinson, 2013; Montes & Tonigan, 2017; Tonigan, McCallion, Frohe, & Pearson, 2017). In a more general context, Borg, Andrée, Soderstrom, & Farde, (2003, p. 1965), suggest there may “be a biological basis for spiritual experiences”, after their positron emission tomography (PET) study found a correlation between the binding potential (neuroreceptor density) of the participants’ serotonin systems and their self-reported self-transcendence scores. Moreover, data from neuroimaging studies indicate that meditation, widely regarded as a spiritual practice, and suggested in A.A.’s twelve-step recovery program (AAWS, 1953), produces neurological (Leung et al., 2018; Tang, Lu, Fan, Yang, & Posner, 2012), as well as cardiovascular changes (Steinhubl et al., 2015). Additionally, links between meditation and neuroplasticity have been observed (Lazar et al., 2005). Meditation also influences the major neurotransmitter systems, and the subsequent changes to neurotransmitters following sustained meditative practices are known to reduce the symptomology of anxiety and depression, highlighting the psychotogenic benefits of meditative practices (Mohandas, 2008). Nonetheless, spirituality is widely regarded as a subjective experience that produces psychophysiological changes (Chong, Fortier, & Morris, 2009; Piedmont & Friedman, 2012). As such, the current study believes that it is more appropriate to investigate spirituality from a qualitative perspective.

There is a lack of qualitative research on the topic of personal concepts of spirituality among members of A.A. (e.g., Forcehimes, 2004; Morjaria & Orford, 2002). The current study seeks to explore the role of spirituality in recovery, from the perspective of individuals in long-term recovery (LTR) from AUD (an average of 30 years recovery), who interpret spirituality as a secular phenomenon; a cohort that previous qualitative studies have not considered. A.A. discourse encourages members to conceptualize their recovery and their weltanschauung (worldview) within a spiritual paradigm (Swora, 2004), and only qualitative methods are capable of interpreting the nuanced meanings contained within individual A.A. narratives. Schaub (2013), a psychotherapist, suggests that healthcare professionals should support their patients to acknowledge and develop their spirituality. A greater understanding of the role that spirituality plays in recovery can better inform future interventions and treatments for AUDs. In general terms, it may also be beneficial for healthcare professionals to consider spirituality as a mechanism of behavior change (MOBC; Kelly, Stout, Magill, Tonigan, & Pagano, 2011), whilst in the context of the current study, spirituality can be viewed as a coping mechanism that supports LTR. The current study’s objective is to explore individual concepts and meanings of spirituality among members of A.A. with LTR.

Method

Participants

Interpretative phenomenological analysis (IPA; Eatough & Smith, 2008) was utilized in this study to explore unique, personal accounts of the lived experience of AUD and recovery, allowing the participants to express their positive self-concepts, so vital to LTR (e.g. Corte & Stein, 2007; Lindgren, Neighbors, Gasser, Ramirez, & Cvencek, 2017). The phenomenological maxim of perceiving phenomena as they arise, and the key concept of temporality, compliments the A.A. notion of being in the present and endeavoring to contain one’s life events within the day. Five participants were recruited, in line with Smith, Flowers, & Larkin’s (2009) suggestion that between three to six participants is a sufficient enough sample size to capture in-depth accounts of individual experiences, as well as “meaningful” similarities and differences “between participants” (p. 51). The mean age of the participants was 64.60 years (SD = 5.95), with a mean of 30.00 years self-reported continuous recovery (SD = 11.08). The participants’ names have been anonymized throughout (see Table 1. Participant demographic information).

Table 1. Participant demographic information

Participant	Age	Ethnicity	Religious upbringing	Belief system	Continuous years of sobriety
Bob	71	White, British	None	Spiritual	44
Elizabeth	69	White, British	None	Other	20
Fearghal	63	White, British	Catholicism	Spiritual	43
Melanie	54	White, British	Catholicism	Agnostic	20
Tim	66	Irish	Catholicism	Spiritual	23

