Negotiating an Alcoholic Identity Within the Alcoholics Anonymous Twelve-Step Recovery Model: a Narrative Inquiry
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Negotiating an alcoholic identity within the Alcoholics Anonymous Twelve-Step recovery model: A Narrative Inquiry Janette Houston Rankine A thesis submitted in partial fulfilment of the requirements of the University of the West of England, Bristol for the degree of Professional Doctorate in Counselling Psychology Faculty of Health and Applied Sciences, University of the West of England, Bristol March 2020 1 Contents Acknowledgments …………………………………………………………………………………………………………… 4 Abstract …………………………………………………………………………………………………………….……………….. 5 Introduction ……………………………………………………………………………………………………………………… 6 Personal interest in the topic………………………………………………………………………………………7 Overview of the structure of the thesis……………………………………………………………………….9 Literature Review Alcoholics Anonymous: Background and approach…………………………………………………..10 The Twelve Steps of Alcoholics Anonymous………………………………………………….………….11 Alcoholics Anonymous and the disease of ‘alcoholism’…………………………………………….11 Power, humility and shame………………………………………………………………………………………14 A cybernetic perspective: Alcoholic pride and humility…………………………………………….16 A more critical outlook……………………………………………………………………………………………..17 Narrative inquiries…………………………………………………………………………………………………….18 Constructing the alcoholic self………………………………………………………………………………….20 Research rationale, aims and questions ……………………………………………………………………….………21 Method Philosophical assumptions………………………………………………………………………………………..23 Methodological rationale………………………………………………………………………………………....25 Ethical considerations……………………………………………………………………………………………….28 Participants……………………………………………………………………………………………………………….29 Recruitment procedure…………………………………………………………………………………………….30 Collecting the narratives……………………………………………………………………………………………30 Analytic strategy……………………………………………………………………………………………………….31 Summary of analysis steps………………………………………………………………………………………..36 2 Analysis and discussion Introduction……………………………………………………………………………………………………….……..37 Graham’s story The ‘quest’ narrative: A journey of self- discovery Introduction………………………………………………………………………………………………………………38 Narrative outline……………………………………………………………………………………………………….39 Russell’s story A narrative of rebirth: From fear and rejection to love and acceptance Introduction………………………………………………………………………………………………………………43 Narrative outline……………………………………………………………………………………………………….44 Adam’s story A chronicle of movement through chaos to consciousness Introduction………………………………………………………………………………………………………………49 Narrative outline……………………………………………………………………………………………………….50 Peter’s story Alcoholic pride and prejudice: An account of an internal battle Introduction……………………………………………………………………………………………….……………..56 Narrative outline……………………………………………………………………………………………………….57 Agency and causality…………………………………………………………………………………………………61 Religiosity, spirituality and morality…………………………………………………………………………..68 The redemptive self…………………………………………………………………………………………………..74 General discussion Summary of findings……………………………………………………………………………………………..….77 Therapeutic implications………………………………………………………………………………………..…79 Strengths and limitations of research……………………………………………………………………….83 Directions for future research…………………………………………………………………………………..84 Reflexive conclusion………………………………………………………………………………………………….86 References………………………………………………………………………………………………………………………...88 3 Appendices A Ethical approval…………………………………………………………………………………………………..101 B Recruitment poster……………………………………………………………………………………………..103 C Participant information sheet………………………………………………………………………………104 D Informed Consent Form………………………………………………………………………………………107 E Sample interview transcription: Graham……………………………………………………………..109 F Sample interview transcription: Russell……………………………………………………………….110 G Sample interview transcription: Adam…………………………………………………………………111 H Sample interview transcription: Peter…………………………………………………………………112 I Journal article……………………………………………………………………………………………………….113 4 Acknowledgments I would like to express my gratitude to the participants who kindly gave up their time to share their personal stories, without whom this study would not have been possible. I especially want to thank my research supervisors. Firstly, Dr. Miltos Hadjiosif for igniting my interest in Narrative Inquiries and for his continued patience, guidance and support which has been deeply appreciated. Secondly, Liz Maliphant for her encouragement and input on the final document. I would also like to thank my recently neglected friends who have nevertheless continued to cheer me on from the side lines. Lastly but certainly not least, I want to extend a heartfelt thank you to my wonderful daughter Kelsi, who has shown the most remarkable patience and understanding throughout not only the present research process, but during my entire counselling psychologist in training journey. 