Cooperation vs. affiliation: an exploratory qualitative study of alcoholics anonymous’ position within the recovery ecosystem

Abstract

Background

Addressing substance use disorder (SUD) requires intricate solutions, usually involving several organizations within a complex institutional environment. Alcoholics Anonymous (AA) shares the recovery ecosystem with other organizations, is ubiquitous across communities, and is notably inexpensive as an intervention; yet the exact nature of the connections between AA and other organizations in the recovery ecosystem is underexplored.

Objective

Explore relationships AA has with other recovery ecosystem organizations and guide future research.

Methods

Data were gathered via ethnographic participant observations, which were triangulated and contextualized via semi-structured interviews with key informants and archival documents.

Results

Though AA does not formally link itself with other organizations, findings point toward strong relationships at the individual level and of an informal nature. Individual members who also have affiliation with other organizations (e.g., legal institutions, treatment services) create bridges, enabling efficient solving of complex issues.

Conclusions

Services wishing to leverage AA (or other mutual-aid) attendance will likely benefit from fostering informal relationships with individual AA members, including lowering barriers to disclosure of recovery status, and contacting local AA service elements capable of making these connections. Similarly, research to advance community-level SUD services and the knowledge-base would benefit from incorporating and partnering with people in recovery.

Keywords:

• Alcoholics anonymous
• recovery-ready ecosystems model
• recovery-oriented systems of care
• substance use disorder
• ethnographic observation

Declaration of interest statement

The authors report no conflicts of interest.

Notes

1 Note that “group” designates the organizational structure that puts on a specific “meeting” (or set of meetings). Though often used interchangeably colloquially, we keep the terms separate throughout for clarity (except when directly quoting participants).

2 A drug treatment court is an intensive substance use program designed for individuals charged with criminal offenses. The program is supervised by a designated judge and collaborative drug court team consisting of traditional courtroom parties (e.g., prosecutor, defense attorneys), as well as service provider representatives (often people in recovery themselves). They have operated in the US since Miami-Dade County implemented the first in 1989.

Additional information

Funding

The authors’ effort in preparing this publication was supported by grant R24DA051950 from the National Institute on Drug Abuse, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.