Data collection

The study’s inclusion criteria were limited to members of A.A. with at least 15 years continuous recovery, who acknowledged having a spiritual concept, which played a meaningful role in their recovery. Prospective participants were approached outside of A.A. meetings by the study’s lead author (also in recovery), who outlined the objectives of the study, before presenting each with an invitation to participate. The first five respondents who agreed to participate were later sent more detailed information about the study. Face-to-face, semi-structured interviews were recorded to collect data, the typical IPA method used to collect rich, meaningful data about the phenomena being explored (Pietkiewicz & Smith, 2014). However, because the study was undertaken during the COVID-19 pandemic, the interviews were conducted using internet video calls (i.e. Skype, Facetime). A.A. encourages its members to develop a concept of spirituality that makes sense to them. The interview schedule, therefore, focussed on eliciting the participants’ individual concepts of spirituality, by posing questions such as Members of Alcoholics Anonymous, in Great Britain anyway, acknowledge differences between religion and spirituality, emphasizing that the A.A. programme of recovery is spiritual and not religious. In your view, is there a difference between being a religious person and being a spiritual person? And: How do you conceptualize a Higher Power? In other words, could you describe your Higher Power? Equally important, was determining the role that spirituality played in maintaining LTR: How do your spiritual beliefs and values influence your behavior, your attitudes and your relationship with others outside of A.A., and in life generally? And similarly: To summarize, how important have spiritual values and principles been in helping you to remain in recovery for (insert the participant’s years of continuous sobriety)? The interviews, which lasted approximately 40 minutes, were later transcribed verbatim.

Analysis

The IPA method synthesizes phenomenological and hermeneutical ideas, and combines them with the idiographic notion of focussing on the minutiae of individual cases (Pietkiewicz & Smith, 2014). This meant employing IPA’s iterative and inductive method of repeated readings of the transcribed texts, in order to become familiar with the participants’ narratives, and identify themes as they emerge. The initial stage of analysis was followed by the typical IPA double hermeneutic method, associated with Heidegger (2010), whereby the researcher seeks to interpret the participants trying to interpret and make sense of “their personal and social” worlds, and the meaning found within them (Smith & Osborne, 2003, p. 53), referred to as meaning-making.

Ethics

Ethical approval of the study was granted by the University of Derby Online Learning Ethics Committee and adhered to the British Psychological Society (BPS) Code of Human Research Ethics (British Psychological Society, 2014).

Results

The current study sought to explore the participants’ individual concepts of spirituality and the role it plays in their recovery. Analysis of the participants’ transcripts revealed five super-ordinate themes for each participant (see Table 2. Participants’ individual super-ordinate themes). A high level of congruity among the participants’ individual themes meant they could be categorized into three higher-order group themes (see Figure 1. Higher-order group themes and their constituent individual super-ordinate themes). Combined, the themes reveal that this cohort of members of A.A. with LTR, conceptualize spirituality as a secular and existential phenomenon, further elucidated in their individual concepts of spirituality (see Figure 2. Participant’s individual concepts of spirituality).

Table 2. Participants’ individual super-ordinate themes

Participant	Themes
Elizabeth	Connecting to self, the world and others.	Personal development facilitating spiritual growth.	Letting go, trusting and being in the now.
Bob	Connecting to self, the world and others.	Accepting and trusting in a spiritual solution.	Organized religion viewed as a negative construct.
Melanie	Being in the world and relating to others.	Accepting and trusting in a spiritual solution.	Religious perspective informed by indoctrination.
Fearghal	Spirituality: a relational and temporal phenomenon.	Trusting in something other than self.	Meaning found in a secular spirituality.
Tim	Being in the world and relating to others.	Accepting and trusting in a spiritual solution.	Ambivalence toward institutionalized religion.

Figure 1. Higher-order group themes and their constituent individual super-ordinate themes

Figure 2. Participant’s individual concepts of spirituality

Spirituality viewed as being in the world in relation to others

I’ve been able to have a deep connection to other people, relate with other people, relate more to, and with the world. (Elizabeth)

This theme represents the feelings of the participants and their conceptualizations of the essential nature of spirituality, which they view as an existential phenomenon, in both a relational and temporal sense.

Spirituality is relational because it is experienced in relationships with others. Moreover, the verb connect, which appears repeatedly throughout the participants’ narratives also highlights the relational aspect of spirituality, suggesting that the intersubjective nature of relationship is both an essential component of the participants’ individual concepts of spirituality and also a fundamental aspect of their everyday lives since they have been in recovery from AUD.