5 Abstract Although the only requirement for membership to Alcoholics Anonymous (AA) is a desire to stop drinking, the claiming of an alcoholic identity is perceived to be the first step towards recovery within the AA Twelve-Step model. US based literature has documented both positive and negative effects of adopting an alcoholic identity, especially in relation to shame. Building on existing literature, whilst adopting a narrative epistemology, the present qualitative study explores how 4 male UK AA members who have adopted the alcoholic label, negotiate this identity through their personal stories. The participants were interviewed face to face and were encouraged to share with me their stories of managing alcohol addiction within the AA framework. The interviews were transcribed and subjected to a narrative analysis, with a particular focus on issues of identity and how this is achieved within the data. Findings suggest that the identity transition from a drinking non-alcoholic to a sober recovering alcoholic is often an internally conflicting experience. Within the obtained accounts, the problem of alcohol dependence is primarily positioned within the self, thus entrenching an individualist and potentially pathologizing view of alcohol addiction. Popular imagery and discourses surrounding narratives of ‘alcoholism’ are explored as part of the conflicting process of claiming the alcoholic identity. The spiritual dimension of the Twelve-Step approach is emplotted in all the stories as key to the transition towards living a more morally directed, less shameful life as a ‘recovering alcoholic’. Hedonistic and eudaimonic senses of well-being are identified and compared within the alcoholic identity transition narratives, within the context of the spiritual aspects of recovery within AA. The reconstruction of the self from a drinking non- alcoholic, to a sober alcoholic in recovery, encompasses much more than the behavioral change of not drinking. It appears to involve embracing a relational identity from where new meaningful connections to others are forged and both personal and communal agency are heightened. In contrast, feelings of powerlessness and isolation are woven through the participant narratives prior to adopting the recovering alcoholic identity. Findings also suggest that the valuable community identity and support that the AA fellowship provides, could also be offered in other areas through changes in community infra-structure. Including social enterprises that are easily accessible for those who do not see AA and the Twelve-Step model as suitable for them. These types of systemic change may provide fruitful ways to balance the potential shortcomings of more individual psychological approaches employed in the treatment of alcohol dependency. 6 Introduction The aim of this qualitative study is to present new understandings of how current UK members of the mutual aid fellowship of Alcoholics Anonymous (AA) make sense of assuming an alcoholic identity. A narrative analysis of AA members’ stories can provide subjective insights into how individuals negotiate this identity against the cultural backdrop of dominant discourses which surround the construct of ‘alcoholic’ (Taleff & Babcock, 1998; Jordan, 2015). A particular interest is directed towards the link between shame and alcohol dependence (Potter- Efron & Caruth, 2002), in exploring how this is managed in accepting the potentially stigmatizing alcoholic label (Gray, 2011; Schomerus et al., 2010; Carp, 2013; Liezille & Jacobs, 2014). There appears to be a divide in the relevant literature as to whether assuming an alcoholic identity in the Twelve-Step treatment model is a shame releasing, or shame enhancing process. The present study takes a social constructionist stance in examining the negotiation of alcoholic identities. Thus, the concept of ‘alcoholic’ is not assumed to be something that exists outside of discursive practices or resides within an individual as an essential part of their nature but, like all knowledge especially those surrounding normative categories, is historically and culturally contingent (Burr, 2003). Labelling oneself an ‘alcoholic’ is the first step in recovery from alcohol addiction within AA’s Twelve-Step recovery model (Borkman, 2008). Indeed, in the AA meeting rooms up and down the country and throughout the world, as often depicted in popular media, before anyone speaks out in AA meetings they generally introduce themselves by saying “Hi my name is X, I am an alcoholic” (Robert, 2015). The only requirement necessary for membership to AA however, is a desire to stop drinking (AA Fact File, 1956). Previous literature has provided varying accounts of the consequences of assuming an alcoholic identity within AA’s Twelve-Step