The temporal aspect of spirituality is also seen as important; A.A. posits the notion, that recovery is likely to be more effective when one’s life is anchored in the present. Dwelling on past behaviors and actions is seen to promote regret and remorse, while on the other hand, projecting one’s being into the future can generate fears and anxieties. Spirituality is viewed by the participants as a means of re-establishing and fostering a relationship with self and others. In short, spirituality is about establishing and developing relational connections:

I think spirituality is the essence of who I, who I am, who I try to be and also, ehm (pause …) the connection I have with myself and the outside world. And I think (pause …) it’s difficult but, ehm (pause …) but spirituality is, is trying to be the best kind of human being I can be, taking into account all my human flaws, but you know the old adage of doing unto others as you would be done unto, just trying to live (pause …) a reasonable, honest life. (Elizabeth)

Elizabeth believes her spirituality embodies vastly more than a single aspect of either her psyche or mind. Framed within the relational context of connectivity, Elizabeth views spirituality as a term that encapsulates the nature of her being. Bob also frames spirituality within the same relational context, connecting self with others, as well as connecting to a power greater than himself, which is not viewed as a religious concept:

Spirituality is a way of life, of connecting with humankind, just means being the best we can be. (Bob)

I mean, I’m, yeh, I don’t put myself apart from any other human being, you know, I’m as vulnerable or as powerful as anyone. We’re all in … . literally all, all human, but, ehm, no, I tap into a source I suppose, it’s a spirit more, it’s a spirit in the Universe., it is a spirit and I tap into that, I connect with it, that’s how I see it. Certainly not my own God, you know, I find that, I find that quite offensive really … . (Bob)

Bob believes the harmonious wholeness of his being is contingent on the inter-connectedness of the three aspects that constitute his being: the mental self, the embodied self and the spiritual self (purpose and meaning in life). He is acutely aware that when he is spiritually disconnected the wholeness of his being becomes fractured. This happens when he is distracted by, and reacts to experiences and events outside of self, giving these things his power.

I believe this word connected, everything’s connected, you know, in, in the mind, body and, mind, body, spirit, sou … . whatever you want to say, the Greeks knew that, didn’t they (?), long, long ago they wrote about it, mind, body, spirit. So, if I’m, I’m off beam with my spiritual way of life, then if I’m reacting at television, at people that I don’t particularly … . If I’m doing, if it’s causing me problems and taking me away from my own life, what’s important, yeh, it’s going to affect me, I, it’ll pull me up, and I think what’s going on, why am I allowing (?), why am I giving my power over to some, ehm, some detached politician that I’ve never met? (Bob)

Melanie’s narrative on this theme highlights the intersubjective nature of being in the world in relation to others. That is, by connecting with others, the boundaries between self and other become less blurred, consequently, one is able to empathize more easily with others. Melanie’s spiritual journey, for instance, began when she realized and accepted recovery was about so much more than just not drinking. Being able to connect and empathize with others enabled Melanie to model her behavior on their desirable characteristics:

I used to see this guy all the time, and I saw this person close up, change from being a very aggressive, angry person to a person who was ehm, a good character, ehm, someone that you would trust, someone you would consider a decent person. And it’s when I saw him, that close, that it really, it dawned on me, actually I’d like to change, I’d like to be a good, a better person, the best person I can be. (Melanie)

Tim reflects on his spiritual experience in A.A. and considers how empathy, a central feature of his concept of spirituality, has brought him closer to others:

I learned how to tell the truth in small steps, and every one of those steps brought about a spiritual experience because it brought me closer to people. (Tim)

Ehm, the ehm, second thing is that allows me to ehm, to fit in with other people, ehm, and it allows me to leave space for other people’s feelings, you know to have empathy, ehm and (pause …) the ability to learn from other people … (Tim)

Fearghal also highlights the empathetic nature of being in relation to others. He considers the fundamental human need for relationship and the reciprocal benefits of empathy. In common with Elizabeth, Bob and Melanie, Fearghal views spirituality essentially, as simply trying to be a better human being:

So, I would just say to you, being the best person, I could possibly be, (pause …) today, is the most spiritual I can be today …. (Fearghal)

Trust: the key to change and spiritual development

… my first sponsor told me that if you, if you can’t believe, you can’t trust, and if you can’t trust you can’t love, and if you can’t love, then you are condemned to live in a world of one. (Tim)

Trust is the central characteristic of the second theme. According to AA (AAWS, 2001) theory, the personality change needed to bring about recovery is dependent on the individual being, or becoming open-minded enough to accept the idea of a spiritual solution to her or his alcohol problem. The participants’ lived experiences show that a transformational change in thinking of such magnitude meant having to accept a new set of attitudes. This involved letting go and trusting in something other than oneself. Such an extremely radical and unfamiliar way of thinking required “a leap of faith”:

And, and you know leap of faith, just to trust and believe, from a, you know a, (pause …) ehm, my conditioning was you don’t trust anybody. You know, your business is kept indoors, nothing is spoken of outside. So really, to think about believing or trusting in, in anything other than, those core beliefs, was a massive task for me. (Elizabeth)

When Bob finally came to A.A., via an alcohol rehabilitation unit, in a National Health Service (NHS) mental health hospital, he was severely damaged, both physically and psychologically. Bob’s nadir experience was the agent that brought about a change in his attitudes, allowing him to be able to trust that someone or something else could help him; gradually, he began to accept A.A.’s spiritual solution. Also while a patient in a mental hospital, Melanie began to trust the A.A. program too, viewing it as a MOBC, that essentially, could change her repetitive drinking behavior:

… I was very desperate at the end, I was very, very desperate and would have done anything. So, I was very open, not just open-minded, I was willing, I just accepted what was said, and I didn’t really understand a lot of it, if I’m honest. I just kind of went along with it, because I thought A.A. saved my life …. (Bob)

… I was in a treatment centre again. Well when I came out I then realised that, er, I was going to have to — still didn’t want to — I realised that I was going to have to work the steps and turn myself from the person who, who needed to drink to a person who didn’t need to drink. At that point I really saw them as some kind of mech, mechanism, a mechanism of change. (Melanie)

Tim struggled to come to terms with the concept of a power greater than himself, feeling that developing a trusting attitude was probably the most difficult thing he has had to do in his life. He describes how trust brought him to a point where he came to believe in a power greater than himself, with whom he has an “honest relationship”:

But I knew I had to get to this position of trust, through belief, yeh? Ehm so, it, it … . how easy was it for me to accept it? I accepted that I had to do it, but it was the bloody most difficult thing I’ve ever done in my life, which was learning how to trust, yeh? And ehm, and actually ehm, the kind of, you know faking it to make it as we say, in other words suspending real belief ehm, and concentrating on learning trust, brought me to a point where I actually believed in a Higher Power, in a power greater than myself, ehm, with whom I have this totally honest relationship. (Tim)

Had he not relapsed after being in recovery for 14 years, Tim would now have been in recovery for 41 years. He has now been in recovery for the last 23 years. Tim believes that finding recovery again, after his four-year long relapse, is based on his practical concept of spirituality, manifested in self-honesty:

So I learned how to tell the truth in small steps, and every one of those steps brought about a spiritual experience because it brought me closer to people.

During his first spell in A.A. Tim was not the least bit interested in the notion of spirituality as a way of maintaining recovery, and he certainly did not understand the concept of “doing the right thing”, but when he returned to A.A. after his four-year relapse, he was absolutely ready and willing to consider the A.A. program in the context of spirituality. He has developed an attitude of integrity, and has learned to question whether his motivations are right:

I work really hard at ehm, at doing the right thing, yeh? It’s, it’s really important to me, it’s what kind of drives my sobriety, that doesn’t mean that I don’t get it wrong, but my motivations now are always, almost always correct, doesn’t mean I don’t make mistakes. (Tim)

… and I know when I’m about to do something wrong (laughs) and I can stop at that point. You know I have enough feeling to know that I can stop and do the right thing … (Tim)

Tim feels that the ability to do what he perceives as the right thing, is the manifestation of his spirituality, and directly impacts on his mental health:

… so ehm, I, I kind of ehm, think doing the wrong thing affects my mental well-being negatively, doing the right thing, which is the spiritual experience, it er, ehm, affects my mental health positively. And there’s a direc … there’s a huge diff … . one hundred percent direct correlation … (Tim)

A secular and existential spirituality

… by the time I come to A.A, I was just in conflict with me and I’d forgotten about religion really. You know, it made no, religion made no sense to me. (Fearghal)

The final theme reveals that all the participants experience spirituality from an existential and secular perspective. Even though Melanie, Fearghal, and Tim were raised as Catholic Christians, by the time they came into A.A., religious ontological explanations of spirituality had no meaning for them; Fearghal’s quote (above), summarizes the feelings of all three. Similarly, Bob cannot find meaning or spirituality within a religious context:

I see it as quite immature. I see it as spiritually immature. Spirituality for me is a … . it, it’s of the whole, it’s, you know, we’re all spiritual beings or we can be, we’ve got that capacity to be. So why get caught up in dogma and theology, because that for me separates human-kind, it doesn’t bring us together, it separates … (Bob)

The God word, used excessively throughout A.A. literature and to a lesser degree the suggested twelve-step program of recovery, initially blocked Melanie’s spiritual growth; she interpreted the Twelve Steps as a quasi-religious construct. She realized, however, that the A.A. program encourages personal agency, allowing members to conceptualize a spiritual way of being that makes sense to them, i.e. “So we used our own conception, however limited it was.” (AAWS, 2001, p. 47):

At that point I really saw them as some kind of mech, mechanism, a mechanism of change, I didn’t see them as spiritual. In fact, I kind of removed it from being spiritual to being psychological, because I couldn’t, ‘cos I still saw the Twelve Steps as a Christian sect, yeh? And it was only after talking to other people in A.A. who, who had similar beliefs to me, who just talked about how they were working the steps, I realised that, actually yeh, I did have, it was sort of spiritual for me, it was a spiritual program, and my spirituality is, I see it differently from other people’s, and that’s OK. (Melanie)

Tim accepts that spirituality within a religious framework exists. He describes his perception of the spiritual relationship that religious people have with their God, compared to the relationship ha has with his Higher Power. His perceives the relationship religious people have with their God as being a contractual one:

So, a religious person, a person that practices religion doesn’t let go of control, in my opinion. Ehm, they have a transactional relationship with God which says: “I will keep the Ten Commandments, perfectly, but if I slip up then I will ask for forgiveness, and I will do my very best practicing these Ten Commandments, then if that happens, then I will go to Heaven, because that’s what you wrote in the Bible”.

Whereas his relationship with a Higher Power is a trusting, non-transactional one. He simply practices the principles of A.A. to the best of his ability and lives his life according to his values:

… so, there’s no result for me, no personal result for me, for being spiritual, while there is a personal result for, if you’re religious … (Tim)

Similarly to Tim, Fearghal feels that viewing religion and spirituality in the context of dichotomously opposed constructs is a naïve and simplistic notion. He argues, however, that spirituality, and what it means to be spiritual, cannot be explained within the confines of a theological belief system believing rather, that one does not need either God or religion to have a spiritual connection. He concedes, however, that some people can and do experience spirituality within a religious framework. Fearghal’s concept of spirituality is both, existential and humanistic; it is an awareness of the connectedness of people, a concept that is intersubjective in its nature. Spirituality was described as the understanding that everyone is in the world together and that being in the world is a shared experience, where everyone experiences a collective sense of affective empathy. That is, a world in which one needs to help others and be helped by them. Fearghal finishes his discourse by posing a thoughtful question:

But, what exists for me, is our connection with other people, you know, is, is ehm (pause …) is, is being at one with other people, that’s what connects me, so I don’t (pause …) see, I still struggle with the spiritual that they talk about in A.A., “cos I don’t know, what is spiritual?” (Fearghal)

Discussion

Using IPA, this study explored the individual concepts of spirituality from the perspective of members of A.A. with at least 15 years continuous recovery, the role it plays in their lives and their beliefs of how spirituality supports their recovery. Theoretically, recovery from AUD can be viewed from the perspective of cognitive theories: self-efficacy theory (Bandura, 1977), and social learning theory (Bandura & Walters, 1977). Strong self-efficacy, which in the context of recovery, is more correctly termed abstinence self-efficacy (DiClemente, Carbonari, Montgomery, & Hughes, 1994) has four main sources of influence. The participants’ duration of time in recovery is testimony to the most efficacious of these influences, “mastery experiences” (Bandura, 1977, p. 191); being able to master an experience (i.e., not drinking a day at a time) strengthens an individual’s belief that they can repeat the behavior. Vicarious experiences and social persuasion also promote self-efficacy; watching others and receiving encouragement from them, supports an individual’s self-belief that change is possible, and that goals can be achieved: “I saw this guy all the time …. and it’s when I saw him, that close, that it really, it dawned on me, actually I’d like to change, I’d like to be a good, a better person, the best person I can be” (Melanie). The final determinant of strong self-efficacy is emotional and physiological states; self-efficacy is easier to practice when an individual is physically and mentally healthy (Bandura, 1982). It has been recognized that spirituality and meaning in one’s life promote more positive emotional states, making it easier to cope with negative mental conditions such as depression (Katsogianni & Kleftaras, 2015: Moreira-Almeida et al., 2014; Puchalski et al., 2009), and adverse physiological states like stress (Corrington Jr, 1989).

Before coming into recovery, the participants used alcohol as their main coping mechanism. However, being in recovery for an average of 30 years, the participants’ narratives show that the spiritual aspect of their recoveries has replaced alcohol as a more adaptive way of coping with the stresses of everyday life. Spirituality is concerned with the human spirit, something that was apparent in the common language that manifested in the participants’ discourses, i.e., “doing the right thing”, “being the best person I can be”. Of the many definitions available, Shockley’s (cited in Cook, 2004) aptly summarizes the common meaning of spirituality in the participants’ narratives: “To be human is to long for ultimate meaning and direction in life; it is to live a spiritual existence” (p. 544), or as Bob simply explains: “Spirituality is a way of life, of connecting with humankind, just means being the best we can be”. Spirituality, therefore, has given the participants something that was absent from their lives before they came into recovery: meaning and purpose.

Theorists believe that people with AUD lack meaning and purpose in their lives (Chapman, 1996; Katsogianni & Kleftaras, 2015), and suggest that finding meaning and purpose in life can be a key to supporting and maintaining recovery (Chen, 2006; Tonigan, Miller, & Connors, 2001; White, Laudet, & Becker, 2006). Holocaust survivor, Victor Frankl (1985), described “Man’s search for meaning”, as a “primary force in his life” (p. 90), with which to fill the existential vacuum; a concept widely used in psychotherapy nowadays to explain emotional emptiness and general feelings of meaningless (Thomas & Segal, 2006). It is generally accepted that AUD has adverse effects on emotions (Robinson et al., 2011; Tonigan et al., 2001): Bob’s statement, “I was nearly dead, emotionally and every other way”, lends support to the A.A. notion that individuals with AUD “suffer from grave emotional and mental disorders” (AAWS, 2001, p. 58). By adopting a spiritual approach, the participants in the current study have sought to address these negative, emotional states. The themes that emerged during the analysis, demonstrate that the primary role that spirituality has played, and continues to play in the participants’ recoveries from AUD, has been the meaning and purpose that their individual recoveries have given to their lives. Spirituality for them, is also about being a better human being, a phrase that appears consistently throughout the participants’ narratives (i.e., “being the best human being you can be”, Fearghal). A similar study, which also found an association between spirituality and LTR, had an almost identical theme: “sense of self as a better person in recovery” (Flaherty, Kurtz, White, & Larson, 2014, p. 341).

Adopting a spiritual approach meant letting go of old ideas, and a willingness to begin trusting in something other than self. So, trust, an “alien” (Elizabeth) notion when they were drinking, led to a change in attitudes that became the key to the participants’ spiritual development. A.A., however, does not prescribe a specific spiritual pathway, that decision is one of personal agency. Indeed, in A.A. there are many paths to spirituality (AAWS, 2014), with A.A. emphasizing that their twelve-step program is a suggested program rather than a stringently mandated one (AAWS, 2001). It is coincidental that the participants have all chosen secular pathways to spirituality, despite three of them being raised as Catholic Christians. That said, they are in agreement that institutional religion has no meaning for them. That is not to say they believe religious pathways cannot lead to spirituality. On the contrary, they all agree that constructing spirituality and religion as being in opposition, is a false dichotomy. Kurtz and White (2015), have addressed the religion, spirituality argument by positing the notion of a recovery spirituality, so named because it encompasses a number of spiritual constructs that traverse religious, spiritual, and secular belief systems (i.e., gratitude, forgiveness, and humility).

The participants’ individual concepts of spirituality have been fundamental in helping them develop a self-concept, that improves both, their self-esteem and self-efficacy; low self-esteem is associated with obsessive behaviors (Szinay, Tombor, Garnett, Boyt, & West, 2019), while increased levels of alcohol abstinence self-efficacy are associated with improved abstinence outcomes (e.g. Bogenschutz, Tonigan, & Miller, 2006; Loeber, Croissant, Heinz, Mann, & Flor, 2006). During their journeys of self-discovery, the participants developed a concept of spirituality they felt comfortable with, and which had meaning for them. Following A.A.’s suggestions means that they have been able to re-connect to self, the world and others, in stark contrast to the loneliness that accompanies excessive alcohol consumption (Mushtaq, Shoib, Shah, & Mushtaq, 2014); loneliness is a risk factor that has been associated with all stages of AUD (Åkerlind & Hörnquist, 1992; Sadava & Thompson, 1986). The important meaning attached to connecting, something that is emphasized throughout the participants’ narratives (i.e., “connected”, “connecting”, “connection”), is no doubt nurtured by the social identity group processes, inherent in A.A.’s model of group recovery (Best et al., 2016) and other mutual-aid recovery pathways (White, 2004). Indeed, the first of A.A.’s Twelve Traditions (AAWS, 1953): “Our common welfare should come first; personal recovery depends upon A.A. unity” (p. 129), is a reminder to all A.A. members, that individual recovery is enhanced by being in relation to others and being able to connect to, and assimilate into the group, in order to be able to empathize with others suffering from similar problems with alcohol.

Conclusion

There is evidence to suggest that engagement with A.A. leads to improved health outcomes and also reduces healthcare costs considerably, most studies, however, have been undertaken in the U.S.A. (e.g. Humphreys et al., 2004; Kelly, Abry, Ferri, & Humphreys, 2020; Kelly & Yeterian, 2008; Timko, DeBenedetti, & Billow, 2006). That said, problem drinkers in the U.K. may be less likely to engage with A.A., partly because they perceive A.A. be a quasi-religious organization (Kurtz, 2010; Lopez Gaston, Best, Day, & White, 2010), as do many healthcare professionals (e.g. Kelly, Stout, Zywiak, & Schneider, 2006; Winzelberg & Humphreys, 1999). By exploring the role that spirituality plays in the participants’ recoveries, the study shows that abstinence from alcohol, within the A.A. paradigm, can be achieved and maintained using individual approaches to spirituality, that are often conceptualized as secular and existential. By challenging the religious myths, that are sometimes associated with A.A., the participants’ discourses demonstrate that recovery in A.A. is accessible to all those who suffer with AUD, regardless of their belief system.

Limitations and recommendations

To reiterate, this study was conducted during the 2020 COVID-19 pandemic. With the exception of Elizabeth, all of the interviews took place via video calls; whether or not this affected either, the content of the participants’ narratives, or the participant-researcher dynamic is difficult to ascertain; regardless, it should be a consideration. Nonetheless, the study has contributed to the limited research undertaken on exploring the role of spirituality in the lives of A.A. members in the UK with LTR. Because the focus of the study was exploring spirituality from a secular perspective, future studies may wish to consider investigating a sample of members of A.A with LTR, that represent both, religious and secular pathways of recovery. Another recommendation for future research on the topic of spirituality and maintaining LTR, could be to study a mixed-sample of A.A. members, members of other mutual-aid groups and individuals who maintain LTR from AUD without the support of a group. Comparing the similarities and differences between these groups could be both, revealing and valuable for future treatments and interventions.

Reflection (lead author)

In common with the study’s participants, I have been in recovery for a considerable time (30 years); my concept of spirituality is also secular. Mutual worlds and meanings, attributable to shared experiences of AUD and LTR, allowed me to reflectively engage in an ‘embodied intersubjective’ researcher/participant relationship (Finlay, 2005, p. 271). Additionally, as an insider, I have access to “the private perceptual world” of the participants, allowing me to feel ‘thoroughly at home in it.’ (Rogers, 1975, p. 3), and arguably, experience a greater degree of empathy than perhaps an outsider is able to. That said, I recognize and acknowledge the influence my biases may have had on that which I seek to understand and interpret (Maykut & Morehouse, cited in Dwyer & Buckle, 2009). I have therefore sought to question my motives throughout the study’s duration, in order to counteract any biases, that may have unduly affected my ability to bracket (the phenomenological notion of discarding one’s preconceptions). These checks and balances were a foremost consideration, to ensure the voices of the participants were heard. Finally, Smith et al.’s (2009) suggestion, that prioritizing positive engagement with the participants, over one’s bracketing concerns, insures that ‘skillful attention to the former facilitates the latter’ (p. 35).

Declaration of interest

We, Ainslea Cross and Kevin McInerney, declare this report to be our own work. Wherever we have referred to the work of others, we have accurately credited their work using the American Psychological Association (APA) referencing system. The submitted work follows the University of Derby advice on good academic conduct and practice.

Data availability statement

The data that support the findings of this study, and also the interview schedule, are available on request from the corresponding author, (KM). The data are not publicly available because they contain information that could compromise the privacy of research participants.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.